Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand





As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.




A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.


“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”


Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.


Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.


The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”


While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.


“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”


Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.


“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”


Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.


“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”


For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.


“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”


“It’s about the cancer, not Lance,” Eddie Bonds said.


That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.


Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.


Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.


“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”


Nienhouse said he had no plans to have the tattoo removed.


As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.


“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”


She also said she did not plan to have her tattoo removed.


“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”


Read More..

Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand





As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.




A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.


“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”


Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.


Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.


The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”


While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.


“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”


Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.


“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”


Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.


“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”


For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.


“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”


“It’s about the cancer, not Lance,” Eddie Bonds said.


That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.


Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.


Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.


“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”


Nienhouse said he had no plans to have the tattoo removed.


As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.


“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”


She also said she did not plan to have her tattoo removed.


“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”


Read More..

Slipstream: If You’re Collecting Our Data, You Ought to Protect It





LAST summer, employees at the National Aeronautics and Space Administration received an in-house newsletter illustrated with mock front pages of USA Today and The Washington Post and seemingly hyperbolic headlines like: “NASA Laptop Stolen, Potential Compromise of 10,000 Employees’ Private Information!”




The catastrophizing turned out to be prescient.


On Halloween, just a few months after the newsletter went out, a laptop used by an employee at NASA headquarters in Washington was stolen from a parked car. Subsequently, NASA sent letters to about 10,000 current and former employees and contractors, warning them that the laptop had not been encrypted. The letter explained that confidential details — like employees’ names, birth dates, Social Security numbers and, in some cases, personal information from background checks — may have been compromised.


When Robert M. Nelson, a solar systems scientist who recently retired after 34 years at the Jet Propulsion Laboratory, part of NASA, received the letter, he felt vindicated. Several years earlier, he and 27 other civilian scientists at the lab sued the agency to try to stop it from conducting open-ended background checks of researchers like them who worked on nonmilitary space projects.


“You’d think an agent of NASA would be a little more careful,” Dr. Nelson says. “Why does NASA need personal data unrelated to our work and then treat it in such a cavalier way that it is stolen from a car unencrypted?”


NASA has since notified an additional 30,000 people whose personal information may have been on the stolen laptop, says Robert Jacobs, a NASA spokesman. He declined to provide the job title of the person who left the laptop in the car. But he said that there had been no indication of identity theft and that the agency has encrypted practically all of its 38,000 laptops.


By now, reports of lost or stolen business devices are so common that many people open data-breach notices from their banks, insurers, medical institutions, schools and state agencies with something like resignation. In fact, negligence by employees and contractors has been a more common cause of corporate data breaches in the United States than malicious attacks, according to a study of 2011 done by the Ponemon Institute, a research center on data security, and financed by Symantec, a data security company. Institutions, companies and government agencies often devote more resources to collecting information about employees and consumers than to protecting it, security specialists say.


“This is an unfortunate but perfectly cautionary tale of not only how we should look more carefully at protecting data after it is collected,” says Lee Tien, a senior staff lawyer at the Electronic Frontier Foundation, a digital rights group in San Francisco, “but also how the data is to be safeguarded before we collect it to make sure it isn’t used improperly or disclosed accidentally.”


Dr. Nelson and his colleagues at the Jet Propulsion Lab, which is operated for NASA by the California Institute of Technology in Pasadena, didn’t set out to become crusaders for workplace data privacy and security. Initially, they wanted only to challenge NASA’s background checks, arguing that civilian scientists had a right to keep their romantic, psychiatric and other intimate information private from the government. Besides, they contended, the space agency would not be able to safeguard the information.


The scientists took their case all the way to the Supreme Court, only to lose. In 2011, the justices unanimously ruled that NASA had legitimate reasons to look into personal issues, like whether an employee had received drug counseling. A federal law called the Privacy Act of 1974, which restricts how government agencies share a person’s data, the justices said, should protect the information obtained in background checks.


“They were clearly wrong,” says Marc Rotenberg, executive director of the Electronic Privacy Information Center, an advocacy group in Washington that filed a friend-of-the-court-brief in the case. “Exactly the problem people anticipated came to pass.”


Privacy advocates say that one obstacle to improving workplace information security is a lack of consequences for employees who compromise personal data. In 2009, for example, the Government Accountability Office issued a report, titled “NASA Needs to Remedy Vulnerabilities in Key Networks,” which urged the agency to institute whole-disk encryption for all of its laptops. Unlike simple computer login passwords — which can often be guessed or bypassed to get to readable files — disk encryption scrambles files so they can’t be read without the correct key.


NASA eventually required the Jet Propulsion Laboratory to encrypt its laptops. But at the time of the Halloween theft, not all laptops at agency headquarters itself had been encrypted. Susan Landau, a Guggenheim fellow in cyber security, privacy and public policy, says companies and agencies are unlikely to improve data security without the threat of penalty.


“What are the personal consequences for employees who allow data breaches to happen?” Ms. Landau asks. “Until people lose their jobs, nothing is going to change.”


Mr. Jacobs declined to comment about whether NASA had disciplined the employee who left the laptop in the car, saying the issue was “covered by privacy.”


DR. NELSON did not emerge from his data rights battle unscathed. Caltech issued disciplinary citations to five employees of the Jet Propulsion Laboratory, including Dr. Nelson, who had used their nasa.gov e-mail addresses to send messages to thousands of colleagues about the Supreme Court decision. An employee who commits a second offense after receiving such a warning could be fired, Dr. Nelson says.


Lawren B. Markle, a spokesman for Caltech, says the employees used government resources, paid for by taxpayers, “to spam thousands of individuals, government officials and agencies, other businesses, and colleges and universities” with their political views.


“As a federal contractor,” Mr. Markle wrote in an e-mail, “we cannot allow the government resources entrusted to us to be used in this manner and particularly not to lobby for political positions.”


He added that a second warning would not automatically lead to dismissal. “The outcome would depend on the severity of the conduct and the history of the employee’s service,” he said.


The five employees have filed cases with the National Labor Relations Board, saying that they were unfairly disciplined because the e-mails were work-related.


“In the short time since the Supreme Court decision, tens of thousands of people have had their data compromised,” Dr. Nelson says. “For warning about what would eventually become true, we received disciplinary citations.”


An administrative judge is to rule on the matter in the coming months, but a Los Angeles office of the labor relations agency found merit in the scientists’ cases, concluding that Caltech unlawfully issued disciplinary warnings for the e-mails, says Mori Rubin, the regional director of the office. Her office also concluded that Caltech had disciplined the scientists for practices that other employees routinely undertook without penalty.


Such are the risks of taking a public stance on privacy.


E-mail: slipstream@nytimes.com.



Read More..

Karzai to Forbid His Forces to Request Foreign Airstrikes





KABUL, Afghanistan — President Hamid Karzai said Saturday that he would issue a decree forbidding his military forces from turning to NATO or American forces to conduct airstrikes, and he condemned the use of torture on detainees by his security forces.




He made his comments in a speech at the Afghan National Military Academy in Kabul. It was the first time he had dwelt at such length and with such passion on human rights.


His proposed ban on Afghan troops from calling in airstrikes came after a joint Afghan-NATO attack last week in Kunar Province, in eastern Afghanistan, that killed four women, one man and five children, all of them civilians, according to local officials.


Mr. Karzai said Gen. Joseph F. Dunford Jr., the commander of the international coalition forces fighting the Taliban and other insurgents in Afghanistan, told him that the airstrike had been requested by the National Directorate of Security, the country’s intelligence service. The attack took place in the Shigal district, an area where two known Taliban commanders were visiting family members, Afghan officials have said.


“Our N.D.S. in their own country calls foreigners to assist them and bombard four or five Al Qaeda or Taliban,” Mr. Karzai said.


“It is very regrettable to hear this,” he added. “You are representing Afghan pride. How do you call for an airstrike from foreigners on your people?”


Civilian casualties in the war on the Taliban has long vexed Mr. Karzai and has been a major point of contention with American and NATO troops. New rules instituted by commanders from the International Security Assistance Force have minimized the loss of life, and the coalition has all but stopped air attacks on populated areas and on homes. The result has been a dramatic drop in civilian casualties caused by foreign forces.


Nevertheless, Afghan troops, who lack their own air support, still turn to foreign forces for help during pitched battles with the Taliban and other insurgents. It was not clear whether there would be exceptions to Mr. Karzai’s decree, but he was clearly dismayed that his own forces would be employing the very techniques he had worked so hard to persuade the West to abandon.


In an unusual move, the Afghan president also publicly acknowledged that torture was a problem in Afghan detention centers and pledged to halt it. In the past, the government has largely deflected charges of torture raised by human rights organizations, contending that any abuse was the work of a few bad actors.


But after a United Nations report released in January detailed abuses or torture at a number of detention sites around the country, Mr. Karzai took a closer and more independent look at the complaints.


He appointed a delegation to investigate the report’s validity, and when the inquiry confirmed many of the allegations, he ordered the security ministries to implement the team’s recommendations. He reiterated that order on Saturday. The recommendations include prosecuting perpetrators of torture, giving detainees access to defense lawyers, providing medical treatment for detainees who are ill or have been beaten, and videotaping all interrogations.


“Not only have foreigners tormented and punished Afghans, but our people have been terrorized and punished by our own sons too,” Mr. Karzai said. “The U.N. report showed that even after 10 years, our people are tortured and mistreated in prisons.”


The United Nations’ human rights office here emphasized the importance of Mr. Karzai’s attention to the issue.


“It is encouraging that the president appears to be personally taking the issue of human rights of all Afghans seriously,” said Georgette Gagnon, the office’s director of human rights. She added that the government should act immediately on the delegation’s recommendations. “We urge them to do so without delay,” she said.


Read More..

The Education Revolution: In China, Families Bet It All on a Child in College


Chang W. Lee/The New York Times


Wu Caoying studied English under her father’s watchful eye in 2006. She is now a sophomore in college. More Photos »







HANJING, China — Wu Yiebing has been going down coal shafts practically every workday of his life, wrestling an electric drill for $500 a month in the choking dust of claustrophobic tunnels, with one goal in mind: paying for his daughter’s education.




His wife, Cao Weiping, toils from dawn to sunset in orchards every day during apple season in May and June. She earns $12 a day tying little plastic bags one at a time around 3,000 young apples on trees, to protect them from insects. The rest of the year she works as a substitute store clerk, earning several dollars a day, all going toward their daughter’s education.


Many families in the West sacrifice to put their children through school, saving for college educations that they hope will lead to a better life. Few efforts can compare with the heavy financial burden that millions of lower-income Chinese parents now endure as they push their children to obtain as much education as possible.


Yet a college degree no longer ensures a well-paying job, because the number of graduates in China has quadrupled in the last decade.


Mr. Wu and Mrs. Cao, who grew up in tiny villages in western China and became migrants in search of better-paying work, have scrimped their entire lives. For nearly two decades, they have lived in a cramped and drafty 200-square-foot house with a thatch roof. They have never owned a car. They do not take vacations — they have never seen the ocean. They have skipped traditional New Year trips to their ancestral village for up to five straight years to save on bus fares and gifts, and for Mr. Wu to earn extra holiday pay in the mines. Despite their frugality, they have essentially no retirement savings.


Thanks to these sacrifices, their daughter, Wu Caoying, is now a 19-year-old college sophomore. She is among the growing millions of Chinese college students who have gone much farther than their parents could have dreamed when they were growing up. For all the hard work of Ms. Wu’s father and mother, however, they aren’t certain it will pay off. Their daughter is ambivalent about staying in school, where the tuition, room and board cost more than half her parents’ combined annual income. A slightly above-average student, she thinks of dropping out, finding a job and earning money.


“Every time my daughter calls home, she says, ‘I don’t want to continue this,’ ” Mrs. Cao said. “And I say, ‘You’ve got to keep studying to take care of us when we get old’, and she says, ‘That’s too much pressure, I don’t want to think about all that responsibility.’ ”


Ms. Wu dreams of working at a big company, but knows that many graduates end up jobless. “I think I may start my own small company,” she says, while acknowledging she doesn’t have the money or experience to run one.


For a rural parent in China, each year of higher education costs six to 15 months’ labor, and it is hard for children from poor families to get scholarships or other government financial support. A year at the average private university in the United States similarly equals almost a year’s income for the average wage earner, while an in-state public university costs about six months’ pay, but financial aid is generally easier to obtain than in China. Moreover, an American family that spends half its income helping a child through college has more spending power with the other half of its income than a rural Chinese family earning less than $5,000 a year.


It isn’t just the cost of college that burdens Chinese parents. They face many fees associated with sending their children to elementary, middle and high schools. Many parents also hire tutors, so their children can score high enough on entrance exams to get into college. American families that invest heavily in their children’s educations can fall back on Medicare, Social Security and other social programs in their old age. Chinese citizens who bet all of their savings on their children’s educations have far fewer options if their offspring are unable to find a job on graduation.


The experiences of Wu Caoying, whose family The New York Times has tracked for seven years, are a window into the expanding educational opportunities and the financial obstacles faced by families all over China.


Her parents’ sacrifices to educate their daughter explain how the country has managed to leap far ahead of the United States in producing college graduates over the last decade, with eight million Chinese now getting degrees annually from universities and community colleges.


But high education costs coincide with slower growth of the Chinese economy and surging unemployment among recent college graduates. Whether young people like Ms. Wu find jobs on graduation that allow them to earn a living, much less support their parents, could test China’s ability to maintain rapid economic growth and preserve political and social stability in the years ahead.


Leaving the Village


Read More..

Fat Dad: Baking for Love

Fat Dad

Dawn Lerman writes about growing up with a fat dad.

My grandmother Beauty always told me that the way to a man’s heart was through his stomach, and by the look of pure delight on my dad’s face when he ate a piece of warm, homemade chocolate cake, or bit into a just-baked crispy cookie, I grew to believe this was true. I had no doubt that when the time came, and I liked a boy, that a batch of my gooey, rich, chocolatey brownies would cast him under a magic spell, and we would live happily ever.

But when Hank Thomas walked into Miss Seawall’s ninth grade algebra class on a rainy, September day and smiled at me with his amazing grin, long brown hair, big green eyes and Jimi Hendrix T-shirt, I was completely unprepared for the avalanche of emotions that invaded every fiber of my being. Shivers, a pounding heart, and heat overcame me when he asked if I knew the value of 1,000 to the 25th power. The only answer I could think of, as I fumbled over my words, was “love me, love me,” but I managed to blurt out “1E+75.” I wanted to come across as smart and aloof, but every time he looked at me, I started stuttering and sweating as my face turned bright red. No one had ever looked at me like that: as if he knew me, as if he knew how lost I was and how badly I needed to be loved.

Hank, who was a year older than me, was very popular and accomplished. Unlike other boys who were popular for their looks or athletic skills, Hank was smart and talented. He played piano and guitar, and composed the most beautiful classical and rock concertos that left both teachers and students in awe.

Unlike Hank, I had not quite come into my own yet. I was shy, had raggedy messy hair that I tied back into braids, and my clothes were far from stylish. My mother and sister had been on the road touring for the past year with the Broadway show “Annie.” My sister had been cast as a principal orphan, and I stayed home with my dad to attend high school. My dad was always busy with work and martini dinners that lasted late into the night. I spent most of my evenings at home alone baking and making care packages for my sister instead of coercing my parents to buy me the latest selection of Gloria Vanderbilt jeans — the rich colored bluejeans with the swan stitched on the back pocket that you had to lie on your bed to zip up. It was the icon of cool for the popular and pretty girls. I was neither, but Hank picked me to be his math partner anyway.

With every equation we solved, my love for Hank became more desperate. After several months of exchanging smiles, I decided to make Hank a batch of my chocolate brownies for Valentine’s Day — the brownies that my dad said were like his own personal nirvana. My dad named them “closet” brownies, because when I was a little girl and used to make them for the family, he said that as soon as he smelled them coming out of the oven, he could imagine dashing away with them into the closet and devouring the whole batch.

After debating for hours if I should make the brownies with walnuts or chips, or fill the centers with peanut butter or caramel, I got to work. I had made brownies hundreds of times before, but this time felt different. With each ingredient I carefully stirred into the bowl, my heart began beating harder. I felt like I was going to burst from excitement. Surely, after Hank tasted these, he would love me as much as I loved him. I was not just making him brownies. I was showing him who I was, and what mattered to me. After the brownies cooled, I sprinkled them with a touch of powdered sugar and wrapped them with foil and red tissue paper. The next day I placed them in Hank’s locker, with a note saying, “Call me.”

After seven excruciating days with no call, some smiles and the usual small talk in math class, I conjured up the nerve to ask Hank if he liked my brownies.

“The brownies were from you?” he asked. “They were delicious.”

Then Hank invited me to a party at his house the following weekend. Without hesitation, I responded that I would love to come. I pleaded with my friend Sarah to accompany me.

As the day grew closer, I made my grandmother Beauty’s homemade fudge — the chocolate fudge she made for Papa the night before he proposed to her. Stirring the milk, butter and sugar together eased my nerves. I had never been to a high school party before, and I didn’t know what to expect. Sarah advised me to ditch the braids as she styled my hair, used a violet eyeliner and lent me her favorite V-neck sweater and a pair of her best Gloria Vanderbilt jeans.

When we walked in the door, fudge in hand, Hank was nowhere to be found. Thinking I had made a mistake for coming and getting ready to leave, I felt a hand on my back. It was Hank’s. He hugged me and told me he was glad I finally arrived. When Hank put his arm around me, nothing else existed. With a little help from Cupid or the magic of Beauty’s recipes, I found love.


Fat Dad’s ‘Closet’ Brownies

These brownies are more like fudge than cake and contain a fraction of the flour found in traditional brownie recipes. My father called them “closet” brownies, because when he smelled them coming out of the oven he could imagine hiding in the closet to eat the whole batch. I baked them in the ninth grade for a boy that I had a crush on, and they were more effective than Cupid’s arrow at winning his heart.

6 tablespoons unsalted butter, plus extra for greasing the pan
8 ounces bittersweet chocolate, chopped, or semisweet chocolate chips
3/4 cup brown sugar
2 eggs at room temperature, beaten
1 teaspoon vanilla extract
1/4 cup flour
1/2 cup chopped walnuts (optional)
Fresh berries or powdered sugar for garnish (optional)

1. Preheat oven to 350 degrees.

2. Grease an 8-inch square baking dish.

3. In a double boiler, melt chocolate. Then add butter, melt and stir to blend. Remove from heat and pour into a mixing bowl. Stir in sugar, eggs and vanilla and mix well.

4. Add flour. Mix well until very smooth. Add chopped walnuts if desired. Pour batter into greased baking pan.

5. Bake for 35 minutes, or until set and barely firm in the middle. Allow to cool on a rack before removing from pan. Optional: garnish with powdered sugar, or berries, or both.

Yield: 16 brownies


Dawn Lerman is a New York-based health and nutrition consultant and founder of Magnificent Mommies, which provides school lectures, cooking classes and workshops. Her series on growing up with a fat father appears occasionally on Well.

Read More..

Bits Blog: Facebook Says Hackers Breached Its Computers

Facebook admitted that it was breached by sophisticated hackers in recent weeks, two weeks after Twitter made a similar admission. Both Facebook and Twitter were breached through a well-publicized vulnerability in Oracle’s Java software.

In a blog post late Friday afternoon, Facebook said it was attacked when a handful of its employees visited a compromised site for mobile developers. Simply by visiting the site, their computers were infected with malware. The company said that as soon as it discovered the malware, it cleaned up the infected machines and tipped off law enforcement.

“We have found no evidence that Facebook user data was compromised,” Facebook said.

On Feb. 1, Twitter said hackers had breached its systems and potentially accessed the data of 250,000 Twitter users. The company suggested at that time that it was one of several companies and organizations to be have been similarly attacked.

Facebook has known about its own breach for at least a month, according to people close to the investigation, but it was unclear why the company waited this long to announce it. Fred Wolens, a Facebook spokesman, said the company wanted to fully investigate the source of the breach before disclosing it. Mr. Wolens said the company was still working closely with law enforcement to determine the source of the attacks.

Like Twitter, Facebook said it believed that it was one of several organizations that were targeted by the same group of attackers.

“Facebook was not alone in this attack,” the company said in its blog post. “It is clear that others were attacked and infiltrated recently as well.”

The attacks add to the mounting evidence that hackers were able to use the security hole in Oracle’s Java software to steal information from a broad range of companies. Java, a widely used programming language, is installed on more than three billion devices. It has long been hounded by security problems.

Last month, after a security researcher exposed a serious vulnerability in the software, the Department of Homeland Security issued a rare alert that warned users to disable Java on their computers. The vulnerability was particularly disconcerting because it let attackers download a malicious program onto its victims’ machines without any prompting. Users did not even have to click on a malicious link for their computers to be infected. The program simply downloaded itself.

After Oracle initially patched the security hole in January, the Department of Homeland Security said that the fix was not sufficient and recommended that, unless “absolutely necessary”, users should disable it on their computers completely. Oracle did not issue another fix until Feb. 1.

Social networks are a prime target for hackers, who look to use people’s personal data and social connections in what are known as “spearphishing” attacks. In this type of attack, a target is sent an e-mail, ostensibly from a connection, containing a malicious link or attachment. Once the link is clicked or attachment opened, attackers take control of a user’s computer. If the infected computer is inside a company’s system, the attackers are able to gain a foothold. In many cases, they then extract passwords and gain access to sensitive data.

Facebook said in its blog post that the updated patch addressed the vulnerability that allowed hackers to access its employees’ computers.

Hackers have been attacking organizations inside the United States at an alarming rate. The number of attacks reported by government agencies last year topped 48,500 — a ninefold jump from the 5,500 attacks reported in 2006, according to the Government Accountability Office.

In the last month alone, The New York Times, The Wall Street Journal and The Washington Post all confirmed that they were targets of sophisticated hackers. But security experts say that these attacks are just the tip of the iceberg.

A common saying among security experts is that there are now only two types of American companies: Those that have been hacked and those that don’t know they’ve been hacked.

Read More..

Meteor Fragments Rain Down on Siberia; Hundreds of Injuries Reported





MOSCOW — Gym class came to a halt inside the Chelyabinsk Railway Institute, and students gathered around the window, gazing at the fat white contrail that arced its way across the morning sky. A missile? A comet? A few quiet moments passed. And then, with incredible force, the windows blew in.




The scenes from Chelyabinsk, rocked by an intense shock wave when a meteor hit the Earth’s atmosphere Friday morning, offer a glimpse of an apocalyptic scenario that many have walked through mentally, and Hollywood has popularized, but scientists say has never before injured so many people.


Students at the institute crammed through a staircase thickly blanketed with glass out to the street, where hundreds stood in awe, looking at the sky. The flash came in blinding white, so bright that the vivid shadows of buildings slid swiftly and sickeningly across the ground. It burst yellow, then orange. And then there was the sound of frightened, confused people.


Around 1,200 people, 200 of them children, were injured, mostly by glass that exploded into schools and workplaces, according to Russia’s Interior Ministry. Others suffered skull trauma and broken bones. No deaths were reported. A city administrator in Chelyabinsk said that more than a million square feet of glass shattered, leaving many buildings exposed to icy cold.


And as scientists tried to piece together the chain of events that led to Friday’s disaster — on the very day a small asteroid passed close to Earth — residents of Chelyabinsk were left to grapple with memories that seemed to belong in science fiction.


“I opened the window from surprise — there was such heat coming in, as if it were summer in the yard, and then I watched as the flash flew by and turned into a dot somewhere over the forest,” wrote Darya Frenn, a blogger. “And in several seconds there was an explosion of such force that the window flew in along with its frame, the monitor fell, and everything that was on the desk.”


“God forbid you should ever have to experience anything like this,” she wrote.


At 9 a.m., the sun had just risen on the Ural Mountains, which form a ridge between European Russia and the vast stretch of Siberia to the east. The area around Chelyabinsk is a constellation of defense-manufacturing cities, including some devoted to developing and producing nuclear weapons. The factory towns are separated by great expanses of uninhabited forest.


As residents of Chelyabinsk began their day on Friday, a 10-ton meteor around 10 feet in diameter was hurtling toward the earth at a speed of about 10 to 12 miles per second, experts from the Russian Academy of Sciences reported in a statement released Friday. Scientists believe the meteor exploded upon hitting the lower atmosphere and disintegrated at an altitude of about 20 to 30 miles above the Earth’s surface — not an especially unusual event, the statement said.


This meteor was unusual because its material was so hard — it may have been made of iron, the statement said — which allowed some small fragments, or meteorites, perhaps 5 percent of the meteor’s mass, to reach the Earth’s surface. Nothing similar has been recorded in Russian territory since 2002, the statement said.


Estimates of the meteor’s size varied considerably. Peter G. Brown, a physics professor and director of the Center for Planetary Science and Exploration at the University of Western Ontario, said it was closer to 50 feet in diameter and probably weighed around 7,000 tons. He said the energy released by the explosion was equivalent to 300 kilotons of TNT, making it the largest recorded since the 1908 Tunguska explosion in Siberia, which is believed to have been caused by an asteroid.


Meteors typically cause sonic booms when they enter the Earth’s atmosphere, and the one that occurred over Chelyabinsk was forceful enough to shatter dishes and televisions in people’s homes. Car alarms were triggered for miles around, and the roof of a zinc factory partially collapsed. Video clips, uploaded by the hundreds starting early Friday morning, showed ordinary mornings interrupted by a blinding flash and the sound of shattering glass.


Maria Polyakova, 25, head of reception at the Park-City Hotel in Chelyabinsk, said it was the light that caught her eye.


“I saw a flash in the window, turned toward it and saw a burning cloud, which was surrounded by smoke and was going downward — it reminded me of what you see after an explosion,” she said. The blast that followed was forceful enough to shatter the heavy automatic glass doors on the hotel’s first floor, as well as many windows on the floor above, she said.


Valentina Nikolayeva, a teacher in Chelyabinsk, described it as “an unreal light” that filled all the classrooms on one side of School No. 15.


“It was a light which never happens in life, it happens probably only in the end of the world,” she said in a clip posted on a news portal, LifeNews.ru. She said she saw a vapor trail, like one that appears after an airplane, only dozens of times bigger. “The light was coming from there. Then the light went out and the trail began to change. The changes were taking place within it, like in the clouds, because of the wind. It began to shrink and then, a minute later, an explosion.”


“A shock wave,” she said. “It was not clear what it was but we were deafened at that moment. The window glass flew.”


The strange light had drawn many to the windows, the single most dangerous place to be. Tyoma Chebalkin, a student at Southern Urals State University, said that the shock wave traveled from the western side the city, and that anyone standing close to windows — security guards at their posts, for instance — was caught in a hail of broken glass.


He spoke to Vozhd.info, an online news portal, four hours after the explosion, when cellphones, which had been knocked out, were still out of order. He said that traffic was at a standstill in the city center, and that everyone he could see was trying to place calls. He said he saw no signs of panic.


In those strange hours, Ms. Frenn, the blogger, wrote down the thoughts that had raced through her mind — radiation, a plane crash, the beginning of a war — and noted that her extremities went numb while she was waiting to hear that the members of her family were unhurt.


When emergency officials announced that what had occurred was a meteor, what occurred to her was: It could happen again.


“I am at home, whole and alive,” she wrote. “I have gathered together my documents and clothes. And a carrier for the cats. Just in case.”


Viktor Klimenko contributed reporting from Moscow, Alan Cowell from London and Rick Gladstone from New York.

Viktor Klimenko contributed reporting from Moscow, Alan Cowell from London and Rick Gladstone from New York.



This article has been revised to reflect the following correction:

Correction: February 15, 2013

An earlier version of this article referred incorrectly to the name of the university at which Peter Brown is the director of the Center for Planetary Science and Exploration. It is Canada’s University of Western Ontario, not Western University.



Read More..

Incomes Flat in Recovery, but Not for the 1%


WASHINGTON — Incomes rose more than 11 percent for the top 1 percent of earners during the economic recovery, but barely at all for everybody else, according to new data.


The numbers, produced by Emmanuel Saez, an economist at the University of California, Berkeley, show overall income growing by just 1.7 percent over the period. But there was a wide gap between the top 1 percent, whose earnings rose by 11.2 percent, and the other 99 percent, whose earnings rose by just 0.4 percent.


Mr. Saez, a winner of the John Bates Clark Medal, an economic laurel considered second only to the Nobel, concluded that “the Great Recession has only depressed top income shares temporarily and will not undo any of the dramatic increase in top income shares that has taken place since the 1970s.”


The disparity between top earners and everybody else can be attributed, in part, to differences in how the two groups make their money. The wealthy have benefited from a four-year boom in the stock market, while high rates of unemployment have continued to hold down the income of wage earners.


“We have in the middle basically three decades of problems compounded by high unemployment,” said Lawrence Mishel of the Economic Policy Institute, a left-of-center research group in Washington. “That high unemployment we know depresses wage growth throughout the wage scale, but more so for the bottom than the middle and the middle than the top.”


In his analysis, Mr. Saez said he saw no reason that the trend would reverse for 2012, which has not yet been analyzed. For that year, the “top 1 percent income will likely surge, due to booming stock prices, as well as retiming of income to avoid the higher 2013 top tax rates,” Mr. Saez wrote, referring to income tax increases for the wealthy that were passed by Congress in January. The incomes of the other “99 percent will likely grow much more modestly,” he said.


Excluding earnings from investment gains, the top 10 percent of earners took 46.5 percent of all income in 2011, the highest proportion since 1917, Mr. Saez said, citing a large body of work on earnings distribution over the last century that he has produced with the economist Thomas Piketty of the Paris School of Economics.


Concern for the declining wages of working Americans and persistent high levels of inequality featured heavily in President Obama’s State of the Union address this week. He proposed raising the federal minimum wage to $9 from $7.25 as one way to ameliorate the trend, a proposal that might lift the earnings of 15 million low-income workers by the end of 2015.


“Let’s declare that in the wealthiest nation on Earth, no one who works full time should have to live in poverty,” Mr. Obama said in his address to Congress.


Mr. Obama’s economic advisers say that he has been animated by the country’s yawning levels of inequality, and the administration has put forward several proposals to address the gap. Those include higher taxes on a small group of the wealthiest families and an expansion of aid to lower- and middle-income families through programs like the Affordable Care Act.


The data analyzed by Mr. Piketty and Mr. Saez shows that income inequality — as measured by the proportion of income taken by the top 1 percent of earners — reached a modern high just before the recession hit in 2009. The financial crisis and its aftermath hit wealthy families hard. But since then, their earnings have snapped back, if not to their 2007 peak.


That is not true for average working families. After accounting for inflation, median family income has declined over the last two years. In 2011, it stagnated for the poorest and dropped for those in the middle of the income distribution, census data show. Median household income, which was $50,054 in 2011, is about 9 percent lower than it was in 1999, after accounting for inflation.


Measures of inequality differ depending on whether they are measured after or before taxes, and whether or not they include government transfers like Social Security payments, food stamps and other credits.


Research led by the Cornell economist Richard V. Burkhauser, for instance, sought to measure the economic health of middle-class households including income, taxes, transfer programs and benefits like health insurance. It found that from 1979 to 2007, median income grew by about 18.2 percent over all rather than by 3.2 percent counting income alone.


In an interview, Mr. Burkhauser said his numbers measured “how are the resources that person has to live on changing over time,” whereas Mr. Piketty and Mr. Saez’s numbers measure “how are different people being rewarded in the marketplace.”


“That’s a fair question to ask, but it’s a very different question to ask than, ‘What resources do Americans have?’ ” Mr. Burkhauser said. Notably, many of the Obama administration’s progressive policies have been aimed at blunting the effects of income inequality, rather than tackling income inequality itself.


Mr. Saez has advocated much more aggressive policies aimed at income inequality. “Falls in income concentration due to economic downturns are temporary unless drastic regulation and tax policy changes are implemented,” Mr. Saez said in his analysis.


The recent policy changes, including tax increases and financial regulatory reform, he wrote, “are not negligible but they are modest relative to the policy changes that took place coming out of the Great Depression. Therefore, it seems unlikely that U.S. income concentration will fall much in the coming years.”


Read More..

Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

Read More..

Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

Read More..

Media Decoder Blog: Indian Music Service, Taking Page From Spotify, Goes Pro

Western music fans have no shortage of digital music services to choose from, and that abundance is spreading around the world. Apple’s iTunes is now in 119 countries, and others are racing to plant their digital flags everywhere. This week, for example, Spotify opened in Italy, Poland and Portugal, bringing its reach to 23 countries.

But just as interesting, and in the long run perhaps as significant to competition, is the rise of services that serve regional markets intensely. One is Saavn, a Spotify-like streaming service that specializes in Indian music, and has garnered 10.5 million monthly users with advertising-supported free listening. This week it will announce that it has taken another page from Spotify’s book, by offering a premium version at $4 a month that eliminates the ads, lets users listen to songs offline and will eventually add other features like higher quality audio.

Saavn, which has offices in New York, India and Mountain View, Calif., has a catalog of 1.1 million songs in nine languages and is available in more than 200 countries, with about 70 percent of its consumption within India, said Rishi Malhotra, one of its founders. Like Spotify, iHeartRadio and other Western services, it is an official partner of Facebook. About 80 percent of its use is on mobile devices, Mr. Malhotra said, and when the premium service, Saavn Pro, is opened in March, it will at first be available only for Apple devices.

The pricing is significantly lower than Western services. “We wanted to make it globally acceptable,” said Mr. Malhotra, who is based in New York. “The $10 price point that you see from a lot of music services we use here is way out of reach from what would fly in India or a lot of other emerging markets.”

Saavn believes it can succeed in India not only through its catalog of Bollywood hits, but through technological touches that may be meaningful only to Indian listeners. One example is the ability to search for a Bollywood song based on the actor who lip-synchs it — often more memorable to fans than the “playback” singer who actually provided the voice.

If successful, Saavn Pro could give the company an advantage in India’s quickly developing digital music market, which already has a handful of streaming services, like Dhingana, as well as a strong presence in downloads from Nokia. Yet that market is still tiny for a country of India’s size and overall media spending. According to the International Federation of the Phonographic Industry, recorded music had only $141 million in trade (or wholesale) value in 2011. A recent report by Ernst & Young said that music and radio combined count for only 2.4 percent of India’s media and entertainment spending, which for 2011 it estimated at $18 billion.

Part of the reason for music’s small proportion of India’s media economy is that popular music in India is dominated by the film industry. But a greater reason is piracy; the federation estimates that 55 percent of Internet users in India go to unlicensed music services on a monthly basis. That is slowly starting to change, music executives say, as courts there crack down on infringement and legitimate digital services proliferate. Apple’s iTunes opened there in December, and Nokia says it sells 1.4 million songs a day at its download store in India.

And Indian record companies are approaching digital business without the baggage that has been complicating deals with Western labels and services for more than a decade, Mr. Malhotra added.

“The labels in India are not reluctant about digital,” he said. “It’s not like they are protecting against some established, older revenue stream. It’s all found revenue for them.”


Ben Sisario writes about the music industry. Follow @sisario on Twitter.

Read More..

Britain Says Equine Drug May Have Entered Food Chain





PARIS — The scandal over horse meat in the European food chain widened Thursday from a case of mislabeling to one of food safety as public health authorities in Britain said that a powerful equine painkiller, potentially harmful to human health, “may have entered the food chain” in France.




British officials sought to reassure the public that the drug — phenylbutazone, or bute, an anti-inflammatory used commonly on lame horses — was found only in trace amounts in a small number of British horse carcasses. Out of 206 carcasses, 8 tested positive for bute, and just 6 of those carcasses were exported to France.


The drug is also used to treat arthritis in humans, and very large doses can cause a potentially fatal blood disorder, aplastic anemia, in which the bone marrow fails to produce enough blood cells.


Even before the discovery, the scandal had plunged the European food industry into crisis. Frozen foods, including hamburger, lasagna, spaghetti Bolognese and moussaka, have been withdrawn from supermarket freezers in Britain, Ireland, Sweden, France and Germany.


But the positive tests for the equine drug have raised fresh concerns, even in countries like France, where eating horse meat is more acceptable than in Britain, where it is taboo. Unlike cattle, which are raised for slaughter in controlled conditions, the lame horses or former plow animals that are sometimes slaughtered for consumption do not carry the same guarantees of origin or quality.


“Unscrupulous criminal elements have been profiting from these unfortunate animals by exploiting a hopelessly flawed horse passport scheme, lax animal export controls at ports and slaughterhouses willing to compromise animal welfare and public safety for a quick profit,” said David Wilson, the spokesman for the Ulster Society for the Prevention of Cruelty to Animals, in Northern Ireland. Suspect frozen beef hamburgers discovered in Ireland first triggered the crisis.


“Many horses that are either valueless or in suffering are being corralled in remote farmyards and packed into vehicles for transport to abattoirs in Ireland and the U.K.,” he said. “After slaughter, many are processed and find their way effortlessly into the European food chain.”


Health experts said that at the level found, a human would have to eat 500 or 600 burgers a day of 100 percent horse meat to be adversely affected.


The police investigating allegations that horse meat was mislabeled as beef said Thursday that they had arrested two men in Wales and another man in West Yorkshire, England, on Tuesday and were holding them on suspicion of fraud.


Checking food safety “from farm to fork” in Europe has been a persistent worry for two decades, since the crisis of mad cow disease in Britain threw the continent into a crisis and prompted a ban on British beef exports to Europe and the United States.


The current scandal has laid bare a supply chain for meat so murky and complex that officials and experts say it is easily susceptible to fraud and manipulation by organized crime. The convoluted route from slaughterhouse to plate has highlighted a weak system of accountability in a vast single market of almost 500 million people, where retailers use layers of meat traders to find the cheapest deals and no regular tests are conducted to authenticate meat products.


“In a cash-rich business like the meat industry, there is ample opportunity for criminals to bribe bureaucrats,” said Misha Glenny, an expert on organized crime in Europe. “Market opportunities create criminal opportunities.”


After days of investigation, French authorities announced on Thursday that they suspected fraud at a French company, Spanghero, which supplied meat — including large quantities of horse meat — to Comigel, a French-owned company whose Luxembourg factory used the meat to make frozen meals sold in supermarkets in 16 countries across Europe, including Britain and Sweden. They said they would suspend Spanghero’s operating license. The company denied any wrongdoing.


The French investigators said that the meat Spanghero sold to Comigel had originated in two Romanian slaughterhouses, in a shipment they said showed clues of containing horse meat. It was then bought by a Dutch food trader who sold it to a Cypriot-registered food trader who sent it to Spanghero.


“The investigation shows that Spanghero knew that the meat labeled as beef could be horse,” BenoĆ®t Hamon, France’s junior minister for social economy, said Thursday. “There was a strong suspicion.” Mr. Hamon added that the fraudulent meat sales had been going on for several months, and involved 28 companies and 13 countries.


Mr. Hamon said that Comigel should have suspected something was amiss. While Comigel maintained it did not realize the meat was not beef, he said, anyone in the business should have been able to tell the difference.


In a statement, Spanghero said that it was the victim, not the perpetrator, of the fraud. “Spanghero confirms having placed an order for beef, having been led to believe it received beef, and having sold back what it thought was beef, properly labeled as such, in line with European and French regulations.”


Chris Elliott, director of the Institute for Global Food Security at Queen’s University, Belfast, said the complex supply chain was vulnerable to fraud since the contents of meat shipments were not routinely verified.


“There are multiple contracts in these supply chains, and the contracts are very tight,” he said. “But there are absolutely no checks. It is really done on trust that the piece of paper that says that you have five tons of beef is beef. There is no verification of the audit trail.”


Spanghero said earlier that it will sue its Romanian suppliers, though French authorities say those suppliers acted in good faith and properly labeled their shipment as horse meat.


“We have respected all of the labeling laws,” Iulian Cazacut, the director of the meatpacking plant, Doly-Com, in Romania’s impoverished northeast, said in an interview. “I am not responsible for the mistakes of others.”


Mr. Cazacut said the company, which processed 427 tons of horse last year, bought horses, no longer fit for work, from local farmers for around 60 cents a pound, far less than the approximately $2.50 a pound fetched by beef.


Dan Bilefsky reported from Paris, and Stephen Castle from London. Reporting was contributed by George Calin from Bucharest, Romania; Andrew Higgins from Brussels; Douglas Dalby from Dublin; and Melissa Eddy from Berlin.



Read More..

Service Cuts May Arise With Merger of Airlines


Donna McWilliam/Getty Images


Thomas W. Horton, chief of American Airlines, left, with Doug Parker, chief executive of US Airways, at a news conference.







And then there were three.




The airline industry took a decisive step toward greater concentration on Thursday with the announcement that American Airlines and US Airways had agreed to merge, forming the nation’s biggest airline. The merged airline, to be called American, leaves just three major carriers — Delta Air Lines and United Airlines too — able to offer extensive domestic and international service, a sharp contraction over the last decade.


But while airline executives argue that mergers are good for passengers because they bring more service to more destinations, some economists and consumer advocates warn that all this consolidation comes at a price for travelers.


With fewer carriers, passengers have fewer options; fares and fees are now more likely to go up, particularly for flights between midsize cities. And more cities, especially smaller ones, can expect to see further reductions in service.


“It’s much easier to have tacit collusion with just three airlines,” said George Hoffer, a transportation economist at the University of Richmond. “It’s not illegal. But it’s like having a few big people in a small boat. Anyone’s decisions tie you all together.”


That helps explain why fees had become so uniform within the industry in recent years, he said, and why all airlines now charge extra fees beyond ticket prices for things like checking bags, rebooking reservations or even picking seats or boarding early.


Those extra fees now account for a growing share of airline revenue and are a big reason behind the industry’s renewed profitability.


Fares, too, have risen in recent years, according to the latest government statistics. Some of that increase, analysts said, reflects rising oil prices. And while airfares on average are still lower than they were in 1995, once adjusted for inflation, they have been steadily rising since 2008.


But some airports, where the number of carriers has fallen, have had steep increases in fares. Ticket prices between Delta’s hub in Atlanta and Detroit, for instance, rose more than 20 percent from 2007 to 2011, while the number of carriers serving that route fell to two from four, according to a study released last year.


Still, most analysts expect the merger to be cleared by federal antitrust authorities, who have approved seven major mergers in the last decade.


The last time the Justice Department challenged a merger was the proposed combination of United Airlines and US Airways in 2001. That merger was rejected on the ground it would reduce choice and possibly lead to higher fares.


Since then, regulators have taken a different view of airline mergers. Instead of looking at any carrier’s overall market share, antitrust authorities now examine whether a merger would decrease competition on specific routes.


The department raised no objections to the merger of Delta and Northwest in 2008. It required United to sell only a handful of takeoff rights at Newark Liberty Airport before allowing its merger with Continental in 2010. And when Southwest bought AirTran, federal regulators found in 2011 that “the merged firm will be able to offer new service routes that neither serves today.”


A decade ago, the Justice Department “would not have stomached mergers the size of Delta-Northwest, United-Continental, or American-US Airways,” said Paul Stephen Dempsey, a professor of global governance in air and space law at McGill University. “Now, having approved the gargantuan Delta and United acquisitions, it cannot equitably deny American the same.”


“Apparently, Washington believes that this is the optimum path to industry health, and that  concentration and collusion is preferable to regulated competition,” he said.


Airline executives say mergers are necessary to reduce financial volatility and restore a measure of stability to a business that lost about $60 billion in the last decade. Instead of stifling competition, the argument goes, bigger airlines with bigger networks provide passengers with more travel options, more destinations and, theoretically, better service.


Read More..

Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

Fitness Tracker

Marathon, half-marathon, 10k and 5K training plans to get you race ready.

A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

Read More..