Tuesday, July 31, 2007

Colleges Can Win Student-Reporter Lawsuits by Running Out the Clock, Court Rules


For student journalists, First Amendment lawsuits now have an immediate deadline, according to a ruling handed down last week by the U.S. Court of Appeals for the 10th Circuit.

The ruling, a unanimous decision by a three-judge panel of the court, rejected an appeal by two recent graduates of Kansas State University who in 2004 served as editors of the Kansas State Collegian, a student newspaper.

The students asserted that the university had violated their First Amendment rights by removing their faculty adviser from the newspaper staff following criticism of the Collegian’s coverage of minority issues.

The judges ruled that the plaintiffs’ status as graduates made their claims moot because, as alumni, they are not subject to censorship by the university....

A spokesman for the Student Press Law Center, an advocacy group for the rights of student journalists, said the ruling had set a troubling precedent.

“The court created a standard for mootness that makes it impossible for virtually any student to make a First Amendment claim because they will graduate before their case is concluded,” said Mark Goodman, the center’s executive director. “It’s just plain wrong.”

It is very interesting, and often discouraging, to compare and contrast instances in which courts invoke mootness to throw cases out (and make judicial resolution of recurrent issues difficult or impossible), and those in which courts find an exception to mootness, characterizing cases as "capable of repetition yet evading review." Apparently first amendment challenges by student journalists don't make the grade, unlike those of moneyed corporations and special interest groups.

Giuliani Calls for Tax Breaks to Buy Health Insurance

New York Times Blog:
The decision by the Giuliani campaign to address health care so early in the primary is a clear recognition of the broad dissatisfaction among voters with the current system, both for those who do have coverage and for the millions who are uninsured.

Using explicitly partisan language, obviously intended to stir memories of Senator Hillary Clinton’s failed bid to reform health care more than a decade ago, Mr. Giuliani cited a series of horror stories and selective statistics about health care in foreign countries that cover all their citizens. Mr. Giuliani said that “socialist” model would bankrupt the government.

“That is where Hillary Clinton, Barack Obama and John Edwards are taking you,” he said. “You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care.”

If only...And from the NYTimes Blog:

Yes, the horror of the “socialist” solution, like in France or Italy, ranked #1 and #2 by the WHO organization for overall quality of health care.

Instead, we have to make sure large corporations make enormous profits in the most innefficient system in the western world.

I’m truly amazed that intelligent people can continue to fall for this fear-mongering nonsense.

I’m embarrassed to be an American citizen when I read garbage like this.

— Posted by Thomas NYC

What the divorce court transcripts tell us about the state legislator who's trying to cut funding for UW Law School.

Althouse: My colleague Ann Althouse has an informative posting on the state legislator leading the effort to defund UW Law School. There is also a story, referenced in her post, in this morning's Wisconsin State Journal. Journalist Susan Lampert Smith concludes her piece this way:
For the greater good, Lasee needs to put his divorce behind him and drop his Jihad against attorneys.

His behavior gives politicians a bad name.

And, ironically, he makes lawyers look pretty good by comparison.

RIP, immortals of the cinema

Bergman and Antonioni, the same day. What incredible losses.
Memories flood back of seeing their films at Cambridge's Brattle Theater in the mid-late '60s, as a rather provincial young undergraduate came to greater worldliness and sophistication. I don't think I saw any of their films before that, growing up in the Miami area. Were there art theaters then, there? I don't remember.
Bergman, both early (and usually stark) and late (often, but not always warmer), meant much more to me.
Time to take those Criterion DVDs down from the shelf to pay respectful homage, and see how their great work affects me at this life stage.

Obama and the 'They' Sayers

washingtonpost.com: By Eugene Robinson

Are white Americans really, truly prepared to elect an African American president?...

One of Barack Obama's principal tasks in the coming months may be convincing African American voters that this whole phenomenon -- a black candidate with a well-financed campaign, proven crossover appeal and a real chance to win -- isn't just another cruel illusion.

I hear from African Americans who are excited about Obama's candidacy but who suspect that somehow, when push comes to shove, "they" won't let him win. It's unclear who "they" might be -- white voters, the "power structure," the alignment of the stars -- and it's unclear how "they" are going to thwart Obama's ambition. The point is that, somehow, he'll be denied.

This anecdotal evidence finds some empirical support in the polls, although it's far from definitive. ...

"What I see is a lot of press fascination with a black candidate who does not yet have 100 percent of the African American vote," Obama said yesterday in a telephone interview. "It's fascinating to me that people would expect that somehow I would be getting unanimous black support at this stage of the campaign, when probably only about 50 percent of black voters know much about me at all."...

Asked about fatalism or resignation among black voters, Obama said, "I'm sure there's some of that going on. The way to solve that problem is to win."...

I have no special sources of insight into how Barack Obama is seen within the African American community(ies), and don't expect to devote much blog attention to that issue--there are other and better sites for that purpose. I do see Obama as offering the best hope of my political lifetime to take us beyond the most divisive aspects of racial block voting, and to establish a new model for American politics and leadership, and a new vision of America in the world--one we desperately need after the depradations of the Bush Administration.

Short of Perjury? Try Impeachment!

washingtonpost.com: By Ruth Marcus

I find myself in an unaccustomed and unexpected position: defending Attorney General Alberto Gonzales. ...

In his Senate testimony last week, Gonzales once again dissembled and misled. He was too clever by seven-eighths. He employed his signature brand of inartful dodging -- linguistic evasion, poorly executed. The brutalizing he received from senators of both parties was abundantly deserved.

But I don't think he actually lied about his March 2004 hospital encounter with then-Attorney General John Ashcroft. I certainly don't think he could be charged with -- much less convicted of -- perjury. ...

Congress deserves better than technically correct linguistic parsing. So the bipartisan fury at Gonzales is understandable. Lawmakers are in full Howard Beale mode, mad as hell at Gonzales and not wanting to take it anymore.

But perjury is a crime that demands parsing: To be convicted, the person must have "willfully" stated a "material matter which he does not believe to be true."

The Supreme Court could have been writing about Gonzales when it ruled that "the perjury statute is not to be loosely construed, nor the statute invoked simply because a wily witness succeeds in derailing the questioner -- so long as the witness speaks the literal truth" -- even if the answers "were not guileless but were shrewdly calculated to evade."

Marcus dismisses calls for a special prosecutor, arguing:
Rather, lawmakers need to concentrate on determining what the administration did -- and under what claimed legal authority -- that produced the hospital room showdown. They need to satisfy themselves that the administration has since been operating within the law; to see what changes might guard against a repetition of the early, apparently unlawful activities; and to determine where the foreign intelligence wiretapping statute might need fixes.

That's where Congress's focus should be -- not on trying to incite a criminal prosecution that won't happen of an attorney general who should have been gone long ago.

It's impossible to know from this vantage (without access to classified information) whether Gonzales could be successfully prosecuted for perjury. It doesn't, and shouldn't, follow that his apparent efforts to deceive Congress (not to speak of the American people), and to frustrate its oversight role, is not deserving of impeachment. Writers for the Washington Post all too often seem caught up in their technical admiration for virtuoso examples of how the Washington game is played; perhaps it is time to just say no to BS at this level, and throw the bums out. This is not a game; people's rights--and lives--are at stake; and we rejected the divine rights of Kings, and Presidents, long ago. Perhaps it's time for another reminder, since the lesson seems to have been lost on this Administration.

Review: Body of Work

New York Times: Abigail Zuger, M.D.
Body of Work
Meditations on Mortality From the Human Anatomy Lab
. By Christine Montross.

It is not easy to write a book about the first year of medical school — not a book anyone would want to read. The usual basics covered in that year’s curriculum are so very basic (cells, molecules and electrical circuits) that students spend much of the year in the library, memorizing facts and grumbling.

Except, of course, for the long hours they spend in gross anatomy laboratory, also a staple of the first-year curriculum. There, every single complicated emotion anyone has ever enunciated about the practice of medicine roars into the open so reliably it is surprising no one has come up with Christine Montross’s idea before. Dr. Montross, a recent medical graduate, has tethered an earnest and readable reflection on the process of becoming a doctor to the methodical dissection of a human cadaver, the first of all too many professional initiation rites.

In the last few years, some of the mystery has been stripped from this particular piece of medical education, thanks to the entrepreneurs behind the traveling exhibition “Bodies” and hundreds of anonymous citizens of China. ...But there is still a world of difference between observing the results of a dissection and personally wielding the scalpel. Medical students generally spend months hunched over a single body once belonging to a generous soul whose name they never learn, but whose intimate medical history they slowly unearth. They use not the miserably fallible tools of the real doctor, but their own two hands. It is the first and the last time most doctors ever see the normal and the abnormal intertwined from head to toe, in three dimensions and shades of beige and gray. ...

And underlying it all is the eternal paradox of medicine: the doctor and the patient who are at once identical and opposite. Before the students dissect out a structure, they instinctively feel for the landmarks on their own bodies. And yet, they cannot identify too closely with their cadavers, or with their patients in years to come, or they will become paralyzed by emotion. ...

By the same token, though, who better to describe the strange terrain between doctor and patient, dissector and cadaver, us and them, than someone actually crossing that no-man’s land? In a few years, Dr. Montross will be on the other side, never to return. That is when she will realize that, as terrifying and humbling it may be to cut up a human body who reminds you of your grandmother, the experience pales beside that of trying to heal a living version, smiling and fully clothed.

After Flawed Executions, States Resort to Secrecy

New York Times: By ADAM LIPTAK

A Missouri doctor who had supervised more than 50 executions by lethal injection testified last year that he sometimes gave condemned inmates smaller doses of a sedative than the state’s protocol called for, explaining that he is dyslexic. “So it’s not unusual for me to make mistakes,” said the doctor, who was referred to in court papers as John Doe I.

The St. Louis Post-Dispatch identified him last July as Dr. Alan R. Doerhoff, revealing that he had been a magnet for malpractice suits arising from his day job as a surgeon and that two hospitals had revoked his privileges. In September, a federal judge barred Dr. Doerhoff from participating “in any manner, at any level, in the State of Missouri’s lethal injection process.”

Naturally, state lawmakers took action to address the issue.

A new law, signed this month by Gov. Matt Blunt, makes it unlawful to reveal “the identity of a current or former member of an execution team,” and it allows executioners to sue anyone who names them. ...

In the wake of several botched executions around the nation, often performed by poorly trained workers, you might think that we would want to know more, not less, about the government employees charged with delivering death on behalf of the state.

But corrections officials say that executioners will face harassment or worse if their identities are revealed, and that it is getting hard to attract medically trained people to administer lethal injections, in part because codes of medical ethics prohibit participation in executions.

The Missouri law addresses that point, too. It bars licensing boards from taking disciplinary actions against doctors or nurses who participate in executions.

In a decision a week ago Sunday, a state court judge in Florida, Carven D. Angel, halted the execution of a death row inmate, saying, “We need to have people with competence and experience” to perform executions.

But, according to lethal injection procedures issued by Florida’s corrections department in May, there is only one job requirement to be an executioner there: you must be “a person 18 years or older who is selected by the warden to initiate the flow of lethal chemicals into the inmate.”

Those credentials struck Judge Angel as a little thin. ...

Tax Report

Tax Report - WSJ.com: By TOM HERMAN

As San Francisco Giants slugger Barry Bonds closes in on Hank Aaron's career home-run record, a thorny question looms: If you're the lucky fan who catches the record-breaking home run ball, what are the tax consequences?" ...

Common sense might suggest the answer is simple: The lucky fan who catches the historic ball shouldn't owe tax until he or she sells it. But relying on common sense to interpret tax laws can often lead to trouble. Asked whether any fan who has ever caught a valuable home-run ball has had to pay tax on it before selling it, an IRS official declines comment....

Yale Law School Prof. Michael Graetz, a former Treasury Department official and co-author of a leading course book on federal income taxation, says that the Bonds issue "would make a great law-school exam question."

Actually, there's way more than one question. Will the Internal Revenue Service require the fan to pay tax immediately, based upon the ball's estimated fair-market value? Or only after the fan sells the ball? Will the fan have to pay tax based on regular federal income-tax rates, which range up to 35%? Or, if the fan waits to sell the ball for more than a year after catching it, would any profit qualify as a long-term capital gain taxed at the maximum rate of 28% on collectibles?

If the prize catch does qualify as a long-term capital gain, what would the fan's cost be for tax purposes? Zero? The price of the ticket? The ticket price plus the value of a new baseball? What if the fan purchased a season ticket? Could he or she consider the cost of the entire season package as the cost basis? Would it make any difference if the person who catches the ball isn't a fan but rather a player standing in the bullpen? Or a groundskeeper?

These are just some of the curveballs that IRS officials don't want to try hitting. ...

"More than innocent-spouse cases, more than small-business owners losing their businesses, more than IRS modernization failures, the prospect of the IRS taxing this hypothetical good-hearted fan unleashed the fury of the American people, not to mention their representatives in Congress," Mr. Rossotti wrote in his memoir, "Many Unhappy Returns."

The IRS quickly reversed itself. Mr. Rossotti issued a statement saying that if a fan caught the ball and gave it back to Mr. McGwire, the fan wouldn't be taxed. "Sometimes pieces of the tax code can be as hard to understand as the infield fly rule," Mr. Rossotti explained. "All I know is that the fan who gives back the home-run ball deserves a round of applause, not a big tax bill." ...

Yale Law Prof. Graetz helped advise the IRS on the Mark McGwire flap in 1998 before Mr. Rossotti issued his statement resolving the issue. In return, the grateful Mr. Rossotti sent Prof. Graetz a baseball signed by Mr. Rossotti, saying: "Thank you for saving us from a strikeout on national TV."

So did Prof. Graetz declare the Rossotti ball on his tax return as income?

No, Prof. Graetz replies with a chuckle, explaining: "I don't think it has a lot of value to anyone but me."

Sunday, July 29, 2007

An Immoral Philosophy

New York Times: By Paul Krugman
So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

Well, here’s what Mr. Bush said after explaining that emergency rooms provide all the health care you need: “They’re going to increase the number of folks eligible through Schip; some want to lower the age for Medicare. And then all of a sudden, you begin to see a — I wouldn’t call it a plot, just a strategy — to get more people to be a part of a federalization of health care.”

Now, why should Mr. Bush fear that insuring uninsured children would lead to a further “federalization” of health care, even though nothing like that is actually in either the Senate plan or the House plan? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would. That is, he fears that voters, having seen how the government can help children, would ask why it can’t do the same for adults.

And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem, never the solution. But it’s hard to convince people that government is always bad when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

This sounds like a caricature, but it isn’t. The truth is that this good-is-bad philosophy has always been at the core of Republican opposition to health care reform. Thus back in 1994, William Kristol warned against passage of the Clinton health care plan “in any form,” because “its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas.” ...

There is, it seems, more basic decency in the hearts of Americans than is dreamt of in Mr. Bush’s philosophy.

Daniel Pearl's father on A Mighty Heart

TNR:By Judea Pearl

...This is a political version of a famous paradox formulated by Bertrand Russell in 1901, which shook the logical foundations of mathematics. Any person who claims to be tolerant naturally defines himself in opposition to those who are intolerant. But that makes him intolerant of certain people--which invalidates his claim to be tolerant.

The political lesson of Russell's paradox is that there is no such thing as unqualified tolerance. Ultimately, one must be able to expound intolerance of certain groups or ideologies without surrendering the moral high ground normally linked to tolerance and inclusivity. One should, in fact, condemn and resist political doctrines that advocate the murder of innocents, that undermine the basic norms of civilization, or that seek to make pluralism impossible. There can be no moral equivalence between those who seek--however clumsily--to build a more liberal, tolerant world and those who advocate the annihilation of other faiths, cultures, or states.

Which brings me to my son, Daniel Pearl. Thanks to the release of A Mighty Heart, the movie based on Mariane Pearl's book of the same title, Danny's legacy is once again receiving attention. Of course, no movie could ever capture exactly what made Danny special--his humor, his integrity, his love of humanity--or why he was admired by so many. ...Traces of these ideas are certainly evident in A Mighty Heart, and I hope viewers will leave the theater inspired by them.

At the same time, I am worried that A Mighty Heart falls into a trap Bertrand Russell would have recognized: the trap of moral equivalence, of seeking to extend the logic of tolerance a step too far. You can see hints of this in the film's comparison of Danny's abduction to Guantánamo--it opens with pictures from the prison--and its comparison of Al Qaeda militants to CIA agents. You can also see it in the comments of the movie's director, Michael Winterbottom, who wrote on The Washington Post's website that A Mighty Heart and his previous film, The Road to Guantánamo, "are very similar. Both are stories about people who are victims of increasing violence on both sides. There are extremists on both sides who want to ratchet up the levels of violence and hundreds of thousands of people have died because of this."

Drawing a comparison between Danny's murder and the detainment of suspects in Guantánamo is precisely what the killers wanted, as expressed in both their e-mails and the murder video. Obviously Winterbottom did not mean to echo their sentiments, and certainly not to justify their demands or actions. Still, I am concerned that aspects of his movie will play into the hands of professional obscurers of moral clarity.

Indeed, following an advance screening of A Mighty Heart, a panelist representing the Council on American-Islamic Relations reportedly said, "We need to end the culture of bombs, torture, occupation, and violence. This is the message to take from the film." The message that angry youngsters are hearing is unfortunate: All forms of violence are equally evil; therefore, as long as one persists, others should not be ruled out. This is precisely the logic used by Mohammed Siddiqui Khan, one of the London suicide bombers, in his 2005 videotape on Al Jazeera. "Your democratically elected governments," he told Westerners, "continuously perpetuate atrocities against my people. ... [W]e will not stop this fight."

Danny's tragedy demands an end to this logic. There can be no comparison between those who take pride in the killing of an unarmed journalist and those who vow to end such acts--no ifs, ands, or buts. Moral relativism died with Daniel Pearl, in Karachi, on January 31, 2002.

There was a time when drawing moral symmetries between two sides of every conflict was a mark of original thinking. Today, with Western intellectuals overextending two-sidedness to reckless absurdities, it reflects nothing but lazy conformity. What is needed now is for intellectuals, filmmakers, and the rest of us to resist this dangerous trend and draw legitimate distinctions where such distinctions are warranted.

A short history of movie theater concession stands

Slate Magazine:By Jill Hunter Pellettieri
How exactly did we form this cultural habit? Today, concessions are the lifeblood of the theater business: According to the National Association of Theatre Owners, they account for approximately 40 percent of theaters' net revenue. But it wasn't always this way....

But theater owners had yet to realize just how lucrative concessions could be. Far from embracing food sales, many were downright hostile toward them, particularly as nickelodeons gave way to the fancier movie houses of the teens and '20s. During those two decades, in an effort to enhance the moviegoing experience, ambitious showmen constructed opulent movie palaces, like Sid Grauman's Chinese Theater in Los Angeles, which opened in 1927. These palaces, some of which cost millions to build, could rival the sophistication of European opera houses. Appointed with expensive antiques, marble columns, bejeweled chandeliers, and even perfume sprayed into common spaces, they transported moviegoers to another world. Yet it was a world without munchies.

Movie theater owners wanted their venues to remain upscale, free from the chomping of snacks you'd find at burlesque shows. They also wanted their plush theaters garbage-free. But as in the nickelodeon days, entrepreneurial vendors sold snacks outside. Popcorn kernels and candy wrappers ended up littering theaters despite owners' best efforts to keep food out.

Then came the Great Depression. Squeezed like everyone else, palace owners sought new sources of revenue. Some deigned to install candy dispensers, and others leased lobby space to popcorn vendors....it wasn't long before theater owners recognized popcorn's lucrative promise and began selling it in-house. Early popcorn popping machines had created disagreeable, burning odors, but by the 1930s, the technology had improved. And because popcorn was so cheap—theaters could sell it for 10 cents a bag and still turn a nice profit—it was a treat that even cash-strapped Americans could manage to splurge on.

Eager to avoid the mistakes of their predecessors, theater builders of the 1930s constructed more humble neighborhood houses, and with concessions becoming a bigger part of the business, the candy counter became an architectural consideration. Theaters still hoping to appeal to highbrow customers offered homemade bonbons, chocolates, and candy apples, but as mass production grew more prevalent, an abundance of newer candies—Jujubes and Jujyfruits, Baby Ruths, Raisinets, Milk Duds, and others—emerged on the scene.

Candy suffered a setback during World War II, however, when sugar was rationed. Popcorn production, on the other hand, was given the go-ahead by the War Production Board because of its health benefits and popularity. Popcorn flourished, solidifying its hold over the concession stand.

After the war, in the mid- to late-1940s, theater owners grappled with another threat—television—that made it more important than ever to capitalize on snack sales. ... From 1948 to 1956, despite a 50 percent decrease in theater attendance, concession sales increased fortyfold. The end of the war meant a return to sugar...

[T]he old standbys are the real moneymakers. We may sigh when the kid behind the counter solicits that $9 for a small Coke and a medium popcorn, but traditional concessions are by now inextricably linked to the moviegoing experience. Not only is there the kid-in-a-candy-store excitement—here's one place where it's still safe to gorge on junk food—but the smell of popcorn that pervades every movie theater can bubble up nostalgia in even the most curmudgeonly customer. A trip to the concession stand might elicit memories of a first date—holding her hand, greasy with popcorn, in the dark theater, or the tug of your teeth on the licorice sticks you ordered as a kid, or the Good & Plenty your grandmother used to buy you on your Saturday trips to the movies. What's $9 for that?

Madison's new Sundance 608 theater complex has raised the local culinary stakes, although recent medical research suggests you won't want to make friends with anyone with greasy palms, or palm oil.

Shafer blows piece about Times and Post headcounts and the future of newspapers

Slate Magazine: By Jack Shafer
[NYT Executive Editor Bill] Keller maintains that headcount growth [that is, an increase in numbers of reporters and editors] has benefited not just the lifestyle sections but the hard-news pages, something I don't dispute in my piece. I write that both newspapers relied more on wire services in 1972—especially the Post—and both papers ran shorter news stories.

But Keller has a larger point to make, writing:

[M]y main purpose in writing is not to belabor metrics, it is to wave a crucifix at the vampires who might be animated by your logic.

Your conclusion seemed to be roughly this: It's possible to cut many pounds of flesh from the country's best newspapers—heck, cut 'em in half!—and still end up with really good papers of the kind that covered Vietnam and Watergate. To do that you just have to confine your knife to all the sections that don't do wars and politics.

And that, in the real world, is bollocks.

If you cut the staff back to a replica of the 1972 New York Times newsroom, the result would be:

—A drastically diminished news report, in print and on line; and, I believe,

—A company that would almost surely be unprofitable, because those features that have grown up since 1972 attract the advertising that currently makes the difference between a paper that makes money and one that loses money.

In other words, the baby is the bath water. Sacrifice the lifestyle and softer news sections that have expanded in the last 30 years and the Times itself becomes unviable. ...

I'd still write that if at the end of all the staff downsizing we ended up with the 1972 Times and Post, we'd be lucky. Not even Keller would argue with that, although he'd surely predict that we'll never be that lucky. I'd still assert that not all reductions in headcount are tragedies. The Post has trimmed staff in recent years, and while I notice the departure of some features, I don't think the overall paper is diminished. Not even Keller would deny that the Post does a good job of covering the news with a staff that's dramatically smaller than that of the Times. A similar point could be made about staff contractions at the Los Angeles Times. ...

Indeed, newspapers may be ailing, but the appetite for news has never been larger, as the successes of the Times and Post Web sites prove. There's got to be a business model in there somewhere.

Reclaiming Islam from Extremists

Washington Post: By Tony Blair

Shortly before I left office, I held a conference on Islam in London. The purpose was to allow Islamic leaders to talk about Islam directly, without mediation, and in a rational not excitable setting. It arose, in part, out of my meetings with Muslims, especially young ones, in different parts of Britain. Their constant complaint was that the only people whose voices got heard were the extreme ones, the ones whose look and language was straight out of central casting – Islam as a militant struggle against “the infidel.” Instead they wanted the true Islam to be heard. Young women were particularly vocal, seeing the extremists as a threat to their rights to equality.

The outcome of the conference was remarkable. Some of the most distinguished scholars and clerics from round the world condemned totally the warping of Islam by the extremists, spoke of the need for more moderate Islam to stand up and be counted and even argued for change and reform within Islam itself.

None of this should blind us to the fact that there are indeed elements within Islam that foment extremism and in a sense more dangerous, elements that, though not extreme themselves, indulge the language and sentiments of the extremists.

But it should alert us to the need not to categorize Islam as one homogeneous entity, to talk of Muslims as if they, as a whole, are defined by a small and actually unrepresentative sect. It should also underline the importance of reaching out and empowering the moderates, the genuine true believers who wish to reclaim their religion from the extremists.

The threat the extremists pose is pervasive and profoundly alarming. They want terrorism to cause chaos and prevent progress, using the impact the carnage causes to make people lose hope in peace. They successfully climb on the back of longstanding disputes, shifting their direction and intensity towards conflict. In the Middle East, in Africa, but even on the streets of European capitals their presence is felt in bloodshed and division. And however reactionary their means and ends, they have a very modern understanding of global communication and how terrorism can be used to blot out any other image.

The terrorists are evil. But they are not stupid.

Defeating this evil will take many things. But one thing above all is essential. Ultimately it can only be defeated within Islam. Moderate, mainstream Islam must triumph.

One other fascinating aspect of the London conference was hearing genuine Islamic scholars speak about their religion in a way usually untold to Western audiences: how Islam was for centuries the progressive force in science and knowledge; how the Koran reveres Jesus and Mary; how the Abrahamic religions share so much common history and tradition; and how the actions of the extremists are not merely wrong, but directly contrary to the teaching of the Prophet Mohammed.

This is the authentic voice of Islam. It needs to be heard and to be listened to.

Claims, particularly those by outsiders, to identify "the authentic voice" of a religious, national, or ethnic group, tend to put me on guard for a proclamation likely to be either hateful or ultra-PC. I've come to be dubious about the existence of single "authentic voices" of large and heterogeneous entities, including those to which I belong. But certain voices, unlikely to be heard amidst the clamor of extremist rhetoric and the excitable responses it calls forth in response, may deserve and benefit from a bit of amplification.

Life in the Academy?

Slate Magazine:
Dear Prudence,
I've just gotten out of a long relationship that ended rather abruptly and badly. My partner and I were together for almost 10 years, most of them wonderful and loving, but the last year was a complete nightmare. We both work in the same profession—academia—which is a small, small world. This means, first, that there is no real possibility of a clean or permanent break, as we will inevitably run into each other at professional conferences several times a year; and second, that we share many of the same friends and colleagues—most of our common friends are colleagues. The problem is that my ex has been airing our dirty laundry—or, more accurately, my dirty laundry—to many of them. I have refrained from doing this myself, in part because one of the reasons for the breakup was my ex's affair with a colleague, and airing my ex's dirty laundry would also involve damaging the reputation of the third party. [???] I have asked my ex to show me the same consideration, or at least to take responsibility for the affair in telling the story, to no avail. I don't want to engage in retributive gossip-mongering, but I also do not want to let an erroneous account of events circulate unchallenged. Also, I'm worried that this nastiness may eventually have some negative effect on my professional life and relationships. Please don't tell me that I shouldn't worry about what other people think or that "mature people will realize that this is just gossip and will not change their opinions of you on the basis of it." We all know that academics are not known for their maturity or social acumen. What can I do?

Prudie responds:
...You don't have to engage in character assassination when you say the breakup was painful for all parties, but ultimately you couldn't salvage your relationship once your ex started cheating on you. (If you want to then set off for a hike on the high road, you can decline to disclose colleague X's identity.) Mention this—reluctantly, painfully—to the most reliably gossipy of your friends...

Ann Slanders used to check such letters for New Haven postmarks, and write them off as creations of Yale frat boys, of whom W was one. He's moved on to larger forms of mischief...and much worse.

Democrats still pursuing prosecutor for Gonzales

Washington Post--The Talk:
Sen. Russ Feingold (D-Wis.) joined Schumer and Democrats Dianne Feinstein (Calif.) and Sheldon Whitehouse (R.I.) on Thursday in asking the administration to appoint a special prosecutor. Feingold said today that he remains convinced that an independent investigation is needed.

'The attorney general, in my view, has at least lied to Congress and may have committed perjury, and I think we need to have somebody who's able to look at both the classified and non-classified material in a way that he can actually determine whether or not criminal charges have to be pursued,' Feingold said on 'Fox News Sunday.'...

The ranking members of the Judiciary Committee were on CBS's "Face the Nation," where Sens. Patrick Leahy (D-Vt.) and Arlen Specter (R-Pa.), did not call for a special prosecutor. They said, however, that they have given Gonzales one week to amend his testimony and advised him to consult a lawyer in doing so.

"I think we ought to give the attorney general a chance to correct the record. There's no doubt, as I have said repeatedly for months now, that the Department of Justice would be much better off without him," Specter said.

Nice advice from a fellow Republican.
Looking back at past presidencies, I think Alberto has earned a place as W's "honorary brother", and should start merchandising Alberto Beer. He probably has some excellent, well-sorted lists to draw on for his mass marketing efforts, both domestic and international.

A Column Prompts a Dressing-Down

washingtonpost.com: By Deborah Howell (Ombudsman)

How did it come to this? Hillary Clinton's cleavage leading off the ombudsman's column?...

[Washington Post fashion editor Robin] Givhan won a 2006 Pulitzer Prize for criticism "for her witty, closely observed essays that transform fashion criticism into cultural criticism." She writes for Style, where staffers pride themselves on being edgy (some say snarky) and provocative. Her editors give her wide latitude to comment, and she regularly ticks off readers. ...

Givhan has frequently written about male candidates -- when former New York mayor Rudy Giuliani stopped the comb-over to hide his baldness. A 2004 piece about John Kerry and John Edwards started off: "Hair has become a central issue in the race for the presidency."

And she has caused ruckuses before, writing critically in 2005 about Vice President Cheney's appearance at a ceremony on the 60th anniversary of the liberation of Auschwitz: "The vice president . . . was dressed in the kind of attire one typically wears to operate a snow blower." The same year she wrote that John Roberts's wife and children were dressed too preciously on the day his nomination to the Supreme Court was announced....

There's a bigger issue about her Clinton piece: Does this have anything to do with whether Clinton should be president? Not a thing. But do we want to read the column about her cleavage? Yes indeed. It was the most viewed story on the Web site all day. So was a recent story on John Edwards's hairdresser.

There has to be a balance in campaign coverage. Readers deserve substance, but they also want to know who these people are, about their families and their lives.

No way to avoid "cleavage" in excerpting this report. Oh well.
But are these the standards to be applied by the Washington Post's Ombuds? Inquiring minds want to know? Rubber-necking (sorry--is that a body part?) as the criterion for elite journalism?

I am a bit curious whether such a column would have run in the Times, and what the Public Editor might have said about it.

Even more interesting: The Murdoch Street Journal. But then again, Ruppert has made a separate peace with Hillary--something about government policy relating to his media interests in China? And Murdoch "journalism" can probably do better (by the WaPo Ombuds standard?) than a dot portrait of Hillary's cleavage ...

Yuk. I have to take a shower.
Your fastidious blogger.

Local boy does, uh, maybe not so good...

washingtonpost.com: By Christopher Lee and Marc Kaufman

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate....

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services. ...

Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released." ...

n 65 pages, the report charts trends in infectious and chronic disease; reviews efforts to curb AIDS, tuberculosis and malaria; calls for the careful monitoring of public health to safeguard against bioterrorism; and explains the importance of proper nutrition, childhood immunizations and clean air and water, among other topics. Its underlying message is that disease and suffering do not respect political boundaries in an era of globalization and mass population movements.

The report was compiled by government and private public-health experts from various organizations, including the National Institutes of Health, the Catholic Medical Mission Board and several universities. Steiger's global health office provided the funding and staff to lead the effort because the surgeon general's office has no budget and few staff members of its own. ...

Richard Walling, a former career official in the HHS global health office who oversaw the draft, said Steiger was the official who blocked its release. "Steiger always had his political hat on," he said. "I don't think public health was what his vision was. As far as the international office was concerned, it was a political office of the secretary. . . . What he was looking for, and in general what he was always looking for, was, 'How do we promote the policies and the programs of the administration?' This report didn't focus on that." ...

Steiger, 37, is a godson of former president George H.W. Bush and the son of a moderate Republican who represented Wisconsin in the House and hired a young Dick Cheney as an intern. The elder Bush appointed Steiger's mother to the Federal Trade Commission in 1989. A biographical sketch of her on the American Bar Association's Web site states that Steiger's parents, now deceased, were "lifelong friends" of many members of the same congressional class, including the Rumsfelds and the Bushes.

Letting Go of the Rope -- Aggressive Treatment, Hospice Care, and Open Access

NEJM: Alexi A. Wright, M.D., and Ingrid T. Katz, M.D., M.H.S.

More Americans are choosing hospice for end-of-life care, but ironically, hospice patients increasingly are forced to give up effective palliative treatments along with aggressive medical intervention. For Joanne Doolin, a 64-year-old mother of three who spent her last 2 years of life fighting colon cancer that eventually made it impossible to eat, enrollment in hospice care involved a difficult trade-off: with only a few weeks left to live and her daughter's wedding approaching, Doolin was forced to choose between entering hospice care and continuing to receive total parenteral nutritional support.

Unfortunately, treatment options are often limited by the economic constraints of hospice care. The hospice that was the closest to Doolin's Boston-area home would accept only patients willing to forgo life-sustaining treatments, including chemotherapy and parenteral nutrition. It cares for only about 20 patients at a time with three nurses, a manager, a part-time chaplain, and a medical director who works there one morning a week. As a small program, it cannot negotiate pricing or spread the cost of expensive medications across many patients. A few large hospices offer what is called open-access care, which allows patients to add hospice care to their current medical treatment, but this option is not available in Massachusetts.

The Medicare hospice benefit reimburses hospices on a per diem basis, paying fixed inpatient and outpatient fees regardless of services provided. Despite adjustments for inflation, the fees have not kept up with the cost of cutting-edge palliative treatments. Many patients who meet the criterion for hospice care — having less than 6 months to live — still opt for palliation from oral chemotherapies, radiation, antiemetics, or blood transfusions. But these treatments can cost more than $10,000 per month — too much for most hospice programs. ...

Although some observers worry that nationwide open access could bankrupt Medicare, most agree that per diem reimbursement rates remain unacceptably low: in 2006, hospices were paid an average of $563 per patient per day for inpatient care (which represents 2.7% of Medicare's total hospice payments) (see Table 2). The average outpatient fee was $126 for a typical day of care, an amount that must cover nursing care; contributions from social workers, chaplains, and volunteers; and all drugs and durable medical equipment, as well as 13 months of bereavement support. ...

A few large hospices and insurance companies are trying to prevent these situations with open-access programs. Last year, Capital Hospice, based in Washington, D.C., paid for palliative chemotherapy, radiation, dialysis, blood transfusions, parenteral nutrition, antibiotics, and other expensive intravenous medications. With an average daily census of 606 patients, the program can spread out the expense. President and chief executive officer Malene Davis likens open access to "two ropes hanging from the ceiling. We've asked people to hold on to the aggressive-treatment rope with both hands," she says, "but when they go on hospice we tell them to let go completely. Open access gives people the choice to let go of active treatment with one hand and grab on to the hospice rope until they feel comfortable letting the other hand go."...

"Whoever wrote [Medicare's hospice] policy has never taken care of sick patients," argues Diane Meier. "Our patients are fighting for their lives and will do anything to extend the length of time they live, as long as they have some quality of life."

These issues arose for our family as we contemplated hospice care for my dying father. We were more sophisticated than many facing these choices, and fortunate that we had located an outstanding geriatrician used to working with hospice, and had private resources to supplement the Medicare hospice budget. While collaboration among physician, hospice team, and institutional staff was not seamless, and some tricky issues needed to be resolved, mostly it worked out, and hospice was a great help. But the integration of hospice philosophy and skills with mainstream medical care is very much a work in progress; we were very concerned that access to mainstream interventions for intercurrent illnesses and symptom relief might be curtailed or unavailable under the hospice contract we were presented with. We reached some informal understandings, which fortunately were never tested in reality; we can't know for sure what would have happened if they were.

Whether full "open access" is the right answer is not altogether clear to me, but the time is rapidly passing for viewing hospice and mainstream medicine as mutually exclusive alternatives; finding paths to more flexible and integrated options for patients and families represents the challenge for the coming generation of end-of-life care.

An interview with Dr. Timothy Quill, director of the Center for Palliative Care and Clinical Ethics at the University of Rochester, can be heard at www.nejm.org.

When Great Art Meets Great Evil

New York Times:
FOR those who find inspiration and edification in great art, it is always painful to be reminded that artists are not necessarily admirable as people and that art is powerless in the face of great evil. That truth was baldly evident in Nazi Germany and in the way the regime used and abused music and musicians, to say nothing of the way it used and abused human beings of all kinds.

Two new novels touch on these issues in very different ways. In “The Savior” (Simon & Schuster), Eugene Drucker, a violinist in the Emerson String Quartet, creates Gottfried Keller, a violinist made to perform for suffering and often unruly patients in army infirmaries and for doomed inmates in a concentration camp. In “Variations on the Beast” (Dragon Press), Henry Grinberg, a psychoanalyst, posits Hermann Kapp-Dortmunder, a powerful maestro, as a fictional rival of Wilhelm Furtwängler (whose qualms about working under the regime he does not share) and Herbert von Karajan (whose vaulting ambition he does).

Mr. Drucker and Mr. Grinberg recently discussed their books and the issues they raise with James R. Oestreich....

DRUCKER Great art is no protection against cruelty, bestiality. I think that both of our books show that. I do think there’s some possibility, if not for redemption, at least for some kind of solace in great art.

I’m thinking of Adorno’s famous phrase that after Auschwitz there could be no poetry. But the fact is that of course the world picks itself up — never fully recovering from the wounds, but the world picks itself up and goes on with its business in every sense of the word.

Maybe humanity saw in the Second World War, on a larger scale than ever before, the depths of depravity to which human nature could sink. And maybe it was more curious than ever that you could have people so involved with great art and willingly consenting to and ordering horrible mass executions to take place. But the fact is that art has continued. And if art could go forward, that means that people could draw some comfort from it.

And you could also say there’s a possibility for greater humanity through art than if you just let yourself be totally pulled down by the horrible things that have happened in the 20th century and that are now happening in various parts of the world. If you just let yourself get pulled down by it, then there’s even less hope for humanity.

Mining of Data Prompted Fight Over Spying


WASHINGTON, July 28 — A 2004 dispute over the National Security Agency’s secret surveillance program that led top Justice Department officials to threaten resignation involved computer searches through massive electronic databases, according to current and former officials briefed on the program.

It is not known precisely why searching the databases, or data mining, raised such a furious legal debate. But such databases contain records of the phone calls and e-mail messages of millions of Americans, and their examination by the government would raise privacy issues....

If the dispute chiefly involved data mining, rather than eavesdropping, Mr. Gonzales’ defenders may maintain that his narrowly crafted answers, while legalistic, were technically correct.

But members of the Senate Intelligence Committee, who have been briefed on the program, called the testimony deceptive.

“I’ve had the opportunity to review the classified matters at issue here, and I believe that his testimony was misleading at best,” said Senator Russ Feingold, Democrat of Wisconsin, joining three other Democrats in calling Thursday for a perjury investigation of Mr. Gonzales.

“This has gone on long enough,” Mr. Feingold said. “It is time for a special counsel to investigate whether criminal charges should be brought.” ...

The first known assertion by administration officials that there had been no serious disagreement within the government about the legality of the N.S.A. program came in talks with New York Times editors in 2004. In an effort to persuade the editors not to disclose the eavesdropping program, senior officials repeatedly cited the lack of dissent as evidence of the program’s lawfulness. ...

Mr. Gonzales defended the surveillance in an appearance before the Senate Judiciary Committee in February 2006, saying there had been no internal dispute about its legality. He told the senators: “There has not been any serious disagreement about the program that the president has confirmed. There have been disagreements about other matters regarding operations, which I cannot get into.”

By limiting his remarks to “the program the president has confirmed,” Mr. Gonzales skirted any acknowledgment of the heated arguments over the data mining. He said the Justice Department had issued a legal analysis justifying the eavesdropping program.

So maybe impeachment is more suitable than a perjury prosecution?

It has long been recognized that telling the literal truth when least expected is one of the most effective means of deception.

Certain Degrees Now Cost More at Public Universities


Should an undergraduate studying business pay more than one studying psychology? Should a journalism degree cost more than one in literature? More and more public universities, confronting rising costs and lagging state support, have decided that the answers may be yes and yes.

Starting this fall, juniors and seniors pursuing an undergraduate major in the business school at the University of Wisconsin, Madison, will pay $500 more each semester than classmates....

Such moves are being driven by the high salaries commanded by professors in certain fields, the expense of specialized equipment and the difficulties of getting state legislatures to approve general tuition increases, university officials say. ...

“This is not the preferred way to do this,” said Patrick V. Farrell, provost at the University of Wisconsin, Madison. “If we were able to raise resources uniformly across the campus, that would be a preferred move. But with our current situation, it doesn’t seem to us that that’s possible.” ...

Mr. Kushner [of Iowa State] said he thought society was no longer looking at higher education as a common good but rather as a way for individuals to increase their earning power.

“There was a time, not that long ago, 10 to 15 years ago, that the vast majority of the cost of education at public universities was borne by the state, and that was why tuition was so low,” he said. “That was based on the premise that the education of an individual is a public good, that individuals go out and become schoolteachers and businessmen and doctors and lawyers, that makes society better. That’s no longer the perception.” ...

Officials at universities that have recently implemented higher tuition for specific majors say students have supported the move.

Students in the business school at the University of Wisconsin, for example, got behind the program because they believed that it would support things like a top-notch faculty. “It’s very important to all the students in the business school to sustain our reputation,” said Jesse C. Siegelman, 21, who expects to graduate in December 2008. ...

While several university officials said students in majors that carried higher costs could bear the burden because they would be better paid after graduation, Mr. Lariviere [of Kansas] said he was skeptical of that rationale. He pointed out that many people change jobs several times over a career and that a major is a poor predictor of lifetime income.

“Where we have gone astray culturally,” he said, “is that we have focused almost exclusively on starting salary as an indicator of life earnings and also of the value of the particular major.”

Answering to No One

washingtonpost.com: By Walter Mondale

The Founders created the vice presidency as a constitutional afterthought, solely to provide a president-in-reserve should the need arise. The only duty they specified was that the vice president should preside over the Senate. The office languished in obscurity and irrelevance for more than 150 years...

But it wasn't until Jimmy Carter assumed the presidency that the vice presidency took on a substantive role. Carter saw the office as an underused asset and set out to make the most of it. He gave me an office in the West Wing, unimpeded access to him and to the flow of information, and specific assignments at home and abroad. He asked me, as the only other nationally elected official, to be his adviser and partner on a range of issues.

Our relationship depended on trust, mutual respect and an acknowledgement that there was only one agenda to be served -- the president's. ...

This all changed in 2001, and especially after Sept. 11, when Cheney set out to create a largely independent power center in the office of the vice president. His was an unprecedented attempt not only to shape administration policy but, alarmingly, to limit the policy options sent to the president. It is essential that a president know all the relevant facts and viable options before making decisions, yet Cheney has discarded the "honest broker" role he played as President Gerald Ford's chief of staff.

Through his vast government experience, through the friends he had been able to place in key positions and through his considerable political skills, he has been increasingly able to determine the answers to questions put to the president -- because he has been able to determine the questions. ...

Rather than subject his views to an established (and rational) vetting process, his practice has been to trust only his immediate staff before taking ideas directly to the president. Many of the ideas that Bush has subsequently bought into have proved offensive to the values of the Constitution and have been embarrassingly overturned by the courts.

The corollary to Cheney's zealous embrace of secrecy is his near total aversion to the notion of accountability. ... His insistence on invoking executive privilege to block virtually every congressional request for information has been stupefying -- it's almost as if he denies the legitimacy of an equal branch of government. Nor does he exhibit much respect for public opinion, which amounts to indifference toward being held accountable by the people who elected him.

Whatever authority a vice president has is derived from the president under whom he serves. There are no powers inherent in the office; they must be delegated by the president. Somehow, not only has Cheney been given vast authority by President Bush -- including, apparently, the entire intelligence portfolio -- but he also pursues his own agenda. The real question is why the president allows this to happen. ...

One question to be addressed is why it is worse for an elected Vice-President to control access to Presidential decisionmaking (if it is that) than for an appointed official. To be sure, a Vice President can't simply be fired (although he/she can be assigned to permanent funeral duty...). In what ways do the problems presented by Cheney extend beyond substance and style (which covers quite a broad swath) to institutional role?

There was some debate, I think in the 1976 Republican primaries, about running Reagan for King (er, President) and then-sitting President Gerald Ford for Prime Minister (formally, Vice President). The elites thought it was a terrible idea, although economists might have gone with comparative advantage theory. Bush-Cheney feels rather like that in practice, without the formal announcement (which is classified and kept in Cheney's office safe). Maybe that's what they meant about a "Fourth Branch" of Government.

Future of Stem Cell Tests May Hang on Defining Embryo Harm

washingtonpost.com: By Rick Weiss

With the active encouragement of the Bush administration, U.S. scientists in the past year have developed several methods for creating embryonic stem cells without having to destroy human embryos.

But some who now wish to test their alternatively derived cells have found themselves stymied by an unexpected barrier: President Bush's stem cell policy.

The 2001 policy says that federal funds may not be used to study embryonic stem cells created after Aug. 9 of that year. It is based on the assumption that the only way to make the cells is by destroying human embryos -- a truism in 2001 but not any longer.

As a result, the National Institutes of Health recently refused to consider a grant application for what would have been the first federal study to compare several of the new, less politically contentious stem cell lines. ...

At the center of the debate is a new technique, pioneered by ACT [Advanced Cell Technology], that obtains stem cells from human embryos while leaving the embryos functionally intact. A single cell, called a blastomere, is removed from an eight-cell human embryo, then coaxed to multiply into a colony of stem cells in a dish. ...

Sean Tipton, president of the Coalition for the Advancement of Medical Research, a stem cell research advocacy group, said the policy amounts to a Catch-22.

"On the one hand, they're saying, 'Find this out,' " Tipton said, referring to the Bush administration's repeated call for scientists to find ways to make and study stem cells without destroying embryos. "On the other hand, they're saying, 'You're not allowed to do the research to answer these questions.' "...

My UW colleague Alta Charo is quoted further down in the story.
Federal stem cell policy certainly exemplifies the high degree of bureaucratic competence and regard for scientific expertise so characteristic of this Administration.

Travelers Face Greater Use of Personal Data

Travelerswashingtonpost.com: By Paul Lewis and Spencer S. Hsu

The United States and the European Union have agreed to expand a security program that shares personal data about millions of U.S.-bound airline passengers a year, potentially including information about a person's race, ethnicity, religion and health.

Under the agreement, airlines flying from Europe to the United States are required to provide data related to these matters to U.S. authorities if it exists in their reservation systems. The deal allows Washington to retain and use it only 'where the life of a data subject or of others could be imperiled or seriously impaired,' such as in a counterterrorism investigation.

According to the deal, the information that can be used in such exceptional circumstances includes "racial or ethnic origin, political opinions, religious orphilosophical beliefs, trade union membership" and data about an individual's health, traveling partners and sexual orientation.

Airlines do not usually gather such data, but officials say it could wind up in passenger files as a result of requests for special services such as wheelchairs, or through routine questioning by airline personnel and travel agents about contacts, lodging, next of kin and traveling companions. Even a request for a king-size bed at a hotel could be noted in the database. ...

Although Homeland Security has said it will move passenger information to "dormant" status after seven years and "expects" to erase it after 15 years, it notified the E.U. that expiration of data will be subject to "further discussions."

Dutch lawmaker Sophia Veld, the European Parliament's standing rapporteur on Passenger Name Records, said the agreement gives a green light to U.S. authorities to use confidential information for unstated purposes. Stavros Lambrinidis of Greece, vice chairman of the parliament's civil liberties, justice and home affairs committee, warned that it allows extra data collection not just in counterterrorism cases but for "a vast and in some cases unidentified number of crimes. So we have function creep."

And make the king suite non-smoking, please. Got that down?

The Hillary Letters II: Avoid Introspection, Refuse to Self-Define, Run for President

New York Times:
Ms. Rodham skates earnestly on the surface of life, raising more questions than answers. “Last week I decided that even if life is absurd why couldn’t I spend it absurdly happy?” she wrote in November of her junior year. She then challenges herself to “define ‘happiness’ Hillary Rodham, acknowledged agnostic intellectual liberal, emotional conservative.”

From there, she deems the process of self-definition to be “too depressing” and asserts that “the easiest way out is to stop any thought approaching introspection and to advise others whenever possible.”

The Hillary Letters I: Neoliberalism or "Compassionate Misanthropy"?

New York Times:
But in many ways her letters are more revealing about her search for her own sense of self.

“Can you be a misanthrope and still love or enjoy some individuals?” Ms. Rodham wrote in an April 1967 letter. “How about a compassionate misanthrope?”

Saturday, July 28, 2007

Cancer Patients, Lost in a Maze of Uneven Care

New York Times:By Denise Grady
Cancer, more than almost any other disease, can be overwhelmingly complicated to treat. Patients are often stunned to learn that they will need not just one doctor, but at least three: a surgeon and specialists in radiation and chemotherapy. Diagnosis and treatment require a seemingly endless stream of appointments. Doctors do not always agree, and patients may find that at the worst time in their lives, when they are ill, frightened and most vulnerable, they also have to seek second opinions on biopsies and therapy, fight with insurers and sort out complex treatment options.

The decisions can be agonizing, in part because the quality of cancer care varies among doctors and hospitals, and it is difficult for even the most educated patients to be sure they are receiving the best treatment. “Let the buyer beware” is harsh advice to give a cancer patient, but it often applies. Excellent care is out there, but people are often on their own to find it. Patients are told they must be their own advocates, but few know where to begin. ...

...When she joined a cancer support group, she recalled, “It was amazing to me the different experiences people were having based on what they could afford or who their provider was. I was able to say, ‘If the provider won’t pay, my family will. I don’t care, I’m going for a second opinion.’ ”

In the support group, it saddened her to hear other patients with advanced disease take the word of a single oncologist, because she believes that if she had done that, she would already be dead. She has come to think that survival may depend on money and access, and, she said, on “your own drive and motivation — are you Type A? — your education and your ability to sort through the medical world and the insurance world terminology.”

This promises to be quite a series.
For all the fuss and negative comment about Michael Moore's narrative techniques, he gets some big things right, as this more conventionally reported piece demonstrates.
Many American patients have their troubles securing a first opinion, let alone a second at a mega-center of their choice. And the disparities in approach, expertise, and outcomes are startling in a field supposedly dominated by science and widespread access to research reports. It would be interesting to know more about comparisons in these regards to the better rated universal systems, such as Canada, France and Germany. (Maybe not Cuba on this one, Michael.)

On Trial for your Life

New York Times:By Denise Grady
Presbyterian rejected two appeals, he took his case to a state review board, where he represented himself because he could not afford a lawyer. Presbyterian showed up with two lawyers, a doctor and a nurse. Dr. Bordenave and a gastroenterologist from Albuquerque testified on Mr. Hendrickson’s behalf.

Mr. Hendrickson and his wife had studied the details of their insurance policy and had also learned — with the help of M. D. Anderson — that in the previous five years, the five surgeons Presbyterian had recommended had performed a total of five Whipple operations.

Ultimately, Mr. Hendrickson won the case, and Presbyterian Health Plan paid the entire bill.

A spokesman for Presbyterian said the case had led the company to allow more patients to be treated at high-volume centers if there was evidence that the results would be better.

Mr. Hendrickson said it was “tough to stand up to attorneys and doctors. I don’t know why I was able to do it. I’m stubborn, I guess. I don’t like to be told what to do. Too many people, I know, they just let it go and they die.”"

Getting effective care for the seriously ill--known in the trade as "medical losses". There probably is an important place in any health care system for effective means of utilization review--that is, are patients receiving appropriate care likely to be helpful to their condition (and not just to the pocketbooks of those proving expensive interventions). It doesn't follow that reviewers should have strong personal financial incentives (amply documented in Michael Moore's SiCKO) to deny care. This is a challenge for any health care system, perhaps not best addressed at the bedside of each individual patient, but through research and medical consensus panels. Achieving universal coverage will not make all such problems go away, but it will give us a better shot at getting the incentives right--and considerably more humane (except for those patients with unlimited resources...)

Sending Back the Doctor’s Bill

New York Times: By ALEX BERENSON
“I always find it ironic that when I go to doctor groups and such, they always talk about the cost of prescription drugs,” said Dana Goldman, director of health economics at the RAND Corporation, a nonprofit research institute in Santa Monica, Calif.In the United States, nearly all doctors are paid piecemeal, for each test or procedure they perform, rather than a flat salary. As a result, physicians have financial incentives to perform procedures that further drive up overall health care spending.

Prescription drugs cost, on average, 30 percent to 50 percent more in the United States than in Europe. But the difference in doctors’ salaries is far larger, Dr. Goldman said.

Doctors in the United States earn two to three times as much as they do in other industrialized countries. Surveys by medical-practice management groups show that American doctors make an average of $200,000 to $300,000 a year. Primary care doctors and pediatricians make less, between $125,000 and $200,000, but in specialties like radiology, physicians can take home $400,000 or more.

In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004....[T]he lower salaries are a significant part of the reason that European countries spend less on health care than the United States does — a fact liberals avoid mentioning when they preach the advantages of a European-style single-payer system. ...

Doctors are paid little for routine examinations and very little for “cognitive services,” such as researching different treatment options or offering advice to help patients get better without treatment.

“I don’t have a view on whether doctors take home too much money or not enough money,” Dr. Bach said. “The problem is the way they earn their money. They have to do stuff. They have to do procedures.”

Primary care doctors and pediatricians, who rarely perform complex procedures, make less than specialists. They are attracting a declining percentage of medical students, and some states are facing a shortage of primary care doctors. ...

Medicare, especially, does not like to second-guess doctors’ clinical decisions, said Dr. Stephen Zuckerman, a health economist at the Urban Institute. “There’s not a lot of utilization review or prior authorization in Medicare,” he said. “If you’re doing the work, you can expect to get paid.”

As a result, doctors have steadily increased the number of procedures they perform on Medicare beneficiaries — and thus have increased their income from Medicare, Dr. Zuckerman said. But the extra procedures have not helped patients’ health much, he said. “I don’t think there’s any real strong evidence of improvements in health status.”

Swabs in Hand, Hospital Cuts Deadly Infections

New York Times:
...Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say....

Several European countries, including the Netherlands and Finland, have all but eliminated MRSA through similarly aggressive campaigns. But at many American hospitals, experts say, high infection rates have been accepted as a cost of doing business. Barely a quarter of American hospitals screen patients for bacterial colonies in any methodical way, a recent survey found.

“People don’t believe it’s in their institution, and, if it is, that it’s too big to do anything about, that you just have to accept it...

...[S]ome infection-control experts warn that [certain measures] may have unintended consequences, including lesser care for patients who linger in isolation. Studies have found that patients in isolation are seen by hospital staff members half as frequently and tend to suffer more from falls, bed sores and stress. ...

A major emphasis at the Pittsburgh hospitals has been hand hygiene. Studies have consistently shown that busy hospital workers disregard basic standards more than half the time. At the veterans hospital, where nurses have taken to pushing elevator buttons with their knuckles, annual spending on hand cleaner has doubled.

The least bad plan for leaving Iraq

Slate Magazine: By Fred Kaplan
Back in the spring of 2004, when Galbraith first proposed splitting Iraq into a loose federation of three ethnic enclaves, I criticized the idea. He did have a point. 'Iraq' was an artifice from its outset, the product of a scheme to widen the British Empire in the wake of the First World War. When the American-led invasion toppled Saddam Hussein, it also imploded the artifice of a unified Iraqi nation, and there was no way to put the monster back together. It would be better, Galbraith argued, to let the Sunnis, Shiites, and Kurds govern themselves in autonomous regions, with a central authority doing little more than equitably distributing oil revenue. ...

My objections remain, but the context has changed. Amputation seems a terrible idea when one's limbs are still flexing. It's a bit more palatable when the alternative is death, and, in Iraq, the gangrene is spreading.

"The Iraq war is lost," Galbraith starkly declares in his new article. "Defeat," he continues, "is defined by America's failure to accomplish its objective of a self-sustaining, democratic, and unified Iraq. And that failure has already taken place....

He has now abandoned his plan for a partitioned federation, regarding the southern two-thirds of Iraq—the areas dominated by Shiite and Sunni Arabs—as hopeless. ...Galbraith no longer describes Iraq as consisting of Shiites, Sunnis, and Kurds. Rather, he calls it "a land divided along ethnic lines into Arab and Kurdish states with a civil war being fought within its Arab part."

Galbraith's own analysis points to one possible approach. Back when he advocated a tripartite federation, he noted (correctly) that Iraq was already moving in that direction—only violently. Now, more each day, sectarian militias are ethnically cleansing neighborhoods, even whole towns, where Shiites and Sunnis once casually mixed.

Before they withdraw, U.S. troops could try to help minorities relocate into areas where their ethnic brethren are in the majority—providing the means of transportation and, to the extent possible, safe passage. Iraqi troops and police may be very keen to assist, if not lead the way, in this mission—at least if Shiite forces are called on to help Shiites, Sunni forces to help Sunnis.

It's extremely discomfiting to abet ethnic segregation—but less so when the alternative might open the gates to mass murder.

Peter Galbraith and Les Gelb were among the early voices recognizing that the quest for a unified Iraq (post-military conflagration) was an illusion, and some form of soft-partition a necessity. Joe Biden signed on sometime later, but has been a pretty solitary voice in Congress in pushing this (as opposed to withdrawal of American troops without a specified future strategy) as a serious foreign policy alternative. Apparently Galbraith has thrown in the towel on effectively separating Sunni and Shi'a domains, and is now focusing on the Kurds. I have yet to read his most recent piece explaining this transition in his thinking (or in conditions on the ground); would that more political and military leaders had recognized the wisdom of this analysis long ago. Some catastrophes just keep getting worser and worser and alternatives (all bad, but some a bit less bad) fewer and fewer.

Iraq Math: From One, Make Three

New York Times: By HELENE COOPER
Mr. Biden’s so-called soft-partition plan — a variation of the blueprint dividing up Bosnia in 1995 — calls for dividing Iraq into three semi-autonomous regions, held together by a central government. There would be a loose Kurdistan, a loose Shiastan and a loose Sunnistan, all under a big, if weak, Iraq umbrella.

“The idea, as in Bosnia, is to maintain a united Iraq by decentralizing it, giving each ethno-religious group — Kurd, Sunni Arab and Shiite Arab — room to run its own affairs, while leaving the central government in charge of common interests,” Mr. Biden and Mr. Gelb wrote in their Op-Ed on May 1, 2006. “We could drive this in place with irresistible sweeteners for the Sunnis to join in, a plan designed by the military for withdrawing and redeploying American forces, and a regional nonaggression pact.”

The proposal acknowledges forthrightly what a growing number of Middle East experts say is plain as day: Iraqi Shiites and Sunnis are not moving toward reconciliation; they still haven’t managed to get an oil law passed, and de facto ethnic cleansing is under way as Sunnis flee largely Shiite neighborhoods and towns, and vice versa.

See my comments on the following post, which also apply to this one.

Mr. Gonzales’s Never-Ending Story

New York Times (Editorial):
"If that does not happen, Congress should impeach Mr. Gonzales."

Well, well.

Gonzales Testimony Part of Broader Effort to Conceal Surveillance Program

TPMmuckraker : By Spencer Ackerman and Paul Kiel
There's a lot of evidence to suggest that Gonzales's careful, repeated phrasing to the Senate that he will only discuss the program that 'the president described' was deliberate, part of a concerted administration-wide strategy to conceal from the public the very broad scope of that initial program. When, for the first time, Program X (as we'll call it, for convenience's sake) became known to senior Justice Department officials who were not its original architects, those officials -- James Comey and Jack Goldsmith, principally -- balked at its continuation. They did not back down until the program had undergone as-yet-unspecified but apparently significant revisions. But when President Bush announced what he would call the 'Terrorist Surveillance Program' in December 2005, he left the clear impression that the program had always functioned the same way since its 2001 inception.

The administration's consistent refusal to discuss any aspect of the program -- current or former -- aside from what President Bush disclosed in December 2005 appears to be intended, specifically, to gloss over Comey and Goldsmith's objections. If that's the case, it could mean that the public has been presented with an inaccurate picture of the origins and scope of Program X. The Bush administration is currently contesting a Senate Judiciary Committee subpoena for documentation establishing Program X's history -- in essence, trying to ensure that the public never learns more about the program and the internal deliberations over it than what President Bush chooses to reveal. ...

The different phases of the program’s implementation did not become clear until Comey’s testimony before the Senate Judiciary Committee in May of this year. Comey did not identify the program, only calling it “a particular classified program.” We won't rehash his story in full here. But during his brief reign as acting attorney general, Comey refused to reauthorize Program X in March of 2004 (here’s an explanation as to why it took two years for this to happen). Comey’s refusal was based on the concerns of Jack Goldsmith, the head of the Department’s Office of Legal Counsel, but the precise nature of Goldsmith’s concern isn’t publicly known. Goldsmith declined to comment for this story.

It all came to a head on March 10, 2004, with the deadline for reauthorizing Program X looming. That afternoon, the White House called a meeting with the so-called "Gang of Eight" -- those congressional leaders briefed about Program X -- and Gonzales and Andrew Card made their infamous visit to Ashcroft’s hospital bed that night. The President initially opted to continue the program despite Ashcroft’s refusal to overrule Comey. But the next day, March 11, when faced with the possible resignation of the top echelon of Department of Justice leadership, the President personally told Comey to recommend what changes needed to be made to Program X in order for the Department of Justice to sign off on its legality. ...

In essence, the issue is this: if Gonzales succeeds in convincing the committee that there really is a material distinction between the program as it existed before and after Comey’s intervention, he won't just save himself from perjury. He will perhaps have preserved an administration strategy of concealing the scope of Program X from the public and most of Congress -- making it appear that the program that Bush disclosed in December 2005, incorporating Comey's objections, is the same program that existed since October 2001, long before Comey put the brakes on at least some aspects of it. That may be at the heart of the White House's claim of executive privilege to prevent the Senate Judiciary Committee from seeing documents detailing the genesis of Program X.

Justice Dept. Lawyers Join Chorus Criticizing Gonzales


WASHINGTON, July 27 — Daniel J. Metcalfe, a lawyer who began his government career in the Nixon administration and retired from the Justice Department last winter, said morale at the department was worse under Attorney General Alberto R. Gonzales than during Watergate.

John S. Koppel, who continues to work at the department as a civil appellate lawyer in Washington, wrote this month that he was “ashamed” of the department and that if Mr. Gonzales told the truth in recent Congressional testimony, “he has been derelict in the performance of his duties and is not up to the job.”

Even though they worry that it may hinder their career prospects, a few current and former Justice Department lawyers have begun to add to the chorus of Mr. Gonzales’s critics who say that the furor over his performance as attorney general, and questions about his truthfulness under oath, could do lasting damage to the department’s work. ...

Mr. Metcalfe, the retired lawyer who was the founding director of the department’s Office of Information and Privacy, said in an interview that the questions over Mr. Gonzales’s competence and credibility had shattered morale at the department, especially after the attorney general’s testimony this week before the Senate Judiciary Committee.

“When you have an attorney general with his personal integrity and credibility so repeatedly reduced to shreds, not to mention in so public a forum, that’s just antithetical to the very nature of the Justice Department and its role in upholding the rule of law,” Mr. Metcalfe said. “This is the Department of Justice and the attorney general, where absolute integrity is Job 1.”

In an opinion article that was first published this month in The Denver Post and has since been circulated in the department, Mr. Koppel, the civil appellate lawyer, said that under the Bush administration the department had been “thoroughly politicized in a manner that is inappropriate, unethical and indeed unlawful.”

Mr. Koppel, who has been with the department since 1981, wrote that his decision to issue such a public criticism of Mr. Gonzales and the department “subjects me to a substantial risk of unlawful reprisal from extremely ruthless people who have repeatedly taken such action in the past.”

“But I am confident,” Mr. Koppel continued, “that I am speaking on behalf of countless thousands of honorable public servants, at Justice and elsewhere.”

Rapture Ready: The Unauthorized Christians United for Israel Tour

The Huffington PostMax Blumenthal
This video is worth a few minutes by those perplexed by the "Christians United for Israel" phenomenon, or interested in the descent of Joseph Lieberman.

New Heart Monitor Battery for Cheney


WASHINGTON (AP) -- Vice President Dick Cheney was in the hospital Saturday for minor surgery to replace the battery that powers a device monitoring his heart rhythms."

Power devolved on George W. Bush during the procedure.

Details of Cheney's informed consent form reveal that he declined the offer to implant some heart during the procedure. Physicians remain mystified at precisely what the heart monitor is monitoring.

Friday, July 27, 2007

The Education of Eliot

New York Times: By Gail Collins
When a new chief executive arrives, legislators are usually unsure of themselves for a while, and this is the precious soft spot when they can be pushed into doing big, bold things. If you screw it up, they’ll instantly revert to their preference for doing small, expensive things instead. (One of Hillary Clinton’s great pluses as a presidential candidate is that having been part of the great screwing up of the beginning of her husband’s administration in 1993, she may have figured out how not to do it again.)

Fat Comes in on Little Cat Feet

New York Times: By Gail Collins
Meanwhile, the researchers say they do not want to encourage the shunning of overweight people, in part because losing a good friend is — like every single other thing in the universe except parsnips — bad for one’s health. (Rather than lose your original chunky friend, Dr. Christakis proposes bringing a third, thin person into the relationship. This sounds like a sitcom of the Fox fall schedule.)

G!d save us from what is likely to follow from this research result. Prejudice against the overweight (of which I am a conspicuous member) is among the last acceptable biases in polite society. Despite the extensive research on the biological bases of obesity, and the overwhelming statistics on the failure rates of diets in producing sustainable weight loss, look for an onslaught of calls for personal responsibility. There are apparently few sensations more pleasurable to the biologically slim than blaming fat folks for their condition.

Meanwhile, health insurance typically refuses to cover bariatric surgery, or even the costs of medical side effects associated with such surgery. Medical costs associated with failed suicide attempts and drunken accidents are generally covered, but not side effects of medically indicated and recommended bariatric procedures. Think about that.

Michael Moore says he's been served

United Press International :
BURBANK, Calif., July 26 (UPI) -- Michael Thursday said the Bush administration has served him with a subpoena regarding his trip to Cuba during the making of his new film, 'Sicko.'

The Oscar-winning filmmaker, who appeared Thursday on NBC's 'The Tonight Show with Jay Leno,' said he was notified about the subpoena at the network's studios in Burbank, Calif.

I wonder if there is some kind of privilege he can invoke to be able to ignore the subpoena--there's a lot of that going around. Maybe one called the First Amendment?

A Day in the Life of Oscar the Cat

NEJM : David M. Dosa, M.D., M.P.H.
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.

More Blather on Necklines

New York Times Blog:
Ms. Givhan’s piece uses the neckline as a tool with which to examine Mrs. Clinton’s uneasy balancing act with femininity as she seeks power in a male-dominated world.

The campaign, meanwhile, is using the article as a tool to build up its bank account. From Ms. Lewis’s appeal:

Frankly, focusing on women’s bodies instead of their ideas is insulting. It’s insulting to every woman who has ever tried to be taken seriously in a business meeting. It’s insulting to our daughters — and our sons — who are constantly pressured by the media to grow up too fast.

Ms. Lewis also lamented that Mrs. Clinton’s wardrobe became a subject in Monday’s Democratic presidential debate. When asked to mention something he didn’t like about Mrs. Clinton, John Edwards expressed reservations about her coral pink jacket, while Senator Barack Obama defended it.

It took some doing to find an excerpt without the "C" word. (not referring to "Clinton", or the other one)

State Official Upholds Race-Conscious Admissions at U. of Wisconsin

Chronicle.com: Peter Schmidt

isconsin’s attorney general has issued an informal legal opinion to state legislators concluding that a race-conscious freshman-admissions policy adopted by the University of Wisconsin’s Board of Regents for the entire university system does not conflict with a state law intended to prevent the system’s campuses from engaging in discrimination.

Soon after the board adopted the policy, in February, 15 state representatives and four state senators sent Attorney General J.B. Van Hollen a letter challenging the legality of the policy, which calls for system campuses to consider race and ethnicity as part of a comprehensive review of applicants. Specifically, their letter alleged that the new policy conflicted with a 1973 law prohibiting the system from making admissions decisions using “sectarian or partisan tests or any tests based upon race, religion, national origin of U.S. citizens, or sex.”

A separate letter, signed by another group of lawmakers, urged Mr. Van Hollen to uphold the policy as legal. They argued that it did not impose any “test,” as described in the 1973 law, and called it “thoughtfully and carefully written to allow admissions officials the flexibility they need to select the student body necessary to ensure the continued success of the institution.”

In the legal opinion, Mr. Van Hollen said the term “test” in the 1973 law was used to refer to an admissions standard that would disqualify any applicants who did not meet it. Because the system’s new admissions policy calls for campuses to consider race as just one of many factors in weighing applicants, it does not impose the sort of racial “test” that the 1973 law prohibits, he said.

Mr. Van Hollen’s letter contained a note of caution for the university system, however, saying that it must make sure applicants are considered as individuals, as required by the U.S. Supreme Court in its key rulings dealing with race-conscious admissions. ...