Michael Kalisman MD




Why Everyone Seems to Have Cancer

January 5th, 2014

Why Everyone Seems to Have Cancer http://www.nytimes.com/2014/01/05/sunday-review/why-everyone-seems-to-have-cancer.html?nl=todaysheadlines&emc=edit_th_20140105&_r=0 Jillian Tamaki By GEORGE JOHNSON Published: January 4, 2014 EVERY New Year when the government publishes its Report to the Nation on the Status of Cancer, it is followed by a familiar lament. We are losing the war against cancer. Graphic Graphic Declining Lethality Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death. Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game. The rhetoric about the war on cancer implies that with enough money and determination, science might reduce cancer mortality as dramatically as it has with other leading killers — one more notch in medicine’s belt. But what, then, would we die from? Heart disease and cancer are primarily diseases of aging. Fewer people succumbing to one means more people living long enough to die from the other. The newest cancer report, which came out in mid-December, put the best possible face on things. If one accounts for the advancing age of the population — with the graying of the baby boomers, death itself is on the rise — cancer mortality has actually been decreasing bit by bit in recent decades. But the decline has been modest compared with other threats. A graph from the Centers for Disease Control and Prevention tells the story. There are two lines representing the age-adjusted mortality rate from heart disease and from cancer. In 1958 when the diagram begins, the line for heart disease is decisively on top. But it plunges by 68 percent while cancer declines so slowly — by only about 10 percent — that the slope appears far less significant. Measuring from 1990, when tobacco had finished the worst of its damage and cancer deaths were peaking, the difference is somewhat less pronounced: a decline of 44 percent for heart disease and 20 percent for cancer. But as the collision course continues, cancer seems insistent on becoming the one left standing — death’s final resort. (The wild card in the equation is death from complications of Alzheimer’s disease, which has been advancing year after year.) Though not exactly consoling, the fact that we have reached this standoff is a kind of success. A century ago average life expectancy at birth was in the low to mid-50s. Now it is almost 79, and if you make it to 65 you’re likely to live into your mid-80s. The median age of cancer death is 72. We live long enough for it to get us. The diseases that once killed earlier in life — bubonic plague, smallpox, influenza, tuberculosis — were easier obstacles. For each there was a single infectious agent, a precise cause that could be confronted. Even AIDS is being managed more and more as a chronic condition. Progress against heart disease has been slower. But the toll has been steadily reduced, or pushed further into the future, with diet, exercise and medicines that help control blood pressure and cholesterol. When difficulties do arise they can often be treated as mechanical problems — clogged piping, worn-out valves — for which there may be a temporary fix. Because of these interventions, people between 55 and 84 are increasingly more likely to die from cancer than from heart disease. For those who live beyond that age, the tables reverse, with heart disease gaining the upper hand. But year by year, as more failing hearts can be repaired or replaced, cancer has been slowly closing the gap. For the oldest among us, the two killers are fighting to a draw. But there are reasons to believe that cancer will remain the most resistant. It is not so much a disease as a phenomenon, the result of a basic evolutionary compromise. As a body lives and grows, its cells are constantly dividing, copying their DNA — this vast genetic library — and bequeathing it to the daughter cells. They in turn pass it to their own progeny: copies of copies of copies. Along the way, errors inevitably occur. Some are caused by carcinogens but most are random misprints. Over the eons, cells have developed complex mechanisms that identify and correct many of the glitches. But the process is not perfect, nor can it ever be. Mutations are the engine of evolution. Without them we never would have evolved. The trade-off is that every so often a certain combination will give an individual cell too much power. It begins to evolve independently of the rest of the body. Like a new species thriving in an ecosystem, it grows into a cancerous tumor. For that there can be no easy fix. These microscopic rebellions have been happening for at least half a billion years, since the advent of complex multicellular life — collectives of cells that must work together, holding back, as best each can, the natural tendency to proliferate. Those that do not — the cancer cells — are doing, in a Darwinian sense, what they are supposed to do: mutating, evolving and increasing in fitness compared with their neighbors, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules. As people age their cells amass more potentially cancerous mutations. Given a long enough life, cancer will eventually kill you — unless you die first of something else. That would be true even in a world free from carcinogens and equipped with the most powerful medical technology. Graphic Graphic Declining Lethality Faced with this inevitability, there have been encouraging reductions in the death toll from childhood cancer, with mortality falling by more than half since 1975. For older people, some early-stage cancers — those that have not learned to colonize other parts of the body — can be cured with a combination of chemicals, radiation therapy and surgery. Others can be held in check for years, sometimes indefinitely. But the most virulent cancers have evolved such wily subterfuges (a survival instinct of their own) that they usually prevail. Progress is often measured in a few extra months of life. OVER all, the most encouraging gains are coming from prevention. Worldwide, some 15 to 20 percent of cancers are believed to be caused by infectious agents. With improvements in refrigeration and public sanitation, stomach cancer, which is linked to Helicobacter pylori bacteria, has been significantly reduced, especially in more developed parts of the world. Vaccines against human papilloma virus have the potential of nearly eliminating cervical cancer. Where antismoking campaigns are successful, lung cancer, which has accounted for almost 30 percent of cancer deaths in the United States, is steadily diminishing. More progress can be made with improvements in screening and by reducing the incidence of obesity, a metabolic imbalance that, along with diabetes, gives cancer an edge. Surprisingly, only a small percentage of cancers have been traced to the thousands of synthetic chemicals that industry has added to the environment. As regulations are further tightened, cancer rates are being reduced a little more. Most of the progress has been in richer countries. With enough political will the effort can be taken to poorer parts of the world. In the United States, racial disparities in cancer rates must be addressed. But there is a long way to go. For most cancers the only identifiable cause is entropy, the random genetic mutations that are an inevitable part of multicellular life. Advances in the science will continue. For some cancers, new immune system therapies that bolster the body’s own defenses have shown glints of promise. Genomic scans determining a cancer’s precise genetic signature, nano robots that repair and reverse cellular damage — there are always new possibilities to explore. Maybe someday some of us will live to be 200. But barring an elixir for immortality, a body will come to a point where it has outwitted every peril life has thrown at it. And for each added year, more mutations will have accumulated. If the heart holds out, then waiting at the end will be cancer. George Johnson is a former reporter and editor at The New York Times and the author of “The Cancer Chronicles.” A version of this news analysis appears in print on January 5, 2014, on page SR1 of the New York edition with the headline: Why Everyone Seems to Have Cancer. Via: Michael Kalisman, Michael Kalisman md, Cancer, The Cancer Chronicles,Declining Lethality,MichaelkalismanMD@gmail.com

The Secret Life of Business Class Seats— The Race to Build a Better Business Class—

August 4th, 2013

The Race to Build a Better Business Class
http://www.nytimes.com/2013/08/04/business/the-race-to-build-a-better-business-class.html?nl=todaysheadlines&emc=edit_th_20130804
Via: Airlines, Business Class Travel, New Seat Design, Comfort Travel, Delta, Lufthansa, British airways, Singapore airline, Michael Kalisman, Michael Kalisman MD, michaelkalismanmd@gmail.com
The Secret Life of Business Class Seats: Jad Mouawad visits B/E Aerospace to see the technology behind business class seats.
By JAD MOUAWAD
Published: August 3, 2013
IN a confidential test lab in a remote office park near the Frankfurt airport, a small Lufthansa team holed up for five years, refining one of the German airline’s most closely guarded secrets. They called it the V concept.
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Early drawings and a computer rendering of Lufthansa’s new business-class seat
Six feet six inches long and almost two feet wide, the V concept is the German carrier’s latest weapon in the fierce competition among global airlines. It is designed to withstand shocks 16 times the force of gravity and comes with a cozy padded footrest. It is a new business-class seat, and if you are traveling round trip from Frankfurt to New York, it can be yours for about $5,000.
“Business class is where competition really is serious,” says Björn Bosler, the airline’s manager for passenger experience design, business and premium, who led Lufthansa’s team of dozens of seat designers and engineers. Bob Lange, senior vice president, head of market and product strategy at Airbus, the European plane maker, agrees: “There’s an arms race going on among carriers.”
Billions are being spent on research and development, architects, industrial designers and even yacht designers to pack seats with engineering innovations and fancy features. Just fabricating a single business-class seat can cost up to $80,000; custom-made first-class models run $250,000 to $500,000.
Those who fly coach may have had a glimpse of these expenditures as they shuffled past the elaborate reclining, angled, semiprivate accommodations in business and first class on their way to the knee-scraping spaces and overstuffed overhead compartments in the main cabin. Travelers in business and first class may represent 10 to 15 percent of long-haul seats globally, but they account for up to half of the revenue of airlines like Lufthansa or British Airways, says Samuel Engel, a vice president at ICF SH&E, an aviation consulting firm. Carriers vying for the attention of these passengers, who have money or corporate accounts that pay for their travel, are counting on good design to escape the grinding commodity nature of their business.
But there is only so much space inside a plane. As the more lucrative seats expand, the coach section often contracts, with more seats jammed into the same cabin space and more discomfort for coach passengers.
“The seat is one of the few elements that an airline can actually make its own,” says Patricia Bastard, an architect and designer who has worked with Air France on its first-class cabin. “There are very few elements like it inside an airplane. There’s customer service, of course. Maybe there’s a bar. But seats are unique to the airline. Seats are critical.”
Lufthansa, Europe’s largest airline and the world’s fourth largest in terms of passengers, is investing $4 billion to improve its cabins, offer satellite-based Internet and upgrade its onboard entertainment system. But the new business-class seat, which first appeared last year on the company’s new Boeing 747-8 planes, is perhaps the boldest attempt to lure the high-value passenger. The seat research, design, manufacture and installation accounts for roughly a third of that $4 billion investment, says Mr. Bosler — more than a billion dollars. Eleven planes are now outfitted with the new seats, and Lufthansa is expected to install about 7,000 of them on 100 wide-body airplanes by 2015.
Lufthansa’s task — like that of all the big airlines — was to create a special environment for those big-spending travelers within the inflexible boundaries of an aircraft fuselage.
“The challenge was finding a solution that provides all customer benefits but also tries to save as much space as possible and get as many passengers on board as possible,” Mr. Bosler says. “There’s only one way for Lufthansa to make money. It’s with passengers on board.”
THE first airplane business-class sections date to the 1970s, when the seats were like oversize, padded armchairs that could recline about 40 degrees. More comfortable seats for frequent business travelers came with the arrival in the 1990s of planes that could fly nonstop almost anywhere in the world. This new generation of ultralong-range airplanes that could fly for 10 to 14 hours — like the Boeing 777 — meant passengers wanted to be able to get real sleep, not just a fitful, head-snapping catnap

The growth of carriers from the Middle East and Asia also set off a transformation in cabin design. Emirates, for instance, created semienclosed suites for its first-class passengers. It installed showers on its Airbus A380 double-decker planes, as well as large bars behind the business-class cabin where passengers could mingle throughout the flight. Over a short span, passenger expectations changed.
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A small Lufthansa team worked on the design for the seat, called the V concept, for five years.
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Six feet six inches long and almost two feet wide, the seat is designed to withstand shocks 16 times the force of gravity.
“Business class today is what first class used to be 10 or 20 years ago,” says Jacques Pierrejean, a designer based in Paris who helped create the first-class cabin for Emirates.
The business and corporate travel market is by far the most lucrative one for the airlines. Business travelers are expected to spend $273 billion this year on airfares, according to a forecast by the Global Business Travel Association, a 4.3 percent gain from 2012.
“Airlines are rational actors, and where they make their investments tells you where they get their revenues from,” Mr. Engel says. “Despite all the technological advances, and e-mail, and videoconferencing, nothing replaces face-to-face meetings. This is why business travel remains so important. And for business travelers to remain productive, they need to fly relatively comfortably over long distances.”
This growth in business travel has spurred considerable innovation in the front of the plane. But finding the right balance among space, comfort and seat features is tricky. Until about five years ago, the norm was for business seats to provide a lie-flat surface at an angle, what was called a “faux flat,” says Mark Hiller, chief executive of Recaro Aircraft Seating, based in Germany, one of three large seat manufacturers. But frequent fliers complained that they slid down their seats during the flight.
Now airlines are increasingly trying to fit fully flat beds for business class. But these seats require more space, which typically means losing about 10 percent of the business-class seats. British Airways, struggling with trying to fit a 73-inch bed inside the 46 inches separating two seats, came up with a design in which half its passengers sit backward, says Peter Cooke, the airline’s design manager. He calls it “the yin-yang configuration,” and it can pack 56 business seats in just seven rows aboard some Boeing 777s by fitting the broader part of passengers’ anatomy (their shoulders) with the narrowest part of their neighbors’ (their feet). “By far,” he says, “it’s the most space-efficient configuration.”
The downside, obviously, is a basic disruption in the traditional seating arrangement aboard a plane. Travelers face each other, risking awkward eye contact. Mr. Cooke says passengers have become used to this quirk — they accept it on trains — and don’t mind flying backward.
Other formations include a design known as the herringbone, which is used by Virgin Atlantic. Seats are staggered diagonally, allowing tighter spacing between the seats. But it means sleeping passengers’ feet stick out in the aisles.
The latest trend is higher-density seating, now used on Emirates, Swiss and Delta, with slightly shorter beds and narrower seats. The trick here is that when a seat unfolds into a bed, it slides under the armrest of the passenger in front.
“It’s a very demanding environment,” says James Park, a designer based in London who has worked with Singapore Airlines and Cathay Pacific. “A business-class seat has to be a working desk, an entertainment center, a dining facility, and it’s also a bed. It also needs to be comfortable in all those configurations.”
Few of these innovations have occurred on American carriers, which have been locked in a scramble for survival over the last decade. Their business model has amounted to jamming as many people as possible on planes with little money to spare on new designs.
But that is starting to change. Delta, United Airlines and American Airlines have all outlined large investments to install new business-class seats, for international flights and transcontinental legs — from New York to Los Angeles or San Francisco.
“Only a few years ago, all domestic carriers were chasing the commoditization of the business,” says Glen W. Hauenstein, Delta Air Lines’ executive vice president for network planning, revenue management and marketing. “That didn’t work. It was a spiral to the bottom.”

Delta, for instance, plans to overhaul its entire long-range fleet by next summer, rolling out a new business-class seat on international flights. The company does not have a first-class cabin, focusing instead on business and coach.
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British Airways configures its seats so that half of the passengers sit backward, to fit more seats into business class.
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Etihad Airways has made aisle access a selling point.
“We cater to corporate clients,” Mr. Hauenstein says. “That’s our sweet spot. And few have first-class policies. American corporations are cost-conscious. We’re a lot more socialistic than we think. And we don’t have a lot of oil sheiks or Russian billionaires.”
IN 2007, after reviewing the available business-class seats on the market, Lufthansa decided to design its own. It hired a design firm, PearsonLloyd, a furniture specialist based in London that had developed a first-class seat for Virgin Atlantic.
Lufthansa polled about 3,000 travelers and employees to establish a list of basic requirements for its new seat. Among them: it would have to become a fully flat bed with a minimum length of six feet; provide adequate privacy but still be open to the rest of the cabin; have ample storage space; and provide comfortable sleep. In addition, Lufthansa did not want to lose more than 10 percent of its business seats.
Lufthansa found that passengers put a lower value on having direct access to the aisle than on having a longer, flat bed. The suggestion was surprising. Many airlines like Singapore and Etihad Airways have made aisle access a big selling point — meaning passengers sitting by a window would not have to climb over someone else to get out. But for Lufthansa, bucking this industry trend meant it could fit more seats in a row — six as opposed to just four.
Over the next two years, the airline refined its sketches. It decided the seat would not need wings on the headrest, a feature common in coach to keep the passenger’s head from slipping during sleep, but deemed superfluous in business class where seats recline fully. The massage function on the seat, once viewed as a particularly tempting feature, was also dropped because it was little used. The seat height adjustment was abandoned for the same reason.
By eliminating these features, Lufthansa managed to cut down the number of electric devices that drive the seat’s movements, reducing potential for breakdowns and costly maintenance. Lufthansa also installed an air-cushion system that required less maintenance than foam, which has to be replaced every three to four years.
There were other new features: an ottoman to rest the feet, more storage, a wider screen, and a foldable table that can rotate to allow a passenger to leave a seat even if a meal tray is on it. When the seat turns into a bed, the armrest lowers, providing more sleeping space.
In 2010, halfway through the development program, Lufthansa tested the seat with passengers on a real flight. The seats were in a secret compartment on the airline’s Frankfurt-to-New York daily flight. Over two months, 1,340 passengers tried them. Their comments led to more tweaks: designers added a small separation on a common tray between each pair of seats, so that passengers’ drinks wouldn’t touch.
“All airlines are different. Their clients are different. The body types sometimes are different,” says Luke Pearson, a designer based in London who designed the seat with Lufthansa. The typical Lufthansa business-class passenger is a man in his mid-40s who travels for business every other month. Germans and Americans account for half of Lufthansa’s business passengers.
“Airlines need to know their demographics and what is their culture of travel. Lufthansa have a very good understanding of their clients,” Mr. Pearson says.
The airline says it received more than 3,500 mostly positive comments from passengers during the seat’s first months of service.
Still, while travelers prefer the new Lufthansa seat to its predecessor, the new seat has not won unanimous approval. Some frequent fliers have criticized Lufthansa’s decision not to offer direct aisle access, or the way passengers’ feet converge on the same footrest (although a partition separates them). One reviewer on the Business Traveller Web site said the V-shaped configuration was “nice if you are traveling with someone, but does make you feel a bit more duty-bound to speak to the person next to you if you are on your own, as there is no privacy screen to divide you.”
Another frequent flier offered this faint praise: “The new Lufthansa Business Class is leagues ahead of the old business class. This is due to the fact the Lufthansa had one of the poorer offerings on this class of service.”

When seats in the front of the cabin get more attention, they create a weight problem for the plane as a whole. Airlines, trying to trim weight to cut fuel costs, have sought to balance out heavier seats in the front, in part, by looking for slimmer and lighter seats in coach, ones in which the seat frame is made with high-grade aluminum or carbon composite rather than welded steel. Some connections are even made of titanium. Attention to such detail has become critical: cutting 2.2 pounds can save as much as $800 a year in fuel cost per seat, according to Mr. Hiller, the Recaro executive.
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On one of its seats destined for short-haul domestic flights, Recaro moved the magazine seat pocket away from the knee area to the upper edge of the seat above the tray, providing a couple more inches of space. Bulky foam padding on seat cushions was replaced with mesh, like modern office chairs, and the backrest is about two inches thinner. The seat weighs just 11 kilograms (24 pounds), down from 20 kilograms for previous generations. It is also “prereclined” at a 15-degree angle but cannot be adjusted.
“In our limited space,” says Carole Peytavin, vice president for research and development at Air France,“the question we need to ask is, who is willing to pay for what level of comfort?”
PASSENGERS still pick airlines based on the availability of flights and schedule, says Mr. Lange of Airbus, a former vice president for marketing there. “But the cabin product is now right behind that.”
This is especially true when it comes to business-class clients. “The business case for airlines to renew their business class,” he says, “is driven by their calculus to gain market share.”
Generally speaking, a first-class seat takes up the space of six to eight coach seats and a business-class seat takes up about four coach seats. The same is roughly true for ticket prices: first class is generally more than twice the price of business; business class is usually four times the price of coach.
Mr. Hauenstein of Delta explains that even with fewer seats in its business-class cabin, an airline can make more money. On its Boeing 747-400s, for instance, Delta went from about 65 cradlelike business seats to 48 flat bed seats. Yet while the total count dropped, Mr. Hauenstein says the switch to better seats increased the profitability of its fleet.
The reason lies in a dark science perfected by airlines years ago, known as revenue management. On any given flight, airlines generally try to maximize their profits by selling similar seats at different prices. The basic insight, which American Airlines figured out before others, was that you could make more money selling 100 seats at 100 different fares than offering every seat at the same price.
In business class, there are typically four buckets of prices, ranging from $2,000, for tickets bought far ahead of time, to $6,000 for last-minute walk-ins. If the seat experience is more pleasant, the airline can charge a premium. Delta decided it could sell more of the more expensive fares, and fewer of the less-expensive ones, since business passengers often buy tickets close to the flight date.
“The old cabin was rarely full,” Mr. Hauenstein says. “But if demand exceeds supply, that’s a good way to make money.”
There’s a saying in the airline business that seats are perishable items. If they go unsold on one flight, they cannot be sold anymore. Likewise, the seat itself has a limited life, which airlines and designers say is about seven years. After that, it looks stale. Other airlines come up with something new and exciting. Passengers expect a fresh look.
And so, by the time Lufthansa is done installing all its new seats throughout the fleet, the airline will have to look for a replacement.
“We’ve already started thinking about a new seat,” says Mr. Bosler. Maybe this one will come with a cup holder.
Via: Airlines, Business Class Travel, New Seat Design, Comfort Travel, Delta, Lufthansa, British airways, Singapore airline, Michael Kalisman, Michael Kalisman MD, michaelkalismanmd@gmail.com

Prostate Cancer–Looser Guidelines Issued on Prostate Screening

May 3rd, 2013

Looser Guidelines Issued on Prostate Screening
ness

The American Urological Association pulled back Friday from its strong support of prostate cancer screening, saying that the testing should be considered primarily by men aged 55 to 69.
The association had staunchly defended the benefits of screening men with the prostate test, even after a government advisory committee, the United States Preventive Services Task Force, said in 2011 that healthy men should not be screened because far more men would be harmed by unnecessary prostate cancer treatments than would be saved from death.
But in new guidelines issued Friday, the urology association said that routine screening is no longer recommended for men 40 to 54 years old at average risk of getting prostate cancer. Screening is also not recommended for men 70 and older.
The guidelines say screening might be beneficial for men 55 to 69, who have a greater risk of cancer, but even here they do not recommend testing. Instead, the association urges men to discuss the benefits and harms with their doctors. And if they do choose screening, an interval of two years rather than annually would be better.
“It’s time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms,’’ Dr. H. Ballentine Carter, a professor of urology and oncology at Johns Hopkins University and chairman of the committee that drafted the guidelines, said in a statement Friday.
The urology association’s previous recommendation, issued in 2009, was that blood testing for P.S.A., which stands for prostate-specific antigen, should be offered to men starting at age 40.
When the government advisory task force recommended against screening, the association expressed outrage and began a lobbying effort, urging the public to try to have the recommendation reversed. One doctor, speaking for the association, characterized the task force recommendation as “flawed, dangerous and catastrophic for men.’’
But some prostate cancer experts say the association risked losing credibility had it stuck to its recommendations for widespread screening. The new guidelines, they say, represent a sort of compromise, aimed at preserving P.S.A. screening by recommending more moderate use.
“The A.U.A. is not dismissing the P.S.A. test as the task force has done,’’ said Dr. Philip W. Kantoff, a prostate cancer specialist at the Dana-Farber Cancer Institute in Boston. “There should be a more reasonable approach to the use of P.S.A.’’ Dr. Kantoff is an oncologist, not a urologist, but was invited to serve on the panel that came up with the new guidelines.
The problem with screening is that levels of P.S.A. in the blood can be elevated for reasons having nothing to do with prostate cancer. That leads numerous men to have unnecessary biopsies, which can cause pain and infections. And biopsies find many cancers that would be so slow growing they would never harm the man. However, since it is difficult to determine the dangerous from the nonaggressive tumors, most men undergo surgery or radiation treatments and then suffer from side effects such as incontinence and erectile dysfunction.
The task force, citing the results of some clinical trials, said that P.S.A. screening saved few lives but subjects many men to unpleasant side effects.
In its guidelines on Friday, the association said that for men 55 to 69, screening would prevent one prostate cancer death for every 1,000 men screened over a decade.
The guidelines say that some men at higher-than-average risk of getting prostate cancer, such as those with a family history, could discuss the benefits and harms of starting screening at an age earlier than 55.
Some other medical societies have issued guidelines that also urge moderate use of the P.S.A. test but the urological association is influential because its members treat many of the cases of prostate cancer. The advent of P.S.A. testing led to a big jump in the number of diagnoses of prostate cancer, increasing the business of urologists.
Dr. Otis W. Brawley, the chief medical officer of the American Cancer Society, said that the new guidelines were “a wonderful thing’’ but that he was concerned that many urologists would continue regular testing anyway. He said the urology association’s new stance is now close to that of the American Cancer Society.
Dr. Brawley has been a critic particularly of mass screening campaigns, such as those held at shopping malls or fairgrounds. “There has been a lot of money made by hospitals and clinics doing these mass screenings,’’ he said.
The new urology guidelines, in that they encourage careful discussions with a man’s doctor, would seem to discourage such mass screening events, Dr. Brawley said

By ANDREW POLLACK
Published: May 3, 2013
• http://www.nytimes.com/2013/05/04/business/prostate-screening-guidelines-are-loosened.html?ref=busi

Via: Dr. Michael Kalisman, Prostate Cancer, Prostate Cancer Screening, incontinence, erectile dysfunction, PSA, Dana-Farber Cancer Institute in Boston, Urology, Oncology , Johns Hopkins University, Michael Kalisman, Michael Kalisman MD, michaelkalismanmd@gmail.com

Holocaust Survivors Pursue Benefits Owed to Them for Decades — Collecting Unpaid Insurance

March 3rd, 2012

Updated March 2, 2012, 9:51 p.m. ET

Collecting Unpaid Insurance

Holocaust Survivors Pursue Benefits Owed to Them for Decades

http://online.wsj.com/article/SB10001424052970203833004577249561911708818.html?KEYWORDS=collecting+unpaid+insurance

 

By LESLIE SCISM

Edith Stern Lowey, a Holocaust survivor, never collected on an insurance policy taken out by her family in the years before they were forced into concentration camps.

The 83-year-old Israeli, whose parents died at Auschwitz, remembers her father telling her as a child: “You have a dowry policy. You’ll get married. There is money put aside.”

Associated Press

Rep. Ilena Ros-Lehtinen (R., Fla.) is sponsoring legislation that would allow survivors to sue foreign insurers for benefits in U.S. courts.

Such policies, which parents used as savings accounts for girls, were widely sold in prewar Europe. “I didn’t see a penny of it,” she says.

Since the 1950s, there have been German and other government reparation programs, class-action lawsuits in the U.S. and international initiatives to provide restitution for all sorts of property seized by the Nazis. A 2000 agreement between the U.S. and Germany was supposed to resolve all Holocaust-era claims with European insurers through an international insurance commission.

Still, tens of thousands of people with claims have gotten nothing, survivors’ groups and advocates say. Now, with most survivors in their 80s, fresh campaigns are under way to get them their benefits before they die—or to get benefits to their heirs.

One is a push by a coalition of survivors’ groups for congressional legislation that would allow civil lawsuits to be filed in the U.S. against European insurance companies. The legislation addresses widespread criticism that the commission lacked sufficient teeth to force insurers to do thorough investigations and establish valid claims in the face of documents lost to Nazi confiscation, the ravages of war or Communist nationalizations.

Passage is hardly a sure thing: Opponents include the U.S. State Department, which says such a law could cause “significant problems in our foreign relations,” according to a statement it issued in November when hearings were held on the bill. The department declined to make additional comments.

Another fresh effort is the Project Holocaust Era Asset Restitution Taskforce, or Project Heart, which is compiling a searchable database of lists of homeowners, businesses, insurance policies and other information from various European sources. The goal: to identify seized property for which no restitution has been paid and help people get compensated.

Staking a Claim

Here are three places to get help with a Holocaust-era insurance claim.

  • Project Heart
    This effort aims to help families get compensation for property for which no restitution has been paid. It has a searchable database of houses, businesses and other property.
  • Holocaust Claims Processing Office, New York Department of Financial Services
    The state provides free help to any survivor or heir, regardless of residence, for claiming bank accounts, insurance policies or works of art.
  • Yad Vashem
    A database of more than 500,000 Holocaust-era Jewish potential policyholders that families can use to get started in their research.

(Source: WSJ research)

The project, an initiative of the Jewish Agency for Israel and partly funded by the Israeli government, has offices in Jerusalem and Milwaukee. Launched in February 2011, it already has 2.2 million records.

Resolving insurance claims has proved complicated. According to historians, Jewish families were big buyers of life insurance as well as policies that provided money for marriages, education and pensions. But by war’s end, few had proof of their ownership, because the Nazis had confiscated or destroyed so much property.

In the immediate postwar years, many survivors sought payment from insurers, but stories are legion of the companies’ rebuffing them for lack of death certificates or proper documents.

The International Commission on Holocaust Era Insurance Claims, set up in 1998, was supposed to have overcome these documentation problems by using relaxed standards of proof. It was established by U.S. state insurance regulators in cooperation with European insurers, the Israeli government and Jewish organizations.

With $550 million in funding from insurers, the commission spent several years developing a database of policyholders by combing through Nazi-era confiscation and tax records and other archives. Claims were matched against this database; the insurers also checked claims against their own records.

The quality of those records varied, and some insurers—such as RAS, a unit of Allianz AG since the 1980s—”had virtually no policy records,” the commission said in its final report in 2007. An Allianz spokeswoman says RAS records in many countries were taken by Communist authorities after they nationalized insurance companies in the postwar period.

Almost every stage of the commission’s work met with controversy, including estimating how much total insurance had been sold to Jewish families and how to value it. In the end, about 14,000 of the roughly 90,000 claimants were awarded policy proceeds, while another 34,000 were given $1,000 “humanitarian” awards. All told, claimants received $306 million. The commission forwarded another $200 million to Jewish causes.

While some commission officials and German authorities have called the process an overall success, others maintain insurers got off the hook too easily. They include Miami Rep. Ilena Ros-Lehtinen, a Republican who heads the House Foreign Affairs Committee, and others pushing for the legislation that would allow federal-court lawsuits.

The proposed legislation has about 70 sponsors. A companion Senate bill is sponsored by Florida Sens. Bill Nelson, a Democrat, and Marco Rubio, a Republican.

Jack Rubin, 83, a native of Czechoslovakia who came to the U.S. as a 17-year-old after liberation from a camp, maintains the European insurers owe billions of dollars to survivors, even as they lavish money on marketing for their U.S. operations.

One day last month, he was among fellow members of the Holocaust Survivors’ Foundation USA protesting at an Allianz-sponsored golf tournament in Boca Raton, Fla., drawing attention to the proposed congressional legislation.

An Allianz spokeswoman says the insurer can’t “undo our ugly history,” adding the company has supported various restitution efforts to meet its obligations and is continuing to accept Holocaust-era claims.

Like Ms. Lowey, Mr. Rubin remembers his father, who also died in Auschwitz, talking about insurance. Ms. Lowey and Mr. Rubin unsuccessfully sought to get policy proceeds through the Holocaust commission.

In correspondence to Congress and to the Holocaust Survivors’ Foundation, German officials have said the country’s insurers anticipated legal peace as a result of their voluntary payments into the restitution effort, and argue that new lawsuits would make it harder to persuade companies in Germany and elsewhere to enter into such agreements. Germany continues to pay for various social-welfare costs of survivors around the globe, officials say.

Write to Leslie Scism at leslie.scism@wsj.com

A version of this article appeared Mar. 3, 2012, on page B8 in some U.S. editions of The Wall Street Journal, with the headline: Collecting Unpaid Insurance

Via: http://online.wsj.com/article/SB10001424052970203833004577249561911708818.html?KEYWORDS=collecting+unpaid+insurance

End Of Life Decision-Why Doctors Die Differently

February 28th, 2012

Why Doctors Die Differently

Careers in medicine have taught them the limits of treatment and the need to plan for the end

  •  

By KEN MURRAY

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Arthur Giron

What’s unusual about doctors is not how much treatment they get compared with most Americans, but how little.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.

It’s not something that we like to talk about, but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made “arrangements,” as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients’ wishes, but when patients ask “What would you do?,” we often avoid answering. We don’t want to impose our views on the vulnerable.

The result is that more people receive futile “lifesaving” care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called “Moving Toward Peace: An Analysis of the Concept of a Good Death,” ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.

Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.

It doesn’t have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months having fun together like we hadn’t had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.

—Dr. Murray is retired clinical assistant professor of family medicine at the University of Southern California. Adapted from an article originally published on Zocalo Public Square.

 Via: http://online.wsj.com/article_email/SB10001424052970203918304577243321242833962-lMyQjAxMTAyMDIwNzEyNDcyWj.html.

Cocoa Bean and Chocolate in Brussels: The Chocolate Trail

December 25th, 2011

Brussels: The Chocolate Trail


CHOCOLATE — like fashion, wine and finance — has become a complex cultural phenomenon. There is basic chocolate for the masses, artisanal chocolate for purists and avant-garde creations for connoisseurs. In Brussels, a polyglot city at the geographic and cultural crossroads of Europe, you get it all.

The capital of Belgium may be known as the Capital of Europe, but it is also, at least as far as most chocolate aficionados are concerned, the World Capital of Chocolate. Ever since the Brussels chocolatier Jean Neuhaus invented the praline 100 years ago, the city has been at the forefront of the chocolate business. There are a million residents and some 500 chocolatiers, about one chocolatier for every 2,000 people. The average Belgian consumes over 15 pounds of chocolate each year, one of the highest rates in the world.

But these days, the industry is changing. With countries like Germany and the Netherlands becoming larger European exporters, in Belgium, a new class of chocolatiers is finding innovative ways to hold on to the country’s chocolate crown. They are breaking away from traditional pralines — which Belgians classify as any chocolate shell filled with a soft fondant center — and infusing ganaches with exotic flavors like wasabi or lemon verbena, and creating such imaginative pairings as blackcurrant and cardamom and raspberry and clove.

I had gotten a taste of Brussels’ classic-contemporary chocolate dichotomy last year on an overnight sojourn from Paris. But between the flea marketing, beer sipping and Art Nouveau strolling — other big draws of Brussels — there was little time for chocolate.

So this fall I returned, intent on exploring three centuries of chocolate history in three days. It was an ambitious task: the city is home to two of the biggest chocolate companies in the world, Godiva and Leonidas, as well as scores of boutique chocolate-makers and haute chocolatiers.

I already knew from my previous visit that Brussels is a curious mix of conservative and avant-garde — in the European quarter alone, you have the cylinder-shaped glass dome of the European Parliament’s Paul-Henri  Spaak building hovering over the neo-Classical-style Place du Luxembourg, while sgraffito-studded beacons of Art Nouveau architecture reside nearby. The city’s chocolate scene reflects that tension. The result is some wonderfully surprising creations. To streamline my sampling strategy, I turned to Robbin Zeff Warner, an American expatriate and a former professor of writing at George Washington University who has been blogging about Belgian chocolatiers since her husband’s post with NATO took them to Brussels in 2008.

“You have chocolate for tourists, and chocolate for Belgians,” Ms. Warner said of the national hierarchy in which chocolate produced by manufacturers like Côte d’Or and Guylian are devoured in vast quantities, but mostly by the city’s six million annual visitors. Bruxellois, Ms. Warner said, prefer the artisanal makers. “The big-name big houses are great. But seeing and tasting real handmade chocolate, while buying it from the person who made the chocolate, is something special.”

To prove her point, as we were leaving Wittamer, the century-old chocolatier in the center of the city that seduces both locals and tourists with its heritage recipes, Robbin suggested we go to Alex & Alex, a nearby Champagne and chocolate bar. Though its chocolates, made by Frederic Blondeel, aren’t made on-site, they’re acknowledged in some circles as some of the best in the city.

The bar is tucked away on one of the antiques store- and art gallery-filled streets that shoot off the Grand Sablon, Brussels’ central square. Its dark, cozy interior, along with the glass of Drappier rosé and array of square bonbons before me, was a lovely respite from the trolling chocolate tourists outside. I found the herbaceous notes of Blondeel’s basil ganache too reminiscent of pesto, but the “Alex’Perience” chocolates were another story. The first velvety impression of high-quality chocolate was followed by a flood of sweet, fruity cassis.

I spent the afternoon circling the Grand Sablon, which, with no fewer than eight chocolatiers, is the city’s epicenter of chocolate. I sampled golf-ball-size truffles at Godiva and molded hamster heads at Leonidas; organic nougat from Pure and minty ganaches at Passion. At Neuhaus, I tried a dark chocolate truffle filled with buttercream and with speculoos, a spicy Belgian cookie.

The more I strolled, the clearer it was that the level of sophistication is evolving. The packaging and presentation at newer chocolatiers is as slick as a Place Vendôme showroom, while the associated terminology — like “cru” and “domain” — is akin to what you’d hear from sommeliers. Such was the case at Pierre Marcolini’s two-story flagship. Smiling saleswomen stood over the glassed-in display of small, rectangular bonbons that looked as exquisite as jewels. Backlighted shelves on the opposite wall showcased what Mr. Marcolini is famous for: his single-origin Grand Cru chocolate bars.

IN 2004, Mr. Marcolini raised the bar when he started scouting the globe for the best cocoa beans. He became the only chocolatier in Brussels to work directly with plantations in countries like Venezuela and Madagascar, bringing the beans back to his ateliers for roasting and grinding.

“Most people think it’s the percentage that makes a difference,” said a saleswoman, speaking of the amount of cocoa in the confections, “but it’s the origin of the cocoa bean that does. It’s a little bit like wine.” Indeed, when I bit into the Cuban cru — Marcolini claims to be the only chocolatier in the world working with cacao from Cuba — I could detect vibrant notes of dried cherries in the slightly acidic chocolate.


December 22, 2011

Brussels: The Chocolate Trail

By AMY M. THOMAS

CHOCOLATE — like fashion, wine and finance — has become a complex cultural phenomenon. There is basic chocolate for the masses, artisanal chocolate for purists and avant-garde creations for connoisseurs. In Brussels, a polyglot city at the geographic and cultural crossroads of Europe, you get it all.

The capital of Belgium may be known as the Capital of Europe, but it is also, at least as far as most chocolate aficionados are concerned, the World Capital of Chocolate. Ever since the Brussels chocolatier Jean Neuhaus invented the praline 100 years ago, the city has been at the forefront of the chocolate business. There are a million residents and some 500 chocolatiers, about one chocolatier for every 2,000 people. The average Belgian consumes over 15 pounds of chocolate each year, one of the highest rates in the world.

But these days, the industry is changing. With countries like Germany and the Netherlands becoming larger European exporters, in Belgium, a new class of chocolatiers is finding innovative ways to hold on to the country’s chocolate crown. They are breaking away from traditional pralines — which Belgians classify as any chocolate shell filled with a soft fondant center — and infusing ganaches with exotic flavors like wasabi or lemon verbena, and creating such imaginative pairings as blackcurrant and cardamom and raspberry and clove.

I had gotten a taste of Brussels’ classic-contemporary chocolate dichotomy last year on an overnight sojourn from Paris. But between the flea marketing, beer sipping and Art Nouveau strolling — other big draws of Brussels — there was little time for chocolate.

So this fall I returned, intent on exploring three centuries of chocolate history in three days. It was an ambitious task: the city is home to two of the biggest chocolate companies in the world, Godiva and Leonidas, as well as scores of boutique chocolate-makers and haute chocolatiers.

I already knew from my previous visit that Brussels is a curious mix of conservative and avant-garde — in the European quarter alone, you have the cylinder-shaped glass dome of the European Parliament’s Paul-Henri  Spaak building hovering over the neo-Classical-style Place du Luxembourg, while sgraffito-studded beacons of Art Nouveau architecture reside nearby. The city’s chocolate scene reflects that tension. The result is some wonderfully surprising creations. To streamline my sampling strategy, I turned to Robbin Zeff Warner, an American expatriate and a former professor of writing at George Washington University who has been blogging about Belgian chocolatiers since her husband’s post with NATO took them to Brussels in 2008.

“You have chocolate for tourists, and chocolate for Belgians,” Ms. Warner said of the national hierarchy in which chocolate produced by manufacturers like Côte d’Or and Guylian are devoured in vast quantities, but mostly by the city’s six million annual visitors. Bruxellois, Ms. Warner said, prefer the artisanal makers. “The big-name big houses are great. But seeing and tasting real handmade chocolate, while buying it from the person who made the chocolate, is something special.”

To prove her point, as we were leaving Wittamer, the century-old chocolatier in the center of the city that seduces both locals and tourists with its heritage recipes, Robbin suggested we go to Alex & Alex, a nearby Champagne and chocolate bar. Though its chocolates, made by Frederic Blondeel, aren’t made on-site, they’re acknowledged in some circles as some of the best in the city.

The bar is tucked away on one of the antiques store- and art gallery-filled streets that shoot off the Grand Sablon, Brussels’ central square. Its dark, cozy interior, along with the glass of Drappier rosé and array of square bonbons before me, was a lovely respite from the trolling chocolate tourists outside. I found the herbaceous notes of Blondeel’s basil ganache too reminiscent of pesto, but the “Alex’Perience” chocolates were another story. The first velvety impression of high-quality chocolate was followed by a flood of sweet, fruity cassis.

I spent the afternoon circling the Grand Sablon, which, with no fewer than eight chocolatiers, is the city’s epicenter of chocolate. I sampled golf-ball-size truffles at Godiva and molded hamster heads at Leonidas; organic nougat from Pure and minty ganaches at Passion. At Neuhaus, I tried a dark chocolate truffle filled with buttercream and with speculoos, a spicy Belgian cookie.

The more I strolled, the clearer it was that the level of sophistication is evolving. The packaging and presentation at newer chocolatiers is as slick as a Place Vendôme showroom, while the associated terminology — like “cru” and “domain” — is akin to what you’d hear from sommeliers. Such was the case at Pierre Marcolini’s two-story flagship. Smiling saleswomen stood over the glassed-in display of small, rectangular bonbons that looked as exquisite as jewels. Backlighted shelves on the opposite wall showcased what Mr. Marcolini is famous for: his single-origin Grand Cru chocolate bars.

IN 2004, Mr. Marcolini raised the bar when he started scouting the globe for the best cocoa beans. He became the only chocolatier in Brussels to work directly with plantations in countries like Venezuela and Madagascar, bringing the beans back to his ateliers for roasting and grinding.

“Most people think it’s the percentage that makes a difference,” said a saleswoman, speaking of the amount of cocoa in the confections, “but it’s the origin of the cocoa bean that does. It’s a little bit like wine.” Indeed, when I bit into the Cuban cru — Marcolini claims to be the only chocolatier in the world working with cacao from Cuba — I could detect vibrant notes of dried cherries in the slightly acidic chocolate.

Afterward, I climbed past the Gothic Notre-Dame du Sablon church to the Place Royale. Rush-hour trams and traffic buzzed by, and the red and black roofs of “lower town” were splayed below me. Done with chocolate for the day, I was ready to experience another national specialty: art. The Royal Museums of Fine Arts offer a trove of works from Belgian and Flemish masters. The sublimely surreal flying fish, skeletal corpses and falling angels of Delvaux and Rubens and the Brueghels seemed an appropriate counterpoint to the indulgence of the day.

My museum outing the next morning was amusingly different. Before I put my change away at the entrance, I was presented with a cookie that had been run under a spigot of molten chocolate. I was inside the rickety 314-year-old Museum of Cocoa and Chocolate, just in time for the next demonstration, presided over by a bushy-browed man in a fluorescent-lighted kitchen with a vat of chocolate before him.

Europe, I learned, was introduced to cocoa beans when Spanish explorers brought them back from what is now Mexico in the late 16th century. They reached Belgium about 100 years later. When King Leopold II colonized the African Congo in 1885, largely for the cocoa crops, the resulting genocide was a dark moment in the country’s history. It is also when Belgian chocolate started earning its formidable reputation.

Outside the museum, I dodged the camera-wielding tour groups gathered before the magnificent Grand’Place, with its 15th-century Town Hall and rows of guild houses, and walked down narrow streets lined with friteries and waffle stands. Soon the cavalcade of chocolatiers continued in the Galerie de la Reine. La Belgique Gourmand, Corné and the original Neuhaus were at home under the soaring glass ceilings of this graceful fin-de-siècle shopping arcade. But as big business as those Belgian brands are, none are national gems the way Mary is.

The 92-year-old chocolatier is a favorite of the Belgian royal family, and with its rows of caramel, marzipan, chocolate mousse, ganache and cream-filled pralines, it was easy to see why. Mary makes small batches of chocolates, so they don’t have to be stored, which is when they lose their flavor. Buzzing from the caramelized hazelnut pralines the saleswoman had offered as a sample, I found myself leaving $70 lighter, but two boxes of pralines and several chocolate bars richer.

Compelled to dig deeper into the chocolate of Brussels, and the city itself, I ambled down the crooked Rue des Bouchers, avoiding eye contact with waiters trying to lure me into their cafes for buckets of mussels; past the big, blocky Bourse where workers in loosened ties ate sandwiches; into St.-Géry, where the canals once used for transporting building materials are now filled in and home to seafood restaurants. I veered left and found the big shop windows of Ste. Catherine, an area popular with artists and fashionistas.

I was on Rue Antoine Dansaert, put on the map by the radical Antwerp Six, the designers who established Belgian fashion in the 1980s. Today the neighborhood is still a bastion of cool with boutiques like Stijl, which features the likes of Ann Demeulemeester, Raf Simons and Dries Van Noten. In recent years, foreign brands have infiltrated, including our very own Marc Jacobs.

Any chic shopping district worth its salt has fantastic places to eat, and I found mine in Selecto, a bistro that opened in August. Drawn by the vintage ad posters that were splashed across the smart black and white interior, I ordered cod served atop polenta, just the sustenance I needed before heading to the lesser-known neighborhood of Ixelles.

The 30-minute walk across town felt like a tour of different cities. I passed comic murals and quirky second-hand shops in the gentrifying Marolles neighborhood. I gazed up at the medieval Porte de Hal, the last remains of the city walls. After crossing the wide, looping Boulevard de Waterloo, the landscape became hillier and the architecture uniform. I was in St.-Gilles, a bonanza of Art Nouveau.

Wrought-iron balconies, turrets, oriel windows: block after block, the residential facades were unique and homogenous at the same time. On my previous trip, I had visited the neighborhood’s crown jewel, the Horta Museum, once the home of the Art Nouveau architect Victor Horta. There was no time for a repeat visit; I was due for a class at Zaabär, a modern chocolatier nearby that is known for its use of foreign spices like cardamom from Malabar, star anise from China and chili pepper from Texas.

My workshop started with the instructor dramatically pouring a bowl of melted chocolate on a marble-topped table as the seven of us international students nearly swooned from the intoxicating aroma. He quickly worked two spatulas through the puddle, keeping it in constant motion. This process, called tempering, is when crystals form, giving chocolate, when it hardens, its sheen and snap.

When it had cooled to the proper working temperature of 32 degrees Celsius, he divided the still-liquid chocolate between two bowls, scraping the film left behind into neat lines. It was a valuable byproduct: cocoa butter, which is largely responsible for making Belgian chocolate superior as local chocolatiers refuse to supplement it with vegetable oils or shortening, as is done in some other countries.

AFTER the instruction came the fun. We dipped dollops of ganache into our chocolate and rolled them in crushed amaretto cookies, Brazil nuts and powdery meringue, creating imperfect, but tasty, truffles. We poured chocolate circles and studded them with cashews, pistachios, almonds, dried cranberries and raisins, producing delicacies known as mendiants. Soon we were on our way, with enough treats to satisfy a kindergarten class, or two.

After the class, I wandered through Ixelles, the farmers’ market on Place du Chatelain, filled with vendors peddling pork sausages, cheeses and jams. Wine had been uncorked and beer was being downed. It was 7 p.m. on a Wednesday, and the crowds of young professionals extending from the market to cafe terraces lining the square told me this was the place to be.

The festive atmosphere continued inside Moss & Bros., one of the area’s many trendy clothing and housewares boutiques. I fell into a conversation with the shopkeeper — about chocolate, naturally. She told me about her favorite chocolatier in the city, Laurent Gerbaud, and insisted I visit.

Which is how I found myself in Mr. Gerbaud’s atelier on the busy Rue Ravenstein the next morning, gazing at a spread of satiny bonbons with figs from Izmir, ginger from Guilin and hazelnuts from Piedmont. Such reliance on global ingredients is what sets apart this new generation of chocolatiers. And as they continue to push the boundaries of creativity, they’re also rewriting the history of Belgian chocolate.

“People pay attention to what they buy, and where,” is how Ryan Stevenson characterized the local chocolate culture. A London-trained Australian transplant who moved to Brussels for its chocolate reputation, he’s acutely aware of Belgians’ devotion to all things cocoa. “This is a way of life that’s really important. It’s important to me, too.” Clearly. Mr. Stevenson is the two-time national Chocolate Master for his host country.

When I visited him in his cluttered lab above St.-Aulaye, the French bakery where he’s pastry chef, Mr. Stevenson was concocting creations for the coming 2011 World Chocolate Masters competition, representing Belgium. Sketches and notes were strewn about near the bins of ingredients and racks of bonbons. Life being all about timing, I got to sample what he was creating for the competition.

The first was a yuzu-flavored ganache atop a pine nut praline. It was tart and nutty, with flavors and textures that melded beautifully beneath a dark chocolate couverture. The second — a milk chocolate caramel with lime and wild flower — was citrusy and woody, chewy and sweet. As it melted in my mouth, I could just taste the evolution of Belgian chocolate that was under way. And if Mr. Stevenson — and Gerbaud and Blondeel — have their way, revolution won’t be far behind.

IF YOU GO

CHOCOLATIERS

Prices are for a kilogram (about 2.2 pounds)

of pralines unless otherwise noted.

Alex & Alex, Rue de la Paille 32; (32-2) 476-612-345, alex-alex.eu. 57 euros, about $73 at $1.28 to the euro. Alex’Perience boxes, containing 12 pralines each, 6.30 to 8.50 euros.

Frederic Blondeel Chocolatier, Quai aux Brix 24; (32-2) 502-21-31; frederic-blondeel.com. 500 grams, 29.50 euros.

Godiva, Grand Sablon-Grote Savel 47/48; (32-2) 502-99-06; godiva.be. 57 euros.

Laurent Gerbaud Chocolatier, Rue Ravenstein 2 D; (32-2) 511-16-02; chocolatsgerbaud.be. 70 euros.

Leonidas, 41 Place du Grand Sablon; (32-2) 513-14-66; leonidas.com. 21.80 euros.

Le St.-Aulaye, Rue Jean Chapelié 4; (32-2) 345-77-85; saintaulaye.be. 85 euros.

Mary, Galerie de la Reine 36; (32-2) 511-39-59; mary.be. 62 euros.

Neuhaus, Rue Lebeau 79; (32-2) 502-38-13; neuhaus.be. 55 euros.

Passion, Grand Sablon; (32-2) 514-77-14 ; passionchocolat.be. 56 euros.

Pure, Rue de Rollebeek 48; (32-2) 502-16-34. 44 euros.

Pierre Marcolini, Rue des Minimes 1; (32-2) 514-12-06; marcolini.be. 79 euros.

Wittamer, Place du Grand Sablon 6; (32-2) 546 11 10; wittamer.com. 74 euros.

Zaabär, Chaussée de Charleroi 125; (32-2) 533-95-80; zaabar.be. Truffles, 7.50 euros for 125 grams.

MUSEUMS

Museum of Cocoa and Chocolate, Rue de la Tête d’Or 9-11; (32-2) 514-20-48; mucc.be. Admission, 5.50 euros.

HOTELS AND DINING

Hooy Kaye Lodge, Arduinkaai 22, Quai aux Pierres de Taille; (32-2) 218-44-40; hooykayelodge.com. An elegantly spare town house in downtown with three spacious rooms; rates from 95 euros, breakfast included.

Hotel Amigo, Rue de l’Amigo 1-3; (32-2) 547-47-47; hotelamigo.com. This Rocco Forte hotel, with contemporary, comfortable rooms, is right off the Grand’Place; doubles from 239 euros.

Selecto, Rue de Flandre 95-97; (32-2) 511-40-95, leselecto.com. Two-course prix-fixe, 32 euros; three-course prix fixe, 38 euros.

AMY M. THOMAS writes about food, fashion and travel. Her book, “Paris, My Sweet,” will be published by Sourcebooks in February.

 Via:http://travel.nytimes.com/2011/12/25/travel/brussels-the-chocolate-trail.html?emc=eta1

Mitt Romney – At Harvard, a Master’s in Problem Solving

December 25th, 2011

At Harvard, a Master’s in Problem Solving

http://www.nytimes.com/2011/12/25/us/politics/how-harvard-shaped-mitt-romney.html?ref=todayspaper

 


THE YOUNG COUPLE Being a married father set Mitt Romney apart in graduate school. Above, with his wife, Ann, and two sons at a business school clambake in 1973.

By JODI KANTOR
Published: December 24, 2011

 A few years after Mitt Romney graduated from Harvard Business School, he returned to share a simple, timeworn lesson in an unusual way.

The Long Run

Shaped by Business School

Articles in this series are exploring the lives and careers of the candidates for president in 2012.

OLD FRIENDS From left, Howard Serkin, Don Polak, Ronald J. Naples and Mitt Romney, part of a business school study group that still gets together for dinners every five years.

Invited to give a presentation on balancing work and family, he began by telling students that they were like multinational corporations, recalled Clayton M. Christensen, who organized the event. “You have the same question as General Electric,” said Mr. Romney, then a young father and a management consultant. “Your resources are your time and talent. How are you going to deploy them?”

He drew a chart called a growth-share matrix with little circles to represent various pursuits: work, family, church. Investing time in work delivered tangible returns like raises and profits.

“Your children don’t pay any evidence of achievement for 20 years,” Mr. Romney said. But if students failed to invest sufficient time and energy in their spouses and children, their families could become “dogs” — consultant-speak for drags on the rest of the company — sucking energy, time and happiness out of the students. The presentation was a hit: Mr. Romney had proved the value of family time based not on emotion but on yield.

That day, Mr. Romney was not only displaying his hallmark brand of almost comically analytical reasoning but also returning to the place where he first absorbed it. From 1971 to 1975, he simultaneously earned business and law degrees from Harvard.

When he arrived, he was the son of a Republican luminary — George W. Romney, who had run the American Motors Corporation before becoming governor of Michigan — who was still insecure about his own talents, according to family members, former classmates and professors. When he graduated, he was an academic star and a hot recruit, convinced he could play on a bigger field than he had previously dreamed. He had found two new homes: in Massachusetts, a state he would eventually govern, and in finance, a field he would eventually help shape.

Those years also help illuminate who Mr. Romney is now: a Republican candidate for president accused of having no core convictions, a once-moderate governor suspected of tailoring his views for political expediency. Nearly four decades ago at Harvard, Mr. Romney embraced an analytical, nonideological way of thinking, say former classmates and professors, one that both matched his own instincts and helped him succeed. On a campus rife with political and social ferment, he willfully distanced himself not only from politics, but also from larger ideological frameworks and heated debates.

Eager, driven and tremendously hardworking, he mastered the Harvard Business School method of literally looking at the world on a case-by-case basis, approaching each problem completely on its own terms and making recommendations based on data.

In the classrooms where Mr. Romney distinguished himself, there were no “right” answers — no right questions even, just a daily search for how to improve results. The Mitt Romney classmates knew then was a gifted fix-it man, attuned to the particulars of every situation he examined and eager to deliver what customers wanted.

“Mitt never struck me as an ideologue outside matters involving church and family,” said Howard Brownstein, a classmate. “He is a relativist, a pragmatist and a problem solver.”

Overprepared

On the first day of business school in fall 1972, Mr. Romney took his assigned seat in the amphitheater-like classroom, slid his name card into a slot where it would be visible to the professor and panicked.

Stewart DeBruicker, his marketing professor, had interrogated a student who gave answers so polished that the rest of the class sat stunned. “These guys are going to be so much better,” he later reminisced to his eldest son, Tagg, who shared his father’s reaction in an interview.

No matter that Mr. Romney had already attended Stanford as well as Brigham Young University as an undergraduate, and one year of Harvard Law School; no matter that his father was by then the secretary of housing and urban development serving under President Richard M. Nixon, and that everyone in the class knew the Romney name, or that the marketing genius who was called on had been warned ahead of time, as students discovered later. Growing anxious “is the way he approaches everything; he’s rarely overconfident,” said the younger Mr. Romney, who eventually earned his own Harvard M.B.A. “He doesn’t take anything for granted and overprepares.”

That was why Mr. Romney was cramming a law degree as well as a business one into four packed years at Harvard: as a kind of insurance for success, to give him more options and training, classmates said. Besides, George Romney, who never graduated from college, had insisted on the law degree. “My dad wanted H.B.S.,” Tagg Romney said, referring to the business school. “The joke is they compromised and did both.”

Initially, Mitt Romney seemed to be preparing to become his father, albeit with a fancier education — he planned to return to the Midwest and become an auto executive. He carried a hand-me-down briefcase with the initials G.W.R. around campus, telephoned his father when a law school project touched on housing policy and wrote a paper on a statute governing automobile dealerships. (“Quite good, not brilliant,” the professor, Detlev F. Vagts, rated it in an interview. “I felt his research was relatively easy.”)

One day Colin C. Blaydon, a finance professor, gazed up into the amphitheater to see a familiar face: George Romney, sitting in on his son’s classes.

Unlike George W. Bush, who was a year behind him in business school and was immortalized in the yearbook blowing a huge bubble of gum, Mr. Romney had limited interest in socializing. (The two barely met, but if Mr. Romney had known where Mr. Bush “was gonna go, I would have been on him like white on rice,” he later told The Atlantic.)

And unlike Barack Obama, who attended Harvard Law School more than a decade later, Mr. Romney was not someone who fundamentally questioned how the world worked or talked much about social or policy topics. Though the campus pulsed with emotionally charged political issues, none more urgent than the Vietnam War, Mr. Romney somehow managed to avoid them.

“Mitt’s attitude was to work very hard in mastering the materials and not to be diverted by political or social issues that were not relevant to what we were doing,” said Mark E. Mazo, a former law school study partner.

Instead, Mr. Romney threw his energy into being the best. Nearly all business school students formed study groups to help them digest the constant flow of cases, but Mr. Romney recruited a murderers’ row of some of the most distinguished students in the class. “He and I said, hey, let’s handpick some superstars,” said Howard Serkin, a classmate.

Every day for an hour, the all-male group — there were relatively few women in the program back then — sat at a semicircular table outside the classroom and briefed one another on the reading material. It was an exercise in mutual protection, since any of them could be called on in class and their performance would affect their grades. Mr. Romney served as a kind of team captain, the other members said, pushing and motivating the others.

“He wanted to make straight A’s,” Mr. Serkin said. “He wanted our study group to be No. 1.” Sometimes Mr. Romney arrived early to run his numbers a few extra times. And if his partners were not prepared, “he was not afraid of saying: ‘You’re letting us down. We want to be the best,’ ” Mr. Serkin added.

The students were experiencing the most unusual, distinguishing aspect of a Harvard Business School education: in every class, even accounting, there were no textbooks, no theories of management, just the school’s vaunted set of cases — one-page summaries of real-life corporate situations.

The case study method “doesn’t start with the theory or even principles,” said Kim B. Clark, a friend of Mr. Romney’s who later became dean of the school. “It starts with ‘All right, what is going on? What does the data tell us?’ ”

The cases did not even lay out questions. Students had to analyze the material, sometimes just a paragraph long, figure out the company’s problems and pose solutions. “The case study method is like trying to train doctors by just showing them [sick] patients, rather than by showing them textbooks to depict what a healthy patient should look like,” said Mr. Brownstein, the former classmate.

Mr. Romney was in his element. His class performances were outstanding; his peers described him as precise, convincing and charismatic. He won the high grades he craved, becoming a George F. Baker Scholar, a distinction awarded to the top students in every business class, and would graduate from the law school with honors as well.

The education “played to his natural instincts to be a problem solver, to be a person who thrived on facts and data,” Mr. Clark said. But he also had an advantage over some other students: the many hours he had spent discussing work with his father had given him insight into the life of a top executive, said Steven C. Wheelwright, a friend from back then who became a Harvard Business School professor.

Socially Apart

If Mr. Romney melded with the school intellectually, he kept some distance from it socially. He was married and a parent. In the liberal precincts of Cambridge, he and his wife, Ann Romney — pictured wearing matching sweaters at a fall 1973 business school clambake, with their two sons on their laps — seemed like they were from “out on the prairies,” Mr. Brownstein said.

The future governor abstained from things many other students were doing: drinking coffee or alcohol, swearing, smoking. (Sometimes he made little coughing noises around smokers, Mr. Brownstein remembered, politely letting them know he disapproved.) When classmates visited the Romneys’ tidy home in suburban Belmont, they felt as if they were visiting a friend’s parents, not members of their own generation, and the young couple’s closest friends came from the Mormon church.

Some who knew Mr. Romney thought his faith contributed to his success at Harvard. He was becoming a leader in the Boston church; earlier, he had spent two years as a missionary in France, acquiring salesmanship and leadership skills, according to Mr. Wheelwright, a fellow Mormon. “You’ve learned a set of principles that are very much what the Harvard Business School happens to be looking for, but also what successful business leaders are like,” he said.

The Romneys did let outsiders into their world, sometimes inviting study group members to their weekly “family home evening,” a night Mormons traditionally set aside for husbands, wives and children to spend time together. (Mr. Brownstein remembered Mrs. Romney showing him her basement: in accordance with Mormon custom, she had a year’s supply of food stored in bins and freezers.)

Mr. Romney’s relationships, even with other church members, had a pattern: he was supportive, earnest and trustworthy, said a dozen friends from those years. But he was not particularly open; confessing frustration or turmoil was just not his way.

One night Mr. Mazo, his law school classmate, watched Mr. Romney wince as he realized the jacket he was wearing had a Camp David logo on it. Mr. Mazo assumed his friend was being modest and did not want to flaunt his father’s presidential connection.

Perhaps, but what Mr. Romney did not discuss was that his father’s experience in the Nixon cabinet was bruising. The two longtime rivals loathed each other and clashed over housing policy. By the summer of 1972, Mitt Romney’s mother, Lenore Romney, even wrote a pleading letter to a top Nixon adviser about what she described as the president’s “low regard” and poor treatment of her husband.

Seeing a parent struggle in the spotlight is the classic trial of the politician’s child, but Mitt Romney said almost nothing about the situation to anyone. He put up with the occasional friendly taunts from his study group members — “If your father had gotten to be president, more doors would be open and you wouldn’t have to study so hard.”

Mr. Romney talked plenty about business, though — the role of the corporation and executives, the ways the old model he had grown up with were changing. By 1973, the economy was sinking, in part because of an oil crisis. But at the same time, businesses were using new technologies, from electronic calculators to mainframe computers, to analyze and exploit data more fully than ever before.

“He was there at this epicenter where you had a few people who realized that these changes opened up enormous opportunities,” Mr. Clark said.

Mr. Romney never seriously considered practicing law. “He wanted to make money, he wanted to solve problems,” said Mr. Serkin, his former classmate. (In Mr. Romney’s world, money is “how you keep score,” he added.)

About a year before he graduated, he attended a recruiting session for the Boston Consulting Group, a small firm in the new field of management consulting. Kenneth Woolley, a Stanford business graduate and a fellow Mormon who led the presentation, told the students that by joining his firm, they would have “the opportunity to deal with business problems at the very highest level at a very young age,” he recalled later. “When you’re 25 years old, you’re looking at problems at the C.E.O. level.” Mr. Romney was enthralled; a few months later, he had a job offer.

Today, Mr. Romney does not speak much about his business school degree. But he remains quite attached to the star study group he put together all those years ago, faithfully attending dinners the men hold every five years.

Clustered around a small table, reviewing cases with them, Mr. Romney was in his comfort zone, observed Stephen M. Waters, another member of the group, and he does not miss a chance to return to that setting. Mr. Romney even showed up the year he was put in charge of cleaning up the troubled 2002 Olympic games, stopping by for an hour before flying to Athens for a meeting of the International Olympic Committee.

“It was like a case in the old days,” Mr. Brownstein recalled. Mr. Romney analyzed it the same way, telling the graying group five things that had to be fixed and how he was going to do it.

The men gathered most recently in 2009, after Mr. Romney’s unsuccessful presidential bid. His old friends asked him about the experience, and he pointed out how much simpler decisions are in business than in politics. “You end up taking into consideration things that wouldn’t be important in a business decision,” Ronald J. Naples remembers him saying.

 Via: http://www.nytimes.com/2011/12/25/us/politics/how-harvard-shaped-mitt-romney.html?ref=todayspaper


Get Ready for a 70% Marginal Tax Rate

July 18th, 2011

Get Ready for a 70% Marginal Tax Rate

Some argue the U.S. economy can bear higher pre-Reagan tax rates. But those rates applied to a much smaller fraction of taxpayers than what we’re headed for without spending cuts.

President Obama has been using the debt-ceiling debate and bipartisan calls for deficit reduction to demand higher taxes. With unemployment stuck at 9.2% and a vigorous economic “recovery” appearing more and more elusive, his timing couldn’t be worse.


Two problems arise when marginal tax rates are raised. First, as college students learn in Econ 101, higher marginal rates cause real economic harm. The combined marginal rate from all taxes is a vital metric, since it heavily influences incentives in the economy—workers and employers, savers and investors base decisions on after-tax returns. Thus tax rates need to be kept as low as possible, on the broadest possible base, consistent with financing necessary government spending.


Second, as tax rates rise, the tax base shrinks and ultimately, as Art Laffer has long argued, tax rates can become so prohibitive that raising them further reduces revenue—not to mention damaging the economy. That is where U.S. tax rates are headed if we do not control spending soon.


The current top federal rate of 35% is scheduled to rise to 39.6% in 2013 (plus one-to-two points from the phase-out of itemized deductions for singles making above $200,000 and couples earning above $250,000). The payroll tax is 12.4% for Social Security (capped at $106,000), and 2.9% for Medicare (no income cap). While the payroll tax is theoretically split between employers and employees, the employers’ share is ultimately shifted to workers in the form of lower wages.


But there are also state income taxes that need to be kept in mind. They contribute to the burden. The top state personal rate in California, for example, is now about 10.5%. Thus the marginal tax rate paid on wages combining all these taxes is 44.1%. (This is a net figure because state income taxes paid are deducted from federal income.)


So, for a family in high-cost California taxed at the top federal rate, the expiration of the Bush tax cuts in 2013, the 0.9% increase in payroll taxes to fund ObamaCare, and the president’s proposal to eventually uncap Social Security payroll taxes would lift its combined marginal tax rate to a stunning 58.4%.


Martin Kozlowski

Boskin

Boskin

But wait, things get worse. As Milton Friedman taught decades ago, the true burden on taxpayers today is government spending; government borrowing requires future interest payments out of future taxes. To cover the Congressional Budget Office projection of Mr. Obama’s $841 billion deficit in 2016 requires a 31.7% increase in all income tax rates (and that’s assuming the Social Security income cap is removed). This raises the top rate to 52.2% and brings the total combined marginal tax rate to 68.8%. Government, in short, would take over two-thirds of any incremental earnings.


Many Democrats demand no changes to Social Security and Medicare spending. But these programs are projected to run ever-growing deficits totaling tens of trillions of dollars in coming decades, primarily from rising real benefits per beneficiary. To cover these projected deficits would require continually higher income and payroll taxes for Social Security and Medicare on all taxpayers that would drive the combined marginal tax rate on labor income to more than 70% by 2035 and 80% by 2050. And that’s before accounting for the Laffer effect, likely future interest costs, state deficits and the rising ratio of voters receiving government payments to those paying income taxes.


It would be a huge mistake to imagine that the cumulative, cascading burden of many tax rates on the same income will leave the middle class untouched. Take a teacher in California earning $60,000. A current federal rate of 25%, a 9.5% California rate, and 15.3% payroll tax yield a combined income tax rate of 45%. The income tax increases to cover the CBO’s projected federal deficit in 2016 raises that to 52%. Covering future Social Security and Medicare deficits brings the combined marginal tax rate on that middle-income taxpayer to an astounding 71%. That teacher working a summer job would keep just 29% of her wages. At the margin, virtually everyone would be working primarily for the government, reduced to a minority partner in their own labor.


Nobody—rich, middle-income or poor—can afford to have the economy so burdened. Higher tax rates are the major reason why European per-capita income, according to the Organization for Economic Cooperation and Development, is about 30% lower than in the United States—a permanent difference many times the temporary decline in the recent recession and anemic recovery.


Some argue the U.S. economy can easily bear higher pre-Reagan tax rates. They point to the 1930s-1950s, when top marginal rates were between 79% and 94%, or the Carter-era 1970s, when the top rate was about 70%. But those rates applied to a much smaller fraction of taxpayers and kicked in at much higher income levels relative to today.


There were also greater opportunities for sheltering income from the income tax. The lower marginal tax rates in the 1980s led to the best quarter-century of economic performance in American history. Large increases in tax rates are a recipe for economic stagnation, socioeconomic ossification, and the loss of American global competitiveness and leadership.


There is only one solution to this growth-destroying, confiscatory tax-rate future: Control spending growth, especially of entitlements. Meaningful tax reform—not with higher rates as Mr. Obama proposes, but with lower rates on a broader base of economic activity and people—can be an especially effective complement to spending control. But without increased spending discipline, even the best tax reforms are doomed to be undone.


Mr. Boskin is a professor of economics at Stanford University and a senior fellow at the Hoover Institution. He chaired the Council of Economic Advisers under President George H.W. Bush

 Via: http://online.wsj.com/article_email/SB10001424052702304911104576443893352153776-lMyQjAxMTAxMDEwODExNDgyWj.html#articleTabs%3Darticle















Cracking crimes with a new DNA technique by checking DNA for 1000-3000 single letter changes (polymorphisms),

March 9th, 2011
Cracking crimes with a new DNA technique



 
By Karin Kloosterman
March 03, 2011


A new invention from Israeli scientists looks deeper into DNA to show with certainty whether or not a suspect was at the scene of a crime.

 

 
By examining the unique elements that make up a person’s DNA, Israeli scientists have made it possible to provide DNA as evidence even when there are multiple sources at a crime scene.

It’s news that will have cold case murder victims smiling in heaven. Israeli scientists have found a way to identify DNA that would otherwise be inadmissible in court – when it comes from a sample of multiple people.

Although forensic DNA analysis is used in less than one percent of all criminal cases, it has helped convict suspects in some of the world’s most heinous crimes, including murder and rape.

Providing certainty without a reasonable doubt is not possible when the DNA comes from multiple sources at a crime scene. According to police officials in Israel, this happens in about one in 10 cases, meaning that important evidence for putting a criminal behind bars is lost.

But a new technique developed at the Hebrew University of Jerusalem by a professor and his student takes the uncertainty out of DNA samples, when more than one person’s DNA fingerprint is in the mix.

The results were published recently in Forensic Science International: Genetics.

While Prof. Ariel Darvasi from the Department of Genetics doesn’t focus on forensics in his day-to-day life, he decided to supervise Lev Voskoboinik’s research after hearing Voskoboinik lecture about the problem and declare that there was no solution. Voskoboinik works at the Israel Police Forensic Biology Laboratory and was looking to earn a second degree in DNA analysis.

Solving the unsolvable

“The questions and problems I like best are where people think there are no solutions. I prefer to think about the problems as solvable – that was the starting point,” says Darvasi.

“Primarily I am working in research related to human diseases, developing standards and research and have never been much into forensics,” he continues. “Forensics though was always a topic I found of interest and there are similarities due to the nature of my research.

“Lev came to my lab with the intent of doing a PhD. I suggested that he do something related to his work.”

The two went through Voskoboinik’s day on the job, and it was only after listening to Voskoboinik present his work to the lab group that the idea surfaced.

In his lecture, Voskoboinik described one of the cases that are common at a crime scene – when blood from more than one victim gets mixed together. In this case, the crime was a murder by gunshot and there were residual skin cells in the DNA sample mixed in with the blood.

Bioinformatics and computation biology

It can happen in any crime, and in one out of 10 cases, says Darvasi, the evidence becomes inadmissible. Voskoboinik said that nothing can be done about it. But he picked the right supervisor, because it was when he said that, that Darvasi came up with the plan.

“That was a year ago or so,” he says. “And we developed a strategy to solve this problem. We proved the concept and theory mathematically. Strategically, we proved that we can identify the DNA with certainty in the presence or absence of certain markers.”

While it will take more replications and validation before it can be used in the court of law, Darvasi believes that it’s just a matter of time. The invention that relies on looking at rare base pairs in DNA is now being commercialized by the university’s tech-transfer arm Yissum and “I have no doubt that it will be used in court,” the researcher states.

Expected to cost $100 to $200 per test, the new technology is a combination of bioinformatics and computation biology. The actual strategy was built on the basics of molecular biology using a lab on a chip.

It requires pinpointing the rare and unusual parts of a suspect’s DNA, rather than reading the DNA to test a mixture to see if the suspect is present or not.

A new tool for CSIs

Almost every cell in our bodies contains DNA. It is the genetic material that tells our cells how to work. Although 99.9 percent of human DNA is the same in each and every one of us, Darvasi is interested in the very minute parts of the 0.1 percent that are unique.

If all points of the rare DNA are in the suspect and the mixture as well, there is strong proof that the suspect was at the scene. To find the rare points, the team looks at all the rare variants that are spread throughout the entire genome and which are not linked one to the other.

The technique consists of investigating the DNA mixture and the suspect’s DNA for 1000-3000 single letter changes (polymorphisms), which are considered relatively rare in any population.

Current DNA fingerprinting methods look at only a few polymorphic sites to see if there is a match. Darvasi’s invention looks deeper into the sample to establish with a very high level of certainty whether or not a suspect’s DNA is in a mixture of up to 10 people.

Looking at large numbers of base pairs, the team can show beyond a reasonable doubt whether or not the suspect was in the sample. Darvasi predicts that with the right investment, the technology could be developed into a product within a year.

Via: DNA, Israel21c, Michael Kalisman

October 12th, 2010

1.   Kalisman, M., Yeschua, R., Wexler, M.R. and Newman, Z.

Treatment of Soft Tissue Injuries Caused by High Velocity Missiles.

Journal Of The Israel Medical Assocation

88:  311-315, 1975.


2.   Wexler, M.R., Kalisman, M., Yeschua, R. and Newman, Z.

The Effect of Pheonoxybenzamine, Phentolamine and 6-Hydroxydopamine

On Skin Flap Survival in Rats.

Journal of Surgical Research

19:  83-87,  1975.


3.   Abudalle, K., Romanoff, H., Stern, Z. and Kalisman, M.

Primary Tumors Of The Thoracic Trachea With Special Emphasis On

Surgical Managment.

International Surgery

61:  347-349, 1976.


4.   Kalisman, M., Yeschua, R., Wexler, M.R. and Newman, Z.

Examination of PH and 02 Tension In Tube and Pedicle Flaps As A

Method for Measuring The Blood Circulation.

The Mount Sinai Journal of Medicine

45:  68-74, 1978.


5.   Kalisman, M., Wxler, M.R., Yeschua, R. and Newman, Z

Treatment of Extensive Avulsions of Skin and Subcutaneous Tissues.

Journal of Dermatologic Surgery and Onocology

4:  322-337, l978.


6.   Kalisman, M., Wexler, M.R., Yeschua, R. and Newman, Z.

Comparison Between the Early Use of Skin Flap and Skin Graft For

The Correction of Large Tissue Loss At The Elbow.

Annals of Plastic Surgery

1:  474-477, 1978.


7.   Scheflan, M., Kalisman, M. and Strutynsky, N.

Malignant Nerve-Sheath Tumor Of The Breast In Patient With Von-

Recklinghausen’s Disease.

Breast

4:  22-25, 1978.


8.   Kalisman, M., Feitell, A. and Buchwald, R.

Pneumatosis Cystoides Interstinalis Diagnosed by Rectoscopy Biopsy

and Barium Enema.

American Journal of Proctology Gasteroenterology & Colon & Rectal

Surgery

29:  26-29, 1978.



9.   Kalisman, M.

Avulsion Injury In Patients Receiving Continuous Corticosteroid

Therapy.

Acta Chirugie Plasticae

20:  3-5, 1978.


10.  Mori, Kl, Shinya, H., Kalisman, M.

A Composit Tumor in Tubulo Villous Adenoma Of The Rectum.

Diseases Of The Colon & Rectum

21:  506-509, 1978.


11.  Kalisman, M., Debeer, R., and Pfeffer, H.

Adenocarcinoma Arising From A Lymphoma.

Clinical Oncology

5:  85-89, l979.


12.  Kalisman, M., and Beck, R.

Lipoma Of The Thumb In A Child.

Annals of Plastic Surgery

2:  165-166, 1979.


13.  Scheflan, M. and Kalisman, M.

Do-it-yourself Hand Anatomy Course.

Resident and Staff Physician

26:  44-48, 1980.


14.  Kreek, M.J., Kalisman, M., Irwin, M., Jeferry, N.F.

and Scheflan, M.

Biliary Secretion Of Methadon and Methadon Metabolites In Men.

Research Communication In Chemical Pathology And Pharmacology

29:  67, l980.


15.  Kalisman, M., Pnini, A., and Sicular, A.

Volvulus Of The Splenic Flexure – Report Of A Case And Review Of The

Literature.

International Surgery

66:  267, 1981.


16.  Kalisman, M., Berlatzki,Y. and Charuzi, I.

Primary Neuroma Of The Appendix Causing Acute Appendicitis.

American Journal Of Proctology, Gasteroenterology & Colon & Rectal

Surgery

22:  38, l981.


17.  Sharzer, L.A., Kalisman, M., Silver, C.E. and Strauch, B.

The Parasternal Paddle:  A Modification Of The Pectoralis Major

Myocutaneous Flap.

Plastic and Reconstructive Surgery

67:  733, l981.


18.  Kalisman, M. and Sharzer, L.A.

Anal Reconstruction With Gracilis Myocutaneous Flap.

Diseases Of The Colon And Rectum

24:  529, l981.



19.  Kalisman, M.

An Easy Method Of Nasal Splinting.

Plastic and Reconstructive Surgery

68:  793, 1981.


20.  Kalisman, M.

Kleppel-Feil Syndrome.

Hospital Physician

17:  137, 1981.


21.  Kalisman, M., Wolff, T.W. and Kleinert, H.E.

Post Mastectomy Brachial Plexus Compression

Breast

7(4):  29, l981.


22.  Kalisman, M.

Gouty Arthritis.

Hospital Physician

17:  47, l981.


23.  Kalisman, M

Osteo-arthritis Of The Proximal Interphalangeal Joint.

Hospital Physician

17(10):  31, l98l.


24.  Kalisman, M., Goldberg, R. and Ship, A.

Dorsal Skin and Fingernails On The Volar Aspect Of The Hand.  An

Unusual Anatomical Deformity.

Plastic and Reconstructive Surgery

69:  694-696, 1982.


25.  Kalisman, M. and Dolich, B.

Infiltrating Lipoma Of The Digital Nerves.

Journal Of Hand Surgery

7:  401-403, 1982.


26.  Kalisman, M., Laborde, K.J., Wolff, T.W.

Ulnar Nerve Compression Secondary To Ulnar Artery False Aneurysm

At The Guyon’s Canal.

Journal of Hand Surgery

7:  137, 1982.


27.  Laborde, K.J., Kalisman, M., Tsai, T.M. and Kleinert, H.E.

Results Of Surgical Treatment Of Painful Neuroma Of The Hand.

Journal of Hand Surgery

7:  190, 1982.


28.  Kalisman, M.

Hamate Fracture.

Hospital Physician

18(3):  89, 1982.


29.  Kalisman, M., Millendorf, J.B.

Hand Infections:  Part I:  Management of Superficial Infections.

Infections in Surgery

1(2):  59-66, 1982.



30. Kalisman, M., Millendorf, J.B.

Hand Infections:  Part II:  Emergencies In Hand Surgery, Deep

Infection.  Infections In Surgery

1(3):  59-69, 1982.


31. Millendorf, J.B., Kalisman, M.

Management of Mandibular Fractures.

Hospital Physician

18(12):  31-38, 1982.


32. Kalisman, M., Millendorf, J.B.

Use And Abuse Of The Tourniquet

Infections In Surgery

2:  197-204, 1983.


33. Tsai, T.M., Kalisman, M., Burns, J. and Kleinert, H.E.

Restoration Of Elbow Flexion By Pectoralis Major and Pectoralis

Minor Transplantation.

Journal of Hand Surgery

8:  186-190, 1983.


34. Atasoy, E., Kalisman, M., Godfrey, A.

The “Antenna” Procedure For the “Hook Nail” Deformity.

Journal of Hand Surgery

8:  55-58, 1983.


35. Lister, G.D., Kalisman, M. and Tsai, T.M.

Reconstruction Of The Hand With Free Microneurovascular Toe-

To-Hand Transfer:  An Experience with 54 Toe Transfers

Plastic and Reconstructive Surgery

71:  372-384, 1983.


36. Kalisman, M., Kleinert, H.E.

Fingernail On The Volar Aspect Of The Finger – An Unusual Congenital

Deformity.

Journal Of Hand Surgery

8:  58-60, 1983.


37. Kalisman, M., Chesher, S.P., Lister, G.D.

Adjustable Dynamic External Splint For Control of First Web Contrac-

ture.  Plastic and Reconstructive Surgery.

71:  266-267, 1983.


38. Kalisman, M., Millendorf, J.B.

Managing Osteomyelitic Wounds of the Lower Extremity

Infections In Surgery

2:321, 1983


39. Scheflan, M., Kalisman, M.

Complications In Breast Reconstruction

Clinics In Plastic Surgery

11:343, 1984.



40. Kalisman, M., Lachman, L.J., Millendorf, J.B.

Management of Orbital Fractures

Hospital Physician

20, 5:8 1984.


41. Kalisman, M., Millendorf, J.B., Schiffman, E.

Clinical Tetanus:  Prevention and Management of an Uncommon Disease

Infections In Surgery

3:291, 1984.


42. Kleinert, H.E., Kalisman, M., Steyers, C.

Complications in Flexor Tendon Injuries

In:  Complications In Hand Surgery.  Editor:  John A. Boswick, Jr.

W.B. Saunders Company – 1985 .


43. Kleinert, H.E., Steyers, C. Kalisman, M.

Complications From Flexor Tendon Surgery

In:  Complications In Hand Surgery. Editor: John A. Boswick, Jr.

W.B. Saunders Company – 1985.


44. Millendorf, J.B., Kalisman, M.

The Management of Mandibular Fractures

Physician Assistant

9:3:106, 1985.


45. Kalisman, M., Millendorf, J.B., Schiffman, E.

Clinical Tetanus: Prevention and Management of an Uncommon Disease

Hospital Physician

2:3:169, 1985.


46. Kalisman, M., Millendorf, J.B.

Breast Reconstruction Following Mastectomy

Hospital Physician

22:5,89-100, 1986.


47. Kalisman, M.

Computers in Plastic Surgery – Forward

Clinics in Plastic Surgery

13:3, 349-350, 1986.


48. Millendorf, J.B., Kalisman, M.

The History of Computing

Clinics in Plastic Surgery

13:3, 351-354, 1986.


49. Kalisman, M., Studin, J.R.

Basic Principles of Computer Technology

Clinics in Plastic Surgery

13:3, 355-366, 1986.


50. Studin, J.R., Kalisman, M.

Computers and Medical Office Management

Clinics in Plastic Surgery

13:3, 367-374, 1986.



51. Rothaus, K.O., Rosenthal, A.M., Kalisman, M.

Computed Tomography-Its Principles and Applications to the

Diagnosis of Facial Fractures

Clinics in Plastic Surgery

13:3, 433-440, 1986.


52. Sakwa, N., Goulian, D., Kalisman, M., Rothaus, K.O.

Computer Use in the Medical Specialties

Clinics in Plastic Surgery

13:3, 493-496, 1986.


53. Kalisman, M., Wendorff, E.R., Millendorf, J.B.

Video Conferencing and Real-Time Communication

Clinics in Plastic Surgery

13:3, 497-508, 1986.


54. Kalisman, A., Kalisman, M.

Image Processing-Principles and Its Future Applications in

Reconstructive and Aesthetic Plastic Surgery

Clinics in Plastic Surgery

13:3, 513-528, 1986.


55. Kalisman, M., Kalisman, A.

Data Storage and Retrieval

Clinics in Plastic Surgery

13:3, 529-544, 1986


56. Kalisman, M., Born,M., Millendorf, J.B.

Thermal Injury of the Upper Extremity

Hospital Physician

22:12, 19-23, 1986.


57. Kalisman, M.

Breast Reconstruction

Infection in Surgery

6:12, 1987.


58. Kalisman, M., Lachman, L.J., Millendorf, J.B.

Detection and Management of Skin Tumors  Part I. Benign Skin Tumor

Infectiions in Surgery

7:3, 1988.


59. Kalisman, M., Millendorf, J.B., Cuadros, L.C.

Detection and Management of Skin Tumors Part II.  Squamous Cell

Carcinoma

Infections in Surgery

7:4, 1988.


60. Kalisman, M., Millendorf, J.B., Orenstein, H.H.

Detection and Management of Skin Tumors Part III.  Malignant Melanoma

Infections in Surgery

7:5, 1988.


61. Kalisman, M., Orenstein, H.H., Millendorf, J.B.

Detection and Management of Skin Tumors Part IV.  Basal Cell Carcinoma

Infections in Surgery

7:6, 1988.




1.  Kalisman, M.

Gouty Arthritis.

Resident And Staff Physician

(In Press)


2.  Kalisman, M.

Capillary Hemangioma (Pyogenic Granuloma).

Resident And Staff Physician

(In Press)


3.  Kalisman, M.

Neurofibroma

Resident And Staff Physician

(In Press)


4.  Kalisman, M.

Localized Scleroderma Of The Hand

Hospital Physician

(In Press)


5.  Strauch, B., Kalisman, M.

Microsurgical Free Flaps.

International Surgery

(In Press)


6.  Kalisman, M., Leak, W.D., Winchell, S.W., Saltsitz, R.B.,

Shanahan, P., Kleinert, H.E.

Peripherial Nerve Blocks In Pediatric Patients.

(Submitted For Publication)


11. Kalisman, M.

Post Mastectomy Breast Reconstruction

Female Patients

(In Press)




PRESENTATIONS


1.  The Examination of PH and O2 In Tube and Pedicle Flap As A Method For

Measuring The Blood Circulation.

New York and Brooklyn Committee On Trauma

New York, 1977.


2.  Volvulus Of The Splenic Flexure.

New York Society Of Colon & Rectal Surgeons

New York, 1978.


3.  Discussion – Transverse Cervical Free Flap, Pectoralis Paddle

Myocutaneous Flap And Distal Latissimus Dorsi Free Flap.

Plastic Surgery Senior Resident’s Conference

Chapel Hill, North Carolina, April, 1980.


4.  The Parasternal Paddle:  A Modification Of The Pectoralis Major

Myocutaneous Flap.

The American Association Of Plastic Surgeons

Scottsdale, Arizona, May, 1980.


5.  The Pluripotential Pectoralis Parasternal Paddle.

American Society For Plastic And Reconstructive Surgery

New Orleans, Lousiana, September, 1980.


6.  Restoration Of The hand With Free Microneurovascular Toe-To-Hand

Transfer:  An Experience With 54 Toe Transfers.

The American Association Of Plastic Surgeons.

Williamsburg, Virginia, 1981.


7.  Visiting Professor Department of Plastic Surgery,  Technion – Israel  Institute of Technology (Faculty of Medicine  Rambam Hospital).

Lectures on Microsurgical Reconstruction of the Upper and Lower   Extremities.

Haifa, Israel, 1984.


8.  Panel Discussion New York Academy of Medicine, Section on Plastic and

Reconstructive Surgery Annual Resident’s Night.

New York, New York, March, 1988.


9.  Sunscreens, Their Use and Application in the Prevention of Premature

Aging of the Skin, Skin Pigmentation, and Skin Cancers.

Woodward and Lothrop.

Washington, D.C., June 1988.


10  The Pathophysiology of the Skin and the Effect of Ultraviolet

Radiation on the Skin and the Development of Premature Aging and

Skin Cancers.

Series of Lectures in Florida (Orlando, Daytona Beach, Jacksonville

and Tampa) Louisiana (New Orleans, Baton Rouge and Lafayette)

April, l989.


11. The Use of Sunscreen to Prevent Acute Burning and Long Term Skin

Damage, Question and Answer, ABC television affiliate.

Baton Rouge, Louisiana, April, 1989.


BOOKS



1.  Computers in Plastic Surgery.  Guest Editor.  Published by W.B. Saunders,    July, l986. Clinics In Plastic Surgery .