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Saturday, February 24, 2007

Power of Positive Thinking

Shaking Riches Out of the Cosmos

Illustration by Tony Cenicola/The New York Times; background photograph by Mark L. Stephenson/Corbis

Published: February 25, 2007

THERE are some surprising secrets behind “The Secret.”

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Peter DaSilva for The New York Times

INSPIRATIONAL Esther and Jerry Hicks, authors of “The Law of Attraction,” in their bus.

Stephani Diani for The New York Times

Rhonda Byrne, the producer of the film and book called “The Secret.”

For one, most of the millions of people who have seen “The Secret,” a documentary that is the biggest thing to hit the New Age movement since the Harmonic Convergence, may not know that there are two versions of the film.

In both, “The Secret” intersperses interviews with authors and inspirational speakers who specialize in personal transformation with short dramatized episodes to deliver a message about how positive thinking will improve one’s health, wealth and love life.

The secret that the movie purports to reveal after millenniums of obscurity is “the law of attraction.” This principle, said to be known by an elite few, including Beethoven and 19th-century robber barons, holds that the universe will make your wishes come true if only you really, truly believe in them.

“Ask, believe, receive,” the movie instructs.

There is no better example of the magic than the staggering success of “The Secret” itself and of its creator, Rhonda Byrne, an Australian documentary producer turned spiritual entrepreneur. With no paid advertising or theatrical release, the movie has sold 1.5 million copies of a DVD at $34.95, according to the producers. More than half the copies have sold in the last month, as word-of-mouth appeal crossed over from New Age circles to the mainstream.

A book based on the movie, also called “The Secret,” which Ms. Byrne wrote in less than a month, jumps to No. 1 this week on the New York Times best-seller list of hardcover advice, how-to and miscellaneous books. “Secret” support groups have formed around the country. In Southern California, real estate brokers show the 92-minute movie to motivate sales representatives. Oprah Winfrey, in the first of two shows dedicated to “The Secret,” said its positive philosophy is the way she has long lived her own life.

In the film a woman says the law of attraction cured her cancer, but many followers settle for more prosaic victories. Victoria Moore, a saleswoman in Silicon Valley, said the principles of “The Secret” help her snag coveted parking spots. “But if I let in the slightest bit of doubt, it doesn’t happen,” she added. Elizabeth Cogan, a self-described shaman from Sparks, Nev., said the principle works at restaurants, where she envisions herself not having to wait for a table.

But behind the success of “The Secret” is a seamier story about the origins of the film. It involves big money and what some participants say are the broken promises of Ms. Byrne. The star of the first version of the movie, released in March last year, demanded to be cut out of the current version, which has been on the market since Oct. 1.

That star, Esther Hicks, 58, has been promoting her own version of the law of attraction with her husband, Jerry Hicks, in books and seminars for two decades. “We teach that you keep saying it the way you want it to be, and if you keep saying it the way you want it to be, the universe will line up and give you exactly what you’ve said you wanted,” Ms. Hicks said.

Ms. Byrne had promised Ms. Hicks 10 percent of DVD revenues to appear in “The Secret,” both parties said. But they had a falling out, and Ms. Hicks could not even bring herself to watch Ms. Byrne this month on “Oprah,” the movement’s moment of triumph.

In a backhanded compliment Ms. Hicks said, “I’ve got to give Rhonda credit,” adding that her former collaborator has shown a monomaniacal dedication to the law of attraction. “I’ve never seen anybody do that like she’s doing it,” Ms. Hicks said. “And never mind honesty, and never mind doing what you said you were going to do, and never mind anything. Just stay in alignment.”

Although “The Secret” is an overnight phenomenon, its message of think-and-grow-rich is but the latest version of a self-help formula dating back more than a century, with roots both secular and religious, and branches that have included Napoleon Hill’s best-selling “Think and Grow Rich” in 1937 and Norman Vincent Peale’s “Power of Positive Thinking” in 1952.

J. Gordon Melton, the director of the Institute for the Study of American Religion in Santa Barbara, Calif., traces the origins of “prosperity consciousness” to 19th-century Christian Science. “It’s always waiting for slightly different forms of expression, the same old message,” he said.

Last Sunday evening the Hickses relaxed in their $1.4 million luxury bus parked outside the Rancho Cordova Marriott near Sacramento, where they had just finished a six-hour workshop on the law of attraction in the hotel ballroom. Three hundred people had paid $195 each to hear Ms. Hicks, a former secretary, summon otherworldly spirits she says speak through her. The spirits, who collectively use the name Abraham, answered participants’ questions.

“I don’t have a lover yet,” one woman said.

Abraham, whose speaking voice is rounder, quicker and more computerlike than Ms. Hicks’s natural voice, replied by repeating the woman’s phrase roughly 20 times and then explained it contained its own negativity, which was leaving the woman paddling upstream on the river of life.

The audience applauded.

The Hickses spend most of the year traveling the country, leading workshops based on the teachings they say Abraham has given them. They record the workshops and have 10,000 subscribers, who pay up to $50 a month for CDs and DVDs of Abraham’s wisdom.

When Ms. Byrne asked Ms. Hicks to appear in “The Secret,” as the most prominent interpreter of the law of attraction, she agreed to give the Hickses approval over much of the movie, according to a contract. But when the couple saw the first cut, they were livid. Ms. Hicks’s voice, chaneling Abraham, was used as narration throughout the film, but her face was never shown.

After negotiation, Ms. Hicks’s image was edited into the film and it was released, ultimately netting the Hickses $500,000 from sales, Ms. Hicks said. But the couple were unhappy with the distribution. They said they understood it would be shown first on Australian television, but instead it was being sold as an Internet download and later as a DVD.

Cynthia Black, the president of Beyond Words Publishing, a New Age imprint, who is both a longtime friend of the Hickses and the publisher of Ms. Byrne’s book version of “The Secret,” tried to broker a peace. She enlisted the help of Jack Canfield, the author of “Chicken Soup for the Soul,” one of the “transformational experts” who appears in “The Secret” (and whose nephew Zach Canfield says he used the law of attraction to score a date with the hip-hop singer Lady Sovereign). But Mr. Canfield was also unable to bring the parties together.

The Hickses consulted their lawyer, and Ms. Byrne in turn demanded changes to the contract, both sides said. No agreement could be reached. Ms. Byrne moved forward with a second version of “The Secret” without the Hickses. Advised by their lawyer to sue, the Hickses said they declined because litigation would take energy from their own pursuit of the law of attraction. “We don’t sue,” said Mr. Hicks, a former circus acrobat and Amway distributor.

Ms. Byrne does not seem overly troubled by the rupture. “I’m grateful to have had the journey with them for the time that we had,” she said, sitting on a plush chair next to a honeysuckle candle in her apartment in Santa Monica, Calif. With a glittering silver circle affixed with false-eyelash glue to the center of her forehead, she related how she had mortgaged her home in Melbourne, where she worked as a television producer, to finance “The Secret” and also received an investment from a former Internet executive in Chicago, Bob Rainone. The cost of the films was about $3 million, Ms. Byrne said.

Ms. Byrne, 55, seems possessed by the energy of her success, jumping from side to side as she speaks. Her gray eyes shine with the fervor of the true believer as she talks about setting the goal of taking her vision to the world and watching it come true. “It’s incredible to actually experience an intention that is so big, to experience it is ... ” She paused as her voice crested and swooped as if on the edge of breaking. “It’s like I can feel the lives, every life changing, the joy,” she said.

Without the Hickses’ 10 percent cut, Ms. Byrne and her Chicago investor will reap millions in additional profits. None of the film’s other self-help gurus were paid. But “even though money was involved,” Ms. Byrne insisted, “it was never about that.”

And the Hickses agreed. “We earn millions of dollars a year” already, Mr. Hicks said.

No, the clash seems mainly over who deserves credit, and the wave of mainstream publicity, for this latest version of prosperity consciousness. The Hickses have preached the law of attraction while traveling with Abraham for 21 years. Ms. Byrne’s exposure to the notion is more recent: she was going through a rough patch in her life in 2004, when her daughter gave her a copy of “The Science of Getting Rich,” first published in 1910.

The book discussed how focusing on gratitude can help a person take control of life. Ms. Byrne delved into the works of other self-help gurus, like Charles Haanel’s “Master Key System” from 1912; Prentice Mulford’s 19th-century “Thoughts Are Things”; and Robert Collier’s “Secret of the Ages” from 1926.

By contrast, Ms. Hicks reads no self-help or spiritual material, she said, wanting to keep her mind clear for Abraham’s messages. Without knowing what others have written, friends of the Hickses said, it is easy to understand why they believe they did the most to popularize the law of attraction before “The Secret.”

“Some of the people who are in the movie, I agree, have clearly listened to Abraham tapes, said Ms. Black, the publisher. “But Abraham has never said ‘This is just mine, don’t share it with everyone.’ ”

For the second version of “The Secret,” Ms. Byrne used Lisa Nichols, an author of “Chicken Soup for the African-American Soul,” and Marci Shimoff, an author of “Chicken Soup for the Woman’s Soul,” to fill gaps left by Ms. Hicks’s removal. (The DVD of the Hicks version of “The Secret” is going for $104 on Amazon.com.)

Walking along the Pacific Ocean at surf’s edge on a sunny day last week, Ms. Byrne said no one owns the law of attraction because it is universal, like another famous law. “I can’t go ‘law of gravity, that’s mine,’ ” she said.

What the Hickses say bothers them most about the second version of “The Secret” is that those who watch it are not receiving enough explanation of the law or being told that its discovery was made by “vibrationally accessing broader intelligence,” Ms. Hicks said.

Bringing forth the voice of Abraham as she sat on a buttery leather seat in her motor home, speaking of herself in the third person, she said, “Esther’s concern is that they will destroy this information because they do not really know it.”



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Friday, February 23, 2007

Mom's get organized

Mom’s Mad. And She’s Organized.

Laura Pedrick for The New York Times

Kiki Peppard is a focal point of mothers fighting for equality.

Published: February 22, 2007

A BABY was passed around like the hors d’oeuvres — in this case, bruschetta, a fruit plate — among the 10 mothers who crowded into Ann Clark’s Sacramento home on a Tuesday night this month. No matter if the baby was crying; this was a child-friendly crowd.

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Joan Blades, left, and Kristin Rowe-Finkbeiner.

Chris Sharp

The mothers all held jobs outside the home (pastry chef, singer in a band, lawyer, hairstylist, nanny) and many had flexible schedules to make it easier to care for their children. Like hundreds of others who have gathered over the last nine months, they huddled around a television to view “The Motherhood Manifesto,” a documentary about the obstacles still facing working mothers, including many of those in the room.

“I’m home with a 2-year-old, so there may be an interruption,” said Ms. Clark, 35, a social worker with two children and a three-day-a-week office job, as she recounted the viewing party the next day and talked about how she related to the mothers in the movie. Like them, she said, her financial situation felt precarious. She wasn’t sure she could count on keeping her part-time position next fall.

“These are issues I’m aware of and feel strongly about,” she said of the movie’s focus on subjects like universal child care, maternity and paternity leave, and workplace discrimination against mothers. That is why she joined MomsRising.org, the mother’s advocacy organization that made the documentary. “It’s a great opportunity to connect with friends — mothers — and together have a chance to change things,” she said.

For years, mothers have been taking to the Internet to blog or post messages about the travails of motherhood, commiserating, fuming or laughing about their shared lives. But in the last year there has been a marked increase in those who are going beyond simply expressing their feelings. In a throwback to their mothers’ — or was it their grandmothers’? — time, they are organizing about family and work issues.

A generation of mothers who are largely perceived as postfeminist in every way, from sex to economic discrimination, has begun a consciousness-raising that is almost old-fashioned were it not for the technology involved. Raised to believe that girls could accomplish anything, these women have reached parenthood, only to find they faced many of the same pay, equity and work-family balance issues that were being fought over decades before. From that awakening, they say, has come the inkling of a new movement.

In many ways, these groups are repackaging issues that have been around for nearly 50 years and have proven intractable despite the efforts of legions of activists, lawyers and elected officials.

But what MomsRising has done, the organizers say, is frame its concerns as family and economic issues, which resonate for a younger generation of women. (They say they will include the fathers later.)

It is not a coincidence that MomsRising is using the tactics of MoveOn.org, the influential liberal organizing site that helped propel Howard Dean’s presidential candidacy. One of the group’s founders is Joan Blades, who, with her husband, Wes Boyd, founded MoveOn.

MomsRising is the newest and most prominent in a loose coalition of advocacy groups, including Mothers & More, the Mothers Movement Online, Mothers Ought to Have Equal Rights and the National Association of Mothers’ Centers, that are sharing information, joining together at rallies and signing one another’s petitions.

They, in turn, are starting to form alliances with labor groups and traditional feminist groups like the National Organization for Women. And they are communicating with what some might see as unlikely allies: traditional family values groups like the Christian Coalition.

The various mother’s rights groups are concentrating much of their effort at state legislatures. In Washington State, they met with the speaker of the house about passing a bill that would allow employees to be paid if they take family- or medical-leave time, and in California, they have proposed legislation that would make it illegal to discriminate based on family status. Senator Sheila Kuehl has agreed to author the bill, which is to be introduced this week. They are also hoping to be heard during next year’s presidential race.

It’s difficult to know just how big the burgeoning movement is. MomsRising, which has been around since last May, has attracted 80,000 members from around the United States. The goal, organizers say, is to build a nonpartisan grass-roots movement millions strong.

Seeing Nancy Pelosi swarmed by children moments after being sworn in as the first female House speaker gives them hope, they said, that they are gaining momentum in a more welcoming political atmosphere.

“It was a joyful thing to see the speaker of the House surrounded by kids,” Ms. Blades said. “We thought, ‘Wow, we’re in the right place at the right time.’ We’ve been waiting for this to happen; we’re ready for this to happen.”

What have these mothers been waiting for? It is all laid out in the MomsRising documentary, which was shown in Washington on Sept. 28 to a crowd that included Senator Ted Kennedy and presidential candidates Hillary Rodham Clinton (her office helped organize the screening), Barack Obama and Christopher J. Dodd.

The film opens with one woman telling her friend that she and her husband have decided to have a baby. “Are you clueless?” the friend asks. “Don’t you know what happens to mothers in America?” One thing the movie makes clear: It isn’t good.

Using data and personal stories of mothers who have been discriminated against in the workplace, the film emphasizes that mothers are less likely to be hired, will make less money, and are more scrutinized for wrongdoing than either single women or men. The reason it cites: There are not enough family-friendly policies in place to help parents.

The seeds for MomsRising were planted in 2004, when Ms. Blades read a book about women and politics by Kristin Rowe-Finkbeiner, 36, a married mother of two. Ms. Blades, 51, said she was astonished to find that many younger women didn’t identify with feminism and by the data showing vast disparities in incomes between mothers and fathers, with single mothers faring particularly badly.

“I’d been doing the MoveOn thing for over eight years and I thought: ‘I’m an organizer and I wasn’t aware of this. I don’t know how many people are aware of this,’ ” she said.

Ms. Blades decided that America’s unfair treatment of mothers would be the subject for her next book, also called “The Motherhood Manifesto,” and she enlisted Ms. Rowe-Finkbeiner as her co-author. From the book came MomsRising, which is mainly financed by individual donors and private foundations.

The founders, each of whom has two children, claim that MomsRising is so new that they do not have a handle yet on who makes up their membership. But in interviews, some members said they grew up watching their mothers struggle to balance career and family.

And while their mothers agitated to be allowed into the workplace, most of these women don’t have the luxury of a choice. Today, 67 percent of women with children under the age of 18 are employed, according to the Bureau of Labor Statistics.

Anita Jackson, 29, of Berkley, Calif., who has an infant daughter, said MomsRising was “addressing true family values as opposed to ideology; real policies that would help moms and dads get to work, pay the bills and have a family life.” Particularly important to her, she said, are workplaces with flexible schedules and universal health care for children.

Like Ms. Jackson, Ashley Boyd, 36, also from Berkeley, was a member of MoveOn. Ms. Boyd, who does not have children but has been involved with women’s issues, said she first received an e-mail message about MomsRising on Mother’s Day last year. “I felt like it was expressing the ideas and energy and excitement I was looking for,” she said. It was she who convinced her friend Ms. Clark to hold the documentary viewing party in Sacramento.

At many house parties, the issue that has generated the most discussion is something that activists call “maternal profiling.” That is using information about a woman’s status as a parent to make managerial decisions, like whether to hire her and how much to pay her.

They are particularly moved by the story of Kiki Peppard, a Pennsylvania woman who, 12 years ago, was refused office jobs after employers found out she was a single mother of two. Ms. Peppard is a rallying point for many women, who are led by the film to believe — mistakenly — that such discrimination is legal. According to two experts in workplace law, it is not.

But many studies indicate that, legal or not, a woman’s status as a mother hurts her at work.

In one study, to be published next month in the American Journal of Sociology, Cornell researchers sent out résumés and cover letters to real employers for hypothetical job applicants. All had the same credentials, but the packages included subtle cues to indicate that some of the applicants were parents. (For example, a résumé might note that an applicant was an officer in a parent-teacher association.)

The goal was to find out if employers are less likely to pursue an interview if they find out that a candidate is a parent, said Shelley Correll, an associate professor of sociology at Cornell, who helped conduct the study. And the answer was “yes for mothers, no for fathers.”

For the women who are fired up about workplace inequities, there is an easy way to fight back, without even leaving the house.

“You get an e-mail to sign a petition,” Ms. Clark said, about the ease she had adding her voice to MomsRising, “and it takes five minutes and you’re done for the day.”

“For women, I know we want to lead more meaningful lives and make a difference, but it’s easy to feel overwhelmed,” she said. “But MomsRising makes it feel manageable. Plus, it creates a community, which is really fun.”



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Sunday, February 18, 2007

Human Nature & Goodness

Op-Ed Columnist

TimesSelect Human Nature Redux

Published: February 18, 2007

Sometimes a big idea fades so imperceptibly from public consciousness you don’t even notice until it has almost disappeared. Such is the fate of the belief in natural human goodness.

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This belief, most often associated with Jean-Jacques Rousseau, begins with the notion that “everything is good as it leaves the hands of the Author of things; everything degenerates in the hands of man.” Human beings are virtuous and free in their natural state. It is only corrupt institutions that make them venal. They are happy in their simplicity, but social conventions make them unwell.

This belief had gigantic ramifications over the years. It led, first of all, to the belief that bourgeois social conventions are repressive and soul-destroying. It contributed to romantic revolts against tradition and etiquette. Whether it was 19th-century Parisian bohemians or 20th-century beatniks and hippies, Western culture has seen a string of antiestablishment rebellions led by people who wanted to shuck off convention and reawaken more natural modes of awareness.

It led people to hit the road, do drugs, form communes and explore free love in order to unleash their authentic selves.

In education, it led to progressive reforms, in which children were liberated to follow their natural instincts. Politically, it led to radical social engineering efforts, because if institutions were the source of sin, then all you had to do was reshape institutions in order to create a New Man.

Therapeutically, it led to an emphasis of feelings over reason, self-esteem over self-discipline. In the realm of foreign policy, it led to a sort of global doctrine of the noble savage — the belief that societies in the colonial world were fundamentally innocent, and once the chains of their oppression were lifted something wonderful would flower.

Over the past 30 years or so, however, this belief in natural goodness has been discarded. It began to lose favor because of the failure of just about every social program that was inspired by it, from the communes to progressive education on up. But the big blow came at the hands of science.

From the content of our genes, the nature of our neurons and the lessons of evolutionary biology, it has become clear that nature is filled with competition and conflicts of interest. Humanity did not come before status contests. Status contests came before humanity, and are embedded deep in human relations. People in hunter-gatherer societies were deadly warriors, not sexually liberated pacifists. As Steven Pinker has put it, Hobbes was more right than Rousseau.

Moreover, human beings are not as pliable as the social engineers imagined. Human beings operate according to preset epigenetic rules, which dispose people to act in certain ways. We strive for dominance and undermine radical egalitarian dreams. We’re tribal and divide the world into in-groups and out-groups.

This darker if more realistic view of human nature has led to a rediscovery of different moral codes and different political assumptions. Most people today share what Thomas Sowell calls the Constrained Vision, what Pinker calls the Tragic Vision and what E. O. Wilson calls Existential Conservatism. This is based on the idea that there is a universal human nature; that it has nasty, competitive elements; that we don’t understand much about it; and that the conventions and institutions that have evolved to keep us from slitting each other’s throats are valuable and are altered at great peril.

Today, parents don’t seek to liberate their children; they supervise, coach and instruct every element of their lives. Today, there really is no antinomian counterculture — even the artists and rock stars are bourgeois strivers. Today, communes and utopian schemes are out of favor. People are mostly skeptical of social engineering efforts and jaundiced about revolutionaries who promise to herald a new dawn. Iraq has revealed what human beings do without a strong order-imposing state.

This is a big pivot in intellectual history. The thinkers most associated with the Tragic Vision are Isaiah Berlin, Adam Smith, Edmund Burke, Alexander Hamilton, James Madison, Friedrich Hayek and Hobbes. Many of them are conservative.

And here’s another perversity of human nature. Many conservatives resist the theory of evolution even though it confirms many of conservatism’s deepest truths.



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Sunday, February 11, 2007

Microbes on Skin

Close Look at Human Arm Finds Host of Microbes

By Rob Stein
Washington Post Staff Writer
Monday, February 12, 2007; A06

Hold out your hand, with the palm facing skyward. Pull the sleeve of your shirt up to your elbow. Now, take a look at the fleshy part of your arm, about halfway between your wrist and your elbow. What do you see?

Nothing, probably.

But that's not what Martin J. Blaser of New York University School of Medicine sees. With the help of the latest scientific tools, Blaser sees a complex, microscopic world teeming with a vast array of microorganisms.

"The skin is home to a virtual zoo," said Blaser, a microbiologist who last week published online the first molecular analysis of the bacteria living on one small patch of human skin. "We're just beginning to explore it."

The analysis revealed that human skin is populated by a diverse assortment of bacteria, including many previously unknown species, offering the first detailed peek at this potentially crucial ecosystem.

The work is part of a broader effort by a small coterie of scientists to better understand the microbial world that populates the human body. Virtually every orifice and the digestive tract are swarming with bacteria, fungi and other microbes. By some estimates, only one out of every 10 cells in the body is human.

"If nothing else, this should be a shot across the bow to the scientific community that says, 'Hey, don't you think we should be taking a closer look at this?' " said David A. Relman, a Stanford University microbiologist. "To me it's still surprising, humbling and shocking how little we truly understand about the makeup of the human microbial community."

Scientists suspect these microbes play important but poorly understood roles, assisting crucial bodily functions and potentially helping prevent or cause many diseases. One recent study found that obese people appear to have a unique mix of microbes in their guts, which could partly account for the obesity epidemic.

"This type of work is setting the stage for a second human sequencing project -- one that examines our microbiomes" -- the genes of the microbial communities populating our bodies -- Jeffrey I. Gordon of Washington University in St. Louis wrote in an e-mail. Gordon reviewed Blaser's paper for publication by the Proceedings of the National Academy of Sciences.

"The result of this human microbiome project will be a more comprehensive view of our genetic landscape and should provide insights about which of our 'human attributes' are derived from products of our microbial self," he said. "This could lead, in turn, to new ways of defining health, new ways for predicting disease predilection, and new ways for treating illnesses affecting various components of our body, including the skin."

Blaser decided to focus on the skin in order to begin to understand the microbial makeup of the body's largest organ. While similar studies have been conducted on the mouth, colon, vagina and other parts of the body, no one had taken a detailed look at skin using the latest genetic tools.

"No one had really done modern work on the skin," Blaser said. "This is really the first attempt to do something like this."

Previous studies of microbes on human skin have been limited to examining those that can be grown in laboratory dishes. But scientists have long suspected that only provided insights into a small fraction of the creatures present, because many organisms cannot be easily grown in the lab.

Blaser's team swabbed an area of skin about the size of silver dollar on the right and left forearms of three healthy men and women. They then used sophisticated molecular techniques to amplify and analyze fragments of bacterial DNA captured by the swabs.

The analysis revealed 182 distinct species, the researchers reported. Of those, 30 had never been seen. They identified an additional 65 species when they sampled four of the volunteers eight to 10 months later, including 14 new species.

"We found a lot of diversity -- both in terms of distant relatives but also cousins. And not just first cousins, but second, third and fourth cousins," Blaser said.

On average, each person's skin harbored about 50 different species, but only four of them were found on all six people, suggesting that the mix of bacteria varies significantly from person to person. But those four species accounted for more than half of all the DNA sequences found, indicating that a relatively few species tend to dominate. And when the researchers analyzed the bacteria using a broader level of classification known as phylum, they found three phyla on all six subjects that accounted for 95 percent of all species.

"It appears that there is a conserved infrastructure or scaffolding of organisms that's common in human skin, and then a lot of transient or uncommon organisms that are person-specific," Blaser said.

"It's like New York City. About 8 million people live here, but there are about 40 million tourists in a year. So at any one time the residents outnumber the tourists, but in aggregate the tourists outnumber the residents," he said.

In fact, when the researchers sampled four of the six volunteers a second time, they found many of the species detected earlier were gone.

"This indicates that there's a lot of tourism going on," Blaser said. "There's a lot of transiency."

Blaser's team did not examine what any of the organisms were doing.

"This is how you start this kind of exploration -- first you ask the question: What's there?" Blaser said. "It's like when people first went to Africa or Antarctica to start to fill in the map."

Scientists assume that most of the organisms have a symbiotic relationship with their human hosts and play some type of beneficial role. But the next step will be to try to characterize their functions.

"We're interested in understanding how we interact with these organisms and how they are communicating with human cells and vice versa," Blaser said.

Some of the organisms may also play a role in diseases such as eczema and psoriasis.

"These are chronic inflammatory diseases of the skin of unknown cause. If these microorganisms have something to do with skin disease, knowing what's there may help us diagnose or perhaps treat these diseases," he said.

Blaser noted that human skin probably has myriad distinct ecosystems, noting that a similar study looking at fungi produced similar results but also found tremendous diversity in different parts of the body.

"If we looked at the armpit or the scalp, who knows what we'd find?" Blaser said. "It's like we're at the zoo, but so far we've just looked in the primate house. We haven't even gotten to the cat house or the elephant house."



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Saturday, February 10, 2007

Nation - States ?

Op-Ed Contributor

California Split

Published: February 10, 2007

Washington

SOMETHING interesting is happening in California. Gov. Arnold Schwarzenegger seems to have grasped the essential truth that no nation — not even the United States — can be managed successfully from the center once it reaches a certain scale. Moreover, the bold proposals that Mr. Schwarzenegger is now making for everything from universal health care to global warming point to the kind of decentralization of power which, once started, could easily shake up America’s fundamental political structure.

Governor Schwarzenegger is quite clear that California is not simply another state. “We are the modern equivalent of the ancient city-states of Athens and Sparta,” he recently declared. “We have the economic strength, we have the population and the technological force of a nation-state.” In his inaugural address, Mr. Schwarzenegger proclaimed, “We are a good and global commonwealth.”

Political rhetoric? Maybe. But California’s governor has also put his finger on a little discussed flaw in America’s constitutional formula. The United States is almost certainly too big to be a meaningful democracy. What does “participatory democracy” mean in a continent? Sooner or later, a profound, probably regional, decentralization of the federal system may be all but inevitable.

A recent study by the economists Alberto Alesina of Harvard and Enrico Spolaore of Tufts demonstrates that the bigger the nation, the harder it becomes for the government to meet the needs of its dispersed population. Regions that don’t feel well served by the government’s distribution of goods and services then have an incentive to take independent action, the economists note.

Scale also determines who has privileged access to the country’s news media and who can shape its political discourse. In very large nations, television and other forms of political communication are extremely costly. President Bush alone spent $345 million in his 2004 election campaign. This gives added leverage to elites, who have better corporate connections and greater resources than non-elites. The priorities of those elites often differ from state and regional priorities.

James Madison, the architect of the United States Constitution, understood these problems all too well. Madison is usually viewed as favoring constructing the nation on a large scale. What he urged, in fact, was that a nation of reasonable size had advantages over a very small one. But writing to Jefferson at a time when the population of the United States was a mere four million, Madison expressed concern that if the nation grew too big, elites at the center would divide and conquer a widely dispersed population, producing “tyranny.”

Few Americans realize just how huge this nation is. Germany could fit within the borders of Montana. France is smaller than Texas. Leaving aside three nations with large, unpopulated land masses (Russia, Canada and Australia), the United States is geographically larger than all the other advanced industrial countries taken together. Critically, the American population, now roughly 300 million, is projected to reach more than 400 million by the middle of this century. A high Census Bureau estimate suggests it could reach 1.2 billion by 2100.

If the scale of a country renders it unmanageable, there are two possible responses. One is a breakup of the nation; the other is a radical decentralization of power. More than half of the world’s 200 nations formed as breakaways after 1946. These days, many nations — including Brazil, Britain, Canada, China, France, Italy and Spain, just to name a few — are devolving power to regions in various ways.

Decades before President Bush decided to teach Iraq a lesson, George F. Kennan worried that what he called our “monster country” would, through the “hubris of inordinate size,” inevitably become a menace, intervening all too often in other nations’ affairs: “There is a real question as to whether ‘bigness’ in a body politic is not an evil in itself, quite aside from the policies pursued in its name.”

Kennan proposed that devolution, “while retaining certain of the rudiments of a federal government,” might yield a “dozen constituent republics, absorbing not only the powers of the existing states but a considerable part of those of the present federal establishment.”

Regional devolution would most likely be initiated by a very large state with a distinct sense of itself and aspirations greater than Washington can handle. The obvious candidate is California, a state that has the eighth-largest economy in the world.

If such a state decided to get serious about determining its own fate, other states would have little choice but to act, too. One response might be for an area like New England, which already has many regional interstate arrangements, to follow California’s initiative — as it already has on some environmental measures. And if one or two large regions began to take action, other state groupings in the Northwest, Southwest and elsewhere would be likely to follow.

A new wave of regional devolution could also build on the more than 200 compacts that now allow groups of states to cooperate on environmental, economic, transportation and other problems. Most likely, regional empowerment would be popular: when the Appalachian Regional Commission was established in 1965, senators from across the country rushed to demand commissions to help the economies and constituencies of their regions, too.

Governor Schwarzenegger may not have thought through the implications of continuing to assert forcefully his “nation-state” ambitions. But he appears to have an expansive sense of the possibilities: this is the governor, after all, who brought Prime Minister Tony Blair of Britain to the Port of Long Beach last year to sign an accord between California and Britain on global warming. And he may be closer to the mark than he knows with his dream that “California, the nation-state, the harmonious state, the prosperous state, the cutting-edge state, becomes a model, not just for the 21st-century American society, but for the larger world.”

Gar Alperovitz, a professor of political economy at the University of Maryland, College Park, is the author of “America Beyond Capitalism.”



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Friday, February 09, 2007

Hospice Care Earlier

Health Plans

A Chance to Choose Hospice, and Hope for a Cure

Ruth Fremson/The New York Times

Charles Tirone of Manhattan rested last month after radiation treatment while enrolled in a hospice program.

Published: February 10, 2007

The American health care system has long given patients a terrible choice: people told that they have a terminal illness must forgo advanced medical treatment to qualify for hospice care. Cancer patients have to pass up chemotherapy, for example, or patients with kidney failure must abandon dialysis.

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Health Plans

This is the first article in a series that will examine new approaches to addressing common shortcomings in the nation’s health care system.

Related

There Is Life After Hospice, and Even Golf in Florida for Some (February 10, 2007)

Hospice Basics (February 10, 2007)

Ruth Fremson/The New York Times

Dr. Andrew Evans, left, with Charles Tirone in January at Roosevelt Hospital in Manhattan.

Forcing patients into this either-or decision has prompted many who might benefit from a hospice program to instead opt for expensive hospital care that may end up costing Medicare and other insurers far more.

But now, some hospice programs and private health insurers are taking a new approach that may persuade more patients to get hospice care for the last months of life. These programs give patients the medical comfort and social support traditionally available through hospice care, while at the same time letting them receive sophisticated medical treatments that may slow or even halt their disease.

Hospice care is intended to help patients and their families better cope with the end of life by providing social services and special care.

Experts say that if the new approach catches on more broadly, more patients who would benefit from hospice care will actually enter hospice programs — and enter them earlier. And more patients, they say, could avoid the costly, crisis-ridden final weeks in a hospital that often still represent the American way of death.

In 2005, only about a third of the 2.4 million people who died in this country were in hospice care. Perhaps twice that many patients should have been in hospice programs, according to specialists in the field. And even many of those who entered hospice care did so only at the very end of their illnesses, spending a week or less in a program that ideally would have helped them cope with the final six months or year of life.

For too many of those patients, “that’s not hospice; it’s last rites,” said Dr. John W. Rowe, the former chairman and chief executive of Aetna, one of the big insurers that is rethinking hospice care.

UnitedHealth is another insurer that now lets hospice patients also receive advanced medical treatments. Meanwhile, some of the nation’s 4,200 hospice programs are offering advanced medical treatment even when they are not paid more to do so.

The new approach, which proponents call “open access” hospice, is an example of the efforts by some insurers and health care providers to try to fix specific problems in the nation’s medical system even as politicians and businesses weigh sweeping health care overhaul proposals in Washington. Being able to have potentially life-prolonging medical treatment makes all the difference to hospice patients like Gary Marko, 42, who has advanced gastric cancer and is recovering from recent surgery for his condition.

“I probably would not have elected to go to hospice, if curative care wasn’t an option,” Mr. Marko said. He is considering taking chemotherapy even as he receives the kind of additional care available through a hospice program, like visits from a nurse and a massage therapist at his home in Covington, Wash. Both types of care will be paid for by the Aetna coverage he receives through his employer.

Dr. Rowe, whose medical specialty is caring for the elderly and is now a health policy professor at Columbia University, pushed Aetna to begin an experiment two years ago to pay for traditional medical care even while covering hospice services, usually at home, like nursing care or a home health aide.

Many doctors say the either-or approach, if it ever made sense, is less valid now that continued advances in medicine can allow even patients with very advanced disease to benefit from new treatments. “The whole dichotomy is entirely false,” said Dr. Ira R. Byock, the director of palliative medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

There are many reasons people are slow to consider hospice care — not the least of which is acknowledging that they are dying.

But Dr. Byock rejects the notion that the only point of hospice is to help people die. He says that by offering nursing care and palliative medicine to relieve pain and improve the quality of life, hospice care can benefit some people so much that they become well enough to leave the programs. The Aetna experiment, for which nearly 400,000 of its roughly 15 million insured members are eligible, provides some evidence that people will take advantage of hospice care if they do not have to give up other treatment intended to prolong life.

Mr. Marko said that once he learned that Aetna would not ask him to forgo chemotherapy, there was no reason not to sign up for the hospice services that allowed him to be more comfortable at home with his wife, Amy, and their three young children. His massage therapy makes him feel better, for example, and he plans to try the acupuncture available through the program.

“What’s to lose?” Mr. Marko said.

What can be gained is more time to take advantage of hospice’s benefits. One woman in the Aetna experiment who had breast cancer was able to continue chemotherapy even as she enrolled in a hospice program that offered the nursing care she needed before she died.

“She just wasn’t ready to give up,” said Sharon Brodeur, a nurse and Aetna administrator who helped develop the experimental program. The patient probably entered the program two or three months earlier than she would have if she had had to give up chemotherapy, Ms. Brodeur said.

The Aetna initiative and other open-access programs are still the exceptions, though.

For example, Medicare which spent about $9 billion on hospice benefits last year out of its total spending of $406 billion, requires patients to give up regular medical coverage if they enter a hospice program.

Medicare officials say that patients can opt for hospice care and then change their mind, resuming traditional coverage. And they say that nothing in Medicare’s rules prevents hospice programs from providing a full range of medical treatments.

But many hospice programs do not offer advanced medical treatments because they say they cannot afford to. Medicare pays a provider about $130 a day for routine hospice care in the home, regardless of the patient’s individual condition. The agency, which introduced the benefit in the mid-1980’s, based its rules on the assumption that it would be too costly to pay for both hospice care and for treatments aimed at prolonging life.

Many experts, though, say that thinking is misguided because it causes patients to spend their last days in a hospital receiving expensive care they may not even want, or to frequently return to the hospital because managing their disease is too much for a family to handle.

“What they’re doing instead is paying for unnecessary emergency room visits,” said Dr. Diane E. Meier, a professor at Mount Sinai School of Medicine in New York and an expert in palliative care.

Medicare officials, though, cite the growing popularity of hospice programs as an indication that the benefit is valuable in its current form.

Hospice care has been allowed to “thrive and prosper,” said Laurence Wilson, the director of chronic care policy for the Center for Medicare Management. But he also emphasized that patients who still wanted aggressive medical treatment had the option of sticking with traditional Medicare coverage.

Hospice is “not all things to all people,” Mr. Wilson said.

Many people in the field say that Medicare’s fixed-payment system discourages some hospice programs from accepting patients who need expensive treatment.

“The perverse incentive is to take the cheapest patient,” said Carolyn Cassin, the chief executive of Continuum Hospice Care, who said such a patient would be someone who had already given up hope and required very little medical care. Continuum Hospice Care is part of the hospital system of the same name in New York and is among the small number of hospice programs that makes a point of taking even those patients who want sophisticated treatment.

Because Continuum Hospice cared for 2,700 patients last year, on a budget of about $42 million, the program is large enough to absorb the cost of some very expensive patients, Ms. Cassin said.

“You’re never going to have to choose between treatment for the disease and care from us,” she said, noting that about 40 percent of Continuum Hospice patients received advanced medical therapies.

When 76-year-old Charles Tirone, who had late-stage lung cancer, was discharged from the hospital late last year, for example, he was able to continue his radiation treatments and still enroll in Continuum’s hospice program. Social workers and nurses managed his care at his West 57th Street apartment in Manhattan, until his death on Tuesday evening.

The social worker assigned to Mr. Tirone “tried her best to make Charlie comfortable,” said Michael Abbassi, a longtime friend who helped care for him.

Many other hospice programs are exploring the Continuum-style of open access, accepting patients with insurance at the end of life who may want and need aggressive medical treatments.

“This has been a big movement and a big discussion over the last five years,” said Malene Davis, the chief executive of Capital Hospice in Falls Church, Va., which cared for about 5,100 patients last year.

Many hospice programs, though, are too small to spread their costs, which would allow them to take patients needing expensive treatments. And if they meet basic state and Medicare requirements that include offering access to a nurse and a doctor 24 hours a day, hospices can essentially pick and choose which treatments to offer as long as they are meeting a patient’s needs.

“There is a huge variation in what programs provide,” said Dr. Mark Leenay, the medical director of palliative initiatives at UnitedHealth, the big insurer.

Because Medicare does not collect detailed data about the medical treatments a hospice patient receives, there is very little information about what services are actually being provided. Some argue that Medicare should simply drop the requirement that patients forgo other coverage if they want hospice care.

As part of a much broader effort toward revamping health care, Senator Ron Wyden, Democrat of Oregon, has introduced legislation that would end that requirement. He says that the change would not significantly raise Medicare’s spending, but that it would give people more control over the way they die.

“People don’t want government making their choices,” he said.

One insurer, Blue Cross and Blue Shield of Rhode Island, which typically pays for treatments like chemotherapy as a way to relieve pain even while covering hospice care, says it has not seen a significant increase in the use of medical services because of this broader coverage.

At Dow Chemical, an employer in the Aetna experiment, the company’s executives agreed to pay for the broader coverage because “it’s the right thing to do,” said Steve Morgenstern, who manages Dow’s health plans.

Aetna plans to continue its experiment, which in its first year increased the average length of a hospice stay to 34 days, up from 27. The insurer’s chief medical officer, Dr. Troyen Brennan, predicts that the company will probably end up extending its coverage to more of its insured members.

“Looking at the preliminary data, everything suggests we should move forward,” he said.

Dr. Rowe, the former Aetna chairman, said insurers should not be in the business of forcing people to give up hope. “When I was in practice,” he said, “I wouldn’t do that to a patient.”



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