Friday, November 30, 2012


"This emerging understanding of autism may change attitudes toward autistic workers." Gareth Cook, New York Times Magazine

IS THERE ANYTHING as mystifying and at the same time as predictable as human behavior? We're at once so much alike and so different. I saw a headline for an article in the November 12, 2012 Psychology Today that read "Unique—Like Everybody Else." Sums it up perfectly.

My theory is that everything about us operates on a continuum — every bodily function, every process, every trait. Because our brains are incredibly complex, I think all those intertwined individual bell curves for every functional variable of how we learn, process, act, react and interact with the world — make us all extremely plaid. You know, as in what color was his shirt? Plaid. That's what I think we all are.

I've passed along articles on autism in the past when I've found a particularly good one. According to Simon Baron-Cohen, being diagnosed as 'on the autism spectrum' hinges on having very high-level systemizing skills combined with very low empathizing abilities. We all fall somewhere on the bell curve for both. 

Having a better understanding of the spectrum has allowed me to make more sense out of some previously incomprehensible behavior, allowing me to more ably meet that person on his or her map of the world. (Why doesn't he notice how frustrated people become trying to get him to see a great, looming forest of a concept when he's got his nose pushed up against one individual tree?? Oh yeah, he literally doesn't 'see' it.)

Below is an article published in the New York Times Magazine about how one set of parents reframed an autistic disability as an ability, and in so doing changed many lives. It's a long piece, but worth it.

Published: November 29, 2012 

When Thorkil Sonne and his wife, Annette, learned that their 3-year-old son, Lars, had autism, they did what any parent who has faith in reason and research would do: They started reading. At first they were relieved that so much was written on the topic. “Then came sadness,” Annette says. Lars would have difficulty navigating the social world, they learned, and might never be completely independent. The bleak accounts of autistic adults who had to rely on their parents made them fear the future.

What they read, however, didn’t square with the Lars they came home to every day. He was a happy, curious boy, and as he grew, he amazed them with his quirky and astonishing abilities. If his parents threw out a date — Dec. 20, 1997, say — he could name, almost instantly, the day of the week (Saturday). And, far more usefully for his family, who live near Copenhagen, Lars knew the train schedules of all of Denmark’s major routes.

One day when Lars was 7, Thorkil Sonne was puttering around the house doing weekend chores while Lars sat on a wooden chair, hunched for hours over a sheet of paper, pencil in hand, sketching chubby rectangles and filling them with numerals in what seemed to represent a rough outline of Europe. The family had recently gone on a long car trip from Scotland to Germany, and Lars passed the time in the back seat studying a road atlas. Sonne walked over to a low shelf in the living room, pulled out the atlas and opened it up. The table of contents was presented as a map of the continent, with page numbers listed in boxes over the various countries (the fjords of Norway, Pages 34-35; Ireland, Pages 76-77).

Thorkil returned to Lars’s side. He slid a finger along the atlas, moving from box to box, comparing the source with his son’s copy. Every number matched. Lars had reproduced the entire spread, from memory, without an error. “I was stunned, absolutely,” Sonne told me.

To his father, Lars seemed less defined by deficits than by his unusual skills. And those skills, like intense focus and careful execution, were exactly the ones that Sonne, who was the technical director at a spinoff of TDC, Denmark’s largest telecommunications company, often looked for in his own employees. Sonne did not consider himself an entrepreneurial type, but watching Lars — and hearing similar stories from parents he met volunteering with an autism organization — he slowly conceived a business plan: many companies struggle to find workers who can perform specific, often tedious tasks, like data entry or software testing; some autistic people would be exceptionally good at those tasks. So in 2003, Sonne quit his job, mortgaged the family’s home, took a two-day accounting course and started a company called Specialisterne, Danish for “the specialists,” on the theory that, given the right environment, an autistic adult could not just hold down a job but also be the best person for it.

For nearly a decade, the company has been modest in size — it employs 35 high-functioning autistic workers who are hired out as consultants, as they are called, to 19 companies in Denmark — but it has grand ambitions. In Europe, Sonne is a minor celebrity who has met with Danish and Belgian royalty, and at the World Economic Forum meeting in Tianjin in September, he was named one of 26 winners of a global social entrepreneurship award. Specialisterne has inspired start-ups and has five of its own, around the world. In the next few months, Sonne plans to move with his family to the United States, where the number of autistic adults — roughly 50,000 turn 18 every year — as well as a large technology sector suggests a good market for expansion.

“He has made me think about this differently, that these individuals can be a part of our business and our plans,” says Ernie Dianastasis, a managing director of CAI, an information-technology company that has agreed to work with Specialisterne to find jobs for autistic software testers in the United States.

For previously unemployable people — one recent study found that more than half of Americans with an autism diagnosis do not attend college or find jobs within two years of graduating from high school — Sonne’s idea holds out the possibility of self-sufficiency. He has received countless letters of thanks and encouragement from the families of autistic people. One woman in Hawaii wrote Sonne asking if she could move her family to Denmark so that her unemployed autistic son could join the Specialisterne team.

I first met Sonne, who is 52, in Delaware at a small conference he organized for parents and government officials who want to help him set up American operations over the coming year. He stood before them, sipping a cup of Dunkin’ Donuts coffee, speaking enthusiastically of his “dandelion model”: when dandelions pop up in a lawn, we call them weeds, he said, but the spring greens can also make a tasty salad. A similar thing can be said of autistic people — that apparent weaknesses (bluntness and obsessiveness, say) can also be marketable strengths (directness, attention to detail). “Every one of us has the power to decide,” he said to the audience, “do we see a weed, or do we see an herb?”

It’s an appealing metaphor, though perhaps a tougher sell in the United States, where you rarely see dandelion salad. It is also, of course, a little too simple. Over eight years of evaluating autistic adults, Sonne has discovered that only a small minority have the abilities Specialisterne is looking for and are able to navigate the unpredictable world of work well enough to keep a job. “We want to be a role model to inspire,” Sonne told me later, “but we can only hire the ones that we believe can fill a valuable role in a consultancy like ours.” In other words, he’s not running a charity. It is Sonne’s ultimate goal to change how “neurotypicals” see people with autism, and the best way to do that, he has decided, is to prove their value in the marketplace.

TDC, Thorkil Sonne’s former employer, is Specialisterne’s oldest customer. When I visited its headquarters in Copenhagen in June, it was obvious why the company finds it useful to engage autistic consultants. Whenever cellphone makers introduce a new product, there are countless opportunities for glitches. The only way TDC can be sure of catching them is to load the software onto a phone and punch the phone keys over and over again, following a lengthy script of at least 200 instructions. The work is tedious, the information age equivalent of the assembly line, but also important and beyond the capacity of most people to perform well. “You will get bored, and then you will take shortcuts, and then it is worthless,” explained Johnni Jensen, a system technician at TDC.

Steen Iversen, a Specialsterne consultant in bluejeans and a bright red polo shirt, showed me how he tackles the task. Iversen, who is 52 and has worked at TDC for four years, laid out several phones on a desk that also held his computer, two bananas, an apple and lines of lime green Post-it notes. He picked up a phone in one hand and demonstrated his technique, his thumb landing on the buttons in quick succession. But his real advantage is mental: he is exhaustive and relentless. When a script called for sending a “long text message,” Iverson keyed in every character the phone was capable of; it crashed. Another time, he found a flaw that could have disabled a phone’s emergency dialing capability, a problem all previous testers had missed. I asked Iversen how he feels at moments like that, and he gently pumped both fists in the air with a shy smile. “I feel victorious,” he said.

Over the years, Jensen has developed strategies for interacting with Iversen and the two other consultants he oversees. Trying to rush them inevitably backfires, he told me. “Sometimes I have to bite my tongue.” Jensen feels protective of the consultants and tries to shield them from the usual stresses of office work, but he is emphatic that the arrangement has endured not because he pities them but because their work is excellent. When Iversen finds a bug, he can recall similar ones from years past, saving Jensen the time and frustration of researching the problem’s history. And, Jensen says, the consultants are far more devoted to accuracy than neurotypical workers. Iversen has punched mobile-phone keys day after day, and not once has he cut a corner or even made a careless mistake.

Christian Andersen, another Specialisterne consultant, works at Lundbeck, a large pharmaceutical company. He compares records of patients who have experienced reactions to Lundbeck’s drugs, making sure the paper records match the digital ones. Errors can creep in when the reports are entered into the company’s database, and tiny mistakes could mean that potential health hazards would go undetected. So Andersen searches for anomalies, computer entry against written report, over and over, hour after hour, day after day.
Before Andersen arrived, his boss, Janne Kampmann, had a hard time finding employees who could do the job well. Most people’s minds wander as they go back and forth between documents, their eyes skimming the typos lurking there. Andersen, however, worked without interruption the morning I visited, attentive and silent until he lifted his head and, pointing to a sheet of paper, said to Kampmann, “Why do we have a 57 instead of 30 milligrams?” Kampmann told me Andersen is one of the best quality-control people she’s ever seen.

For years, scientists underestimated the intelligence of autistic people, an error now being rectified. A team of Canadian scientists published a paper in 2007 showing that measures of intelligence vary wildly, depending on what test is used. When the researchers used the Wechsler scale, the historical standard in autism research, a third of children tested fell in the range of intellectual disability, and none had high intelligence, consistent with conventional wisdom. Yet on the Raven’s Progressive Matrices, another respected I.Q. test, which does not rely on language ability, a majority of the same children scored at or above the middle range — and a third exhibited high intelligence. Other scientists have demonstrated that the autistic mind is superior at noticing details, distinguishing among sounds and mentally rotating complex three-dimensional structures. In 2009, scientists at King’s College London concluded that about a third of autistic males have “some form of outstanding ability.”

This emerging understanding of autism may change attitudes toward autistic workers. But intelligence, even superior intelligence, isn’t enough to get or keep a job. Modern office culture — with its unwritten rules of behavior, its fluid and socially demanding work spaces — can be hostile territory for autistic people, who do better in predictable environments and who tend to be clumsy at shaping their priorities around other people’s requirements.

Most Specialisterne consultants work in the offices of the companies that use their services, but some need to operate out of Specialisterne’s more forgiving work space. Even those capable of working on site sometimes get into trouble. In one case, the company was contacted by a medical-technology company, which needed help testing new prescription-tracking software. This seemed a marvelous bit of luck, says Rune Oblom, Specialisterne’s business manager, because there was a consultant on staff interested in illnesses. Everything was going fine until a medical team arrived to try out the software, and the consultant spent the entire morning recounting to them, in detail, the medical treatments that he, his mother and the rest of his family received over the years. Another consultant was assigned to finish the software-testing job. “I told him that the doctors were not very happy and felt he was a disturbing factor,” Oblom says. “But he couldn’t see it.”

The consultant has since been moved to another company, where he has done well at his professional tasks but still misses social cues. In Denmark, there is a tradition of bringing cake to the office on Fridays, and Oblom recently learned from the on-site supervisor that the consultant happily eats cake but has never volunteered to bring one himself. Then there was the time he tasted a co-worker’s cake and pronounced it terrible. Oblom told me that he plans to tell the consultant that he has to bring in cake now and then — and he will do it, Oblom predicts, without understanding the reason — but he’s not going to encourage the consultant to be more polite. The concept of socially mandated dishonesty would mystify him, Oblom said, so the other employees will just have to deal with it.

Specialisterne tries to anticipate, or at least mitigate, conflicts by assigning every consultant to a neurotypical coach. The coach checks in with the consultants regularly, monitoring their emotional well-being and helping them navigate the social landscape of the office. Henrik Thomsen, a jolly man who runs Specialisterne in Denmark while Sonne works on international expansion, told me about one consultant who is fascinated by train schedules. Severe storms can disrupt the trains around Copenhagen, and if the consultant’s train was delayed, he would start the day with a tour of his colleagues at the Specialisterne office, telling each how the commute played out, station by station. Sometimes another consultant would get annoyed and tell him to “cut the crap,” Thomsen says, “and then the real fun would begin.” So now Thomsen listens to the radio as he drives in, taking mental note of potential delays. When Thomsen arrives at work, he invites the consultant into his office first thing, listens to the day’s commuting story and then asks him to please get to work.

Specialisterne’s headquarters occupy part of a three-story complex in a Copenhagen suburb. Sonne showed me around the building: in addition to the consulting business, there is a nonprofit focused on spreading the Specialisterne business model, and a small school for people on the autism spectrum in their late teens and early 20s. In the largest room, boxes of Legos are stacked against one wall, and a pair of long, waist-high tables for Lego activities occupy the center, under a string of halogen lights.

When Sonne started the company, one of his biggest challenges was determining who would be able to thrive as a tech consultant in an office environment. A traditional interview was clearly not going to do the trick, and he had to think of other ways to identify marketable strengths in people who have difficulty communicating.

Lars had always enjoyed Legos, and talking to other parents, Sonne heard stories about how the toy bricks brought out remarkable, hidden abilities. “For many parents,” Sonne told me, “this was one of the few moments when they could be proud of their children.” So he decided to ask potential employees to follow the assembly directions included in the Lego Mindstorms kits and watch them build the robots.

This turned out to be so revealing that assessing job skills in the autistic population has itself become part of Specialist­erne’s business, with local government sending about 50 people a year to the company for five-month evaluations. (Specialisterne considers some for consulting jobs; others might end up doing clerical work, mowing lawns or other tasks for municipalities.) The Specialisterne evaluators place the candidates in groups for part of the time to see how well they work in teams, in addition to assessing the skills (reasoning, following directions, attending to details) that are naturally on display in a Mindstorms session. The assignments also reveal how a person handles trouble. More than once a candidate has become derailed because a Lego piece does not match the shade of gray depicted in the manual. Yet it is also not uncommon for a candidate to notice a struggling partner, stop and patiently explain how to get back on track.

The Specialisterne school uses Legos, too. Frank Paulsen, a red-haired man with a thin beard who is the school’s principal, told me about a session he once led in which he handed out small Lego boxes to a group of young men and asked them to build something that showed their lives. When the bricks had been snapped together, Paulsen asked each boy to say a few words. One boy didn’t want to talk, saying his construction was “nothing.” When Paulsen gathered his belongings to leave, however, the boy, his teacher by his side, seemed to want to stay. Paulsen tried to draw him out but failed. So Paulsen excused himself and stood up.

The boy grabbed Paulsen’s arm. “Actually,” he said, “I think I built my own life.”
Paulsen eased back into his seat.

“This is me,” the boy said, pointing to a skeleton penned in by a square structure with high walls. A gray chain hung from the back wall, and a drooping black net formed the roof. To the side, outside the wall, two figures — a man with a red baseball cap and a woman raising a clear goblet to her lips — stood by a translucent blue sphere filled with little gold coins. That, the boy continued, represented “normal life.” In front of the skeleton were low walls between a pair of tan pillars, and a woman with a brown pony tail looked in, brandishing a yellow hairbrush. “That is my mom, and she is the only one who is allowed in the walls.”

The boy’s teacher was listening, astonished: In the years she’d known him, she told Paulsen later, she had never heard him discuss his inner life. Paulsen talked to the boy, now animated, for a quarter of an hour about the walls, and Paulsen suggested that perhaps the barriers could be removed. “I can’t take down the walls,” the boy concluded, “because there is so much danger outside of them.”

In June, Sonne announced the opening of a United States headquarters in Wilmington, Del. The state’s governor, Jack Markell, was there, as was a representative from CAI, the company that is Specialisterne’s first real partner in the United States. The company says it plans to begin recruiting and training autistic software testers in Delaware next month, and if all goes well, it will expand the program to other states. Specialisterne is also talking with Microsoft about setting up a pilot program in Fargo, N.D., where it has a large software-development operation.

Tyler Cowen, an economist at George Mason University (and a regular contributor to The Times), published a much-discussed paper last year that addressed the ways that autistic workers are being drawn into the modern economy. The autistic worker, Cowen wrote, has an unusually wide variation in his or her skills, with higher highs and lower lows. Yet today, he argued, it is increasingly a worker’s greatest skill, not his average skill level, that matters. As capitalism has grown more adept at disaggregating tasks, workers can focus on what they do best, and managers are challenged to make room for brilliant, if difficult, outliers. This march toward greater specialization, combined with the pressing need for expertise in science, technology, engineering and mathematics, so-called STEM workers, suggests that the prospects for autistic workers will be on the rise in the coming decades. If the market can forgive people’s weaknesses, then they will rise to the level of their natural gifts.

“Specialization is partly about making good use of the skills of people who have one type of skill in abundance but not necessarily others,” says Daron Acemoglu, an economist at M.I.T. and co-author of “Why Nations Fail.” In other words, there is good money to be made doing the work that others do not have the skills for or are simply not interested in.

As Sonne tries to build up his business in the United States, though, he faces practical challenges. For one thing, in Denmark, the government helps cover some of the additional expense of managing autistic workers, and it pays Specialisterne so it can give its employees full-time salaries even though they only work part time. Specialisterne pays its consultants in Denmark between $22 and $39 an hour, a rate negotiated with unions, and in Delaware it plans to start with salaries between $20 and $30 an hour. And while two Delaware charitable foundations have pledged $800,000 to Specialisterne, Sonne estimates that it will take $1.36 million, and three years, for the business to become self-sustaining.

Another challenge involves expectations. A new stereotype of autistic people as brainiacs, endowed with quirky superminds, is just as misguided as the old assumption that autistic people are mentally disabled, Sonne says. Autistic people, like everyone else, have diverse abilities and interests, and Specialisterne can’t employ all of them. Most people Specialisterne evaluates in Denmark don’t have the right qualities to be a consultant — they are too troubled, too reluctant to work in an office or simply lack the particular skills Specialisterne requires. The company hires only about one in six of the men and women it assesses.

April Schnell, who is organizing a Specialisterne effort in the Midwest and has an autistic son, told me that she traveled to Copenhagen for a conference organized by the company for their volunteers from around the world. One day, she and the others were given the Mindstorms challenges used to assess candidates. As she struggled to solve one of the more difficult ones, she realized that her son, Tim, who is 15, would find the work uninteresting and probably too difficult: Specialisterne is not likely to be the answer for him. “I was just very aware, there is a gap here,” she said. “My heart was a little sad.”

One Friday evening, Sonne drove me to his house southwest of Copenhagen, navigating through whipping rain and the last clots of rush-hour traffic. Lars was waiting at the door to welcome us. Now 16, Lars evokes a Tolkien elf — thin and blond with exceptionally pale skin. He was outgoing from the start, eager to give me a tour of the house, yet he only glanced at my face.

Lars has the sweet demeanor of a much younger boy. Several times he affectionately rubbed his father’s head, the hair a short thin fur, calling the bald spot “Mr. Moon.” He gushed about trains, and at dinner Annette gently told him that we might not want to hear too much more about international conventions on track signals. I played Lars in a round of speed chess in the living room. There was never much doubt about the outcome, but at one point he issued an earnest warning: “Take care to not weaken your king’s position unnecessarily.” It was too late. After we put the pieces away, I complimented him on his final moves — an elegant and lethal attack with rooks, a bishop and a knight — and he did a balletic twirl, arms out. I joked with his family about how crushed I felt in defeat, and Lars walked over and put a consoling hand on my shoulder. Perhaps, I suggested to Lars, I would be allowed a rematch? “No,” he said simply.

When I asked Lars what he thought about his father’s company, he said he has played with the Mindstorms robots but does not see himself working there. “I want to be a train driver,” Lars announced. “It is the country’s most beautiful job. You get to control a lot of horsepower. Who wouldn’t want to do that?”

At the outset, it was Thorkil’s aim to persuade Danish tech companies to hire his autistic employees. Now he wants all kinds of companies, all over the world, to learn from what Speecialisterne is doing. He figures that if he is successful, then maybe a national railway will consider hiring a candidate as seemingly unlikely as his son, as long as he has the right skills.

Certainly he has seen how transformative getting the right job can be for the autistic workers themselves. Before coming to Specialisterne, Iversen, who works at TDC, had not had a job for 12 years and spent the days sleeping and nights surfing the Internet. Niels Kjaer once worked as a physicist, receiving his diagnosis only after becoming clinically depressed when he didn’t get an academic job. When he came to Specialisterne, where he works on improving technology that grades eggs as they pass by on a conveyor belt, he was on sick leave from a job driving a cab.

Christian Andersen, who works at Lundbeck, the pharmaceutical company, was bullied and beaten for years as a schoolboy. He received his diagnosis at age 15 only because, fearing he might be suicidal, he checked himself into a hospital. After high school — inspired by a Hemingwayesque teacher who regaled his students with tales of outdoor exploits — Andersen tried a vocational school for landscaping. But he was overwhelmed by the requirement that he learn to drive. He tried another tech school but flailed, became depressed and had a breakdown in 2005. Andersen was living at home without prospects, playing video games. He couldn’t even land a job at a grocery store. Later that year, his parents encouraged him to apply to Specialisterne.

I joined Andersen one morning on his commute to Lundbeck’s headquarters across town. Riding on a yellow city bus, we talked about video games. He still loves Halo; Diablo 3 he finds frustrating. “You turn a corner and then — splat! — you are dead.” As we drew closer to the office, our conversation drifted to his job. He spoke with surprising insight about the psychological importance of work. “I have grown very much as a person,” Andersen told me. “I have become more confident and self-assured.” The job allowed him to move out of his parents’ house and into an apartment. After a while, Andersen informed me, he “started using body language.” It’s not something anyone taught him. He just watched people, he said, and “monkey see, monkey do.”

When he started at Lundbeck, he was constantly anxious because he dreaded making an error. Now the stress grips him far less often and is readily dispelled with a phone call to a coach at Specialisterne. He admits to being proud, having come so far. He was touched to be invited recently to join his department for some after-work bowling. But he doesn’t spend a lot of time thinking about these aspects of his employment anymore. “Of course it feels good,” Andersen said, “but there is such a thing as ‘here we go again.’ ” 

It’s only a job, after all.
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Wednesday, November 28, 2012

Hear hear

"If we would learn what the human race really is at bottom, we need only observe it in election times." — Mark Twain, Mark Twain's Autobiography 

THIS EDITORIAL APPEARED in the November 20 New York Times, and I liked it so much I wanted to share it, but then I misplaced it. After a little hunt, I've found it again. I couldn't agree more.

A Broken Election System
Published: November 20, 2012 369 

While President Obama was delivering his victory speech in the early hours of Wednesday, Nov. 7, people were still standing in line in Florida to vote. Thousands had waited hours to vote in New York, Pennsylvania and Ohio, some in the cold, some giving up wages to do so. In a spontaneous aside — “by the way, we have to fix that” — the president acknowledged the unnecessary hardship of casting a vote in the United States and established a goal that he now has an obligation to address.

The long lines can be shortened with commitments from Washington, as well as state and local governments, but they are just the most glaring symptom of a deeply broken democratic process. In too many states, it’s also needlessly difficult to register to vote. States controlled by Republicans continue to erect partisan impediments to participation. And the process for choosing a candidate remains bound to unlimited and often secret campaign donations that are bound to lead to corruption.

“Fixing that” can start with the following actions:

Voting in the United States is controlled by a widely varying patchwork of state, county and local laws. Many election boards are poorly financed or run by dysfunctional partisans, unable to quickly fix broken scanners or touch screens. Some state lawmakers have no interest in making the process easier, believing that too few polling places or other impediments make it harder for minorities or poor people to participate.

This is where Congress can play a role. It has the power to establish a nonpartisan federal elections board to maintain a national registration database, mandate the choice of voting machines and set standards for counting provisional ballots. A federal law, such as those proposed by Representatives George Miller of California and John Lewis of Georgia, could require a clear early-voting period, removing the issue as a political football in states like Florida and Ohio, and standards for absentee voting.

Congress also can provide financial incentives to the states to do the job right. A bill introduced recently by Senator Christopher Coons, a Democrat of Delaware, would give grants to states that make registration easy, including allowing same-day registration; allow early voting; require no excuses for voting absentee; properly train poll workers; and provide sufficient polling places.

But states don’t have to wait for a resolution to the inevitable partisan struggles over these bills. Seventeen states already send electronic registration data from motor vehicle departments to election agencies, and 10 allow people to register online. These paperless systems have the potential to enroll significantly more people.

The Republican drive to keep Democratic-leaning groups from voting, through methods like voter ID requirements, failed miserably this year and may have produced a backlash among minority voters, who turned out in large numbers. It’s time for Republicans to give up this misguided and offensive effort. And, if they don’t, Mr. Obama should make a national effort to pressure them now that he has no personal stake in it.

Unlimited contributions aren’t going away, even though many outside Republican groups lost this year. A bill introduced by House Democrats would sever the informal relationships between “super PACs” and the candidates they support, and use federal matching money to encourage small contributions to presidential and Congressional candidates. It also remains vital for Congress to pass the Disclose Act and eliminate the use of secret campaign donations.

Ultimately, only a constitutional amendment can counter the misbegotten Supreme Court assertion that money is speech and thus can play an unlimited role in American politics.

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Serious drug interactions

"Medicine sometimes snatches away health, sometimes gives it." Publius Ovidius Naso, Roman poet, known as Ovid in the English-speaking world

THE ARTICLE BELOW appeared today on NBC News and ABC News online and details the potentially deadly consequences of taking prescription medicine with grapefruit juice. There are 85 drugs that interact negatively with grapefruit juice and with 13 of them, the interaction can kill you. 

In the text, Dr. David Bailey is quoted as saying that most people know about the potentially lethal danger of taking prescription meds with grapefruit juice, but I took simvastatin for a year or so, and I was never told by my doctor or any pharmacist about the risk. This is the first I've heard of it; I'm passing this article on to you so that you won't remain as uninformed as I was.

By JoNel Aleccia, NBC News

If you kick-start your day with a glass of grapefruit juice, be careful.

Canadian scientists say the number of common prescription drugs that can interact badly with the tart citrus is climbing, with the potential for dangerous, even deadly, results.

Twenty-six new drugs that can cause serious harm when mixed with grapefruit have been introduced in the past four years alone, bringing the total to 43, said Dr. David Bailey, a clinical pharmacologist at the Lawson Health Institute Research Center in London, Ontario. That’s an average of more than six new drugs a year.

“What I’ve seen has been disturbing,” said Bailey, lead author on a study published in the Canadian Medical Association Journal. “It’s hard to avoid putting a drug out on the market that is not affected by grapefruit juice.”

More than 85 drugs that interact with whole grapefruit, grapefruit concentrate or fresh grapefruit juice have been identified, though not all have serious consequences. Those that do, however, can cause problems that include acute kidney failure, respiratory failure, gastric bleeding -- and worse.

“When I say sudden death, I’m not being sensational,” said Bailey, who said 13 drugs may be lethal when mixed with grapefruit.

The heart drug dronedarone, or Multaq, for instance, has a very high risk of interaction when taken with grapefruit, which may cause a rare form of ventricular tachycardia or rapid heart rhythm, the researchers found.

Mixing the prescription painkiller oxycodone with grapefruit can cause serious breathing problems, and adding the fruit to a dose of the popular statin simvastatin, or Zocor, can lead to rhabdomyolysis, a breakdown of muscle fibers that can lead to kidney damage.

The trouble with grapefruit has been known for two decades, ever since Bailey and his colleagues first discovered that ingestion of the fruit with certain prescription drugs can concentrate the medication in a patient’s bloodstream.

Drinking less than a cup of grapefruit juice once a day for three days, for instance, can lead to a 330 percent concentration of simvastatin, the researchers reported.

“I’ve seen a 10-fold increase in some patients,” Bailey said.

And it doesn’t matter whether the grapefruit is consumed hours before the pills, the researchers found. The problem is caused by an active ingredient in some citrus fruits, including grapefruit, limes and pomelos. Even the Seville oranges used in marmalades can trigger it. The fruits produce organic chemical compounds called furanocoumarins, which interfere with a human digestive enzyme.

That enzyme, called CYP3A4, helps metabolize toxic substances to keep them from getting into the bloodstream. Typically, that means the enzyme inactivates the effects of about 50 percent of all medications. Doctors adjust for that when prescribing drugs.

However, when the furanocoumarins in citrus inhibit that enzyme, the drugs can become concentrated in a patient’s system. In some cases, it can be like getting a triple or quadruple dose of medication, Bailey said.

Drugs known to interact with grapefruit do carry warnings, but Bailey said he believes that neither doctors nor patients may take the threat seriously enough.

“Basically, most people are sort of aware of grapefruit juice drug interactions, but I don’t think it’s in the forefront of their mind on a regular basis,” he said.

It’s not clear how many people actually are harmed by grapefruit interactions, mostly because the side effects are often not recognized as being related to the citrus, said Bailey, who included eight case reports in his study.

“For every case report, there are at least 100 that have never been reported,” he said.

Part of the concern lies in the fact that people older than 45 are most likely to consume grapefruit juice -- and to take prescription drugs. Seniors older than 70 have the most trouble tolerating excessively high levels of drugs, Bailey noted.

“These are the individuals with the greatest chance of exposure," he said.

Patients worried about the interaction of grapefruit with their medications should talk with their doctors, Bailey said. And doctors should make sure to ask about grapefruit consumption when prescribing drugs.

Some grapefruit lovers may have cut back already because of the risk of drug interaction. Consumption of grapefruit juice has dropped in the past decade, falling from .44 gallons of juice per person per year in 2000 to .15 gallons per person in 2011, according to figures from the Florida Department of Citrus.

Officials there say that although some drugs do interact with grapefruit, most do not. In most cases, doctors can prescribe drugs in the same class that don’t interact, noted Karen Mathis, a department spokeswoman.
“These medications often can provide the same therapeutic effect with no need to avoid grapefruit juice,” she said in a statement.

And not all citrus poses a problem, Bailey noted. Sweet oranges, such as navel and Valencia varieties, don’t contain the damaging compound.

“You have an alternative there,” he suggested. “If you want to take your medications with orange juice, you’re home free.”

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Tuesday, November 27, 2012

Lost in translation

"He has that rare ability to somehow be completely adorable and completely macho at the same time." — Marissa Blake-Zweiber, editor of The Onion Style and Entertainment

THIS OUGHT TO give you a laugh. You just can't make this stuff up! Oh wait. They did make it up — but probably didn't imagine anybody would take it seriously. From today's online New York Times


A state-run newspaper in China reported, accurately, that The Onion has named North Korea’s leader its Sexiest Man Alive for 2012. Left unsaid in the report, which was featured on the English-language home page of People’s Daily Online on Tuesday, is whether the editors of the Chinese Communist Party’s newspaper are in on the joke that the American publication is, well, kidding.

Although the People’s Daily report, accompanied by a 55-photograph slide show, clearly cited The Onion, there was no reference in either English or Chinese to the fact that the original item was satirical.

The Chinese newspaper’s three-paragraph report read:

An entirely accurate summary of a report from The Onion by the Chinese Communist Party’s newspaper.

The Onion has named North Korean supreme leader Kim Jong Un as the “Sexiest Man Alive for the year 2012.”

“With his devastatingly handsome, round face, his boyish charm, and his strong, sturdy frame, this Pyongyang-bred heartthrob is every woman’s dream come true. Blessed with an air of power that masks an unmistakable cute, cuddly side, Kim made this newspaper’s editorial board swoon with his impeccable fashion sense, chic short hairstyle, and, of course, that famous smile,” it said.

“He has that rare ability to somehow be completely adorable and completely macho at the same time,” said Marissa Blake-Zweiber, editor of The Onion Style and Entertainment.
For some reason, the editors in Beijing chose to omit the section of the Onion report which listed “prior ‘Sexiest Man Alive’ winners,” including:

• 2011: Bashar al-Assad
• 2010: Bernie Madoff
• 2009: Charles and David Koch (co-winners)
• 2008: Ted Kaczynski

The Associated Press tried and failed to reach the editors of People’s Daily for comment late on Tuesday in Beijing.

The editors of The Onion, for their part, added an update to their report on Tuesday, reading: “For more coverage on The Onion’s Sexiest Man Alive 2012, Kim Jong-Un, please visit our friends at the People’s Daily in China, a proud Communist subsidiary of The Onion Inc. Exemplary reportage, comrades.”

A screen capture of the People's 
Daily home page on Tuesday.

Regular readers of The Lede will be aware that this is not the first time The Onion has been apparently mistaken for a news organization by journalists. In September, Iran’s Fars News Agency plagiarized The Onion, running an edited version of a satirical report as if it were real, and then defended itself by claiming that the fake news item had uncovered a deeper truth.

Fars also pointed at the time to the ever-expanding list of news organizations that have been mistaken The Onion for a news source. Among them, as The A.P. explained, is another Chinese paper, the Beijing Evening News, which picked up a story from The Onion in 2002 “that claimed members of Congress were threatening to leave Washington unless the building underwent a makeover that included more bathrooms and a retractable dome.”

As The Lede suggested in September, the increasingly lighthearted tone in the reports of many serious news organizations, as they compete for attention on social networks in the Internet era, could be making such mistakes more common.
The image of North Korea’s leader featured on the People’s Daily home page on Tuesday, for instance, was taken from a recent Time magazine cover that referred to him as “Lil’ Kim,” playing on a joke frequently made by bloggers who use the name of a female rapper to refer to the young leader.

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Monday, November 26, 2012

The joy of hanging out

"One cannot think well, love well, sleep well, if one has not dined well." Virginia Woolf

PAUL AND I have enjoyed our break from work. Beside spending time with family, whether they are so by birth or by choice, we did virtually nothing — a little cleaning, laundry and ironing on my part and a little cooking on Paul's. 

I take that back; actually Paul did a lot of cooking. He made a huge batch of whipped sweet potatoes and baked gluten-free chocolate chip cookies and brownies to take to the Stein's for Thanksgiving. Friday he grilled a chicken, made green bean casserole, and I made a fruit salad that we took to Virginia's that night along with more sweet potatoes and a bakery pumpkin pie. 

Saturday Paul made homemade chicken soup, and today he roasted a turkey. He hadn't intended to cook a turkey, but the day after Thanksgiving fresh turkeys were 99 cents a pound at Fareway, and he said he couldn't pass up getting one.

Wednesday late afternoon we had dinner with Paul's parents at Jason's Deli. It's a surprising chain; they have gluten-free as well as organic offerings. Recent studies seem to indicate that you don't get more nutrition from organic produce, but that's not what I'm after. I'm looking for less — pesticides and herbicides, that is.

The last five days I've also been rediscovering how gratifying it is to read a really good book. I've almost finished Lost on Planet China by J. Maarten Troost. Like his first two books, The Sex Lives of  Cannibals and Getting Stoned with Savages, he presents geo-political viewpoints without being pedantic, history without being tedious and humor without being contrived. I would die happy if I could write like he does.

Oh yes, Paul and I have also been testing the hypothesis: is it possible to ever have too much green bean casserole? It took several days of experimentation on our part to reach the conclusion that it is indeed possible to grow tired of green bean casserole, but it takes four consecutive days of eating it at least once a day and possibly twice. I am apparently less convinced than he is considering that I chose to have it for breakfast today, but then again, I like drinking green bean juice straight from the can. Today Paul told me I'm actually going to turn into a green bean. I'd be okay with that. 

Below are pictures from the Stein's and pictures of our cute furry babies taken this weekend.

Just some of the food! You should have seen 
the desserts! I was particularly fond of Gail's scalloped corn.

Larry made one regular roast turkey, one 
roasted, smoked turkey and two kinds of dressing.

Top row: Larry, Pop, Blossom and Sharon. Bottom row: Allen, Daphna and David. There were 18 more people besides those pictured here for a total of 25. I'm told 50 is the Stein's record. 

Paul and David. Paul used to babysit for both David and
Allen; the latter can probably blame playing the trombone on Paul.

Sharon's dad and his significant other,
Blossom, who live in Kansas City.

The adorable Miss Shye.

The beautiful Miss Shiva.

The extra-large and lovable Boy Boy

All three in the nest where they (and we) spent a lot of time this weekend.
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Thursday, November 22, 2012

Happy Thanksgiving 2012

"I celebrated Thanksgiving in an old-fashioned way. I invited everyone in my neighborhood to my house, we had an enormous feast, and then I killed them and took their land." Jon Stewart 

YA GOTTA LOVE Jon Stewart. He has an aptitude for putting history in perspective.

Today is Thanksgiving, or as the rest of the world calls it: Thursday. Except for those on the other side of the International Dateline, of course, where it's Friday. We're headed to Larry and Sharon Stein's to overeat.

Thanksgiving last year.

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Monday, November 19, 2012

A brand new person

"Babies are such a nice way to start people." Don Herold, American humorist, writer, illustrator and cartoonist

AS OF 11/16/12 Paul and I have a brand new great-niece. Her name is Lauren Emery Janke, daughter of Lindsay and Ryan Janke, and baby sister to Marin Avery Janke. Welcome to the world, tiny one.

Baby Lauren and daddy Ryan.

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Saturday, November 17, 2012

I promise — mostly

"Our biggest political division is the war between the empty places and the crowded places." — Gail Collins

THESE ARE THE last two things I'm going to say about the election. No really. I'm also thinking that this post's title would do nicely as a headline for the David Petraeus/Paula Broadwell affair.

I promise — mostly.

First, looking at the map of the New York Times county by county, red vs. blue presidential election results, I gotta say, I think Gail Collins called it way back on June 15. Here's what she had to say:

"People who live in crowded places tend to appreciate government. It’s the thing that sets boundaries on public behavior, protects them from burglars and cleans the streets. If anything, they’d like it to do more. (That pothole’s been there for a year!) The people who live in empty places don’t see the point. If a burglar decides to break in, that’s what they’ve got guns for. Other folks don’t get in their way because their way is really, really remote. Who needs government? It just makes trouble and costs money."

2012 presidential election results by county.

Secondly, I said it before, but I love saying it again, I'm relieved, thrilled, delighted, happy, ecstatic, over the moon, elated, exhilarated, joyous, jubilant — you get get the point — that Todd Akin (legitimate rape), Richard Mourdock (pregnancy from rape is something God intended), John Koster (the rape thing) and let's not forget Rick Santorum (rape victims should make the best of a bad situation), who was running to be the Republican nominee, all lost.

Here's what I keep thinking: if these comments are what they feel safe in saying in public, can you imagine what the thoughts in their heads must be like — you know, the stuff they think wouldn't be prudent to say out loud?!! That's why I'm relieved, thrilled, delighted . . . . and you should be too.

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Friday, November 16, 2012

Here's to trombones and clarinetists

"Some of the wise boys who say my music is loud, blatant and that's all, should see the faces of the kids who have driven a hundred miles through the snow to see the band." — Stan Kenton

LAST NIGHT WAS the second Turner Center Jazz Orchestra concert of the season, directed by Andy Classen and presenting the music of Stan Kenton. It was ab fab. 

I discovered two new tunes I really like: one is called Intermission Riff by trumpeter Ray Wetzel, who played with Woody Herman, Stan Kenton, the Charlie Barnet Orchestra and Tommy Dorsey, before he died in a car wreck in 1951 at the age of 27. The other tune I especially enjoyed was Decoupage, written in 5/4 time, by Hank Levy.

Kenton seems to have been particularly fond of low brass. His repertoire contains many pieces that rely heavily on a trombone section and at times call for a second bass trombone or even a tuba; in our case both were played by the excellent Mike Short. The other bones in the section were Grady McGrannahan, Richard Early, John Benoit and of course Paul. Paul played a fast, high, long feature on Grenada Smoothie and performed extremely well, as he did throughout the program. Nah, I'm not biased.

I'm mentioning clarinets not because there were any parts for them last night; actually, I've been wanting to say something about the rigors of clarinet playing ever since the previous TCJO concert. That was the one featuring jazz standards by Ellington, Basie, Miller, Dorsey and Herman, and at least two of the pieces had big, big clarinet features played by John Morgan and Drake Department of Music Chairman, Clarence Padilla

I was pleasantly surprised by how much I enjoyed those clarinet-dominant compositions; you just don't get to hear a clarinet much unless you listen to classical music. I also learned something intriguing. After the performance, I complimented John and Clarence on how well they played, and both of them said in unison, "Holy moly, it was so much work!!!" Of course I wanted to know why. They both said that it's because playing the clarinet is way, way, WAY harder than playing the sax; a clarinet is harder to keep in tune and much harder to blow, and since they play both instruments, they know from comparison. They were tuckered, and now I know why. 

So here's to the trombonists of the world; they play the same stuff as trumpets, but trumpets have buttons — and to clarinetists who don't get nearly enough notoriety or respect.

BTW, tickets are already being purchased for the next TCJO concert featuring Scott Smith on December 20, so get yours now just to be on the safe side. 

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Wednesday, November 14, 2012

What is hip?

"The marriage institution cannot exist among slaves, and one sixth of the population of democratic America is denied its privileges by the law of the land. What is to be thought of a nation boasting of its liberty, boasting of its humanity, boasting of its Christianity, boasting of its love of justice and purity, and yet having within its own borders three millions of persons denied by law the right of marriage?" ― Frederick Douglass, My Bondage and My Freedom, 1855

IF YOU SUBSTITUTED the word "homosexuals" for "slaves" and didn't know when or by whom the fervent appeal above was written, you could easily suppose it to be contemporary.

With the election last Tuesday, nine states and Washington DC have now legalized same-sex marriage. When I look at the map of the United States published by the New York Times, designating the status of each state on the issue, I'm proud to see that Iowa is a bastion of equality smack dab in the middle the sea of prejudice surrounding it. Yay, Iowa

Check out the age breakdown below the map. For a state whose demographic definitely skews toward elderly, we remain young at heart, mind and soul. I'm just going to come right out and say it: we're hip!

Quit it!

"A politician thinks of the next election; a statesman thinks of the next generation." James Freeman Clarke, American theologian and author

HERE'S A SCREEN capture from the ABC News website today. Don't you just want to shout, "Stop running for President already!"

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Tuesday, November 13, 2012


"A good marriage is where both people feel like they’re getting the better end of the deal." — Anne Lamott, American fiction and non-fiction writer

TODAY IS OUR 19th wedding anniversary. In a role reversal from the norm, Paul has to keep me straight on how long we've been married. In fact we had to make a long drive today because I got mixed up and scheduled an out of town appointment with a prospective client. 

Paul said, "You do realize that that's our anniversary!" Oops.

I'm just not good at the whole-day-of-the-week, number-of-the-day thing. I know our anniversary is November 13, but I somehow got it in my head that the 13th was Wednesday. After playing with the Des Moines Big Band last night, a three-hour drive was not something Paul was looking forward to. Me neither. I drove around putting up Turner Center Jazz Orchestra posters last night, and then baked Paul some gluten-free, chocolate chip cookies, so I wasn't thrilled about having to hit the road either. 

We got married in Cuernavaca, Mexico.

Happily for us, we enjoy just spending time together. As we were making our way to FayetteI told Paul that I'm glad we don't have the kind of marriage that makes me feel like he'd darn well better show up with an expensive present as reparation for staying married to him. 

Paul is the best thing in my life. I take that back, he is my life. As an anniversary present, he made a website called I Love My Kelly. It's an actual website — with pictures and 100 reasons why he loves me! He managed to totally surprise me which isn't very easy. I Love My Paul!

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