Getting to Mandalay for Orbis

Dolores, the incredibly busy Orbis travel agent, and I traded many emails to crystallize the flight to Mandalay for me and my family.

Itinerary: Reno--San Fran--Tokyo--Bangkok--Yangon--Mandalay.

Unfortunately the trip started off with a delay out of Reno.
By the time we arrived in San Francisco, our flight to Bangkok had taken off.

In San Francisco, we met with a United airline representative to re-book our flights to Mandalay.
This somewhat intellectual, actually nerdy, looking chap, confidently proclaimed that not only could he rebook our flights but that instead of having us recheck our baggage in Bangkok, he could have it checked all the way to Mandalay. The key to the success of this seemingly improbable goal was the use of some sort of “radio ID tag.” Taken in by his confidence, I stated to my wife, Shilpa, that he must be some sort of “savant” in the alternate reality of the air travel universe. Overhearing this comment and perhaps pleased that his greatness has been recognized, he glanced up from the counter with a broad smile, shook my hand vigorously and presented us with food vouchers for six hungry Dhindsa’s. Happily surprised by this gift, I took the occasion to lecture my children about the virtues of showing appreciation to strangers.

Many hours later after passing through Los Angeles, Tokyo, and Bangkok we arrived in Yangon, Myanmar! (Our suitcases, perhaps not surprisingly, did not arrive.)


When we arrived in Yangon, we saw Dr. Charlene Hsu and Dr. Jin Kim, two other members of the Orbis Volunteer Faculty team. They were having their picture taken in the airport by a tall, Middle Eastern man. For a moment, I thought that Ahmad Gomaa, the excellent and cherubic Egyptian ophthalmologist, who had been in charge of the Orbis program in Enugu, Nigeria had undergone a total makeover.

Breaking my sleep-deprived random associations, this possible male model then asked us to take his snapshot with the plane in the background… Then another set of photos—this time with the Dhindsa clan and Drs. Hsu and Kim. (At this point, I am thinking we did not get this paparazzi type treatment on our last Orbis trip in Enugu from Ahmed and Amelia). After the extended photo shoot, I asked the middle Eastern gentleman what the plan was now—pass through customs, baggage collection, get on connecting flight to Mandalay etc. ?
(I am also getting a bit nervous about all this photography in a government building—in... Myanmar.) He looks at me quizzically. I respond with my own look of confusion. Breaking the silence and dead-locked gazes, Dr. Hsu explains that this gentleman is not from Orbis , but simply a random passenger/tourist who wanted to have his photo taken, and that she and Dr. Kim then wanted their photo take with the plane in the background etc…”Okaaaay….”


Once we get through customs, we set about trying to deal with our lost luggage. Not being very facile in Burmese, we search about for an English-speaking airport official.
After a number of attempts we find someone who in halting English tells us to go wait at the “Lost Luggage” podium. Dutifully we do so. However, nobody comes to the podium for what seems to be an eternity. We try to engage airport officials passing by. They all smile politely and keep moving.

Meanwhile, my wife and I strategize:
Priority 1—Get to Mandalay by tomorrow am, as this is the official start of the program (screening day).
Priority 2—Get our luggage.

Shilpa suggests that she and the 4 kids could stay in Yangon, and hopefully catch a flight the next day to Mandalay, when the luggage arrives. I am thinking: There seems to be a dearth of English speakers (at least in the airport) and while Shilpa is fluent in Gujrati, and the kids in Latin, our Burmese vocabulary is limited to “Mingalarpar”--—“Hi.”

We will have no telephonic means of communication.-- in an unfamiliar country. As we mull together all these points, an angel appears—actually an English-speaking representative from Bangkok Air. After a bit of negotiation, she assures us that she will get our luggage to us in Mandalay. Still weighing the likelihood of this, Dr. Charlene Hsu suddenly appears with an expeditor hired by Orbis. The expeditor urgently informs us that the domestic flight to Mandalay is leaving imminently. Taking her at her word (forgetting about our luggage issues), all six of us break out into a run behind this middle aged lady expeditor, out of the international terminal, into the sweltering heat, and in to the domestic terminal, several blocks away.

In the departure lounge, we seat ourselves next to our new found friends: Drs. Hsu and Kim.

For the next 5 minutes we fan ourselves furiously prior to boarding the rather small “Mandalay Air” plane. I focus on the fact that we are now only an hour and a half away from Mandalay. Unexpectedly, about 30 minutes later the plane begins to descend. The Captain states that we are stopping in the new capital of Myanmar: "Naypyidaw." “Okaaay” …After about a 5 minute pause, the captain continues that we will let a few passengers off and take off again and head off to Mandalay."--alleviating my fear that we had boarded the wrong plane. I settle back in my seat as my mind now wanders back to the lost luggage. However, the plane remains on the tarmac for about 30 minutes, at which point the captain explains that we should be taking off in about 5 minutes-- after “technical difficulties” are solved. This "tehnical difficulty" phrase gets repeated every 5 minutes... for the next 30 minutes. It is then decided, without explanation, that the plane will be evacuated.

All the passengers are then shepherded to the terminal of the airport via a rather modern appearing (at least relative to the airplane) bus.

We are deposited in a glass encased waiting room in the terminal. We take this opportunity to get to know Dr. Hsu and Dr. Kim and some other passengers, including an American who does psychological counseling of former child soldiers in Liberia, and who is vacationing here. I am thinking her skills might come in handy any time—here as not only the kids, but the adults all seem a bit anxious. (Another example of the really unique people one meets in travel to exotic destinations). She keeps my 7 year old daughter entertained and happy by sharing roasted pumpkin seeds with her.(As I gaze at Isabelle's happy face—I ponder why we can’t all find stress relief in the ingestion of such simple morsels. Maybe that is why I am not a counselor of former child soldiers).

After about an hour, the airline officials kindly announce that we can leave our room of confinement and head off to the airport café, where they will be serving “refreshments.” The official casually notes that they are unable to repair the technical difficulties with the airplane but hopefully at some point another plane will come from Yangon to pick us up and take us to Mandalay. My wife and two little ones head through the narrow doorway toward the café’ with the child psychologist. I try to engage in conversation and even a bit of levity with Dr. Kim. But he just keeps shaking his head, muttering, “This is not good.”

Suddenly an airport shuttle bus comes up to the waiting room and starts loading up the passengers from our room. An airline spokesman, notes that the technical difficulties have been fixed. Feeling simultaneously confused and somewhat anxious in that I have no idea where my wife and little ones are, I try to exit through the door to get them. Another smiling airport official blocks my exit, gesturing me to go through the other doors to get on the bus. Unable to speak enough Burmese to explain my goals, I resort to hemi-ballistic, wild gesticulations. Out of the corner of my eye, I note that Dr. Kim and the rest of the gang are now headed off to the airplane as the shuttle pulls away.

A surge of desperation nearly propels me through the “human barrier” when my wife and kids show up at the doorway. Wipe brow. Breathe sigh of relief. Another shuttle bus comes to take us to the plane.

As we board the plane, we pass Dr. Kim, who looks up at me from his seat, shakes his head, and mutters, “This is not good.”

Fortunately, our trip to Mandalay is uneventful.

As we headed off the airplane, all six members of the Dhindsa family almost simultaneously utter one word: “Wow!”as we spotted the Orbis DC 10 flying eye hospital. It looks beautiful in its pristine white with the bold, blue logo and slogan emblazoned near the front of the aircraft: “Orbis
Saving Sight Worldwide.”

We are greeted at the airport by my old “kaibigan” (“friend” in Tagalog), Leo. Originally from the Phillipines, Leo is a scrub nurse with whom I had done thousands of cases together at the King Khaled Eye Specialist Hospital (KKESH). I had left KKESH and moved to Reno five years ago. Leo had left to work for KKESH 12 years ago to work for Orbis (which I belief is a career record for Orbis Flying Hospital staff. The intensity of the flying hospital usually can only be handled in one or two year increments). Leo was an amazingly good scrub tech back in the day in Saudi. We had a great time on the long bus ride back to the hotel catching up on our mutual acquaintances and reminiscing about the good old days at KKESH.

Once, we made it to the hotel we were greeted by Dr. Ekta Aggarwal, a most charming ophthalmologist from Chennai, and Orbis Medical Director, Dr. Hunter Cherwek. The always thinking Hunter, presciently anticipating that our luggage would be lost, bestowed upon us an extensive array of clotheing-- for all the Dhindsa’s, (his entire wardrobe?) including his famous, as I was later to learn, elastic-waisted pants). My 14 year old boy, Ryan spied a “Tiger Beer” T shirt in Hunter's wardrobe and quickly claimed it for himself.

We also had the pleasure of handing off the corneas we had brought all the way from Reno-- on ice. (Daneille had fedexed us these from the New York Orbis office the day before we left.) The kids, as Danielle had predicted, really got a kick out of our responsibility for "bringing the eyes" to Myanmar! (We were relieved to hear from the cornea specialist on the trip, Dr. Robert Pineda, that the corneas all appeared viable upon transplantation surgery).

Happy that we would not be condemned to wearing our rather “ripe” clothing much longer (Though our family is close-knit, any further sharing of body odor could lead to a rather spectacular unraveling of such ties, or so I was afraid), we relaxed in the well-appointed lobby with a hotel-provided refreshing, actually almost glowing, green lemonade drink--spiked with cayenne pepper. Savoring this unusual concoction and feeling quite content having finally hooked up with the Orbis crew, I allowed my adrenalin levels to come down-- to the strains of old Beatles standards wafting by from the local, live lobby band. Another unexpected pleasure in our first hour in Mandalay...




LEO--gets down!

TB Patients Chafe Under Lockdown in South Africa

PORT ELIZABETH, South Africa — The Jose Pearson TB Hospital here is like a prison for the sick. It is encircled by three fences topped with coils of razor wire to keep patients infected with lethal strains of tuberculosis from escaping.

But at Christmastime and again around Easter, dozens of them cut holes in the fences, slipped through electrified wires or pushed through the gates in a desperate bid to spend the holidays with their families. Patients have been tracked down and forced to return; the hospital has quadrupled the number of guards. Many patients fear they will get out of here only in a coffin.

“We’re being held here like prisoners, but we didn’t commit a crime,” Siyasanga Lukas, 20, who has been here since 2006, said before escaping last week. “I’ve seen people die and die and die. The only discharge you get from this place is to the mortuary.”

Struggling to contain a dangerous epidemic of extensively drug-resistant tuberculosis, known as XDR-TB, the South African government’s policy is to hospitalize those unlucky enough to have the disease until they are no longer infectious. Hospitals in two of the three provinces with the most cases — here in the Eastern Cape, as well as in the Western Cape — have sought court orders to compel the return of runaways.

Think Apple: It Boosts Creativity

(But all us Apple users already knew this :)


You don’t need to be a Mac owner to be a cutting-edge hipster. Turns out just thinking about Apple can make you more creative.

That’s according to researchers at Duke University and the University of Waterloo, who found that exposing people to a brand’s logo for 30 milliseconds will make them behave in ways associated with that brand. And in Apple’s case that means more creatively, Gavan Fitzsimons, one of the Duke professors who conducted the study, tells the Business Technology Blog. The study will be published in the April issue of the Journal of Consumer Research.

The Next Saffron Revolution

The Dalai Lama wants to talk peace, but the anger of his long-suffering people is only hardening.

The streets of Dharamsala, India, ordinarily a gantlet of signs for yoga schools and other New Age trekker traps, have turned into a huge open-air photo gallery of bloodied Tibetan corpses. It's a gruesome sight—awful enough, in fact, to crack the fabled composure of the Himalayan town's best-known resident, the Dalai Lama, the exiled spiritual leader of some 6 million Tibetans.

Fears and Tears

I just say hmmm....


In an exclusive interview, the Dalai Lama talks to NEWSWEEK about the violence in Tibet, his vision of the future—and how he manages to sleep in spite of his distress over the killings.
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Some images of the recent casualties have been graphic and disturbing. Have you seen them? What was your reaction? We heard you wept.
Yes, I cried once. One advantage of belonging to the Tibetan Buddhist culture is that at the intellectual level there is a lot of turmoil, a lot of anxiety and worries, but at the deeper, emotional level there is calm. Every night in my Buddhist practice I give and take. I take in Chinese suspicion. I give back trust and compassion. I take their negative feeling and give them positive feeling. I do that every day. This practice helps tremendously in keeping the emotional level stable and steady. So during the last few days, despite a lot of worries and anxiety, there is no disturbance in my sleep. [Laughs]

See-saw to power African schools

A young inventor is hoping to tap the unbounded energy of children in a playground to power schools in Africa.

Buddhist Monk Praying at Shwedagon Pagoda

Myanmar

I hope to be able to blog in a bit more detail about our trip to Myanmar, and more specifically my wonderful experience with the flying eye hospital. However, as soon as I came back to the States, I was on both general ophthalomology call and retina call. So I haven't had much time. At least my jet lag is coming in handy as those late night ER visits aren't that big of a deal!

China and Darfur

Is the Chinese Government orchestrating I.T. assaults on websites that advocate for Darfur?

The Save Darfur Coalition reported that it has been subject to sophisticated Internet attacks — attacks that apparently originated in China. And Eric Reeves, who runs a Darfur-related website, says that his site has been attacked as well, along with that of Dream for Darfur, an organization that focuses on pressuring China in the run-up to the Olympics because of its close associations with the Sudanese government.

Harvard Law, Hoping Students Will Consider Public Service, Offers Tuition Break

Concerned by the low numbers of law students choosing careers in public service, Harvard Law School plans to waive tuition for third-year students who pledge to spend five years working either for nonprofit organizations or the government.

Simmering Resentments Led to Tibetan Backlash

BEIJING — Chinese leaders have blamed “splittists” led by the exiled Dalai Lama for spurring violent protests in Tibet and orchestrating a public relations sneak attack on the Communist Party, as they gear up to play host to the Olympics Games this summer.

But to many Tibetans and their sympathizers, the weeklong uprising against Chinese rule in Lhasa reflects years of simmering resentment over Beijing’s interference in Buddhist religious rites, its tightened political control and the destruction of the environment across the Himalayan territory the Tibetans consider sacred. If there is a surprise, it may be that Beijing has managed to keep things stable for so long.

How a Blind Man Will Lead a State

Interesting comments follow the article as well...

In a few days, New York will have a new governor who also happens to be legally blind.

For people with sight, it’s hard to imagine how a person who is blind copes with day-to-day living, let alone the challenges of running a state. But over the years, in various interviews, Lt. Gov. David A. Paterson has given us glimpses into how he has managed his education and career in politics without sight.
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Mr. Paterson also shared interesting insights into how people with disabilities are treated if they appear to be coping well.

My truest disability has been my ability to overcome my physical disability. So in other words, as soon as people see that I can be independent, then they hold me to the standard that everyone else is.

Psychotherapy for All: An Experiment

The clinic is at the forefront of a program that has the potential to transform mental health treatment in the developing world. Instead of doctors, the program trains laypeople to identify and treat depression and anxiety and sends them to six community health clinics in Goa, in western India.

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

Researchers say that even in places with very poor people, the ailments require urgent attention. Severe depression can be as disabling as physical diseases like malaria, the researchers say, and can have serious economic effects. If a subsistence farmer is so depressed that he cannot get out of bed, neither he nor his children are likely to eat.

In India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

As a result, most Indians with mental illness go untreated, especially in poor and rural areas. “There is a huge treatment gap for people with depression,” said Dr. Vikram Patel of the London School of Hygiene and Tropical Medicine, the psychiatrist who began the Siolim project. “In most places in the developing world, 80 percent to 90 percent of people with severe depression don’t receive adequate treatment.”
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After completing training, he spent two years in Zimbabwe as a researcher. He hoped to prove that Western concepts of mental illness did not apply in the developing world. Instead, he came to the opposite conclusion, that the ailments were in fact just as common and just as treatable as in the West.
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ven clinicians who look for depression may miss it. For reasons that no one fully understands, depressed patients in the developing world often complain of physical symptoms like fatigue, headache and insomnia rather than emotional problems like sadness or regret.

Passion and Attention to Detail

"Passion and Attention to Detail"--Two qualities you can't teach as per Orbis medical director, Hunter Cherwek; yet, abundant in evidence in working with the Flying Eye Hospital crew this past week.
Wonderful people in their professionalism, work-ethic, skills, and enthusiasm.
Hunter is a great leader of a great team.
I am again very impressed by the Orbis organization--the best international ophthalmology NGO, by a long shot, with which
I have been privileged to work.

Time out of mind

But the quest to spend time the way we do money is doomed to failure, because the time we experience bears little relation to time as read on a clock. The brain creates its own time, and it is this inner time, not clock time, that guides our actions. In the space of an hour, we can accomplish a great deal — or very little.
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The brain’s inclination to distort time is one reason we so often feel we have too little of it. One in three Americans feels rushed all the time, according to one survey. Even the cleverest use of time-management techniques is powerless to augment the sum of minutes in our life (some 52 million, optimistically assuming a life expectancy of 100 years), so we squeeze as much as we can into each one.

Believing time is money to lose, we perceive our shortage of time as stressful. Thus, our fight-or-flight instinct is engaged, and the regions of the brain we use to calmly and sensibly plan our time get switched off. We become fidgety, erratic and rash.
(..)
The remedy is to liberate ourselves from Franklin’s equation. Time is not money but “the element in which we exist,” as Joyce Carol Oates put it more than two decades ago (in a relatively leisurely era). “We are either borne along by it or drowned in it.”

In Mandalay!

We made it into Mandalay last night and I was greeted at the Mandalay airport my good friend, Leo Mercado, who I had not seen in the past 8 years. Leo was one of the best scrub tech I ever worked with while I was in Saudi Arabia. We did thousands of cases together. It was so great to see him again. We reminisced about all the great memories we have of KKESH. The other neat thing about the airport was that we could see the Orbis DC 10 on the tarmac--magnificent site!

We drove back to the Mandalay Hill Resort, where we were greeted with green lemonade with cayenne drinks in the lobby and by Hunter--medical director for Orbis. It was great to see him--a veritable waterfall of energy and enthusiasm. He and and many of the Orbis crew waited for our delayed plane and missed climbing up the hill behind the hotel to see the sunset. Very kind indeed. Even kinder, he brought down half his clothes to share with me and my 3 boys as our luggage had been lost. (Ryan, my 14 year old, was proudly sporting Hunter's "Tiger Beer" Tshirt today!)

We had a sumptuous breakfast at the hotel, a 7am meeting, and then at 8 am we started our day at the clinic. I saw about 40 patients--many patients with advanced diabetic retinopathy. The trainees are quite motivated and bright--it was a pleasure working with them. It was also nice meeting the other members of the Orbis crew and the other volunteer faculty. This is a much bigger crew than when we were in Enugu on my last orbis trip, due to the presence of the airplane. The crew comes from all over the world. Both the crew and the Burmese are striking in their kindness. It has been a great first day!

Tonight we have dinner with our hosts and tomorrow it is off to the plane to do some surgery!

Soaring Food Prices Putting U.S. Emergency Aid in Peril

The U.S. government's humanitarian relief agency will significantly scale back emergency food aid to some of the world's poorest countries this year because of soaring global food prices, and the U.S. Agency for International Development is drafting plans to reduce the number of recipient nations, the amount of food provided to them, or both, officials at the agency said.

USAID officials said that a 41 percent surge in prices for wheat, corn, rice and other cereals over the past six months has generated a $120 million budget shortfall that will force the agency to reduce emergency operations. That deficit is projected to rise to $200 million by year's end. Prices have skyrocketed as more grains go to biofuel production or are consumed by such fast-emerging markets as China and India

IN bANGKOK

Well, after numerous delays due to West Coast Fog, we finally left LA at 9pm. We were supposed to leave at 12:30pm from San Fran. 12 hour flight to Osaka was great in an Airbus 340. Individual DVD players/gaming systems per seat were great for the kids. As a bonus of the delay we got to fly Thai airways instead of United as previously scheduled. We have always loved all the Thai carriers. In Osaka, we refueled and then another 6 hours to Bangkok--can't believe how modernized the airport has become! Okay, two more flights to go...Bangkok to Yangon and then Yangon to Mandalay. But for now a few hours of R and R and surfing. (BTW read some great articles in the Feb 14 issue of the New York Review of Books--highly recommended!)

The start of the journey

Sent from my iPhone

Going back to Burma, to Burma, to B....

It's been about a decade since we have been in Burma. Blogging might be light for awhile unless I can get a decent internet connection there....

Blind Irishman sees with the aid of son's tooth in his eye

DUBLIN (AFP) - An Irishman blinded by an explosion two years ago has had his sight restored after doctors inserted his son's tooth in his eye, he said on Wednesday. ADVERTISEMENT Bob McNichol, 57, from County Mayo in the west of the country, lost his sight in a freak accident when red-hot liquid aluminium exploded at a re-cycling business in November 2005.
(Hat to tip to freeze who has a fascinating photo up on his blog btw)

Yemen’s Marginalized Class

Why does this kind of discrimination exist everywhere in the world--even in the poorest countries of the world? Why do we dehumanize those who are different than us, and consequently treat them as sub-humans? Yesterday,I was listening to a podcast interview with a Jewish lady whose son was killed by a Palestinian sniper and a Palestinian whose brother was killed by an Israeli lady. They are part of a group that is trying to bring reconciliation to the Palestinan/Israeli conflict through a non-governmental initiative. There was a statement made in that podcast worth remembering:
"We have to use our pain to help heal humanity."


SANA, Yemen — By day, they sweep the streets of the Old City, ragged, dark-skinned men in orange jump suits. By night, they retreat to fetid slums on the edge of town.

They are known as “Al Akhdam” — the servants. Set apart by their African features, they form a kind of hereditary caste at the very bottom of Yemen’s social ladder.

Degrading myths pursue them: they eat their own dead, and their women are all prostitutes. Worst of all, they are reviled as outsiders in their own country, descendants of an Ethiopian army that is said to have crossed the Red Sea to oppress Yemen before the arrival of Islam.
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In one Akhdam shantytown on the edge of Sana, more than 7,000 people live crammed into a stinking warren of low concrete blocks next to a mountain of trash. Young children, many of them barefoot, run through narrow, muddy lanes full of human waste and garbage.

A young woman named Nouria Abdullah stood outside the tiny cubicle — perhaps 6 feet by 8 feet, with a ceiling too low to allow her to stand up — where she lives with her husband and six children. Inside, a thin plastic sheet covered a dirt floor. A small plastic mirror hung on the wall, and a single filthy pillow lay in the corner.

Nearby, a single latrine, in a room approximately 3 feet by 3 feet, serves about 50 people. The residents must carry water in plastic jugs from a tank on the edge of the slum, supplied by a charity group.

Wearing a brown dress, with a rag tied around her head, Ms. Abdullah said she and her family brought in no more than 1,000 Yemeni riyals a week, about $5. She begs for change, while her husband, Muhammad, gathers metal and electrical components from trash heaps and sells them.

The Little Girl by the Sea Found the Angel in Me

Lion Kisses Rescuer

Orphans of Rwanda

I didn't until just now learn that one of my favorite charities, "Orphans of Rwanda," was featured in the New York Times on my birthday!
Here is a great write-up of this organization...

Ange Benitha Bamuyugire is not your typical orphan in Rwanda. Orphans in Rwanda are generally living at or beyond the brink of desperate poverty. Ange, however, is a terrific student who’s studying computer science at the country’s finest technical institution, the Kigali Institute of Science and Technology. She’ll be starting an internship soon at a Rwandan company that develops websites. But there’s more to her story.

She survived the 1994 genocide. She saw her father brutally slain by a band of killers wielding machetes. Although she survived with her mother and sister, she lost her entire extended family: grandparents, aunts, uncles and cousins.

In spite of its history and staggeringly high proportion of orphans – approximately 1 out of every 6 children – Rwanda is not exceptional. In fact, sub-Saharan Africa has more orphans than any other region in the world today. The United Nations estimates that of the 43 million orphans in sub-Saharan Africa, about 14 million are AIDS orphans, a number that is expected to rise to 20 million by 2010.

So the question is: does the world really care enough to help these orphans (or non-orphans, for that matter) beyond the age 18?

PlayPump Water Systems

This is a FANTASTIC idea!!

Princeton Plans for an Early Year Abroad

This sounds like a great idea to me...

Seizing on students’ desire for a year off before college, Princeton University is working to create a program to send a tenth or more of its newly admitted students to a year of social service work in a foreign country before they set foot on campus as freshmen.

A Rip-Off by Health Insurers?

When patients visit an out-of-network doctor, insurers typically agree to pay 80 percent of the reasonable and customary rate charged by doctors in the same geographic area. The patient is stuck with the rest, and as any patient knows, that rate always seems to fall short of what their own doctor is charging. If the attorney general’s investigators are right, we can understand why.

The numbers are mainly compiled by an obscure company known as Ingenix, which — as it turns out — is owned by UnitedHealth Group, one of the nation’s largest health insurers. Ingenix collects billing information from UnitedHealth and other health care payers to compile a database that is then used by the insurers to determine out-of-network reimbursement rates.

This system is an invitation for abuse. UnitedHealth owns the company whose database will affect its costs and profitability, so both have a strong financial interest in keeping reimbursement rates low. Even Ingenix seems unwilling to stand behind its numbers. In licensing its database to insurers, it stresses that the data is “for informational purposes only” and does not imply anything about “reasonable and customary” charges. Yet that is precisely what the health insurers use the data for, as Ingenix knows, according to investigators.
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The attorney general’s investigators did their own survey and concluded that $200 is the fair market rate in New York City and Nassau County for a 15-minute consultation with a doctor for an illness of low to moderate severity. Ingenix, the investigators said, calculated the rate as $77, of which United would pay $62, leaving the patient to pay $138.

My Saudi Valentine

TOMORROW will be my second Valentine’s Day in the United States. As I’ve discovered, the celebration here bears little resemblance to the one I know from growing up in Saudi Arabia.
Yes, there are dates. But in Saudi Arabia, we eat them. As for the other kind of dating — the kind that will fill restaurants here tomorrow night — don’t count on it.

Can Sugar Substitutes Make You Fat?

In a series of experiments, scientists at Purdue University compared weight gain and eating habits in rats whose diets were supplemented with sweetened food containing either zero-calorie saccharin or sugar. The report, published in Behavioral Neuroscience, presents some counterintuitive findings:

Animals fed with artificially sweetened yogurt over a two-week period consumed more calories and gained more weight — mostly in the form of fat — than animals eating yogurt flavored with glucose, a natural, high-calorie sweetener. It's a continuation of work the Purdue group began in 2004, when they reported that animals consuming saccharin-sweetened liquids and snacks tended to eat more than animals fed high-calorie, sweetened foods. The new study, say the scientists, offers stronger evidence that how we eat may depend on automatic, conditioned responses to food that are beyond our control.

College a waste of time and money for kids

And from the School of Unconventional Wisdom...

Last week I made an off-the-cuff comment in my column that stirred up several e-mails asking if I was serious. What I said was that I had no intention of sending my kids to college. I was dead serious. I find the thought of college abhorrent, particularly for 18- to 20-year-olds. Kids have a lot of energy at that point, and to deaden it with a forced, unsupervised diversity of random topics taught by mostly mediocre professors is a waste of that energy.

ne reader asked what her kid should be doing instead of college. Here are some of my responses: (READ ON)

You Remind Me of Me

Artful persuasion depends on eye contact, but not just any kind. If one person prefers brief glances and the other is busy staring deeply, then it may not matter how good the jokes are or how much they both loved “Juno.” Rhythm counts.
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They have found that immediate social bonding between strangers is highly dependent on mimicry, a synchronized and usually unconscious give and take of words and gestures that creates a current of good will between two people.

Kenya’s War of Words

WHEN you find yourself at a wedding discussing how more than 800 people have been killed and more than 250,000 kicked out of their homes for having certain ethnic origins, you know there is something terribly wrong with your country. Living in Nairobi the past few months has been like living in a relatively comfortable glass cave in the middle of hell.

Diabetes Study Partially Halted After Deaths

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

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The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

Symptoms: Metabolic Syndrome Is Tied to Diet Soda

Researchers have found a correlation between drinking diet soda and metabolic syndrome — the collection of risk factors for cardiovascular disease and diabetes that include abdominal obesity, high cholesterol and blood glucose levels — and elevated blood pressure.
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the risk of developing metabolic syndrome was 34 percent higher among those who drank one can of diet soda a day compared with those who drank none.

Jackson Pollack

Feeling artistic?

New Food Formula: Tastes Fine, Kills Worms

Kraft Foods, the conglomerate built on macaroni and cheese, is working on a new and unusual product line — food that is not only tasty, but kills intestinal worms.

It is not intended for sale in the United States, but is aimed at rural Asia, Africa and Latin America, where worms leave millions of children lethargic, dangerously anemic and, sometimes, passing blood.

Bring Bri Back

~ Official Brianna Information Site ~

Brianna Zunino Denison
Brianna's website is dedicated to her safe return!

Abducted January 20, 2008 in Reno Nevada
If you have any information please call now!

Reno Police Department Tip Line: 775-745-3521
Secret Witness Line: 775-322-4900

Clouds over Reno

This picture depicts the mood over Reno as we continue to search for Brianna Denison...


For more on Brianna, check out the Reno Gazette Journal updates here

Nets and New Drug Make Inroads Against Malaria

Widespread distribution of mosquito nets and a new medicine sharply reduced malaria deaths in several African countries, World Health Organization researchers reported Thursday.

The report was one of the most hopeful signs in the long battle against a disease that is estimated to kill a million children a year in poor tropical countries.

“We saw a very drastic impact,” said Dr. Arata Kochi, chief of malaria for the W.H.O. “If this is done everywhere, we can reduce the disease burden 80 to 85 percent in most African countries within five years.”

The Darfur Contagion Spreads

I just had an email from Chad that the U.N. is today evacuating Guereda, a major town in eastern Chad that has been a base for helping Darfuri refugees. Frankly, this will mean that more Darfuri refugees will die, but the U.N. has to protect its own people as well. It’s an agonizing position for aid organizations to face when their own staff are attacked.

One of the most frustrating parts of the international failure in Darfur is that we’ve allowed the slaughter to spread from Sudan to Chad and Central African Republic. We may not be able to send troops easily into Sudan itself, but we can certainly do so in Chad (and France, under Nicolas Sarkozy, is finally preparing to do that). In the meantime, the slaughter is continuing in towns like Guereda, which used to be completely stable.

Rethinking the Meat-Guzzler

Grain, meat and even energy are roped together in a way that could have dire results. More meat means a corresponding increase in demand for feed, especially corn and soy, which some experts say will contribute to higher prices.

This will be inconvenient for citizens of wealthier nations, but it could have tragic consequences for those of poorer ones, especially if higher prices for feed divert production away from food crops. The demand for ethanol is already pushing up prices, and explains, in part, the 40 percent rise last year in the food price index calculated by the United Nations’ Food and Agricultural Organization.

Though some 800 million people on the planet now suffer from hunger or malnutrition, the majority of corn and soy grown in the world feeds cattle, pigs and chickens. This despite the inherent inefficiencies: about two to five times more grain is required to produce the same amount of calories through livestock as through direct grain consumption, according to Rosamond Naylor, an associate professor of economics at Stanford University. It is as much as 10 times more in the case of grain-fed beef in the United States.

The environmental impact of growing so much grain for animal feed is profound. Agriculture in the United States — much of which now serves the demand for meat — contributes to nearly three-quarters of all water-quality problems in the nation’s rivers and streams, according to the Environmental Protection Agency.

Because the stomachs of cattle are meant to digest grass, not grain, cattle raised industrially thrive only in the sense that they gain weight quickly. This diet made it possible to remove cattle from their natural environment and encourage the efficiency of mass confinement and slaughter. But it causes enough health problems that administration of antibiotics is routine, so much so that it can result in antibiotic-resistant bacteria that threaten the usefulness of medicines that treat people.

Great Drug, but Does It Prolong Life?

Some patients do receive significant benefits from statins, like Lipitor (from Pfizer), Crestor (AstraZeneca) and Pravachol (Bristol-Myers Squibb). In studies of middle-aged men with cardiovascular disease, statin users were less likely to die than those who were given a placebo.

But many statin users don’t have established heart disease; they simply have high cholesterol. For healthy men, for women with or without heart disease and for people over 70, there is little evidence, if any, that taking a statin will make a meaningful difference in how long they live.

(..)

How is this possible, if statins lower the risk of heart attack? Because preventing a heart attack is not the same thing as saving a life. In many statin studies that show lower heart attack risk, the same number of patients end up dying, whether they are taking statins or not.

Hitting It Off, Thanks to Algorithms of Love

Once upon a time, finding a mate was considered too important to be entrusted to people under the influence of raging hormones. Their parents, sometimes assisted by astrologers and matchmakers, supervised courtship until customs changed in the West because of what was called the Romeo and Juliet revolution. Grown-ups, leave the kids alone.

But now some social scientists have rediscovered the appeal of adult supervision — provided the adults have doctorates and vast caches of psychometric data. Online matchmaking has become a boom industry as rival scientists test their algorithms for finding love.

Work Out and Drink Up

If you want to live a long and healthy life, you're probably trying to eat right, exercise regularly and get enough sleep. Good steps. Now how about adding a little alcohol to your regimen?
(..)
"You shouldn't even think about doing it until age 45 or 50. There's absolutely no proof of a preventative and protective effect before age 45."

Cell Phone Can Read Documents for Blind

The Nokia cell phone is loaded with software that turns text on photographed documents into speech. In addition to telling whether a bill is worth $1, $5, $10 or $20, it also allows users to read anything that is photographed, whether it's a restaurant menu, a phone book or a fax. While the technology is not new, the NFB and the software's developer say the cell phone is the first to incorporate the text-to-speech ability.

Agustin Barrios: La Catedral, III. Allegro solemne

Incredible Precision!

Think Your Job is Tough?

Think your job is tough?

Mapping the Most Complex Structure in the Universe: Your Brain

By mapping every synapse in the brain, researchers hope to create a "connectome" -- a diagram that would elucidate the brain's activity at a level of detail far outstripping today's most advanced brain-monitoring tools like fMRI.

"You're going to see things you didn't expect," said Jeff Lichtman, a Harvard professor of molecular and cellular biology. "It gives us an opportunity to witness this vast complicated universe that has been largely inaccessible until now."

The effort is part of a new field of scientific research called connectomics. The field is so new that the first course ever taught on it recently ended at MIT. It is to neuroscience what genomics is to genetics.

Wealth of Ideas: Bill Gates Issues Call for a Benevolent Capitalism

Davos Speech Sets a Plan to Use Market Forces
To Help Poor Countries; 'We Have to Find a Way'

Mr. Gates isn't abandoning his belief in capitalism as the best economic system. But in an interview with the Journal last week at his Microsoft office in Redmond, Washington, Mr. Gates said he has grown impatient with the shortcomings of capitalism. He said he has seen those failings first-hand on trips for Microsoft to places like the South African slum of Soweto, and discussed them with dozens of experts on disease and poverty. He has voraciously read about those failings in books that propose new approaches to narrowing the gap between rich and poor.

In particular, he said, he is troubled that advances in technology, health care and education tend to help the rich and bypass the poor. "The rate of improvement for the third that is better off is pretty rapid," he said. "The part that's unsatisfactory is for the bottom third -- two billion of six billion."
(..)

With Thursday's speech, Mr. Gates adds his high-profile name to the ranks of those who argue that unfettered capitalism can't solve broad social problems. Muhammad Yunus, the Bangladeshi economist who won the 2006 Nobel Peace Prize for his work providing small loans to the poor, is traversing the U.S. this month promoting a new book that calls capitalism "half developed" because it focuses only on the profit-oriented side of human nature, not on the satisfaction derived from helping others.

Key to Mr. Gates's plan will be for businesses to dedicate their top people to poor issues -- an approach he feels is more powerful than traditional corporate donations and volunteer work. Governments should set policies and disburse funds to create financial incentives for businesses to improve the lives of the poor, he said Thursday. "If we can spend the early decades of the 21st century finding approaches that meet the needs of the poor in ways that generate profits for business, we will have found a sustainable way to reduce poverty in the world," Mr. Gates said.

In the interview, Mr. Gates was emphatic that he isn't calling for a fundamental change in how capitalism works. He cited Adam Smith, whose treatise, "The Wealth of Nations," lays out the rationale for the self-interest that drives capitalism and companies like Microsoft. That shouldn't change, "one iota," Mr. Gates said.

But there is more to Adam Smith, he added. "This was written before 'Wealth of Nations,' " Mr. Gates said, flipping through a copy of Adam Smith's 1759 book, "The Theory of Moral Sentiments." It argues that humans gain pleasure from taking an interest in the "fortunes of others." Mr. Gates quoted from that book in his speech.
(..)
To a degree, Mr. Gates's speech is an answer to critics of rich-country efforts to help the poor. One perennial critic is Mr. Easterly, the New York University professor, whose 2006 book, "The White Man's Burden," found little evidence of benefit from the $2.3 trillion given in foreign aid over the past five decades.

Mr. Gates said he hated the book. His feelings surfaced in January 2007 during a Davos panel discussion with Mr. Easterly, Liberian President Ellen Johnson Sirleaf and then-World Bank chief Paul Wolfowitz. To a packed room of Davos attendees, Mr. Easterly noted that all the aid given to Africa over the years has failed to stimulate economic growth on the continent. Mr. Gates, his voice rising, snapped back that there are measures of success other than economic growth -- such as rising literacy rates or lives saved through smallpox vaccines. "I don't promise that when a kid lives it will cause a GNP increase," he said. "I think life has value."

Brushing off Mr. Gates's comments, Mr. Easterly responds, "The vested interests in aid are so powerful they resist change and they ignore criticism. It is so good to try to help the poor but there is this feeling that [philanthropists] should be immune from criticism."

The 247 lb. Vegan

NFL star Tony Gonzalez is out to answer a question: Can a football player live entirely on plants?

Congo Deaths Remain High

DAKAR, Senegal — Five years after Congo’s catastrophic war officially ended, the rate at which people are dying in the country remains virtually unchanged, according to a new survey, despite the efforts of the world’s largest peacekeeping force, billions of dollars in international aid and a historic election that revived democracy after decades of violence and despotism.

The survey, released Tuesday, estimated that 45,000 people continue to die every month, about the same pace as in 2004, when the international push to rebuild the country had scarcely begun. Almost all the deaths come from hunger and disease, signs that the country is still grappling with the aftermath of a war that gutted its infrastructure, forced millions to flee and flattened its economy.

African Superbugs to the Rescue!

"Brother, can you spare a malaria pill?"
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And while we worry about what might happen to the ecosystem if we release a mosquito with a small change in its genes, millions of people roll in their beds (or on mats on the floor), fevered and ill. We shouldn't release modified mosquitoes before they are ready. But when they are ready and the inevitable invocation of the precautionary principle comes, we should try to weigh the caution we are used to being able to afford against the real suffering of real people whose lives are so different from our own that it is difficult to comprehend.

A New, Global Oil Quandary: Costly Fuel Means Costly Calories

This is the other oil shock. From India to Indiana, shortages and soaring prices for palm oil, soybean oil and many other types of vegetable oils are the latest, most striking example of a developing global problem: costly food.
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The food price index of the Food and Agriculture Organization of the United Nations, based on export prices for 60 internationally traded foodstuffs, climbed 37 percent last year. That was on top of a 14 percent increase in 2006, and the trend has accelerated this winter.

In some poor countries, desperation is taking hold. Just in the last week, protests have erupted in Pakistan over wheat shortages, and in Indonesia over soybean shortages. Egypt has banned rice exports to keep food at home, and China has put price controls on cooking oil, grain, meat, milk and eggs.

According to the F.A.O., food riots have erupted in recent months in Guinea, Mauritania, Mexico, Morocco, Senegal, Uzbekistan and Yemen.

“The urban poor, the rural landless and small and marginal farmers stand to lose,” said He Changchui, the agency’s chief representative for Asia and the Pacific

Antidepressant Studies Unpublished

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.

New Questions on Treating Cholesterol

For decades, the theory that lowering cholesterol is always beneficial has been a core principle of cardiology. It has been accepted by doctors and used by drug makers to win quick approval for new medicines to reduce cholesterol.

But now some prominent cardiologists say the results of two recent clinical trials have raised serious questions about that theory...

For patients and drug companies, the stakes are enormous. Led by best sellers like Lipitor from Pfizer, cholesterol-lowering medicines, taken by tens of millions of patients daily, are the largest drug category worldwide, with annual sales of $40 billion.

Despite widespread use of the drugs, though, heart disease remains the biggest killer in the United States and other industrialized nations, and many people still have cholesterol levels far higher than doctors recommend.

(..)

Because the link between excessive LDL cholesterol and cardiovascular disease has been so widely accepted, the Food and Drug Administration generally has not required drug companies to prove that cholesterol medicines actually reduce heart attacks before approval.

The Single Best Way to Lose Weight

Keep a food diary. Studies show that a journal doesn't just aid weight loss — it turbo-charges it. When researchers from Kaiser Permanente Center for Health Research followed more than 2,000 dieters who were encouraged to record meals and snacks, they found that the single best predictor of whether a participant would drop weight was whether the person kept a food diary.

Guest Post: “We Got Out of Kenya, But What About the People Who Live There?”

From the "How to Change the World Blog:
An account of an American Humanitarian who was in in Kenya when post-election rioting broke out.
At the bottom of the post she provides highlights of some of her Kenyan friends--and in doing so pointing out the important fact that, similar to my experiences in Africa, there are many, many citizens dedicated to improving the lot of their countrymen, often at significant financial loss and (esp. now in Kenya) risk...

But that’s just our story. It matters less than the stories of countless people who now must reshape their lives to the devastating changes they face in Kenya today.

Allow me to provide some examples.

First, there’s Carol, a willowy, confident young woman who serves as an interpreter for her extended family, many whom have been afflicted by congenital blindness and deafness. She uses a sign language that has evolved over generations, and with it she helps her siblings run a home-based knitting business that produces sweaters, hats, and other clothing items for babies and children. Carol planned to enter university in Nairobi this spring with the dream of studying special education. Her family’s sustenance, and her educational options will be affected by Kenya’s sudden plummet from stability, and these developments weigh heavily on her mind.

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In a crisis like this, in a country like Kenya, any small token of support can work wonders. Even if you don’t support Kenya with your wallet, support it in your heart. Think of the highly-educated, industrious people of Kenya, half of whom are twenty years of age or younger, and of the hopes, security, and actual prospects that they have lost in the last two weeks. Imagine yourself, or your child, in a similar situation, and ask yourself what you would do. And what you would want others to do to help you through this time.

Whether you send a prayer or a wish or an even more tangible form of support, put yourself in their shoes. Use the freedom that you have—so similar to that which the people of Kenya truly believed was theirs—to wish the people of Kenya the safety and strength to survive what is likely to be a very hard times ahead.
Ellen Petry Leanse
Menlo Park, California

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Here is another excellent article on the current state affairs in Keyna:




Kenya isn't Rwanda

Experiments in malaria prevention

A link from the excellent PSD Blog on the economics of malaria bed net pricing....


Does raising the price of long lasting anti-malarial insecticide-treated nets (ITNs) from $0 to a $0.75 kill the demand? At least in theory, cost sharing can help reduce wastefulness and save money without serious adverse effects of healthcare of most people.

Based on a field experiment in Kenya, a new paper explores the effects that cost sharing of the price of ITNs charged to pregnant women had on infant mortality.

Only in Zimbabwe: 10 - Million - Dollar Bill

HARARE, Zimbabwe (AP) -- Zimbabweans will be soon lining their pockets with 10-million-dollar bills.

The central bank annouced Thursday it would increase the denomination of the nation's highest bank note more than tenfold to keep pace with the world's highest inflation rate, officially estimated at 25,000 percent annually. Independent financial institutions say real inflation is closer to 150,000 percent.

The new 10-million note is the equivalent of about $4 at the dominant black market exchange rate.

He said special arrangements were being made to pay soldiers, police and other uniformed services ''because it is not desirable to see them queuing for cash.''

Generation Me vs. You Revisited

Conventional wisdom, supported by academic studies using the Narcissistic Personality Inventory, maintains that today’s young people — schooled in the church of self-esteem, vying for spots on reality television, promoting themselves on YouTube — are more narcissistic than their predecessors. Heck, they join Facebook groups like the Association for Justified Narcissism. A study released last year by the Pew Research Center for the People and the Press dubbed Americans age 18 to 25 as the “Look at Me” generation and reported that this group said that their top goals were fortune and fame.
(..)
Ms. Twenge attributed her findings in part to a change in core cultural beliefs that arose when baby-boom parents and educators fixated on instilling self-esteem in children beginning in the ’70s. “We think feeling good about yourself is very, very important,” she said in an interview. “Well, that never used to be the case back in the ’50s and ’60s, when people thought about ‘What do we need to teach young people?’ ” She points to cultural sayings as well — “believe in yourself and anything is possible” and “do what’s right for you.” “All of them are narcissistic,” she said.

However, some scholars argue that a spike in selfishness among young people is, like the story of Narcissus, a myth.

The Falling-Down Professions

And even more blogging about the New York Times Article noting the the demise of the medical and legal professions....

The story goes on to talk about tech billionaires and investment bankers as the new cool, but we’d argue that you could take the money and status elements out of this story and it would still hold up. Flexibility, creativity, autonomy. This is what everyone wants from work.

It’s not because people are spoiled. Or have a short attention span. The reason is that control has become a form of currency. Freedom is a form of compensation. And when you look at what a grind both the legal and medical professions have become, it makes you shudder. People would rather have a life and we don’t blame them.

Freedom = Success (And not the other way around)

More reaction to the New York Times article: "The Falling Down Professions" which I also blogged about below...

The really interesting shift isn’t from one profession to the next, but from one way of thinking about the arc of a career and working life in general to the next. It goes something like this:

Old version: work hard (for a very long time), achieve success, earn freedom (to retire and do all the things you missed out on while you were working)


New version: find work that affords you freedom = success

FBI Picks Terrorism Expert to Lead Agency's National Security Sector

My good friend, Bassem Youssef, continues to hold the FBI's feet to the fire....

Bassem Youssef, a decorated FBI supervisor who was born in Egypt and speaks fluent Arabic, also said jealousy, discrimination and flawed directives hinder the FBI's attempts to fight terrorism.

"The FBI has publicly stated that expertise in working counterterrorism matters, and cultural understanding of the Middle East and the radical Islamic groups, as well as the language, are not necessary to run the counterterrorism division," said Youssef, speaking publicly for the first time on the subject Saturday at an American Library Association meeting.
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The FBI named a career-long expert in terrorism to its top national security job yesterday as one of its own agents went public with allegations that the bureau still lacks the experience and skills needed to effectively combat terrorists.

Agent Bassem Youssef, a whistle-blower who alleged he was passed over for promotions after the Sept. 11, 2001, attacks, said in an interview with The Washington Post that counterterrorism agents and their managers still lack basic knowledge about Middle Eastern culture, Arabic language and terrorist mind-sets.
(..)

Youssef was among those inside the FBI to raise concerns. A decorated counterterrorism agent in the 1990s who was singled out for praise by then-FBI Director Louis J. Freeh, Youssef was passed over for promotions after the attacks on the World Trade Center and Pentagon and pursued a discrimination lawsuit.

As a result of Youssef's litigation, several of the bureau's top terrorism managers acknowledged in depositions that they had limited experience in terrorism or limited knowledge of Middle Eastern culture before taking their jobs. An internal investigation eventually substantiated Youssef's claims that the FBI retaliated against him.

Pursuing happiness behind the veil

To be the American wife of a Saudi is to forsake familiar freedoms — or enjoy them secretly — in exchange for a secure, family-centered life

Why people believe weird things about money

Would you rather earn $50,000 a year while other people make $25,000, or would you rather earn $100,000 a year while other people get $250,000? Assume for the moment that prices of goods and services will stay the same.

Surprisingly -- stunningly, in fact -- research shows that the majority of people select the first option; they would rather make twice as much as others even if that meant earning half as much as they could otherwise have. How irrational is that?

This result is one among thousands of experiments in behavioral economics, neuroeconomics and evolutionary economics conclusively demonstrating that we are every bit as irrational when it comes to money as we are in most other aspects of our lives. In this case, relative social ranking trumps absolute financial status. Here's a related thought experiment. Would you rather be A or B?
(..)
Consider one more experimental example to prove the point: the ultimatum game. You are given $100 to split between yourself and your game partner. Whatever division of the money you propose, if your partner accepts it, you each get to keep your share. If, however, your partner rejects it, neither of you gets any money.

How much should you offer? Why not suggest a $90-$10 split? If your game partner is a rational, self-interested money-maximizer -- the very embodiment of Homo economicus -- he isn't going to turn down a free 10 bucks, is he? He is. Research shows that proposals that offer much less than a $70-$30 split are usually rejected.

Drug Approved. Is Disease Real?

Fibromyalgia is a real disease. Or so says Pfizer in a new television advertising campaign for Lyrica, the first medicine approved to treat the pain condition, whose very existence is questioned by some doctors.

For patient advocacy groups and doctors who specialize in fibromyalgia, the Lyrica approval is a milestone. They say they hope Lyrica and two other drugs that may be approved this year will legitimize fibromyalgia, just as Prozac brought depression into the mainstream.

But other doctors — including the one who wrote the 1990 paper that defined fibromyalgia but who has since changed his mind — say that the disease does not exist and that Lyrica and the other drugs will be taken by millions of people who do not need them.

Blood on Asphalt

Amen...

Reuters runs this story on the Saudi fascination with the video-sharing website YouTube. Now this fascination is not limited to Saudis as YouTube has become an international phenomenon in short time, but as with almost everything else, outsiders seem to think that our country is a piece from outer space and not a part of this world, and anything we do is worthy of attention and newspapers headlines.

The story touches on the dangerous car stunts by Saudi youth that can be found on the site, and quotes a university student saying that teenagers immerse themselves in these acts because they have nothing better to do. This is an excuse I hear so often when people try to explain this stupidity: “they are bored,” I’m told.

I admit it: this country lacks proper entertainment outlets for the youth. There are no cinema theaters, extracurricular activities in schools and universities have little to offer, and sports clubs are poorly managed and can’t cope with the large numbers of youth in this fast growing nation. However, and no matter how many excuses some can come up with to explain why young men here are into cars ‘drifting’, I still think that there is no justification to put the lives of others in danger.

Having a Little Work Done (at the Mall)

It still blows me away when I read articles like this....There is so much suffering amongst the billions of people living outside of the U.S. People who can only expect to live to 40 or 50; people--children who die daily because they can't get access to basic medical care. The other side of this is that some patients in America will want this sort of esoteric treatment and happily pay for it. Yet they will be unhappy to pay their copay for a procedure that may save them from blindness. This cosmetic surgery trend brings out the worse in many ways in our healthcare system...It makes me wonder what exactly are "our" priorities...

ANDREW RUDNICK snickered when he first saw a medical spa offering Botox and laser hair-removal services on a visit to a Las Vegas mall in 2002. He laughed at the thought of someone — anyone — shopping for the latest fashions, grabbing a bite to eat and then, oh yeah, strolling in for a quick shot of Botox to zap out a nasty wrinkle.
(..)

Nonsurgical treatments “are effective, they’re safe and they’re affordable — and there’s no down time,” said Dr. Foad Nahai, a plastic surgeon in Atlanta and president of the society.

Some doctors’ offices are joining in. In New York, Dr. Bruce K. Moskowitz, an ophthalmologist and oculofacial plastic surgeon, says demand on the cosmetic side of his business has skyrocketed, to 50 percent of his business, from 25 percent 15 years ago. To meet demand, he opened a medspa in his office; patients in the waiting room can read brochures about Botox and fillers when they come in for eye checkups.

Obesity now a 'lifestyle' choice for Americans, expert says

WASHINGTON (AFP) - As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.


(..)

In "The Fattening of America", published this month, Finkelstein says that adult obesity more than doubled in the United States between 1960 and 2004, rising from 13 percent to around 33 percent.

Globally, only Saudi Arabia fares worse than the United States in terms of the percentage of adults with a severe weight problem -- 35 percent of people in the oil-rich desert kingdom are classified as obese, the book says, citing data from the World Health Organization and Organization for Economic Cooperation and Development.

Fine Dining with Mobile Devices

Sage advice for our increasingly interconnected world...

People often say we're multi-tasking ourselves to death. Is that really what we're doing? I think not.

I call what we're doing today continuous partial attention, or cpa, for short.

Continuous partial attention and multi-tasking are two different attention strategies, motivated by different impulses. When we multi-task, we are motivated by a desire to be more productive and more efficient. Each activity has the same priority - we eat lunch AND file papers. We stir the soup AND talk on the phone. With multi-tasking, one or more activities is somewhat automatic, like eating lunch or stirring soup. That activity can be paired with another activity that's automatic or with an activity that requires more cognition, like writing an email or talking on the phone. At the core of multi-tasking is a desire to be more productive. We multi-task to CREATE more opportunity for ourselves -time to DO more and time to RELAX more.

In the case of continuous partial attention, we're motivated by a desire not to miss anything. There's a kind of vigilance that is not characteristic of multi-tasking. With cpa, we feel most alive when we're connected, plugged in and in the know. We constantly SCAN for opportunities - activities or people - in any given moment. With every opportunity we ask, "What can I gain here?"

Our opportunity: remembering to find the OFF switch on our devices, now and then, and tune in to the present with engaged attention.

I believe attention is the most powerful tool of the human spirit. We can enhance or augment our attention with practices like meditation and exercise, diffuse it with technologies like email and Blackberries or alter it with pharmaceuticals. In the end, though, we are fully responsible for how we choose to use this extraordinary tool.

Jump-Start on Slow Trek to Treatment for a Disease

Last month, the Bill and Melinda Gates Foundation donated $19 million to the Drugs for Neglected Diseases Initiative to further one of its goals: finding a new drug for African sleeping sickness.
(..)
But the gift spotlights just how tricky the search for new treatments can be when the disease is fearsome but nearly forgotten because its victims are poor and obscure.
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“Sleeping sickness” is too benign a nickname for human African trypanosomiasis, which is caused by a protozoan spread by biting tsetse flies. When the parasites enter the brain, victims hallucinate wildly. They have been known to chase neighbors with machetes, throw themselves into latrines and scream with pain at the touch of water. Only at the end do they lapse into a lassitude so great that they cannot eat, followed by coma and death.

About 150,000 people contract the disease each year, but 50 million people in 36 countries live in areas where they are at risk.

The best treatment now is eflornithine, sometimes called the resurrection drug because it can pull the dying out of comas.

It is almost a miracle that eflornithine is available. It was discovered in 1980 at Pace University in New York. By early 2000, the last 7,500 doses in the world were running out. The patentholder, a precursor of the drug maker Sanofi-Aventis, abandoned it in 1995 because it had not lived up to its anticancer potential. Then, in late 2000, plans to make a topical form emerged. It was the key ingredient in Vaniqa, a cream to prevent facial hair in women.

After critics accused Sanofi-Aventis of catering to vain rich women while letting poor Africans die, the company agreed to make an injectable form of the drug and now gives it free to the World Health Organization and Doctors Without Borders.

But in rural Africa, eflornithine is very hard to use. Patients need intravenous infusions four times a day for two weeks. When a “hospital” is a row of iron beds under a thatched roof, and the “nursing staff” is mostly relatives of the sick who sleep on the floor, round-the-clock treatment is hard. There might be no night nurse to insert an IV line.

For that reason, many countries do not adopt it. They still use the drug melarsoprol, which, Dr. Pécoul said, “is not effective and sometimes kills.”

Congress Asks Pfizer: Why Is Dr. Jarvik Qualified To Pitch Lipitor?

Dr. Robert Jarvik is the inventor of the Jarvik artificial heart, right? You know that because he's the pitch-man for Lipitor, a heavily advertised cholesterol drug. Have you ever stopped to ask yourself why inventing an artificial heart qualifies the man to pitch a drug?

5o Things I've Learned in 5o years

I esp. liked:

10. Empathy is the greatest virtue. From it, all virtues flow. Without it, all virtues are an act.

11. The Golden Rule is the greatest moral truth. If you don’t believe in it, at least try to fake it.

12. Keeping perspective is the greatest key to happiness. From a distance, even a bumpy road looks smooth.

and

33. The 10-minute jump start is the best way to get going on a big task you’ve been avoiding. Set a timer and begin, promising yourself that you’ll quit after 10 minutes and do something else. The momentum will carry you forward.

50 things I've learned in 50 years, a partial list in no particular order from Chicago Tribune Columnist, Eric Zorn

Reversal Of Alzheimer's Symptoms Within Minutes In Human Study

ScienceDaily (Jan. 9, 2008) — An extraordinary new scientific study, which for the first time documents marked improvement in Alzheimer’s disease within minutes of administration of a therapeutic molecule, has just been published in the Journal of Neuroinflammation.
(..)

The new study documents a dramatic and unprecedented therapeutic effect in an Alzheimer’s patient: improvement within minutes following delivery of perispinal etanercept, which is etanercept given by injection in the spine. Etanercept (trade name Enbrel) binds and inactivates excess TNF. Etanercept is FDA approved to treat a number of immune-mediated disorders and is used off label in the study.

Why They Really Run

A nicely written essay from Michael Kinsley..the concept of keeping one's ambitions under wraps seems to be a peculiar cultural norm applicable to not only politicians but to all of us....

Ladies and gentlemen, they are running because they are ambitious. No, really, they are. You probably suspected as much. And yet you would abandon any candidate who dared to admit this, or at least they all believe that you would. We all are told at our high school graduations to be ambitious, then for the rest of our lives it becomes a shameful secret. Ambition can take many forms. Four decades ago, Norman Podhoretz, the editor of Commentary, created a sensation with a book called Making It that revealed how even intellectuals are ambitious. But the purest form of ambition is political ambition, because it represents a desire to rule over other people.
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The one sin for which redemption and forgiveness are not available is ambition. And yet it's the one sin we know they are all guilty of.

Street Smarts in Bangkok

This article sure brings back great, mouth-watering memories of are many trips to Thailand. If our next vacation,to Myanmar, goes as planned, we will be enjoying similar cuisine. (I am not holding my breath though as my last two trips, Kenya and Cambodia, have both been cancelled). BTW there is a great slide show on the sidebar of the article, capturing the beauty of the food and culture in downtown Bangkok...

A decade ago, when I first moved to Bangkok, a friend who had emigrated there long before me let me in on a secret: the best food in Thailand is served by street vendors and at basic mom-and-pop restaurants. To prove his point, he dragged me to Chote Chitr, tucked into a side alley and decorated with nothing but a wall calendar. I saw no foreigners, and we pored through a menu all in Thai. We sampled the specialties, and I was quickly convinced, eating the same dishes then that I would enjoy 10 years later, and dozens of times in between.

The Falling-Down Professions

While I doubt the great majority of people are going to feel sorry for doctors and lawyers after reading the linked article, I am impressed that it holds the number 1 spot in the most read articles at the New York Times(nytimes.com). The article accurately portrays the great erosion of a sense of satisfaction many individuals in these fields now face in the U.S.

In healthcare the causes are many: the bias towards sensationalism in the media (which distorts the fact that most MDs are bright and caring by focusing on the few that aren't), the insurance companies which demand excessive documentation and then throw out every 3rd or 4th claim for payment submitted by physicians (or so it is said),the rise of consumerism with its attendant demands, the fact that every patient is a potential litigant, the ratio of severe vs. trivial pathology seen in the U.S. (vs. the developing world), the incessant decrease in reimbursement rates which do not allow patients the time they wish to have with their doctors etc...

I was at a dinner recently with 4 doctors--every single one of which was looking for a way to get out of the practice of medicine. In other places I have visited and worked in such as the Far East, the Middle East, and Africa--doctors are accorded much more respect than here. Even though a well--off doctor in say, Jos, Nigeria may only make $500/month I would venture to say that such an indivdual, treated as a professional, is happier in many ways than many of my colleagues here...
I often wonder if the general public realizes how demoralized doctors are here and how many of the brightest minds are now going into alternate fields...

So now who’s going to cheer up the doctors?

As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had.
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OR at least, it is not all about money. The pay is still good (sometimes very good), and the in-laws aren’t exactly complaining. Still, something is missing, say many doctors, lawyers and career experts: the old sense of purpose, of respect, of living at the center of American society and embodying its definition of “success.”

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One doctor responding to the American College of Physician Executives survey wrote: “I find it necessary about once every month or two to stay in bed for 24 to 48 hours. I do this on short notice when I get the feeling I might punch somebody.”

Increasing workloads and paperwork might be tolerable if the old feeling of authority were still the same, doctors said. But patients who once might have revered them for their knowledge and skill often arrive at the office armed with a sense of personal expertise, gleaned from a few hours on www.WebMD.com, doctors said, not to mention a disdain for the medical system in general.
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“What irritates me the most is the use of the term ‘provider,’” said Dr. Brian A. Meltzer, an internist in Pennington, N.J., who now practices pro bono on the side, but works full time for Johnson & Johnson’s venture capital division. “We didn’t go to provider school.”
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And then there is, yes, the money issue. Or rather, money envy. Associates at major New York firms often start at $150,000 to $180,000, said Bill Coleman, the chief compensation officer at Salary.com, a company that tracks income statistics. Partners at the country’s biggest 100 firms took home an average of $1.2 million in 2006, according to American Lawyer.

Hardly small sums, but for many senior investment bankers, bonuses and salaries this year will average $2.25 million to $2.75 million, according to Options Group, an executive search and consulting firm.

Doctors rarely approach such heights. While income varies widely, a typical physician might earn $150,00 to $300,000, according to Salary.com data. A surgeon might make $250,000 to $400,000; hot-shot surgeons can earn $750,000 a year, and superstars over a million dollars.
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This star-system mentality is particularly attractive to college students, many of whom were reared with the ’80s philosophy that every child was a potential superstar, Mr. Coleman said. And they want immediate rewards — not exactly the mentality that will fuel a student through years of medical school, a residency and additional training for a specialty.

Short, Stout, Has a Handle on Colds

Originally part of a millennia-old Indian yogic tradition, the practice of nasal irrigation — jala neti — is performed with a small pot that looks like a cross between Aladdin’s lamp and your grandmother’s gravy boat. The neti pot made its way into this country in the early 1970s as a yoga meditation device, but even as yoga became mainstream, the neti pot remained on the fringes of alternative culture.

That is, until now. Due to a confluence of influences, the neti pot is having what can only be termed a moment, sold in drugstores, health food stores, even at Wal-Mart and Walgreens.

The practice gained wide exposure last spring when it was introduced on Oprah Winfrey’s show by a frequent guest, Dr. Mehmet Oz, a cardiothoracic surgeon and an author of health books. Dr. Oz explained that bathing the sinus cavities in a warm saline solution can reduce symptoms of allergies, cold, flu and other nasal problems.

Author Comes to Natural Food's 'Defense'

As someone who has been continuously astonished and a bit embarrased by the American contribution of endless varieties of processed foodstuff, marketed as "new and improved food" to the global culinary plate, I found this interview to be a refreshing confirmation of my opposition to processed food...

Author Michael Pollan discusses his latest book, In Defense of Food: An Eater's Manifesto. He boils his philosophy of nutrition down to seven words: "Eat food. Not too much. Mostly plants."

What's Tearing Kenya Apart? History, for One Thing

A worthwhile read from this professor of African studies at Harvard...

The immediate cause of the crisis was Kenya's delicate ethnic balance. The incumbent president, Kibaki, is a member of Kenya's largest and probably most powerful ethnic group, the Kikuyu, who total about 22 percent of the population; his rival, Odinga, is a member of the Luo, who comprise some 13 percent of the populace and live predominantly in western Kenya. In their bitter contest, in which Odinga promised to end ethnic favoritism and spread the country's wealth more equitably, ethnicity was the deciding factor, and a marred victory on either side had always been likely to spark violence. Both men are rich, elitist African politicians who have far more in common with each other than they do with their supporters; in their struggle over power, both are using their followers as proxies in a smoldering war. Still, Odinga has a real point about vote tampering; the chief of the E.U. election monitoring mission said that his officials had been turned away from the central vote-counting room in Nairobi, and even Kibaki's hand-picked head of Kenya's electoral commission, Samuel Kivuitu, told reporters that he did "not know whether Kibaki won the election."

Enter Britain, Kenya's former colonial ruler, which now prides itself on being a purveyor of global democracy. Foreign Secretary David Miliband and his U.S. counterpart, Secretary of State Condoleezza Rice, issued a joint statement calling for compromise. Prime Minister Gordon Brown rushed to the phone lines, offering Kibaki and Odinga a quick lesson in democratic principles. In a Kiplingesque touch redolent of the colonial "white man's burden," Brown reportedly told both men, "What I want to see is . . . ." Miliband directed the Kenyan leaders to "behave responsibly."

I doubt that the irony of Brown and Miliband's message was lost on Kibaki or Odinga. Today's Britain, between its botched war on terror and lack of checks on executive power (to name but a few flaws), falls far short of the democratic ideals so paternalistically espoused by Brown and other British leaders. Still, the prime minister's jaw-dropping chutzpah -- on display not only in Kenya but also in former imperial possessions such as Pakistan and Iraq -- is rooted less in Brown's own tin ear than in the nature and structures of yesteryear's British colonial rule. So are today's crises in the former empire. If you're looking for the origins of Kenya's ethnic tensions, look to its colonial past.

Far from leaving behind democratic institutions and cultures, Britain bequeathed to its former colonies corrupted and corruptible governments. Colonial officials hand-picked political successors as they left in the wake of World War II, lavishing political and economic favors on their proteges. This process created elites whose power extended into the post-colonial era.

Added to this was a distinctly colonial view of the rule of law, which saw the British leave behind legal systems that facilitated tyranny, oppression and poverty rather than open, accountable government. And compounding these legacies was Britain's famous imperial policy of "divide and rule," playing one side off another, which often turned fluid groups of individuals into immutable ethnic units, much like Kenya's Luo and Kikuyu today. In many former colonies, the British picked favorites from among these newly solidified ethnic groups and left others out in the cold. We are often told that age-old tribal hatreds drive today's conflicts in Africa. In fact, both ethnic conflict and its attendant grievances are colonial phenomena.

Kenyan Riot Police Turn Back Rioting Protestors

This may put a dent in vacation plans--scheduled to go to Kibera and Kisumu in 3 days...Hmm...

Within the span of a week, one of the most developed, promising countries in Africa has turned into a starter kit for disaster. Tribal militias are roaming the countryside with rusty machetes, neighborhoods are pulling apart, and Kenya’s economy, one of the biggest on the continent, is unraveling — with fuel shortages rippling across East Africa because the roads in Kenya, a regional hub, are too dangerous to use. Roadblocks set up by armed men, something synonymous with anarchic Somalia, have cropped up across the country, in towns on the savannah and in the cramped slums.
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The fighting is especially brutal in the Rift Valley, which is ethnically divided between tribes that support the president and tribes that back the opposition.

In Kiambaa, a village in the Rift Valley about a five-hour drive from Nairobi, the tensions boil down to Kalenjin, the biggest tribe in this area, and Luo, the tribe of Mr. Odinga, versus Kikuyu, Mr. Kibaki’s tribe.

It was Kikuyus who were burned to death on Tuesday in the Kenya Assemblies of God church. The church was simple, made of mud and sticks, and about the size of a tennis court.
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The Kikuyu are Kenya’s biggest tribe at 22 percent of the population. They are concentrated in central Kenya, but because they were the tribe favored by the British during colonial times, they became the privileged class and branched out across the country, running shops, restaurants, banks and factories. In the Rift Valley, many Kikuyus have small businesses and farms.

100 Interesting Things from the BBC

100 things we didn't know last year

World's Toughest Woman

Ines Ramírez Pérez is a peasant woman living in rural Mexico. She speaks Zapotec but not Spanish and has no medical training. She nevertheless performed a successful caesarean section on herself: both she and her baby survived.

Ramírez was alone in her cabin in Rio Talea, Southern Mexico when her labour started. The nearest midwife was more than 50 miles away over rough terrain and rough roads and her husband was drinking at a cantina. Rio Talea has 500 people and only one phone, but it was not nearby.

At midnight, on 5 March 2000 — after 12 hours of continual pain and little advancement in labour, Ramírez sat down on a bench, drank from a bottle of rubbing alcohol, and used a kitchen knife to cut open her abdomen. Ramírez cut through her skin in a diagonal line from across her stomach to below her navel (a typical C-section incision is well below the navel). After operating on herself for an hour, she reached inside her uterus and pulled out her baby boy. She then severed the umbilical cord with a pair of scissors and became unconscious. When she regained consciousness, she wrapped clothes around her bleeding abdomen and asked her 6-year-old son, Benito, to run for help. Several hours later, the village health assistant found Perez alert and lying beside her live baby. He sewed her 7-inch incision with an available needle and thread. She was eventually taken to the nearest hospital, where two obstetricians examined her and the baby: they found both alive and well but could not explain why.

Describing her experience in her native Zapotec language, Ramírez said, “I couldn’t stand the pain anymore. If my baby was going to die, then I decided I would have to die, too. But if he was going to grow up, I was going to see him grow up, and I was going to be with my child. I thought that God would save both our lives.”