The Boss: New Leaders Inc. C.E.O. on Giving Children a Chance





I AM the youngest of 10 children in my family, and the only one born in the United States. My father was a municipal judge who fled Haiti during the Duvalier regime. He and my mother settled in the Bedford-Stuyvesant area of Brooklyn, but could not initially afford to bring over my four brothers and five sisters, who stayed in Haiti with relatives.







Jean S. Desravines is the chief executive of New Leaders Inc. in New York.




AGE 41


FAVORITE PASTIMES Karate and taekwondo


MEMORABLE BOOK "How Children Succeed: Grit, Curiosity and the Hidden Power of Character," by Paul Tough






Since he did not speak English fluently, my father worked as a janitor and had a second job as a hospital security guard. He later took a third job driving a taxi at night to pay for my tuition at Nazareth Regional High School, a Roman Catholic school in Brooklyn. My parents were determined that I was going to get a good education, and wanted to keep me away from local troubles, which did claim two of my childhood friends.


Working so many jobs overwhelmed my father. He had a heart attack and died at age 59 behind the wheel of his taxi. My mother found it difficult to cope without my father and moved back to Haiti in 1989 with two of my siblings. I thought I would have to leave school because I had no money for tuition, but Nazareth agreed to pay my way.


I wound up sleeping in my car for almost three months, showering at school after my track team’s practice. I also held down two jobs, both in retailing, and one of my sisters and I rented a basement apartment in East Flatbush.


After graduating from high school in 1990, I attended St. Francis College in Brooklyn, on athletic and academic scholarships. I worked first at the New York City Board of Education, where H. Carl McCall was president, then in his office after he became New York State comptroller. I later worked in the office of Ruth Messinger, then the Manhattan borough president.


I broadened my nonprofit organization experience at the Faith Center for Community Development while earning my master’s of public administration at New York University. I married my high school sweetheart, Melissa, and we now have two children.


In 2001, I began to work toward my original goal — improving educational opportunities for children — and joined the city’s Department of Education. I was later recruited under the new administration of Mayor Michael R. Bloomberg to help start a program as part of his Children First reforms.


In 2003, I became the Department of Education’s executive director for parent and community engagement, and, two years later, senior counselor to Joel I. Klein, then the school chancellor. He taught me a great deal about leadership and how to change the education system. But I began to realize public education could not be transformed without great principals who function like C.E.O.’s of their schools.


So in 2006 I returned to the nonprofit world, to New Leaders, a national organization founded in 2000 to recruit and develop leaders to turn around low-performing public schools. Initially, I managed city partnerships and expanded our program in areas like New Orleans and Charlotte, N.C.


In 2011, I became C.E.O., and revamped our program to produce even stronger student achievement results, streamlined our costs, diversified funding sources and forged new partnerships. We have an annual budget of $31.5 million, which comes from foundations, businesses, individuals and government grants, and a staff of about 200 people at a dozen locations.


We have a new partnership with Pearson Education to provide greater learning opportunities to public school principals. The goal of these efforts is to have a great principal in each of our nation’s public schools — to make sure that, just as I did, all kids get a chance at success.


As told to Elizabeth Olson.



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Well: Holly the Cat's Incredible Journey

Nobody knows how it happened: an indoor housecat who got lost on a family excursion managing, after two months and about 200 miles, to return to her hometown.

Even scientists are baffled by how Holly, a 4-year-old tortoiseshell who in early November became separated from Jacob and Bonnie Richter at an R.V. rally in Daytona Beach, Fla., appeared on New Year’s Eve — staggering, weak and emaciated — in a backyard about a mile from the Richter’s house in West Palm Beach.

“Are you sure it’s the same cat?” wondered John Bradshaw, director of the University of Bristol’s Anthrozoology Institute. In other cases, he has suspected, “the cats are just strays, and the people have got kind of a mental justification for expecting it to be the same cat.”

But Holly not only had distinctive black-and-brown harlequin patterns on her fur, but also an implanted microchip to identify her.

“I really believe these stories, but they’re just hard to explain,” said Marc Bekoff, a behavioral ecologist at the University of Colorado. “Maybe being street-smart, maybe reading animal cues, maybe being able to read cars, maybe being a good hunter. I have no data for this.”

There is, in fact, little scientific dogma on cat navigation. Migratory animals like birds, turtles and insects have been studied more closely, and use magnetic fields, olfactory cues, or orientation by the sun.

Scientists say it is more common, although still rare, to hear of dogs returning home, perhaps suggesting, Dr. Bradshaw said, that they have inherited wolves’ ability to navigate using magnetic clues. But it’s also possible that dogs get taken on more family trips, and that lost dogs are more easily noticed or helped by people along the way.

Cats navigate well around familiar landscapes, memorizing locations by sight and smell, and easily figuring out shortcuts, Dr. Bradshaw said.

Strange, faraway locations would seem problematic, although he and Patrick Bateson, a behavioral biologist at Cambridge University, say that cats can sense smells across long distances. “Let’s say they associate the smell of pine with wind coming from the north, so they move in a southerly direction,” Dr. Bateson said.

Peter Borchelt, a New York animal behaviorist, wondered if Holly followed the Florida coast by sight or sound, tracking Interstate 95 and deciding to “keep that to the right and keep the ocean to the left.”

But, he said, “nobody’s going to do an experiment and take a bunch of cats in different directions and see which ones get home.”

The closest, said Roger Tabor, a British cat biologist, may have been a 1954 study in Germany which cats placed in a covered circular maze with exits every 15 degrees most often exited in the direction of their homes, but more reliably if their homes were less than five kilometers away.

New research by the National Geographic and University of Georgia’s Kitty Cams Project, using video footage from 55 pet cats wearing video cameras on their collars, suggests cat behavior is exceedingly complex.

For example, the Kitty Cams study found that four of the cats were two-timing their owners, visiting other homes for food and affection. Not every cat, it seems, shares Holly’s loyalty.

KittyCams also showed most of the cats engaging in risky behavior, including crossing roads and “eating and drinking substances away from home,” risks Holly undoubtedly experienced and seems lucky to have survived.

But there have been other cats who made unexpected comebacks.

“It’s actually happened to me,” said Jackson Galaxy, a cat behaviorist who hosts “My Cat From Hell” on Animal Planet. While living in Boulder, Colo., he moved across town, whereupon his indoor cat, Rabbi, fled and appeared 10 days later at the previous house, “walking five miles through an area he had never been before,” Mr. Galaxy said.

Professor Tabor cited longer-distance reports he considered credible: Murka, a tortoiseshell in Russia, traveling about 325 miles home to Moscow from her owner’s mother’s house in Voronezh in 1989; Ninja, who returned to Farmington, Utah, in 1997, a year after her family moved from there to Mill Creek, Wash.; and Howie, an indoor Persian cat in Australia who in 1978 ran away from relatives his vacationing family left him with and eventually traveled 1,000 miles to his family’s home.

Professor Tabor also said a Siamese in the English village of Black Notley repeatedly hopped a train, disembarked at White Notley, and walked several miles back to Black Notley.

Still, explaining such journeys is not black and white.

In the Florida case, one glimpse through the factual fog comes on the little cat’s feet. While Dr. Bradshaw speculated Holly might have gotten a lift, perhaps sneaking under the hood of a truck heading down I-95, her paws suggest she was not driven all the way, nor did Holly go lightly.

“Her pads on her feet were bleeding,” Ms. Richter said. “Her claws are worn weird. The front ones are really sharp, the back ones worn down to nothing.”

Scientists say that is consistent with a long walk, since back feet provide propulsion, while front claws engage in activities like tearing. The Richters also said Holly had gone from 13.5 to 7 pounds.

Holly hardly seemed an adventurous wanderer, though her background might have given her a genetic advantage. Her mother was a feral cat roaming the Richters’ mobile home park, and Holly was born inside somebody’s air-conditioner, Ms. Richter said. When, at about six weeks old, Holly padded into their carport and jumped into the lap of Mr. Richter’s mother, there were “scars on her belly from when the air conditioner was turned on,” Ms. Richter said.

Scientists say that such early experience was too brief to explain how Holly might have been comfortable in the wild — after all, she spent most of her life as an indoor cat, except for occasionally running outside to chase lizards. But it might imply innate personality traits like nimbleness or toughness.

“You’ve got these real variations in temperament,” Dr. Bekoff said. “Fish can by shy or bold; there seem to be shy and bold spiders. This cat, it could be she has the personality of a survivor.”

He said being an indoor cat would not extinguish survivalist behaviors, like hunting mice or being aware of the sun’s orientation.

The Richters — Bonnie, 63, a retired nurse, and Jacob, 70, a retired airline mechanics’ supervisor and accomplished bowler — began traveling with Holly only last year, and she easily tolerated a hotel, a cabin or the R.V.

But during the Good Sam R.V. Rally in Daytona, when they were camping near the speedway with 3,000 other motor homes, Holly bolted when Ms. Richter’s mother opened the door one night. Fireworks the next day may have further spooked her, and, after searching for days, alerting animal agencies and posting fliers, the Richters returned home catless.

Two weeks later, an animal rescue worker called the Richters to say a cat resembling Holly had been spotted eating behind the Daytona franchise of Hooters, where employees put out food for feral cats.

Then, on New Year’s Eve, Barb Mazzola, a 52-year-old university executive assistant, noticed a cat “barely standing” in her backyard in West Palm Beach, struggling even to meow. Over six days, Ms. Mazzola and her children cared for the cat, putting out food, including special milk for cats, and eventually the cat came inside.

They named her Cosette after the orphan in Les Misérables, and took her to a veterinarian, Dr. Sara Beg at Paws2Help. Dr. Beg said the cat was underweight and dehydrated, had “back claws and nail beds worn down, probably from all that walking on pavement,” but was “bright and alert” and had no parasites, heartworm or viruses. “She was hesitant and scared around people she didn’t know, so I don’t think she went up to people and got a lift,” Dr. Beg said. “I think she made the journey on her own.”

At Paws2Help, Ms. Mazzola said, “I almost didn’t want to ask, because I wanted to keep her, but I said, ‘Just check and make sure she doesn’t have a microchip.’” When told the cat did, “I just cried.”

The Richters cried, too upon seeing Holly, who instantly relaxed when placed on Mr. Richter’s shoulder. Re-entry is proceeding well, but the mystery persists.

“We haven’t the slightest idea how they do this,” Mr. Galaxy said. “Anybody who says they do is lying, and, if you find it, please God, tell me what it is.”

Read More..

Well: Holly the Cat's Incredible Journey

Nobody knows how it happened: an indoor housecat who got lost on a family excursion managing, after two months and about 200 miles, to return to her hometown.

Even scientists are baffled by how Holly, a 4-year-old tortoiseshell who in early November became separated from Jacob and Bonnie Richter at an R.V. rally in Daytona Beach, Fla., appeared on New Year’s Eve — staggering, weak and emaciated — in a backyard about a mile from the Richter’s house in West Palm Beach.

“Are you sure it’s the same cat?” wondered John Bradshaw, director of the University of Bristol’s Anthrozoology Institute. In other cases, he has suspected, “the cats are just strays, and the people have got kind of a mental justification for expecting it to be the same cat.”

But Holly not only had distinctive black-and-brown harlequin patterns on her fur, but also an implanted microchip to identify her.

“I really believe these stories, but they’re just hard to explain,” said Marc Bekoff, a behavioral ecologist at the University of Colorado. “Maybe being street-smart, maybe reading animal cues, maybe being able to read cars, maybe being a good hunter. I have no data for this.”

There is, in fact, little scientific dogma on cat navigation. Migratory animals like birds, turtles and insects have been studied more closely, and use magnetic fields, olfactory cues, or orientation by the sun.

Scientists say it is more common, although still rare, to hear of dogs returning home, perhaps suggesting, Dr. Bradshaw said, that they have inherited wolves’ ability to navigate using magnetic clues. But it’s also possible that dogs get taken on more family trips, and that lost dogs are more easily noticed or helped by people along the way.

Cats navigate well around familiar landscapes, memorizing locations by sight and smell, and easily figuring out shortcuts, Dr. Bradshaw said.

Strange, faraway locations would seem problematic, although he and Patrick Bateson, a behavioral biologist at Cambridge University, say that cats can sense smells across long distances. “Let’s say they associate the smell of pine with wind coming from the north, so they move in a southerly direction,” Dr. Bateson said.

Peter Borchelt, a New York animal behaviorist, wondered if Holly followed the Florida coast by sight or sound, tracking Interstate 95 and deciding to “keep that to the right and keep the ocean to the left.”

But, he said, “nobody’s going to do an experiment and take a bunch of cats in different directions and see which ones get home.”

The closest, said Roger Tabor, a British cat biologist, may have been a 1954 study in Germany which cats placed in a covered circular maze with exits every 15 degrees most often exited in the direction of their homes, but more reliably if their homes were less than five kilometers away.

New research by the National Geographic and University of Georgia’s Kitty Cams Project, using video footage from 55 pet cats wearing video cameras on their collars, suggests cat behavior is exceedingly complex.

For example, the Kitty Cams study found that four of the cats were two-timing their owners, visiting other homes for food and affection. Not every cat, it seems, shares Holly’s loyalty.

KittyCams also showed most of the cats engaging in risky behavior, including crossing roads and “eating and drinking substances away from home,” risks Holly undoubtedly experienced and seems lucky to have survived.

But there have been other cats who made unexpected comebacks.

“It’s actually happened to me,” said Jackson Galaxy, a cat behaviorist who hosts “My Cat From Hell” on Animal Planet. While living in Boulder, Colo., he moved across town, whereupon his indoor cat, Rabbi, fled and appeared 10 days later at the previous house, “walking five miles through an area he had never been before,” Mr. Galaxy said.

Professor Tabor cited longer-distance reports he considered credible: Murka, a tortoiseshell in Russia, traveling about 325 miles home to Moscow from her owner’s mother’s house in Voronezh in 1989; Ninja, who returned to Farmington, Utah, in 1997, a year after her family moved from there to Mill Creek, Wash.; and Howie, an indoor Persian cat in Australia who in 1978 ran away from relatives his vacationing family left him with and eventually traveled 1,000 miles to his family’s home.

Professor Tabor also said a Siamese in the English village of Black Notley repeatedly hopped a train, disembarked at White Notley, and walked several miles back to Black Notley.

Still, explaining such journeys is not black and white.

In the Florida case, one glimpse through the factual fog comes on the little cat’s feet. While Dr. Bradshaw speculated Holly might have gotten a lift, perhaps sneaking under the hood of a truck heading down I-95, her paws suggest she was not driven all the way, nor did Holly go lightly.

“Her pads on her feet were bleeding,” Ms. Richter said. “Her claws are worn weird. The front ones are really sharp, the back ones worn down to nothing.”

Scientists say that is consistent with a long walk, since back feet provide propulsion, while front claws engage in activities like tearing. The Richters also said Holly had gone from 13.5 to 7 pounds.

Holly hardly seemed an adventurous wanderer, though her background might have given her a genetic advantage. Her mother was a feral cat roaming the Richters’ mobile home park, and Holly was born inside somebody’s air-conditioner, Ms. Richter said. When, at about six weeks old, Holly padded into their carport and jumped into the lap of Mr. Richter’s mother, there were “scars on her belly from when the air conditioner was turned on,” Ms. Richter said.

Scientists say that such early experience was too brief to explain how Holly might have been comfortable in the wild — after all, she spent most of her life as an indoor cat, except for occasionally running outside to chase lizards. But it might imply innate personality traits like nimbleness or toughness.

“You’ve got these real variations in temperament,” Dr. Bekoff said. “Fish can by shy or bold; there seem to be shy and bold spiders. This cat, it could be she has the personality of a survivor.”

He said being an indoor cat would not extinguish survivalist behaviors, like hunting mice or being aware of the sun’s orientation.

The Richters — Bonnie, 63, a retired nurse, and Jacob, 70, a retired airline mechanics’ supervisor and accomplished bowler — began traveling with Holly only last year, and she easily tolerated a hotel, a cabin or the R.V.

But during the Good Sam R.V. Rally in Daytona, when they were camping near the speedway with 3,000 other motor homes, Holly bolted when Ms. Richter’s mother opened the door one night. Fireworks the next day may have further spooked her, and, after searching for days, alerting animal agencies and posting fliers, the Richters returned home catless.

Two weeks later, an animal rescue worker called the Richters to say a cat resembling Holly had been spotted eating behind the Daytona franchise of Hooters, where employees put out food for feral cats.

Then, on New Year’s Eve, Barb Mazzola, a 52-year-old university executive assistant, noticed a cat “barely standing” in her backyard in West Palm Beach, struggling even to meow. Over six days, Ms. Mazzola and her children cared for the cat, putting out food, including special milk for cats, and eventually the cat came inside.

They named her Cosette after the orphan in Les Misérables, and took her to a veterinarian, Dr. Sara Beg at Paws2Help. Dr. Beg said the cat was underweight and dehydrated, had “back claws and nail beds worn down, probably from all that walking on pavement,” but was “bright and alert” and had no parasites, heartworm or viruses. “She was hesitant and scared around people she didn’t know, so I don’t think she went up to people and got a lift,” Dr. Beg said. “I think she made the journey on her own.”

At Paws2Help, Ms. Mazzola said, “I almost didn’t want to ask, because I wanted to keep her, but I said, ‘Just check and make sure she doesn’t have a microchip.’” When told the cat did, “I just cried.”

The Richters cried, too upon seeing Holly, who instantly relaxed when placed on Mr. Richter’s shoulder. Re-entry is proceeding well, but the mystery persists.

“We haven’t the slightest idea how they do this,” Mr. Galaxy said. “Anybody who says they do is lying, and, if you find it, please God, tell me what it is.”

Read More..

Jeffrey Sprecher’s Improbable Path to Buying the N.Y.S.E.





WHEN nearly all else had failed, Jeffrey C. Sprecher flew to New York City and crashed at his sisters’ apartment, a cramped walk-up on the Upper West Side, one flight above a noisy bar.




It was January 2000, and Mr. Sprecher had been cold-calling Wall Street for weeks. He was searching desperately for someone to back his small company in Atlanta, a business that was eating up his money and years of his life.


That’s when a black limousine pulled up in front of the bar, Jake’s Dilemma. The limo had been sent by the mighty Goldman Sachs to fetch Mr. Sprecher, and as he sank into the back seat that winter day, he set off on an improbable journey that has since taken him to the pinnacle of American finance.


Today Mr. Sprecher, a man virtually unknown outside of financial circles, is poised to buy the New York Stock Exchange. Not one of the 2,300 or so stocks traded on the New York Stock Exchange (combined value of those shares: about $20.1 trillion). No, Jeff Sprecher is buying the entire New York Stock Exchange.


It sounds preposterous. A businessman from Atlanta blows into New York and walks off with the colonnaded high temple of American capitalism. But if all goes according to plan, his $8.2 billion acquisition, announced a few days before Christmas, will close later this year. And with that, 221 years of Wall Street history will come to an end. No more will New York be the master of the New York Stock Exchange. Instead, from its bland headquarters 750 miles from Wall Street, Mr. Sprecher’s young company, IntercontinentalExchange, will run the largest stock exchange in the nation and the world.


Mr. Sprecher, 57, certainly plays the role of a wily upstart. He may wear power suits and a Patek Philippe watch, but he comes across as unusually casual and self-deprecating for a man in his position. He pokes fun at himself for his shortcomings — “I don’t know how to manage people,” he says — and his love of obscure documentaries.


How the New York Stock Exchange fell into Mr. Sprecher’s hands is, at heart, a story of the disruptive power of innovation. ICE, as IntercontinentalExchange is known, did not even exist 13 years ago. It has no cavernous trading floor, no gilded halls, no sweaty brokers braying for money on the financial markets. What it has is technology.


Like many young companies that are upending the old order in business, ICE has used computer power to do things faster and cheaper, if not always better, than people can. Its rapid ascent reflects a new Wall Street where high-speed computers now dominate trading, sometimes with alarming consequences. New, electronic trading systems have greatly reduced the cost of buying and selling stocks, thus saving mutual funds — and, by extension, ordinary investors — countless millions. But they have also helped usher in a period of hair-raising volatility.


Mr. Sprecher (pronounced SPRECK-er) has probably done more than anyone else to dismantle the trading floors of old and replace human brokers with machines. Along the way, he and ICE have traced an arc through some of the defining business stories of our time — from the rise and fall of Enron, to the transformation of old-school investment banks into vast trading operations, to the Wall Street excesses that not long ago helped derail the entire economy. Now, after a series of bold acquisitions, he is about to become the big boss of the Big Board.


Does it really matter who owns the New York Stock Exchange and its parent company, NYSE Euronext? For most people, stock exchanges are probably a bit like plumbing. Most of us don’t think much about them — until something goes wrong. But lately, some things have gone spectacularly wrong.


One sign of trouble came in 2010, when an errant trade ricocheted through computer networks and touched off one of the most harrowing moments in stock market history. The Dow Jones industrial average plunged 900 points in a matter of minutes, and a new phrase entered the lexicon: flash crash.


Since then, flash crashes in individual stocks have been remarkably common, as the centuries-old system of central exchanges has given way to a field of competing electronic systems.


ICE wasn’t involved in any of these problems. In fact, it has been praised as one of the first exchanges to put limits on lightning-quick, high-frequency trading. This points to Mr. Sprecher’s deftness in piloting his company through periods of regulation, deregulation and now re-regulation.


While many banking executives have clashed with Washington, Mr. Sprecher has sensed the changing winds and tacked accordingly. He also stays close — some say too close — to the powerful Wall Street firms that are his customers.


It is perhaps unsurprising that some of the people who make their living on the Big Board’s floor are a bit nervous about the exchange’s new boss. But Mr. Sprecher says they have nothing to fear. His friends and business associates say he could actually turn out to be the best hope for restoring trust in the stock market. After all, he has beaten the odds before.


“There were a number of times when the odds were long, but he wasn’t deterred from stepping in,” says James Newsome, who was Mr. Sprecher’s regulator at the Commodity Futures Trading Commission before becoming his competitor as chief executive of the New York Mercantile Exchange. “A lot of people, if they don’t think they will win, they won’t participate. Jeff doesn’t operate like that.”


For now, Mr. Sprecher is still spending much of his time at ICE’s headquarters in suburban Atlanta. The contrast with the New York Stock Exchange is striking. Behind its neoclassical face, the Big Board is a sprawling labyrinth of historic oil paintings, gilded leather chairs, stained wood and elegant dining rooms — all set amid crowds of gawking tourists.


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Priest Is Planning to Defy the Vatican’s Orders to Stay Quiet


Jekaterina Saveljeva for The New York Times


The Rev. Tony Flannery, an Irish priest, was suspended by the Vatican last year. “I refuse to be terrified into submission,” he said.







DUBLIN — A well-known Irish Catholic priest plans to defy Vatican authorities on Sunday by breaking his silence about what he says is a campaign against him by the church over his advocacy of more open discussion on church teachings.




The Rev. Tony Flannery, 66, who was suspended by the Vatican last year, said he was told by the Vatican that he would be allowed to return to ministry only if he agreed to write, sign and publish a statement agreeing, among other things, that women should never be ordained as priests and that he would adhere to church orthodoxy on matters like contraception and homosexuality.


“How can I put my name to such a document when it goes against everything I believe in,” he said in an interview on Wednesday. “If I signed this, it would be a betrayal not only of myself but of my fellow priests and lay Catholics who want change. I refuse to be terrified into submission.”


Father Flannery, a regular contributor to religious publications, said he planned to make his case public at a news conference here on Sunday.


The Vatican’s doctrinal office, the Congregation for the Doctrine of the Faith, wrote to Father Flannery’s religious superior, the Rev. Michael Brehl, last year instructing him to remove Father Flannery from his ministry in County Galway, to ensure he did not publish any more articles in religious or other publications, and to tell him not to give interviews to the news media.


In the letter, the Vatican objected in particular to an article published in 2010 in Reality, an Irish religious magazine. In the article, Father Flannery, a Redemptorist priest, wrote that he no longer believed that “the priesthood as we currently have it in the church originated with Jesus” or that he designated “a special group of his followers as priests.”


Instead, he wrote, “It is more likely that some time after Jesus, a select and privileged group within the community who had abrogated power and authority to themselves, interpreted the occasion of the Last Supper in a manner that suited their own agenda.”


Father Flannery said the Vatican wanted him specifically to recant the statement, and affirm that Christ instituted the church with a permanent hierarchical structure and that bishops are divinely established successors to the apostles.


He believes the church’s treatment of him, which he described as a “Spanish Inquisition-style campaign,” is symptomatic of a definite conservative shift under Pope Benedict XVI.


“I have been writing thought-provoking articles and books for decades without hindrance,” he said. “This campaign is being orchestrated by a secretive body that refuses to meet me. Surely I should at least be allowed to explain my views to my accusers.”


His superior was also told to order Father Flannery to withdraw from his leadership role in the Association of Catholic Priests, a group formed in 2009 to articulate the views of rank-and-file members of the clergy.


In reply to an association statement expressing solidarity with Father Flannery, the Congregation for the Doctrine of the Faith denied it was acting in a secretive manner, pointed out that Father Flannery’s views could be construed as “heresy” under church law, and threatened “canonical penalties,” including excommunication, if he did not change his views.


This month, the Congregation for the Doctrine of the Faith wrote to an American priest, Roy Bourgeois, notifying him of his laicization, following his excommunication in 2008 over his support for the ordination of women.


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Analysis: Amid Tears Lance Armstrong Leaves Unanswered Questions in Oprah Winfrey Interview





In an extensive interview with Oprah Winfrey that was shown over two nights, Lance Armstrong admitted publicly for the first time that he doped throughout his cycling career. He revealed that all seven of his Tour de France victories were fueled by doping, that he never felt bad about cheating, and that he had covered up a positive drug test at the 1999 Tour with a backdated doctor’s prescription for banned cortisone.




Armstrong, the once defiant cyclist, also became choked up when he discussed how he told his oldest child that the rumors about Armstrong’s doping were true.


Even with all that, the interview will most likely be remembered for what it was missing.


Armstrong had not subjected himself to questioning from anyone in the news media since United States antidoping officials laid out their case against him in October. He chose not to appeal their ruling, leaving him with a lifetime ban from Olympic sports.


He personally chose Winfrey for his big reveal, and it went predictably. Winfrey allowed him to share his thoughts and elicited emotions from him, but she consistently failed to ask critical follow-up questions that would have addressed the most vexing aspects of Armstrong’s deception.


She did not press him on who helped him dope or cover up his drug use for more than a decade. Nor did she ask him why he chose to take banned performance-enhancing substances even after cancer had threatened his life.


Winfrey also did not push him to answer whether he had admitted to doctors in an Indianapolis hospital in 1996 that he had used performance-enhancing drugs, a confession a former teammate and his wife claimed they overheard that day. To get to the bottom of his deceit, antidoping officials said, Armstrong has to be willing to provide more details.


“He spoke to a talk-show host,” David Howman, the director general of the World Anti-Doping Agency, said from Montreal on Friday. “I don’t think any of it amounted to assistance to the antidoping community, let alone substantial assistance. You bundle it all up and say, ‘So what?’


Jeffrey M. Tillotson, the lawyer for an insurance company that unsuccessfully withheld a $5 million bonus from Armstrong on the basis that he had cheated to win the Tour de France in 2004, said his client would make a decision over the weekend about whether to sue Armstrong. If it proceeds, the company, SCA Promotions, will seek $12 million, the total it paid Armstrong in bonuses and legal fees.


“It seemed to us that he was more sorry that he had been caught than for what he had done,” Tillotson said. “If he’s serious about rehabbing himself, he needs to start making amends to the people he bullied and vilified, and he needs to start paying money back.”


Armstrong, who said he once believed himself to be invincible, explained in the portion of the interview broadcast Friday night that he started to take steps toward redemption last month. Then, after dozens of questions had already been lobbed his way, he became emotional when he described how he told his 13-year-old son, Luke, that yes, his father had cheated by doping. That talk happened last month over the holidays, Armstrong said as he fought back tears.


“I said, listen, there’s been a lot of questions about your dad, my career, whether I doped or did not dope, and I’ve always denied, I’ve always been ruthless and defiant about that, which is probably why you trusted me, which makes it even sicker,” Armstrong said he told his son, the oldest of his five children. “I want you to know it’s true.”


At times, Winfrey’s interview seemed more like a therapy session than an inquisition, with Armstrong admitting that he was narcissistic and had been in therapy — and that he should be in therapy regularly because his life was so complicated.


In the end, the interview most likely accomplished what Armstrong had hoped: it was the vehicle through which he admitted to the public that he had cheated by doping, which he had lied about for more than a decade. But his answers were just the first step to clawing back his once stellar reputation.


On Friday, Armstrong appeared more contrite than he had during the part of the interview that was shown Thursday, yet he still insisted that he was clean when he made his comeback to cycling in 2009 after a brief retirement, an assertion the United States Anti-Doping Agency said was untrue. He also implied that his lifetime ban from all Olympic sports was unfair because some of his former teammates who testified about their doping and the doping on Armstrong’s teams received only six-month bans.


Richard Pound, the founding chairman of WADA and a member of the International Olympic Committee, said he was unmoved by Armstrong’s televised mea culpa.


“If what he’s looking for is some kind of reconstruction of his image, instead of providing entertainment with Oprah Winfrey, he’s got a long way to go,” Pound said Friday from his Montreal office.


Armstrong acknowledged to Winfrey during Friday’s broadcast that he has a long way to go before winning back the public’s trust. He said he understood why people recently turned on him because they felt angry and betrayed.


“I lied to you and I’m sorry,” he said before acknowledging that he might have lost many of his supporters for good. “I am committed to spending as long as I have to to make amends, knowing full well that I won’t get very many back.”


Armstrong also said that the scandal has cost him $75 million in lost sponsors, all of whom abandoned him last fall after Usada made public 1,000 pages of evidence that Armstrong had doped.


“In a way, I just assumed we would get to that point,” he said of his sponsors’ leaving. “The story was getting out of control.”


In closing her interview, Winfrey asked Armstrong a question that left him perplexed.


“Will you rise again?” she said.


Armstrong said: “I don’t know. I don’t know. I don’t know what’s out there.”


Then, as the interview drew to a close, Armstrong said: “The ultimate crime is the betrayal of these people that supported me and believed in me.”


Read More..

Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


Read More..

Business Briefing | Medicine: F.D.A. Clears Botox to Help Bladder Control



Botox, the wrinkle treatment made by Allergan, has been approved to treat adults with overactive bladders who cannot tolerate or were not helped by other drugs, the Food and Drug Administration said on Friday. Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity. “Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence,” Dr. Hylton V. Joffe, director of the F.D.A.’s reproductive and urologic products division, said in a statement. “Today’s approval provides an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.”


Read More..

With Graph Search, Facebook Bets on More Sharing


SAN FRANCISCO — Facebook’s greatest triumph has been to persuade a seventh of the world’s population to share their personal lives online.


Now the social network is taking on its archrival, Google, with a search tool to mine that personal information, just as people are growing more cautious about sharing on the Internet and even occasionally removing what they have already put up.


Whether Facebook’s more than one billion users will continue to divulge even more private details will determine whether so-called social search is the next step in how we navigate the online world. It will also determine whether Facebook has found a business model that will make it a lot of money.


“There’s a big potential upside for both Facebook and users, but getting people to change their behaviors in relation to what they share will not be easy,” said Andrew T. Stephen, who teaches marketing at the University of Pittsburgh and studies consumer behavior on online social networks.


This week, Facebook unveiled its search tool, which it calls graph search, a reference to the network of friends its users have created. The company’s algorithms will filter search results for each person, ranking the friends and brands that it thinks a user would trust the most. At first, it will mine users’ interests, photos, check-ins and “likes,” but later it will search through other information, including status updates.


“While the usefulness of graph search increases as people share more about their favorite restaurants, music and other interests, the product doesn’t hinge on this,” a Facebook spokesman, Jonathan Thaw, said.


Nevertheless, the company engineers who created the tool — former Google employees — say that the project will not reach its full potential if Facebook data is “sparse,” as they call it. But the company is confident people will share more data, be it the movies they watch, the dentists they trust or the meals that make their mouths water.


The things people declare on Facebook will be useful, when someone searches for those interests, Tom Stocky, one of the creators of Facebook search, said in an interview this week. Conversely, by liking more things, he said, people will become more useful in the eyes of their friends.


“You might be inclined to ‘like’ what you like so when your friends search, they’ll find it,” he said. “I probably would never have liked my dentist on Facebook before, but now I do because it’s a way of letting my friends know.”


Mr. Stocky offered these examples of how more information may be desirable: A single man may want to be discovered when a friend of a friend is searching for eligible bachelors in San Francisco or a restaurant that stays open late may want to be found by a night owl.


“People have shared all this great stuff on Facebook,” Mr. Stocky said. “It’s latent value. We wanted a way to unlock that.”


Independent studies suggest that Facebook users are becoming more careful about how much they reveal online, especially since educators and employers typically scour Facebook profiles.


A Northwestern University survey of 500 young adults in the summer of 2012 found that the majority avoided posting status updates because they were concerned about who would see them. The study also found that many had deleted or blocked contacts from seeing their profiles and nearly two-thirds had untagged themselves from a photo, post or check-in.


“These behavioral patterns seem to suggest that many young adults are less keen on sharing at least certain details about their lives rather than more,” said Eszter Hargittai, an associate professor of communication studies at Northwestern, who led the yet unpublished study among men and women aged 21 and 22.


Also last year, the Pew Internet Center found that social network users, including those on Facebook, were more aggressively pruning their profiles — untagging photos, removing friends and deleting comments.


Read More..

Analysis: Amid Tears Lance Armstrong Leaves Unanswered Questions in Oprah Winfrey Interview





In an extensive interview with Oprah Winfrey that was shown over two nights, Lance Armstrong admitted publicly for the first time that he doped throughout his cycling career. He revealed that all seven of his Tour de France victories were fueled by doping, that he never felt bad about cheating, and that he had covered up a positive drug test at the 1999 Tour with a backdated doctor’s prescription for banned cortisone.




Armstrong, the once defiant cyclist, also became choked up when he discussed how he told his oldest child that the rumors about Armstrong’s doping were true.


Even with all that, the interview will most likely be remembered for what it was missing.


Armstrong had not subjected himself to questioning from anyone in the news media since United States antidoping officials laid out their case against him in October. He chose not to appeal their ruling, leaving him with a lifetime ban from Olympic sports.


He personally chose Winfrey for his big reveal, and it went predictably. Winfrey allowed him to share his thoughts and elicited emotions from him, but she consistently failed to ask critical follow-up questions that would have addressed the most vexing aspects of Armstrong’s deception.


She did not press him on who helped him dope or cover up his drug use for more than a decade. Nor did she ask him why he chose to take banned performance-enhancing substances even after cancer had threatened his life.


Winfrey also did not push him to answer whether he had admitted to doctors in an Indianapolis hospital in 1996 that he had used performance-enhancing drugs, a confession a former teammate and his wife claimed they overheard that day. To get to the bottom of his deceit, antidoping officials said, Armstrong has to be willing to provide more details.


“He spoke to a talk-show host,” David Howman, the director general of the World Anti-Doping Agency, said from Montreal on Friday. “I don’t think any of it amounted to assistance to the antidoping community, let alone substantial assistance. You bundle it all up and say, ‘So what?’


Jeffrey M. Tillotson, the lawyer for an insurance company that unsuccessfully withheld a $5 million bonus from Armstrong on the basis that he had cheated to win the Tour de France in 2004, said his client would make a decision over the weekend about whether to sue Armstrong. If it proceeds, the company, SCA Promotions, will seek $12 million, the total it paid Armstrong in bonuses and legal fees.


“It seemed to us that he was more sorry that he had been caught than for what he had done,” Tillotson said. “If he’s serious about rehabbing himself, he needs to start making amends to the people he bullied and vilified, and he needs to start paying money back.”


Armstrong, who said he once believed himself to be invincible, explained in the portion of the interview broadcast Friday night that he started to take steps toward redemption last month. Then, after dozens of questions had already been lobbed his way, he became emotional when he described how he told his 13-year-old son, Luke, that yes, his father had cheated by doping. That talk happened last month over the holidays, Armstrong said as he fought back tears.


“I said, listen, there’s been a lot of questions about your dad, my career, whether I doped or did not dope, and I’ve always denied, I’ve always been ruthless and defiant about that, which is probably why you trusted me, which makes it even sicker,” Armstrong said he told his son, the oldest of his five children. “I want you to know it’s true.”


At times, Winfrey’s interview seemed more like a therapy session than an inquisition, with Armstrong admitting that he was narcissistic and had been in therapy — and that he should be in therapy regularly because his life was so complicated.


In the end, the interview most likely accomplished what Armstrong had hoped: it was the vehicle through which he admitted to the public that he had cheated by doping, which he had lied about for more than a decade. But his answers were just the first step to clawing back his once stellar reputation.


On Friday, Armstrong appeared more contrite than he had during the part of the interview that was shown Thursday, yet he still insisted that he was clean when he made his comeback to cycling in 2009 after a brief retirement, an assertion the United States Anti-Doping Agency said was untrue. He also implied that his lifetime ban from all Olympic sports was unfair because some of his former teammates who testified about their doping and the doping on Armstrong’s teams received only six-month bans.


Richard Pound, the founding chairman of WADA and a member of the International Olympic Committee, said he was unmoved by Armstrong’s televised mea culpa.


“If what he’s looking for is some kind of reconstruction of his image, instead of providing entertainment with Oprah Winfrey, he’s got a long way to go,” Pound said Friday from his Montreal office.


Armstrong acknowledged to Winfrey during Friday’s broadcast that he has a long way to go before winning back the public’s trust. He said he understood why people recently turned on him because they felt angry and betrayed.


“I lied to you and I’m sorry,” he said before acknowledging that he might have lost many of his supporters for good. “I am committed to spending as long as I have to to make amends, knowing full well that I won’t get very many back.”


Armstrong also said that the scandal has cost him $75 million in lost sponsors, all of whom abandoned him last fall after Usada made public 1,000 pages of evidence that Armstrong had doped.


“In a way, I just assumed we would get to that point,” he said of his sponsors’ leaving. “The story was getting out of control.”


In closing her interview, Winfrey asked Armstrong a question that left him perplexed.


“Will you rise again?” she said.


Armstrong said: “I don’t know. I don’t know. I don’t know what’s out there.”


Then, as the interview drew to a close, Armstrong said: “The ultimate crime is the betrayal of these people that supported me and believed in me.”


Read More..

DealBook: Michael Dell’s Empire in a Buyout Spotlight

The computer empire of Michael S. Dell spreads across a campus of low-slung buildings in Round Rock, Tex.

But his financial empire — estimated at $16 billion — occupies the 21st floor of a dark glass skyscraper on Fifth Avenue in Manhattan.

It is there that MSD Capital, started by Mr. Dell 15 years ago to manage his fortune, has quietly built a reputation as one of the smartest investors on Wall Street. By amassing a prodigious portfolio of stocks, companies, real estate and timberland, Mr. Dell has reduced his exposure to the volatile technology sector and branched out into businesses as diverse as dentistry and landscaping.

Now, Mr. Dell is on the verge of making one of the biggest investments of his life. The 47-year-old billionaire and his private equity backers are locked in talks to acquire Dell, the company he started with $1,000 as a teenager three decades ago, in a leveraged buyout worth more than $20 billion. MSD could play a role in the Dell takeover, according to people briefed on the deal.

The private equity firm Silver Lake has been in negotiations to join with Mr. Dell on a transaction, along with other potential partners like wealthy Asian investors or foreign funds. Mr. Dell would be expected to roll his nearly 16 percent ownership of the company into the buyout, a stake valued at about $3.5 billion. He could also contribute additional personal money as part of the buyout.

That money is managed by MSD, among the more prominent so-called family offices that are set up to handle the personal investments of the wealthy. Others with large family offices include Bill Gates, whose Microsoft wealth financed the firm Cascade Investment, and New York’s mayor, Michael R. Bloomberg, who set up his firm, Willett Advisors, in 2010 to manage his personal and philanthropic assets.

“Some of these family offices are among the world’s most sophisticated investors and have the capital and talent to compete with the largest private equity firms and hedge funds,” said John P. Rompon, managing partner of McNally Capital, which helps structure private equity deals for family offices.

A spokesman for MSD declined to comment for this article. The buyout talks could still fall apart.

In 1998, Mr. Dell, then just 33 years old — and his company’s stock worth three times what it is today — decided to diversify his wealth and set up MSD. He staked the firm with $400 million of his own money, effectively starting his own personal money-management business.

To head the operation, Mr. Dell hired Glenn R. Fuhrman, a managing director at Goldman Sachs, and John C. Phelan, a principal at ESL Investments, the hedge fund run by Edward S. Lampert. He knew both men from his previous dealings with Wall Street. Mr. Fuhrman led a group at Goldman that marketed specialized investments like private equity and real estate to wealthy families like the Dells. And Mr. Dell was an early investor in Mr. Lampert’s fund.

Mr. Fuhrman and Mr. Phelan still run MSD and preside over a staff of more than 100 overseeing Mr. Dell’s billions and the assets in his family foundation. MSD investments include a stock portfolio, with positions in the apparel company PVH, owner of the Calvin Klein and Tommy Hilfiger brands, and DineEquity, the parent of IHOP and Applebee’s.

Among its real estate holdings are the Four Seasons Resort Maui in Hawaii and a stake in the New York-based developer Related Companies.

MSD also has investments in several private businesses, including ValleyCrest, which bills itself as the country’s largest landscape design company, and DentalOne Partners, a collection of dental practices.

Perhaps MSD’s most prominent deal came in 2008, in the middle of the financial crisis, when it joined a consortium that acquired the assets of the collapsed mortgage lender IndyMac Bank from the federal government for about $13.9 billion and renamed it OneWest Bank.

The OneWest purchase has been wildly successful. Steven Mnuchin, a former Goldman executive who led the OneWest deal, has said that the bank is expected to consider an initial public offering this year. An I.P.O. would generate big profits for Mr. Dell and his co-investors, according to people briefed on the deal.

Another arm of MSD makes select investments in outside hedge funds. Mr. Dell invested in the first fund raised by Silver Lake, the technology-focused private equity firm that might now become his partner in taking Dell private.
MSD’s principals have already made tidy fortunes. In 2009, Mr. Fuhrman, 47, paid $26 million for the Park Avenue apartment of the former Lehman Brothers chief executive Richard S. Fuld. Mr. Phelan, 48, and his wife, Amy, a former Dallas Cowboys cheerleader, also live in a Park Avenue co-op and built a home in Aspen, Colo.

Both are influential players on the contemporary art scene, with ARTNews magazine last year naming each of them among the world’s top 200 collectors. MSD, too, has dabbled in the visual arts. In 2010, MSD bought an archive of vintage photos from Magnum, including portraits of Marilyn Monroe and Mahatma Gandhi, and has put the collection on display at the University of Texas, Mr. Dell’s alma mater.

Just as the investment firms Rockefeller & Company (the Rockefellers, diversifying their oil fortune) and Bessemer Trust (the Phippses, using the name of the steelmaking process that formed the basis of their wealth) started out as investment vehicles for a single family, MSD has recently shown signs of morphing into a traditional money management business with clients beside Mr. Dell.

Last year, for the fourth time, an MSD affiliate raised money from outside investors when it collected about $1 billion for a stock-focused hedge fund, MSD Torchlight Partners. A 2010 fund investing in distressed European assets also manages about $1 billion. The Dell family is the anchor investor in each of the funds, according to people briefed on the investments.

MSD has largely remained below the radar, though its name emerged a decade ago in the criminal trial of the technology banker Frank Quattrone on obstruction of justice charges. Prosecutors introduced an e-mail that Mr. Fuhrman sent to Mr. Quattrone during the peak of the dot-com boom in which he pleaded for a large allotment of a popular Internet initial public offering.

“We know this is a tough one, but we wanted to ask for a little help with our Corvis allocation,” Mr. Fuhrman wrote. “We are looking forward to making you our ‘go to’ banker.”

The e-mail, which was not illegal, was meant to show the quid pro quo deals that were believed to have been struck between Mr. Quattrone and corporate chieftains like Mr. Dell — the bankers would give executives hot I.P.O.’s and the executives, in exchange, would hold out the possibility of giving business to the bankers. (Mr. Quattrone’s conviction was reversed on appeal.)

The MSD team has also shown itself to be loyal to its patron in other ways.

On the MSD Web site, in the frequently asked questions section, the firm asks and answers queries like “how many employees do you have” and “what kind of investments do you make.”

In the last question on the list, MSD asks itself, “Do you use Dell computer equipment?” The answer: “Exclusively!”


This post has been revised to reflect the following correction:

Correction: January 18, 2013

An earlier version of this article misstated when an MSD affiliate raised money from outside investors for a hedge fund. It was last year, not earlier this year. The article also misstated which hedge fund and its focus. It was MSD Torchlight Partners, a stock-focused hedge fund, not MSD Energy Partners, an energy-focused hedge fund.

Read More..

Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

Read More..

Well: The Fallout of a Chance Medical Finding

An incidental finding — I was convinced of it. My patient had undergone a CT scan of the abdomen at another hospital because of stomach pains and “incidentally noted” was a 2-centimeter mass in her adrenal gland. She brought in the report for me to see, nervous that she might have cancer.

I reassured her that it was exceedingly unlikely that she had cancer. Benign masses in the adrenal gland are nearly as common as birthmarks. They almost never cause symptoms and we stumble across them only because we do so many scans for other reasons. They’ve even earned their own appellation: incidentalomas, and that’s what I was sure she had.

Of course a tiny fraction — 1 to 2 percent — of these adrenal masses can wreak havoc by churning out an excess of adrenal hormones or by being cancerous. Luckily, the mass on my patient’s scan possessed all the reassuring characteristics of benignity: it was small, low-attenuating, well circumscribed, with smooth borders. And she had no symptoms to suggest adrenal hyperactivity or cancer. It was most likely a benign adrenal adenoma that would never cause her harm.

Nevertheless, once the incidentaloma had been given life, so to speak, it was no longer incidental. We were now obliged to run some highly complicated — and expensive — lab tests. I winced as I ordered urinary metanephrines to test the adrenaline-producing capacity of the adrenal. The computer warned me with exclamation points and asterisks that this was a “greater-than-$100-send-out test.” Explaining how to correctly collect a 24-hour urine sample was its own involved discussion. Then I had to explain the even more complicated logistics of the overnight dexamethasone-suppression test to evaluate the cortisol-producing capacity of the adrenal.

After that, I considered the follow-up CT scans, recommended at six months, one year and two years, to ensure that the mass wasn’t growing. What about all that radiation? One group of endocrinologists estimated that the chance of uncovering a malignant cancer in patients like mine was roughly equal to the chance of causing a fatal cancer from the radiation of these follow-up CT scans. And might these CT scans pick up other incidental findings, opening yet more Pandora’s boxes of medical evaluation?

And what about the issue of skyrocketing medical costs? The evaluation of this incidentaloma was going to cost more than a thousand dollars. Tens of millions of CT scans are done every year in the United States. It doesn’t take many back-of-the-envelope calculations to see how quickly the costs of incidental findings, and their subsequent evaluations, add up. How much should the societal obligation weigh into the decisions for my patient?

My thoughts flitted back to the doctor who had ordered this CT in the first place. Perhaps if the doctor had had more time to spend on the history and physical, the CT would not have been necessary. From my 15 years with this patient, I knew that her symptoms could be voluminous in quantity and quality. This wasn’t to say that something serious couldn’t squeak in, but over the years I have learned that it takes immense perseverance and patience to tease out the significance of each symptom. Otherwise we’d be doing a CT every week for her.

But I could understand how a doctor in a busy ER on a weekend might have been overwhelmed by the plethora of symptoms and simply ordered a CT “to be on the safe side.” I wished that doctor had tried to call me before ordering the scan, but what’s done was done. The fallout of that decision was now in my lap.

By now we had run well over our allotted time and my patient was utterly overwhelmed by the complex testing procedures and schedules. The adrenal mass was an incidental finding, after all, but it had completely steamrolled our visit. My patient’s diabetes, obesity, depression, arthritis and elevated cholesterol all ended up with the short end of the clinical stick — an outcome that surely is not incidental to her health.


Danielle Ofri is an associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review. Her most recent book is “Medicine in Translation: Journeys With My Patients.”

Read More..

DealBook: Michael Dell’s Empire in a Buyout Spotlight

The computer empire of Michael S. Dell spreads across a campus of low-slung buildings in Round Rock, Tex.

But his financial empire — estimated at $16 billion — occupies the 21st floor of a dark glass skyscraper on Fifth Avenue in Manhattan.

It is there that MSD Capital, started by Mr. Dell 15 years ago to manage his fortune, has quietly built a reputation as one of the smartest investors on Wall Street. By amassing a prodigious portfolio of stocks, companies, real estate and timberland, Mr. Dell has reduced his exposure to the volatile technology sector and branched out into businesses as diverse as dentistry and landscaping.

Now, Mr. Dell is on the verge of making one of the biggest investments of his life. The 47-year-old billionaire and his private equity backers are locked in talks to acquire Dell, the company he started with $1,000 as a teenager three decades ago, in a leveraged buyout worth more than $20 billion. MSD could play a role in the Dell takeover, according to people briefed on the deal.

The private equity firm Silver Lake has been in negotiations to join with Mr. Dell on a transaction, along with other potential partners like wealthy Asian investors or foreign funds. Mr. Dell would be expected to roll his nearly 16 percent ownership of the company into the buyout, a stake valued at about $3.5 billion. He could also contribute additional personal money as part of the buyout.

That money is managed by MSD, among the more prominent so-called family offices that are set up to handle the personal investments of the wealthy. Others with large family offices include Bill Gates, whose Microsoft wealth financed the firm Cascade Investment, and New York’s mayor, Michael R. Bloomberg, who set up his firm, Willett Advisors, in 2010 to manage his personal and philanthropic assets.

“Some of these family offices are among the world’s most sophisticated investors and have the capital and talent to compete with the largest private equity firms and hedge funds,” said John P. Rompon, managing partner of McNally Capital, which helps structure private equity deals for family offices.

A spokesman for MSD declined to comment for this article. The buyout talks could still fall apart.

In 1998, Mr. Dell, then just 33 years old — and his company’s stock worth three times what it is today — decided to diversify his wealth and set up MSD. He staked the firm with $400 million of his own money, effectively starting his own personal money-management business.

To head the operation, Mr. Dell hired Glenn R. Fuhrman, a managing director at Goldman Sachs, and John C. Phelan, a principal at ESL Investments, the hedge fund run by Edward S. Lampert. He knew both men from his previous dealings with Wall Street. Mr. Fuhrman led a group at Goldman that marketed specialized investments like private equity and real estate to wealthy families like the Dells. And Mr. Dell was an early investor in Mr. Lampert’s fund.

Mr. Fuhrman and Mr. Phelan still run MSD and preside over a staff of more than 100 overseeing Mr. Dell’s billions and the assets in his family foundation. MSD investments include a stock portfolio, with positions in the apparel company PVH, owner of the Calvin Klein and Tommy Hilfiger brands, and DineEquity, the parent of IHOP and Applebee’s.

Among its real estate holdings are the Four Seasons Resort Maui in Hawaii and a stake in the New York-based developer Related Companies.

MSD also has investments in several private businesses, including ValleyCrest, which bills itself as the country’s largest landscape design company, and DentalOne Partners, a collection of dental practices.

Perhaps MSD’s most prominent deal came in 2008, in the middle of the financial crisis, when it joined a consortium that acquired the assets of the collapsed mortgage lender IndyMac Bank from the federal government for about $13.9 billion and renamed it OneWest Bank.

The OneWest purchase has been wildly successful. Steven Mnuchin, a former Goldman executive who led the OneWest deal, has said that the bank is expected to consider an initial public offering this year. An I.P.O. would generate big profits for Mr. Dell and his co-investors, according to people briefed on the deal.

Another arm of MSD makes select investments in outside hedge funds. Mr. Dell invested in the first fund raised by Silver Lake, the technology-focused private equity firm that might now become his partner in taking Dell private.
MSD’s principals have already made tidy fortunes. In 2009, Mr. Fuhrman, 47, paid $26 million for the Park Avenue apartment of the former Lehman Brothers chief executive Richard S. Fuld. Mr. Phelan, 48, and his wife, Amy, a former Dallas Cowboys cheerleader, also live in a Park Avenue co-op and built a home in Aspen, Colo.

Both are influential players on the contemporary art scene, with ARTNews magazine last year naming each of them among the world’s top 200 collectors. MSD, too, has dabbled in the visual arts. In 2010, MSD bought an archive of vintage photos from Magnum, including portraits of Marilyn Monroe and Mahatma Gandhi, and has put the collection on display at the University of Texas, Mr. Dell’s alma mater.

Just as the investment firms Rockefeller & Company (the Rockefellers, diversifying their oil fortune) and Bessemer Trust (the Phippses, using the name of the steelmaking process that formed the basis of their wealth) started out as investment vehicles for a single family, MSD has recently shown signs of morphing into a traditional money management business with clients beside Mr. Dell.

Last year, for the fourth time, an MSD affiliate raised money from outside investors when it collected about $1 billion for a stock-focused hedge fund, MSD Torchlight Partners. A 2010 fund investing in distressed European assets also manages about $1 billion. The Dell family is the anchor investor in each of the funds, according to people briefed on the investments.

MSD has largely remained below the radar, though its name emerged a decade ago in the criminal trial of the technology banker Frank Quattrone on obstruction of justice charges. Prosecutors introduced an e-mail that Mr. Fuhrman sent to Mr. Quattrone during the peak of the dot-com boom in which he pleaded for a large allotment of a popular Internet initial public offering.

“We know this is a tough one, but we wanted to ask for a little help with our Corvis allocation,” Mr. Fuhrman wrote. “We are looking forward to making you our ‘go to’ banker.”

The e-mail, which was not illegal, was meant to show the quid pro quo deals that were believed to have been struck between Mr. Quattrone and corporate chieftains like Mr. Dell — the bankers would give executives hot I.P.O.’s and the executives, in exchange, would hold out the possibility of giving business to the bankers. (Mr. Quattrone’s conviction was reversed on appeal.)

The MSD team has also shown itself to be loyal to its patron in other ways.

On the MSD Web site, in the frequently asked questions section, the firm asks and answers queries like “how many employees do you have” and “what kind of investments do you make.”

In the last question on the list, MSD asks itself, “Do you use Dell computer equipment?” The answer: “Exclusively!”


This post has been revised to reflect the following correction:

Correction: January 18, 2013

An earlier version of this article misstated when an MSD affiliate raised money from outside investors for a hedge fund. It was last year, not earlier this year. The article also misstated which hedge fund and its focus. It was MSD Torchlight Partners, a stock-focused hedge fund, not MSD Energy Partners, an energy-focused hedge fund.

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China Objects After Shell Is Fired From Myanmar





BANGKOK — China said Thursday that it had expressed “grave concern” to the Myanmar government after a shell, apparently fired during fighting between Myanmar troops and ethnic rebels, landed in Chinese territory, and a Chinese government spokesman called for an immediate cease-fire.




The Chinese response was unusually strong given the close ties between the two countries in recent years, and it suggested that China was growing increasingly impatient and nervous about the Myanmar government’s campaign against ethnic Kachin rebels.


“China has lodged urgent representation to Myanmar over the incident, to express grave concerns and dissatisfaction,” said Hong Lei, a spokesman for China’s Foreign Ministry, who called for a cease-fire, according to the official Xinhua news agency.


Daw Aung San Suu Kyi, the opposition leader in Myanmar’s Parliament, called for an immediate stop to the fighting. But her comments, reported by the Irrawaddy online news site, were equivocal. She said she could not help more forcefully to resolve the conflict because she was not on the ethics committee.


“That doesn’t mean that I don’t take responsibility for the matter or that I don’t care about it, but different committees should respect each other and not interfere in each other’s work,” she said.


Myanmar’s government has repeatedly said that it wants to negotiate with the Kachin rebels, “We want to reduce our offensive and return to talks,” U Ye Htut, a spokesman for President Thein Sein, said in an interview with The Irrawaddy online news site that was posted on Thursday.


But the military appears to be accelerating its campaign against the Kachin using heavy artillery, attack helicopters and other aircraft to flush out guerrillas from their positions surrounding Laiza, a town along the border with China tha is the headquarters of the Kachin Indepedence Army..


Human Rights Watch on Friday called on Myanmar to stop what it described as “indiscriminate” shelling of Laiza, where three civilians were killed earlier this week from what rebels said was an attack by government troops.


Xinhua said the artillery shell was the fourth “bomb” dropped inside China since Dec. 30, when three others landed in Chinese territory.


Bertil Lintner, a specialist on Myanmar’s ethnic groups, said China feared an influx of refugees and further damage to trade along the border. The fighting has disrupted a number of Chinese hydroelectric projects in Myanmar, as well as jade mining.


“They are getting increasingly annoyed with what’s going on at the border,” Mr. Lintner said. “But the Chinese don’t really know what to do. They can’t antagonize the K.I.A.,” he said, referring to the Kachin Independence Army, “and they can’t antagonize the Burmese government either.”


Kachin rebels still control swaths of territory along the border with China, including areas where Chinese companies own plantations.


The Chinese government dealt directly with the Kachin for more than two decades, including the 17-year period when a cease-fire with the government allowed the Kachin to control border trade and maintain a degree of autonomy. The cease-fire collapsed in June 2011.


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State of the Art: Imagining Ho-Hum C.E.S. as an Action Movie - State of the Art





Hi boss! I’m back from the Consumer Electronics Show in Las Vegas. You assigned me to report on what’s new and exciting, but I have some bad news. The answer is: almost nothing.




I mean, think about it: Apple, Google, Microsoft and Facebook don’t even attend C.E.S.; they’d rather make their product announcements on their own schedules without being locked into this every-January thing. It’s still a big show, bigger than ever this year, with 3,200 exhibits and 150,000 attendees, but I wonder why people bother. Whose product announcement will get any press at all when it’s buried by 3,199 others?


C.E.S.’s organizers publish a daily magazine during the show that profiles new products announced there. Here are some actual examples: “Braven Expands Bluetooth Speaker Line.” “Armpocket Unveils Smartphone Cases.” “Bits Ltd. Expands Line of Surge Protectors.”


So if you want an exciting column from me, the thrills won’t come from the news of new products at C.E.S. I’ll have to spice things up another way. See what you think of this.


As he plummets toward the Nevada desert, two deafening sounds assail Daxton Blackthorne’s eardrums — the wind rushing past his ears at terminal velocity, and a deafening explosion over his head. Fumbling for his parachute cord, he’s blasted by the searing heat from the fireball that, until seconds ago, was his Cessna Citation.


For now, though, his concern isn’t the air-to-air missile that has just dispatched his jet, courtesy of the Bora Boran Mafia on his tail. It isn’t even the fact that Daxton Blackthorne is all that stands between them and the collapse of American democracy.


It’s finding a good place to land.


There! Squinting in the blinding sun, he spots an enormous chain of low-slung buildings, stretching through the bustling downtown like a sleeping cobra: the Las Vegas Convention Center.


He hits the roof of the South Hall hard — too hard. Keeping low, he scuttles across the gravel to a ventilation shaft and emerges, moments later, in a blasting cacophony of color, sound and electronics.


He hears the crash of boots behind him as his pursuers explode from the same shaft. Got to move, Daxton thinks. Detaching his ’chute, he darts among the booths, dodging clumps of buyers, reporters and electronics executives.


He weaves among the exhibits, barely noting their wares. External battery packs for phones. Car chargers for phones. Screen protectors for phones. Cases for phones.


What is this place? he thinks, pulse pounding.


Booth after booth. GPS units. Tablets. Earbuds. Bluetooth speakers. Phone cases. Row after row of Chinese manufacturers he’s never heard of. Like this one, Huwei, selling the world’s largest Android phone — the thin, shiny Ascend Mate, with a 6.1-inch screen. That’d be like talking into a cutting board, he thinks.


He bursts into the Central Hall, and the sensory overload is immediate; he pauses, gasping, to take it in. TV screens. Thousands. Screens bigger than a man. Screens stacked up to the distant ceiling. Screens brighter and louder than explosives in the morning. Sharp, Sony, Samsung, LG, Toshiba, Panasonic. The bombardment is almost as lethal as the one that took down his Cessna.


Here are OLED screens, with incredibly black blacks, vivid colors and razor-thin bodies; this LG model is only 0.16 inches thick. Panasonic and Sony each claim “the world’s largest OLED screen” — 56-inch prototypes.


Footsteps pound behind him. Too late to run. He’ll blend in. He merges into a throng of eager showgoers.


“Three-D may have been a flop,” a rep is saying. “But this year, the industry is back with an irresistible offering: 4K television. Ultra HD, we call it. You thought HDTV was sharp? Now imagine: four times as many pixels. Stunning picture quality, in stunning screen sizes.”


Daxton figures you’d have to sit pretty darned close to see any difference between HDTV and 4KTV. But never mind that — out of the corner of his eye, Daxton spots the black uniforms of his pursuers, fanning through the crowd. Play along, he thinks. “Excuse me,” he shouts in a faux French accent. “What is there to watch in 4K?”


“Unfortunately, 4K video requires too much data for today’s cable, satellite, broadcast, Blu-ray, or Internet streaming,” is the reply. “But at Sony, we’re leading the way! If you buy our 84-inch 4K television for $25,000, we’ll lend you a hard drive with 10 Sony movies on it — in gorgeous 4K.”


Daxton can think of better uses for $25,000; a jetpack would come in handy right about now. He dives into the crowd. Must. Find. Disguise.


A crowd wearing headsets is gathered before a Samsung TV. That’ll do. He grabs one; it covers both his eyes and his ears.


“You’re seeing a prototype of Samsung’s OLED dual-view technology,” the spokesman says. “This TV can display two 3-D video sources simultaneously, or four regular ones. Imagine: Your children can be playing Xbox while you watch the Super Bowl!” Daxton moves the switch on the earpiece; sure enough, the TV’s image changes accordingly, along with the audio from the tiny earpiece speakers.


But angry shouts in Tahitian are closing in. He bolts through an archipelago of audio booths, hawking celebrity headphones bearing the names of the rapper 50 Cent, the heavy-metal band Motorhead, the runner Usain Bolt, the N.F.L. quarterback Tim Tebow and the TV reality star Snooki. When did Snooki become an audiophile? he wonders.


By the time he storms into the North Hall, his lungs are screaming. He stands, panting, in a broader area populated by gleaming, polished automobiles. Here are Ford and General Motors, announcing new developer programs, open platforms for new apps that will run on their cars’ computer screens. Ford’s Sync AppLink bans games and video apps, for safety reasons. Good thinking, Daxton thinks. Wouldn’t want distracted driving.


Here are Audi and Lexus, announcing self-driving cars. Glancing at the video loop, he notes that the Audi prototype can, at this point, drive itself only through specially equipped parking garages, like the one set up at the Mandarin Oriental for a demonstration.


But on the Lexus stage, he spots something much more enticing: a car, festooned with sensors, that can actually drive itself on regular roads, much like Google’s fleet of 12 autonomous cars.


“California and Nevada have both made self-driving cars legal, with certain restrictions,” the executive on stage says. “And this Lexus LS safety-research vehicle is a pioneer. The 360-degree laser on the roof detects objects up to 230 feet away; the front camera knows if the traffic light is red or green. Side cameras, GPS and radar enhance what could someday be a safe, efficient, road-aware vehicle.”


There’s a burst of commotion from Daxton’s near right. It’s them. He vaults onto the stage. “Love the idea of self-driving cars,” Daxton tells the presenter. “But right now, I need a car I can drive myself.”


A saber blade shatters the air next to his ear. With a burst of adrenaline, he dives through the open window of the Lexus. His assailants push through the crowd and clamber after him, but he’s already powered on the car. Huddling low, he guns the engine and shifts into gear.


As a hail of bullets shatters the rear window, the Lexus arcs off the stage, plows through seven rotating shelves of phone cases, and, in a cloud of plaster and twisted beams, erupts through the wall of the convention center.


With a wry smile, Daxton adjusts his rear-view mirror just in time to see the knot of black-suited Bora Borans shaking their fists in the distance.


He brushes some safety glass off his shoulder, slips on sunglasses, and leans back into the leather seat.


“Now that’s what I call an exciting show,” he says, grinning, and he swings onto the open road for home.


This article has been revised to reflect the following correction:

Correction: January 17, 2013

An earlier version of this article misspelled the name of a Chinese technology company. It is Huawei, not Huwei.



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Some With Autism Diagnosis Can Recover, Study Finds


Doctors have long believed that disabling autistic disorders last a lifetime, but a new study has found that some children who exhibit signature symptoms of the disorder recover completely.


The study, posted online on Wednesday by the Journal of Child Psychology and Psychiatry, is the largest to date of such extraordinary cases and is likely to alter the way that scientists and parents think and talk about autism, experts said.


Researchers on Wednesday cautioned against false hope. The findings suggest that the so-called autism spectrum contains a small but significant group who make big improvements in behavioral therapy for unknown, perhaps biological reasons, but that most children show much smaller gains. Doctors have no way to predict which children will do well.


Researchers have long known that between 1 and 20 percent of children given an autism diagnosis no longer qualify for one a few years or more later. They have suspected that in most cases the diagnosis was mistaken; the rate of autism diagnosis has ballooned over the past two decades, and some research suggests that it has been loosely applied.


The new study should put some of that skepticism to rest.


“This is the first solid science to address this question of possible recovery, and I think it has big implications,” said Sally Ozonoff of the MIND Institute at the University of California, Davis, who was not involved in the research. “I know many of us as would rather have had our tooth pulled than use the word ‘recover,’ it was so unscientific. Now we can use it, though I think we need to stress that it’s rare.”


She and other experts said the findings strongly supported the value of early diagnosis and treatment.


In the study, a team led by Deborah Fein of the University of Connecticut at Storrs recruited 34 people who had been diagnosed before the age of 5 and no longer had any symptoms. They ranged in age from 8 to 21 years old and early in their development were in the higher-than-average range of the autism spectrum. The team conducted extensive testing of its own, including interviews with parents in some cases, to gauge current social and communication skills.


The debate over whether recovery is possible has simmered for decades and peaked in 1987, when the pioneering autism researcher O. Ivar Lovaas reported that 47 percent of children with the diagnosis showed full recovery after undergoing a therapy he had devised. This therapy, a behavioral approach in which increments of learned skills garner small rewards, is the basis for the most effective approach used today; still, many were skeptical and questioned his definition of recovery.


Dr. Fein and her team used standardized, widely used measures and found no differences between the group of 34 formerly diagnosed people and a group of 34 matched control subjects who had never had a diagnosis.


“They no longer qualified for the diagnosis,” said Dr. Fein, whose co-authors include researchers from Queens University in Kingston, Ontario; Children’s Hospital of Philadelphia; the Institute of Living in Hartford; and the Child Mind Institute in New York. “I want to stress to parents that it’s a minority of kids who are able to do this, and no one should think they somehow missed the boat if they don’t get this outcome.”


On measures of social and communication skills, the recovered group scored significantly better than 44 peers who had a diagnosis of high-functioning autism or Asperger’s syndrome.


Dr. Fein emphasized the importance of behavioral therapy. “These people did not just grow out of their autism,” she said. “I have been treating children for 40 years and never seen improvements like this unless therapists and parents put in years of work.”


The team plans further research to learn more about those who are able to recover. No one knows which ingredients or therapies are most effective, if any, or if there are patterns of behavior or biological markers that predict such success.


“Some children who do well become quite independent as adults but have significant anxiety and depression and are sometimes suicidal,” said Dr. Fred Volkmar, the director of the Child Study Center at the Yale University School of Medicine. There are no studies of this group, he said.


That, because of the new study, is about to change.


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