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.”

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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.”

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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.”

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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.

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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..

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!”

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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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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.

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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.”

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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.

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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.”

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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!”

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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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