This is not a blog.

Questions and Answers to the 2012 WFAN Super Bowl Contest

2012-01-25T01:39:00.002-05:00

There's an ongoing site dedicated to sharing the Questions and Answers to the 2012 WFAN Mike Francesa Super Bowl Contest. As of 1/24/2012, nobody has won the contest yet, since everybody is getting stumped by the final audio clip question.

Recent project: HemOnc.org

2012-01-12T17:12:00.004-05:00

Most of my extra time nowadays is spent working on HemOnc.org, which is a hematology/oncology and chemotherapy regimen wiki intended to be used for oncologists. It's my hope that a community of engaged and motivated individuals will contribute to make it a valuable resource and source of knowledge-sharing for the hematology/oncology community. It's intended mainly for medical individuals, who I encourage to check it out.

Of course, I've continued to keep Peter Yang's Cleanup Tool up and running for use by UCLA, Olive View, and BIDMC. It's very gratifying to see them still a part of daily work at these institutions.

Please feel free to leave me any comments about my projects, particularly if you have suggestions or would like to contribute.

Wine: taste and price

2008-05-07T14:22:00.000-04:00

NYTimes

May 7, 2008
The Pour
Wine’s Pleasures: Are They All in Your Head?
By ERIC ASIMOV

THE mind of the wine consumer is a woolly place, packed with odd and arcane information fascinating to few. Like the pants pocket of a 7-year-old boy, it’s full of bits of string, bottle caps and shiny rocks collected while making the daily rounds of wine shops, restaurants, periodicals and the wine-soaked back alleys of the Internet. It’s harmless stuff, really, except to those within earshot when a wine lover finds it necessary to elaborate on the nose, legs and body of a new infatuation.

Yet in recent months American wine drinkers have taken their turn as pop culture’s punching bags. In press accounts of two studies on wine psychology, consumers have been portrayed as dupes and twits, subject to the manipulations of marketers, critics and charlatan producers who have cloaked wine in mystique and sham sophistication in hopes of better separating the public from its money.

One of the studies was devised by Robin Goldstein, a food writer, to try to isolate consumers from outside influence so they could simply judge wine by what’s in the glass. He had 500 volunteers sample and rate 540 unidentified wines priced from $1.50 to $150 a bottle. The results are described in a new book, “The Wine Trials,” to be published this month by Fearless Critic Media.

The book wraps the results in a discussion of marketing manipulations and statistical validity, but a brief article in the April 7 issue of Newsweek magazine, naturally, seized on the book’s populist triumphs: a $10 bottle of bubbly from Washington state outscored Dom Pérignon, which sells for $150 a bottle, while Two-Buck Chuck, the cheap Charles Shaw California cabernet sauvignon, topped a $55 bottle of Napa Valley cabernet.

“Their results might rattle a few wine snobs, but the average oenophile can rejoice: 100 wines under $15 consistently outperformed their upscale cousins,” the article exulted.

Two caveats are in order here. First, it turns out that the results of the tastings are more nuanced than the Newsweek article let on. In fact, the book shows that what appeals to novice wine drinkers is significantly different from what appeals to wine experts, which the book defines as those who have had some sort of training or professional experience with wine. The experts, by the way, preferred the Dom Pérignon.

Second, there is, of course, no such thing as the “average oenophile,” as Newsweek put it. Most people in the wine trade understand that consumers have any number of reasons for their buying decisions, whatever their psychological and financial state. Some are reassured by easy-to-understand labels with friendly animals. Others want only naturally produced wines or bottles with a modest carbon footprint. Some are status-seekers and score-chasers, while others are contrarians, or only drink red wine.

But assuming for the moment that it’s true that most drinkers prefer the cheap stuff, why does anyone bother buying $55 cabernet? One answer is provided by a second experiment, in which presumably sober researchers at the California Institute of Technology and the Stanford Business School demonstrated that the more expensive consumers think a wine is, the more pleasure they are apt to take in it.

The researchers scanned the brains of 21 volunteer wine novices as they administered tiny tastes of wine, measuring sensations in the medial orbitofrontal cortex, the part of the brain where flavor responses apparently register. The subjects were told only the price of the wines. Without their knowledge, they tasted one wine twice, and were given two different prices for that wine. Invariably they preferred the one they thought was more expensive.

“Forget those blurbs about bouquets, body and berries,” one newspaper account crowed. “A meticulous new study found that the more people think a wine cost, the more they like it. And the less they think it cost, the less they like it.”

Big surprise. Sommeliers all over know that the hardest wine to sell in a restaurant is the cheapest bottle on the list. “Yeah, clients don’t want to be embarrassed in front of a date, so they don’t order the cheapest wines,” said Fred Dexheimer, the wine director of the BLT restaurant group. The fact is, the correlation between price and quality is so powerful that it affects not just our perception of wine but of all consumer goods.

“It’s not just about wine, it’s about everything!” said Prof. Dan Ariely, a behavioral economist at the Massachusetts Institute of Technology and author of the book “Predictably Irrational: The Hidden Forces That Shape Our Decisions” (HarperCollins, $25.95), which examines how people make all sorts of real life decisions. Regardless of the situation, Professor Ariely found, suggestion has a powerful effect on perception and belief.

In one experiment, volunteers who received mild electric shocks were given placebo pills to relieve the pain. They were told that the pills cost either 10 cents or $2.50. The participants believed that both kinds of pills helped relieve pain, but the seemingly more expensive pills had a much greater effect.

“If you expect not to get something as good, lo and behold, it’s not as good,” Professor Ariely said. “We think of it as an objective reality. We don’t see how much is created by our mind.”

Even so, wine drinkers tend to be the punch line. People are unlikely to be ridiculed for buying $300 jeans that are washed, bleached and beaten over rocks instead of $60 jeans that will last a decade. But wine buyers who prefer the $20 bottle over a $10 bottle? All that stuff about aromas and complexity? Forget it!

Are wine consumers really easily manipulated victims, the flip side of the stereotype of wine drinkers as pretentious snobs? What have they done to be singled out from other consumers who might equally be portrayed as knuckling under to hype and salesmanship, like connoisseurs of clothes, handbags or shoes, car aficionados or golf fanatics, food or film lovers?

The answer rests, I think, both in the insecure and uncomfortable attitudes that Americans hold toward wine and in the difficulty of bringing some sort of objective and universal criteria to the fleeting and obscure realms of aroma, taste and texture.

The consumption of wine has been growing steadily in the United States rising to 283 million cases in 2006 from almost 189 million cases in 1993, according to the Adams Wine Handbook, which tracks consumption.

Yet drinking more hasn’t made Americans more comfortable with wine. People with little interest in wine tend to see it as somehow foreign and threatening. Even among the curious, fears abound, of being embarrassed or appearing unsophisticated, of choosing the wrong wine, or of liking the wrong one. Every year books come out purporting to help the winephobic avoid embarrassment, impress their bosses or learn shortcuts to wine knowledge. But I sense no decrease in the number of people whose questions to me are prefaced by a sheepish, “I don’t know anything about wine, though I really should.”

Meanwhile, consumers face an impenetrable swamp of winespeak: Wine Spectator recently evaluated one Argentine red as, “Dark and rich, with lots of fig bread, mocha, ganache, prune and loam notes. Stays fine-grained on the finish, with lingering sage and toast hints.”

To hack through it all, consumers embrace scores, an easy shorthand that unfortunately requires that every wine be judged on the same seemingly objective scale, regardless of the subjective nature of taste. Anybody can understand that a wine rated 90 beats an 89, right?

Yet the rating system has bred an attitude toward wine that ignores context, which is perhaps more important a consideration to the enjoyment of wine than anything else. The proverbial little red wine, so delicious in a Tuscan village with your sweetie, never tastes the same back home in New Jersey. Meanwhile, the big California cabernet, which you enjoyed so much with your work buddies at a steakhouse, ties tucked between buttons, doesn’t have that triumphant lift with a bowl of spaghetti.

This is one problem with trying to judge wine in the sort of clinical vacuum sought by studies like the one in “The Wine Trials.” In the end, I don’t think you can ever eliminate context. The trick is to distinguish between the harmful or disingenuous — the marketing come-ons, the point chasing, what the guy next to you thinks — from the beneficial: the food, the company, the environment. Even in a blind tasting situation, wine is evaluated in the company of other wines, which is a different sort of context but a context nonetheless. Perhaps they’ve chosen the best wines to be sipped and spat out, but not the best wines for dinner.

Ultimately, context may be the most underrated aspect of enjoying wine. Tyler Colman, a wine writer and blogger (drvino.com), whose first book, “Wine Politics,” will shortly be published by the University of California Press, has a second book coming out this fall, “A Year of Wine” (Simon & Schuster), that focuses on context.

“The mood and the food and the context really matters,” he said. “It’s the neglected pairing.”

Just as understanding when to dress up and when to dress down is intuitive for many people, so, too, does it become instinctive over time for wine lovers to know which is the proper bottle to open. But that requires experience of many different wines. Eventually the novelty of great wines, or expensive wines, can wear off.

“Sometimes a great Beaujolais is a better choice than La Tâche,” said Nathan Vandergrift, a statistical researcher at the University of California at Irvine, who has seen the wine business as a retailer, an importer and distributor, and most recently as a blogger at the Vulgar Little Monkey Translucency Report. Mr. Vandergrift has had plenty of Beaujolais, and a fair amount of La Tâche, one of the most highly sought wines in the world.

Would that we all could achieve that sense of freedom and zen-like serenity, where we’ve had our fill of all else and can simply choose the right wine because it’s the right wine.

Smarter --> lower life expectancy?

2008-05-07T14:20:00.000-04:00

NYTimes

May 7, 2008
Editorial Notebook
The Cost of Smarts
By VERLYN KLINKENBORG

Research on animal intelligence always makes me wonder just how smart humans are. Consider the fruit-fly experiments described in Carl Zimmer’s piece in the Science Times on Tuesday. Fruit flies who were taught to be smarter than the average fruit fly tended to live shorter lives. This suggests that dimmer bulbs burn longer, that there is an advantage in not being too terrifically bright.

Intelligence, it turns out, is a high-priced option. It takes more upkeep, burns more fuel and is slow off the starting line because it depends on learning — a gradual process — instead of instinct. Plenty of other species are able to learn, and one of the things they’ve apparently learned is when to stop.

Is there an adaptive value to limited intelligence? That’s the question behind this new research. I like it. Instead of casting a wistful glance backward at all the species we’ve left in the dust I.Q.-wise, it implicitly asks what the real costs of our own intelligence might be. This is on the mind of every animal I’ve ever met.

Every chicken that looks at you sideways — which is how they all look at you — is really saying what Thoreau said less succinctly: you are endeavoring to solve the problem of a livelihood by a formula more complicated than the problem itself. Thoreau himself would not dispute that he was hoping to recover the chicken’s point of view. He went to Walden Pond “to remember well his ignorance.”

Research on animal intelligence also makes me wonder what experiments animals would perform on humans if they had the chance. Every cat with an owner, for instance, is running a small-scale study in operant conditioning. I believe that if animals ran the labs, they would test us to determine the limits of our patience, our faithfulness, our memory for terrain. They would try to decide what intelligence in humans is really for, not merely how much of it there is. Above all, they would hope to study a fundamental question: Are humans actually aware of the world they live in? So far the results are inconclusive.

Income: Costmetic Dentist vs. Primary Care Doc

2008-04-14T00:12:00.000-04:00

Wall Street Journal

Tale of Two Docs:
Why Dentists Are Earning More
Dr. Bryson Focuses On Cosmetics, Not Insurance;
A Family Physician Lags
A $15,000 'Smile Makeover'
By MARK MAREMONT
Staff Reporter of THE WALL STREET JOURNAL
January 10, 2005

(See Corrections & Amplifications item below.)

YARDLEY, Pa. -- Randy Bryson and his brother-in-law Larry Fazioli are both medical professionals in their 40s who practice in Pennsylvania. The similarity ends there.

At Dr. Bryson's office here in suburban Philadelphia, a fountain softly burbles in the airy reception area, and patients are offered cappuccino or paraffin-wax hand treatments while they wait. Dr. Bryson works four days a week, drives a Mercedes, and lives in a 4,000-square-foot house with a pool. He and his wife, who works part-time in the same practice, together take home more than $500,000 a year.

At Dr. Fazioli's busy practice near Pittsburgh, patients crowd a utilitarian waiting room, and his cramped office is piled high with records awaiting dictation. Dr. Fazioli says he works between 55 and 80 hours a week, and his annual income of less than $180,000 has been stagnant or down the past few years. He drives a Chevrolet.

The key to their different lives: Dr. Bryson is a dentist, and Dr. Fazioli is a family-practice physician.

Once the poor relations in the medical field, dentists in the past few years have started making more money than many types of physicians, including internal-medicine doctors, pediatricians, psychiatrists, and those in family practice, according to survey data from the American Dental Association and American Medical Association.

On average, general dentists in 2000, the most recent year for which comparative data are available, earned $166,460 -- compared with $164,100 for general internal-medicine doctors, $145,700 for psychiatrists, $144,700 for family-practice physicians, and $137,800 for pediatricians. All indications are that dentists have at least kept pace with physicians since then.

Those figures are a sharp contrast to 1988, when the average general dentist made $78,000, two-thirds the level of the average internal-medicine doctor, and behind every other type of physician. From 1988 to 2000, dentists' incomes more than doubled, while the average physician's income grew 42%. The rate of inflation during that same period was 46%.

Factor in hours worked -- dentists tend to put in 40-hour weeks, the ADA says, while the AMA says physicians generally work 50 to 55 hours -- and the discrepancy is even greater.

"I feel so bad for Larry," says Dr. Bryson of his brother-in-law the doctor. "Especially when he's on call, he puts in some pretty long hours. Physically, it's really taking a toll on him."

Dr. Fazioli says he still gets a lot of satisfaction out of being a doctor and earns a comfortable living. But he admits he'd steer his children away from primary-care medicine as a career. Of his three sons, he adds, two might be interested in dentistry instead. "They see that Randy is doing OK," he says.

Many specialist physicians, such as cardiologists and radiologists, continue to rake in large incomes, generally exceeding those of specialist dentists such as oral surgeons and periodontists. But specialist dentists, too, have seen their paychecks increase at a much faster rate than their physician counterparts.

Healthier Teeth

Dentists have grown richer even as cavities, once the main cause for visiting them, have declined, largely because of fluoridation of drinking water and improved preventive care. According to a study published in the Journal of the American Dental Association in 1999, cavities in 6-to-18-year-olds dropped by three-fifths from the early 1970s to the early 1990s -- even though many children in lower socioeconomic groups still lack adequate dental care.

As people born in the 1960s and later have grown into adulthood, they tend to need fewer fillings than their parents did and are keeping their teeth longer. Painful disease-related procedures such as root canals are declining, too.

So why are dentists so handily outpacing doctors? In part, it's because dentists have avoided being flattened by the managed-care steamroller, and instead many have turned into upscale marketers. Dental care makes up less than 5% of the overall U.S. health bill, and hasn't been a major focus of cost-cutting.

Although some dental insurers have tightened up on reimbursements, most private dental insurance is still paid on a fee-for-service basis. Many optional procedures aren't covered by insurance, leaving dentists free to charge whatever the market will bear. About 44% of all dental care is paid by patients out of their own pockets, according to federal statistics for 2002, compared with just 10% for all physician and clinical costs.

While dentists may be able to focus more on marketing costly optional treatments, many physicians can't make the same kind of switch in their practices.

In competing for patients' own dollars, dentists have become more entrepreneurial, tapping into today's image-conscious zeitgeist. Many dental offices are festooned with pitches for everything from $400 teeth-whitening treatments to $1,200-per-tooth veneer jobs.

There are even $30,000-plus full "smile makeovers" offered by a growing coterie of dentists who specialize in high-end cosmetic procedures. Public awareness of such techniques has been heightened by reality-TV shows such as ABC's "Extreme Makeover" and Fox Broadcasting's "The Swan."

L. Jackson Brown, an economist who is associate executive director at the ADA, says cosmetic procedures account for about 10% of the nation's $80 billion annual dental bill, and are rising fast.

Sally McKenzie, a dental-practice consultant in La Jolla, Calif., who has been in business for 25 years, calls it a "golden era for dentistry." The most common call she gets, Ms. McKenzie says, is to help dentists manage "uncontrolled growth."

The situation is a sharp turnaround from the 1980s, when dentistry seemed to be in decline. Falling rates of tooth decay and a glut of dentists produced much soul-searching in the profession. Several dental schools closed, while others slashed enrollment. Dentists wrung their hands over their inability to get more insurance coverage -- a failure that now looks heaven-sent.

Dentists also have taken advantage of new technology, some of it controversial even within the profession. One major advance was the invention of porcelain veneers, which are wafer-thin shells of material that are bonded to the fronts of teeth to repair chips or misalignment. Unlike older surfacing materials, porcelain resists staining and looks like a natural tooth surface. Some dentists claim the procedure, which involves an irreversible filing down of natural teeth, can create problems. But proponents say that, done right, such veneers can stay in place for years.

"Today, you can create a smile" from materials that people "can't tell are not real teeth," says Joe Barton, a Jacksonville, Fla., dentist who specializes in cosmetic procedures. He says he typically charges from $12,000 to $14,000 to put veneers on 10 front teeth, requiring about 3½ hours of his time. "We are competing with cars and vacations and jet skis and new homes, in terms of what people are spending their disposable income on," he says.

Some dentists use sophisticated software-imaging programs to show patients virtual before-and-after photos of what their teeth could look like with cosmetic help. Others have installed $100,000 computer-assisted design devices to make crowns in their own offices.

Intra-oral video cameras, tiny pen-shaped devices that can be used to display images of the inside of a patient's mouth, have become de rigueur. The cameras, which typically cost $2,000 or more, have little clinical purpose -- but there's nothing like seeing an up-close video of unsightly teeth on an overhead TV to persuade a patient that something needs to be done.

The turnabout in fortunes has made some dentists pity their physician colleagues. Robert H. Gregg, a dentist in Cerritos, Calif., says he had an operation for a snapped Achilles tendon a few years ago, which required him to go under general anesthesia for more than an hour. He was amazed his insurer paid just $2,000 to his orthopedic surgeon for the procedure. "I get about $3,000 for a three-unit bridge," Dr. Gregg says. "He's getting pennies on the dollar to what his skill level was."

Dr. Gregg says he offered to pay more out of his own pocket. The surgeon's office manager, he adds, "told me I was the first person" to ever make such a request.

The dentist and physician who are brothers-in-law, Drs. Bryson and Fazioli, both grew up in western Pennsylvania. They are related through Dr. Fazioli's wife, Robin, who is Dr. Bryson's younger sister. She sardonically refers to her brother and husband as "the prince and the pauper." She says she "definitely" doesn't want her sons to follow her husband into medicine. "I see how hard he works," she says. "I tell them, 'maybe you should go into dentistry. See how well Uncle Randy is doing.' "

Dr. Bryson, 44 years old, wanted to be a dentist from the time he was 5, his sister recalls. "We called him Rockefeller Bryson," she says. "He always liked the finer things in life."

While attending dental school in Philadelphia, Dr. Bryson met his wife, Toni Margio, a fellow student. They soon opened a joint practice in affluent Yardley, about a half-hour north of the city.

By the late 1990s, their practice was booming. But Dr. Margio says they both felt like they were "always on roller skates." They worked 10-to-12-hour days, and had to rely on Dr. Margio's mother to care for their son, now 8 years old. Dental insurers were forcing them to discount fees.

Five years ago, after attending classes at the Las Vegas Institute for Advanced Dental Studies, a school known for an aggressive brand of cosmetic dentistry, they dramatically changed their practice. They stopped accepting insurance -- patients are billed directly and can wrestle with insurers on their own -- and started plugging veneers, whitening and other elective procedures.

"We shifted from needs-based dentistry to wants-based dentistry," says the youthful-looking Dr. Bryson, who has a dazzling smile. "It has totally transformed our practice and our personal lives. We see a much smaller number of patients, at a slower pace. I can't wait to get in in the morning."

At their open, two-story office, large photos of patients with gleaming smiles adorn walls painted light blue. Classical music plays in the background, and the air is filled with a pleasant smell. "Aromatherapy," says Dr. Margio, a petite, dark-haired woman with a perfect-looking set of teeth.

On a recent afternoon, a patient is sitting in one of Dr. Bryson's exam rooms with small electrodes attached to her face. The nerve-stimulating device feeds data about the patient's jaw muscles to a computer system.

"Move your lower jaw forward," Dr. Bryson instructs, peering at the computer screen. "Perfect."

The patient, who complains of jaw pain from grinding her teeth, is being fitted for a night mouth guard, or orthotic. Although many dentists charge from $200 to $500 for guards, Dr. Bryson sells one he says is designed to keep the patient's jaw more relaxed. The price: $2,200, little or none of which is likely to be covered by insurance.

'Smile Makeover'

To help patients afford such treatments -- or the $12,000 to $15,000 they charge for a partial "smile makeover" of eight to 10 teeth -- Drs. Bryson and Margio offer financing plans that allow patients to borrow from a bank and pay their bills over as long as five years.

The couple say their practice's gross revenues are up about 60% to about $1.6 million a year since they shifted their focus five years ago. Costs have also risen, to close to 65% of revenue in some years, mainly because of outlays for computers and continuing dental education.

Since changing their practice, Dr. Bryson says he has cut back from 60-hour weeks to 32 clinical hours a week, plus some paperwork time. Dr. Margio now works 18 clinical hours, giving her more time with their son. Both take every Wednesday off. "I coach my son's soccer team," Dr. Bryson says. "I don't miss a practice."

The work, he says, is also more satisfying. "I get patient letters, I get hugs. People cry when they see their teeth. I never got that before."

Across the state in New Castle, at 2 p.m. on a recent Wednesday, Dr. Fazioli was scheduled to have left his office an hour earlier. "This is supposed to be my half day," says Dr. Fazioli, a compact man with a mustache, graying temples and a self-deprecating manner. "But I'm lucky if I get home at 3 or 4."

An overflow of patients has left him behind schedule, and his desk is piled high with records to dictate. "Patient canceled colonoscopy," Dr. Fazioli says into his tape recorder, recounting his exam of an elderly woman. "Says she didn't feel comfortable with the procedure. She's still smoking cigarettes. Had a discussion with her about the need for total cigarette cessation."

He groans as a nurse brings in another armful of charts. "No more. I gotta get out of here."

Becoming a doctor once seemed like a dream job for Dr. Fazioli, who grew up in a mill town about 10 miles from New Castle. His father had operated machinery for a U.S. Steel mill until it closed in the 1970s. After working as a pharmacist, Dr. Fazioli attended medical school, and in 1990 hung out his own shingle as a family practitioner.

At first, the practice grew quickly. His income early on was more than $130,000 a year, and he added a couple of partners. Being a doctor in a small city, he says, means "you get a lot of respect. It's nice when you help people. They're grateful."

The trouble started with the managed-care reforms of the mid-1990s, Dr. Fazioli says. Signing managed-care contracts provided him with easy access to new patients. But more patients meant more office visits at the cut-rate fees demanded by insurers. The federal government's Medicare program has been another headache. Medicare patients make up at least a third of his practice.

"Our reimbursements have stayed flat, but our overhead is up," says Dr. Fazioli, 47. "My take-home pay has definitely gone down." He says he had hoped to slow down a bit as he neared 50, "But I definitely can't do that right now. I've got to keep seeing patients."

Although his typical work week is about 50 to 55 hours, every third week he's on call, pushing the work load closer to 80 hours and often requiring him to go to the hospital in the wee hours.

Dr. Fazioli and his family live in a colonial-style house in a wooded area outside of New Castle. He won't give his exact income, but says it's between $150,000 and $180,000 a year. If he had to do it all over again, he says, he'd still consider being a primary-care doctor, but "I'd look hard at other areas, other states."

As for his brother-in-law the dentist, Dr. Fazioli says, "Randy certainly did his homework. People who come to him want his service. He can charge as much as he can."

Dr. Fazioli recently went to a local dentist to get a bridge put in. The procedure, he says, took about 1½ hours over two visits. The bill: $1,200, all of which he had to pay from his own pocket. "I was thinking, 'How many people do I have to see to get that?' " Dr. Fazioli says. "If I made $200 in that amount of time, I'd be lucky."

Corrections & Amplifications:
The total number of root canal procedures performed in the U.S. rose 13% from 1990 to 1999, according to the American Association of Endodontists, a trade group of specialist dentists who focus on that treatment. But the rate among people 45 years and younger is declining. This article incorrectly said the total number of root canals is falling.

Medicare having difficulty saving money

2008-04-06T22:08:00.001-04:00

NYTimes

April 7, 2008
Health Plans
Medicare Finds How Hard It Is to Save Money
By REED ABELSON

An ambitious three-year experiment to see whether the Medicare system could prevent expensive hospital visits for people with chronic conditions like congestive heart failure and diabetes has suggested that such an approach may cost more than it saves.

The test borrowed a practice long available through private health plans. Nurses periodically place phone calls to patients to check whether they are taking their drugs and seeing the right doctors. The idea is that keeping people healthier can help patients avoid costly complications.

After paying eight outside companies about $360 million since mid-2005 to try to improve such patients’ health, Medicare is still trying to figure out whether the companies were able to keep people healthier. But the preliminary data indicate that the government is unlikely to save money.

The experiment, meanwhile, is proving something else: how difficult it can be, politically and practically, to make fundamental changes in the sprawling $400 billion federal Medicare program, which now covers some 44 million Americans.

With health costs soaring, few would dispute that the government needs to find better ways to spend its Medicare dollars. But because the system relies heavily on private industry and is subject to Congressional oversight, few changes come easily, and even experimental programs can take on lives of their own.

Several of the companies, including two that specialize in disease management, Healthways and Health Dialog, are pressing Medicare to continue the project in some fashion beyond the end of this year, saying the government mishandled the experiment.

The senators from the home states of those two companies, including John Kerry, Democrat of Massachusetts, and Lamar Alexander, Republican of Tennessee, have taken up their cause, demanding that Medicare rethink ending the experiment.

“Stopping this program,” the senators wrote in a letter to Medicare last month, “creates serious health risks for the Medicare beneficiaries already enrolled and heavily reliant” on the services provided by the experiment.

Medicare, for its part, says the experiment so far has not reduced medical bills enough to offset the fees the companies are charging the government — as much as $2,000 a year for each patient. A final accounting of the experiment is likely to come no sooner than next year.

About 160,000 people have taken part in the test, known as the Medicare Health Support program, and some 70,000 are still receiving calls from nurses employed by the companies.

Experts say that Medicare and the companies alike were too optimistic about how easy it would be to prevent costly complications and hospital visits by patients who are very sick.

“Everybody shares some blame,” said Dr. David B. Nash, a health policy professor at Thomas Jefferson University in Philadelphia, who at the outset was enthusiastic about the program’s prospects for transforming Medicare.

On the experiment’s front lines are nurses like Jill Coker, who works for Healthways and makes 25 to 30 telephone calls a day, trying to ensure that each patient receives a call every few weeks. Through dozens of such nurses, Healthways, based in Nashville, is overseeing the care of 16,000 people in Maryland and Washington.

Ms. Coker said she spent most of her time on rudimentary issues, like explaining to patients what prescription drugs they are on and helping them devise ways to make sure they remember to take their medicine. She may also arrange a conference call with a patient’s doctor if there are some worrisome new symptoms, or she may direct someone to a specialist to get better care.

“There have been numerous diabetics who didn’t even know what an endocrinologist was,” she said.

Medicare has not finished studying how well patients do under the program and whether patients are satisfied with the help. Three of the original companies — Cigna, McKesson and LifeMasters — eventually dropped out.

The program has failed to meet the government’s original financial target: an overall savings to Medicare of 5 percent after factoring in the companies’ fees and the patients’ medical bills.

Initially, the companies were supposed to return their payments if they did not hit that target. Late last year, Medicare relaxed its standard, requiring only that the experiment not end up costing the government money.

The agency says that it will consider keeping any promising pieces of the program. But it says it cannot legally extend the experiment beyond December if it is not budget neutral.

“We want to lift up the seat cushions to find every nickel and dime we can find,” said Herb B. Kuhn, the deputy administrator for Medicare. The agency says no final decision on the fate of the program has been made.

But some health care experts say Medicare should move on to seek other ways of managing the care of the chronically ill, if alternatives seem to hold greater potential to deliver both cost savings and better care.

“Medicare is doing exactly what we should want Medicare to do — to test different life forms of disease management and see what works best,” said Dr. Arnold Milstein, the chief physician for Mercer Health and Benefits, a consulting firm. But, he said, “This particular form of disease management is not looking promising.”

Medicare is already exploring other ideas, like the development of so-called “medical homes,” where a doctor with a team of other professionals oversees a patient’s care. A few doctors’ groups involved in a separate Medicare experiment have reported some success in saving the government money by more actively managing their patients’ care.

Dr. Mark B. McClellan, who was the head of Medicare when the experiment began and is now a policy analyst at the Brookings Institution in Washington, says the point of Medicare’s experiments is to find out which approaches might work. “This is a hard problem that is not going to be solved all at once,” he said.

Many of the companies involved in the program say the experiment was flawed in the way it was designed and that Medicare has failed to work with them to make the program a success.

“We haven’t proven anything,” said Dr. Jeffrey L. Kang, a former Medicare official who is now the chief medical officer for the insurer Cigna.

The companies say Medicare signed up patients who were much sicker than they had expected. Instead of giving companies a chance to intervene before someone went to the hospital, Dr. Kang said, most of the patients were already so ill that it was “no longer a preventive program.”

The companies also say Medicare failed to make good on its promise to give them timely information about the use of prescription drugs, for example, or lab results that would have allowed them to help direct the patients’ care.

“We overestimated the real desire expressed by the organization,” said Ben R. Leedle Jr., the chief executive of Healthways, who has been an outspoken critic of Medicare. His company’s stock fell by 16 percent in a single day after the agency announced the experiment’s preliminary results in January.

Mr. Leedle says that Healthways will probably be able to demonstrate savings from at least some of its Medicare efforts, although the company also says it is projecting a loss on the experiment because it may have to pay back federal fees. Medicare has not made public data on the results for individual companies.

For its part, Medicare said that it had worked extensively with the companies to address their concerns and that its final analysis would take into account how sick the patients initially were.

One thing that already seems clear is that after the fees are paid to the contractors, any cost savings may be elusive. In late January, the agency estimated that to meet their targets the five remaining companies would need to reduce their monthly claims by an average of $300 to $800 per patient for the remainder of the experiment. That would represent a 20 to 40 percent reduction in the patients’ current medical bills.

George B. Bennett, the chief executive of Health Dialog, which is overseeing about 15,000 Medicare patients in western Pennsylvania, favors continuing the experiment, but with adjustments. He wants Medicare to give the companies more flexibility to manage patients in ways they say have already been proven to work among the employees they cover in commercial plans. Such measures, he said, include giving the insurer a bigger role in selecting the patients, with an eye toward identifying the ones most likely to be helped.

“Medicare actually has the possibility of saving $20 billion to $30 billion,” Mr. Bennett said, “if they undergo what is being done in the private sector.”

Whatever happens with this particular program, Medicare says it wants to keep experimenting. “We’re not giving up on this stuff,” said Mr. Kuhn, the Medicare deputy. “We definitely want these programs to work.”

Doctors and excess tests & consults

2008-03-12T00:43:00.001-04:00

NYTimes

March 11, 2008
Essay
Many Doctors, Many Tests, No Rhyme or Reason
By SANDEEP JAUHAR, M.D.

I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.

He underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to work-up chronic anemia).

Despite this wearying schedule, he maintained an upbeat manner, walking the corridors daily with assistance to chat with nurses and physician assistants. When he was discharged, follow-up visits were scheduled for him with seven specialists.

This man’s case, in which expert consultations sprouted with little rhyme, reason or coordination, reinforced a lesson I have learned many times since entering practice: In our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.

Though accurate data is lacking, the overuse of services in health care probably cost hundreds of billions of dollars last year, out of the more than $2 trillion that Americans spent on health.

Are we getting our money’s worth? Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place, according to the Commonwealth Fund, a health-care research group, among major industrialized countries in health-care quality, access and efficiency.

And in the United States, regions that spend the most on health care appear to have higher mortality rates than regions that spend the least, perhaps because of increased hospitalization rates that result in more life-threatening errors and infections. It has been estimated that if the entire country spent the same as the lowest spending regions, the Medicare program alone could save about $40 billion a year.

Overutilization is driven by many factors — “defensive” medicine by doctors trying to avoid lawsuits; patients’ demands; a pervading belief among doctors and patients that newer, more expensive technology is better.

The most important factor, however, may be the perverse financial incentives of our current system.

Doctors are usually reimbursed for whatever they bill. As reimbursement rates have declined in recent years, most doctors have adapted by increasing the quantity of services. If you cut the amount of air you take in per breath, the only way to maintain ventilation is to breathe faster.

Overconsultation and overtesting have now become facts of the medical profession. The culture in practice is to grab patients and generate volume. “Medicine has become like everything else,” a doctor told me recently. “Everything moves because of money.”

Consider medical imaging. According to a federal commission, from 1999 to 2004 the growth in the volume of imaging services per Medicare patient far outstripped the growth of all other physician services. In 2004, the cost of imaging services was close to $100 billion, or an average of roughly $350 per person in the United States.

Not long ago, I visited a friend — a cardiologist in his late 30s — at his office on Long Island to ask him about imaging in private practices.

“When I started in practice, I wanted to do the right thing,” he told me matter-of-factly. “A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor — stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor — a thorough doctor — the other cardiologist was.

“I tried to practice ethical medicine, but it didn’t help. It didn’t pay, both from a financial and a reputation standpoint.”

His nuclear imaging camera was in an adjoining “procedure” room. He broke down the monthly costs for me: camera lease, $4,500; treadmill lease, $400; office space, $1,000; technician fee, $1,800; nurse fee, $1,000; and miscellaneous expenses of $200.

“Now say I get on average $850 per nuclear stress test,” he said. “Then I have to do at least 10 stress tests a month just to cover the costs, no profit going into my pocket.”

“So,” I said, “there’s pressure on you to do more than 10 stress tests a month, whether your patients need it or not.”

He shrugged and said, “That is what I have to do to break even.”

Last year, Congress approved steep reductions in Medicare payments for certain imaging services. Deeper cuts will almost certainly be forthcoming. This is good; unnecessary imaging is almost certainly taking place, leading to false-positive results, unnecessary invasive procedures, more complications and so on.

But the problem in medicine today is much larger than imaging. Doctors are doing too much testing and too many procedures, often for the sake of business. And patients, unfortunately, are paying the price.

“The hospital is a great place to be when you are sick,” a hospital executive told me recently. “But I don’t want my mother in here five minutes longer than she needs to be.”

Dr. Sandeep Jauhar is a cardiologist on Long Island and the author of the new memoir “Intern: A Doctor’s Initiation.”

Go on a savings spree

2008-02-22T09:38:00.000-05:00

NYTimes

February 22, 2008
Op-Ed Contributor
Go on a Savings Spree
By DALTON CONLEY

CONGRESS has passed and President Bush has signed legislation to rescue the economy from the jaws of recession. The $168 billion package, which includes an effort to increase consumer spending by distributing $600 rebates to individuals, can be faulted in many ways: with two wars and a budget deficit the nation can’t really afford it; it will probably arrive too late in the business cycle to actually make a difference; and the near-universal aspect of the rebates doesn’t make much sense. But the most fundamentally troubling thing is the premise that while consumer overspending got us into this mess, more will get us out of it. This is akin to the old saw about curing a hangover with the hair of the dog that bit you.

What if instead of giving rebates we helped create an investor society by seeding universal investment accounts? This would not only pump cash into the economy, through the slightly more indirect route of investment, it would also help us correct some of the near-fatal flaws in our long-term economic landscape.

The recent slowdown in gross domestic product growth is only a symptom of recession, not the cause. While there are many things to blame for the current crisis — most notably the subprime mortgage mess — one factor that has received little attention is America’s low savings rate. In 2005, net private savings in the United States were negative. In other words, we were spending money that we didn’t have, chipping away at our national wealth.

The last time the savings rate dipped into the red was during the Great Depression. At that time, of course, it made sense not to save. Joblessness was high and money scarce; we needed to dip into our kitty to survive. But our negative savings during the Bush boom had a different cause. Evidently, we felt so flush with (paper) gains in the stock and housing markets that we spent money as if there were no tomorrow.

Republicans have long argued that the way to stimulate long-term growth is by promoting investment over spending. Hence their perennial efforts to lower taxes on capital gains, dividends and corporate profits. But whether such policies actually stimulate increased investment is open to debate, since the wealthy folks who gain most from these tax reductions are probably already investing their money. And the tax savings don’t trickle down as much as their advocates claim.

Democrats, more concerned with helping working families, consider consumer spending to be the magic bullet, so they favor tax rebates. But this only encourages us to continue our profligate ways.

Why not combine the best of both philosophies and try to stimulate investment by all Americans? The simplest approach would be to seed universal mutual fund accounts for low-income Americans. The best way to do this would be through a so-called refundable tax credit deposited directly into a special investment account for each taxpayer. In future years, the government could contribute an additional 50 cents for every dollar the taxpayer deposited into this account. Think of it as a universal 401(k), but one that could be used not only for retirement but also for things like a down payment on a house, college expenses or unexpected health costs.

Such investment incentives would do more than just help stimulate business growth by providing new capital. They would fundamentally change taxpayers’ lives. Some research suggests that asset-holders behave more responsibly and are more civic-minded than those without wealth. After all, they have a stake in the future of the economy and their community. This is why banks in cities don’t readily offer mortgages for apartments in buildings in which most of the tenants are renters, not owners. My own research suggests that having savings and investment equity is one of the best predictors of whether someone’s children will attend and graduate from college. Investing motivates people of all income levels to defer gratification and become knowledgeable about the economy and society.

Finally, to the extent that investment accounts grow, they decouple economic security from job security. By providing a cushion during employment transitions, they are the best possible form of unemployment insurance.

For some reason, legislation to create universal investment accounts — proposed by senators and representatives from both parties over the past decade — has repeatedly stalled in Congress. But now the economy is in trouble, and there is general agreement that this is a time for action. President Bush has already authorized the plan to stimulate more of the spending that got us into this trouble. But it’s still not too late to make the effort to create a true investor society.

Dalton Conley, the chairman of New York University’s sociology department, is the author, most recently, of “The Pecking Order: A Bold New Look at How Family and Society Determine Who We Become.”

Visiting Santa Monica

2008-02-22T02:29:00.000-05:00

NYTimes

February 22, 2008
American Journeys | Santa Monica, California
Classic Beach, but Much More in Santa Monica
By LOUISE TUTELIAN

WITH its classic amusement pier, glittering bay and surfers bobbing on swells, Santa Monica was a perfect setting for “Baywatch.” But take a short walk inland, and this city on the edge of Los Angeles reveals itself as more than a stereotypical beach town.

Within its borders, drawings by Picasso and Dubuffet hang in the same art complex as a vast installation by a graffiti crew. A well-preserved Mission-style bungalow sits around the corner from a steel performance space by Frank Gehry. Shops sell goods ranging from vintage Parisian wedding gowns to a whimsical map made entirely out of license plates. There are homegrown coffee bars on nearly every block, with names like Groundwork or the Legal Grind, dispensing caffeine and counsel at the same time.

“The pier, the bike path — they’re the only things most people know about Santa Monica,” said Colleen Dunn Bates, editor of “Hometown Santa Monica,” an insider’s guide to the city. “And they’re fun. But they don’t reflect everything that the city really offers.”

Although it’s surrounded on all sides by districts that are part of the City of Los Angeles — Pacific Palisades, Venice and West Los Angeles — Santa Monica asserts its own identity as an eight-square-mile separate city, and its population of about 96,000 is spread through several distinct neighborhoods. To make the most of time there, enjoy the games and famed carousel of the Santa Monica Pier and then step back from the beach to sample the city’s variety the way Santa Monicans themselves do.

On one recent Saturday, Ren Farrar was luring passers-by to his stand at the open-air Santa Monica Farmers’ Market, close to the beach on Arizona Avenue. By state law, all goods at the market must be grown in California, and much of the produce is picked within 24 hours of its appearance there.

“Care to try a sample?” Mr. Farrar, 37, of Spring Hill Jersey Cheese of Petaluma, shouted as I walked by. Watching intently as I savored a cube of his Old World Portuguese, he observed, “This is mild enough to go with anything, yet firm enough to stand up to the heat.”

Down the block, Adams’ Stuff’ N Olives featured feta and anchovy-stuffed olives. Fair Hills Farms offered six kinds of organic apples. Across the street, shoppers dropped dried nectarines, plums and pears into bags. A family strolled by, munching on Cajun spiced almonds and sipping ice-cold lemonade, both produced only a few miles away.

Nate Allen, 30, a personal chef and restaurant consultant from nearby Venice, shops at the market routinely, as do many of the top chefs in the area.

“The greatest thing about this market is that you’re going to get what is absolutely perfect and in season for this region,” said Mr. Allen, who flaunts his trade by sporting a seven-inch-long tattoo of a knife on one forearm and a tattooed fork on the other. “For visitors, by the time you get to the last vendor, you’ve got a great picnic for wherever you want to go.”

He often takes his own picnic to the Backbone Trail, a 69-mile system that roughly follows the crest of the Santa Monica Mountains from Will Rogers State Historic Park just north of Santa Monica to Point Mugu State Park in Ventura County. Hikers can take an easy, sage-scented, two-mile loop from the parking lot at Will Rogers up to Inspiration Point, a sensational overlook of Santa Monica Bay from the Palos Verdes Peninsula to Point Dume in Malibu.

On a clear day, a hiker can see Catalina Island and the white dots of sails. Behind are the slopes of the Santa Monica Mountains, and in the distance, the high-rises of downtown Los Angeles. Up there, the muted chattering of birds and the hum of insects are the only sounds.

Back in northern Santa Monica, natural sights give way to architectural ones. Adelaide Drive, at the north end of the city, offers intriguing examples of early-20th-century architecture. Two of the homes designated as city landmarks are the Craftsman-style Isaac Milbank House (No. 236) — designed by the same firm that did Grauman’s Chinese Theater in Hollywood — and the stucco Worrel House (No. 710), which was built in the mid-1920s and has been described as a “Pueblo-Revival Maya fantasy.”

(Another selection of carefully kept old houses, in styles from Victorian and Craftsman to Spanish colonial revival, await in the Third Street Historic District.)

Some of the city’s best shopping is also on its northern rim, where the 10-block Montana Avenue district is known for upscale clothes, home décor, crafts, jewelry and art. At Every Picture Tells A Story (No. 1311-C) a lithograph of the cover of “Charlotte’s Web” signed by the illustrator, Garth Williams, hangs on a wall, and in the gallery (the store is also a children’s bookstore) original works by Maurice Sendak, Dr. Seuss and others are $150 to $150,000.

Next door, Rooms & Gardens (No. 1311-A) sells furniture, antiques and accessories like pillows fashioned from an antique Indian sari. The actress Mary Steenburgen, one of the store’s three owners, praised the walkability of the area — not a common commodity in Southern California — when I asked her about the location of her store.

“The thing I love about Montana is that you feel as if you are in a pedestrian city,” she said. “It’s fun to look out the window and see people walking by with their dogs, instead of just cars streaming by.”

Santa Monica is sunny almost all the time, but visitors who hit a rare rainy day might spend a good portion of it at Bergamot Station, a complex of art galleries that many miss because it’s so hard to find. Built on the site of a former trolley-line stop — hence its name — the complex is on Santa Monica’s east side, next to a freeway on a dead-end street. Inside corrugated tin warehouses, two dozen galleries show contemporary drawings, paintings, photographs, sculpture and mixed-media works.

Sherrie Goldfarb of West Los Angeles and her friend Nancy Recasner of Studio City, Calif., hopped puddles between buildings after one rain this winter. “I wander through here with friends and the variety of work is amazing,” said Ms. Goldfarb, 57, a regular at the galleries.

Many boldface names are represented. At Ikon Ltd./Kay Richards, drawings by Dubuffet, Basquiat and Picasso, among others, are on display through March 1. “Rarely Seen,” a show of Henri Cartier-Bresson photographs, is running through May 10 at the Peter Fetterman Gallery.

Those who want to sense what Santa Monica was like as a sleepy town of tiny bungalows can visit Ocean Park on the city’s south end, which borders Venice. This funky neighborhood, one of the birthplaces of skateboarding in the late 1960s (part of “Lords of Dogtown” was filmed there), got a makeover in the 1990s; the tiny bungalows now sell for millions.

Artsy Main Street, Ocean Park’s central artery of merchants, restaurants and galleries, manages to merge sneaker stores and used-book shops with Armani Exchange and Patagonia stores. At Varga (No. 2806) apparel and accessories seem jointly inspired by ’40s pin-ups, Barbie dolls and young Hollywood celeb-style. The inventory at Relish, off Main Street at 208 Pier Avenue, ranges from bath salts ($20 to $40) to a pinball baseball game ($110). The Frank Gehry-designed steel boxes of Edgemar (No. 2415-2449 Main Street) house retail tenants and a performance space around an open courtyard.

Appraise your purchases over a martini with a mermaid toothpick at the Galley (No. 2442), a steakhouse with signature décor (think tiki bar with Christmas lights), a soulful juke box and old-salt appeal. No wonder — it opened its thick plank doors in 1934, making it Santa Monica’s oldest restaurant.

As the day wanes, consider watching the jet set (the one with its own jets) fly into the sunset. Opt for dinner next to the runway at the Santa Monica Municipal Airport. Those in the know reserve a window table at the Pan-Asian fusion restaurant Typhoon or the more intimate sushi restaurant the Hump (pilot slang for the Himalayas) upstairs.

But at sunset, the most thrilling view in town is back at the beach, from the top of the solar-powered 130-foot-high Pacific Wheel, the Ferris wheel at the Santa Monica Pier. Yes, it’s touristy, and yes, it might be crowded, but it is, after all, the city’s iconic symbol.

As my seat on the wheel glided upward one evening, the entire city of Santa Monica, and far beyond, slid into view. Below, the cast and crew of the film “17 Again,” starring Matthew Perry and Zac Efron, were shooting on the beach, as they would be all night long. The whole scene was bathed in a deep pink and violet glow.

It felt just fine to act like a tourist for a while.

VISITOR INFORMATION

SANTA MONICA, adjacent to Los Angeles, has 3.5 miles of coastline, all publicly accessible; two miles of this waterfront make up Santa Monica State Beach. The city’s north-south numbered streets run from Second Street, a block from the water, eastward to 26th. The major east-west arteries are San Vicente, Wilshire, Santa Monica, Pico and Ocean Park Boulevards.

The Santa Monica Pier, with rides, games, souvenir shops and a 1922 carousel, is at the foot of Colorado Avenue. The Pacific Wheel, a Ferris wheel at the pier, will be closed May 5 to 22 as a new wheel is installed.

Beach lovers can step onto the sand from Loews Santa Monica Beach Hotel at 1700 Ocean Avenue (310-458-6700; www.loewshotels.com; rooms from $349). The 72-room Ambrose (1255 20th Street; 310-315-1555; www.ambrosehotel.com; from $229) feels more like a Mission-style hideaway with stained-glass windows and fireside library.

The Santa Monica Farmers’ Market is held on Arizona Avenue from Second to Fourth Streets, on Wednesdays from 8:30 a.m. to 1:30 p.m. and Saturdays from 8:30 a.m. to 1 p.m.

The Backbone Trail is in Will Rogers State Historic Park (1501 Will Rogers State Park Road, off West Sunset Boulevard, Pacific Palisades; 310-454-8212; www.nps.gov/samo/planyourvisit/backbonetrail.htm), which is open from 8 a.m. to sunset daily. Parking is $7. Picnic tables are available at Inspiration Point.

Most galleries at Bergamot Station (2525 Michigan Avenue; www.bergamotstation.com) are open from 10 a.m. to 6 p.m. Tuesday to Friday, and 11 a.m. to 5:30 p.m. on Saturday. Because Michigan Avenue is bisected by a freeway, the best access to this dead-end section of it is off Cloverfield Avenue.

At the Galley (2442 Main Street; 310-452-1934, www.thegalleyrestaurant.net) a 12-ounce sirloin is $23 and seafood diablo is $24.

Typhoon, at the Santa Monica Airport (3221 Donald Douglas Loop South off Airport Road; 310-390-6565; www.typhoon.biz) offers Pan-Asian fare including Thai river prawns ($21) and stir-fried crickets ($10). Upstairs, the Hump (310-313-0977; www.thehump.biz) serves some of the freshest sushi in town.

Americans cutting back on consumer spending

2008-02-06T04:51:00.000-05:00

NYTimes

February 5, 2008
Economy Fitful, Americans Start to Pay as They Go
By PETER S. GOODMAN

For more than half a century, Americans have proved staggeringly resourceful at finding new ways to spend money.

In the 1950s and ’60s, as credit cards grew in popularity, many began dining out when the mood struck or buying new television sets on the installment plan rather than waiting for payday. By the 1980s, millions of Americans were entrusting their savings to the booming stock market, using the winnings to spend in excess of their income. Millions more exuberantly borrowed against the value of their homes.

But now the freewheeling days of credit and risk may have run their course — at least for a while and perhaps much longer — as a period of involuntary thrift unfolds in many households. With the number of jobs shrinking, housing prices falling and debt levels swelling, the same nation that pioneered the no-money-down mortgage suddenly confronts an unfamiliar imperative: more Americans must live within their means.

“We don’t use our credit cards anymore,” said Lisa Merhaut, a professional at a telecommunications company who lives in Leesburg, Va., and whose family last year ran up credit card debt it could not handle.

Today, Ms. Merhaut, 44, manages her money the way her father did. Despite a household income reaching six figures, she uses cash for every purchase. “What we have is what we have,” Ms. Merhaut said. “We have to rely on the money that we’re bringing in.”

The shift under way feels to some analysts like a cultural inflection point, one with huge implications for an economy driven overwhelmingly by consumer spending.

While some experts question whether most Americans, particularly baby boomers, will ever give up their buy-now/pay-later way of life, the unraveling of the real estate market appears to have left millions of families with little choice, yanking fresh credit from their grasp.

“The long collapse in the United States savings rate is over,” said Ethan S. Harris, chief United States economist for Lehman Brothers. “People are going to start saving the old-fashioned way, rather than letting the stock market and rising home values do it for them.”

In 1984, Americans were still saving more than one-tenth of their income, according to the government. A decade later, the rate was down by half. Now, the savings rate is slightly negative, suggesting that on average Americans spend more than their disposable income.

Though the savings rate does not account for the increased value of stock and property, or the gains on retirement accounts, many economists still view it as the most useful gauge of the degree to which Americans are making provisions for the future.

For the 34 million households who took money out of their homes over the last four years by refinancing or borrowing against their equity — roughly one-third of the nation — the savings rate was running at a negative 13 percent in the middle of 2006, according to Moody’s Economy.com. That means they were borrowing heavily against their assets to finance their day-to-day lives.

By late last year, the savings rate for this group had improved, but just to negative 7 percent and mostly because tightened standards made loans harder to get.

“For them, that game is over,” said Mark Zandi, chief economist at Economy.com. “They have been spending well beyond their incomes, and now they are seeing the limits of credit.”

Many times before, of course, Americans have found innovative ways to finance spending, even when austerity seemed unavoidable. It could happen again.

The Me Decade was declared dead in the recession of the early 1980s, only to yield to the Age of Greed and later the Internet boom of the 1990s. Over the longer term, the economy should keep growing at a pace that reflects improving productivity and population gains.

But for the first time in decades, credit is especially tight as the bursting of the housing bubble has spread misery across the financial system. In homes now saturated with debt, conspicuous consumption and creative financing have come to seem a sign of excess not unlike that of a suntan in an age of skin cancer.

The return to reality is on vivid display at shopping centers, where consumers used to trading up to higher-price stores are now heading to discounters. Wal-Mart and T. J. Maxx are thriving, but business has slowed at Coach, Tiffany and Williams-Sonoma.

Not long ago, Elena Gamble would have looked at the Cadillac parked across the street from her modest home in Elk City, Okla., and felt a twinge of jealousy.

“We live in a small town, and everybody looks at your clothes and what you drive and where you have your hair done,” said Ms. Gamble, who earns about $2,600 a month as a grievance counselor at a local prison.

Now, she and her husband — a prison guard who brings home $2,000 a month — are grappling with $10,000 in high-interest debt. They no longer go to the movies or out to eat, except occasionally to McDonald’s. They quit their Internet service. Their car was repossessed. “What we say now is, ‘If we can’t afford it, we can’t buy it,’ ” Ms. Gamble said.

And when she looks across the street at that Cadillac, her envy has been replaced by pity for the neighbor on the hook.

“I say, ‘Oh my, you’re living here, and driving that? There’s got to be something wrong,’ ” Ms. Gamble said. “ ‘You’re in debt, and you’re in trouble.’ ”

For decades, that envy has been a prime engine of economic growth. Debt-willing consumers hungering for the latest-generation this and the fastest that kept factories busy from Michigan to Malaysia.

From 1980 to 2007, consumer spending swelled from 63 percent of the economy to over 70 percent, according to Economy.com, while the share of after-tax income absorbed by household debt increased from 11 percent to more than 14 percent.

During the technology boom of the 1990s, an extravagant mind-set took hold. In ads for the discount broker Ameritrade, a spiky-haired hipster ridiculed middle-aged professionals for settling for conventional returns.

Even after the “stock market as money machine” line of thinking proved bogus, extra spending continued. The Federal Reserve cut interest rates to near record lows, banks marketed mortgages with exotically lenient terms and another fable of wealth creation took hold: the notion that housing prices could go up forever.

The come-ons for stocks were replaced by a new crop of advertisements. A house was no longer a mere place to live; it was a checkbook that never required a deposit. Between 2004 and 2006, Americans pulled more than $800 billion a year from their homes via sales, cash-out mortgages and home equity loans.

“People have come to view credit as savings,” said Michelle Jones, a vice president at the Consumer Credit Counseling Service of Greater Atlanta.

Some Americans have so much wealth that they can spend enough to fuel much of the economy. The top fifth of American earners generates half of all consumer spending, noted Dean Maki, chief United States economist at Barclays Capital.

For the others, some say credit is an intrinsic part of modern life, and Americans will soon be back for more. “A river of red ink runs through the history of the American pocketbook,” said Lendol Calder, author of “Financing the American Dream: A Cultural History of Consumer Credit.”

“Partly because of desire, partly because of optimism, partly because lenders have been free to invent useful borrowing tools that minimized shame and bother,” he added, “I think it will take a great catastrophe, greater than the Great Depression, to wean Americans from their reliance on consumer credit.”

Credit counselors are now swamped by calls not just from people of modest means, but from professionals earning six-figure incomes, their access to finance warping their distinction between necessity and desire.

“The longer someone has lived on a high income, the harder it is for someone to cut back,” said Manuel Navarro of Money Management International in San Diego. “I ask them, ‘Do you really need to have a 60-inch flat-screen TV hanging on your wall?’ ”

Fran Barbaro has an M.B.A. and a résumé of computer industry jobs with salaries reaching $150,000 a year. She used to have a stock portfolio worth about $1 million. She hung original art on the walls of her three-bedroom house in Boston.

But divorce, illness and motherhood drained her savings. Her home is worth less than she owes, and she owes another $200,000 to credit card companies, banks and tax collectors.

Ms. Barbaro, 50, said she knew she was living beyond her means. But her house demanded work. Her two boys needed after-school programs running $25,000 a year. Medical bills multiplied.

“These were simple day-to-day expenses,” she said. “The money was always there.”

Until it wasn’t. Her take-home pay is $5,200 a month, but her debt payments reach $4,400.

Ms. Barbaro has rented out her house while negotiating to lower her mortgage. She has moved to an apartment, where her sons sleep in the lone bedroom while she sleeps on a pull-out sofa.

“It’s the worst,” Ms. Barbaro said. “How do you salvage what you have and hopefully go back?”

101 simple appetizers

2007-12-20T00:46:00.000-05:00

NYTimes

December 19, 2007
The Minimalist
101 Simple Appetizers in 20 Minutes or Less
By MARK BITTMAN

YOU want good food at a holiday cocktail party and you want to impress people? You don’t want a caterer, you refuse to heat up frozen food, and you want to show that your expertise extends beyond buying perfectly ripe hunks of cheese and juicy olives? Then think about doing some cooking.

Here is a collection of party foods that are as easy to eat as they are to make. Each can be produced in 20 minutes or less. Many can be served at room temperature. And none require a plate. (Few people can juggle plate, wineglass and fork successfully, let alone gracefully.)

Most of these recipes are beyond minimalist: they never do in two steps what can be done in one, and they need no embellishment. As you scan these recipes for ideas, mostly think this: The ones you find most appealing are the ones your guests will like. Choose a few, spend an hour or two in the kitchen, and you’ll be in great shape.

On Bread or Crackers

1 Red peppers and anchovies: Drizzle piquillos or other roasted red peppers with olive oil, and top with a good anchovy fillet. A caper or two on each is not amiss.

2 Top rye flatbread with thin slices of crisp apple and pickled plain or schmaltz herring (not herring in cream sauce).

3 Sear skirt steak to medium-rare, not more than 8 minutes. Cut into chunks 1/2-inch to 1 inch, first with the grain, then against it. Spread bread with coarse mustard and/or butter. Top with steak and coarse salt.

4 Toss high-quality crab meat with minced shallots, a little tarragon or a lot of parsley and/or basil, and enough mayonnaise to bind. Also good on lettuce leaves.

5 Mash together best-quality tuna, minced anchovies, minced garlic, chopped oil-cured olives and olive oil as necessary.

6 New York comfort food: Spread cream cheese or crème fraîche on small bagels or bagel chips; black bread is also terrific. Top with sturgeon, sable or lox.

7 Slice soft goat cheese and brush with olive oil. Sprinkle with salt, pepper and chopped herbs, then with bread crumbs. Bake at 350 degrees until soft, about 10 minutes, and serve hot.

8 Might not be the new ketchup, but great stuff: purée skinned roasted peppers or piquillos with some of their liquid, salt and olive oil. Serve alone or with other foods — a piece of cheese, even.

9 Top buttered bread with shaved country ham, prosciutto or regular deli ham and bread-and-butter pickles.

10 Chop shrimp fine, then sauté in a minimum of oil, or poach quickly and drain. Mix premade pesto with mayonnaise so that it is gluey. Combine cooled shrimp with sufficient pesto to bind; chill.

11 Tapenade: Combine about 1 pound pitted black olives in food processor with 1/4 cup drained capers, at least 5 anchovies, 2 garlic cloves, black pepper and olive oil as necessary to make a coarse paste. Can also be a dip. Use sparingly; it’s strong.

12 A kind of Moroccan tapenade: As above, but use good green olives with capers; olive-oil-canned tuna (instead of anchovies); garlic, if desired; and cumin.

13 Chop fresh mushrooms. Cook slowly in olive oil with salt and pepper until very soft. Stir in minced garlic and parsley. Cook a few more minutes until garlic mellows. (Especially good if you add reconstituted dried porcini.)

14 Mix together a bit of flour and good paprika. Cut Manchego or similar sheep’s milk cheese into 1/2-inch-thick slices. Dip in flour, then beaten egg, then bread crumbs, and fry quickly to brown on both sides. Drain on paper towels and serve hot.

15 Beef tartare: Carefully pulse good beef in food processor. For each pound, add an egg, a teaspoon dry mustard, a tablespoon Dijon mustard, a tablespoon Worcestershire, Tabasco to taste, 1/2 cup chopped scallions and a touch of minced garlic. Salt and pepper, if necessary. Amazing stuff.

16 Put a thick film of olive oil in a skillet over low heat with lots of thin-sliced garlic. When it sizzles, add shrimp along with pimentón. Raise the heat just enough to get the shrimp going, and cook until it’s pink. Stir in parsley. Spoon a little of the oil onto pieces of bread and top with shrimp.

17 Season cornmeal with lots of chili powder, salt and black pepper. Heat a thick film of neutral oil (or oil mixed with butter) in a skillet. Dredge shucked clams, oysters or chicken breast pieces in the cornmeal and cook about 2 minutes a side, or until crisp. Serve on bread with mayonnaise, or sprinkle with lemon or lime juice and serve on toothpicks. It’s almost convenience food when prepared with shucked mollusks.

Bruschetta

18 Bruschetta is the basis for so many good things. Don’t make it too crisp, and start with good country bread. Brush thick slices with olive oil. Broil until toasted on both sides. While it’s still hot, rub with cut clove of garlic on one side (optional). Drizzle with a bit more olive oil, sprinkle with salt, and serve, or top with prosciutto or tapenade.

19 More than party food, and an amazing snack: Top bruschetta with white beans cooked soft (or use canned) and finished with minced garlic, sage, olive oil and salt.

20 One more level: Make white beans as above. Toss with good quality canned tuna and mash. Spoon over bruschetta.

21 Top bruschetta with chopped, well-cooked broccoli rabe or other greens tossed with minced garlic and olive oil while still warm. Health food, practically. Also good with a layer of Tuscan beans (above).

On Toothpicks

22 Cut pork tenderloin into 1-inch slices; broil or sauté until done. Cut each piece across into 3 or 4 thin slices, then pile onto round bread slices, toasted or not. Top with slice of Manchego and bit of piquillo pepper.

23 Cut chorizo into chunks. Cook in a lightly oiled skillet until nicely browned. Kielbasa is equally good (or better), if not as hip.

24 Portable Caprese: Skewer a small ball of mozzarella, a grape tomato and a bit of basil leaf. Sprinkle with salt and pepper, and drizzle with oil.

25 A no-brainer: Cut slab of bacon into 1/2-inch chunks. Cook in a skillet, a broiler or a high-heat oven until nice and crisp. Skewer with a grape tomato.

26 Even jazzier: Cut just-ripe pears in 1/2-inch cubes; sprinkle with a little salt, sugar and cayenne. Spear with bacon.

27 Pair crispy bacon chunks with one cube of beet and one of goat cheese.

28 Angels on horseback: Wrap oysters or not-too-large sea scallops in bacon; skewer with toothpicks. Broil, turning once, until bacon is done.

29 You can call them devils on horseback: Wrap pitted dates (replacing the pit with an almond if you like) in bacon. Skewer with toothpicks and broil, turning once, until bacon is done.

30 Rumaki, a 1960s cocktail food that deserves reviving: Brush canned water chestnuts (or chicken liver halves, or crimini mushrooms, or pieces of portobello) with a little soy sauce; wrap in pieces of bacon. Skewer closed with toothpicks and broil, turning once, until bacon is done.

31 Wash mussels or littleneck clams well; steam open in covered pot. Let cool, remove from shells, and serve with aioli, flavored mayonnaise or vinaigrette.

32 Cook real bay scallops in hot butter or oil for just a couple of minutes. Sprinkle with lemon juice and parsley and serve hot.

33 Crab cakes: For each pound crab meat, add an egg, 1/4 cup each minced bell pepper and onion, 1/4 cup mayonnaise, 1 tablespoon Dijon mustard, 2 tablespoons bread or cracker crumbs, salt and pepper. Shape into small cakes and refrigerate, if time allows. Dredge in flour, then brown in oil (or oil mixed with butter). Serve with lemon wedges, aioli or tartar sauce.

34 Meatballs: Combine 1 thick slice white bread with 1/2 cup milk; let sit for 5 minutes. Squeeze milk from bread and gently mix bread with 1/2 pound not-too-lean ground sirloin, 1/2 pound ground pork, 1/2 cup chopped onion, 1/2 cup freshly grated Parmesan, 1/4 cup chopped fresh parsley leaves and salt and pepper. Shape into 1-inch balls. (If mixture doesn’t hold well, add more bread crumbs and an egg.) Broil about 5 minutes, turning once or twice.

35 Cod cakes with sauce rouge: I’m hedging on time here, but you’re really getting two recipes in one: Combine 1 pound chopped boneless cod, an egg, 1/4 cup mayonnaise, a tablespoon Dijon mustard and some salt and pepper. Add bread or cracker crumbs until you can shape the mixture into cakes. If possible, refrigerate for an hour. Meanwhile, cook chopped canned tomatoes in olive oil with salt and cayenne until saucy. Shape small cod cakes. Dredge in flour, sauté in butter and oil until nicely browned. Serve hot or at room temperature, with sauce on the side.

36 The banderilla: The first tapa created, or at least that’s what people tell me. Skewer a crisp pickled pepper, an anchovy and a pitted green olive. Incredible with dry (fino) sherry.

37 Toss peeled shrimp with lots of minced garlic, pimentón or paprika, cayenne, olive oil, lemon juice, salt and pepper. Broil until done, turning once, about five minutes.

38 Marinated mushrooms: Cut button mushrooms into chunks and toss with lemon juice, olive oil, salt and pepper. Let rest five minutes. Spear two chunks with a piece of Parmesan about the same size.

39 Cut tuna or tenderloin of beef into bite-size pieces. Sear in hot pan until browned on one side; turn; smear browned side with dark miso slightly thinned with sake. Continue to cook another minute or two.

40 Flash-cooked squid: Marinate whole baby squid for 5 minutes in olive oil, a little sherry vinegar, salt and pepper. Sear on both sides in a very hot pan or broiler for less than 3 minutes total. Cut into pieces and sprinkle with more salt. You can do this with shrimp and scallops, too.

41 Soak a couple of tablespoons of black beans in sherry. Blast bite-size shrimp in a little peanut oil until just about cooked through; add minced garlic (and chili and ginger, if you like), then cook 30 seconds. Add black beans and their liquid, and toss. Turn off heat and add a little soy sauce. Serve on toothpicks.

42 Chicken meunière: Sounds fancier than it is, and works with veal, turkey, pork, oysters, clams, shrimp, etc. Cut boneless meat into bite-size pieces (not too small). Dredge in flour, brown quickly in a combination of butter and oil. Serve with lemon wedges.

43 Cut tenderloin or other tender beef into bite-size chunks. Toss with a lot of roughly chopped basil (say, 1 cup basil per pound of meat) and peanut oil. Stir-fry with garlic and red pepper flakes until rare. Sprinkle with soy sauce or nam pla and lime juice.

On Skewers

44 Chicken kebab, Greek style: Cut boneless, skinless chicken thighs into 1-inch chunks. Toss with minced onion, minced garlic, lemon juice, olive oil, salt, pepper, crumbled bay leaf and oregano. Skewer. Broil, turning occasionally, until browned.

45 Chicken kebab, South Asian style: Cut boneless, skinless chicken thighs into 1-inch chunks. Toss with equal amounts ground cardamom, minced garlic, ground allspice, ground turmeric and thyme leaves; add a dash of nutmeg and peanut oil to moisten. Skewer. Broil, turning occasionally, until nicely browned.

46 Chicken kebab, faux-tandoori style: Cut boneless, skinless chicken thighs into 1-inch chunks. Toss with yogurt, chopped onion, minced garlic, minced lime zest, ground cumin, coriander, paprika, cayenne and lime juice. Skewer and broil, turning occasionally, until nicely browned.

47 Chicken teriyaki: Cut 1 pound of boneless, skinless chicken thighs into 1-inch chunks. Toss with 1/4 cup each soy sauce, sake and mirin, and a tablespoon of sugar. Skewer. Boil remaining sauce for a minute or so. Broil the chicken, turning and basting with the sauce after a couple of minutes.

48 Pork kebabs, West Indian style: Mix 1 tablespoon garlic, 1/2 teaspoon ground allspice, a pinch of nutmeg, a teaspoon of fresh thyme leaves, 1/4 cup chopped onion and the juice of a lime. Toss with 1 pound pork shoulder (you need some fat or these will be tough) cut into 1-inch cubes. Skewer and broil about 5 minutes.

49 Pork kebabs, Iberian style. Mix 1 tablespoon garlic, 1/4 cup chopped onion, 1 tablespoon ground cumin, 2 teaspoons paprika, 1 tablespoon grated or minced lemon zest and 1/4 cup freshly squeezed lemon juice. Toss with 1 pound cubed pork shoulder (with fat). Skewer. Broil about 5 minutes.

Finger Foods

50 The egg’s gift to cocktail parties: Hard-cook eggs, peel, and cut in half; carefully remove the yolks. Mash yolks with salt, mayonnaise, good mustard and cayenne. You can also add minced radish, snow peas, scallions (or any crunchy vegetables) or curry powder. Spoon back into the whites, sprinkle with paprika, pimentón or parsley.

51 Even more fabulous: Cook eggs as above. Mash yolks with cooked and minced shrimp, a little chopped olive, minced onion, parsley, salt, pepper and mayonnaise to bind. Spoon back into whites. Garnish with parsley or a piece of anchovy or shrimp.

52 Aioli with steamed cold vegetables: Make the mayonnaise yourself or flavor bottled mayonnaise with lemon, garlic, anchovy (if you like it) and a little saffron (if you have it) for amazing color. Serve with lightly cooked carrots, snap peas, purple potatoes, seafood, etc.

53 Shrimp cocktail: Combine ketchup with chili powder, pepper, lemon juice, Worcestershire, Tabasco and horseradish. Make lots, because people will be double-dipping. Serve with cooked shrimp.

54 Sprinkle rib lamb chops (rack of lamb, separated) or loin chops with good coarse curry powder, or any spice mix you like. Broil quickly, until crisp but not well-done. Serve hot, with yogurt mixed with same spice rub. These will go very fast.

55 Stuff Medjool dates with a piece of Parmesan or Manchego or an almond. Or fresh goat cheese. Or mozzarella, and bake until the cheese begins to melt.

56 Wrap small pieces of melon, figs and/or dates with thinly sliced prosciutto.

57 Buy the best anchovies you can find. Curl each around a tiny ball of butter. Eat.

58 Teeny tiny hamburgers: The hardest part is finding teeny tiny buns, but you can use toast squares. Make them small from beef mixed with salt and pepper. Cook quickly in a hot skillet and serve with ketchup and bits of onion and tomato.

59 Nachos: Yes, nachos. Top a layer of tortilla chips with grated cheese (something orange is traditional) and bake until cheese melts. Top with warm beans seasoned with chili powder, along with chopped scallions. Other possible toppings: jalapeños, sour cream, cilantro, tomatoes, olives.

60 Hot wings: Cut chicken wings into three sections; discard the tips. Sprinkle with salt and pepper and broil until browned on one side, about 5 minutes. Meanwhile, melt butter with vinegar, garlic and hot sauce to taste. Pour off excess fat, baste the wings with hot sauce, turn them, baste again, and brown. Baste once more and serve, with napkins.

61 Sweet wings: As above, but melt the butter with Dijon mustard and honey or maple syrup.

62 Soy ginger wings: This time baste with equal parts vinegar and soy sauce, mixed with a couple of tablespoons each minced ginger and sesame oil. You can sprinkle toasted sesame seeds on the wings.

63 Put peeled raw shrimp in a food processor with garlic, chili, ginger, shallot or red onion, salt, pepper and cilantro; chop finely. Shape into small patties and shallow-fry or broil, then serve with napkins or on buns, with lime juice or spiced mayonnaise.

64 Gently cook raw nuts in oil or butter (or a mixture) with salt and spices — pimentón, chili powder, curry powder, ginger, sugar — whatever combination you like. When they’re fragrant, bake for 10 minutes at 350 degrees. Let cool or they won’t be crunchy.

65 Beyond simple: Buy decent tortilla chips; sprinkle with lime juice and chili powder. Eat fast, before they get soggy.

66 Coat good olives in olive oil mixed with crushed garlic, rosemary, thyme, and/or lemon or orange peel; spices, like chilies, are O.K. Let sit overnight if time allows.

67 Little pizza bianca: Cut prepared dough into small pieces and press out. Brush with oil, sprinkle with rosemary and good coarse salt. Bake at about 500 degrees until browned. Cut up to serve.

68 Quarter quail, rub with olive oil or peanut oil. Broil, skin side down, about 3 minutes. Broil, skin side up, until brown, crisp and cooked through, about 5 minutes more. Brush lightly with pesto or soy sauce and sesame oil, and serve hot or warm.

69 Popcorn parmigiana: Make real popcorn, pour melted butter over it, and toss with fresh Parmesan.

70 Cut baby back ribs into individual ribs; sprinkle with salt and pepper (lots). Broil, turning as needed, 10 minutes or so. Sprinkle with lemon juice.

71 Fill endive leaves with crème fraîche or sour cream and caviar or salmon roe. Or use drained ricotta mixed with chopped parsley, thyme, a little olive oil and a little minced garlic.

72 Steamed asparagus wrapped in prosciutto. That’s the recipe.

73 Cucumber and caviar: Take 3/4-inch-thick slices of cucumber. (The quality of the cuke is more important than that of the caviar; it has to be good enough to leave the skin on.) Scoop out most of the seeds, leaving the bottom of each slice intact. Fill it with a spoonful of yogurt, sour cream or crème fraîche mixed with dill, and top with caviar or salmon roe.

74 Boil frozen or fresh edamame in pods for 3 to 5 minutes. Sprinkle with coarse salt. For this they charge you eight bucks.

Dips and Spreads

75 Purée white or other beans (if canned, drain them) with garlic and olive oil in food processor, adding olive oil as needed. Stir in lemon juice to taste. Garnish with chopped scallions or red onion. You can add cumin or chopped rosemary with lemon zest.

76 Hummus: Truly one of the great culinary inventions. Mix four parts well-cooked or canned chickpeas with one part tahini, along with some of its oil, in a food processor. Add garlic, cumin or pimentón and purée, adding as much olive oil as needed. Stir in lemon juice, salt and pepper to taste; garnish with olive oil and pimentón.

77 Drain good whole-fat yogurt in cheesecloth for 15 minutes; squeeze to remove remaining liquid. Add salt, pimentón and olive oil. Thin with a little more yogurt to use as a dip, or serve on crackers or bread.

78 Mix four parts drained yogurt (as above), farmer cheese or cream cheese with one part sour cream, until creamy. Add thyme and chopped parsley (or any fresh herbs), minced garlic, salt and pepper.

79 Start by draining yogurt as above but do not squeeze; or use sour cream. Stir in chopped seeded cucumber, bell pepper, scallion, dill, then add salt, pepper and lemon juice to taste. Or use chopped arugula and/or cress, with some herbs. Or use horseradish and/or Dijon mustard, with or without vegetables. Or minced or puréed onion or shallots and chopped fresh parsley. Always taste for salt.

80 Drain yogurt as above but do not squeeze; or use sour cream. Add flaked smoked trout or whitefish, or minced smoked salmon, along with chopped parsley, cayenne and lemon juice. Or add minced onion with salmon roe or caviar.

81 Taramosalata: Take 3 or 4 slices good white bread, preferably stale, and soak in water to cover for a few minutes. Squeeze out water, purée bread with 2 or 3 cloves garlic, 8 ounces fish roe (tarama) and at least 1/4 cup olive oil, adding more as needed. Stir in lemon juice and pepper to taste.

82 Mix four parts cream cheese or fresh goat cheese to one part chopped walnuts. A little spice mix (chili powder, curry powder, whatever) is nice in here. Or, replace the nuts with roasted peppers, olive oil and minced anchovies.

83 Boursin: Maybe you have a few Ritz? Mash cream cheese with minced garlic (if you have roasted garlic, so much the better), pepper and small amounts of minced thyme, tarragon and rosemary.

84 Mix three parts cream cheese, one part minced cooked shrimp, a few mashed capers and pepper.

85 Mash four parts goat cheese with one part fig jam.

Little Sandwich Triangles

86 Layer cooked ham and cheese (Gruyère, Cantal or good Cheddar) on thin bread, then press and grill in a not-too-hot skillet with butter or oil.

87 Finding top-quality roast beef is worth a little legwork. Slice it thin and serve with horseradish on rye.

88 Dice cooked shrimp, toss with chopped onion and/or celery, and bind with aioli or well-seasoned mayonnaise.

89 Extra seasoning takes this egg salad higher: Toss chopped hard-cooked eggs with scallions, chopped anchovies and parsley. Bind with well-seasoned mayo.

90 Toss shredded or cubed chicken with minced shallot or red onion, chopped black olives, olive oil, lemon zest, lemon juice, salt, pepper and chopped herbs. Adjust seasoning to taste. Serve on slices of toast.

91 Cheese quesadillas: Use 4-inch tortillas; on each, put grated cheese, scallions and minced canned green chilies or chopped fresh poblanos. Salsa and beans are optional. Top with another tortilla. Griddle with oil, turning once, about 5 minutes.

You Might Need a Fork

92 This is easier than carpaccio: Cut trimmed filet mignon into 1/2-inch or smaller cubes. Toss with arugula, parsley, olive oil, lemon juice, salt and pepper.

93 Make parsley pesto (parsley, garlic, oil, lemon juice) in a food processor. Sauté whole shrimp or small pieces of fish in oil. Arrange fish on small beds of the pesto. You can put this on bread and forget the plates.

94 Ceviche: Thinly slice — or cut into 1/4-inch dice — sea or true bay scallops (or any really fresh fish). Toss with a bit of peeled and minced bell pepper, some lime zest and about 1/4 cup lime juice per pound. Add salt and cayenne to taste. Garnish with cilantro.

95 Mock ceviche: Briefly poach a mixture of (for example) shrimp, scallops and squid, cut to bite size. Drain, then combine with olive oil, minced fresh chili, red onion, and (optional) garlic. Finish with lime juice and cilantro and serve in lettuce cups.

Soups and Wraps

96 Bisque: Heat shrimp, lobster, fish or chicken broth with minced onion and chopped tomato for 5 minutes. Add chopped shrimp or lobster to the simmering stock, and cook another two minutes. Purée, then add heavy cream or half-and-half, along with salt and pepper. Serve in small cups garnished, if you like, with a piece of cooked shrimp or lobster.

97 Avocado soup: Put 2 cups avocado flesh in a blender with 3 cups whole milk along with some salt and cayenne. Purée, then add fresh lime or orange juice to taste, and adjust seasoning. Refrigerate or serve immediately in small cups garnished with a piece of avocado or cooked shrimp.

98 Gazpacho: Chop 2 pounds of tomatoes and a cucumber; blend with a couple of slices of day-old bread, torn into pieces, olive oil, sherry vinegar, garlic (optional) and anchovies (optional). Add a little water (or more oil) to the blender, if necessary. Taste and adjust seasoning, then serve in small cups. Optional garnishes include minced bell pepper, a drizzle of olive oil, a piece of anchovy, and/or parsley.

99 Buy roast duck and take meat off bones; toss with hoisin sauce and roughly chopped scallions. Roll in small tortillas.

100 Roll prosciutto and Parmesan in small tortillas. Bake gently to soften the cheese.

101 Broil a good hot dog, roll in a good tortilla spread with brown or Dijon mustard. Slice. You know everyone will eat them.

Doctor as drug rep experience

2007-11-25T17:36:00.000-05:00

NYTimes

November 25, 2007
Dr. Drug Rep
By DANIEL CARLAT

I. Faculty Development

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.”

I thought about his proposition. I had a busy private practice in psychiatry, specializing in psychopharmacology. I was quite familiar with Effexor, since I had read recent studies showing that it might be slightly more effective than S.S.R.I.’s, the most commonly prescribed antidepressants: the Prozacs, Paxils and Zolofts of the world. S.S.R.I. stands for selective serotonin reuptake inhibitor, referring to the fact that these drugs increase levels of the neurotransmitter serotonin, a chemical in the brain involved in regulating moods. Effexor, on the other hand, was being marketed as a dual reuptake inhibitor, meaning that it increases both serotonin and norepinephrine, another neurotransmitter. The theory promoted by Wyeth was that two neurotransmitters are better than one, and that Effexor was more powerful and effective than S.S.R.I.’s.

I had already prescribed Effexor to several patients, and it seemed to work as well as the S.S.R.I.’s. If I gave talks to primary-care doctors about Effexor, I reasoned, I would be doing nothing unethical. It was a perfectly effective treatment option, with some data to suggest advantages over its competitors. The Wyeth rep was simply suggesting that I discuss some of the data with other doctors. Sure, Wyeth would benefit, but so would other doctors, who would become more educated about a good medication.

A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

The next morning, the conference began. There were a hundred or so other psychiatrists from different parts of the U.S. I recognized a couple of the attendees, including an acquaintance I hadn’t seen in a while. I’d heard that he moved to another state and was making a bundle of money, but nobody seemed to know exactly how.

I joined him at his table and asked him what he had been up to. He said he had a busy private practice and had given a lot of talks for Warner-Lambert, a company that had since been acquired by Pfizer. His talks were on Neurontin, a drug that was approved for epilepsy but that my friend had found helpful for bipolar disorder in his practice. (In 2004, Warner-Lambert pleaded guilty to illegally marketing Neurontin for unapproved uses. It is illegal for companies to pay doctors to promote so-called off-label uses.)

I knew about Neurontin and had prescribed it occasionally for bipolar disorder in my practice, though I had never found it very helpful. A recent study found that it worked no better than a placebo for this condition. I asked him if he really thought Neurontin worked for bipolar, and he said that he felt it was “great for some patients” and that he used it “all the time.” Given my clinical experiences with the drug, I wondered whether his positive opinion had been influenced by the money he was paid to give talks.

But I put those questions aside as we gulped down our coffees and took seats in a large lecture room. On the agenda were talks from some of the most esteemed academics in the field, authors of hundreds of articles in the major psychiatric journals. They included Michael Thase, of the University of Pittsburgh and the researcher who single-handedly put Effexor on the map with a meta-analysis, and Norman Sussman, a professor of psychiatry at New York University, who was master of ceremonies.

Thase strode to the lectern first in order to describe his groundbreaking work synthesizing data from more than 2,000 patients who had been enrolled in studies comparing Effexor with S.S.R.I.’s. At this time, with his Effexor study a topic of conversation in the mental-health world, Thase was one of the most well known and well respected psychiatrists in the United States. He cut a captivating figure onstage: tall and slim, dynamic, incredibly articulate and a master of the research craft.

He began by reviewing the results of the meta-analysis that had the psychiatric world abuzz. After carefully pooling and processing data from eight separate clinical trials, Thase published a truly significant finding: Effexor caused a 45 percent remission rate in patients in contrast to the S.S.R.I. rate of 35 percent and the placebo rate of 25 percent. It was the first time one antidepressant was shown to be more effective than any other. Previously, psychiatrists chose antidepressants based on a combination of guesswork, gut feeling and tailoring a drug’s side effects to a patient’s symptom profile. If Effexor was truly more effective than S.S.R.I.’s, it would amount to a revolution in psychiatric practice and a potential windfall for Wyeth.

One impressive aspect of Thase’s presentation was that he was not content to rest on his laurels; rather he raised a series of potential criticisms of his results and then rebutted them convincingly. For example, skeptics had pointed out that Thase was a paid consultant to Wyeth and that both of his co-authors were employees of the company. Thase responded that he had requested and had received all of the company’s data and had not cherry-picked from those studies most favorable for Effexor. This was a significant point, because companies sometimes withhold negative data from publication in medical journals. For example, in 2004, GlaxoSmithKline was sued by Eliot Spitzer, who was then the New York attorney general, for suppressing data hinting that Paxil causes suicidal thoughts in children. The company settled the case and agreed to make clinical-trial results public.

Another objection was that while the study was billed as comparing Effexor with S.S.R.I.’s in general, in fact most of the data compared Effexor with one specific S.S.R.I.: Prozac. Perhaps Effexor was, indeed, more effective than Prozac; this did not necessarily mean that it was more effective than the other S.S.R.I.’s in common use. But Thase announced that since the original study, he had analyzed data on Paxil and other meds and also found differences in remission rates.

For his study, Thase chose what was at that time an unusual measure of antidepressant improvement: “remission,” rather than the more standard measure, “response.” In clinical antidepressant trials, a “response” is defined as a 50 percent improvement in depressive symptoms, as measured by the Hamilton depression scale. Thus, if a patient enters a study scoring a 24 on the Hamilton (which would be a moderate degree of depression), he or she would have “responded” if the final score, after treatment, was 12 or less.

Remission, on the other hand, is defined as “complete” recovery. While you might think that a patient would have to score a 0 on the Hamilton to be in remission, in fact very few people score that low, no matter how deliriously happy they are. Instead, researchers come up with various cutoff scores for remission. Thase chose a cutoff score of 7 or below.

In his study, he emphasized the remission rates and not the response rates. As I listened to his presentation, I wondered why. Was it because he felt that remission was the only really meaningful outcome by which to compare drugs? Or was it because using remission made Effexor look more impressive than response did? Thase indirectly addressed this issue in his paper by pointing out that even when remission was defined in different ways, with different cutoff points, Effexor beat the S.S.R.I.’s every time. That struck me as a pretty convincing endorsement of Wyeth’s antidepressant.

The next speaker, Norm Sussman, took the baton from Thase and explored the concept of remission in more detail. Sussman’s job was to systematically go through the officially sanctioned “slide deck” — slides provided to us by Wyeth, which we were expected to use during our own presentations.

If Thase was the riveting academic, Sussman was the engaging populist, translating some of the drier research concepts into terms that our primary-care-physician audiences would understand. Sussman exhorted us not to be satisfied with response and encouraged us to set the bar higher. “Is the patient doing everything they were doing before they got depressed?” he asked. “Are they doing it even better? That’s remission.” To further persuade us, he highlighted a slide showing that patients who made it all the way to remission are less likely to relapse to another depressive episode than patients who merely responded. And for all its methodological limitations, it was a slide that I would become well acquainted with, as I would use it over and over again in my own talks.

When it came to side effects, Effexor’s greatest liability was that it could cause hypertension, a side effect not shared by S.S.R.I.’s. Sussman showed us some data from the clinical trials, indicating that at lower doses, about 3 percent of patients taking Effexor had hypertension as compared with about 2 percent of patients assigned to a placebo. There was only a 1 percent difference between Effexor and placebo, he commented, and pointed out that treating high blood pressure might be a small price to pay for relief from depression.

It was an accurate reading of the data, and I remember finding it a convincing defense of Effexor’s safety. As I look back at my notes now, however, I notice that another way of describing the same numbers would have been to say that Effexor leads to a 50 percent greater rate of hypertension than a placebo. Framed this way, Effexor looks more hazardous.

And so it went for the rest of the afternoon.

Was I swallowing the message whole? Certainly not. I knew that this was hardly impartial medical education, and that we were being fed a marketing line. But when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold. I was truly impressed with Effexor’s remission numbers, and like any physician, I was hopeful that something new and different had been introduced to my quiver of therapeutic options.

At the end of the last lecture, we were all handed envelopes as we left the conference room. Inside were checks for $750. It was time to enjoy ourselves in the city.

II. The Art and Science of Detailing

Pharmaceutical “detailing” is the term used to describe those sales visits in which drug reps go to doctors’ offices to describe the benefits of a specific drug. Once I returned to my Newburyport office from New York, a couple of voice-mail messages from local Wyeth reps were already waiting for me, inviting me to give some presentations at local doctors’ offices. I was about to begin my speaking — and detailing — career in earnest.

How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways. This meant that I was about to join some 200,000 American physicians who are being paid by companies to promote their drugs. I felt quite flattered to have been recruited, and I assumed that the rep had picked me because of some special personal or professional quality.

The first talk I gave brought me back to earth rather quickly. I distinctly remember the awkwardness of walking into my first waiting room. The receptionist slid the glass partition open and asked if I had an appointment.

“Actually, I’m here to meet with the doctor.”

“Oh, O.K. And is that a scheduled appointment?”

“I’m here to give a talk.”

A light went on. “Oh, are you part of the drug lunch?”

Regardless of how I preferred to think of myself (an educator, a psychiatrist, a consultant), I was now classified as one facet of a lunch helping to pitch a drug, a convincing sidekick to help the sales rep. Eventually, with an internal wince, I began to introduce myself as “Dr. Carlat, here for the Wyeth lunch.”

The drug rep who arranged the lunch was always there, usually an attractive, vivacious woman with platters of gourmet sandwiches in tow. Hungry doctors and their staff of nurses and receptionists would filter into the lunch room, grateful for free food.

Once there was a critical mass (and crucially, once the M.D.’s arrived), I was given the go-ahead by the Wyeth reps to start. I dove into my talk, going through a handout that I created, based on the official slide deck. I discussed the importance of remission, the basics of the Thase study showing the advantage of Effexor, how to dose the drug, the side effects, and I added a quick review of the other common antidepressants.

While I still had some doubts, I continued to be impressed by the 10 percent advantage in remission rates that Effexor held over S.S.R.I.’s; that advantage seemed significant enough to overcome Effexor’s more prominent side effects. Yes, I was highlighting Effexor’s selling points and playing down its disadvantages, and I knew it. But was my salesmanship going to bring harm to anybody? It seemed unlikely. The worst case was that Effexor was no more effective than anything else; it certainly was no less effective.

During my first few talks, I worried a lot about my performance. Was I too boring? Did the doctors see me as sleazy? Did the Wyeth reps find me sufficiently persuasive? But the day after my talks, I would get a call or an e-mail message from the rep saying that I did a great job, that the doctor was impressed and that they wanted to use me more. Indeed, I started receiving more and more invitations from other reps, and I soon had talks scheduled every week. I learned later that Wyeth and other companies have speaker-evaluation systems. After my talks, the reps would fill out a questionnaire rating my performance, which quickly became available to other Wyeth reps throughout the area.

As the reps became comfortable with me, they began to see me more as a sales colleague. I received faxes before talks preparing me for particular doctors. One note informed me that the physician we’d be visiting that day was a “decile 6 doctor and is not prescribing any Effexor XR, so please tailor accordingly. There is also one more doc in the practice that we are not familiar with.” The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company.

A note from another rep reminded me of a scene from “Mission: Impossible.” “Dr. Carlat: Our main target, Dr. , is an internist. He spreads his usage among three antidepressants, Celexa, Zoloft and Paxil, at about 25-30 percent each. He is currently using about 6 percent Effexor XR. Our access is very challenging with lunches six months out.” This doctor’s schedule of lunches was filled with reps from other companies; it would be vital to make our sales visit count.+

Naïve as I was, I found myself astonished at the level of detail that drug companies were able to acquire about doctors’ prescribing habits. I asked my reps about it; they told me that they received printouts tracking local doctors’ prescriptions every week. The process is called “prescription data-mining,” in which specialized pharmacy-information companies (like IMS Health and Verispan) buy prescription data from local pharmacies, repackage it, then sell it to pharmaceutical companies. This information is then passed on to the drug reps, who use it to tailor their drug-detailing strategies. This may include deciding which physicians to aim for, as my Wyeth reps did, but it can help sales in other ways. For example, Shahram Ahari, a former drug rep for Eli Lilly (the maker of Prozac) who is now a researcher at the University of California at San Francisco’s School of Pharmacy, said in an article in The Washington Post that as a drug rep he would use this data to find out which doctors were prescribing Prozac’s competitors, like Effexor. Then he would play up specific features of Prozac that contrasted favorably with the other drug, like the ease with which patients can get off Prozac, as compared with the hard time they can have withdrawing from Effexor.

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money.

Once drug companies have identified the doctors, they must woo them. In the April 2007 issue of the journal PLoS Medicine, Dr. Adriane Fugh-Berman of Georgetown teamed up with Ahari (the former drug rep) to describe the myriad techniques drug reps use to establish relationships with physicians, including inviting them to a speaker’s meeting. These can serve to cement a positive a relationship between the rep and the doctor. This relationship is crucial, they say, since “drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship.”

III. Uncomfortable Moments

I gave many talks over the ensuing several months, and I gradually became more comfortable with the process. Each setting was somewhat different. Sometimes I spoke to a crowded conference room with several physicians, nurses and other clinical staff. Other times, I sat at a small lunch table with only one other physician (plus the rep), having what amounted to a conversation about treating depression. My basic Effexor spiel was similar in the various settings, with the focus on remission and the Thase data.

Meanwhile, I was keeping up with new developments in the research literature related to Effexor, and not all of the news was positive. For example, as more data came out comparing Effexor with S.S.R.I.’s other than Prozac, the Effexor remission advantage became slimmer — more like 5 percent instead of the originally reported 10 percent. Statistically, this 5 percent advantage meant that only one out of 20 patients would potentially do better on Effexor than S.S.R.I.’s — much less compelling than the earlier proportion of one out of 10.

I also became aware of other critiques of the original Thase meta-analysis. For example, some patients enrolled in the original Effexor studies took S.S.R.I.’s in the past and presumably had not responded well. This meant that the study population may have been enriched with patients who were treatment-resistant to S.S.R.I.’s, giving Effexor an inherent advantage.

I didn’t mention any of this in my talks, partly because none of it had been included in official company slides, and partly because I was concerned that the reps wouldn’t invite me to give talks if I divulged any negative information. But I was beginning to struggle with the ethics of my silence.

One of my most uncomfortable moments came when I gave a presentation to a large group of psychiatrists. I was in the midst of wrapping up my talk with some information about Effexor and blood pressure. Referring to a large study paid for by Wyeth, I reported that patients are liable to develop hypertension only if they are taking Effexor at doses higher than 300 milligrams per day.

“Really?” one psychiatrist in the room said. “I’ve seen hypertension at lower doses in my patients.”

“I suppose it can happen, but it’s rare at doses that are commonly used for depression.”

He looked at me, frowned and shook his head. “That hasn’t been my experience.”

I reached into my folder where I kept some of the key Effexor studies in case such questions arose.

According to this study of 3,744 patients, the rate of high blood pressure was 2.2 percent in the placebo group, and 2.9 percent in the group of patients who had taken daily doses of Effexor no larger than 300 milligrams. Patients taking more than 300 milligrams had a 9 percent risk of hypertension. As I went through the numbers with the doctor, however, I felt unsettled. I started talking faster, a sure sign of nervousness for me.

Driving home, I went back over the talk in my mind. I knew I had not lied — I had reported the data exactly as they were reported in the paper. But still, I had spun the results of the study in the most positive way possible, and I had not talked about the limitations of the data. I had not, for example, mentioned that if you focused specifically on patients taking between 200 and 300 milligrams per day, a commonly prescribed dosage range, you found a 3.7 percent incidence of hypertension. While this was not a statistically significant higher rate than the placebo, it still hinted that such moderate doses could, indeed, cause hypertension. Nor had I mentioned the fact that since the data were derived from placebo-controlled clinical trials, the patients were probably not representative of the patients seen in most real practices. Patients who are very old or who have significant medical problems are excluded from such studies. But real-world patients may well be at higher risk to develop hypertension on Effexor. +

I realized that in my canned talks, I was blithely minimizing the hypertension risks, conveniently overlooking the fact that hypertension is a dangerous condition and not one to be trifled with. Why, I began to wonder, would anyone prescribe an antidepressant that could cause hypertension when there were many other alternatives? And why wasn’t I asking this obvious question out loud during my talks?

I felt rattled. That psychiatrist’s frown stayed with me — a mixture of skepticism and contempt. I wondered if he saw me for what I feared I had become — a drug rep with an M.D. I began to think that the money was affecting my critical judgement. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.

There was another problem: one of Effexor’s side effects. Patients who stopped the medication were calling their doctors and reporting symptoms like severe dizziness and lightheadedness, bizarre electric-shock sensations in their heads, insomnia, sadness and tearfulness. Some patients thought they were having strokes or nervous breakdowns and were showing up in emergency rooms. Gradually, however, it became clear that these were “withdrawal” symptoms. These were particularly common problems with Effexor because it has a short half-life, a measure of the time it takes the body to metabolize half of the total amount of a drug in the bloodstream. Paxil, another short half-life antidepressant, caused similar problems.

At the Wyeth meeting in New York, these withdrawal effects were mentioned in passing, though we were assured that Effexor withdrawal symptoms were uncommon and could usually be avoided by tapering down the dose very slowly. But in my practice, that strategy often did not work, and patients were having a very hard time coming off Effexor in order to start a trial of a different antidepressant.

I wrestled with how to handle this issue in my Effexor talks, since I believed it was a significant disadvantage of the drug. Psychiatrists frequently have to switch medications because of side effects or lack of effectiveness, and anticipating this potential need to change medications plays into our initial choice of a drug. Knowing that Effexor was hard to give up made me think twice about prescribing it in the first place.

During my talks, I found myself playing both sides of the issue, making sure to mention that withdrawal symptoms could be severe but assuring doctors that they could “usually” be avoided. Was I lying? Not really, since there were no solid published data, and indeed some patients had little problem coming off Effexor. But was I tweaking and pruning the truth in order to stay positive about the product? Definitely. And how did I rationalize this? I convinced myself that I had told “most” of the truth and that the potential negative consequences of this small truth “gap” were too trivial to worry about.

As the months went on, I developed more and more reservations about recommending that Effexor be used as a “first line” drug before trying the S.S.R.I.’s. Not only were the newer comparative data less impressive, but the studies were short-term, lasting only 6 to 12 weeks. It seemed entirely possible that if the clinical trials had been longer — say, six months — S.S.R.I.’s would have caught up with Effexor. Effexor was turning out to be an antidepressant that might have a very slight effectiveness advantage over S.S.R.I.’s but that caused high blood pressure and had prolonged withdrawal symptoms.

At my next Lunch and Learn, I mentioned toward the end of my presentation that data in support of Effexor were mainly short-term, and that there was a possibility that S.S.R.I.’s were just as effective. I felt reckless, but I left the office with a restored sense of integrity.

Several days later, I was visited by the same district manager who first offered me the speaking job. Pleasant as always, he said: “My reps told me that you weren’t as enthusiastic about our product at your last talk. I told them that even Dr. Carlat can’t hit a home run every time. Have you been sick?”

At that moment, I decided my career as an industry-sponsored speaker was over. The manager’s message couldn’t be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much “medical education” I provided.

IV. Life After Drug Money

A year after starting my educational talks for drug companies (I had also given two talks for Forest Pharmaceuticals, pushing the antidepressant Lexapro), I quit. I had made about $30,000 in supplemental income from these talks, a significant addition to the $140,000 or so I made from my private practice. Now I publish a medical-education newsletter for psychiatrists that is not financed by the pharmaceutical industry and that tries to critically assess drug research and marketing claims. I still see patients, and I still prescribe Effexor. I don’t prescribe it as frequently as I used to, but I have seen many patients turn their lives around because they responded to this drug and to nothing else. +

In 2002, the drug industry’s trade group adopted voluntary guidelines limiting some of the more lavish benefits to doctors. While the guidelines still allow all-expenses-paid trips for physicians to attend meetings at fancy hotels, they no longer pay for spouses to attend the dinners or hand out tickets to musicals. In an e-mail message, a Wyeth spokesman wrote that Wyeth employees must follow that code and “our own Wyeth policies, which, in some cases, exceed” the trade group’s code.

Looking back on the year I spent speaking for Wyeth, I’ve asked myself if my work as a company speaker led me to do bad things. Did I contribute to faulty medical decision making? Did my advice lead doctors to make inappropriate drug choices, and did their patients suffer needlessly?

Maybe. I’m sure I persuaded many physicians to prescribe Effexor, potentially contributing to blood-pressure problems and withdrawal symptoms. On the other hand, it’s possible that some of those patients might have gained more relief from their depression and anxiety than they would have if they had been started on an S.S.R.I. Not likely, but possible.

I still allow drug reps to visit my office and give me their pitches. While these visits are short on useful medical information, they do allow me to keep up with trends in drug marketing. Recently, a rep from Bristol-Myers Squibb came into my office and invited me to a dinner program on the antipsychotic Abilify.

“I think it will be a great program, Dr. Carlat,” he said. “Would you like to come?” I glanced at the invitation. I recognized the name of the speaker, a prominent and widely published psychiatrist flown in from another state. The restaurant was one of the finest in town.

I was tempted. The wine, the great food, the proximity to a famous researcher — why not rejoin that inner circle of the select for an evening? But then I flashed to a memory of myself five years earlier, standing at a lectern and clearing my throat at the beginning of a drug-company presentation. I vividly remembered my sensations — the careful monitoring of what I would say, the calculations of how frank I should be.

“No,” I said, as I handed the rep back the invitation. “I don’t think I can make it. But thanks anyway.”

Daniel Carlat is an assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report.

Turkey carving

2007-11-21T22:56:00.000-05:00

NYTimes

November 21, 2007
Butcher’s Method Takes Carving Off the Table
By JULIA MOSKIN

BEFORE breakfast on Thanksgiving, as the first Americans rise to preheat the oven, the question of who is going to carve the bird starts to ripple anxiously across the land.

By mealtime, many cooks will be tired of hovering over the turkey and ready to unload it, but just try to find a taker.

“One year my 13-year-old nephew, Josh, was the only one willing to take it on,” said Nissa Goldstein, a retired teacher in West Hartford, Conn. “Of course, everyone was shouting instructions at him, and he ended up locking himself in his room and refusing to come out.”

It is generally agreed that the art of carving is in sad decline. The definition of the “man of the house,” who would traditionally assume the job, is increasingly slippery. Family members recognize the risks involved in taking a knife to a relative’s hard work; guests often decline such a high-profile role. Add the inherent drowsiness of Thanksgiving, a cold day devoted to a single huge meal, consider the tendency in many families to start in on the house cocktail as soon as guests begin to trickle in, and the general unwillingness to put blade to bird becomes unsurprising.

“One year the turkey took a long time to cook and I went to carve it after about 13 beers,” said Maurice Landry, who lives near Lake Charles, La. “The way I remember it, I bore down to take off the leg and the whole thing went shooting off the platter and knocked over the centerpiece.”

All of these are good reasons to adopt the high-yield, low-profile carving method described here. It involves a radically untraditional step — often followed by professionals, but new to many home cooks — that makes carving easier, if less spectacular.

“I don’t cut like a chef, I cut like a butcher,” said Ray Venezia, the meat director for the four Fairway markets, a third-generation butcher and one of the biggest turkey purveyors in New York City.

Instead of slicing the meat from the roast at the table, Mr. Venezia’s carving protocol calls for the biggest pieces, the breasts and the thighs, to be removed whole, then boned and sliced on a cutting board. “Trying to carve from the carcass is like trying to cut it off a beach ball: it’s all curved surfaces and it moves around under the knife,” he said. “Give me a flat cutting board any time.”

Roger Bassett, the owner of the Original Turkey in Reading Terminal Market in Philadelphia, uses the same method for the 30 turkeys carved and served at his store every day. “Cutting a turkey the traditional way, where you leave the meat on the bird and cut down, you can’t cut across the grain,” he said. “The pieces you end up with are all stringy because the fibers are long instead of short.”

Mr. Venezia demonstrated the method to me twice last week; I then tested it on two roast chickens, and met with howling success.

It is important to start with a turkey that has rested for at least 20 minutes; 40 is even better, so that the meat has firmed enough to cut cleanly. Mr. Venezia does not use a carving fork. (“Why pierce the meat more than you have to and let the juices run out?”) Instead, he holds the bird in place with one hand and uses the other for cutting.

He counsels against using a large or unfamiliar knife, like a wedding set carving knife. Since most of the cutting is done with the first few inches of the blade, a small, sharp knife that you know how to wield is a wise choice. For our demonstration he used an eight-inch boning knife with a plastic handle that cost, by his estimate, $10. He used a larger knife only for slicing. The skin can be removed or left on the breast, as a matter of taste and aesthetics.

At the end there was almost nothing left on the carcass: a turkey that weighed 22 pounds raw was reduced to a denuded two-pound skeleton and a platter mounded with thick, clean slices of breast and thigh and a few whole pieces for those who like the bony bits.

“You’ll find that people eat a lot more of the dark meat when it’s carved this way,” Mr. Venezia said. Still, he advises ordering a pound of turkey for each person and five or six pounds extra, to make sure there is enough white meat for those who will not eat anything else.

Mr. Venezia said this method was easier on the carver and more satisfying at the table. “I look at a turkey as I would look at any primal cut of meat,” he said, referring to the sides of beef and rumps of lamb that butchers break down into retail cuts. “I want to get the most meat off that carcass, and I want the meat to come off in nice, thick pieces. Not shreds, not chunks, and no ragged edges.”

The only disadvantage of this method is that it eliminates the opportunity for showboating. It requires counter space and is probably best done in the kitchen (although a roomy sideboard with a cutting board on top would be fine), making it ideal for less-experienced carvers. Mr. Bassett, who is used to carving with an audience, said he preferred to present the turkey in its whole, golden-brown, burnished state, then retreat to the kitchen to carve it.

“If you want the Norman Rockwell moment, this is not the method for you,” said Michael Darre, professor of poultry science at the University of Connecticut. “However, you will get a lot of meat off the bird.”

Although modern domesticated birds do not do a lot of flying, he said, the largest muscle is still the pectoralis major, the breast, which has the heavy job of pushing down the wing during flight.

“These days the breast can be dry because the soft muscle doesn’t hold fat and hemoglobin as well as an exercised muscle would,” Dr. Darre said. “But the payoff is that nice, mild turkey flavor.”

Even for the experts, carving the turkey is the most intimidating part of the day. Their advice to the anxious: don’t panic or start hacking away, even if guests are baying for turkey and the meat is beginning to cool. “Piping hot gravy will take care of everything,” Mr. Venezia said. “That’s your endgame.”

Bartending history

2007-11-04T01:03:00.000-04:00

NYTimes

October 31, 2007
The Bartender Who Started It All
By WILLIAM GRIMES

IN 1863, an English traveler named Edward Hingston walked into the Occidental Hotel in San Francisco and stepped up to the bar. There he beheld a magnificent figure wielding two mixing glasses and “all ablaze with diamonds,” a jewelry display that included a clustered stickpin in his shirtfront, diamond cufflinks and an array of diamond rings. Just as dazzling were the drinks, unheard of in Britain: strange mixtures like crustas, smashes and daisies. Here was something to write home about.

Hingston was looking at none other than Jerry Thomas, “the Jupiter Olympus of the bar,” to lift a phrase from the bartender’s own drink book, the first ever published in the United States. In a cocktail-besotted era, Thomas was first without equals, an inventor, showman and codifier who, in the book known variously as “The Bar-Tender’s Guide,” “How to Mix Drinks” or “The Bon-Vivant’s Companion,” laid down the principles for formulating mixed drinks of all categories and established the image of the bartender as a creative professional.

Like Davy Crockett, Daniel Boone and Buffalo Bill Cody, he was the sort of self-invented, semimythic figure that America seemed to spawn in great numbers during its rude adolescence. More than a century after his death, he still casts a spell, a palpable influence on Dale DeGroff, chief animator of cocktail’s new wave, and his many progeny, from Eben Klemm of the B. R. Guest restaurant group to Audrey Saunders at the Pegu Club.

Thomas finally gets his due in “Imbibe!” (Perigee Books, $23.95), a biography and annotated recipe book by David Wondrich. Mr. Wondrich, a former classics scholar and the drink correspondent for Esquire, was intrigued by the often-puzzling recipes in Thomas’s book, and frustrated by Herbert Asbury, whose fancifully embellished version of Thomas’s life, presented in a reprint of the 1887 edition of “The Bon-Vivant’s Companion,” wraps sparse facts in a thick layer of myth, conjecture and purple prose.

Mr. Wondrich puts the drinks in context, with their ingredients explained, their measurements accurately indicated, and their place in the overall cocktail scheme clearly mapped out. At the same time, Thomas himself appears, for the first time, as a living presence: a devotee of bare-knuckle prize fights, a flashy dresser fond of kid gloves, an art collector, a restless traveler usually carrying a fat wad of bank notes and a gold Parisian watch. A player, in short.

“Before, especially coming from Asbury, I had a sense of Thomas as a magisterial, godlike creature,” Mr. Wondrich said in a telephone interview. “Now I see him as a sporty, Damon Runyon type.”

The sporty types can be hard to pin down. “Bartenders, then as now, were itinerant, and the sporting life was not big on documentation,” Mr. Wondrich said. “There’s only one bartender’s diary for all of the 19th century, and most of that consists of the author drinking a lot and being sick the next day.”

Mr. Wondrich tracked Thomas from his birthplace in Sackets Harbor, N.Y., to California, where he worked as a bartender, gold prospector and minstrel-show impresario, and back to New York, where he presided over a series of bars before going broke — probably, Mr. Wondrich theorizes, after buying bad stocks on margin. Along the way, Thomas plied his trade, by his own account, in towns as various as St. Louis, New Orleans, Chicago and Charleston, S.C. One newspaper obituary placed him, improbably, in Keokuk, Iowa.

As he wandered, he picked up on the latest developments in the art, inventing new cocktails and building a serious following for his particular blend of craftsmanship and showmanship, epitomized in his signature drink, the Blue Blazer, a pyrotechnic showpiece in which an arc of flame passed back and forth between two mixing glasses. At the Occidental, Thomas was earning $100 a week, more than the vice president of the United States. When he died, in 1885, newspapers all over the country observed his passing in substantial obituaries.

Thomas’s most celebrated bar was at Broadway and 22nd Street, occupying the basement and one bay of what is now Restoration Hardware. “They really ought to put some sort of plaque there,” Mr. Wondrich said.

On the walls of Thomas’s saloon hung caricatures of the political and theatrical figures of the day, many of them executed by Thomas Nast, including one, now lost, depicting Thomas “in nine tippling postures colossally,” as a newspaper reporter described it. Customers could look at themselves in fun-house mirrors that made them look fat or thin. By this time Thomas was middle-aged, with a wife and two daughters, and at 205 pounds one of the lighter members of the Fat Men’s Association, but still, undeniably, a sport.

Thomas’s life spanned the three great ages of the cocktail, the archaic, the baroque and the classic, a helpful chronology proposed by Mr. Wondrich.

In 1830, the probable year of his birth, the main American mixed drinks were punches, toddies and slings — nothing more than brandy, gin or whiskey sweetened with a little sugar. Thomas found his professional footing in an age of flamboyant creativity, when bartenders experimented with a bewildering array of ingredients and styles, and by the time of his death in 1885 he had seen the birth of the more streamlined modern cocktail typified by the manhattan and the martini.

It is the baroque cocktail that occupied most of Mr. Wondrich’s attention. Thomas, however, could be maddeningly vague in his recipes. Mr. Wondrich was able to determine that a wineglass, as a unit of measure, equaled two ounces. He also discovered that most of the gin recipes envisioned the strongly flavored, malty Dutch gin, not the style known as London dry, which did not take off until the 1890s. Sugar, in Thomas’s age, came in a dense loaf and was less refined than modern white sugar but not as raw as raw sugar (Mr. Wondrich compromises by using Demerara or turbinado sugar, pulverized in a food processor.)

Ice was an art. Bartenders, working deftly with a pick or shaver, went to work on a solid frozen block and, depending on the drink, extracted fine shards or large lumps or any size of piece in between.

Bartenders did not use cocktail shakers. Instead, they tossed their ingredients back and forth between two mixing glasses. They also used gum Arabic, an emulsifier, in their simple syrup, which added a velvety mouth-feel to certain cocktails. “It really smooths off the edges in all-liquor drinks,” Mr. Wondrich said. “They just slide right down.”

The universe of drinks, in the middle of the 19th century, did conform to certain patterns, reflected in the organization of Thomas’s bar book. The old-fashioned punches, often hot and mixed in large quantities for communal consumption, gave way to a variety of individual drinks, all of them iced, and all involving fruit: the Collins, the fizz, the daisy, the sour, the cooler and the cobbler. The punch, too, began appearing as an individual drink. The daisy, a sour sweetened with orange cordial or grenadine, merits special attention because in Mexico it encountered tequila. The Spanish for daisy? Margarita.

The sling developed complications, incorporating ice and bitters, and became the cocktail, which Thomas made in three styles, plain, fancy and improved.

To make an improved brandy cocktail, for example, you strained the plain version (brandy, bitters and gum syrup, plus one or two dashes of Curaçao) into a fancy wine glass, moistened the rim of the glass with lemon and added a twist of lemon to the drink. (Thomas’s book was the first to mention the twist, which replaced grated nutmeg as the final flourish to a drink.) In the improved cocktail, maraschino liqueur was substituted for Curaçao. Add fruit juice and the cocktail became a crusta.

From the basic cocktail repertory of Thomas’s youth developed the myriad mixtures that Mr. Wondrich calls evolved cocktails. Their name is legion, and most of them, in the inspired early decades of the baroque age, came from the West Coast, source of the zany drinks that astounded so many foreign visitors — cocktails like the fiscal agent and the vox populi. Thomas, a young man on the scene, picked up the new recipes and carried them back East.

Toward the end of Thomas’s glorious reign as king of the bar, a new kind of cocktail was emerging — lighter, less alcoholic and usually involving vermouth, a key ingredient in the manhattan and the martini.

The final, expanded edition of “The Bon-Vivant’s Companion,” published two years after Thomas’s death, trembles at the dawn of the cocktail’s modern age. The manhattan makes its appearance, as well as a cocktail called the Martinez, which has caused no end of confusion, since it looks like “martini” but calls for maraschino, sweet vermouth and the sweetened gin known as Old Tom. On the other hand, the original martini, often made with gin and vermouth in a 50-50 ratio, and almost always with orange bitters, does not look very much like the mercilessly dry vodka martini of the present day. But here we step into a world that Thomas never lived to see, even if he built its foundations. As Mr. Wondrich justly observes, Thomas, by departing from the code of the bartending fraternity and sharing his secrets, earned his place as “the father of mixology, of the rational study of the mixed drink.”

Dale DeGroff, who has done more than anyone to bring baroque standards back to the bar, encountered Thomas for the first time in the early 1980s, when Joe Baum, who wanted a different kind of bar for his new restaurant Aurora, directed him to “The Bon-Vivant’s Companion.”

It was a revelation. At a time when bartenders relied on powdered mixes, canned fruit juices and a narrow repertory of perhaps a dozen drinks, Thomas imparted a lofty sense of the bartender’s vocation. The recipes, embracing categories of mixed drinks and exotic ingredients not seen since Prohibition, opened up a dizzying range of possibilities that Mr. DeGroff explored at Aurora and, most influentially, at the Rainbow Room.

Mr. DeGroff, now a consultant, no longer tends bar, but the little revolution sparked by Thomas’s book continues to shake things up, carried forward by a new generation of bartenders inspired by his example and by a book written when Abraham Lincoln was president. Out of the remote past, Thomas’s finger still points the way to the future.

Perceptions of women vs. men - workplace

2007-11-01T06:45:00.000-04:00

NYTimes

November 1, 2007
Life’s Work
The Feminine Critique
By LISA BELKIN

DON’T get angry. But do take charge. Be nice. But not too nice. Speak up. But don’t seem like you talk too much. Never, ever dress sexy. Make sure to inspire your colleagues — unless you work in Norway, in which case, focus on delegating instead.

Writing about life and work means receiving a steady stream of research on how women in the workplace are viewed differently from men. These are academic and professional studies, not whimsical online polls, and each time I read one I feel deflated. What are women supposed to do with this information? Transform overnight? And if so, into what? How are we supposed to be assertive, but not, at the same time?

“It’s enough to make you dizzy,” said Ilene H. Lang, the president of Catalyst, an organization that studies women in the workplace. “Women are dizzy, men are dizzy, and we still don’t have a simple straightforward answer as to why there just aren’t enough women in positions of leadership.”

Catalyst’s research is often an exploration of why, 30 years after women entered the work force in large numbers, the default mental image of a leader is still male. Most recent is the report titled “Damned if You Do, Doomed if You Don’t,” which surveyed 1,231 senior executives from the United States and Europe. It found that women who act in ways that are consistent with gender stereotypes — defined as focusing “on work relationships” and expressing “concern for other people’s perspectives” — are considered less competent. But if they act in ways that are seen as more “male” — like “act assertively, focus on work task, display ambition” — they are seen as “too tough” and “unfeminine.”

Women can’t win.

In 2006, Catalyst looked at stereotypes across cultures (surveying 935 alumni of the International Institute for Management Development in Switzerland) and found that while the view of an ideal leader varied from place to place — in some regions the ideal leader was a team builder, in others the most valued skill was problem-solving. But whatever was most valued, women were seen as lacking it.

Respondents in the United States and England, for instance, listed “inspiring others” as a most important leadership quality, and then rated women as less adept at this than men. In Nordic countries, women were seen as perfectly inspirational, but it was “delegating” that was of higher value there, and women were not seen as good delegators.

Other researchers have reached similar conclusions. Joan Williams runs the Center for WorkLife Law, part of the University of California Hastings College of the Law in San Francisco. She wrote the book “Unbending Gender” and she, too, has found that women are held to a different standard at work.

They are expected to be nurturing, but seen as ineffective if they are too feminine, she said in a speech last week at Cornell. They are expected to be strong, but tend to be labeled as strident or abrasive when acting as leaders. “Women have to choose between being liked but not respected, or respected but not liked,” she said.

While some researchers, like those at Catalyst and WorkLife Law, tend to paint the sweeping global picture — women don’t advance as much as men because they don’t act like men — other researchers narrow their focus.

Victoria Brescoll, a researcher at Yale, made headlines this August with her findings that while men gain stature and clout by expressing anger, women who express it are seen as being out of control, and lose stature. Study participants were shown videos of a job interview, after which they were asked to rate the applicant and choose their salary. The videos were identical but for two variables — in some the applicants were male and others female, and the applicant expressed either anger or sadness about having lost an account after a colleague arrived late to an important meeting.

The participants were most impressed with the angry man, followed by the sad woman, then the sad man, and finally, at the bottom of the list, the angry woman. The average salary assigned to the angry man was nearly $38,000 while the angry woman received an average of only $23,000.

When the scenario was tweaked and the applicant went on to expand upon his or her anger — explaining that the co-worker had lied and said he had directions to the meeting — participants were somewhat forgiving, giving women who explained their anger more money than those who had no excuse (but still less money than comparative men).

Also this summer, Linda C. Babcock, an economics professor at Carnegie Mellon University, looked at gender and salary in a novel way. She recruited volunteers to play Boggle and told them beforehand that they would receive $2 to $10 for their time. When it came time for payment, each participant was given $3 and asked if that was enough.

Men asked for more money at eight times the rate of women. In a second round of testing, where participants were told directly that the sum was negotiable, 50 percent of women asked for more money, but that still did not compare with 83 percent of men. It would follow, Professor Babcock concluded, that women are equally poor at negotiating their salaries and raises.

There are practical nuggets of advice in all this data. Don’t be shy about negotiating. If you blow your stack, explain (or try). “Some of what we are learning is directly helpful, and tells women that they are acting in ways they might not even be aware of, and that is harming them and they can change,” said Peter Glick, a psychology professor at Lawrence University in Appleton, Wis.

He is the author of one such study, in which he showed respondents a video of a woman wearing a sexy low-cut blouse with a tight skirt or a skirt and blouse that were conservatively cut. The woman recited the same lines in both, and the viewer was either told she was a secretary or an executive. Being more provocatively dressed had no effect on the perceived competence of the secretary, but it lowered the perceived competence of the executive dramatically. (Sexy men don’t have that disconnect, Professor Glick said. While they might lose respect for wearing tight pants and unbuttoned shirts to the office, the attributes considered most sexy in men — power, status, salary — are in keeping with an executive image at work.)

But Professor Glick also concedes that much of this data — like his 2000 study showing that women were penalized more than men when not perceived as being nice or having social skills — gives women absolutely no way to “fight back.” “Most of what we learn shows that the problem is with the perception, not with the woman,” he said, “and that it is not the problem of an individual, it’s a problem of a corporation.”

Ms. Lang, at Catalyst, agreed. This accumulation of data will be of value only when companies act on it, she said, noting that some are already making changes. At Goldman Sachs, she said, the policy on performance reviews now tries to eliminate bias. A red flag is expected to go up if a woman is described as “having sharp elbows or being brusque,” she said. “The statement should not just stand,” she said. “Examples should be asked for, the context should be considered, would the same actions be cause for comment if it was a man?”

In fact, Catalyst’s next large project is to advise companies on ways they can combat stereotypical bias. And Professor Glick has some upcoming projects, too. One looks at whether women do better in sales if they show more cleavage. A second will look at the flip side of gender stereotypes at work: hostility toward men.

Craigslist golddigger post response background

2007-10-11T10:25:00.000-04:00

NYTimes

October 8, 2007
Acquisitive Craigslist Post Reddens Faces All Around
By ANDREW ADAM NEWMAN

Last month on Craigslist.com, someone who described herself as a “spectacularly beautiful” 25-year-old placed a personal ad seeking a husband who made at least $500,000 a year, because “$250,000 won’t get me to Central Park West.”

As her post hit the blogs, it received a scathing response from a man who said he fit her description and told her that her proposition was a bad business deal. “In economic terms, you are a depreciating asset and I am an earning asset,” he wrote, because “your looks will fade and my money will likely continue into perpetuity.”

Last week, this exchange spilled over into the e-mail world, where the it turned into a popular item to send to friends as a joke. The difference between this and other outrageous share-mail messages, however, was that instead of remaining anonymous, its ostensible author signed his name and the company where he worked, which happened to be the investment banking division of JPMorgan Chase.

This detail, which may have provoked nearly as much mirth as the contents of the exchange, made the correspondence either more or less credible. Would someone with a big job at a prestigious company really have linked his name to a message that read in part: “You’re 25 now and will likely stay pretty hot for the next 5 years, but less so each year. Then the fade begins in earnest. By 35 stick a fork in you!”

The man who is widely credited with writing the response did not respond to a voice message, but the media relations department at JPMorgan Chase confirmed that he worked there and said that he was not the author. Rather, a company spokesman said, he had forwarded the e-mail message to friends, and the signature setting on his e-mail accompanied the response when it wound up on blogs.

By this account, the employee was just an accidental sexist, the latest object lesson in the dangers of e-mail getting into the wrong hands — the Wall Street equivalent of a Pittsburgh Steelers coach who passed along an e-mail message with a sex video to the National Football League commissioner, among others.

“Your workplace computer does not exist as a tool for forwarding jokey things,” said Will Schwalbe, an author of “Send: The Essential Guide to E-Mail for Office and Home.”

As for the legitimacy of the original posting by the husband seeker, a spokeswoman for Craigslist wrote in an e-mail message that “it does look as if the post was made sincerely.” A message sent to the Craigslist mailbox seeking comment yielded no response.

Craigslist declined to say how many people responded to the personal ad (which asked, among other things, for names of bars, restaurants and gyms where rich single men hung out). And so far, the identity of the responder remains a mystery too.

“I wish we wrote it because I think it’s great,” said John Carney, editor of DealBreaker, a Wall Street gossip site that posted the exchange on Wednesday.

Mr. Carney said that he had received the zinger in an e-mail message from someone other than the author, and his source did not know who wrote it. (The response never appeared on Craigslist itself.)

On Thursday, Howard Lindzon posted it to his blog. After a commenter asked who wrote it, Mr. Lindzon responded “me,” but then said in a telephone interview that he had been kidding. The traffic the posting drew was serious, though. Mr. Lindzon usually gets about 3,000 daily visitors, but popularity-rating sites digg.com and reddit.com linked to the item, drawing more than 100,000 visitors and crashing his server.

Brett Michael Dykes, a blogger notorious for fake listings on Craigslist, said he had received about 40 e-mail messages accusing him of posting the husband-seeking personal ad. But he said he had not written it and was stumped about its provenance.

“I’ve probably read it five or six times, and I go back and forth,” Mr. Dykes said. “Sadly I think it may be real. I have met in New York City that type of girl.”

By now, Mr. Dykes said, a blogger would have taken credit for the listing if it were a hoax, but “who would want to step from the shadows and say, ‘I’m the gold digger’?”

And Mr. Carney said he was not holding his breath that the Wall Street type would step forward. “In the age of ultrasensitivity to sexual harassment, people might think that this guy’s response about women being depreciating assets is not exactly how they want their firm to be perceived by the public,” he said.

Kids learning multiple languages--NJ

2007-10-08T01:02:00.000-04:00

NYTimes

October 7, 2007
Parenting
Diversity as Normal as Speaking Chinese
By MICHAEL WINERIP

SUMMIT, N.J.

AT the ripe old age of 3, Sidney Kinsale is in her second year of learning two foreign languages. She attends a preschool here on Tuesdays, Wednesdays and Thursdays where she learns Chinese. Then on Fridays, she goes to a second preschool in Scotch Plains where she learns Spanish.

“I’m not sure she’ll totally get it all,” says her mother, Carlene, whose college degree is in early childhood studies. “But our hope is she’ll have a love for language and continue Mandarin and Spanish until she’s fluent.”

The Kinsales are not alone. The Mandarin preschool here, Bilingual Buds, has grown to 110 students from 10 in three years. The Scotch Plains school, Little Lingoes, which opened 15 months ago, now serves 50 students, ages 1 to 8, teaching Spanish and Mandarin.

But while the Kinsales are delighted with the language training — Sidney was at a backyard birthday party recently, swinging and counting in Mandarin, when a Chinese-American woman commented on her “perfect” accent — that is not the only reason the parents like the two preschools.

Ms. Kinsale says that what she wanted for Sidney was a high-quality, nurturing, racially diverse school. At the two language schools, she has come to appreciate the mix of Asian, white, black and Hispanic children. “People who start their children on a language so young understand it’s a multicultural world and they want their children to be part of it,” she says.

Ms. Kinsale, 42, and her husband, Stirling, 50, an attorney with the state public defender’s office in Newark, live in Millburn, a predominantly white town. As a black couple, that has meant constantly working at finding the diversity they want for their children.

“I want my children to feel diversity is normal,” says Ms. Kinsale, who also has a son, Stirling Jr., 6. “I prefer my children do not recognize this early that there are situations when they’re the minority.

“If my son walked in and saw you,” she says, pointing to a reporter’s shirt, “he wouldn’t say you’re white, he’d say you’re a blue man with glasses.”

This is new to them, and they are still figuring it out. Until two years ago, they lived in Orange, N.J., a community that is three-quarters black. They were happy there, they say, with a nice house that they spent a lot of time renovating and a racially mixed group of neighbors. But when Stirling was 4, they began looking ahead to school and studied the state test results. At Orange High School, more than half the students did not pass the 2005/2006 state proficiency test in English, and three-quarters failed math. “I looked at the report and looked at my husband and said, ‘Do you mind selling this house?’ ” says Ms. Kinsale.

They were determined to find the best school district for what they could afford. “Taxes and real estate were so high,” she says. They pored over test scores and real estate listings in suburbs that were a reasonable commute to Mr. Kinsale’s Newark office and found a three-bedroom home in Millburn. At Millburn High, 98 percent scored proficient in English, 97 percent in math, and the school ranked first in SAT scores among the state’s public high schools.

For the Kinsales there was only one drawback: Millburn is 1 percent black. The public defender’s office where Mr. Kinsale works is racially mixed, and his colleagues who lived in integrated towns voiced their surprise. “Many of my husband’s co-workers live in South Orange or Maplewood,” says Ms. Kinsale. “A lot said, ‘You’re sure Millburn’s what you want?’ ”

They’re not. “It’s been two years, and I do question if Millburn is the right place,” she says. “My husband and I felt whatever we do, there are pros and cons, and maybe these are the cons we choose to deal with. Our hope is with church and different cultural events, our children will recognize who they are and not feel intimidated or self-conscious.”

Sundays, the Kinsales attend Bethany Baptist, a black church in Newark, and Thursday evenings, Mr. Kinsale takes Stirling to the church gym for a sports night. “It’s good that they see other black families, but it’s not perfect either,” Ms. Kinsale says. “They’re seeing either all white or all black, and I’m looking for diversity.”

This bothers Mr. Kinsale less than his wife. While she spent the first half of her life in Trinidad and Tobago and was not exposed to America’s racial divides, Mr. Kinsale grew up in Queens, attended virtually all-black Andrew Jackson High, then went to virtually all-white Williams College. “I’m malleable,” he says. “Williams was a big adjustment — a lot of classmates had trust funds that kicked in at 21. But I adapted and I survived and I enjoyed it.

“It’s a competitive world, and I want my children to be competitive,” Mr. Kinsale says. “If they’re going to be successful in a white-dominated society, they need to be exposed to this, and I believe they will excel.”

He says that while his wife focuses on how people will treat their children as part of a minority, “I’m more confident about their ability to fit in and assimilate.”

At Bilingual Buds, Sharon Huang, the owner, says about a third of the 110 children come from Chinese-American families who don’t speak Mandarin, but want their children to do so; a third are families of all backgrounds who have adopted a Chinese child; and a third, like the Kinsales, have no Chinese connection.

It’s total immersion — classes are taught by bilingual, Chinese- or Taiwanese-born teachers who speak Mandarin the whole time. Lessons are familiar, so children understand the context. One recent morning, the teacher, Jing Zhou, read them “Jin Fa Nu Hai Er He San Zhi Xiong” — “Goldilocks and the Three Bears.” When Ms. Zhou showed them the book’s cover, Sidney said, “I have this book.” And when Ms. Zhou started reading, Sidney said, “I have the same pages.” In the room were white, black and Asian dolls, and even the three stuffed bears Ms. Zhou used to tell the story were diverse: Daddy Bear was beige; Mommy Bear, brown; Baby Bear, green.

The teachers are better educated than those at most preschools — half have a master’s degree — making Bilingual Buds more costly. Five days of preschool, from 9 a.m. to 2:30 p.m., is $12,870 a year.

Until now, Ms. Kinsale has been a stay-at-home mom, but last week she started working part time as an aide at another preschool and increased Sidney’s time at Bilingual Buds from two to three half-days a week.

“I’m not making much,” she says, “and most will go to the extra day for Sidney, but to me, that’s worth it.”

England Red vs. Gray Squirrels

2007-10-07T20:31:00.000-04:00

NYTimes

October 7, 2007
The Squirrel Wars
By D.T. MAX

When you think of England, Rupert Redesdale is who you think of. He has a slanting forehead, a nose shaped like an adze and the pink face of an aristocrat from the Georgian era. But in fact his family is far older: it is one of five in Britain that can trace its roots directly back to William the Conqueror, the last successful invader of England, in 1066. “Our original name was Bertram,” he told me recently. “We were Normans.” Redesdale, a 40-year-old baron, can stand on a Northumberland hilltop and see the Rede Valley, with the Rede River running through it. He is able to say things like, “Our family had a castle in Mitford, but Robert the Bruce, the sod, knocked it down.”

I first met Lord Redesdale one day in August in the Lake District, about 80 miles southwest of his home in the Rede Valley. The Lake District, in the north of England, is on the front lines of a new Hundred Years’ War. It is a war between rodents. Since the 19th century, gray squirrels, an American import, have been overtaking Britain’s native red squirrels and claiming their territory. The grays have moved up from the south of England, thinning out the reds along the way. The reds now survive mostly in Scotland and the English counties, like Northumberland, that border it. The grays are larger and tougher and meaner than the reds. They can eat newly fallen acorns, and the reds cannot. They cross open lands that the reds are scared of. They are more sociable than reds, allowing for higher population densities. Although gray males cannot mate with red females, they often intimidate red males out of doing so. “It’s like: ‘That’s my girl. You move away!’ ” Redesdale said.

The situation has now reached a crisis point: there are only an estimated 160,000 red squirrels left in Britain, whereas there are more than 2 million grays. Without human intervention, reds could be gone from England in 10 years. The red squirrel is a national icon, and the British government is trying hard to save it. Deliberately killing a red squirrel or disturbing its nest, called a drey, is a crime. Last year the government set up more than a dozen refuges for red squirrels in the north of England. The country’s National Lottery granted £626,000 to a group called Save Our Squirrels to run the reserves. Save Our Squirrels, or S.O.S., is a who’s who of British conservation organizations, among them the Mammals Trust and Natural England. It has a toll-free number for reporting sightings of grays and reds and works to raise public awareness of the red’s plight.

Redesdale, too, has planted his standard on behalf of the red army. Last year, with a grant of £148,000 from the Department for Environment, Food and Rural Affairs, he founded an organization called the Red Squirrel Protection Partnership. The work of Redesdale’s organization is different from that of S.O.S. It shoots, or traps and then smashes on the head, every gray it can find. It currently has 20 core members, with another 150 or so irregulars.

The day I met Redesdale, he had broken off the long summer holiday from the House of Lords to try to enlist new recruits. A woman named Sue Southworth, the proprietor of the Squirrels Pantry Tea Room, was holding a meeting in her home in Cockermouth on the red squirrel. Redesdale had driven two hours to be there. He told me he knew the crowd would not be big, but his organization practices retail species elimination — he says he wants a trap in every backyard from Carlisle to Newcastle — and every pair of hands counts. He is enthusiastic and unapologetic about his work and does not use euphemisms the way the S.O.S. organizations do. “What is this ‘method of cranial concussion’?” Redesdale asked Southworth and the two other women who met him in Southworth’s high-ceilinged living room, quoting something he had heard at a red-squirrel preservation conference. “Why not just say ‘hit on the head’? Sounds better.”

Red squirrels evoke strong emotions in many Britons, especially in the north where people still grow up seeing them. And to be sure, these women, Southworth in particular, were passionate about them. There was a set of Beatrix Potter figurines on a shelf in Southworth’s living room, including one of Squirrel Nutkin, the eponymous red squirrel of one of Potter’s best-known books, and there were red-squirrel pillows and fleece blankets. Outside in her garden, Southworth had a red-squirrel topiary, with two bumps for paws, evocative of the Venus of Willendorf in shrub.

“Can I, um, suggest something?” Redesdale said to the three women. He was seated on a couch with a red-squirrel throw. “I was thinking . . . it would be great to form a sort of mobile kill group.” He explained: “We just knock on people’s doors and find out if there’s a gray and get them to put the traps in.” One person a day, he said, would go around and do the actual killings. The women gave Redesdale a “Candid Camera” look. Was this a joke?

Redesdale doesn’t travel alone. Always by his side is a man named Paul Parker. Parker is a professional pest controller from Newcastle. He keeps 300 dead grays in his freezer, seven of them skinned, waiting for the day he will have time to cook them. When I asked Redesdale how many squirrels the Red Squirrel Protection Partnership had killed to date, he said, “We’ve taken 2,000 whatsis. . . .” and Parker added, in his heavy Newcastle accent, “2,000 — 300 — 32.” They laughed like boys killing flies for sport.

“And then at the end of the week,” Redesdale continued, speaking to the three women, “we’ll probably have 1,000 squirrels taken out. If we do that, that will knock them back two years in their advance.” He added, “We’d get a lot of publicity.”

“And the fun of killing them as well,” Parker said. Parker and Redesdale laughed again, Falstaff and Prince Hal. This time the women smiled too, a bit nervously.

So did the women want to be part of the solution? Redesdale asked.

They hesitated. Redesdale and Parker seemed like pranksters. On the other hand, they were government-financed pranksters.

“Aye,” they said.

“Brilliant,” Redesdale said.

Parker took out his business card. The women looked a bit doubtful again. It had a three-dimensional image of a mole on it and the words: “Ants, Bees, Wasps, Bed bugs, Fleas. Cluster flies, Woodworm, Snails. Rapid response.”

The first gray squirrels came to Britain to amuse the rich, probably in the early 19th century. Landed gentry kept grays in cages as animal exemplars of can-do Yankee spirit. But in 1876, the gray passed from guest to resident in the British Isles. A Mr. Brocklehurst, who had brought over gray squirrels from America, released two on his property near Cheshire in central England. Many more releases took place. The wealthy had grown bored of the grays and set them loose.

They spread quickly. By 1910, they were spotted in Woburn, about 50 miles to the northwest of London, and they reached Wales, 150 miles away, by the mid-1920s. Few Britons were pleased, but little was done about the problem. It was the more numerous native red squirrel that was in the rifle sights of the time. In the early decades of the century, for instance, a hunting association called the Highland Squirrel Club killed 82,000 red squirrels, in part to protect the timber industry. (Squirrels damage trees by stripping off the bark.)

But over time the red squirrel became beloved in Britain. It supplanted the realm’s old icon, the lion, as the symbol of a gentler, more evolved nation. There was Squirrel Nutkin, Potter’s irreverent playful red, and also Tufty Fluffytail, the Safety Squirrel, a public-service creation whose warnings about danger on the road began in the early 1950s and lasted until the ’80s. As the red rose in popularity, the gray sank in public esteem. Potter’s attempt to follow up Squirrel Nutkin with a story about a gray squirrel, Timmy Tiptoes, did not achieve the same success. In 1922, a government permanent secretary was quoted in The Times of London calling grays “sneaking, thieving, fascinating little alien villains.”

A nationalist subtext attached to the objections to the grays. “I know of more than one patriotic Englishman who has been embittered against the whole American nation on account of the presence of their squirrels in his garden,” wrote the Oxford squirrel authority A. D. Middleton in 1931. When the Forestry Commission began an investigation in the late ’20s of the effect of grays, a New York Times article bore the headline “American Squirrel on Trial for His Life in England” and suggested a fair jury would be hard to find. In 1932, Britain indicted the gray: it classed it as a pest and made it a crime to release one into the wild. That meant there was only one way out for any gray caught in a trap. A National Anti-Grey Squirrel Campaign enforced the sentence.

Many bad things were said about grays at the time, but then as now, the heart of the English objection to the grays comes down to this: they outcompete the reds. They are simply better at the job of being squirrels. Britain’s taste for unfettered competition has always been fitful, and how much it tipped the playing field in favor of the reds varied. At first, the job of controlling grays was largely left to the private landowners who had first imported them. But as the grays pushed up England, the government got involved. Beginning in the 1930s, it offered half a shilling per gray-squirrel tail, eventually raising the bounty to 2. The arrangement was politically popular but flawed: farmers and ranchers had a good reason to kill gray squirrels but no reason to eliminate them entirely. In the late ’50s, the government called off the program after estimating that there were more grays than before. From then until the early 2000s, and especially during the Thatcher-Major years, when the British government re-enthroned competition in Britain, the gray was left alone, and it extended its range, at the expense of the red, from the top of Wales to the Scottish border.

Redesdale and Parker didn’t tell me there was going to be a gray squirrel in the trunk of their car. We were in the gift shop at the south end of the Northumberland national park, near the town of Hexham. It was the day after the meeting in Sue Southworth’s living room, and Redesdale had promised to take me to see a place where he had cleared out grays and the reds had come back in. He and Parker had been busy. The gray toll was now 2,353, up 21 from the day before.

Redesdale sat with Parker, who was dressed in the exterminator outfit he wears: toxic-green sweater and pants. With them was a local groundskeeper. They were looking at maps of Northumberland, seeing how the war was going. Redesdale explained the Red Squirrel Protection Partnership to the groundskeeper. “So you on board for being part of the killing team?” he asked the man.

“Aye.”

“Brilliant.”

Redesdale has a strained relationship with the main red-squirrel protection groups: they need him; they call him sometimes when they get a gray squirrel sighting over their toll-free hot line; but he takes up a lot of their time. Carri Nicholson, the project manager for S.O.S., told me that she thinks of Redesdale as a kind of naughty child. “If you can’t play nicely, you’ll have to go to your room,” she said she tells him.

Most of all, S.O.S. officials say they wish Redesdale would trap squirrels only where reds and grays are currently competing, in the north, rather than in areas more toward the south, like Hexham, which are considered a lost cause. “Lord Redesdale wants to get rid of grays all over Northumberland,” Peter Lurz, an ecologist at Newcastle University, told me. “I think it’s a tall order. You’re dealing with a rodent that has two litters a year.” He added, “Unless you remove 70 percent of the rodents you’re just making room for the litters.” He suggested that Redesdale’s efforts had only “psychological impact.”

Lurz was an architect of the plan for the red-squirrel reserves that the government established last year: 16 in the north of England. He based his plan on the observation he made in the field that because the red squirrel is smaller than the gray, it can live on less food. It does fine, for instance, in a conifer forest, without rich acorns and beechnuts; in such an environment the grays will leave for a better habitat elsewhere. As it happens, the large conifer forests in Britain are in the north, where the reds remain. According to the initial government plan, S.O.S. would monitor the red and gray squirrel populations in the refuges. The Forestry Commission would replenish conifer trees that make the habitat desirable for reds. And the government would establish buffer zones along the perimeters — places where it would encourage landowners to kill any grays they found. The reserves seemed a fitting solution for postcolonial Britain. The gray would keep what it had won. The red, like the British themselves, would content itself with a small homeland in return for peace.

The refuges might have held the grays back, at least for a while, but as they were being created, it became clear to Lurz that any contact between grays and reds — even the minimal amount occurring in the refuges — was going to be catastrophic. This is because grays have yet another weapon in their arsenal: they carry a virus, to which they appear to be immune, that kills the reds. The disease, called squirrelpox, is awful to see: it turns the soft tissues around their eyes, ears and nose to sludge. Death comes within two weeks. Last summer, Lurz, having carefully studied squirrel-population records, calculated that where infected grays mixed with reds, the reds very quickly disappeared. “It was too much of a coincidence,” Lurz told me. In fact, he noted, “dirty” grays took land away from reds at roughly 20 times the rate healthy grays did.

Lurz estimates that two-thirds of grays carry the squirrelpox virus. In light of Lurz’s work, it was clear that buffer zones alone would not save the red squirrels. The only solution was to start killing grays and to kill them quickly. Scotland, which has refuges that are administered separately from those of England and Wales, took up arms. It hired two culling officers to trap at key spots along its border with England. (I asked to meet with them but was told that “for their safety” I would not be allowed.)

In England, however, nothing similar happened. The blue-chip organizations associated with S.O.S. spoke passionately of saving the reds, but, sensitive to the opposition of animal-rights groups, they have not made trapping a priority. “They just keep faffing around,” Redesdale says. He calls them “talking shops.” In fact, the hands of S.O.S. are somewhat tied: its National Lottery grant specifically forbids using its funds to cull grays. “Until we can get better funding,” Nicholson, the project manager for S.O.S., says, “the most we can achieve is stasis.”

There may not really be any reason to do more: red squirrels, after all, are not scarce outside the British Isles. In fact, worldwide — reds live throughout Europe and Asia — they probably outnumber grays. It is only in Britain (and more recently in Italy, where grays were introduced in 1948) that the red is considered threatened. In addition, Britain is not a place where killing animals goes down easily anymore. Animal-rights advocates put themselves between the hunter and the fox he pursued until hunting with hounds was outlawed a few years ago after extensive parliamentary debate. Highways have toad crossings. Many people prefer to build little bridges for squirrels over roadways — the S.O.S. Web site provides a blueprint — than to spend their time killing animals.

This mood shifts only when an animal threatens the carefully set ecological dinner party that is rural England. I saw this force at work when Redesdale and Parker set out to convert a woman at the gift shop at the Northumberland national park. Like many people Redesdale talks to, she was at first surprised at what he told her. She said she thought she was part of the effort already: she supported Save Our Squirrels.

Redesdale clarified: “There are two organizations. They promote red squirrels; we kill grays. We just kill grays.”

“We just kill grays, that’s all,” Parker echoed.

The woman, who looked to be in her 60s, gave the “Candid Camera” look.

“But surely the two go together, don’t they?” she asked.

Redesdale explained why they did not. He said that to preserve reds you had to wage war on the grays without pity.

“We used to often see red squirrels, but I don’t think we’ve seen any recently,” the woman said.

Redesdale laid out the details of his trapping plan. “We can probably give you a trap today — we just have to get rid of the occupant,” Redesdale said, referring to the one in the trunk of his car. He and Parker laughed. Redesdale gave his handsome goofy smile, flashed his excellent teeth.

The woman held on: “It’s a shame because they are quite nice in a way” — grays — “when they are climbing the tree.”

Redesdale broke in: “If they weren’t wiping out the reds we wouldn’t be doing this. The other thing is they do wipe out the birds.”

This seemed to give her pause. Songbirds are popular in rural England. “I had a nice mistle thrush nesting at the bottom of my garden and the magpies came,” she remembered sadly.

Sensing his opportunity, Redesdale told Parker to give the woman his card.

She took it and read it. She looked like she had been tricked.

“We’ve got to get you a proper card made up,” Redesdale said to Parker.

In March 2006, the House of Lords debated the question of the red squirrel, one of its favorites. It was logical that the august body would be interested in red squirrels. Many members of the House own lots of land, their taste tends to be nostalgic and they themselves might be seen as endangered — the government has cut the number of hereditary peers in the House nearly 90 percent in the last decade.

Earl Peel rose to call attention to the decline in numbers of the reds and its significance. “To many,” he said, “the red squirrel represents an integral part of our woodland landscape — an iconic creature, immortalized by Beatrix Potter, through the charismatic character of Squirrel Nutkin.” But before turning his attention to Squirrel Nutkin, Earl Peel proposed conducting “a brief health check” of various other Beatrix Potter characters. “Starting with Tabitha Twitchit and Tom Kitten” — both cats — “they are truly on top of their game. . . . Let us now consider the status of Mr. Tod, the fox. On second thoughts, given that he has taken up 700 hours of parliamentary time, it would be somewhat hypocritical of me to prolong the debate.” He went on: “That brings me on seamlessly to the other really controversial character that graced the class of 1912 — and that of course is Tommy Brock,” Potter’s badger. “Hasn’t he done well?”

Peel continued: “Despite suffering from and carrying tuberculosis, he has successfully managed to establish himself in the hearts and minds of the nation as being more important than dairy cows or, indeed, farmers’ livelihoods, and like Mr. Tod, has managed to secure his very own legislation.”

Peel concluded his health check: “Squirrel Nutkin must look back on his alma mater and think to himself, ‘How could it have all gone so wretchedly wrong for me?’ ”

Redesdale rose to congratulate Peel. “My Lords,” he said, “I thank the noble earl, Lord Peel, for initiating the debate and commend him for his bravery. It takes a brave man to initiate a debate that had Radio 4 saying this morning that he would be calling for an immediate cull of gray squirrels. I hate to say that his postbag will immediately be filled with letters from irate people who love gray squirrels.”

He continued: “One of the problems in the public perception is that gray squirrels are the only squirrels they see. They see them in parks and gardens, and they are sociable and friendly animals. Yesterday, I walked through St. James’s Park and watched tourists feeding gray squirrels crisps by hand. In Regent’s Park, a gray squirrel came up to my son and me and actually climbed up my leg to look in my pocket.”

Lord Hoyle soon cut off Redesdale: “My Lords, perhaps they are friendlier in Regent’s Park than they are in St. James’s Park. One that ran up my leg bit me.”

Redesdale resumed: “Efforts involving buffer zones have been undertaken to halt the advance of the gray squirrel. It is unfortunate that in Northumberland, when there was talk of a cull of gray squirrels, there was such public outcry that much of that work had to be deferred.”

Lady Saltoun of Abernethy, the 21st to hold that title in Scotland, then spoke to point out the inherent superiority of the red over the gray squirrel: “Red squirrels,” she said, “are rather like quiet, well-behaved people who do not make a nuisance or an exhibition of themselves or commit crimes and so do not get themselves into the papers in the vulgar way gray squirrels do.” She continued: “Red squirrels do not strip bark from trees; damage arable crops, market gardens and garden plants; dig up bulb and corms from recently sown seed; eat birds’ eggs; or eat telephone wires and electricity cables, as gray squirrels do.” Lady Saltoun suggested some research be done on whether gray squirrels tasted good. She foresaw a fight at the dinner table: “I have a nasty feeling that . . . children in particular would say, ‘Oh, no, I couldn’t possibly eat that,’ just as they say they cannot eat dear little bunny rabbits. But this is worth having a look at.”

Lord Inglewood concluded with a call to action. “We have been far too intellectual about this and tried to be far too clever,” he said. The matter was simple: “There has to be at least some killing of gray squirrels.” To Inglewood’s mind, British governments over the years, regardless of political persuasion, were guilty of “squeamishness.” And “as far as the red squirrel is concerned,” he went on, “squeamishness spells nemesis for this lovely and iconic creature. Those involved with trying to preserve the red squirrel in this country have adopted a policy of appeasement towards the grays. The red squirrels have had Chamberlains and not Churchills, but it is Churchills that they need.” Inglewood finished with a dark prediction: “Unless something radical and imaginative is done . . . Squirrel Nutkin and his friends and relations are going to be toast.”

The gray in the trunk of the car still awaited us. “We gray squirrels who are about to die salute you,” Redesdale said. We walked back to the vehicle, parked near the gift shop. Parker had said he wanted me to shoot the squirrel — that grays were in Britain was, after all, my fault as an American — and I did not want to. He had also asked Redesdale to shoot the squirrel, and he did not want to either. Now Redesdale seemed to be summoning his nerve. “We keep on being told by the bunny-huggers, you know the wildlife-trust people, I mean I’m all for — I mean killing things to me is bad,” he said. “I’m all for it but at some point you have to nail your colors to the mast.”

I had by that point learned more about Redesdale: he and his wife met at a human rights conference; he has mixed feelings about being a lord (“No one really cares if it’s you that shows up”); when he first sat in the House of Lords, at age 23, he looked across at a cousin who was the Tory whip and remembers thinking, “I’d rather eat warm vomit,” after which he joined the Liberal Democrats, a party that, he points out proudly, is to the left of Labor; and he does not like guns (“I don’t see the sport in hunting”).

All the same, Redesdale was the officer; Parker, the enlisted man. If Redesdale did not kill the squirrel, he would never be able to lead. And had his family not led for 1,000 years? So we drove to an isolated parking lot, and Parker took the cage out of the trunk. He put the trap — “it’s me killing trap,” he said — on the asphalt. This was the place this animal was going to die.

The squirrel, large and dark gray with just a hint of red to his fur, wheeled around the cage looking for a way out. Then it made a piteous noise, a whee-whee-whee sound. Parker handed the air rifle to Redesdale, and he pointed it.

“That’s the, uh, trigger?” Redesdale said.

“That’s right,” Parker said.

The squirrel paused. Redesdale steadied the barrel over its head. Then came the shot.

“You’ve got it,” Parker said softly.

But he hadn’t.

“Is it dead?” I asked stupidly.

The squirrel raced around the cage, blood dripping from somewhere around its mouth. WHEE-WHEE-WHEE. The same noise.

“I know it’s bad when they run,” Redesdale apologized. I thought I saw the warm-vomit look in his eyes.

The squirrel kept running and finally stopped when it realized there was still nowhere to go. Redesdale once more placed the rifle over its head. POP! The squirrel fell on its side and shook, scrabbled and shimmied twice around the cage like a break dancer.

“They’re dead when they do that, aren’t they?” Redesdale said, sounding more Macbeth than Prince Hal. Parker assured him it was dead: these were just the death throes. Parker put the dead squirrel — number 2,354 — and the cage back in the trunk, and we trooped out of the parking lot to look for reds.

Parker said he had done a lot of trapping in the area. Some of his traps are just cages on the ground, but here Parker had set one about two feet off the ground, connecting a blackthorn tree and a pine tree via a cross-strut. Some bird feed and a half a coconut dangled above. The gray was supposed to sample the coconut and feed and then come down the trunk and try Parker’s trademark hazelnuts, drilled for easy access, inside the trap. The smell of the grays caught earlier in the trap is supposed to keep the reds away. But today the trap was empty. An owl waited high in a tree, looking down at us from above its white-ruffled collar. Redesdale’s mobile rang. It was Sky TV. They wanted him to be on to talk about the new foot-and-mouth outbreak and were willing to send a van to his home. “Brilliant,” he said.

Then we saw movement in the blackthorn tree. There was a red-orange flash high off the ground. We drew together and watched a red squirrel from behind a stone building as it silently tumbled and turned. In direct sunlight, its plush tail seemed almost blonde. Other times it was russet. It stood on its hind legs.

This was the red-squirrel money shot, the one on the fund-raising postcards: rounded rump, fluffy russet tail curled up and over the back, almost to the point of touching the squirrel’s head. The head itself is inclined slightly, and the paws are brought together around the acorn or beechnut. In this position the red looks like a tiny country vicar giving advice to a young married couple or like a trusted servant who is suggesting gently that His Grace might wish to come to dinner. Seen in profile, the paws are where breasts would be and convey a sense of the delicacy and femininity of the animal.

I could see even from below how soft the red’s fur was. Its belly was white, giving it a two-toned Twenties sort of elegance. Its plushness made me think of bunnies or maybe even baby bears or lemurs. The red squirrel’s head was wide and gave the face a roundness, which combined with the huge ears suggested a newborn baby. There were no tufts on this one — reds loose their tufts in summer — but even without them, it looked like an old man who had rolled out of bed.

Like millions of Americans, I see gray squirrels in my yard every day. They have that helter-skelter, fritzed-out agitated and agitating quality, that urban jumpiness. They always seem to be watching you. This red, by contrast, was uninterested in us, benignly disdainful, like one of the spirits of the forest, the trolls under the bridge and the wise little sprites who appear on tree limbs to play tricks. It wanted to be there. It belonged there. But it was hard to believe it would be there long.

D. T. Max, a frequent contributor, is the author of “The Family That Couldn’t Sleep: A Medical Mystery,” a scientific and cultural history of prion diseases, which is now out in paperback.

Microsoft Electronic Health Record

2007-10-07T20:29:00.000-04:00

NYTimes

October 5, 2007
Microsoft Offers System to Track Health Records
By STEVE LOHR

Microsoft is starting its long-anticipated drive into the consumer health care market by offering free personal health records on the Web and pursuing a strategy that borrows from the company’s successful formula in personal computer software.

The venture by Microsoft, which is called HealthVault and was announced yesterday in Washington, comes after two years spent building a team, expertise and technology. In recent months, Microsoft managers have met with many potential partners, including hospitals, disease-prevention organizations and health care companies.

The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association, Johnson & Johnson LifeScan, NewYork-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region. The partner strategy is a page from Microsoft’s old playbook. To make its operating system, Windows, the dominant platform for personal computers, Microsoft persuaded other companies to build on its technology, and it helped them do it.

“The value of what we’re doing will go up rapidly as we get more partners,” said Peter Neupert, the vice president in charge of Microsoft’s health group.

The consumer health offering includes a personal health record and Internet searches tailored for health queries, under the name Microsoft HealthVault (www.healthvault.com).

The personal information, Microsoft said, will be stored in a secure, encrypted database. Its privacy controls, the company said, are set entirely by the individual, including what information goes in and who gets to see it. HealthVault searches are conducted anonymously, Microsoft said, and will not be linked to any personal information in a HealthVault personal health record.

The company hopes that individuals will give doctors, clinics and hospitals permission to submit information like medicines prescribed and data on blood pressure and cholesterol levels.

Mr. Neupert said such data transfers would then be automatic, over the Internet, which is why the partnerships are so important.

At NewYork-Presbyterian Hospital in New York, Aurelia G. Boyer, the chief information officer, explained that the hospital was committed to helping patients manage their own health care. After an initial discussion with Microsoft, the hospital has pledged to start a pilot project to enable some kinds of patient data — E.K.G.’s, perhaps — to be automatically sent to a person’s HealthVault account.

The Microsoft entry comes at a time when people are increasingly using online tools, especially searches, to find health information. Tighter curbs on medical spending and an aging population with more health concerns are expected to prompt consumers to take a larger role in managing their own care, including using online tools. But that trend has not gone very far yet.

Microsoft is also moving ahead at a time when other large technology companies have hit bumps in their health initiatives.

For example, the leader of Google’s health group, Adam Bosworth, left last month. The company has been developing offerings broadly similar to Microsoft’s, including personal health records stored in Google data centers and an enhanced search for health information.

The head of Cisco’s health care practice, Dr. Jeffrey Rideout, recently left to join a private equity firm, Ziegler HealthVest Management. And Dossia, a coalition led by Intel to provide employees at several large companies with personal health records, is going more slowly than planned.

But while some other technology companies are pulling back or slowing down in health, “Microsoft is stepping forward and finally declaring the hand it will play,” said Dr. David J. Brailer, who was the health information technology coordinator in the Bush administration. He now leads a firm that invests in medical ventures, Health Evolution Partners.

At the American Heart Association, Dr. Daniel Jones, the president, said working with Microsoft was a way to accelerate his group’s efforts to curb heart disease. Microsoft is collaborating with the association on an online tool for managing blood pressure. Heart patients will be able to go to the association’s Web site, open a HealthVault account and submit their blood-pressure readings, weight and medications.

At first, Dr. Jones said, consumers will probably enter the data themselves, but later they may have it sent from a doctor’s office or laboratory. Ideally, he said, patients would share the information with their doctor or nurse, who could call or send an e-mail message to warn of any disturbing changes. “The potential here is very great,” Dr. Jones said. “And we all recognize the power of Microsoft to reach millions of households.”

Microsoft has also signed up health care companies. Johnson & Johnson LifeScan, the nation’s largest producer of the glucose monitors used by many diabetes patients, plans to enable the monitors’ readouts to be uploaded to a Microsoft HealthVault account. “We see this as a potentially powerful tool in helping patients manage their diabetes,” said Tom West, president of Johnson & Johnson LifeScan.

Privacy is a serious consideration and one likely to slow the spread of personal health records. But Microsoft’s privacy principles have impressed Dr. Deborah Peel, chairwoman of the Patient Privacy Rights Foundation, a nonprofit group. In terms of patient control and openness to outside audits, “Microsoft is setting an industry standard for privacy,” Dr. Peel said.

Mr. Neupert of Microsoft said the key to building trust in the service would be a track record on privacy. Consumers, he noted, initially were reluctant to try online banking because of privacy worries. But today, online banking is mainstream.

“It’s going to be a long journey,” Mr. Neupert said. “To make a difference in health care, it is going to take time and scale. And Microsoft has both.”

Hyperactivity and food additives

2007-09-09T17:13:00.000-04:00

NYTimes

September 6, 2007
Some Food Additives Raise Hyperactivity, Study Finds
By ELISABETH ROSENTHAL

Common food additives and colorings can increase hyperactive behavior in a broad range of children, a study being released today found.

It was the first time researchers conclusively and scientifically confirmed a link that had long been suspected by many parents. Numerous support groups for attention deficit hyperactivity disorder have for years recommended removing such ingredients from diets, although experts have continued to debate the evidence.

But the new, carefully controlled study shows that some artificial additives increase hyperactivity and decrease attention span in a wide range of children, not just those for whom overactivity has been diagnosed as a learning problem.

The new research, which was financed by Britain’s Food Standards Agency and published online by the British medical journal The Lancet, presents regulators with a number of issues: Should foods containing preservatives and artificial colors carry warning labels? Should some additives be prohibited entirely? Should school cafeterias remove foods with additives?

After all, the researchers note that overactivity makes learning more difficult for children.

“A mix of additives commonly found in children’s foods increases the mean level of hyperactivity,” wrote the researchers, led by Jim Stevenson, a professor of psychology at the University of Southampton. “The finding lends strong support for the case that food additives exacerbate hyperactive behaviors (inattention, impulsivity and overactivity) at least into middle childhood.”

In response to the study, the Food Standards Agency advised parents to monitor their children’s activity and, if they noted a marked change with food containing additives, to adjust their diets accordingly, eliminating artificial colors and preservatives.

But Professor Stevenson said it was premature to go further. “We’ve set up an issue that needs more exploration,” he said in a telephone interview.

In response to the study, some pediatricians cautioned that a diet without artificial colors and preservatives might cause other problems for children.

“Even if it shows some increase in hyperactivity, is it clinically significant and does it impact the child’s life?” said Dr. Thomas Spencer, a specialist in Pediatric Psychopharmacology at Massachusetts General Hospital.

“Is it powerful enough that you want to ostracize your kid? It is very socially impacting if children can’t eat the things that their friends do.”

Still, Dr. Spencer called the advice of the British food agency “sensible,” noting that some children may be “supersensitive to additives” just as some people are more sensitive to caffeine.

The Lancet study focused on a variety of food colorings and on sodium benzoate, a common preservative. The researchers note that removing this preservative from food could cause problems in itself by increasing spoilage. In the six-week trial, researchers gave a randomly selected group of several hundred 3-year-olds and of 8- and 9-year-olds drinks with additives — colors and sodium benzoate — that mimicked the mix in children’s drinks that are commercially available. The dose of additives consumed was equivalent to that in one or two servings of candy a day, the researchers said. Their diet was otherwise controlled to avoid other sources of the additives.

A control group was given an additive-free placebo drink that looked and tasted the same.

All of the children were evaluated for inattention and hyperactivity by parents, teachers (for school-age children) and through a computer test. Neither the researchers nor the subject knew which drink any of the children had consumed.

The researchers discovered that children in both age groups were significantly more hyperactive and that they had shorter attention spans if they had consumed the drink containing the additives. The study did not try to link specific consumption with specific behaviors. The study’s authors noted that other research suggested that the hyperactivity could increase in as little as an hour after artificial additives were consumed.

The Lancet study could not determine which of the additives caused the poor performances because all the children received a mix. “This was a very complicated study, and it will take an even more complicated study to figure out which components caused the effect,” Professor Stevenson said.

Prius for home power

2007-09-05T03:06:00.000-04:00

NYTimes

September 2, 2007
Greentech
Power to the People: Run Your House on a Prius
By JIM MOTAVALLI

WHEN Hurricane Frances ripped through Gainesville, Fla., in 2004, Christopher Swinney, an anesthesiologist, was without electricity for a week. A few weeks ago, Dr. Swinney lost power again, but this time he was ready.

He plugged his Toyota Prius into the backup uninterruptible power supply unit in his house and soon the refrigerator was humming and the lights were back on. “It was running everything in the house except the central air-conditioning,” Dr. Swinney said.

Without the Prius, the batteries in the U.P.S. unit would have run out of power in about an hour. The battery pack in the car kept the U.P.S. online and was itself recharged by the gasoline engine, which cycled on and off as needed. The U.P.S. has an inverter, which converts the direct current electricity from the batteries to household alternating current and regulates the voltage. As long as it has fuel, the Prius can produce at least three kilowatts of continuous power, which is adequate to maintain a home’s basic functions.

This form of vehicle-to-grid technology, often called V2G, has attracted hobbyists, university researchers and companies like Pacific Gas & Electric and Google. Although there is some skepticism among experts about the feasibility of V2G, the big players see a future in which fleets of hybrid cars, recharged at night when demand is lower, can relieve the grid and help avert serious blackouts.

Willett Kempton, a senior scientist in the Center for Energy and Environmental Policy at the University of Delaware, said the power capacity of the automotive fleet was underutilized.

Mr. Kempton is helping to explore the V2G capabilities of a fuel-cell bus and battery-electric vehicles. The technology is also well-suited for so-called plug-in hybrids, which are being developed by General Motors, Toyota and other automakers. Plug-in hybrids will use larger battery packs and recharge from a household outlet for 10 to 30 miles of electric-only driving. When modified, they can return electricity to the grid from their batteries.

Google has four Priuses with plug-in capacity at its headquarters in Mountain View, Calif. With some advice from P.G.& E., Google equipped one to supply power to the grid.

Keith Parks, an analyst at the Minneapolis-based utility Xcel Energy, offers what he calls a “pie-in-the-sky vision” for V2G in which a company would offer incentives to its employees to buy plug-in hybrids. The parking lot would be equipped with recharging stations, which could also return power to the grid from the vehicles.

Both Xcel Energy and the federal National Renewable Energy Laboratory, Mr. Parks’s former employer, are investigating V2G technology.

“We see this as a win-win,” said Sven Thesen, director of P.G.& E.’s Clean Air Transportation office. The utility owns Sparky, a Prius converted to plug-in operation by EnergyCS of Monrovia, Calif.

“It’s the first new use for the electric power infrastructure in 100 years,” said Jesse Berst of Smartgridnews.com.

But the V2G vision is not likely to be realized soon because engineers are wrestling with battery technology, cost and weight. A word of caution is added by John DeCicco, a mechanical engineer and senior fellow for automotive strategies at the nonprofit group Environmental Defense. “It’s hard to take seriously the promises made for plug-in hybrids with 30-mile all-electric range or any serious V2G application any time soon,” he said. “It’s still in the science project stage.”

No automaker is selling a plug-in hybrid vehicle, but some ambitious people are making their own. Converting a stock Prius to back up the grid is much easier, and the guru for such conversions is Richard Factor, 61, an inventor from Kinnelon, N.J.

Mr. Factor says that small U.P.S. units, often used to provide backup power for computer servers, are inexpensive. His system, which he estimates would cost $2,000 to $4,000 to duplicate, incorporates a large U.P.S. mounted in his home and a long electrical cord to the Prius, where it connects through the car’s built-in relay terminals. His system is designed to integrate with the grid, but he said more rudimentary systems could be built for as little as $200.

During a recent six-hour power failure, Mr. Factor estimated that his 2005 Prius used less than one gallon of gasoline.

The V2G potential of Honda’s full hybrid vehicles is unexplored, but the company is doubtful of using them to power homes. “We would not like to see stresses on the battery pack caused by putting it through cycles it wasn’t designed for,” said Chris Naughton, a Honda spokesman. “Instead, they should buy a Honda generator that was made for that purpose.”

Sweating

2007-08-14T06:19:00.000-04:00

NYTimes

August 14, 2007
Sweatology
By ABIGAIL ZUGER

Like the finish line of a long road race, the Times Square subway platform one recent hot afternoon was a study in wet humanity, from drenched (a large woman in shorts and a skimpy, sweat-splotched top, flushed and vigorously fanning herself), to barely bedewed (an elderly man in a suit and tie calmly reading his paper).

Who would believe that every sufferer had the same model of personal air-conditioner operating at full blast?

Sweat is our interior coolant, part of a uniquely human biologic machine. The machine drips and occasionally stalls: long waits on torpid platforms can inspire glum reflections on how it will hold up as the planet heats up. But experts counsel optimism: the system is sturdy, adjustable and even reproducible by engineers working to make our future sweaty selves more comfortable.

Humans operate in a tiny range of preferred internal temperatures. We can tolerate overcooling, routinely recovering from long periods of hypothermia with body temperatures diving 20 or more degrees below normal.

But we have little tolerance for even brief overheating: the brain malfunctions with six or seven degrees of fever, and an internal temperature of 110, barely a dozen degrees above normal, is often cited as the upper limit compatible with life. So a good internal air-conditioner is essential, both to dissipate the heat generated by the body’s metabolism and to relieve the heat absorbed from miserable summer weather.

“It is plain old unglamorous sweat that has made humans what they are today,” writes the evolutionary anthropologist Nina G. Jablonski in her recent book “Skin.” “Without plentiful sweat glands keeping us cool with copious sweat, we would still be clad in the thick hair of our ancestors, living largely apelike lives.”

Fur inhibits sweat-induced cooling, and furry animals generally have other ways to lose heat. In humans, Dr. Jablonski argues, sweat glands evolved as body hair vanished, allowing optimal cooling of the enlarging hominid brain and an active lifestyle even in the blazing sun.

For sedentary pursuits in temperate weather, people have no need to sweat: excess metabolic heat easily moves from blood vessels at the surface of the skin into the surrounding air. Because the skin is not completely waterproof, some evaporation of water from skin cells adds a little extra cooling.

But when the body’s owner decides to exercise, the muscles generate too much heat for the air to absorb. The same thing happens when the temperature climbs into the 90s: the skin stops losing heat to the air and absorbs it instead. Then temperature-sensing nerves in the skin and the body’s interior tell the brain to unleash a flow of sweat for heavy-duty evaporation and cooling.

Humidity reduces evaporation and makes everyone sweatier. A breeze enhances evaporation and makes skin cooler (unless the air is so hot the body absorbs its heat instead). Dehydration markedly reduces sweat production. So does sunburn.

But individual sweat patterns still vary enormously. Age, sex, genes, weight and shape play a role, said Craig Crandall, a thermoregulation expert at University of Texas Southwestern Medical Center and Presbyterian Hospital, both in Dallas. So does nonexercise activity, and so, according to a pivotal set of sweat studies done during World War II, does clothing, although not in the way one might predict.

Some people have fewer than two million sweat glands; some have as many as four million. Heavy sweaters may have glands five times average size; their big glands are more sensitive to nerve stimuli and make more sweat.

Everyone’s inner temperature cycles around a slightly different genetically determined version of 98.6 set by the hypothalamus, the brain region that serves as thermostat. We run a little cooler in the morning, a little warmer in the late afternoon. Women run about half a degree higher after ovulation. With menopause the female thermostat becomes notoriously trigger-happy, imagining excess heat where none exists and generating unnecessary sweat.

Men may be more thermally stable, but not for long: beginning about age 60 both sexes sweat less, even if they are in good physical condition, and even if they become seriously overheated. Thus the statistics that during heat waves the elderly are at highest risk of heat stroke.

As for obesity, it is complicated, Dr. Crandall said. Fat may insulate the interior from very hot external temperatures, but it also may compromise heat transfer from interior to skin. Carrying more weight generates more metabolic heat to get rid of. That means more sweat, but research suggests that large people cannot grow more sweat glands to cope with the extra heat load. Radiation of heat from skin to air may become especially important in their heat control.

Over all, though, these factors make small difference in sweat rate. The bigger differences come from activities that may fall short of exercise. Even brief spurts of walking or leg jiggling generate metabolic heat that turns into sweat, as do anger and frustration. The sweatiest person on the subway platform is probably the one who just ran for a train and missed it, Dr. Crandall said.

And as for clothing: less is not always better. In studies during World War II, researchers sat volunteers on wooden boxes in the California desert, some wearing standard olive drab military fatigues, some in light tan summer uniforms, and some “near naked.” The unclothed “soldiers” sweated about 30 percent more than the others — an indication of how much heat their unprotected skin was absorbing from the environment.

And so the average urban warrior might be forewarned that near-nudity on hot subway platforms may be counterproductive, as may be vigorous fanning, pacing and gesticulating if the train is late.

What will happen as the planet heats and more is asked of our sweat glands? No problem, experts say: the system can easily rev up into a high, efficient gear.

The process is called heat acclimation and is routinely seen in athletes training in hot weather. At first their internal temperatures climb, they sweat profusely, lose large quantities of salt in their sweat and feel miserable. But as the days pass they sweat even more, their salt loss diminishes, both skin and internal temperatures drop, and their endurance improves.

At least in part, heat acclimation reflects bigger, juicier sweat glands: in monkeys exposed to continuous heat and humidity, individual sweat glands more than doubled in volume after only two months.

And it took only a week or so for the research subjects in the California desert to develop high sweat rates, low pulse rates and low rectal temperatures. They could work more comfortably, with greatly improved well-being.

In the words of the scientists, they had become “desertworthy.”

All in all, Dr. Crandall pointed out, global warming is likely to be far less thermally dramatic for the individual person than a relocation from Canada to Florida, with its accompaniment of larger, more efficient sweat glands and slightly moister skin.

If the world does become a sweatier place, some engineers are primed to cope. Two years ago, a team at the United States Department of Energy’s National Renewable Energy Laboratory in Colorado completed work on a mannequin, christened Adam, who sweats like a human being and can complain like one, too.

Adam’s slim carbon frame is covered with 120 separate temperature-sensing and sweating zones; water seeps from an interior two-quart reservoir out through his porous skin. He is wirelessly connected to a computer whose software forms his hypothalamus. Other software based on human reactions to a range of temperatures provides estimates of his comfort in various situations.

Adam was devised to help reduce automobile fuel consumption by evaluating ways to limit air-conditioner use. Fully dressed in a car parked in the hot sun, he gets as wet on his back and rear end as any human driver, and just as irritable. Programmers can also rev up his metabolic rate to provide a good, sweaty simulation of road rage, said one of his creators, John Rugh, a senior mechanical engineer.

Adam has helped evaluate clothes for astronauts to wear underneath their spacesuits, and devices to warm injured soldiers. Currently unemployed, he is looking for other work mimicking the human experience in temperature extremes, Mr. Rugh said.

Sweet tea

2007-08-12T00:20:00.000-04:00

Slate

I Wish I Lived in a Land of Lipton …
What makes Southern sweet tea so special?
By Jeffrey Klineman
Posted Wednesday, Aug. 8, 2007, at 1:06 PM ET

"It's rough. It's been rough on that food. It's different eating here than it is at the house. Ain't got no sweet tea, and ain't got no fried chicken."
—Boo Weekley, PGA golfer from Milton, Fla., interviewed by the BBC on Day 2 of the British Open, 7/20/2007

You can't blame Boo Weekley for not knowing—before last month, the man had never left North America. And there are some fairly major associations between Great Britain and tea. But poor Weekley had the same awful realization most of us have when we leave Dixie: When you order sweet tea, you probably aren't going to get it. And even if you're lucky enough to find something bearing its name, it's probably not quite the same.

Drinking sweet tea is one of the oldest and most exceptional Southern traditions. As Dolly Parton's character in Steel Magnolias puts it, it's the "house wine of the South"—a clear, orange-to-red tinted tea brewed from six or seven Lipton or Luzianne tea bags, poured hot onto a cup or more of sugar or a pool of simple syrup, and then diluted into a gallon pitcher in the fridge. It's served over a mound of ice in a huge glass—so cold that you can watch your napkin drown in a puddle of condensation.

By "sweet tea," we mean "sweet." As one food technologist told me, some of the sweetest glasses can hit 22 Brix of sugar. That means that 22 percent of the liquid consists of dissolved sugar solids, or, to put it in more meaningful terms: close to twice what you'd find in a can of Coke. Still, there's a balance to the flavor—the tea is brewed long and strong, so it gets an astringency that can only be countered by lots of the sweet stuff.

Southerners, of course, have a taste for sugar that is demonstrably stronger than what you find up North. We like our pecan pie and pralines sweet enough to make the dentist cringe. All of the major soda companies—the Coca-Cola Co., PepsiCo, Dr Pepper—started in the South. Bourbon, that sweetest of whiskies, is from Kentucky. A mint julep, that classic Southern cocktail, is basically a whiskey'd up sweet tea, with mint, ice, simple syrup, and booze.

One chef I spoke with—Scott Peacock, who spent eight years bunking and writing with the Grand Dame of Southern cooking, the late Edna Lewis—suggested that Dixie's taste for sweet may have evolved from the use of sugar as a preservative. Peacock's dad grew up in a small Alabama town where they didn't have much refined sugar. In towns like that, he said, they grew cane, milled it, and put it in jars. People anticipated the crystallization of the cane sugar with great excitement, eager to stir it into their tea.

Sugar worship might account for much of sweet tea's popularity, but I think its appeal lies in the ice. Southerners seem to have a particular fascination with ice. This may stem, most obviously, from the fact that the Southern climate is often steamier than a Rat Pack schvitz. In an early essay about Southern cuisine published by the American Philosophical Society called Hog Meat and Cornpone: Food Habits in the Ante-Bellum South, Sam Hilliard wrote that a container of cool—not even cold—water, pulled from a nearby spring, was a delicacy at the table. Tea was mostly a drink for the upper class, and early on, it was the rich who had access to the ice that came down on ships or in wagons, at least until icehouses were built in cities (Southern farmers had to wait for the arrival of the Model T). If ice was a luxury, then putting out a pitcher of ice-cold tea must have been quite a bit of hospitality. One historian, Joe Gray Taylor, wrote in Eating, Drinking, and Visiting in the South: An Informal History that the rural electrification—and, consequently, refrigeration—wrought by the Tennessee Valley Authority in the 1930s was "probably more appreciated for the ice cubes it provided … than for any of its other services."

Offering up a glass of sweet tea on a hot day in the South is as welcoming a gesture as passing the doobie at a Phish show. It's so ingrained in the Southern DNA—Marion Cabell Tyree included the recipe in a cookbook called Housekeeping in Old Virginia as early as 1879—that people now post videos online of their infants sampling the stuff. It's a frequent menu item for the condemned, as well as a centerpiece at church suppers. As an April Fools' Day prank in 2003, Georgia State Rep. John Noel introduced a bill that would have made it a misdemeanor for a restaurant owner not to include sweet tea on the menu. Most Southerners can easily tell the difference between fresh sweet tea and the stuff from concentrate—and unless their sugar jones is too strong that day, chances are they'll send the latter back.

It's a refreshing combination of sweet and cold, sure, but how does something that's simply tasty become the unofficial beverage for an entire region? Well, there's this: The South reveres its traditions, and sweet tea is one of them. Dixie has had some embarrassments in its time: There's that whole Civil War thing, the whole Judge Roy Moore thing, that whole Naples, Fla., Swamp Buggy Queen thing, to name a few. Getting your nose rubbed in your own traditions too many times makes you cling to those that aren't, well, illegal. And you revere them as much because they have proven resistant to change as you do for their particular qualities.

For me, personally—and I suspect I'm not alone—sweet tea is a primal link to my own Southern past. I grew up a Jewish kid in Atlanta, with a mom from Brooklyn, N.Y., and a dad from Cleveland. To assimilate with my classmates, I quickly learned to say y'all, talk about Herschel Walker, put honey on my biscuits, and enjoy sweet tea. While my parents made us drink an unsweetened mint tea blend at home, I strong-armed them into stopping by Po Folks on the way home from baseball practice. A middling Southern-style chain (we didn't know enough to eat at Mary Mac's), known for horrible phonetic misspellings, heavily larded chicken, and, most importantly, sweet tea served in Mason Jars, it was practically the only place I could get hooked up properly—at least, that is, until I began raiding the always-full homemade pitchers in my friends' refrigerators.

I may live in Massachusetts now, but I still consider myself Southern at heart. In the fall, I ask the bartender to let me watch the Bulldogs game. In the spring, I feel a potentially suicidal need to stop wearing a coat. And in the summer, I still look for sweet tea. Even on the rare occasion I can find someplace that has it on the menu, it's often slightly off. Maybe it isn't sweet enough. Maybe it's the lack of free refills. Whatever it is, it chills me.
Jeffrey Klineman is a freelance writer in Cambridge, Mass. His work has appeared in Boston magazine, George, Commonwealth, Razor, Self, and Penthouse.

101 meals in 10 minutes or less

2007-08-03T20:05:00.000-04:00

NYTimes

July 18, 2007
The Minimalist
Summer Express: 101 Simple Meals Ready in 10 Minutes or Less
By MARK BITTMAN

The pleasures of cooking are sometimes obscured by summer haze and heat, which can cause many of us to turn instead to bad restaurants and worse takeout. But the cook with a little bit of experience has a wealth of quick and easy alternatives at hand. The trouble is that when it’s too hot, even the most resourceful cook has a hard time remembering all the options. So here are 101 substantial main courses, all of which get you in and out of the kitchen in 10 minutes or less. (I’m not counting the time it takes to bring water to a boil, but you can stay out of the kitchen for that.) These suggestions are not formal recipes; rather, they provide a general outline. With a little imagination and some swift moves — and maybe a salad and a loaf of bread — you can turn any dish on this list into a meal that not only will be better than takeout, but won’t heat you out of the house.

1 Make six-minute eggs: simmer gently, run under cold water until cool, then peel. Serve over steamed asparagus.

2 Toss a cup of chopped mixed herbs with a few tablespoons of olive oil in a hot pan. Serve over angel-hair pasta, diluting the sauce if necessary with pasta cooking water.

3 Cut eight sea scallops into four horizontal slices each. Arrange on plates. Sprinkle with lime juice, salt and crushed chilies; serve after five minutes.

4 Open a can of white beans and combine with olive oil, salt, small or chopped shrimp, minced garlic and thyme leaves in a pan. Cook, stirring, until the shrimp are done; garnish with more olive oil.

5 Put three pounds of washed mussels in a pot with half a cup of white wine, garlic cloves, basil leaves and chopped tomatoes. Steam until mussels open. Serve with bread.

6 Heat a quarter-inch of olive oil in a skillet. Dredge flounder or sole fillets in flour and fry until crisp, about two minutes a side. Serve on sliced bread with tartar sauce.

7 Make pesto: put a couple of cups of basil leaves, a garlic clove, salt, pepper and olive oil as necessary in a blender (walnuts and Parmesan are optional). Serve over pasta (dilute with oil or water as necessary) or grilled fish or meat.

8 Put a few dozen washed littlenecks in a large, hot skillet with olive oil. When clams begin to open, add a tablespoon or two of chopped garlic. When most or all are opened, add parsley. Serve alone, with bread or over angel-hair pasta.

9 Pan-grill a skirt steak for three or four minutes a side. Sprinkle with salt and pepper, slice and serve over romaine or any other green salad, drizzled with olive oil and lemon.

10 Smear mackerel fillets with mustard, then sprinkle with chopped herbs (fresh tarragon is good), salt, pepper and bread crumbs. Bake in a 425-degree oven for about eight minutes.

11 Warm olive oil in a skillet with at least three cloves sliced garlic. When the garlic colors, add at least a teaspoon each of cumin and pimentón. A minute later, add a dozen or so shrimp, salt and pepper. Garnish with parsley, serve with lemon and bread.

12 Boil a lobster. Serve with lemon or melted butter.

13 Gazpacho: Combine one pound tomatoes cut into chunks, a cucumber peeled and cut into chunks, two or three slices stale bread torn into pieces, a quarter-cup olive oil, two tablespoons sherry vinegar and a clove of garlic in a blender with one cup water and a couple of ice cubes. Process until smooth, adding water if necessary. Season with salt and pepper, then serve or refrigerate, garnished with anchovies if you like, and a little more olive oil.

14 Put a few slices of chopped prosciutto in a skillet with olive oil, a couple of cloves of crushed garlic and a bit of butter; a minute later, toss in about half a cup bread crumbs and red chili flakes to taste. Serve over pasta with chopped parsley.

15 Call it panini: Grilled cheese with prosciutto, tomatoes, thyme or basil leaves.

16 Slice or chop salami, corned beef or kielbasa and warm in a little oil; stir in eggs and scramble. Serve with mustard and rye bread.

17 Soak couscous in boiling water to cover until tender; top with sardines, tomatoes, parsley, olive oil and black pepper.

18 Stir-fry a pound or so of ground meat or chopped fish mixed with chopped onions and seasoned with cumin or chili powder. Pile into taco shells or soft tacos, along with tomato, lettuce, canned beans, onion, cilantro and sour cream.

19 Chinese tomato and eggs: Cook minced garlic in peanut oil until blond; add chopped tomatoes then, a minute later, beaten eggs, along with salt and pepper. Scramble with a little soy sauce.

20 Cut eggplant into half-inch slices. Broil with lots of olive oil, turning once, until tender and browned. Top with crumbled goat or feta cheese and broil another 20 seconds.

21 While pasta cooks, combine a couple cups chopped tomatoes, a teaspoon or more minced garlic, olive oil and 20 to 30 basil leaves. Toss with pasta, salt, pepper and Parmesan.

22 Make wraps of tuna, warm white beans, a drizzle of olive oil and lettuce and tomato.

23 The New York supper: Bagels, cream cheese, smoked salmon. Serve with tomatoes, watercress or arugula, and sliced red onion or shallot.

24 Dredge thinly sliced chicken breasts in flour or cornmeal; cook about two minutes a side in hot olive oil. Place on bread with lettuce, tomato and mayonnaise.

25 Upscale tuna salad: good canned tuna (packed in olive oil), capers, dill or parsley, lemon juice but no mayo. Use to stuff a tomato or two.

26 Cut Italian sausage into chunks and brown in a little olive oil; chop onions and bell peppers and add them to the pan. Cook until sausage is browned and peppers and onions tender. Serve in sandwiches.

27 Egg in a hole, glorified: Tear a hole in a piece of bread and fry in butter. Crack an egg into the hole. Deglaze pan with a little sherry vinegar mixed with water, and more butter; pour over egg.

28 New Joe’s Special, from San Francisco: Brown ground meat with minced garlic and chopped onion. When just about cooked, add chopped spinach and cook, stirring, until wilted. At the last minute, stir in two eggs, along with grated Parmesan and salt and pepper.

29 Chop prosciutto and crisp it in a skillet with olive oil; add chopped not-too-ripe figs. Serve over greens dressed with oil and vinegar; top all with crumbled blue cheese.

30 Quesadilla: Use a combination of cheeses, like Fontina mixed with grated pecorino. Put on half of a large flour tortilla with pickled jalapenos, chopped onion, shallot or scallion, chopped tomatoes and grated radish. Fold tortilla over and brown on both sides in butter or oil, until cheese is melted.

31 Fast chile rellenos: Drain canned whole green chilies. Make a slit in each and insert a piece of cheese. Dredge in flour and fry in a skillet, slit side up, until cheese melts.

32 Cobb-ish salad: Chop bacon and begin to brown it; cut boneless chicken into strips and cook it with bacon. Toss romaine and watercress or arugula with chopped tomatoes, avocado, onion and crumbled blue cheese. Add bacon and chicken. Dress with oil and vinegar.

33 Sauté 10 whole peeled garlic cloves in olive oil. Meanwhile, grate Pecorino, grind lots of black pepper, chop parsley and cook pasta. Toss all together, along with crushed dried chili flakes and salt.

34 Niçoise salad: Lightly steam haricot verts, green beans or asparagus. Arrange on a plate with chickpeas, good canned tuna, hard-cooked eggs, a green salad, sliced cucumber and tomato. Dress with oil and vinegar.

35 Cold soba with dipping sauce: Cook soba noodles, then rinse in cold water until cool. Serve with a sauce of soy sauce and minced ginger diluted with mirin and/or dry sake.

36 Fried egg “saltimbocca”: Lay slices of prosciutto or ham in a buttered skillet. Fry eggs on top of ham; top with grated Parmesan.

37 Frisée aux lardons: Cook chunks of bacon in a skillet. Meanwhile, make six-minute or poached eggs and a frisée salad. Put eggs on top of salad along with bacon; deglaze pan with sherry vinegar and pour pan juices over all.

38 Fried rice: Soften vegetables with oil in a skillet. Add cold takeout rice, chopped onion, garlic, ginger, peas and two beaten eggs. Toss until hot and cooked through. Season with soy sauce and sesame oil.

39 Taco salad: Toss together greens, chopped tomato, chopped red onion, sliced avocado, a small can of black beans and kernels from a couple of ears of corn. Toss with crumbled tortilla chips and grated cheese. Dress with olive oil, lime and chopped cilantro leaves.

40 Put a large can of chickpeas and their liquid in a medium saucepan. Add some sherry, along with olive oil, plenty of minced garlic, smoked pimentón and chopped Spanish chorizo. Heat through.

41 Raita to the rescue: Broil any fish. Serve with a sauce of drained yogurt mixed with chopped cucumber, minced onion and cayenne.

42 Season boneless lamb steaks cut from the leg with sweet curry powder. Sear on both sides. Serve over greens, with lemon wedges.

43 Migas, with egg: Sauté chopped stale bread with olive oil, mushrooms, onions and spinach. Stir in a couple of eggs.

44 Migas, without egg: Sauté chopped stale bread with chopped Spanish chorizo, plenty of garlic and lots of olive oil. Finish with chopped parsley.

45 Sauté shredded zucchini in olive oil, adding garlic and chopped herbs. Serve over pasta.

46 Broil a few slices prosciutto until crisp; crumble and toss with parsley, Parmesan, olive oil and pasta.

47 Not exactly banh mi, but... Make sandwiches on crisp bread with liverwurst, ham, sliced half-sours, shredded carrots, cilantro sprigs and Vietnamese chili-garlic paste.

48 Not takeout: Stir-fry onions with cut-up broccoli. Add cubed tofu, chicken or shrimp, or sliced beef or pork, along with a tablespoon each minced garlic and ginger. When almost done, add half cup of water, two tablespoons soy sauce and plenty of black pepper. Heat through and serve over fresh Chinese noodles.

49 Sprinkle sole fillets with chopped parsley, garlic, salt and pepper; roll up, dip in flour, then beaten egg, then bread crumbs; cook in hot olive oil about three minutes a side. Serve with lemon wedges.

50 The Waldorf: Toast a handful of walnuts in a skillet. Chop an apple or pear; toss with greens, walnuts and a dressing made with olive oil, sherry vinegar, Dijon mustard and shallot. Top, if you like, with crumbled goat or blue cheese.

51 Put a stick of butter and a handful of pine nuts in a skillet. Cook over medium heat until both are brown. Toss with cooked pasta, grated Parmesan and black pepper.

52 Grill or sauté Italian sausage and serve over store-bought hummus, with lemon wedges.

53 Put a tablespoon of cream and a slice of tomato in each of several small ramekins. Top with an egg, then salt, pepper and grated Parmesan. Bake at 350 degrees until the eggs set. Serve with toast.

54 Brown small pork (or hot dog) chunks in a skillet. Add white beans, garlic, thyme and olive oil. Or add white beans and ketchup.

55 Dredge skate or flounder in flour and brown quickly in butter or oil. Deglaze pan with a couple of spoonfuls of capers and a lot of lemon juice or a little vinegar.

56 Make a fast tomato sauce of olive oil, chopped tomatoes and garlic. Poach eggs in the sauce, then top with Parmesan.

57 Dip pork cutlets in egg, then dredge heavily in panko; brown quickly on both sides. Serve over lettuce, with fresh lemon, or bottled Japanese curry sauce.

58 Cook chicken livers in butter or oil with garlic; do not overcook. Finish with parsley, lemon juice and coarse salt; serve over toast.

59 Brown bratwursts with cut-up apples. Serve with coleslaw.

60 Peel and thinly slice raw beets; cook in butter until soft. Take out of pan and quickly cook some shrimp in same pan. Deglaze pan with sherry vinegar, adding sauce to beets and shrimp. Garnish with dill.

61 Poach shrimp and plunge into ice water. Serve with cocktail sauce: one cup ketchup, one tablespoon vinegar, three tablespoons melted butter and lots of horseradish.

62 Southeast Asia steak salad: Pan- or oven-grill skirt or flank steak. Slice and serve on a pile of greens with a sauce of one tablespoon each of nam pla and lime juice, black pepper, a teaspoon each of sugar and garlic, crushed red chili flakes and Thai basil.

63 Miso steak: Coat beef tenderloin steaks (filet mignon) with a blend of miso and chili paste thinned with sake or white wine. Grill or broil about five minutes.

64 Pasta with fresh tomatoes: Cook chopped fresh tomatoes in butter or oil with garlic until tender, while pasta cooks. Combine and serve with grated Parmesan.

65 Sauté squid rings and tentacles in olive oil with salt and pepper and garlic; add chopped tomatoes. Cook until the tomatoes break down. Serve over pasta.

66 Salmon (or just about anything else) teriyaki: Sear salmon steaks on both sides for a couple of minutes; remove. To skillet, add a splash of water, sake, a little sugar and soy sauce; when mixture is thick, return steaks to pan and turn in sauce until done. Serve hot or at room temperature.

67 Rich vegetable soup: Cook asparagus tips and peeled stalks or most any other green vegetable in chicken stock with a little tarragon until tender; reserve a few tips and purée the rest with a little butter (cream or yogurt, too, if you like) adding enough stock to thin the purée. Garnish with the reserved tips. Serve hot or cold.

68 Brush portobello caps with olive oil; sprinkle with salt and pepper and broil until tender. Briefly sweat chopped onions, then scramble eggs with them. Put eggs in mushrooms.

69 Buy good blintzes. Brown them on both sides in butter. Serve with sour cream, apple sauce or both.

70 Sauté squid rings and tentacles in olive oil with salt and pepper. Make a sauce of minced garlic, smoked pimentón, mayo, lots of lemon juice and fresh parsley. Serve with a chopped salad of cucumber, tomato, lettuce, grated carrot and scallion, lightly dressed.

71 Press a lot of coarsely ground black pepper onto both sides of filet mignon or other steaks or chopped meat patties. Brown in butter in a skillet for two minutes a side. Remove steaks and add a splash of red wine, chopped shallots and a bit of tarragon to skillet. Reduce, then return steaks to pan, turning in the sauce for a minute or two.

72 World’s leading sandwich: prosciutto, tomato, butter or olive oil and a baguette.

73 Near instant mezze: Combine hummus on a plate with yogurt laced with chopped cucumbers and a bit of garlic, plus tomato, feta, white beans with olive oil and pita bread.

74 Canned sardines packed in olive oil on Triscuits, with mustard and Tabasco.

75 Boil-and-eat shrimp, cooked in water with Old Bay seasoning or a mixture of thyme, garlic, paprika, chopped onion, celery, chili, salt and pepper.

76 Make a thin plain omelet with two or three eggs. Sauté cubes of bacon or pancetta or strips of prosciutto until crisp. Cut up the omelet and use it and the meat to garnish a green salad dressed with olive oil and balsamic vinegar.

77 Sear corn kernels in olive oil with minced jalapeños and chopped onions; toss with cilantro, black beans, chopped tomatoes, chopped bell pepper and lime.

78 Cook shrimp in a skillet slowly (five minutes or so) to preserve their juices, with plenty of garlic and olive oil, until done; pour over watercress or arugula, with lemon, pepper and salt.

79 Liverwurst on good sourdough rye with scallions, tomato and wholegrain mustard.

80 Not-quite merguez: Ground lamb burgers seasoned with cumin, garlic, onion, salt and cayenne. Serve with couscous and green salad, along with bottled harissa.

81 Combine crab meat with mayo, Dijon mustard, chives and tarragon. Serve in a sandwich, with potato chips.

82 Combine canned tuna in olive oil, halved grape tomatoes, black olives, mint, lemon zest and red pepper flakes. Serve with pasta, thinning with olive oil or pasta cooking water as needed.

83 Pit and chop a cup or more of mixed olives. Combine with olive oil, a little minced garlic, red pepper flakes and chopped basil or parsley. Serve over pasta.

84 Cook chopped tomatillos with a little water or stock, cilantro and a little minced fresh chili; serve over grilled, broiled or sautéed chicken breasts, with corn tortillas.

85 A winning sandwich: bresaola or prosciutto, arugula, Parmesan, marinated artichoke hearts, tomato.

86 Smoked trout fillets served with lightly toasted almonds, shredded fennel, a drizzle of olive oil and a sprinkle of lemon.

87 Grated carrots topped with six-minute eggs (run under cold water until cool before peeling), olive oil and lemon juice.

88 Cut the top off four big tomatoes; scoop out the interiors and mix them with toasted stale baguette or pita, olive oil, salt, pepper and herbs (basil, tarragon, and/or parsley). Stuff into tomatoes and serve with salad.

89 Pasta frittata: Turn cooked pasta and a little garlic into an oiled or buttered skillet. Brown, pressing to create a cake. Flip, then top with three or four beaten eggs and loads of Parmesan. Brown other side and serve.

90 Thai-style beef: Thinly slice one and a half pounds of flank steak, pork shoulder or boneless chicken; heat peanut oil in a skillet, add meat and stir. A minute later, add a tablespoon minced garlic and some red chili flakes. Add 30 clean basil leaves, a quarter cup of water and a tablespoon or two of soy sauce or nam pla. Serve with lime juice and more chili flakes, over rice or salad.

91 Dredge calf’s liver in flour. Sear in olive oil or butter or a combination until crisp on both sides, adding salt and pepper as it cooks; it should be medium-rare. Garnish with parsley and lemon juice.

92 Rub not-too-thick pork or lamb chops with olive oil; sprinkle with salt and pepper plus sage or thyme. Broil about three minutes a side and drizzle with good balsamic vinegar.

93 Cut up Italian sausage into chunks and brown in a little olive oil until just about done. Dump in a lot of seedless grapes and, if you like, a little slivered garlic and chopped rosemary. Cook, stirring, until the grapes are hot. Serve with bread.

94 Ketchup-braised tofu: Dredge large tofu cubes in flour. Brown in oil; remove from skillet and wipe skillet clean. Add a little more oil, then a tablespoon minced garlic; 30 seconds later, add one and a half cups ketchup and the tofu. Cook until sauce bubbles and tofu is hot.

95 Veggie burger: Drain and pour a 14-ounce can of beans into a food processor with an onion, half a cup rolled oats, a tablespoon chili powder or other spice mix, an egg, salt and pepper. Process until mushy, then shape into burgers, adding a little liquid or oats as necessary. Cook in oil about three minutes a side and serve.

96 A Roman classic: In lots of olive oil, lightly cook lots of slivered garlic, with six or so anchovy fillets and a dried hot chili or two. Dress pasta with this.

97 So-called Fettuccine Alfredo: Heat several tablespoons of butter and about half a cup of cream in a large skillet just until the cream starts to simmer. Add slightly undercooked fresh pasta to the skillet, along with plenty of grated Parmesan. Cook over low heat, tossing, until pasta is tender and hot.

98 Rub flank steak or chuck with curry or chili powder before broiling or grilling, then slice thin across the grain.

99 Cook a couple of pounds of shrimp, shell on or off, in oil, with lots of chopped garlic. When they turn pink, remove; deglaze the pan with a half-cup or so of beer, along with a splash of Worcestershire sauce, cayenne, rosemary and a lump of butter. Serve with bread.

100 Cook red lentils in water with a little cumin and chopped bacon until soft. Top with poached or six-minute eggs (run under cold water until cool before peeling) and a little sherry vinegar.

101 Hot dogs on buns — with beans!

Zonbu low energy computer

2007-08-03T15:59:00.000-04:00

NYTimes

July 16, 2007
A PC That Uses Less Energy, but Charges a Monthly Fee
By JOHN MARKOFF

SAN FRANCISCO, July 15 — Subscription-based personal computers are not a new idea — and never popular — but Grégoire Gentil and Alain Rossmann have devised a green twist.

This summer the pair will begin selling a simplified Linux-based PC for $99 and a $12.95 monthly subscription charge. They say that the deal is better than it looks because the 15-watt PC can save up to $10 a month in electricity compared with a standard 200-watt PC.

Their company is Zonbu, and the Zonbu computer will be sold through its Web site, zonbu.com. The founders said that the PC had received the highest certification possible from the Green Electronics Council, a nonprofit group that has created a product classification standard known as Epeat (for Electronic Product Environmental Assessment Tool).

The designation is meant to help consumers make educated choices when buying computer-related equipment and encourage electronics makers to build products that are more energy efficient and have a lower impact on the environment.

Zonbu said that it would be the first desktop computer for consumers to receive the gold rating.

The computer is the size of a cigar box and uses a low-power Intel-compatible microprocessor from VIA Technologies of Taiwan. It comes with four gigabytes of flash memory instead of a disk drive, a spinning mechanical part that uses much of a PC’s power. It also lacks a fan, another big energy user.

The Zonbu PC also uses a Gentoo version of the Linux operating system and will come with a range of software applications like the Mozilla Firefox browser, Skype voice-over-Internet service, OpenOffice software suite and many games. An additional 25 gigabytes of free online storage is available, with more offered for purchase.

Mr. Gentil, the chief executive and a Stanford-educated computer engineer, said that the idea for Zonbu came to him in his frustration over providing extensive computer support to his family in Paris and their various PCs.

“My father was crashing his Windows machine all the time,” Mr. Gentil said. That led him and Mr. Rossmann, a former Apple executive who has started many Silicon Valley companies, to pursue the possibility of creating an appliancelike computer tailored to consumers who have no computer expertise.

The two men think they can sell the PC the same way that cellphones are sold, subsidizing the cost of the hardware with the revenue from the monthly service charge.

“The market we want to target is the second PC in the home,” Mr. Gentil said. “If you want to give a PC to your kids or put it in the kitchen, this is a good candidate.”

Zonbu is based in Menlo Park, Calif. The system will lack a keyboard, mouse and monitor, which the company will sell as options. It plans to sell a version without a service fee to Linux software developers for $250, so that they will create more applications for the Zonbu PC.

The Linux operating system, once the province of computer enthusiasts, has now matured to the point where it could be a commercial rival to Windows and Macintosh, Mr. Gentil said.

Reasons for sex

2007-07-31T04:48:00.000-04:00

NYTimes

July 31, 2007
The Whys of Mating: 237 Reasons and Counting
By JOHN TIERNEY

Scholars in antiquity began counting the ways that humans have sex, but they weren’t so diligent in cataloging the reasons humans wanted to get into all those positions. Darwin and his successors offered a few explanations of mating strategies — to find better genes, to gain status and resources — but they neglected to produce a Kama Sutra of sexual motivations.

Perhaps you didn’t lament this omission. Perhaps you thought that the motivations for sex were pretty obvious. Or maybe you never really wanted to know what was going on inside other people’s minds, in which case you should stop reading immediately.

For now, thanks to psychologists at the University of Texas at Austin, we can at last count the whys. After asking nearly 2,000 people why they’d had sex, the researchers have assembled and categorized a total of 237 reasons — everything from “I wanted to feel closer to God” to “I was drunk.” They even found a few people who claimed to have been motivated by the desire to have a child.

The researchers, Cindy M. Meston and David M. Buss, believe their list, published in the August issue of Archives of Sexual Behavior, is the most thorough taxonomy of sexual motivation ever compiled. This seems entirely plausible.

Who knew, for instance, that a headache had any erotic significance except as an excuse for saying no? But some respondents of both sexes explained that they’d had sex “to get rid of a headache.” It’s No. 173 on the list.

Others said they did it to “help me fall asleep,” “make my partner feel powerful,” “burn calories,” “return a favor,” “keep warm,” “hurt an enemy” or “change the topic of conversation.” The lamest may have been, “It seemed like good exercise,” although there is also this: “Someone dared me.”

Dr. Buss has studied mating strategies around the world — he’s the oft-cited author of “The Evolution of Desire” and other books — but even he did not expect to find such varied and Machiavellian reasons for sex. “I was truly astonished,” he said, “by this richness of sexual psychology.”

The researchers collected the data by first asking more than 400 people to list their reasons for having sex, and then asking more than 1,500 others to rate how important each reason was to them. Although it was a fairly homogenous sample of students at the University of Texas, nearly every one of the 237 reasons was rated by at least some people as their most important motive for having sex.

The best news is that both men and women ranked the same reason most often: “I was attracted to the person.”

The rest of the top 10 for each gender were also almost all the same, including “I wanted to express my love for the person,” “I was sexually aroused and wanted the release” and “It’s fun.”

No matter what the reason, men were more likely to cite it than women, with a couple of notable exceptions. Women were more likely to say they had sex because, “I wanted to express my love for the person” and “I realized I was in love.” This jibes with conventional wisdom about women emphasizing the emotional aspects of sex, although it might also reflect the female respondents’ reluctance to admit to less lofty motives.

The results contradicted another stereotype about women: their supposed tendency to use sex to gain status or resources.

“Our findings suggest that men do these things more than women,” Dr. Buss said, alluding to the respondents who said they’d had sex to get things, like a promotion, a raise or a favor. Men were much more likely than women to say they’d had sex to “boost my social status” or because the partner was famous or “usually ‘out of my league.’ ”

Dr. Buss said, “Although I knew that having sex has consequences for reputation, it surprised me that people, notably men, would be motivated to have sex solely for social status and reputation enhancement.”

But then, men were also more likely than women to say they’d had sex because “I was slumming.” Or simply because “the opportunity presented itself,” or “the person demanded that I have sex.”

If nothing else, the results seem to be a robust confirmation of the hypothesis in the old joke: How can a woman get a man to take off his clothes? Ask him.

To make sense of the 237 reasons, Dr. Buss and Dr. Meston created a taxonomy with four general categories:

Physical: “The person had beautiful eyes” or “a desirable body,” or “was good kisser” or “too physically attractive to resist.” Or “I wanted to achieve an orgasm.”

Goal Attainment: “I wanted to even the score with a cheating partner” or “break up a rival’s relationship” or “make money” or “be popular.” Or “because of a bet.”

Emotional: “I wanted to communicate at a deeper level” or “lift my partner’s spirits” or “say ‘Thank you.’ ” Or just because “the person was intelligent.”

Insecurity: “I felt like it was my duty” or “I wanted to boost my self-esteem” or “It was the only way my partner would spend time with me.”

Having sex out of a sense of duty, Dr. Buss said, showed up in a separate study as being especially frequent among older women. But both sexes seem to practice a strategy that he calls mate-guarding, as illustrated in one of the reasons given by survey respondents: “I was afraid my partner would have an affair if I didn’t.”

That fear seems especially reasonable after you finish reading Dr. Buss’s paper and realize just how many reasons there are for infidelity. Some critics might complain that the list has some repetitions — it includes “I was curious about sex” as well as “I wanted to see what all the fuss was about” — but I’m more concerned about the reasons yet to be enumerated.

For instance, nowhere among the 237 reasons will you find the one attributed to the actress Joan Crawford: “I need sex for a clear complexion.” (The closest is “I thought it would make me feel healthy.”)Nor will you find anything about gathering rosebuds while ye may (the 17th-century exhortation to young virgins from Robert Herrick). Nor the similar hurry-before-we-die rationale (“The grave’s a fine and private place/ But none I think do there embrace”) from Andrew Marvell in “To His Coy Mistress.”

From even a cursory survey of literature or the modern mass market in sex fantasies, it seems clear that this new taxonomy may not be any more complete than the original periodic table of the elements.

When I mentioned Ms. Crawford’s complexion and the poets’ rationales to Dr. Buss, he promised to consider them and all other candidates for Reason 238.

You can nominate your own reasons at TierneyLab. You can also submit nominations for a brand new taxonomy: reasons for just saying “No way!” Somehow, though, I don’t think this list will be as long.

Cat visits indicate impending death - NEJM

2007-07-26T03:46:00.000-04:00

July 26, 2007
Oscar the Cat Predicts Patients' Deaths
By THE ASSOCIATED PRESS

Filed at 3:15 a.m. ET

PROVIDENCE, R.I. (AP) -- Oscar the cat seems to have an uncanny knack for predicting when nursing home patients are going to die, by curling up next to them during their final hours. His accuracy, observed in 25 cases, has led the staff to call family members once he has chosen someone. It usually means they have less than four hours to live.

''He doesn't make too many mistakes. He seems to understand when patients are about to die,'' said Dr. David Dosa in an interview. He describes the phenomenon in a poignant essay in Thursday's issue of the New England Journal of Medicine.

''Many family members take some solace from it. They appreciate the companionship that the cat provides for their dying loved one,'' said Dosa, a geriatrician and assistant professor of medicine at Brown University.

The 2-year-old feline was adopted as a kitten and grew up in a third-floor dementia unit at the Steere House Nursing and Rehabilitation Center. The facility treats people with Alzheimer's, Parkinson's disease and other illnesses.

After about six months, the staff noticed Oscar would make his own rounds, just like the doctors and nurses. He'd sniff and observe patients, then sit beside people who would wind up dying in a few hours.

Dosa said Oscar seems to take his work seriously and is generally aloof. ''This is not a cat that's friendly to people,'' he said.

Oscar is better at predicting death than the people who work there, said Dr. Joan Teno of Brown University, who treats patients at the nursing home and is an expert on care for the terminally ill

She was convinced of Oscar's talent when he made his 13th correct call. While observing one patient, Teno said she noticed the woman wasn't eating, was breathing with difficulty and that her legs had a bluish tinge, signs that often mean death is near.

Oscar wouldn't stay inside the room though, so Teno thought his streak was broken. Instead, it turned out the doctor's prediction was roughly 10 hours too early. Sure enough, during the patient's final two hours, nurses told Teno that Oscar joined the woman at her bedside.

Doctors say most of the people who get a visit from the sweet-faced, gray-and-white cat are so ill they probably don't know he's there, so patients aren't aware he's a harbinger of death. Most families are grateful for the advanced warning, although one wanted Oscar out of the room while a family member died. When Oscar is put outside, he paces and meows his displeasure.

No one's certain if Oscar's behavior is scientifically significant or points to a cause. Teno wonders if the cat notices telltale scents or reads something into the behavior of the nurses who raised him.

Nicholas Dodman, who directs an animal behavioral clinic at the Tufts University Cummings School of Veterinary Medicine and has read Dosa's article, said the only way to know is to carefully document how Oscar divides his time between the living and dying.

If Oscar really is a furry grim reaper, it's also possible his behavior could be driven by self-centered pleasures like a heated blanket placed on a dying person, Dodman said.

Nursing home staffers aren't concerned with explaining Oscar, so long as he gives families a better chance at saying goodbye to the dying.

Oscar recently received a wall plaque publicly commending his ''compassionate hospice care.''

------

Science writer Alicia Chang in Los Angeles contributed to this report.

Volume 357:328-329 July 26, 2007 Number 4

A Day in the Life of Oscar the Cat
David M. Dosa, M.D., M.P.H.

Oscar the Cat awakens from his nap, opening a single eye to survey his kingdom. From atop the desk in the doctor's charting area, the cat peers down the two wings of the nursing home's advanced dementia unit. All quiet on the western and eastern fronts. Slowly, he rises and extravagantly stretches his 2-year-old frame, first backward and then forward. He sits up and considers his next move.

In the distance, a resident approaches. It is Mrs. P., who has been living on the dementia unit's third floor for 3 years now. She has long forgotten her family, even though they visit her almost daily. Moderately disheveled after eating her lunch, half of which she now wears on her shirt, Mrs. P. is taking one of her many aimless strolls to nowhere. She glides toward Oscar, pushing her walker and muttering to herself with complete disregard for her surroundings. Perturbed, Oscar watches her carefully and, as she walks by, lets out a gentle hiss, a rattlesnake-like warning that says "leave me alone." She passes him without a glance and continues down the hallway. Oscar is relieved. It is not yet Mrs. P.'s time, and he wants nothing to do with her.

Oscar jumps down off the desk, relieved to be once more alone and in control of his domain. He takes a few moments to drink from his water bowl and grab a quick bite. Satisfied, he enjoys another stretch and sets out on his rounds. Oscar decides to head down the west wing first, along the way sidestepping Mr. S., who is slumped over on a couch in the hallway. With lips slightly pursed, he snores peacefully — perhaps blissfully unaware of where he is now living. Oscar continues down the hallway until he reaches its end and Room 310. The door is closed, so Oscar sits and waits. He has important business here.

Twenty-five minutes later, the door finally opens, and out walks a nurse's aide carrying dirty linens. "Hello, Oscar," she says. "Are you going inside?" Oscar lets her pass, then makes his way into the room, where there are two people. Lying in a corner bed and facing the wall, Mrs. T. is asleep in a fetal position. Her body is thin and wasted from the breast cancer that has been eating away at her organs. She is mildly jaundiced and has not spoken in several days. Sitting next to her is her daughter, who glances up from her novel to warmly greet the visitor. "Hello, Oscar. How are you today?"

Oscar takes no notice of the woman and leaps up onto the bed. He surveys Mrs. T. She is clearly in the terminal phase of illness, and her breathing is labored. Oscar's examination is interrupted by a nurse, who walks in to ask the daughter whether Mrs. T. is uncomfortable and needs more morphine. The daughter shakes her head, and the nurse retreats. Oscar returns to his work. He sniffs the air, gives Mrs. T. one final look, then jumps off the bed and quickly leaves the room. Not today.

Making his way back up the hallway, Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.

One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.

Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.

On his way back to the charting area, Oscar passes a plaque mounted on the wall. On it is engraved a commendation from a local hospice agency: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat." Oscar takes a quick drink of water and returns to his desk to curl up for a long rest. His day's work is done. There will be no more deaths today, not in Room 310 or in any other room for that matter. After all, no one dies on the third floor unless Oscar pays a visit and stays awhile.

Note: Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves.

waubers's China Impressions

2007-07-15T16:46:00.000-04:00

Ars

First off, Shenzhen China is an arm-pit of a city. Don't go there unless you have to.

If you do go there, the only good hotel (i.e. one with anyone who speaks any English and a level of quality at least as good as a holiday inn in the USA) is the Dragon Spring.

Some points on the Dragon Spring Hotel:
1. The lobby smells of fish.
2. The AC in your room only runs in spurts. It will typically stop working around 23:00, so do try to fall asleep by then, unless you enjoy falling asleep in your own sweat.
3. If you drop a duce, be sure you flush before you put any TP into the bowl. All 3 of us in my group managed to plug up the shitter. Sadly, it was a Kohler Toilet, which you'd think could handle my decadent western shits.
4. Don't eat the steamed buns at breakfast. Seriously, this wasn't a joke and we didn't know. We all ate a couple our first day and one guy even said "these taste like paper." We found out about the news story the next day.
5. Orange Juice = Orange Fanta; Apple Juice = Pineapple Fanta; Haw Juice = whothefuckknows.
6. Don't pour your own beer into your glass, you make the servers look sad when you do that.

If, like my companions, you feel the need to go out drinking every night you're traveling for work, and you happen to be staying at the Dragon Spring hotel DO NOT patronize the Dragon Spring Garden Opera House Bar and Lounge. If you do, some tips:

1. FOR THE LOVE OF GOD, REFUSE ANY GIRLS WHO TRY TO SIT WITH YOU!
2. DON'T LET THE MADAME SIT ANY GIRLS WITH YOU.
3. Don't nod your head when they say "you like beer but not girl" This is a question, not a funny statement.
4. DON'T LET THEM SIT ANY GUYS AT YOUR TABLE.
5. DON'T LET THEM SIT THE MUSICAL ACT AT YOUR TABLE, they will drink all your beer, which is amazing because they couldn't have weighed more than 160lbs combined.
6. REFUSE THE FRUIT PLATE, it's $290cny
7. When you try to leave, regardless of how drunk you might be, don't get off on the 6th floor, even if it's the first floor the elevator opens on. It's a brothel. With women.
8. When asked, do not follow the hostess to the 5th floor. It's a brothel. With no women.
9. Always know where your buddy is, lest he be abducted.
10. Laugh at the jokes of the comedian, even though you can't understand them.
11. Tsing Tao is pronounced Chee-ing Tao.
12. DO NOT LET YOUR MANAGER SIGN YOUR NAME AND ROOM TO THE BILL. I have know idea how I'm going to explain a 1200CNY bill for "Night Club" to accounting, even though I only had three beers.
13. You might be a Westerner, but FOR THE LOVE OF GOD YOU ARE NOT A VIP, and as such, DO NOT PRESS THE VIP BUTTON IN THE ELEVATOR.

Observations on Hong Kong.
1. Hong Kong is hot!
2. Hong Kong IS FUCKING HOT, wear deodorant on your balls.
3. Hong Kong is awesome, easily the coolest city I've ever seen.
4. Visit Victoria Peak at night, it's awe-inspiring.
5. Take a taxi to Victoria Peak, the tram is fucking scary.
6. The waiters at Bubba Gump Shrimp (on top of Victoria Peak) are pretty cool.
7. Hong Kong has a city-wide lazer and fireworks show every Saturday night, it's sweet, especially when you're a couple thousand feet above the city.
8. DRINK LOTS OF WATER. It's a bad sign when you stop sweating an it's 35C outside.
9. Remember that beer != water, even beer as watery as Tsing Tao.
10. Taxi's are a very reasonable way to get around the city.
11. The SkyLounge at the Hotel Nikko is awesome, but for the love of god be careful what you order. I still don't know how we're going to explain a $400us bar-tab with only 3 people drinking, for less than 2 hours.
12. The SkyLounge has impeccable service.
13. Hong Kong is very very expensive.
14. Everyone should visit Hong Kong, it's truly an amazing city. More impressive than London or Paris. IMO.

Energy saving in NYC buildings

2007-07-14T15:28:00.000-04:00

NYTimes

July 15, 2007
The Cost of Saving Energy
By J. ALEX TARQUINIO

NEW YORKERS have often been told that they use less energy than most Americans, partly because they live in the most densely populated city in the country.

And that’s true, up to a point.

Sure, New Yorkers have the benefit of an extensive mass-transit system, which means lower auto emissions, but the city’s residential buildings are less energy-efficient than those in many other places in the country, particularly in eco-friendly states like California and Vermont.

“The main reason that New Yorkers use much less electricity is that our apartments are so much smaller” than homes in other cities, said Rohit Aggarwala, the director of the Long-Term Planning and Sustainability Office, part of the Mayor’s Office of Operations.

In fact, most big New York buildings, both commercial and residential, are wasting thousands of dollars a year on energy, the city says. Energy use by buildings accounts for almost 80 percent of the city’s greenhouse gas emissions, and residential buildings for about a third of that. These gases are released in creating the energy used to heat, cool and light the buildings, as well as to run myriad household appliances and gadgets.

Mayor Michael R. Bloomberg has created a blueprint, called PlaNYC, to control future development in the city, with a goal of reducing total greenhouse gas emissions in 2030 by 30 percent, compared with 2005 levels.

While some reductions can be accomplished by toughening the requirements for new construction, about 85 percent of the buildings that will exist in the city in 2030 are already standing.

And those buildings need to go on an energy diet.

There are a number of relatively inexpensive things that residential buildings could do that would immediately lower their energy costs and that would reduce their “carbon footprints,” the emissions these buildings are responsible for, Mr. Aggarwala said.

The easiest, and cheapest, is to install energy-efficient light bulbs in all common areas. More expensive plans — the costs of which can often be offset by loans and grants from New York State — include replacing old inefficient boilers with more efficient modern ones and installing solar panels on the roof.

Ashok Gupta, a senior energy economist and the director of the air and energy program at the Natural Resources Defense Council, a nonprofit environmental group in New York, said many buildings start with the least expensive measures with the biggest immediate payoff — buying fluorescent bulbs for about $4 each, for example, or thermostatic radiator valves for about $90 each.

But that is where a lot of buildings stop, and Mr. Gupta said he would like to see them reach a bit further, to measures whose costs could be recouped in two to five years. The next step, for example, might be installing motion sensors that would dim the lights by 50 percent when the hallways and stairwells were not in use.

In a 60,000-square-foot building with 40 apartments, hiring an electrician to install motion sensors might cost $11,000, according to estimates produced by Optimal Energy Inc., a consulting company in Bristol, Vt., that has done regional energy-efficiency studies for New York State and Con Edison. The building could save that much in lower electricity bills over two years, assuming that it was already using fluorescent bulbs, and the sensors alone would reduce its carbon dioxide emissions by about 40 metric tons per year, the company said.

That would be the equivalent of driving a car that gets 25 miles per gallon for 110,250 miles, according to Dr. Stuart Gaffin, an associate research scientist at the Center for Climate Systems Research at Columbia University.

As you would expect, it would take longer to recoup the costs of the more expensive measures.

Optimal Energy estimates, for example, that it would cost about $20,000 to weatherize that 60,000-square-foot apartment building, which could be paid for by five years of lower heating bills. Weatherizing would include sealing gaps around windows, exterior doors, and interior pipes and wiring.

Some residential buildings might also consider installing solar panels on the roof, to provide a nonpolluting source of electricity to light the hallways and run the elevators. Experts recommend doing this only after more glaring energy inefficiencies have been addressed, because in a large apartment house, solar panels are not going to produce enough energy to replace Con Edison.

Solar requires patience. It could take up to 15 years to break even on $19,000 spent on solar panels, and that is after subsidies and tax breaks offered by the state and federal governments. Mayor Bloomberg has proposed an additional subsidy for installing solar panels on buildings in New York City.

Mr. Gupta of the Natural Resources Defense Council contends that environmentalists often sell themselves short by focusing too much on payback periods. “Nobody asks what the payback period is for a marble lobby,” he said. But if a lot of large commercial and residential buildings installed solar panels, he said, that could go a long way toward reducing the city’s overall impact on global warming.

“From a societal perspective, the benefits are huge,” Mr. Gupta said.

As it stands, very few apartment buildings in New York have taken the first step and hired energy consultants. The first step most consultants suggest is to switch to fluorescent bulbs (a cheap fix), and then to solve the heating problems (to keep residents from being uncomfortable).

The Towers Cooperative, an eight-building complex with 111 apartments in Jackson Heights, Queens, last year hired Power Concepts, an energy auditor in Manhattan.

Once the audit was done, Bobbi Turner, the building’s manager, sat down with the board. They decided to start with the fixes that their in-house maintenance staff could do — for example, installing fluorescent bulbs as the old incandescents burned out. Ms. Turner said the electricity bills for the common areas were 7 percent lower last year than in 2005.

For now, Ms. Turner and the board have decided to forgo many costlier measures that were recommended, including installing separate boilers for hot water and heat to cut down on the fuel the co-op uses in the warm weather when residents need hot water but not heat.

It would have cost $86,000 to do this in all eight buildings, with a payback period of five and a half years.

But the buildings’ staff did implement other suggested improvements to the heating system, which included installing thermostatic radiator valves in all apartments.

“Our job is to make sure that we are doing things as efficiently as possible,” Ms. Turner said.

The co-op did not have a maintenance increase this year, and Ms. Turner attributes this largely to the cost savings from the efficiency measures that have been implemented so far.

Other buildings have needed to take more extensive measures to solve more complicated problems.

At 395 Riverside Drive, a 15-story co-op at the corner of 112th Street, the apartments on the west side of the building were often cold because of wintertime blasts of wind off the Hudson River. If the heat was turned up to offset the cold, apartments on the east side of the building got too hot.

The board at 395 Riverside Drive ordered an energy audit from the Association for Energy Affordability, based in Manhattan, which recommended installing additional heat sensors and upgrading the computer that regulated the heat.

These changes were made last fall, at a cost of almost $8,000. The building paid $8,500 less on fuel bills, a decrease of nearly 16 percent, from December 2006 to April 2007, despite a spike in heating oil prices, according to the building’s management company.

And the residents were more comfortable, said Dr. Eric Linden, a periodontist who is a former vice president of the co-op board.

The building also replaced the bulbs in the hallways with fluorescents, although, as at the co-op in Queens, the in-house staff replaced them gradually.

Dr. Linden credits these changes with keeping a lid on maintenance. The monthly fees, which range from $500 to $2,200, depending on the size of the apartment, rose 3 percent this spring.

“But we might have had to raise them 4 to 6 percent if the energy costs had gotten completely out of control,” Dr. Linden said.

Remarkably, the age of a building seems to have no correlation with how energy efficient or inefficient it is. Some of New York City’s most efficient are old brick-and-mortar buildings “that just have amazingly good maintenance staff,” said Michael Colgrove, a senior project manager at New York State Energy Research Authority, whose goal is to make multifamily buildings more efficient.

On the flip side, Mr. Colgrove said, owners in condominiums built 5 or 10 years ago should not be complacent. “Almost all new construction in this city can easily improve their energy efficiency by 20 percent,” he said.

Daniel M. Krainin, a lawyer who is the president of a Brooklyn co-op, had an energy audit done for his building, a converted brownstone with eight apartments in Park Slope.

F. L. Andrew Padian, the director of multifamily services at Steven Winter Associates, an architecture and engineering firm in Norwalk, Conn., that performed the audit, recommended five measures. So far, the co-op has acted on only one, installing a mixing valve on the boiler for $550. Mr. Krainin said that this cut the building’s oil bill by more than $400 in the last year.

Sometimes, Mr. Padian said, cutting fuel use is simply a matter of recalibrating some controls. “When I can walk in with a screwdriver and cut energy bills by 40 percent, people are really happy,” he said. “In other buildings, the old boiler is responsible for 85 percent of the energy waste.”

The four other measures that he recommended for the building would cost about $30,000 in all: replacing the old boiler with an efficient unit, replacing the old beat-up windows with new double-paned windows, insulating the roof and installing motion sensors on the lights in the basement.

“Thirty thousand dollars would be a lot of money for a co-op our size,” Mr. Krainin said.

After reading the audit report, residents voiced their reservations until they learned that the co-op could finance the work with a below-market loan subsidized by the state.

“Now everyone is sold on the idea that if we can do it without increasing the maintenance fees, then it makes sense,” Mr. Krainin said. “But I think we might have had more objections if we’d gotten to the point that it would cost people money in the form of higher maintenance fees or a surcharge.”

That may be the sentiment of many co-op and condo boards now, but energy-efficiency experts say that attitudes are changing fast.

Jonathan F. P. Rose, a New York developer who specializes in energy-efficient construction, said the public is much more aware of environmental issues like global warming than it was a few years ago.

Developers are racing to build new condominiums that can be marketed as “green.” And Mr. Rose said that older condos and co-ops could distinguish themselves with “energy smart building” certificates if they successfully completed the new state energy-efficiency program and cut their energy use by 20 percent.

“This isn’t a fad,” Mr. Rose said. “I think this is a cultural transition. In the future, I think there will be such a preference for green buildings that those buildings will have an edge.”

Doctor errors

2007-07-12T22:55:00.000-04:00

NYTimes

July 7, 2007
Op-Ed Contributor
Mental Malpractice
By JEROME GROOPMAN

Boston

ONE kind of new year comes for all of us in January — the one we celebrate with Champagne. But another, more stressful new year begins for doctors in July, when the new interns arrive in our emergency rooms, clinics and wards. Hospital personnel have always joked, “Don’t get sick in July,” since for decades the trainees were loosely supervised.

Today, most hospitals closely watch over interns. But at the start of this new medical year, a significant deficiency remains in the system: the way in which doctors are trained to think.

One of my first experiences with the problem came in 1983, during the first week in July as it happens, when my wife, Pam, also a doctor, and I were traveling to Boston from California with our son Steven, then 9 months old. Steve had developed a low-grade fever, had dark and loose stools and was irritable, refusing to nurse. Stopping in Connecticut to visit my in-laws, we consulted the town pediatrician. The doctor quickly dismissed Pam’s concerns. “You’re overanxious,” he told her. “Doctor-parents are like this.”

By the time we arrived in Boston, the baby was ashen and he was jerking his knees to his chest and wailing in pain. We rushed to the emergency room at Children’s Hospital, where a new surgical resident examined him, ordered X-rays and blood tests and made the correct diagnosis: an intussusception, an intestinal obstruction. It was a hectic night, and the novice doctor was being pulled in many directions. He told us there was no urgency to operate and left us alone with our flailing child.

I had worked one year in a research lab at this hospital and phoned the senior hematologist who had been my mentor. He contacted an attending surgeon, who came to the emergency room and whisked Steve to the operating room. “It was fortunate that we operated when we did,” the surgeon told us later. The intestine was at the point of bursting, spilling its contents into the abdomen, precipitating peritonitis and possibly shock.

Today at Children’s Hospital, you no longer need to know a powerful member of the staff. Every intern’s plan of treatment is validated by an attending doctor as part of the “patient safety movement.” Systematic checks and double checks also have been instituted to guard against logistical mistakes, like mixing up blood samples in the laboratory or labeling “left” as “right” on a limb X-ray.

Still, doctors get their diagnoses wrong 15 percent to 20 percent of the time, and half of these mistakes result in serious harm or even death — because the majority of misdiagnoses result from errors in thinking, not logistics.

In analyzing patients’ problems, doctors look for typical signs and symptoms. Often after listening to a patient’s complaints for just 18 seconds, studies show, a doctor will interrupt, having already formulated his or her diagnosis. Too often, shortcuts lead in the wrong direction.

As a young doctor, I had an elderly patient who complained of discomfort under her breastbone. I examined her, performed several tests and quickly concluded that she had indigestion. The antacids I prescribed brought little relief, but my mind was so fixed that her persistent complaints sounded to me like a nail scratching a chalkboard.

Several weeks later, I was paged to the emergency room. The woman was in shock. The discomfort under her breastbone, it turned out, had been caused by a tear in her aorta. After she died, my colleagues commiserated, saying that a torn aorta can be hard to diagnose, that the woman was so old that she probably would not have survived surgery to repair the tear. But that provided cold comfort, and I have never forgotten, nor forgiven myself.

In some hospitals, mistakes are categorized as “E.T.” for errors in technique and “E.J.” for errors in judgment. Errors in technique might involve placing a needle too far into the chest and puncturing a lung or inserting a breathing tube into the esophagus instead of the trachea — mistakes that, with practice, doctors can learn to stop making.

Errors in judgment are not so easily avoided, because we have largely failed to learn anything about how we think. Modern clinical practice has incorporated DNA analysis to illuminate the causes of disease, robotics to facilitate operations in the brain and computers to refine M.R.I. images, but we have paid scant attention to the emerging science of cognitive psychology, which could help us explore how we make decisions.

This science has grown from the work of Amos Tversky and Daniel Kahneman, who some three decades ago began a series of experiments to examine how people make choices when they are uncertain. Economists have used their work to understand why people in the marketplace often make irrational decisions. People invest in a company because their relatives did in the past, for example, or they choose a fund manager simply because he outperformed the market two years in a row.

This growing body of research can illuminate many irrational aspects of medical decision-making, too. The snap judgments that doctors make, for example, can be understood as “anchoring errors”; the first symptoms anchor the doctor’s mind on an incorrect diagnosis. Doctors also fall into a cognitive trap known as “availability,” meaning that we too readily recall our most recent or dramatic clinical experiences and assume they correspond to a new patient’s problem.

We make “affective” errors, too, letting our feelings color our thinking. Such feelings may be drawn from stereotypes — the Connecticut pediatrician casting my wife as overanxious or my viewing my elderly patient as a chronic complainer — or they may be excessively positive. Too much empathy may keep a doctor from performing an uncomfortable procedure that is vital to making the correct diagnosis.

I have started teaching these concepts of cognitive psychology in continuing medical education courses, and recently used my misdiagnosis of the torn aorta to illustrate the common thinking trap. My wife, Pam, has introduced fourth-year medical students at our hospital to the cognitive detours doctors commonly take. But such instruction needs to be widespread. In classes and on hospital rounds, medical schools and hospitals should teach doctors why some diagnoses succeed and why some fail. And as part of the assessment of clinical competency for obtaining a license, doctors should be expected to demonstrate their fluency in the application of cognitive science, as they are required to do in other sciences.

Once we are schooled in the way we think, we will also be better able to answer questions from patients and their families about how we arrive at our diagnoses. And that may make everyone more confident about visiting a clinic or a hospital in July.

Jerome Groopman, a professor of medicine at Harvard, is the author, most recently, of “How Doctors Think.”

iPhone parts and profit margin

2007-07-03T16:06:00.000-04:00

Apple sees fat margins with iPhone, report says
'Teardown' analysis finds device is more profitable than iPod, Apple TV

By Rex Crum, MarketWatch
Last Update: 1:59 PM ET Jul 3, 2007
SAN FRANCISCO (MarketWatch) -- Hot on the heels of the iPhone launch, shares of Apple Inc. jumped to a new all-time high Tuesday following a report on the high profit margins the company is likely to earn from the device. Shares of Apple were up nearly 5% to close at $127.17 during a shortened trading session Tuesday, on a volume of 41.3 million shares. Normal daily average is 28.9 million shares.

That set a new closing high for a stock that has gained nearly 50% since the company introduced the iPhone in early January. The device went on sale Friday to long lines of customers, some of whom camped out on the street to save their place. The action followed a report earlier in the day by technology-research firm iSuppli, which found after taking apart an 8-gigabyte iPhone that producing the device costs Apple about $266 for the hardware. Based on the $599 price tag of the 8-gigabyte iPhone, the company stands to record gross margins of more than 55% for every unit sold, the report said. According to iSuppli, those profits would be even greater that the 40% to 50% margins Apple earns from the various versions of its iPod device. The company's new Apple TV set-top box has margins of about 21%, iSuppli added, after performing "teardown" analysis on those devices as well. Apple stands to record gross margins of more than 55% for every unit sold, according to iSuppli. Apple hopes to sell about 10 million iPhones within a year and claim 1% of the mobile-phone market. ISuppli estimates that Apple will sell 4.5 million iPhones this year and 13.5 million in 2008.

According to iSuppli, the iPhone's component suppliers run the gamut of semiconductor and other technology names. The research firm said that Samsung Electronics is "perhaps the biggest winner" among the iPhone parts suppliers, with its components making up $76.25, or about 30.5% of the parts in the 8GB iPhone. Samsung's contributions include the device's applications processor, NAND flash and DRAM memory chips. Infineon Technologies AG found its way into the iPhone with its digital baseband, radio-frequency transceiver and power-management technologies, and National Semiconductor Corp. supplies the chip that connects the iPhone's display to its graphics controller. ISuppli said the touch-screen, considered to be one of the iPhone's top selling points, is supplied by Epson, Sharp and Toshiba Matsushita, while the display module is provided by German company Balda and its Chinese partner, TPK Holdings.
Other companies in the iPhone include Marvell Technology Group with its Wi-Fi baseband chip; CSR PLC, which provides the iPhone's Bluetooth technology; and Wolfson Microelectronics, which makes the audio-processing chip. Also on Tuesday, media outlets reported that Apple's carrier partner AT&T Inc. has fixed the issues that caused some iPhone buyers long delays in getting their wireless service activated.

HIPAA misunderstandings

2007-07-03T08:00:00.000-04:00

NYTimes

July 3, 2007
Keeping Patients’ Details Private, Even From Kin
By JANE GROSS

An emergency room nurse in Palos Heights, Ill., told Gerard Nussbaum he could not stay with his father-in-law while the elderly man was being treated after a stroke. Another nurse threatened Mr. Nussbaum with arrest for scanning his relative’s medical chart to prove to her that she was about to administer a dangerous second round of sedatives.

The nurses who threatened him with eviction and arrest both made the same claim, Mr. Nussbaum said: that access to his father-in-law and his medical information were prohibited under the Health Insurance Portability and Accountability Act, or Hipaa, as the federal law is known.

Mr. Nussbaum, a health care and Hipaa consultant, knew better and stood his ground. Nothing in the law prevented his involvement. But the confrontation drove home the way Hipaa is misunderstood by medical professionals, as well as the frustration — and even peril — that comes in its wake.

Government studies released in the last few months show the frustration is widespread, an unintended consequence of the 1996 law.

Hipaa was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply Hipaa regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Some reports blame the language of the law itself, which says health care providers may share information with others unless the patient objects, but does not require them to do so. Thus, disclosures are voluntary and health care providers are left with broad discretion.

The unnecessary secrecy is a “significant problem,” said Mark Rothstein, chairman of a privacy subcommittee that advises the Department of Health and Human Services, which administers Hipaa. “It’s drummed into them that there are rules they have to follow without any perspective,” he said about health care providers. “So, surprise, surprise, they approach it in a defensive, somewhat arbitrary and unreasonable way.”

Susan McAndrew, deputy director of health information privacy at the Department of Health and Human Services, said that problems were less frequent than they once had been but that health care providers continued to hide behind the law. “Either innocently or purposefully, entities often use this as an excuse,” she said. “They say ‘Hipaa made me do it’ when, in fact, they chose for other reasons not to make the permitted disclosures.”

Mr. Rothstein, one of Hipaa’s harshest critics, has led years of hearings across the country. Transcripts of those hearings, and accounts from hospital administrators, patient advocates, lawyers, family members, and law enforcement officials offer an anthology of Hipaa misinterpretations, some alarming, some annoying:

¶Birthday parties in nursing homes in New York and Arizona have been canceled for fear that revealing a resident’s date of birth could be a violation.

¶Patients were assigned code names in doctor’s waiting rooms — say, “Zebra” for a child in Newton, Mass., or “Elvis” for an adult in Kansas City, Mo. — so they could be summoned without identification.

¶Nurses in an emergency room at St. Elizabeth Health Center in Youngstown, Ohio, refused to telephone parents of ailing students themselves, insisting a friend do it, for fear of passing out confidential information, the hospital’s patient advocate said.

¶State health departments throughout the country have been slowed in their efforts to create immunization registries for children, according to Dr. James J. Gibson, the director of disease control in South Carolina, because information from doctors no longer flows freely.

Teaching staff to protect records is easier than teaching them to share them, said Robert N. Swidler, general counsel for Northeast Health, a nonprofit network in Troy, N.Y., that includes several hospitals.

“Over time, the staff has become a little more flexible and humane,” Mr. Swidler said. “But nurses aren’t lawyers. This is a hyper-technical law and it tells them they may disclose but doesn’t say they have to.”

Many experts, including critics like Mr. Rothstein and proponents like Ms. McAndrew, distinguish different categories of secrecy.

There are “good faith nondisclosures,” as when a floor nurse takes a phone call from someone claiming to be a family member but cannot verify that person’s identity. Then there are “bad faith nondisclosures,” like using Hipaa as an excuse for not taking the time to gather records that public health officials need to help child abuse investigators trying to build a case.

Most common are seat-of-the-pants decisions made by employees who feel safer saying “no” than “yes” in the face of ambiguity.

That seemed to be what happened to his own mother, Mr. Rothstein said, when she called her doctor’s office to discuss a problem. She was told by the receptionist that the doctor was not available, Mr. Rothstein said, and then inquired if the doctor was with a patient or out of the office. “I can’t tell you because of Hipaa,” came the reply. In fact the doctor was home sick, which would have been helpful information in deciding whether to wait for a call back or head for the emergency room.

The law, medical professionals and privacy experts said, has had the positive effect of making confidentiality a priority as the nation moves toward fully computerized, cradle-to-grave medical records.

But safeguarding electronic privacy required a tangle of regulations issued in 2003, followed last year by 101 pages of “administrative simplification.”

Senator Edward M. Kennedy, Democrat of Massachusetts, a sponsor of the original insurance portability law, was dismayed by the “bizarre hodgepodge” of regulations layered onto it, several staff members said, and by the department’s failure to provide “adequate guidance on what is and is not barred by the law.” To that end, Mr. Kennedy, along with Senator Patrick M. Leahy, Democrat of Vermont, plans to introduce legislation creating an office within the Department of Health and Human Services dedicated to interpreting and enforcing medical privacy.

“In this electronic era it is essential to safeguard the privacy of medical records while insuring our privacy laws do not stifle the flow of information fundamental to effective health care,” Mr. Kennedy said.

This spring, the department revised its Web site, www.hhs.gov/ocr/hipaa, in the interest of clarity. But Hipaa continues to baffle even the experts.

Ms. McAndrew explained some of the do’s and don’ts of sharing information in a telephone interview:

Medical professionals can talk freely to family and friends, unless the patient objects. No signed authorization is necessary and the person receiving the information need not have the legal standing of, say, a health care proxy or power of attorney. As for public health authorities or those investigating crimes like child abuse, Hipaa defers to state laws, which often, though not always, require such disclosure. Medical workers may not reveal confidential information about a patient or case to reporters, but they can discuss general health issues.

Ms. McAndrew said there was no way to know how often information was withheld. Of the 27,778 privacy complaints filed since 2003, the only cases investigated, she said, were complaints filed by patients who were denied access to their own information, the one unambiguous violation of the law.

Complaints not investigated include the plights of adult children looking after their parents from afar. Experts say family members frequently hear, “I can’t tell you that because of Hipaa,” when they call to check on the patient’s condition.

That is what happened to Nancy Banks, who drove from Bartlesville, Okla., to her mother’s bedside at Town and Country Hospital in Tampa, Fla., last week because Ms. Banks could not find out what she needed to know over the telephone.

Her 82-year-old mother had had a stroke. When Ms. Banks called her room she heard her mother “screaming and yelling and crying,” but conversation was impossible. So Ms. Banks tried the nursing station.

Whoever answered the phone was not helpful, so Ms. Banks hit the road. Twenty-two hours later, she arrived at the hospital.

But more of the same awaited her. She said her mother’s nurse told her that “because of the Hipaa laws I can get in trouble if I tell you anything.”

In the morning, she could speak to the doctor, she was told.

The next day, Ms. Banks was finally informed that her mother had had heart failure and that her kidneys were shutting down.

“I understand privacy laws, but this has gone too far,” Ms. Banks said. “I’m her daughter. This isn’t right.”

A hospital spokeswoman, Elena Mesa, was asked if nurses were following Hipaa protocol when they denied adult children information about their parents.

She could not answer the question, Ms. Mesa said, because Hipaa prevented her from such discussions with the press.

Freerunning LA

2007-06-29T00:19:00.000-04:00

NYTimes

June 29, 2007
Throwing Yourself Against the Wall
By ETHAN TODRAS-WHITEHILL

THE brick wall was only three feet high, but thick, capped by an unforgiving slab of concrete. “So you want to dive headfirst at it,” Cliff Kravit, 27, standing by my side, was explaining, his waist-length hair pulled back in a ponytail. “You have to commit to it. Trust yourself.”

To demonstrate the move, known as the Kong jump, Mr. Kravit’s fellow traceurs flew at the wall, and just when it looked as if they would snap a shin, rib or collarbone, slapped their hands on the far edge of the top of the wall and whipped their legs through like gorillas hurtling a pommel horse. They went over in succession, each landing beyond the wall and segueing fluidly into a roll on the grass. Silverton Nguyen, 21, the last to go, dispensed with the wall-slap altogether, diving gracefully over headfirst, as if the patch of grass were a swimming pool, and landing in midroll.

Mr. Kravit nodded. “So just like that,” he said. Then he laughed. “Well, not like Silverton.”

I was there to learn the basics of parkour, a French discipline of urban gymnastics with philosophical underpinnings. Earlier, Mr. Kravit had encouraged me to “learn how to not be confined by what so many people take as boundaries, and learn to move past those boundaries.”

I was finding this difficult. It was a wall. Walls are built to bound things, forcibly separate them, in this case this pathway from that patch of grass on the U.C.L.A. campus.

The crux of the parkour philosophy, Mr. Kravit explained, is usefulness and efficiency. A parkour practitioner, or traceur, trains his or her body and mind to be able to get from Point A to Point B in the quickest way possible in order to be useful to others.

“If someone is in a burning building, you’re not going to necessarily have to walk up all the stairs or take an elevator up,” Mr. Kravit said. “You might find a new way to get up and save that person.”

I looked at the wall again. I wasn’t sure how diving at it headfirst would make me more “useful,” except if I were taken an emergency room doctor in need of practice. Nevertheless, I took a deep breath, a running start, and dived.

Parkour, along with its cousin freerunning, is a burgeoning discipline in the United States, one popular among athletic young men with limitless energy and bodies like Gumby. It is like skateboarding without the board, a set of movements designed to allow the practitioner to pass fluidly and often beautifully through an urban environment without hindrance from obstacles like railings, walls and even parking garages.

It has attracted adherents through documentaries, YouTube videos, commercials, Madonna’s latest tour and the opening sequence of the recent James Bond movie, “Casino Royale,” which features Sébastien Foucan, the founder of freerunning, bouncing off cranes and rooftops like a SuperBall.

But although the online videos of men scaling drainage pipes and jumping from rooftop to rooftop make it seem like the latest extreme sport, its metaphysical component makes it more of a nascent martial art. Freerunning focuses on the feeling and aesthetic expression of freedom, thinking that can be traced to the transcendentalism of Rousseau and Thoreau. And parkour’s “utility,” of which Mr. Cliff and other traceurs speak, is akin to the Utilitarianism of John Stuart Mill and Jeremy Bentham in its application of mathematical principles to everyday life.

Each movement and progression is scrutinized and evaluated according to its efficiency: sure, that Kong jump got me over the wall, but was it the fastest and easiest way over?

Cliff Kravit and Silverton Nguyen are members of PKCali, a loose-knit group of California traceurs. Like many of the grassroots organizations of its type that have formed over the last few years, PKCali offers a monthly indoor gym session to teach parkour techniques to those who wish to try it, without the ripped skin and bruises that inevitably result from doing it outdoors.

WHEN Mr. Kravit started the gym session two years ago, 10 to 15 people came each week. Now he breaks the program into basics and advanced classes, and the basics class alone has as many as 40 students.

After the Kong jumps, Mr. Kravit suggested I try a “cat leap” — a jump at, not over, a wall where the hands clasp the top of the wall at the same time that the feet slam into its face, like a feline bracing for a fall.

The team demonstrated by leaping nine feet over a fountain, but I confined myself to repeated short jumps at a gravelly concrete wall not much taller than I am. As I wiped the blood from my hands, Mr. Kravit showed me his own mitts, which were as calloused as a construction worker’s. The final move he showed me was a “tic-tac,” in which you run at a wall from one angle, jump, then kick it with one foot, sending yourself flying in another direction.

Although it seems like child’s play, the discipline has a life-changing impact for some practitioners. The youngest of the five that day was Devon Martinez, 16, who is almost 6 feet tall with long, powerful legs and matted, curly brown hair. When Devon started doing parkour at 13, he was faring poorly in school. But after a year or so of training and reading the philosophy behind the sport, he started to apply his training to his life.

“I would be like: ‘Here’s an assignment. If I don’t do it, I’m going to fail, and I’m useless,’ ” he said. “So I have to do it to be useful. I have to do it to get past the obstacle.” Now he does well in school and in parkour; the shoe company 510 recently asked to sponsor him, he said, because of his influence in the California parkour community.

Parkour developed into its current form through David Belle, a Frenchman whose father was a soldier and a firefighter. Growing up in Lisses, south of Paris, Mr. Belle met Sébastien Foucan, and together they developed their techniques and prowess to their current movie-ready form.

But over the years, Mr. Foucan and Mr. Belle disagreed over the philosophy behind parkour. Mr. Belle wanted the definition restricted to a useful form of motion, while such limits did not sit well with Mr. Foucan.

So they split, with Mr. Belle’s useful and efficient form remaining “parkour” — from the French word “parcours,” meaning “course” or “journey” — and Mr. Foucan’s artsier discipline becoming “freerunning.” Today, the two exist side by side, sometimes practiced by the same people or simply assumed to be the same thing. Small cults of personality have built up around the two men and their philosophies.

To the casual viewer, the main difference between freerunning and parkour is that freerunners will use techniques like flips that are beautiful but not necessarily useful. But beneath the surface, the philosophical focus is quite distinct.

“In freerunning, we use obstacles creatively to add to our movement or as launchpads to create new movement,” said Levi Meeuwenberg, 20, a freerunner from Traverse City, Mich., who, along with Mr. Foucan, recently toured with Madonna. “When you come upon obstacles in life — relationships, money troubles, whatnot — you can use the obstacle to your advantage, like learning a lesson from it.”

Both parkour and freerunning are, on some level, the art of doing all those things you wanted to as a 5-year-old on the playground that your mother wouldn’t let you do. But the brain of a conscious adult performs a more mature calculus, factoring in an adult body’s capabilities, adding up the consequences of messing up, and asking, “Do you really need to try this?” That calculus, that fear and the successful overcoming of both, can be a strong draw.

IN a patio behind one of the U.C.L.A. buildings, Devon stood at the edge of a fountain, contemplating the 10-foot gap between the ledge on which he was standing and the gravelly wall beyond it. The idea was to do a cat leap, jumping the gap and sticking to the wall beyond it like Spider-Man. Beneath the wall was a slim ledge, less than a foot wide, so if the jump failed, he would fall quite a way to the shallow pool of water below.

He walked through the approach several times, planning his steps. After exhaling deeply through puffed cheeks, he began his run, only to stop at the last second.

Finally, one of the group, familiar with Devon’s routine and knowing exactly which buttons to push, called out, “You can’t do it!” Devon spun around, sprinted straight for the gap and leapt it, his hands and shoes scraping as they caught the wall beyond. Continuing the motion, he pulled himself up onto the wall, turned and squatted.

Waggling a finger, breathless, grinning, he said, “Don’t tell me what I can’t do!”

PARKOUR GROUPS

Parkour and freerunning groups have been formed in many urban areas across the country, and several offer gym or outdoor sessions for beginners.

LOS ANGELES The home page at www.pkcali.com has news of sessions in California, as well as monthly gym sessions, which are divided between beginner and advanced ($15; check Web site for dates).

BOULDER, COLO. Two gym sessions are conducted every Saturday by Colorado Parkour, one beginner and one advanced ($12 for drop-ins, $10 each for a 10-week course; www.coloradoparkour.com/classes.html).

CHICAGO The local parkour Web site, www.aeroparkour.com, is under construction, so make contact through the forums at www.chicagoparkour.net to join a weekend outdoor jam session for training.

WASHINGTON Primal Fitness, a parkour gym, offers a range of classes for different levels, schedules and ages (www.primal-fitness.com).

NEW YORK NYPK posts information on New York and New Jersey jam sessions on its Web site (www.nyparkour.com) and is also host to a forum for traceurs in the area.

Summer drinks

2007-06-27T22:07:00.000-04:00

Iced Coffee? No Sweat
By CINDY PRICE

BEFORE I go telling everybody that the secret to great iced coffee is already in the kitchen, my friend Keller wants me to confess: I didn’t know from iced coffee until he showed me the light.

It’s important to cop to this now, because not a summer goes by that he does not painstakingly remind me, a rabid iced-coffee drinker, that he’s the one who introduced me to the wonders of cold-brewed iced coffee. The funny thing is, when the subject came up we were holed up in a summer rental with three friends off the coast of Puerto Rico, on a tiny island not exactly swimming in upmarket coffee houses.

Our first morning there I brewed a blend from the local grocery in the coffeepot, laced it with a little half-and-half and sugar, then let it cool. Classy, I thought, carrying the pitcher to the table. “I’ll just take it hot,” he mumbled, while I blinked in disbelief.

Clearly, this boy didn’t know any better. A drink has a time and place. Surely he didn’t subscribe to drinking hot coffee in summer?

“No, I only drink iced coffee if it’s cold-brewed,” he said.

For five days we watched him sullenly sip his hot coffee on a broiling Caribbean island in the dead of summer. We chided him for his pretensions, ridiculed him, tried valiantly to break him, but he patiently waited us out. Once we tried it we would understand, he explained. Like friends disputing a baseball stat in a bar with no access to Google, we had no way to settle the argument.

Two weeks later, back in Brooklyn, I saw a sign: “Cold-Brewed Iced Coffee Served Here.” Fine, then. I threw down two bucks and took a sip. Though it pains me to admit, the difference was considerable. Without the bitterness produced by hot water, the cold-brewed coffee had hints of chocolate, even caramel. I dropped my sugar packet — no need for it. The best brews hardly need cream. It really is the kind of thing a gentleman might spend five days in hot-coffee solitary confinement for.

Most days I’m too lazy to hunt down the elusive cold-brewed cup. But recently I discovered an interesting little fact. Cold-brewed coffee is actually dirt simple to make at home. Online, you’ll find a wealth of forums arguing for this bean or that, bottled water over tap, the 24-hour versus the 12-hour soak. You can even buy the Toddy cold-brew coffee system for about $30.

But you can also bang it out with a Mason jar and a sieve. You just add water to coffee, stir, cover it and leave it out on the counter overnight. A quick two-step filtering the next day (strain the grounds through a sieve, and use a coffee filter to pick up silt), a dilution of the brew one-to-one with water, and you’re done. Except for the time it sits on the kitchen counter, the whole process takes about five minutes.

I was curious to see how it would taste without all the trappings. The answer is, Fantastic. My friend Carter, something of a cold-brewing savant, turned me onto another homegrown trick: freeze some of the concentrate into cubes. Matched with regular ice cubes, they melt into the same ratio as the final blend.

Very fancy. Can’t wait to tell Keller.

Chapter 1: I Drank the Water
By FRANCISCO GOLDMAN

IN Mexico City, where I live sometimes, I have a routine. I get out of the gym at about 9:30 and walk across the park to my favorite cantina, where the waiters know to bring me a shot of Herradura blanco tequila and a Victoria beer immediately. I love tequila and I believe that Herradura blanco, fiery and peppery, those first sips going down with the combustion of a space shuttle liftoff, is the great commercial tequila. I like mezcal too. Nothing macho about it: I just like the clean cactus and earth flavors, the warm ebullient high, and that you can drink a number of shots without feeling bloated.

I don’t often drink frozen drinks. How many of those can a person actually drink in a long night? But one night in Mexico City six years ago I drank frozen daiquiris, and I will never forget it, or at least I will never forget one of those drinks, the last one.

It was at a party in the writer Mario Bellatin’s house: crowded kitchen, someone manning the blender, bags of purified ice like the ones you get at gasoline stations. Slushy daiquiris in clear plastic cups, an appealing light lime color suggesting late afternoon drinks at the beach, when the salty bracing tartness of Mexican limes is especially delicious. I had one daiquiri and then another. Then they ran out of ice. Some of us were standing there, holding out empty cups. What, no more? There was still rum, there were still limes. But the blender guy was reaching deep into the freezer, struggling to dislodge an old ice cube tray, buried in furry ice. Enough for a few more daiquiris. Half an hour after drinking mine I felt a mule kick inside my stomach. Then I felt cold.

I went home. For the next two days I shivered and thrashed around in bed, burning with fever. A mesmerizing sensation of physically dwindling away. I hallucinated a strange scene, or dreamed one with my eyes open: convent servants searching the dawn streets of 19th-century Guatemala City for just the right Indian man to bring back to their Mother Superior.

I’d been waiting all summer for book and archival research to come alive. Suddenly, it had. I got out of bed, wrote it all down, went back to bed. Another scene came to me. That’s how I finally began that novel. Thanks to a daiquiri and bad Mexico City ice.

Forbidden Pleasure in the Desert
By DEXTER FILKINS

WE’D walked together down a road lined with craters. Walked slowly, of course. Looking for wires, animal carcasses, that sort of thing. The telltale signs of hidden bombs. It was a sweltering Iraqi morning, with the mist of the Euphrates infiltrating our lungs.

Later on, the captain regaled me with stories. We were both from Florida. His best tale concerned a tactic his men had devised to search Iraqi villages. A blond woman was in the unit he led, and all she had to do upon entering an Iraqi village was stand atop a Bradley fighting vehicle and pull off her helmet, letting her golden locks tumble to her shoulders.

Within minutes — blond hair being a thing of fascination in Iraq — much of the male population would be gathered round the Bradley. The Americans would then quietly search the village for guns. Worked every time, the captain said. We had a great laugh.

The talk turned to beer. If you could just get us a couple of cans, the captain said. He looked longingly at me. The captain hadn’t had a drink since he had arrived in Iraq, he said; none of his troops had. General Order No. 1, as it is called, decrees, among other things, that no American soldier shall consume alcohol in a war zone. Alone in the Iraqi desert, cold beer is something soldiers dream about.

Traveling around Iraq was still easy in 2003; so was buying alcohol. A couple of nights later, with a case of Carlsberg in the trunk, a photographer and I drove at high speed across the black Iraqi desert and pulled into the base. The captain came out to meet us. We’d put the beer in a black garbage bag. He cradled the sack like treasure.

“Oh, you guys are great,” the captain said, hustling it away. “Anything you want. Anything.”

I never saw the captain after that. My only regret is that I didn’t share one of those beers with him.

June 27, 2007
The Cherries of Persia
By ELAINE SCIOLINO

THE ruby-colored iced drink came in a tall glass set on a painted tray. There were other offerings: ice water, hot tea. But the bright color beckoned.

It was the summer of 1999 and I was in Shiraz, the Iranian city of calm, good sense and mystical poetry, a place not of religious pilgrimage but of roses, nightingales, rich people who smoke opium and some of the best wine-producing grapes in the world.

I had been invited to lunch at the home of Ayatollah Majdeddin Mahallati, a senior Shiite cleric whose family had once wielded extraordinary power and influence.

The drink I chose — a sour cherry confection — had the taste of summer. Bitingly tart and soothingly sweet rather than sour, it blocked out the noise and heat and rules of the Islamic Republic just outside the doors of the ayatollah’s house.

The sour cherry season in Iran is short — only about three weeks from mid-June to early July. The harvest triggers a mad rush to preserve the fruit’s electric vibrancy. Sour cherries boiled in sugar and water with just a hint of vanilla produce a rich syrup called sharbat-e albalu. It is stored in bottles to be mixed with water and masses of ice to drink on special occasions throughout the year.

On the day of our lunch, the learned ayatollah looked at the glowing liquid and recited from memory a poem of Iran’s greatest epic poet, Abolqasem Ferdowsi: “Two things are my favorite, a young companion and an old wine. The young companion takes away all your sorrows, the old wine gives richness to your life.”

The ayatollah said he was speaking only metaphorically, of course. Shiraz grapes once produced the finest wine in Iran. But we were in the Islamic Republic, which bans all alcohol. Shiraz also produces some of Iran’s best sour cherries. So, blissfully, we sipped on sour cherries instead.

June 27, 2007
A Taste of Freedom
By GABRIELLE HAMILTON

ONCE when I was about 13 years old, my best friend, Renee, and I did that thing where you each tell your parents that you are sleeping over at the other’s house, and they don’t even check. With relative ease, we found ourselves distinctly unchaperoned and hitchhiking the 20 miles to the Trenton, N.J., train station and catching a train to New York City.

With even greater ease, we found ourselves — such is the power of the teenage sense of immortality — perched on bar stools at an Upper West Side restaurant saying, “Um, I think I’ll have a Long Island iced tea, please.” It was the only drink we knew to order. We’d been getting blitzed on them for some time by siphoning off our parents’ liquor and replacing it with tap water. I remember being curled up on the orange shag rug, feeling the whole planet spin.

The bartender did not card us. The bartender did not roll his eyes to the heavens. He filled — freehand — two giant tulip-shape glasses that could have doubled as hurricane lamps with well liquors, prefab sour mix and cola from a sticky soda gun. And set them down in front of us.

We were both the youngest in our families and in so many ways by the time we were 10 we were practically 20. We blew smoke rings. We wore eye shadow. But we were, decisively, not 20. We pooled our crumpled bills and quarters, parsed out in stacks of four, and paid our bill to the penny. We did not tip. Poor service? No, we just didn’t know to. That’s how young we were.

Renee and I made it back unharmed. We caught the last train to Trenton and because we were lit and he was the only other guy in our car, we met a young comedian on the train. We fell over in our seats laughing at all his jokes. And he drove us home and let us out at the end of Renee’s silent driveway and we were safe and unmolested, and we grew up and lived our lives. And I am now in my 40’s and still drink Long Island iced tea.

In spite of having had the kind of adolescence that had orange shag and startlingly distracted parents — some of the things that have made people my age fashionably full of irony — I have never succumbed to that deadly stance. I drink Long Island iced tea sincerely. It is not part of a fashion trend that favors Peter Frampton haircuts and Tab.

To be sure, I am not drinking exactly the same Long Island iced tea. Now it is a carefully measured cocktail, made in a tall pint glass packed with ice cubes, filled with premium liquors, topped with Coke from a freshly cracked glass bottle. And I usually stick to just one, with some very delicious fried thing to eat, like fat-bellied clams or oysters with a spicy tartar sauce. The food absorbs the alcohol in just the right way so you get high but not blitzed. Which is safer when hitchhiking.

For a Future That’s Always Rosy
By MONIQUE TRUONG

HIDDEN within our current tastes and penchants are the persistent and often ignoble residues of our former selves. I call it the Holly Golightly-Lula Mae Principle. Allow me to demonstrate how it works.

Of late, my summer drink of choice is a white sangria. It’s a floral concoction of white sparkling wine, Cointreau, apple juice and a splash of club soda, generously perfumed with thin slices of white nectarines, green pears and sweet navel oranges.

This is my reverse-engineered recipe for a drink that I had first at a restaurant so incandescently hip and cool that it saw no reason to cook its food. An editor at a fancy magazine was paying, so I allowed myself to be taken to a raw foods restaurant. In lieu of a proper meal, I decided to drink myself full and I did.

I don’t remember too much about the raw foods, but that nutty place really had a way with the white sangria. I serve pitchers of it now on summer evenings and nod with delight when my friends comment on its subtle beauty and intoxicating charm. I hesitate to share with them, though, why my inner Lula Mae adores this chic little quaff.

White sangria reminds me of the bottles of convenience store wine coolers that my girlfriends and I consumed in alarming quantities in the back seat of cars while stuck in Texas in the prime of our teenage years. Sweet, cheap and perversely and resolutely not beer (long necks being the patriotic drink of the Republic of Texas), wine coolers were our fast ticket out of sobriety and the confines of our suburban youth.

As we twisted off their caps and guzzled their artificial flavors, we were imagining the future. Beautiful and transporting, ambrosial with promises, and complex but never complicated: we wanted it so much we could taste it. The future for us finally arrived and, of course, wasn’t quite what we had desired, but a sip of white sangria on a summer night comes pretty close.

Dry Dock It’s Not
By SAM SIFTON

DAVID BERSON is a gallivanting boat captain who runs an electric launch, Glory, out of Greenport, N.Y., on the North Fork of Long Island. Captain Berson has been a deck monkey, a guitar hero and a yellow-cab hack over the years, an instructor of celestial navigation and a fair handler of canvas and rope. He smokes a pipe, is a friend of the masses and counts himself a fan of both Emma Goldman and Blind Willie Johnson. He sails cautiously and well, then pours rum with a heavy hand.

This is his recipe, a modification of that great Caribbean libation the Painkiller, which itself found birth at the Soggy Dollar Bar on Jost Van Dyke in the British Virgin Islands. The Painkiller features dark rum over shaved ice, frothed with orange and pineapple juice along with some sweetened coconut cream, topped with a shaving of nutmeg. It is rich stuff, a little complicated, a bit much for a long Saturday night of drinking under sea grape and palms.

Captain Berson, who served under Eben Whitcomb on the great coasting schooner Harvey Gamage, used to anchor off Jost Van Dyke and has put down his fair share of Painkillers, both at the Soggy Dollar and at the more rough-and-tumble Rudy’s Mariners Inn above Great Harbour. He has, over time, whittled down the ingredients for his own version of the drink, for reasons of both thrift and flavor, to come up with a minimalist take on the classic. His friends call it the Greenport Shuffle, for its eventual effect on one’s gait.

The color should be yellow, cut with bruised brown, like a pineapple left to ripen two days too long, sprinkled with rust. It should taste of summer, and offer the feeling of night air on sunburned skin.

Online restaurant reservations

2007-06-24T05:14:00.000-04:00

NYTimes

June 18, 2007
Restaurant Reservations Go Online
By KATIE HAFNER

SAN FRANCISCO, June 17 — Town Hall, one of the busiest restaurants in this food-crazed city, seems the very model of old-fashioned dining. Patrons who arrive to claim their reserved seats are greeted by a hostess who consults a piece of paper with the day’s reservations and leads her guests to the appointed table.

But upstairs, in the restaurant’s office, a different scene is playing out. In a veritable mission-control setting, a reservationist answers eight phone lines while seated in front of two computers that log reservations and hold an archive of past and future electronic bookings.

The software also reveals the idiosyncrasies of thousands of guests. The restaurant staff knows in advance, for instance, that a regular always insists on a table under a particular piece of artwork. They know about another person’s request for kosher food — but only when dining in certain company. And there is the guest so reliably late that staff members know to add 45 minutes to the reservation time.

After decades of relying on telephones to book tables, and piles of index cards — or a maitre d’hotel’s memory — to collect information about diners and their quirks, the restaurant business has finally gone unabashedly high-tech.

Technology may not make it any easier for diners to get a reservation at the most sought-after spots, like the French Laundry in Yountville, Calif., or Babbo in New York City. But the perseverance of a San Francisco-based company called OpenTable, which has come to dominate the business of online restaurant reservations, is making it much easier for restaurants to manage reservations and improve customer service.

The change is subtle, but sweeping. Some 7,000 high-end restaurants around the world now use OpenTable, with the highest concentration in New York and San Francisco. Hundreds more are signing on every month.

“All restaurants have to do it, whether you like it or not,” said Charles Phan, the owner and executive chef of the Slanted Door, currently ranked as the most popular restaurant in San Francisco on OpenTable.com. “There’s no way around it. At this point, there’s no other technology or easy solution for making Web reservations.”

Making a reservation through OpenTable costs the diner nothing. And it reduces the inconvenience. Say you want a table on short notice at a busy Manhattan restaurant — Danny Meyer’s Union Square Cafe. Placing a phone call there usually requires calling during business hours, enduring loud jazz for hold music, and talking with a reservationist for a while before finding an acceptable time. OpenTable might give you the same results, but it will do the work in 10 seconds.

Andrew Shapiro, a business strategist who lives in Manhattan, said OpenTable was the first place he turned to for reservations. His loyalty was recently cemented when he used OpenTable to snag a reservation at a popular sushi restaurant around the corner within 15 minutes of his desired mealtime.

Mr. Shapiro said he and his wife had a couple of favorite restaurants that did not take reservations. “The truth is, those places have gotten less attention from us lately,” he said. “It would be as if an airline didn’t allow you to buy tickets online.”

Mr. Shapiro said he also liked the one-click cancellation feature. And he likes the convenience of making a reservation at 2 a.m. (One-third of OpenTable’s reservations are made between 10 p.m. and 10 a.m.)

The other end, however, is where the service has real benefit.

The reservations that pop up on the restaurants’ computer screens, especially those made by regulars, are accompanied by an important tidbit or two.

Doug Washington, a co-owner of Town Hall, said the notes were not just helpful, they are occasionally indispensable. Next to the name of one regular, who has a habit of bringing in women he is not married to, is an instruction to make sure the man’s wife has not booked a separate table for the same day.

Another frequent guest asks the restaurant to send over dessert compliments of the chef but to put the charge on the guest’s bill. Of another, who takes many of his first dates to Town Hall, the instructions read, “Do not treat like a regular!”

But unlike owners of most OpenTable restaurants, Mr. Washington will not use a computer at the door. “When you’re coming into a restaurant you should still feel like you’re walking into someone’s home,” he said.

OpenTable, which started in 1999, did not take off right away. The restaurant business greeted OpenTable with a shrug at first, even contempt. Few restaurant owners could see the advantage of paying a dollar per diner to an Internet company, especially when they already had more business than they could handle.

But the company deployed an aggressive sales force, and went to work persuading owners that dining reservations would eventually go the way of hotel and airline reservations by requiring fewer personnel. Restaurant owners began to see how the service increased the number of customers, and they liked the way the software managed the reservation process. Many of the restaurants discovered that they had to surrender to the automation because their popularity suffered if they did not.

“It was a long, long time before that was proven,” said Bill Gurley, a Silicon Valley venture capitalist whose company, Benchmark, has invested $21.6 million in OpenTable over the years.

It took three years for OpenTable to seat its one-millionth diner. But now, the company seats two million diners every month. And Zagat, the restaurant rating service, has adopted OpenTable for reservations made through its site, zagat.com

“It’s not a cheap solution, but it’s a good one,” said Laurence Kretchmer, who, together with Bobby Flay, owns three restaurants, including Bar Americain in Manhattan, all of which are on OpenTable. New York now has more restaurants on OpenTable than San Francisco does.

New York restaurant owners are still resisting the surcharge, especially when it means paying for people who would have eaten at their restaurants anyway. “It adds up,” said Steven Pipes, vice president of hospitality at the Jack Parker Corporation, owners of Le Parker Meridien, home to Norma’s, a popular brunch spot in Midtown Manhattan.“We spend thousands of dollars.”

Still, Mr. Pipes is quick to appreciate the high ranking on OpenTable’s most-booked list. And he likes the information he gleans from the system. “We can know what kind of seating people like,” Mr. Pipes said. “And we can know if they have a favorite server.” And that favorite server can note, ever so discreetly, whether a customer happened to order the restaurant’s $1,000 frittata, or that he is a reliably generous tipper.

“In the old days, the question was, ‘Where should we eat?’ Now it’s, ‘Where can we eat?,’ said Danny Meyer, a prominent New York restaurant owner who is an OpenTable investor and board member. OpenTable, he said, offers diners ideas for the first question and answers for the second. “You literally get all that information within four seconds.”

Among the top-tier establishments, there are still some holdouts. Chez Panisse, the famed restaurant in Berkeley, Calif., is not on OpenTable. But that is not for lack of trying on OpenTable’s part. “We’re in discussions with them,” said Jaleh Bisharat, vice president of marketing at OpenTable.

Thomas Keller’s French Laundry, on the other hand, arguably the most popular restaurant in the nation, signed up in early 2003 and Per Se, his New York version, is also there. “Thomas Keller needs more reservations like a hole in the head,” Mr. Meyer said. “But even he knows that anyone truly into hospitality is being disingenuous to say they wouldn’t benefit from all that great guest information provided automatically.”

Carl Pavano

2007-06-21T22:29:00.000-04:00

ESPN

Money for Nothing: What makes Carl Pavano not tick?
by Michael Weinreb

SOUTHINGTON, Conn. — There is a photograph gathering dust atop a television set in a suburban Connecticut basement, a joyous and wholesome image for which Carl Pavano, of all people, was the catalyst, and in which he does not implicitly appear. But I have been assured he is down there somewhere, in the depths of that pile, amid the tangled mass of arms and legs and cleats and hats. And given that he has just thrown the final pitch to win the Connecticut high school baseball championship, given that he was the impetus for this spontaneous celebration that took place more than 13 years ago, in the shadow of a scoreboard badly in need of an electrician, he is most likely trapped near the very bottom.

The man in possession of this photograph, and of this basement, is John Fontana, and there is one particular story that Fontana, who has since retired as the baseball coach at Southington High, likes to share about that state championship game. It is an anecdote he has crafted and shaped and retold over and over again when people have queried him, at various junctures, about Carl Pavano's apparent dearth of testicular fortitude. It goes like this:

Top of the seventh and final inning, Southington High up 4-1. Fontana has a reliever warming up, just in case Pavano tires, but mostly, he admits, because he knows how to push Pavano's buttons. So he calls timeout.

Pavano says, "Coach, don't come out here."

Fontana keeps on walking toward the mound. Pavano says, "Don't embarrass yourself." Fontana takes a few more steps, and Pavano says, "If you reach for this ball, I'm going to sit right down on the rubber and embarrass you."

So it progresses, in archetypal fashion: Fontana backs away, Pavano strikes out the next hitter, completes the game, and is mobbed by his ecstatic teammates. By the next season, at age 19, he is pitching for the Red Sox Class A League franchise in Battle Creek, Mich., a 6-foot-5, 225-pound alpha male, a cocksure ladies' man with a willful streak and a bright future, the envy of all those around him. His early career path is peripatetic, but, like an episode of "Entourage," it always seems to wind up just fine: At age 27, after a series of stops and starts and nagging arm injuries and Zelig-like brushes with fame, after he allows Mark McGwire's 70th home run and is traded once for Pedro Martinez and again for Cliff Floyd, he pitches his way to a World Series ring with the Florida Marlins. And the following season, after a brief tryst with Alyssa Milano (Alyssa Milano!), he wins 18 games and becomes a free agent with leverage and several clamoring suitors.

And then just a few days before Christmas 2004, Pavano signs a four-year, $39.95 million contract with the New York Yankees, the team his mother adores, and the team his grandfather envisioned him pitching for, because while Southington is located on the cusp of Red Sox Nation, Pavano's was always a Yankees family.

But what has happened since that day is the reason I am here, sitting in Fontana's basement, bearing witness to his recollections while staring at a photograph of a teenaged boy with a square jaw who bears a resemblance to a young Elvis Presley. Because what transpired between Pavano and the Yankees will take its place among the most bizarre and sad and pathetic sagas in the history of a franchise that has borne witness to decades of inexplicable behavior. In the course of 30 arduous months, Pavano has not merely endured the very public and very embarrassing breakdown of his body and his pitching arm, he survived the wreck of his Porsche while speeding in Florida (he broke two ribs, a fact he did not disclose to the Yankees until 11 days later, when he was scheduled to return to the team from a rehab assignment) and he also survived a nasty breakup with an aspiring model from Queens (which ended when she accused him, on the front page of the New York Post, of cheating) and so many extended stints in the purgatory of the disabled list that even his own teammates gave up on him. In turn, his reputation has devolved from a promising (if overpriced) free-agent to that of a con artist, an idler, a curse, a walking punch line, a target for YouTube parodies and mocking blog posts, and a metaphor for all that had been going wrong with these floundering Yankees, and with the string of pitching failures signed by their general manager, Brian Cashman, and, for that matter, with every overpaid and pampered free agent in the history of modern sport who has failed to live up to his value.

It is nothing new for Yankees fans to devour one of their own — this is considered an almost inevitable byproduct of living and playing baseball in the world's most unforgiving city, for the game's most absurdly competitive and deep-pocketed franchise. The list is long, and includes a wide range of personalities and talents, from outright busts like Don Gullett to Hall of Famers like Dave Winfield to more recent Cashman-acquired disasters such as Jeff Weaver and Javier Vazquez. In the 1980s, New York swallowed Ed Whitson, another free-agent signing who became so psyched out by the venom directed toward him that he could no longer pitch at Yankee Stadium. And there is, of course, always the ongoing tragicomedy known as Alex Rodriguez, whose reputation serves as a daily reminder that money cannot begin to purchase street cred.

But what makes Carl Pavano's tale unique is the sheer improbability of his failures to perform; in one particularly ignominious moment, the Yankees told reporters that Pavano had actually injured his buttocks while lurching for a ground ball in spring training — the man, they said, had a bruised ass. At another point, teammates sniped about Pavano's indifference to his plight, citing his fondness for eating candy bars and getting massages in the Yankees clubhouse while unable to throw a single pitch. And what makes his fall from grace so fascinating, from a psychological perspective, is that it leads to questioning whether Pavano's body actually broke his spirit, or whether, as a legion of Yankees fans will forever be convinced, the spirit broke the body.

"It was one of those things where you're in a bathtub, and you increase the temperature one degree a minute until you're scalding yourself," says Mike Vaccaro, a columnist for the New York Post. "Every couple of days, it was something new and weird and different and strange with him. You can't ever get inside someone's head, and you don't want to accuse them of faking it, but it's hard to believe there isn't something else going on here. At some point, you have to earn your 40 million bucks."

It seems improbable, at this moment, that Pavano will ever do such a thing. In early June, after yet another bizarre and prolonged dispute with Yankees management over whether he actually needed reconstructive Tommy John elbow surgery — allowing one last time for the implication, true or not, that Pavano did not want to pitch — he finally had the surgery done. By the time he completes his rehabilitation, the 2008 season will most likely have ended, and Pavano's tenure with the Yankees will most likely have been euthanized along with it.

And in four years, Pavano will have won five games, a simple calculation that works out to nearly $8 million per victory.

"Say I live in New York and I've never met him," says Dave Marek, one of Pavano's high school teammates, one of the joyous figures in that photograph on Fontana's television set, and a lifelong Yankees fan. "I'd probably be saying, 'Who is this guy? What a clown.' That's the hardest part of this whole thing."

Understandably, Carl Pavano's Yankees legacy has become a rather awkward subject to address; and not just because Fontana, once Pavano's mentor, still keeps in touch with Pavano's parents, who operate a dry-cleaning business set in a strip mall just a few miles from Fontana's home — and who declined to speak to ESPN.com, apparently at the behest of their son. ("Carl's hurting right now," his father, Carmen, said. "Let it go the way it is.") It is awkward because Fontana is as baffled by this absurdist chain of events as Pavano's childhood friends and his ex-girlfriend and the former high school teammates who have witnessed his implosion from afar.

"People are always saying to me, 'What's going on with Carl?'" Marek says.

"Like we're the doctors," says another Southington teammate Bob McKee. "Like we're supposed to know what's going on in his head."

Ask Fontana that question — What's going on in Carl's head? — and he will tell you of a boy he once coached who was so precise that they not only called pitches but the locations for him. He will repeat once more the story of that high school championship game, and tell how Pavano once drove several hours to visit him when Pavano was playing in the minor leagues and Fontana was having heart problems. And he will insist that Pavano dotes on his sisters and his nephews and nieces and can't wait to start a family of his own, once he finds the right partner, once he is finished with what all involved will admit is a storied ability — with regard to women, at least — to play the field.

"Maybe a nice country girl," Fontana says. "Sometimes people need someone like that, for stability. But I'm guessing. I'm not telling him what to do. I don't think anybody's gotten to know Carl that well."

I met up with the latest of Carl Pavano's ex-girlfriends ("I think if he were a professional ladies' man, he'd do pretty well," says one of his high school teammates) on a humid afternoon at a restaurant in midtown Manhattan. She was wearing a baseball cap pulled low over her eyes and carrying a Louis Vuitton bag she had "inadvertently" taken home for free because of a cashier's error. She was also more than an hour late, in part because she was rushing from a meeting with a movie producer; when I asked her the name of the movie, she batted her eyelashes and said she had no idea, only that she was likely to be cast as "the seductress." Her name, by the way, is Gia Allemand, and she is most certainly not a country girl, unless a country girl can be defined as a 23-year-old aspiring bikini model from Howard Beach in Queens, who recently posed half-naked for Maxim magazine's Web site — I will pause here to allow you to Google the photos — and shows up with her new manager, a man by the name of Horacio Blackwood, in tow.

It should be noted, for the record, that Allemand was not particularly interested in discussing her relationship with Carl Pavano. She would rather forget it ever happened, in the same way Yankees fans would rather forget their own tormented relationship with Pavano ever happened. "We had a bad breakup," she says. "I'm trying not to be mean."

But Allemand is also a firm believer in the inalterable cosmic force known as karma; and this, she says, is what happened with Pavano. Karma caught up with him. Karma dragged him down by his gluteus maximus.

In truth, karma might have already collided with Pavano by the time he met Allemand, which, she says, is what they bonded over in the first place. Allemand was in a professional ballet company, until she injured her hamstring and Achilles tendon and couldn't dance anymore. Pavano still aspires to be a pitcher but has always been fragile. Fontana says Pavano's parents told him he'd had arm problems since Little League, something that the Yankees and Cashman, on the basis of one good season, presumed was behind him. And once he joined the Yankees, coincidentally or not, that fragility became renowned. In July 2005, five weeks after he was booed off the mound during a 17-1 loss to the Red Sox, Pavano went on the 15-day disabled list with right shoulder tendinitis. In mid-August, right shoulder tendinitis became rotator cuff tendinitis, and Pavano was finished for the season.

The following February, Pavano complained of back problems. He began the season on the disabled list. He pitched one inning of an exhibition game, then departed to have an MRI performed on his left buttock (in case you are in need of specifics), began the season on the disabled list, then in May complained of soreness in his right triceps, and in June had surgery for a bone chip in his right elbow.

In the meantime, Allemand says she infused Pavano with the power of positive thinking, and with the dime-store spiritual principles she'd picked up in an Oprah-endorsed tome called "The Secret," which breaks down the meaning of life into a facile equation that goes something like this: Think about something positive, and you can attract positivity. (When I asked her why, if this is the case, she didn't return to Louis Vuitton and insist they charge her the proper price for her new purse, she shrugged and laughed and said this was a case of karma repaying her.) But none of this came naturally to Pavano, who is inherently distrustful of all but a few people in this world, who is on his third agent after a legal dispute with his previous representative, Scott Shapiro, that has been publicly attributed to Pavano's contract being worth only $39,950,000 instead of the $40 million Pavano expected (though one of his lawyers insists this is not the cause of the dispute).

"Carl's a really private person," says childhood friend Shawn LaBonte from his home in Florida. "He loves skiing and four-wheeling and fishing and boating. He just wants to be left alone. He doesn't want to be in the spotlight. But then again, it comes with the territory. And he's just not a city guy — but then again, he's always wanted to be a Yankee."

Allemand wanted Pavano to give back. She preached and cajoled him about manufacturing positive karma, and she was naive enough to assume she was actually making progress. She was, she says, on the verge of starting a charitable foundation with Pavano. She was in the passenger's seat of the Porsche with him in August 2006 when he hydroplaned and crashed into a truck. ("He's always been a maniac," LaBonte says, "a hundred and twenty miles [an hour], full-speed ahead; I hope that was a wake-up call.") Allemand stood up for him in the tabloids a month later, when the news emerged that Pavano had made three rehab starts while hiding his broken ribs from the Yankees (headline: CRASH TEST DUMMY). To the fans, to the media, to his teammates ("I hope his car didn't get dinged up too bad," Johnny Damon joked), and to a man like Brian Cashman, who had staked his reputation on this signing, it was an inexplicable and unnecessary deception. But this is the nature of Carl Pavano, who was perhaps the last person to comprehend a rather obvious truth: The worst thing in the known universe a man who supposedly values his privacy can do, beyond establishing an exploratory presidential campaign or marrying a thespian Scientologist, is to sign a contract with the New York Yankees.

"Emotionally, I was not a big believer in Carl making the move to the Yankees," Fontana says. "He had other offers, from other teams. What's the difference between making $36 million and $39 million? If you hadn't won a World Series, I'd say go to the Yankees. Or if it was $60 million versus $30 million. But it wasn't."

But how was he supposed to resist such a temptation when this was what his family wanted for him? He was born in 1976, the only son of Carmen and Ann Marie Pavano, and by the time he was 2 years old, his mother was already dressing him in a wool Yankees jacket she had bought at a department store, a jacket she's kept preserved in plastic wrapping in a closet for almost 30 years.

I should acknowledge that I borrowed those details from a story that Tyler Kepner, the Yankees beat reporter for The New York Times, wrote in the spring of 2005 (in it, Pavano also insisted that his family hadn't affected his decision to sign with New York). In February 2007, Kepner wrote in a blog entry of the difficulty he had in convincing Pavano to comment for what was an unimpeachably positive article. "Pavano seemed surly and miserable, for no obvious reason," Kepner wrote, and this is how his teammates began to see him, as well: In spring training before this season, Mike Mussina said that Pavano "needs to show us he wants to pitch for us," leading to a closed-door meeting between the two, and more promises from Pavano that he was doing all he could to earn his money.

By then, almost no one believed him anymore.

A short time later, after his ugly public breakup with Allemand, and after a respectable outing as the team's surprise Opening Day starter (a horrifying prospect for the fans who had already mocked him for more than two years), Pavano's elbow acted up again. This, Gia Allemand might claim, was karma, biting Pavano on the posterior one last time. Still, with respect to the opinion of the woman who was recently named Miss Red Hot Taj Mahal, perhaps there was something else going on, something based in the psyche, in Pavano's inability to pitch with pain, or in his unwillingness to contribute to a franchise that, in his view, seemed to have publicly humiliated him — according to one source, Yankees management downplayed the seriousness of his injuries and would later admit Pavano's buttocks injury was actually based in a recurrence of a back problem, and the tendinitis that excused him in 2005 might actually have been a stress fracture.

Or perhaps it was simply a toxic combination of all these things, a simultaneous breakdown of body and spirit.

"I wish I could tell you what he thinks because I don't even know," says LaBonte, who has known Pavano "since we were born."

"I sometimes wonder if Carl could be doing more than he is doing. But then again, it's not my body."

And in the end, it would seem, the man's true motives are irrelevant. Because it is the perception that will linger. And the perception is that Pavano never wanted to be in this situation in the first place, and this attitude manifested itself in his broken physique; hence George King, the beat writer for The New York Post, dubbing him the "American Idle." And Will Carroll, a senior writer for Baseball Prospectus, who writes a regular column about injuries, claimed Pavano could likely have pitched through his pain, instead of having season-ending surgery, and was essentially "stealing money" at this point. ("I was probably more harsh in that assessment than I needed to be," Carroll says now. "Still, you do have to question whether the guy is going to be able to come back all the way.")

This was how his teammates saw him, so this was how the media saw him, and so this was how the fans saw him, as well. Steve Lombardi, of the Yankees blog Was Watching, offered one of the tamer nicknames bestowed upon Pavano in the blogosphere: Lucy Van Pelt. "The Yankees and their fans are Charlie Brown," Lombardi wrote, "and the football is the hope and promise that Pavano will help the team."

On some level, this is absurd: Comparing the Yankees to Charlie Brown is like comparing Warren Buffett to Elmer Fudd. But Pavano, coming as he has on the heels of Weaver, Vazquez and others, and coming in the midst of a fallow period in Yankees history, has done something remarkable: He has induced neurosis into a franchise that always somehow seemed above such things.

"He's become a poster child of sorts," says Dom Amore, who covers the Yankees for Pavano's local paper, The Hartford Courant. "Every time the Yankees sign a pitcher who gets hurt, they're going to say he's another Carl Pavano. He's going to be remembered for things that you don't want to be remembered for."

And so New York City and Carl Pavano are most likely finished. It was a bad breakup, perhaps the worst he has ever endured; depending on how his rehabilitation from Tommy John surgery progresses, it might signal an end to his baseball career. Of course, on some level, a breakup like this could occur only in New York, where nothing ends quietly. When a free-agent bust of this magnitude occurs anywhere else, the reaction is often forgiving — does anyone truly care that Wayne Garland blew up in Cleveland or Darren Dreifort self-destructed in Los Angeles?

But somewhere along the way, as the Yankees sank to the bottom of the American League East standings in the early stages of this season, it became personal between the Yankees and Pavano. Despite his protestations of innocence and helplessness, and even as Cashman told reporters that he "never once thought [Pavano] laid down on this club," it was far too late to offer apologies to the most impatient and impractical fan base in the known universe. In their minds, 13 years after Pavano threatened to sit down on the job and embarrass the hell out of someone, he actually did it. To them. And his own pitiful karma seemed to have dragged down the entire franchise, to the bottom of the division, to yet another Yankee summer in the new millennium, marred by discontent and desperation.

"Carl attracts negativity," Gia Allemand said.

On June 5, at a Manhattan hospital, Pavano finally had his elbow surgery. As if cleansing themselves of his aura, the Yankees painted over his space in the players' parking lot and reassigned it to Roger Clemens. That same night, they defeated the Chicago White Sox and commenced their longest winning streak in more than two years.

Michael Weinreb is a freelance writer and the author of "The Kings of New York: A Year Among the Geeks, Oddballs and Geniuses Who Make Up America's Top High School Chess Team," published by Gotham Books. He can be reached at http://www.michaelweinreb.com.

Skin & UV damage

2007-06-21T22:28:00.001-04:00

MSN

Sun damage: The true price of tanning
From MayoClinic.com
MayoClinic.com

The warm golden cast of the sun is very alluring. And many people can't resist spending hours beneath its glow.

But not all of the sun's rays are pleasing. Ultraviolet (UV) light, the invisible but intense rays of the sun, damages your skin. Some of those harmful effects — such as suntan or sunburn — are visible right away. But other skin changes, including liver spots or deep wrinkles, appear and worsen over time. With repeated sun exposure, the skin damage can even progress into cancerous tumors.

From the first clue that your skin has undergone a change to the development of cancer, here's how the sun damages your skin and what you can do about it.

The first signs of skin damage

You're likely familiar with two of the more common sun-induced changes to your skin: suntan and sunburn. But you may not know that the darkening and reddening of your skin are the first signs of skin damage.

Suntan

A suntan is the result of injury to the epidermis, the top layer of your skin. A tan develops when UV light accelerates the production of melanin. Melanin is the dark pigment in the epidermis that gives your skin its normal color. The extra melanin — produced to protect the deeper layers of your skin — creates the darker color of a "tan." A suntan is your body's way of blocking out the ultraviolet rays to prevent further injury to the skin, but the protection only goes so far.

Sunburn

Eventually, ultraviolet light causes the skin to burn, bringing pain, redness and swelling. Depending on the severity of the burn, the dead, damaged skin may peel away to make room for new skin cells. Though the symptoms of sunburn may fade after several days, the damage to your skin remains. Sun exposure that is intense enough to cause a burn can also damage the DNA of skin cells. This damage sometimes leads to skin cancer.

People with darker skin pigment are less likely to burn because of the protective action of the melanocytes, which produce melanin. However, even those with darker skin types can burn with repeated exposures to UV light. This intense exposure can produce negative effects in the skin, including dry, rough patches, wrinkling and other skin disorders. So even though people with darker skin can tan and tolerate longer periods of sun exposure without "burning," the sun can still cause skin damage.

Image
Illustration of the layers of your skin
Illustration of the layers of your skin

Ultraviolet light can damage all layers of your skin: the epidermis, dermis and subcutaneous tissue (fat). To protect itself from damage, your skin increases the production of melanocytes, which ...
Enlarge Image

Photoaging: Looking older than you are

Over the years, your skin naturally begins to show signs of aging. For example, you may notice more wrinkles and thinner, more fragile skin. Exposure to UV light can accelerate these changes and make you appear older than you are. Skin changes caused by the sun are called photoaging.

The results of photoaging include:
# Weakening of connective tissues, which reduces the skin's strength and elasticity
# Thinner, more translucent-looking skin
# Deep wrinkles
# Dry, rough skin
# Fine red veins on your cheeks, nose and ears
# Freckles, mostly on your face and shoulders
# Large brown lesions (macules) on your face, back of hands, arms, chest and upper back (solar lentigines, or liver spots)
# White macules on the lower legs and arms

Serious skin damage: Noncancerous and cancerous skin tumors

Extended and repeated exposure to UV light can cause noncancerous (benign) and cancerous skin tumors:
# Seborrheic keratoses. The precise cause isn't known, but these lesions are seen in aging skin. These tan, brown or black growths have a wart-like or waxy, pasted-on appearance and range in size from very small to more than 1 inch (2.5 centimeters) across. Typically, seborrheic keratoses don't become cancerous, but they can resemble skin cancer.
# Actinic keratoses. Also known as solar keratoses, actinic keratoses appear as rough, scaly areas in sun-exposed areas. They vary in color from whitish, pink or flesh-colored to brown-to-dark-brown patches. They're most commonly found on the face, ears, lower arms and hands of fair-skinned people whose skin has been damaged by the sun. Many doctors consider actinic keratoses to be precancerous because they may develop into skin cancer.
# Skin cancer. Skin cancer develops mainly on areas of skin exposed to a lot of sun, including your scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. Some types of skin cancer appear as a small growth or as a sore that bleeds, crusts over, heals and then reopens. In the case of melanoma, an existing mole may change or a new, suspicious-looking mole may develop. Other types of melanoma develop in areas of long-term sun exposure and start as dark flat spots that slowly darken and enlarge, known as lentigo maligna. See your doctor if you notice a new skin growth, a bothersome change in your skin, a change in the appearance or texture of a mole, or a sore that doesn't heal within two weeks.

Bottom line: Keep your skin healthy

All people, regardless of age, should take the necessary steps to protect their skin. For the most complete sun protection, use all three of these methods — in order of importance:
# Avoid the sun during high-intensity hours. The sun's rays are most damaging from 10 a.m. to 4 p.m. Reduce the time you spend outdoors during these hours.
# Wear protective clothing. Cover your skin with clothing, such as long-sleeved shirts, long pants and wide-brimmed hats. Also, keep in mind that certain clothing styles and fabrics offer better protection from the sun than do others. For example, long-sleeved shirts offer better protection than short-sleeved shirts do just as tighter fabrics are better than those that are loose.
# Use sunscreen. Apply sunscreen liberally 30 minutes before going outdoors so that your skin has time to absorb the sunscreen. Then reapply according to the directions on the label — usually about every hour.

You don't need to hide away indoors to protect your skin. Just be smart about your sun exposure and take precautions to keep your skin healthy for years to come.

Refractive materials for invisibility

2007-06-12T02:16:00.001-04:00

NYTimes

June 12, 2007
Light Fantastic: Flirting With Invisibility
By KENNETH CHANG

Increasingly, physicists are constructing materials that bend light the “wrong” way, an optical trick that could lead to sharper-than-ever lenses or maybe even make objects disappear.

Last October, scientists at Duke demonstrated a working cloaking device, hiding whatever was placed inside, although it worked only for microwaves.

In the experiment, a beam of microwave light split in two as it flowed around a specially designed cylinder and then almost seamlessly merged back together on the other side. That meant that an object placed inside the cylinder was effectively invisible. No light waves bounced off the object, and someone looking at it would have seen only what was behind it.

The cloak was not perfect. An alien with microwave vision would not have seen the object, but might have noticed something odd. “You’d see a darkened spot,” said David R. Smith, a professor of electrical and computer engineering at Duke. “You’d see some distortion, and you’d see some shadowing, and you would see some reflection.”

A much greater limitation was that this particular cloak worked for just one particular “color,” or wavelength, of microwave light, limiting its usefulness as a hiding place. Making a cloak that works at the much shorter wavelengths of visible light or one that works over a wide range of colors is an even harder, perhaps impossible, task.

Nonetheless, the demonstration showed the newfound ability of scientists to manipulate light through structures they call “metamaterials.”

Obviously the military would be interested in any material that could be used to hide vehicles or other equipment. But such materials could also be useful in new types of microscopes and antennae. So far, scientists have written down the underlying equations, performed computer simulations and conducted some proof-of-principle experiments like the one at Duke. They still need to determine the practical limitations of how far they can bend light to their will.

The method is not magic, nor are the materials novel. Physicists are taking ordinary substances like fiberglass and copper to build metamaterials that look like mosaics of repeating tiles. The metamaterials interact with the electric and magnetic fields in light waves, manipulating a quantity known as the index of refraction to bend the light in a way that no natural material does.

“There are some things that chemistry can’t do on its own,” said John B. Pendry, a physicist at Imperial College London. “The additional design flexibility with introducing structure as well as chemistry into the equation enables you to reach properties that just haven’t been accessible before.”

When a ray of light crosses a boundary from air to water, glass or other transparent material, it bends, and the degree of bending is determined by the index of refraction.

Air has an index of 1. Water’s index of refraction is about 1.3. That is why rippling water waves distort the view of a pond bottom, for instance. It is refraction that makes a straw in a glass of water look as if it is bending toward the surface, and fish swimming in a pond look closer to the surface than they really are.

Diamonds have a refractive index of 2.4, giving them their sparkling beauty.

For visible light, transparent materials like glass, water and diamonds all have an index of 1 or higher, meaning that when the light enters, its path bends inward, closer to the perpendicular. Because the index is uniform throughout a material, the bending occurs only as the light crosses a boundary.

But with metamaterials, scientists can now also create indexes of refraction from 0 to 1. In the Duke cloaking device, the index actually varies smoothly from 0, at the inside surface of the cylinder, to 1, at the outside surface. That causes the path of light to curve not just at the boundaries, but also as it passes through the metamaterial.

Metamaterials first took center stage in a scientific spat a few years ago over a startling claim that the index of refraction could be not just less than 1, but also negative, less than 0. Light entering such a material would take a sharp turn, almost as if it had bounced off an invisible mirror as it crossed the boundary.

The refractive index depends on the response of a material to electric and magnetic fields. Typically within a material, electrons flow in a way to minimize the effects of an external electric field, producing an internal electrical field in the opposite direction. But that is not universally true. For some metals like silver, an oscillating electric field induces a field in the same, not opposite, direction.

Victor G. Veselago, a Russian physicist, realized in the 1960s that if it were possible to find a material that responded in a contrarian way not just to electric fields and but also magnetic fields, a result would be a negative index of refraction.

Dr. Pendry was among the first to start making metamaterials in the late ’90s, building a structure of thin wires that responded to electrical fields in a way opposite most materials. He also designed one that reacted similarly to magnetic fields.

Dr. Smith, then at the University of California, San Diego, attended a talk by Dr. Pendry at a conference in 1999. He and his colleagues built the first metamaterial to combine electric and magnetic behavior.

The journal Physical Review Letters rejected his scientific paper describing the experiment, considering it simplistic and uninteresting. Only then did Dr. Smith come upon Dr. Veselago’s work on negative refraction and the larger implications of the experiment. “We had it, but we didn’t realize it,” said Dr. Smith, who is now at Duke. “Then I rewrote the abstract, and it was accepted.”

That set off a contentious back and forth that lasted several years between researchers who made and measured negative-refraction metamaterials and those who said that the experiments showed nothing of the sort, that negative refraction was at best an illusion and violated the laws of physics.

Part of the difficulty in resolving the controversy was that the negative refraction experiments were at microwave wavelengths. Designing metamaterials for shorter wavelengths and higher frequencies like visible light is more difficult, because fewer materials are transparent at the higher frequencies.

“Just look around the room,” Dr. Pendry said. “How many things can you see through? Not many. You’re running out of road.”

This year, researchers at the Ames Laboratory in Iowa and Karlsruhe University in Germany reported making a metamaterial that had a negative index of refraction for a visible wavelength.

Some critics remain unmollified. Nicolás García of the Spanish National Research Council still calls Dr. Pendry’s statements on negative refraction “propaganda.” But today, most physicists accept the negative refraction interpretation.

The debate did highlight limits of metamaterials. They are dispersive, meaning the angle of refraction depends very sensitively on the frequency of light, and they are lossy, meaning that they absorb energy from the light as it passes through.

Nonetheless, Dr. Pendry has proposed that negative refraction materials can be used to make a “superlens” because they sidestep a process called diffraction that blurs images taken via conventional optics.

Researchers led by Xiang Zhang, a professor at the University of California, Berkeley, have demonstrated that a thin, flat piece of silver can indeed produce such images, able to resolve two thin lines separated by 70 billionths of a meter.

“You put your object on one side and your image will be projected on the other side,” Dr. Zhang said.

The superlens can also preserve detail lost in conventional optics. Light is usually thought of as having undulating waves. But much closer up, light is a much more jumbled mess, with the waves mixed in with more complicated “evanescent waves.”

The evanescent waves quickly dissipate as they travel, and thus are usually not seen. A negative refraction lens actually amplified the evanescent waves, Dr. Pendry calculated, and that effect was demonstrated by Dr. Zhang’s experiment. A negative refraction could someday lead to an optical microscope that could make out tiny biological structures like individual viruses.

The main limit now is that an object has to be placed very close to the lens, within a fraction of a wavelength of light.

Another possible use would be for a DVD-type recorder. The finer focus could allow more data like high-definition movies to be packed in the same space, perhaps the entire Library of Congress on a platter the size of today’s DVD, Dr. Zhang said.

The metamaterials researchers also look for new problems to solve. “Now it’s sort of fired up our imaginations to do this cloaking thing,” Dr. Pendry said, “because we realized we could actually make one using these materials.”

In May 2006, Dr. Pendry and Dr. Smith proposed a design that would cloak a single microwave frequency. By October, Dr. Smith’s group at Duke demonstrated a working version, although simplified and imperfect. Dr. Smith’s microwave design cannot be adapted to visible light, because the energy absorption problem becomes too great.

This year, Vladimir M. Shalaev of Purdue displayed a different design, avoiding the absorption problem. He said it would cloak visible light, albeit just a single wavelength at a time. “We can make our cloak for any of these colors but not for all of them simultaneously,” Dr. Shalaev said. “At least, it starts looking like it’s doable.”

He said he hoped to build the design, which requires tiny rods arrayed around a cylinder, in a few years. Metamaterials could also be used for other novel devices. Dr. Shalaev suggested an “anticloak” that would trap light of a certain wavelength. “That could be used as a sensing device,” he said.

Whether the cloak could be made big enough to cover a teenage wizard or an alien spaceship is another question. “I’m fairly pessimistic knowing what I know now,” Dr. Smith said.

Dr. Shalaev said it would be a challenge. “I don’t know,” he said. “We hope it is possible.”

Oncologists and Medicare reimbursements

2007-06-11T22:25:00.000-04:00

NYTimes

June 12, 2007
Incentives Limit Any Savings in Treating Cancer
By ALEX BERENSON

When Medicare cracked down two years ago on profits that doctors made on drugs they administered to patients in their offices, it ended a windfall worth hundreds of thousands of dollars a year for each physician.

The change, which mainly affected drugs to treat cancer and its side effects, had an immediate effect. In all, cancer doctors billed about $4.4 billion for chemotherapy and anemia medications in 2005, down from $5.6 billion in 2004, with Medicare covering 80 percent of the bills in each year. The difference mostly represented profit that doctors had made on the drugs.

But the change did not reduce overall federal spending on cancer care, which increased slightly. And cancer doctors say the change did nothing to reduce a larger problem in cancer treatment.

Some physicians say that cancer doctors responded to Medicare’s change by performing additional treatments that got them the best reimbursements, whether or not the treatments benefited patients. Those doctors also say that Medicare’s reimbursement policies are responsible.

“The system doesn’t value the time we spend with patients,” said Dr. Peter Eisenberg, a cancer doctor in Greenbrae, Calif., and director of the American Society of Clinical Oncology. “The system values procedures.”

The ballooning cost of cancer treatment, one of Medicare’s most expensive categories, offers a vivid example of how difficult it may be to rein in the nation’s runaway health care spending without fundamentally changing the way doctors are paid.

Cancer patients and their families play a role in rising costs, too, because they understandably want doctors to exhaust every possible treatment, even if the doctors might serve their patients better simply by talking and listening to them.

In general, oncologists make money by providing chemotherapy, even when it has little chance of success. Oncologists naturally dislike telling cancer patients that they have exhausted all available treatments. Ending chemotherapy, after all, means acknowledging that a patient’s disease has become terminal.

“There’s pretty good evidence at this point,” said Dr. Richard Deyo, professor of medicine at the University of Washington and an expert on health care spending, “that there are plenty of patients for whom there’s little hope, who are terminally ill, whom chemotherapy is not going to help, who get chemotherapy.”

With the new limits on cancer drug profits, some cancer doctors are searching for new income — like performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans.

They are also putting new pressure on cancer patients to make out-of-pocket drug co-payments, which can amount to hundreds of dollars a month. In some cases, they are requiring patients to get injections of certain drugs at the hospital instead of in their offices.

Some oncologists say that such changes are necessary because Medicare has not raised its fees for chemotherapy enough to make up the difference. They say they are losing money on Medicare patients and are pressing Medicare to reverse the changes.

Unless it does, a number of doctors say they will be forced to close their practices, and cancer patients, especially in rural areas, may not be able to get treatment.

But that does not yet appear to be a problem. An independent federal commission said last year that the Medicare changes had not reduced patients’ access to care.

The system under which cancer doctors profit on chemotherapy drugs — and so-called supportive care medications, like anemia medicine that is given to counter the side effects of chemotherapy — came into being more than two decades ago. That was when advances in treatment made it possible for patients to receive chemotherapy in doctors’ offices instead of hospitals.

Instead of writing prescriptions that patients filled at pharmacies, cancer doctors bought drugs themselves, then administered them to patients and billed Medicare or private insurers for reimbursement.

Today, the drugs range from relatively inexpensive treatments like Taxol, a breast cancer drug that costs about $150 a dose, to a new wave of biotechnology therapies like Avastin, a drug for colon and lung cancer that can cost as much as $8,800 a dose.

Before 2005, Medicare paid a markup of 20 percent to 100 percent on many drugs, and private insurers paid even more. Doctors pocketed the difference, after certain expenses, as profit.

Because the profits on different drugs varied enormously, doctors had an incentive to prescribe medications with the highest margins. Medicare requires a 20 percent co-payment by patients on chemotherapy medicines, but before 2005 doctors sometimes forgave those co-payments because their profits were so great.

The profits helped drive a vast increase in the amounts doctors billed Medicare for injectable drugs, which soared to $10.9 billion by 2004 from $2.9 billion in 1997. Besides drugs for cancer, the figures include injectable drugs for arthritis and other diseases, though chemotherapy and anemia medications were the largest categories.

The increase in spending, and concerns about the perverse incentives created by the system, caused Congress to change the reimbursement system to more closely tie Medicare payments to what doctors actually pay for the drugs.

Now, drug reimbursement is supposed to amount to only 6 percent more than the average price of the drug paid by all doctors. Because of the change, the overall amount that doctors billed Medicare for injectable drugs fell 6 percent from 2004 to 2005, to $10.3 billion.

Doctors who buy large quantities of medicine can still get big rebates from drug companies, so they can continue to make money on prescriptions — even if it is not at the levels of the past. But those who buy only small quantities get no rebates. And once expenses are calculated, they may actually lose money on certain drugs for Medicare patients.

Private insurers are slowly reducing their reimbursement levels as well, though for most cancer patients they are still paying more than Medicare does.

As a result of the Medicare cutbacks, some doctors say they have been forced to refer patients to hospitals for chemotherapy treatment. Because of the complexities of Medicare rules, hospitals can make money providing chemotherapy for patients even in cases when doctors cannot. But it can be a serious inconvenience for people who are very ill and may have a few months to live.

Dr. Arthur Hooberman, a Chicago oncologist, said his group had sent seven patients to hospitals for treatments in the last few months.

“Our feeling is if we break even on chemotherapy, we’ll give it,” Dr. Hooberman said. But, he added, “we’re not going to pay for people’s chemotherapy.” Dr. Hooberman said Medicare needed to start paying doctors more for other care to make up for their lost drug profits.

Geraldine Lotrich, a lung cancer patient of Dr. Hooberman who has had to receive chemotherapy treatment at a local hospital, said she would rather have remained in his office, where the nurses know her and the doctor can stop in during her five-hour infusion.

“It’s kind of upsetting,” Ms. Lotrich said.

Ari Straus, the chief operating officer of Aurora Healthcare Consulting, which works with doctors to increase their profits, said Medicare’s changes had squeezed oncologists. “Five years ago, many physicians were earning over $1 million per year on drug sales alone,” Mr. Straus said. “It created a perception problem for oncologists that they earn an enormous amount on drugs, but that’s not true anymore. Today, the majority of oncologists break even, and some lose money on drugs.”

A few oncologists and their colleagues see the professional situation as worse. “We’re seeing the dismantling of the community oncology system,” said Steve Coplon, chief executive of the West Clinic, a group of cancer centers in Tennessee that has 28 doctors and sees about 5,000 new patients a year.

Mr. Coplon said his practice had lost $3 million in 2006 on Medicare patients. But invoking confidentiality, he declined to explain how the group had calculated that figure, how much money it made on privately insured patients, how much money it made over all, or how much its doctors earned.

For now, even the oncologists most critical of the 2005 rule changes do not say that patients are being denied treatment, rather that they are being inconvenienced by being forced to receive it in hospitals. And no hard statistics exist to show how many patients have been affected in this way.

In testimony to Congress in July 2006, Mark E. Miller, executive director of the Medicare Payment Advisory Commission, said his group had found that “access to chemotherapy drugs remained good” and had “no evidence that quality of care declined” as a result of the reimbursement changes. The commission is an independent federal group that advises Congress on issues affecting Medicare.

Now, oncologists are lobbying Medicare officials and members of Congress to reverse some of the changes and again raise the prices the government pays for drugs.

But Dr. Robert Geller, who worked as an oncologist in private practice from 1996 to 2005 before leaving to become senior medical director at Alexion, a biotechnology company, said that increasing drug reimbursement might raise oncologists’ profits but would not relieve the system’s deeper flaws.

As long as oncologists continue to be paid by the procedure instead of for spending time with patients, they will find ways to game the system, however much money they make or lose on prescribing drugs, he said.

“People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine,” Dr. Geller said. “When you start thinking of oncology as a business, then all these decisions make sense.”

Age of kids starting kindergarten

2007-06-05T04:12:00.000-04:00

NYTimes

June 3, 2007
When Should a Kid Start Kindergarten?
By ELIZABETH WEIL

According to the apple-or-coin test, used in the Middle Ages, children should start school when they are mature enough for the delayed gratification and abstract reasoning involved in choosing money over fruit. In 15th- and 16th-century Germany, parents were told to send their children to school when the children started to act “rational.” And in contemporary America, children are deemed eligible to enter kindergarten according to an arbitrary date on the calendar known as the birthday cutoff — that is, when the state, or in some instances the school district, determines they are old enough. The birthday cutoffs span six months, from Indiana, where a child must turn 5 by July 1 of the year he enters kindergarten, to Connecticut, where he must turn 5 by Jan. 1 of his kindergarten year. Children can start school a year late, but in general they cannot start a year early. As a result, when the 22 kindergartners entered Jane Andersen’s class at the Glen Arden Elementary School near Asheville, N.C., one warm April morning, each brought with her or him a snack and a unique set of gifts and challenges, which included for some what’s referred to in education circles as “the gift of time.”

After the morning announcements and the Pledge of Allegiance, Andersen’s kindergartners sat down on a blue rug. Two, one boy and one girl, had been redshirted — the term, borrowed from sports, describes students held out for a year by their parents so that they will be older, or larger, or more mature, and thus better prepared to handle the increased pressures of kindergarten today. Six of Andersen’s pupils, on the other hand, were quite young, so young that they would not be enrolled in kindergarten at all if North Carolina succeeds in pushing back its birthday cutoff from Oct. 16 to Aug. 31.

Andersen is a willowy 11-year teaching veteran who offered up a lot of education in the first hour of class. First she read Leo Lionni’s classic children’s book “An Extraordinary Egg,” and directed a conversation about it. Next she guided the students through: writing a letter; singing a song; solving an addition problem; two more songs; and a math game involving counting by ones, fives and tens using coins. Finally, Andersen read them another Lionni book. Labor economists who study what’s called the accumulation of human capital — how we acquire the knowledge and skills that make us valuable members of society — have found that children learn vastly different amounts from the same classroom experiences and that those with certain advantages at the outset are able to learn more, more quickly, causing the gap between students to increase over time. Gaps in achievement have many causes, but a major one in any kindergarten room is age. Almost all kindergarten classrooms have children with birthdays that span 12 months. But because of redshirting, the oldest student in Andersen’s class is not just 12 but 15 months older than the youngest, a difference in age of 25 percent.

After rug time, Andersen’s kindergartners walked single-file to P.E. class, where the children sat on the curb alongside the parking circle, taking turns running laps for the Presidential Fitness Test. By far the fastest runner was the girl in class who had been redshirted. She strode confidently, with great form, while many of the smaller kids could barely run straight. One of the younger girls pointed out the best artist in the class, a freckly redhead. I’d already noted his beautiful penmanship. He had been redshirted as well.

States, too, are trying to embrace the advantages of redshirting. Since 1975, nearly half of all states have pushed back their birthday cutoffs and four — California, Michigan, North Carolina and Tennessee — have active legislation in state assemblies to do so right now. (Arkansas passed legislation earlier this spring; New Jersey, which historically has let local districts establish their birthday cutoffs, has legislation pending to make Sept. 1 the cutoff throughout the state.) This is due, in part, to the accountability movement — the high-stakes testing now pervasive in the American educational system. In response to this testing, kindergartens across the country have become more demanding: if kids must be performing on standardized tests in third grade, then they must be prepping for those tests in second and first grades, and even at the end of kindergarten, or so the thinking goes. The testing also means that states, like students, now get report cards, and they want their children to do well, both because they want them to be educated and because they want them to stack up favorably against their peers.

Indeed, increasing the average age of the children in a kindergarten class is a cheap and easy way to get a small bump in test scores, because older children perform better, and states’ desires for relative advantage is written into their policy briefs. The California Performance Review, commissioned by Gov. Arnold Schwarzenegger in 2004, suggested moving California’s birthday cutoff three months earlier, to Sept. 1 from Dec. 2, noting that “38 states, including Florida and Texas, have kindergarten entry dates prior to California’s.” Maryland’s proposal to move its date mentioned that “the change . . . will align the ‘cutoff’ date with most of the other states in the country.”

All involved in increasing the age of kindergartners — parents, legislatures and some teachers — say they have the best interests of children in mind. “If I had just one goal with this piece of legislation it would be to not humiliate a child,” Dale Folwell, the Republican North Carolina state representative who sponsored the birthday-cutoff bill, told me. “Our kids are younger when they’re taking the SAT, and they’re applying to the same colleges as the kids from Florida and Georgia.” Fair enough — governors and state legislators have competitive impulses, too. Still, the question remains: Is it better for children to start kindergarten later? And even if it’s better for a given child, is it good for children in general? Time out of school may not be a gift to all kids. For some it may be a burden, a financial stress on their parents and a chance, before they ever reach a classroom, to fall even further behind.

Redshirting is not a new phenomenon — in fact, the percentage of redshirted children has held relatively steady since education scholars started tracking the practice in the 1980s. Studies by the National Center for Education Statistics in the 1990s show that delayed-entry children made up somewhere between 6 and 9 percent of all kindergartners; a new study is due out in six months. As states roll back birthday cutoffs, there are more older kindergartners in general — and more redshirted kindergartners who are even older than the oldest kindergartners in previous years. Recently, redshirting has become a particular concern, because in certain affluent communities the numbers of kindergartners coming to school a year later are three or four times the national average. “Do you know what the number is in my district?” Representative Folwell, from a middle-class part of Winston-Salem, N.C., asked me. “Twenty-six percent.” In one kindergarten I visited in Los Altos, Calif. — average home price, $1 million — about one-quarter of the kids had been electively held back as well. Fred Morrison, a developmental psychologist at the University of Michigan who has studied the impact of falling on one side or the other of the birthday cutoff, sees the endless “graying of kindergarten,” as it’s sometimes called, as coming from a parental obsession not with their children’s academic accomplishment but with their social maturity. “You couldn’t find a kid who skips a grade these days,” Morrison told me. “We used to revere individual accomplishment. Now we revere self-esteem, and the reverence has snowballed in unconscious ways — into parents always wanting their children to feel good, wanting everything to be pleasant.” So parents wait an extra year in the hope that when their children enter school their age or maturity will shield them from social and emotional hurt. Elizabeth Levett Fortier, a kindergarten teacher in the George Peabody Elementary School in San Francisco, notices the impact on her incoming students. “I’ve had children come into my classroom, and they’ve never even lost at Candy Land.”

For years, education scholars have pointed out that most studies have found that the benefits of being relatively older than one’s classmates disappear after the first few years of school. In a literature review published in 2002, Deborah Stipek, dean of the Stanford school of education, found studies in which children who are older than their classmates not only do not learn more per grade but also tend to have more behavior problems. However, more recent research by labor economists takes advantage of new, very large data sets and has produced different results. A few labor economists do concur with the education scholarship, but most have found that while absolute age (how many days a child has been alive) is not so important, relative age (how old that child is in comparison to his classmates) shapes performance long after those few months of maturity should have ceased to matter. The relative-age effect has been found in schools around the world and also in sports. In one study published in the June 2005 Journal of Sport Sciences, researchers from Leuven, Belgium, and Liverpool, England, found that a disproportionate number of World Cup soccer players are born in January, February and March, meaning they were old relative to peers on youth soccer teams.

Before the school year started, Andersen, who is 54, taped up on the wall behind her desk a poster of a dog holding a bouquet of 12 balloons. In each balloon Andersen wrote the name of a month; under each month, the birthdays of the children in her class. Like most teachers, she understands that the small fluctuations among birth dates aren’t nearly as important as the vast range in children’s experiences at preschool and at home. But one day as we sat in her classroom, Andersen told me, “Every year I have two or three young ones in that August-to-October range, and they just struggle a little.” She used to encourage parents to send their children to kindergarten as soon as they were eligible, but she is now a strong proponent of older kindergartners, after teaching one child with a birthday just a few days before the cutoff. “She was always a step behind. It wasn’t effort and it wasn’t ability. She worked hard, her mom worked with her and she still was behind.” Andersen followed the girl’s progress through second grade (after that, she moved to a different school) and noticed that she didn’t catch up. Other teachers at Glen Arden Elementary and elsewhere have noticed a similar phenomenon: not always, but too often, the little ones stay behind.

The parents of the redshirted girl in Andersen’s class told a similar story. Five years ago, their older daughter had just made the kindergarten birthday cutoff by a few days, and they enrolled her. “She’s now a struggling fourth grader: only by the skin of her teeth has she been able to pass each year,” the girl’s mother, Stephanie Gandert, told me. “I kick myself every year now that we sent her ahead.” By contrast, their current kindergartner is doing just fine. “I always tell parents, ‘If you can wait, wait.’ If my kindergartner were in first grade right now, she’d be in trouble, too.” (The parents of the redshirted boy in Andersen’s class declined to be interviewed for this article but may very well have held him back because he’s small — even though he’s now one of the oldest, he’s still one of the shortest.)

Kelly Bedard, a labor economist at the University of California, Santa Barbara, published a paper called “The Persistence of Early Childhood Maturity: International Evidence of Long-Run Age Effects” in The Quarterly Journal of Economics in November 2006 that looked at this phenomenon. “Obviously, when you’re 5, being a year older is a lot, and so we should expect kids who are the oldest in kindergarten to do better than the kids who are the youngest in kindergarten,” Bedard says. But what if relatively older kids keep doing better after the maturity gains of a few months should have ceased to matter? What if kids who are older relative to their classmates still have higher test scores in fourth grade, or eighth grade?

After crunching the math and science test scores for nearly a quarter-million students across 19 countries, Bedard found that relatively younger students perform 4 to 12 percentiles less well in third and fourth grade and 2 to 9 percentiles worse in seventh and eighth; and, as she notes, “by eighth grade it’s fairly safe to say we’re looking at long-term effects.” In British Columbia, she found that the relatively oldest students are about 10 percent more likely to be “university bound” than the relatively youngest ones. In the United States, she found that the relatively oldest students are 7.7 percent more likely to take the SAT or ACT, and are 11.6 percent more likely to enroll in four-year colleges or universities. (No one has yet published a study on age effects and SAT scores.) “One reason you could imagine age effects persist is that almost all of our education systems have ability-groupings built into them,” Bedard says. “Many claim they don’t, but they do. Everybody gets put into reading groups and math groups from very early ages.” Younger children are more likely to be assigned behind grade level, older children more likely to be assigned ahead. Younger children are more likely to receive diagnoses of attention-deficit disorder, too. “When I was in school the reading books all had colors,” Bedard told me. “They never said which was the high, the middle and the low, but everybody knew. Kids in the highest reading group one year are much more likely to be in the highest reading group the next. So you can imagine how that could propagate itself.”

Bedard found that different education systems produce varying age effects. For instance, Finland, whose students recently came out on top in an Organization for Economic Cooperation and Development study of math, reading and science skills, experiences smaller age effects; Finnish children also start school later, at age 7, and even then the first few years are largely devoted to social development and play. Denmark, too, produces little difference between relatively older and younger kids; the Danish education system prohibits differentiating by ability until students are 16. Those two exceptions notwithstanding, Bedard notes that she found age effects everywhere, from “the Japanese system of automatic promotion, to the accomplishment-oriented French system, to the supposedly more flexible skill-based program models used in Canada and the United States.”

The relative value of being older for one’s grade is a particularly open secret in those sectors of the American schooling system that treat education like a competitive sport. Many private-school birthday cutoffs are set earlier than public-school dates; and children, particularly boys, who make the cutoff but have summer and sometimes spring birthdays are often placed in junior kindergarten — also called “transitional kindergarten,” a sort of holding tank for kids too old for more preschool — or are encouraged to wait a year to apply. Erika O’Brien, a SoHo mother who has two redshirted children at Grace Church, a pre-K-through-8 private school in Manhattan, told me about a conversation she had with a friend whose daughter was placed in junior kindergarten because she had a summer birthday. “I told her that it’s really a great thing. Her daughter is going to have a better chance of being at the top of her class, she’ll more likely be a leader, she’ll have a better chance of succeeding at sports. She’s got nothing to worry about for the next nine years. Plus, if you’re making a financial investment in school, it’s a less risky investment.”

Robert Fulghum listed life lessons in his 1986 best seller “All I Really Need to Know I Learned in Kindergarten.” Among them were:

Clean up your own mess.

Don’t take things that aren’t yours.

Wash your hands before you eat.

Take a nap every afternoon.

Flush.

Were he to update the book to reflect the experience of today’s children, he’d need to call it “All I Really Need to Know I Learned in Preschool,” as kindergarten has changed. The half day devoted to fair play and nice manners officially began its demise in 1983, when the National Commission on Excellence in Education published “A Nation at Risk,” warning that the country faced a “rising tide of mediocrity” unless we increased school achievement and expectations. No Child Left Behind, in 2002, exacerbated the trend, pushing phonics and pattern-recognition worksheets even further down the learning chain. As a result, many parents, legislatures and teachers find the current curriculum too challenging for many older 4- and young 5-year-olds, which makes sense, because it’s largely the same curriculum taught to first graders less than a generation ago. Andersen’s kindergartners are supposed to be able to not just read but also write two sentences by the time they graduate from her classroom. It’s no wonder that nationwide, teachers now report that 48 percent of incoming kindergartners have difficulty handling the demands of school.

Friedrich Froebel, the romantic motherless son who started the first kindergarten in Germany in 1840, would be horrified by what’s called kindergarten today. He conceived the early learning experience as a homage to Jean-Jacques Rousseau, who believed that “reading is the plague of childhood. . . . Books are good only for learning to babble about what one does not know.” Letters and numbers were officially banned from Froebel’s kindergartens; the teaching materials consisted of handmade blocks and games that he referred to as “gifts.” By the late 1800s, kindergarten had jumped to the United States, with Boston transcendentalists like Elizabeth Peabody popularizing the concept. Fairly quickly, letters and numbers appeared on the wooden blocks, yet Peabody cautioned that a “genuine” kindergarten is “a company of children under 7 years old, who do not learn to read, write and cipher” and a “false” kindergarten is one that accommodates parents who want their children studying academics instead of just playing.

That the social skills and exploration of one’s immediate world have been squeezed out of kindergarten is less the result of a pedagogical shift than of the accountability movement and the literal-minded reverse-engineering process it has brought to the schools. Curriculum planners no longer ask, What does a 5-year-old need? Instead they ask, If a student is to pass reading and math tests in third grade, what does that student need to be doing in the prior grades? Whether kindergarten students actually need to be older is a question of readiness, a concept that itself raises the question: Ready for what? The skill set required to succeed in Fulgham’s kindergarten — openness, creativity — is well matched to the capabilities of most 5-year-olds but also substantially different from what Andersen’s students need. In early 2000, the National Center for Education Statistics assessed 22,000 kindergartners individually and found, in general, that yes, the older children are better prepared to start an academic kindergarten than the younger ones. The older kids are four times as likely to be reading, and two to three times as likely to be able to decipher two-digit numerals. Twice as many older kids have the advanced fine motor skills necessary for writing. The older kids also have important noncognitive advantages, like being more persistent and more socially adept. Nonetheless, child advocacy groups say it’s the schools’ responsibility to be ready for the children, no matter their age, not the children’s to be prepared for the advanced curriculum. In a report on kindergarten, the National Association of Early Childhood Specialists in State Departments of Education wrote, “Most of the questionable entry and placement practices that have emerged in recent years have their genesis in concerns over children’s capacities to cope with the increasingly inappropriate curriculum in kindergarten.”

Furthermore, as Elizabeth Graue, a former kindergarten teacher who now studies school-readiness and redshirting at the University of Wisconsin, Madison, points out, “Readiness is a relative issue.” Studies of early-childhood teachers show they always complain about the youngest students, no matter their absolute age. ‘In Illinois it will be the March-April-May kids; in California, it will be October-November-December,” Graue says. “It’s really natural as a teacher to gravitate toward the kids who are easy to teach, especially when there’s academic pressure and the younger kids are rolling around the floor and sticking pencils in their ears.”

But perhaps those kids with the pencils in their ears — at least the less-affluent ones — don’t need “the gift of time” but rather to be brought into the schools. Forty-two years after Lyndon Johnson inaugurated Head Start, access to quality early education still highly correlates with class; and one serious side effect of pushing back the cutoffs is that while well-off kids with delayed enrollment will spend another year in preschool, probably doing what kindergartners did a generation ago, less-well-off children may, as the literacy specialist Katie Eller put it, spend “another year watching TV in the basement with Grandma.” What’s more, given the socioeconomics of redshirting — and the luxury involved in delaying for a year the free day care that is public school — the oldest child in any given class is more likely to be well off and the youngest child is more likely to be poor. “You almost have a double advantage coming to the well-off kids,” says Samuel J. Meisels, president of Erikson Institute, a graduate school in child development in Chicago. “From a public-policy point of view I find this very distressing.”

Nobody has exact numbers on what percentage of the children eligible for publicly financed preschool are actually enrolled — the individual programs are legion, and the eligibility requirements are complicated and varied — but the best guess from the National Institute for Early Education Research puts the proportion at only 25 percent. In California, for instance, 76 percent of publicly financed preschool programs have waiting lists, which include over 30,000 children. In Pennsylvania, 35 percent of children eligible for Head Start are not served. A few states do have universal preschool, and among Hillary Clinton’s first broad domestic policy proposals as a Democratic presidential candidate was to call for universal pre-kindergarten classes. But at the moment, free high-quality preschool for less-well-to-do children is spotty, and what exists often is aimed at extremely low-income parents, leaving out the children of the merely strapped working or lower-middle class. Nor, as a rule, do publicly financed programs take kids who are old enough to be eligible for kindergarten, meaning redshirting is not a realistic option for many.

One morning, when I was sitting in Elizabeth Levett Fortier’s kindergarten classroom in the Peabody School in San Francisco — among a group of students that included some children who had never been to preschool, some who were just learning English and some who were already reading — a father dropped by to discuss whether or not to enroll his fall-birthday daughter or give her one more year at her private preschool. Demographically speaking, any child with a father willing to call on a teacher to discuss if it’s best for that child to spend a third year at a $10,000-a-year preschool is going to be fine. Andersen told me, “I’ve had parents tell me that the preschool did not recommend sending their children on to kindergarten yet, but they had no choice,” as they couldn’t afford not to. In 49 out of 50 states, the average annual cost of day care for a 4-year-old in an urban area is more than the average annual public college tuition. A RAND Corporation position paper suggests policy makers may need to view “entrance-age policies and child-care polices as a package.”

Labor economists, too, make a strong case that resources should be directed at disadvantaged children as early as possible, both for the sake of improving each child’s life and because of economic return. Among the leaders in this field is James Heckman, a University of Chicago economist who won the Nobel in economic science in 2000. In many papers and lectures on poor kids, he now includes a simple graph that plots the return on investment in human capital across age. You can think of the accumulation of human capital much like the accumulation of financial capital in an account bearing compound interest: if you add your resources as soon as possible, they’ll be worth more down the line. Heckman’s graph looks like a skateboard quarter-pipe, sloping precipitously from a high point during the preschool years, when the return on investment in human capital is very high, down the ramp and into the flat line after a person is no longer in school, when the return on investment is minimal. According to Heckman’s analysis, if you have limited funds to spend it makes the most economic sense to spend them early. The implication is that if poor children aren’t in adequate preschool programs, rolling back the age of kindergarten is a bad idea economically, as it pushes farther down the ramp the point at which we start investing funds and thus how productive those funds will be.

Bedard and other economists cite Heckman’s theories of how people acquire skills to help explain the persistence of relative age on school performance. Heckman writes: “Skill begets skill; motivation begets motivation. Early failure begets later failure.” Reading experts know that it’s easier for a child to learn the meaning of a new word if he knows the meaning of a related word and that a good vocabulary at age 3 predicts a child’s reading well in third grade. Skills like persistence snowball, too. One can easily see how the skill-begets-skill, motivation-begets-motivation dynamic plays out in a kindergarten setting: a child who comes in with a good vocabulary listens to a story, learns more words, feels great about himself and has an even better vocabulary at the end of the day. Another child arrives with a poor vocabulary, listens to the story, has a hard time following, picks up fewer words, retreats into insecurity and leaves the classroom even further behind.

How to address the influence of age effects is unclear. After all, being on the older or younger side of one’s classmates is mostly the luck of the birthday draw, and no single birthday cutoff can prevent a 12-month gap in age. States could try to prevent parents from gaming the age effects by outlawing redshirting — specifically by closing the yearlong window that now exists in most states between the birthday cutoffs and compulsory schooling. But forcing families to enroll children in kindergarten as soon as they are eligible seems too authoritarian for America’s tastes. States could also decide to learn from Finland — start children in school at age 7 and devote the first year to play — but that would require a major reversal, making second grade the old kindergarten, instead of kindergarten the new first grade. States could also emulate Denmark, forbidding ability groupings until late in high school, but unless very serious efforts are made to close the achievement gap before children arrive at kindergarten, that seems unlikely, too.

Of course there’s also the reality that individual children will always mature at different rates, and back in Andersen’s classroom, on a Thursday when this year’s kindergartners stayed home and next year’s kindergartners came in for pre-enrollment assessments, the developmental differences between one future student and the next were readily apparent. To gauge kindergarten readiness, Andersen and another kindergarten teacher each sat the children down one by one for a 20-minute test. The teachers asked the children, among other things, to: skip; jump; walk backward; cut out a diamond on a dotted line; copy the word cat; draw a person; listen to a story; and answer simple vocabulary questions like what melts, what explodes and what flies. Some of the kids were dynamos. When asked to explain the person he had drawn, one boy said: “That’s Miss Maple. She’s my preschool teacher, and she’s crying because she’s going to miss me so much next year.” Another girl said at one point, “Oh, you want me to write the word cat?” Midmorning, however, a little boy who will not turn 5 until this summer arrived. His little feet dangled off the kindergarten chair, as his legs were not long enough to reach the floor. The teacher asked him to draw a person. To pass that portion of the test, his figure needed seven different body parts.

“Is that all he needs?” she asked a few minutes later.

The boy said, “Oh, I forgot the head.”

A minute later the boy submitted his drawing again. “Are you sure he doesn’t need anything else?” the teacher asked.

The boy stared at his work. “I forgot the legs. Those are important, aren’t they?”

The most difficult portion of the test for many of the children was a paper-folding exercise. “Watch how I fold my paper,” the teacher told the little boy. She first folded her 8 1/2-by-11-inch paper in half the long way, to create a narrow rectangle, and then she folded the rectangle in thirds, to make something close to a square.

“Can you do it?” she asked the boy.

He took the paper eagerly, but folded it in half the wrong way. Depending on the boy’s family’s finances, circumstances and mind-set, his parents may decide to hold him out a year so he’ll be one of the oldest and, presumably, most confident. Or they may decide to enroll him in school as planned. He may go to college or he may not. He may be a leader or a follower. Those things will ultimately depend more on the education level achieved by his mother, whether he lives in a two-parent household and the other assets and obstacles he brings with him to school each day. Still, the last thing any child needs is to be outmaneuvered by other kids’ parents as they cut to the back of the birthday line to manipulate age effects. Eventually, the boy put his head down on the table. His first fold had set a course, and even after trying gamely to fold the paper again in thirds, he couldn’t create the right shape.

Mets bang for the buck players

2007-06-05T02:37:00.000-04:00

NYTimes

June 5, 2007
Bargain-Basement Acquisitions Help Mets Reach the Top
By BEN SHPIGEL

At 12:01 a.m. on Dec. 21, 2005, the office of Commissioner Bud Selig sent an e-mail message to every team in baseball listing 50 players who had become free agents because their teams had not offered them contracts for the next season.

The message included inauspicious players like Joe Dillon, Brian Myrow and Hiram Bocachica. It also included an outfielder named Endy Chávez, who had hit a combined .216 that season with Washington and Philadelphia. In 48 hours, the Mets were congratulating themselves for quickly signing Chávez to a one-year deal worth $500,000.

Eighteen months later, the Mets are still patting themselves on the back, and why shouldn’t they? They are a third of the way through the 2007 season and are just where they hoped to be — with the best record in the National League and a tidy lead over Atlanta in an improved N.L. East. They have been successful by avoiding slumps — they are one of two teams not to lose more than two games in a row this season — by playing standout defense, and in particular, by using Chávez and other bargain acquisitions like infielder Damion Easley and starting pitcher Jorge Sosa to cope with the numerous injuries the team has had.

It is the success of those backup players this year, and for that matter, the standout performances of Chávez and José Valentín last season, that have underlined how savvy General Manger Omar Minaya and his staff have been the past three seasons in making moves that had more to do with scouting and judgment than with the Mets’ considerable financial resources.

To sign Chávez and Valentín, or Easley and Sosa before this season, a blank check was not required. Other teams, even small-market ones, could have tried to grab them. All told, Minaya acquired those four players for about $3.5 million. They are the kind of below-the-radar moves, perhaps more than the expensive signings of Pedro Martínez, Carlos Beltrán and Billy Wagner or the trades for Carlos Delgado and Paul Lo Duca, that have earned Minaya the admiration of his peers.

“Once you have your core guys, you start filling in the other spots,” Minaya said in a recent interview. ”

The Mets’ method for evaluating talent is not much different from that of other teams. But not every team is benefiting from low-cost moves the way the Mets are. A detailed look at two of those signings — Chávez and Easley — is instructive.

In the case of Chávez, the Mets, toward the end of the 2005 season, sought a backup outfielder who would represent a substantial upgrade over Gerald Williams. They liked Jeff DaVanon, who had played with the Los Angeles Angels in 2005, but not as much as Chávez, a natural center fielder who could play all three outfield positions and had the experience of being an everyday player; Chávez played 273 games in 2003 and 2004 in Montreal. The Expos’ general manager at the time was Minaya, who never forgot Chávez’s superb defense and called his agent, Peter Greenberg, a few hours after learning that Philadelphia did not tender Chávez a contract for the 2006 season.

In the Mets’ front office, questions emerged about Chávez’s offensive skills. His reluctance to bunt and take pitches had quickened his departure from Washington during the 2005 season, and he had a loopy swing that did not match his strengths. But the Mets figured that working with the hitting coach Rick Down would eliminate some of his bad habits. “With Endy, not too many stats guys were jumping all over him,” Minaya said. “He’s a scout’s guy, and as a general manager, you’re only as good as your scouts.”

John Ricco, an assistant general manager for the Mets, was hammering out a deal with Chávez when Minaya learned that Baltimore had joined the bidding. The Baltimore third baseman Melvin Mora, who like Chavez is from Venezuela and is one of his close friends, had implored the Orioles to improve their offer. To reinforce his own recruiting pitch, Minaya spoke to Chávez. Their time together in Montreal might have given the Mets an edge. “I’m trying to take care of him because he took care of me,” Chávez said.

Chávez missed nearly three weeks of spring training last season participating in the World Baseball Classic, and Manager Willie Randolph had trouble forming an opinion of him. “We just kept telling him, ‘Trust our scouts, trust our scouts,’ ” Minaya said of Randolph. “And he did.”

Randolph knew much more about Easley, but not as much as the Mets’ vice president for development, Tony Bernazard. After the Mets decided not to re-sign Chris Woodward, their resident backup middle infielder, they pored over the free-agent class for 2007.

As soon as the free-agent signing period began in November, Bernazard, who had known Easley for about 15 years, called him at his home in Arizona. The Mets, he explained, were looking for a right-handed complement to Valentín, who is on the disabled list, and someone who could come off the bench late in a game and hit a fastball. That is something that Easley, with seven homers this season, one short of the team lead, has done with great success. “We wanted someone unselfish,” Bernazard said. “Mr. Easley was very comfortable in that role.”

Easley drew interest from several other teams, including the Yankees, but he said he did not really consider any team but the Mets for two reasons. He had never been to the playoffs, and he felt the Mets had a great chance to get there. The other reason required a little more analysis. He examined how the Mets used Woodward over the past two seasons and figured that he would probably receive similar, if not more, opportunities.

“I knew I wasn’t going to get 500 or 600 plate appearances here, so I started thinking what kind of a difference I would make if I got 200 or 250 at-bats,” Easley said. “And when you sign a guy expecting to get 200 or 250 at-bats from him, you really have to do your homework. I know the Mets did theirs.”

For that matter, the Mets also did their homework with relief pitchers Chad Bradford and Darren Oliver, two acquisitions who greatly benefited the Mets last season for a combined cost of $2 million. Both have moved on, but Chávez, Easley, Sosa and Valentín are all here. Who knows who else Minaya may have his eye on?

Money advice for graduates

2007-06-02T13:48:00.000-04:00

NYTimes

June 2, 2007
Your Money
More Advice Graduates Don’t Want to Hear
By DAMON DARLIN

Last year at this time, as college graduates walked out into the world, I wrote a column giving advice on how they could save money.

In droves, parents sent the column to their children. And some of those children wrote to me to vent. What I suggested was impractical, many said. How would you like to try to live on $40,000 a year in Washington or San Francisco, several asked.

What I was proposing was not radical. It was mostly the simple things my mother had drummed into me. It was advice like diverting 10 percent of your income to savings before anything else and ignoring raises and putting them into savings, too. Learn to cook, I said, and never borrow money to pay for a depreciating asset.

I also suggested cutting out the latte habit, which was my symbol for those little things in life that when turned into a habit, add up to money that could have been spent on something worthwhile and memorable.

Other people, my wife among them, pointed out that I may have been too draconian on that point. Consistent savings is a lot easier if there are small rewards along the way; otherwise, life seems as if it is just one bowl of cold grass porridge after another.

Fine feedback, indeed, and my wife’s counsel reminds me that I should have added one other bit of advice: find a partner and stay together. Study after study show that two can live more cheaply together than each alone and that divorce is the great destroyer of wealth.

But, dear graduates, the crux of the advice is still compelling. While there may be a debate among economists about how much 50- and 60-year-olds should be saving for retirement, there is little dispute about how much the young should save: more.

Saving while young is critical. It isn’t just because of the power of compounding. By that I mean that if you start saving now it will build to a larger nest egg by the time you are 65 than if you wait to start at 45. Or to put it another way, you can save a smaller amount now rather than a larger amount later.

Bank $250 a month for 40 years in a I.R.A. or a 401(k) and you will receive about $500,000, assuming a 6 percent return. Start at age 45 and you would have to put in $1,078 a month to generate the same amount by age 65.

But there is another compelling reason to get into the habit of saving. (Here is where this column also turns into advice for the older folks who are giving you this to read.) People who save a lot get used to a lower rate of consumption while working, so less money is needed in retirement.

Stretching to save a little more yields a double dividend. You accumulate more assets and you lower the amount you will need in retirement because you will not have the habit of spending extravagantly to feel fulfilled.

Inevitably though, we return to the question: How can you possibly afford to put away that much? If you are only making $40,000, a not-untypical starting salary for a college-educated professional in a big city, the weekly gross of $769 works down to $561 in take-home pay after income taxes and payroll taxes for Social Security and Medicaid.

Were you to divert 10 percent of your salary to a 401(k) plan, the bottom line becomes $509.

In other words, a regular habit of savings costs you $52 a week. You easily frittered that away last week on things that you cannot even recall this week. A useful exercise that proves the point: For a week, try to list everywhere you spend cash or use your credit card.

Could you save another 10 percent a week, or $50? If you do, you are nearly set for life.

Can you live on $1,950 a month? Rents being what they are in certain cities like New York, San Francisco or Washington, sure, it will be tight. People do it by finding a roommate and watching their expenses (or asking for an occasional handout from Mom and Dad).

There may be another compelling reason to save and that is that while many aspects of retirement savings are predictable, the big unknowable is health care costs. “If you believe in the logic of the life cycle model, then once you get used to peanut butter, all else follows,” said Jonathan Skinner, a economics professor at Dartmouth College who has studied retirement issues and recently wrote a paper titled “Are You Sure You’re Saving Enough for Retirement?” for the National Bureau of Economic Research. “That’s the assumption that I am questioning: Do people want to be stuck in peanut butter in retirement?”

He said he came to the conclusion that a strategy to reduce retirement expenses “will be dwarfed by rapidly growing out-of-pocket medical expenses.” He noted projections based on the Health and Retirement Study, a survey of 22,000 Americans over the age of 50 sponsored by the National Institute on Aging found that by 2019, nearly a tenth of elderly retirees would be devoting more than half of their total income to out-of-pocket health expenses. He said, “These health care cost projections are perhaps the scariest beast under the bed.”

As Victor Fuchs, the professor emeritus of economics and health research and policy at Stanford University, told me, money is most useful when you are old because it makes all the difference whether you wait for a bus in the rain to get to the doctor’s appointment or you ride in a cab.

“Saving for retirement may ultimately be less about the golf condo at Hilton Head and more about being able to afford wheelchair lifts, private nurses and a high-quality nursing home,” Professor Skinner said.

His best advice for people in their 20s and 30s: maximize workplace matching contributions, seek automatic savings mechanisms like home mortgages and hope “that their generation can still look forward to solvent Social Security and Medicare programs.”

•

Over the last two years I’ve been dispensing advice in this space about how to spend and save more wisely. This will be my last column for a spell as I am taking on editing duties that give me little time for reporting. But before I go, I want to remind the young graduates, their parents who scrimped and saved to get them there, and anyone else who stuck with me this far that are a few other rules of life worth considering.

Among them are the following. Links are available at nytimes.com/business:

Never pay a real estate agent a 6 percent commission.

Buy used things, except maybe used tires.

Get on the do-not-call list and other do-not-solicit lists so you can’t be tempted.

Watch infomercials for their entertainment value only.

Know what your credit reports say, but don’t pay for that knowledge: go to www.annualcreditreport.com to get them.

Consolidate your cable, phone and Internet service to get the best deal.

Resist the lunacy of buying premium products like $2,000-a-pound chocolates.

Lose weight. Carrying extra pounds costs tens of thousands of dollars over a lifetime.

Do not use your home as a piggy bank if home prices are flat or going down or if interest rates are rising.

Enroll in a 401(k) at work immediately.

Postpone buying high-tech products like PCs, digital cameras and high-definition TVs for as long as possible. And then buy after the selling season or buy older technology just as a new technology comes along.

And, I’m sorry, I’m really serious about this last one: make your own coffee.