June 2009

“In the spring,” wrote Tennyson, “a young man’s fancy lightly turns to thoughts of love.” And so in keeping with the spirit of the season, this week’s column looks at love affairs — mathematically. The analysis is offered tongue in cheek, but it does touch on a serious point: that the laws of nature are written as differential equations. It also helps explain why, in the words of another poet, “the course of true love never did run smooth.”


To illustrate the approach, suppose Romeo is in love with Juliet, but in our version of the story, Juliet is a fickle lover. The more Romeo loves her, the more she wants to run away and hide. But when he takes the hint and backs off, she begins to find him strangely attractive. He, on the other hand, tends to echo her: he warms up when she loves him and cools down when she hates him.

What happens to our star-crossed lovers? How does their love ebb and flow over time? That’s where the math comes in. By writing equations that summarize how Romeo and Juliet respond to each other’s affections and then solving those equations with calculus, we can predict the course of their affair. The resulting forecast for this couple is, tragically, a never-ending cycle of love and hate. At least they manage to achieve simultaneous love a quarter of the time.

ZZBCH (118)

The model can be made more realistic in various ways. For instance, Romeo might react to his own feelings as well as to Juliet’s. He might be the type of guy who is so worried about throwing himself at her that he slows himself down as his love for her grows. Or he might be the other type, one who loves feeling in love so much that he loves her all the more for it.

Add to those possibilities the two ways Romeo could react to Juliet’s affections — either increasing or decreasing his own — and you see that there are four personality types, each corresponding to a different romantic style.


My students and those in Peter Christopher’s class at Worcester Polytechnic Institute have suggested such descriptive names as Hermit and Malevolent Misanthrope for the particular kind of Romeo who damps out his own love and also recoils from Juliet’s. Whereas the sort of Romeo who gets pumped by his own ardor but turned off by Juliet’s has been called a Narcissistic Nerd, Better Latent Than Never, and a Flirting Fink. (Feel free to post your own suggested names for these two types and the other two possibilities.)

Although these examples are whimsical, the equations that arise in them are of the far-reaching kind known as differential equations. They represent the most powerful tool humanity has ever created for making sense of the material world. Sir Isaac Newton used them to solve the ancient mystery of planetary motion. In so doing, he unified the heavens and the earth, showing that the same laws of motion applied to both.

In the 300 years since Newton, mankind has come to realize that the laws of physics are always expressed in the language of differential equations. This is true for the equations governing the flow of heat, air and water; for the laws of electricity and magnetism; even for the unfamiliar and often counterintuitive atomic realm where quantum mechanics reigns.

1 Princesa-Tigre 1

In all cases, the business of theoretical physics boils down to finding the right differential equations and solving them. When Newton discovered this key to the secrets of the universe, he felt it was so precious that he published it only as an anagram in Latin. Loosely translated, it reads: “It is useful to solve differential equations.”

The silly idea that love affairs might progress in a similar way occurred to me when I was in love for the first time, trying to understand my girlfriend’s baffling behavior. It was a summer romance at the end of my sophomore year in college. I was a lot like the first Romeo above, and she was even more like the first Juliet.

The cycling of our relationship was driving me crazy until I realized that we were both acting mechanically, following simple rules of push and pull. But by the end of the summer my equations started to break down, and I was even more mystified than ever. As it turned out, the explanation was simple. There was an important variable that I’d left out of the equations — her old boyfriend wanted her back.

In mathematics we call this a three-body problem. It’s notoriously intractable, especially in the astronomical context where it first arose. After Newton solved the differential equations for the two-body problem (thus explaining why the planets move in elliptical orbits around the sun), he turned his attention to the three-body problem for the sun, earth and moon. He couldn’t solve it, and neither could anyone else. It later turned out that the three-body problem contains the seeds of chaos, rendering its behavior unpredictable in the long run.

Newton knew nothing about chaotic dynamics, but he did tell his friend Edmund Halley that the three-body problem had “made his head ache, and kept him awake so often, that he would think of it no more.”
I’m with you there, Sir Isaac.
For models of love affairs based on differential equations, see Section 5.3 in Strogatz, S. H. (1994) “Nonlinear Dynamics and Chaos.” Perseus, Cambridge, MA.
For Newton’s anagram, see page vii in Arnol’d, V. I. (1988) “Geometrical Methods in the Theory of Ordinary Differential Equations.” Springer, New York.
Chaos in the three-body problem is discussed in Peterson, I. (1993) “Newton’s Clock: Chaos in the Solar System.” W.H. Freeman, San Francisco.
For the quote about how the three-body problem made Newton’s head ache, see page 158 in Volume II of Brewster, D. (1855) “Memoirs of the Life, Writings, and Discoveries of Sir Isaac Newton.” Thomas Constable and Company, Edinburgh.
For readers who are curious about the math used here:
In the first story above, Romeo’s behavior was modeled by the differential equation dR/dt = aJ. This equation describes how Romeo’s love (represented by R) changes in the next instant (represented by dt). The amount of change (dR) is just a multiple (a) of Juliet’s current love (J) for him. This equation idealizes what we already know – that Romeo’s love goes up when Juliet loves him – by assuming something much stronger. It says that Romeo’s love increases in direct linear proportion to how much Juliet loves him. This assumption of linearity is not emotionally realistic, but it makes the subsequent analysis much easier. Juliet’s behavior, on the other hand, was modeled by the equation dJ/dt = -bR. The negative sign in front of the constant b reflects her tendency to cool off when Romeo is hot for her. Given these equations and an assumption about how the lovers felt about each other initially (R and J at time t = 0), one can use calculus to inch R and J forward, instant by instant. In this way, we can figure out how much Romeo and Juliet love (or hate) each other at any future time. For this elementary model, the equations should be familiar to students of math and physics: Romeo and Juliet behave like simple harmonic oscillators.


* Text by Steven Strogatz, May 26, 2009


chica milkshake

Some Comments:

* I never could understand differential equations and I never could understand women. Oh well.
It’s easy to see the ebb & flow in practice but the trick is to see where you both are on the curve and adjust for it at the right time. Each woman is different so there’s probably some other underlying wave form that dampens or reinforces the peaks and valleys.
— Johnny E

* Rather wonderful isn’t it that God has given us the ability to see the very cosmic principles that influence our lives? Being aware of them can only lead to more freedom for the human mind and spirit.
— Steve

* OK, math unpredictable is fun. Still, there are only a small set of actions that are possible given the real world constraints of actions. The same stories occur again and again with only small varions from story to story where we fill in the names and the details.
I can appreciate math and life but I sense there is still more to grasp even as I try to run variables in my mind.
Keep us thinking. I am just frustrated at the prospect there must be many variables that we can not phantom … . Somehow, if we ever where to meet other intelligent life we would better appreciate the role of math in the differences and similarities reflected in the possible.
Hard to think it all through, but I am tempted to try… .
— Mark

* There are four factors necessary for having the best chance at a love that will last:
1. Mutual attraction.
2. Mutual good-heartedness.
3. Compatibility.
4. Maturity.
Maybe that’s why lasting love is so hard to find.
— Ronald E. Maxson

* Here is a mathematician who twigged in time: “There was an important variable that I’d left out of the equations.” Mathematicians often analyze models of reality, which first require that they determine what variables to consider and what to leave out. History, especially in economics and the biosciences, shows they can sometimes get this profoundly wrong. In economics there is, from time to time, a “meltdown,” that brings economists (or at least those who trust economists) to there senses. In the biosciences the meltdowns are less obvious. Nevertheless – Bravo differential equations!
Donald R. Forsdyke, Kingston, Canada
— Donald R. Forsdyke

* Although the concept might be beyond comprehension of the ‘present day scientists/ mathematicians’, in the ‘recent times’ it is accepted that the mysterious moon – that in the three-body problem made Newton’s head ache – evolved from earth-moon itself. And, reading between lines the ‘Hindu mythology’, one would find the same phenomenon is indicated with the help of cryptic clues in the story related with Androgynous Shiva losing His ‘better half’, or consort, in a ‘sacred fire’ that was arranged by her father and, therefore, at a later stage Shiva remarrying her as the daughter of Himalaya – as she was yet another form of His original wife itself!
Thus moon virtually is indicated as a reflection/ projection in space of the energy at the centre of earth that apparently acts as a protective layer, like a bullet-proof jacket as its model, to help sustain eternally not only earth but also the entire solar system…The ancient astronomers resorted to astrology and Palmistry etc. to deal with expected human behaviour, and not simple mathematics…
— JC Joshi

* Nice introduction to differential equations, though a small error might confuse people – it should be ” The amount of change (dR) that occurs every moment (dt) is just a multiple (a) of Juliet’s current love (J) for him . “
— LJ Graham

* Attending la creme de la creme instiution of higher education Shimer College, my astute classmates came to the conclusion that, “Most people say two plus two are four. By the time we leave here, we’ll say, ‘Oh yeah, want to make a bet?’”
And so an interesting love square/pentacle of the century was predicted.
Call them Romeo and Juliet, or Hermit and Malevolent Misanthrope.
Or you could call them MICKEY and MICKEY or DONALD and DONALD. Let me regress.
I had an interesting, influential experience as a child. Likening myself as a princess, I played in tower of blue with the tough kids, who kept shouting, “Donald Duck.” We were the elite, with wings we could access the tower complete with slide. At the bottom were the angry peasants, working class, shouting MICKEY mouse. These kids were blocked off from the ladder to the slide and lacked the wings and the latitude to enforce order. They were rioting, crying with disorder, “MICKEY mouse.” Their Furies had been awoken. They felt their day of reckoning had come. I stood atop the tower, smug at my position, watching the contorted angry expressions of the children without access, I wanted to help them. I wanted to say that I like the elitist Donalds, but I like you MICKEYS too. So mass chaos ensued. Tower children shouted, “Donald Duck,” while the children below angrily insisted “MICKEY Mouse.” I was captivated by this scene. I didn’t know what I should be shouting. Even as a child, I had a sense of “Don’t be a racist, be an elitist mentality” while similtaneously wanting to help the rest rise. I suppose that is why I am still single, I am searching for that right MICKEY, Donald combo.
— Eve of Blue Tower

* I have always advised my engineering students not to draw on the equations that we use in classes in order to understand social interactions, if for no other reason than that even though there are some amusing comparisons they will probably not get a useful answer and will waste time more usefully spent on social interactions trying to do math problems.
That said, one can’t help but wonder about the three (or more) body problem that is usual at that age, and their LaGrange points (points of stability between mutually attractive large objects). Perhaps the constant tweeting and texting that occurs these days is the maintenance of some kind of metastable equilibrium in an ages-old problem.
— Scott

* “It later turned out that the three-body problem contains the seeds of chaos, rendering its behavior unpredictable in the long run.”
hence: literature, one solution to describing these iterations of love, or love stories –
thanks for a fab article!
— 411bee

* If you enjoyed this piece you will also enjoy Steven Strogatz in programs 12 and 13 of Mathematics Illuminated, a new 13-part multimedia resource that explores major themes in mathematics, from mankind’s earliest study of prime numbers to the cutting edge mathematics used to consider the shape of the universe.
The entire resource is free to all at http://www.learner.org/courses/mathilluminated/.
— Scott Roberts

* I think this theory is the perfect explanation why engineers and mathematicians should feel less confident in explaining love and human relationships:). Applying a clinical equation to human interaction probably works when you calculate how many people might show to a party, but not to predict relationships.
First, you cannot assume a relationship between J&R can exist in isolation from everything else and furthermore you cannot assume you know the number of variables: what do they both want in life, how important are to them the wishes of their family, what are those wishes, new potential love interests, incompatibility and so on. Romeo and Juliet might have experienced absolute love, but they didn’t make it past their teens so there is an inherent limitation of choosing them as examples. And why would you
assume Juliet to be the fickle one?
— Ashleen Hayes

* The problem with modeling real social dynamics is (1) it’s not deterministic, (2) it’s not autonomous, and (3) it’s not as simple as a 2-variable system. But that doesn’t keep us modelers from trying!
One of my favorite social models is by Sergio Rinaldi on cycles in the love poetry of Petrarch. He manages to get rather good fits to the data – and with an autonomous, deterministic differential equation model. But it has three variables ;-)
This article is available free on JStor.
— Sharon Lubkin

* The Romeo/Juliet ambivalent tryst represents about 10% of types of romantic relationships. Since 10% is relatively infrequent, it is probably easier to predict than say romantic relationships that are based on normal attachment processes (70-80%).
There are too many variables in the love equation to try to simplify it with a math model. (Although it is a way to amuse oneself.) People marry for many reasons besides love, for example, they might be pregnant, they wanted to married by a certain age, they receive pressure from family and/or peers, sex guilt, religious influences, fear of not obtaining a better catch, etc. You think the three-body problem is bad, try adding all the other influences!
It might help to read the psychology literature on romantic relationships. Even though I minored in math at Cal, and have tender feelings for the subject, I doubt romance will be explained in math departments.
— Joe

* Interesting article: the example seems to be (inadequate) mathematics to describe social interactions. The gender demographic of readers commenting is also interesting: 7 males (8 including this response), 2 indeterminate and 1 female. Hmmm…
– Mike
— mike mittleman

* This illustrates one problem with blind faith in the power of mathematics–you don’t always know if you have identified all the relevant variables for an equation. Solving problems completely can require an exceedingly large number of variables and exceedingly complex equations. At the end of the day, even supercomputers could turn out to be fallible for lack of the correct variables. As you point out, Isaac Newton recognized this when he tried to understand the movements of only three bodies. Imagine then, trying to understand what influences the behavior of “star-crossed lovers.”
— ttj

*Per Maxson:, there are four independent variables for lasting love:
1. Mutual attraction.
2. Mutual good-heartedness.
3. Compatibility.
4. Maturity.
Maybe that’s why lasting love is so hard to find.
If each variable can only be either there or not there, then the probability of getting all four as positive is 1/16 or about 6%. So lasting love on average only occurs 6% of all couples/marriages. Is this true? Can data support this?
— Manny

* Great correlation evaluated between the hearts and maths. Better if a survey is conducted or the real time analysis is done and results are published. That adds more weight to the theory.
— Harish

* So then now knowing this and having the ability to Meta-think about it, do I then doom myself to a near impossible 2nd order differential equation?
Let me explain. Since I can now know that I might be dooming myself to a SHO off set by pi/2 or something, then I will modify my behavior. This modification, this meta thinking, then would be a 2nd order term. How about solving that one?
Oh sure, if it gets bad enough, I can use a Bessel function, but then again approximating a woman as sphereical might be counter reproductive.
— Rob

* In the arithmetic of love, one plus one equals everything,
and two minus one equals nothing.
— Dru

* Professor Strogatz,
I find it curious that you deemed it necessary to point out the “tongue in cheek” nature of your delightful excursion into the mathematics of love. But I am grateful for your perspective which moves the discussion beyond the plane geometry of “three’s company” to the far more stimulating venue of differential calculus.
I would only add that your observation regarding the collective behaviour of Romeo and Juliet as harmonic oscillators confirms my own observation over the years that families that engage in music strengthen their emotional bonds (i.e., are more harmonious).
Leo Toribio
Pittsburgh, PA

When a new crop of future business leaders graduates from the Harvard Business School next week, many of them will be taking a new oath that says, in effect, greed is not good.


Nearly 20 percent of the graduating class have signed “The M.B.A. Oath,” a voluntary student-led pledge that the goal of a business manager is to “serve the greater good.” It promises that Harvard M.B.A.’s will act responsibly, ethically and refrain from advancing their “own narrow ambitions” at the expense of others.
What happened to making money?

That, of course, is still at the heart of the Harvard curriculum. But at Harvard and other top business schools, there has been an explosion of interest in ethics courses and in student activities — clubs, lectures, conferences — about personal and corporate responsibility and on how to view business as more than a money-making enterprise, but part of a large social community.
“We want to stand up and recite something out loud with our class,” said Teal Carlock, who is graduating from Harvard and has accepted a job at Genentech. “Fingers are now pointed at M.B.A.’s and we, as a class, have a real opportunity to come together and set a standard as business leaders.”

At Columbia Business School, all students must pledge to an honor code: “As a lifelong member of the Columbia Business School community, I adhere to the principles of truth, integrity, and respect. I will not lie, cheat, steal, or tolerate those who do.” The code has been in place for about three years and came about after discussions between students and faculty.

In the post-Enron and post-Madoff era, the issue of ethics and corporate social responsibility has taken on greater urgency among students about to graduate. While this might easily be dismissed as a passing fancy — or simply a defensive reaction to the current business environment — business school professors say that is not the case. Rather, they say, they are seeing a generational shift away from viewing an M.B.A. as simply an on-ramp to the road to riches.

Those graduating today, they say, are far more concerned about how corporations affect the community, the lives of its workers and the environment. And business schools are responding with more courses, new centers specializing in business ethics and, in the case of Harvard, student-lead efforts to bring about a professional code of conduct for M.B.A.’s, not unlike oaths that are taken by lawyers and doctors.

“I don’t see this as something that will fade away,” said Diana C. Robertson, a professor of business ethics at the Wharton School of the University of Pennsylvania. “It’s coming from the students. I don’t know that we’ve seen such a surge in this activism since the 1960s. This activism is different, but, like that time, it is student-driven.”
A decade ago, Wharton had one or two professors who taught a required ethics class. Today there are seven teaching an array of ethics classes that Ms. Robertson said were among the most popular at the school. Since 1997, it has had the Zicklin Center for Business Ethics Research. In addition, over the last five years, students have formed clubs around the issues of ethics that sponsor conferences, work on microfinance projects in Philadelphia or engage in social impact consulting.

“It’s been a dramatic change,” Ms. Robertson added. “This generation was raised learning about the environment and raised with the idea of a social conscience. That does not apply to every student. But this year’s financial crisis and the downturn have brought about a greater emphasis on social ethics and responsibility.”

At Harvard, about 160 from a graduating class of about 800 have signed “The M.B.A. Oath,” which its student advocates contend is the first step in trying to develop a professional code not unlike the Hippocratic Oath for physicians or the pledge taken by lawyers to uphold the law and Constitution.

Part of this has emerged by the beating that Wall Street and financiers have taken in the current economic crisis, which can set the stage for reform, Harvard students say.

“There is the feeling that we want our lives to mean something more and to run organizations for the greater good,” said Max Anderson, one of the pledge’s organizers who is about to leave Harvard and take a job at Bridgewater Associates, a money management firm.

“No one wants to have their future criticized as a place filled with unethical behaviors,” he added. “We want to learn from those mistakes, do things differently and accept our duty to lead responsibly. Realistically, we have tremendous potential to affect society for better or worse. Let’s humbly step up. We are looking out for our own interest, but also for the interest of our employees and the broader public.”

Bruce Kogut, director of the Sanford C. Bernstein & Company Center for Leadership and Ethics at Columbia, said that this emphasis did not mean that students were necessarily going to shun jobs that paid well. Rather, they will think about how they earn their income, not just how much.

At Columbia, an ethics course is required, but students have also formed a popular “Leadership and Ethics Board,” that sponsors lectures with topics like “The Marie Antoinettes of Corporate America.”

“The courses make people aware that the financial crisis is not a technical blip,” Mr. Kogut said. “We’re seeing a generational change that understands that poverty is not just about Africa and India. They see inequities and the role of business to address them.”

Dalia Rahman, who is about to leave Harvard for a job with Goldman Sachs in London, said she signed the pledge because “it takes what we learned in class and makes it more concrete. When you have to make a public vow, it’s a way to commit to uphold principles.”

* By LESLIE WAYNE, NYT, May 30, 2009


Some Comments

* 20% of Harvard’s MBA students signed it?? I’m not even sure if I can call that “a good start.” Naturally, the majority of the students, regardless of oath, will go on to lead lives in which they show at least a moderate degree of compassion towards their fellow humans…but in a field marred by ethics scandal after scandal after scandal, for a mere 20% to swear an oath of ethical practice is still embarassing, even worrisome. Imagine if 20% of medical students at a school were to accept the Hippocratic Oath. Would we be proud of those 20%, or shocked at the other 80%? The reality remains: significant further reform – years, if not decades – is necessary before the business sector will regain the trust it has spent decades losing.
— David, Ithaca, NY

* Experience is a wonderful teacher. None of these new graduates have it and I doubt they will gain the moral bearings they need to fulfill their pledges working for Goldman Sachs and Bridgewater Associates as their first ‘real’ jobs.

When I earned my MBA 40 years ago this month we didn’t even think about greed. I don’t remember it ever being mentioned.

These kids need to work for small businesses where the decisions they make will materially impact the value of the business and the lives of every employee associate.

After they learn how to take care of their colleagues and their customers, then they can consider meeting the pledge obligations at a larger firm where the experience they gained will truly serve the larger human cause.
— rlk, chappaqua, NY

* Isn’t it insulting for grown men and women to have to promise that they won’t lie, cheat, or steal? It’s like asking young doctors to promise out loud that they won’t fondle their female patients, or young lawyers to promise that they won’t forge documents. If young businessmen feel a need to make promises like that, it’s an appalling indictment of the management environment they’re going into.
— Schigolch, Bernalillo, NM

* My name is Max Anderson. I’m one of the student organizers of the MBA Oath. I want to thank everyone for reading the article and posting your thoughts. It is eye-opening to read some of the more cynical and pessimistic remarks. Perhaps the reputation of MBAs is even worse than we feared. Perhaps we have all the more reason to push for this. Some of you have said that it is the system that is corrupt and we can’t change it. Maybe you are right, but we are actually looking for long-term systemic change. We know this isn’t the total answer. Far from it. There are no silver bullets. But we have to start somewhere. Why not start by stating our values and aspirations. Sure it will be hard to keep these. But if it weren’t hard it wouldn’t mean anything.

Making an oath on graduation day isn’t like saying “abracadabra” and magically everyone is always ethical all of the time. The real test will be the thousands of decisions we make in our careers when we have to put our necks on the line for our values. However I don’t think these are empty words. Making a marriage vow a guarantee that a marriage will stay together. Yet we still believe in the power of marriage vows. A public commitment can be powerful.

A few of you have asked “why the other 80% haven’t signed.” Well we just got started this week. We graduate next week. We expect the number will rise, we’re already closer to 30%.
— Max Anderson, Cambridge, MA

* Recently, sitting at a bar in Philadelphia, I was subjected to a loud conversation by three young men who were either Wharton students or recent graduates. The outburst by the most inebriated of the bunch was dedicated to his role models in the business world. At the absolute top were Michael Milken and Jeffrey Skilling.

I felt sick and it was not the beer.

Stiffer sentencing and enforcement are what’s needed instead of some juvenile pledges.
— BB, PA

Sleeping detainees CIA interrogators at Guantanamo Bay subjected dozens of detainees to sleep deprivation, shackling the prisoners in a standing position for up to 11 days at a time. Recently released Justice Department memorandums claim sleep deprivation studies show that “surprisingly, little seem[s] to go wrong with the subjects physically.” Wait, is it really safe to go without sleep?


No—extended bouts of sleeplessness can cause an array of physical symptoms and might eventually kill you. The effects begin within the first 24 hours of sleep deprivation. First, the body undergoes subtle hormonal changes—cortisol and TSH levels increase, leading to a rise in blood pressure. A day or two later, it stops metabolizing glucose properly, creating carbohydrate cravings. (This phenomenon may have gone unnoticed among the detainees, who were already on a calorie-restricted diet.) A person’s body temperature will also drop, and his or her immune response becomes somewhat suppressed. All of these physiological changes are reversible, though—take a nap, and you’ll be on the road back to normal.

Amanda Schaffer discussed why people sleep. William Saletan reported on the military’s sleep-reduction program. David Plotz tried a drug for the chronically sleep-deprived. Seth Stevenson tested over-the-counter sleep aids.
It’s possible that given enough time, sleep deprivation can kill you. While no human being is known to have died from staying awake, animal research strongly suggests it could happen. In the 1980s, a University of Chicago researcher named Allan Rechtschaffen conducted a series of groundbreaking experiments on rats.

After 32 days of total sleep deprivation, all the rats were dead. Curiously, researchers still do not agree on the cause of death. It’s possible that the rats’ body temperature dropped so much that they succumbed to hypothermia. Another theory posits that the rats’ immune systems became so depressed that bacteria normally sequestered in their intestines spread throughout their bodies—though Rechtschaffen counters that his rats perished even when they were administered antibiotics. A third explanation points to some evidence of brain damage among the sleep-deprived rats. It’s also possible that extreme levels of stress contributed to the rats’ demise.

There’s every reason to believe that humans would experience the same end result if they were kept awake for long enough. Our knowledge of prolonged, complete sleep deprivation in humans is limited because intolerable psychological effects such as hallucination and paranoia take hold long before the more severe physical symptoms. Most human studies involve no more than two to three days of complete deprivation or a week of partial sleep deficits. Data on more prolonged sleep deprivation come from anecdotes, animal research, or surveys of chronically sleep-deprived groups like medical residents.

Got a question about today’s news? Ask the Explainer .
Explainer thanks Charles A. Czeisler of Harvard Medical School and Brigham and Women’s Hospital, James B. Maas of Cornell University, Amita Sehgal of the University of Pennsylvania, and Jerry Siegel of UCLA.

*By Brian Palmer, May 11, 2009

IS your medical insurance bad for your health? If you have a high-deductible plan, the answer may be yes.

The investment firm Fidelity recently surveyed employees at various companies who had opted for a high-deductible health plan linked to a health savings account. About half of those workers said they or a family member had chosen not to seek medical care for minor ailments as many as four times in the last year to avoid paying the out-of-pocket expenses.


As any doctor will tell you, small health problems left untreated can become big problems, warns Kathleen Stoll, director of health policy at the health care advocacy group Families USA. “This is just one of the many high-deductible pitfalls consumers need to watch out for,” Ms. Stoll said.

High-deductible health plans are essentially insurance policies that charge lower monthly premiums than traditional plans because the consumer is responsible for paying the first $1,000 to $5,000 or more in medical bills before the insurance kicks in. The plans, sometimes called catastrophic insurance, are often used in conjunction with a health savings account.

With these accounts, earnings on savings are allowed to accumulate tax free and roll over year to year, as long as the money is ultimately used to pay for medical expenses. To qualify for one of these tax-sheltered savings accounts, an insurance plan must have a deductible of at least $2,300 for families and $1,150 for individuals.

A person can put up to $3,000 annually in these accounts, or $5,950 for a family.

People who can best take advantage of this tax break are those who can afford to contribute the maximum but do not spend it all on health care. The idea is that the money accumulates over the years, providing a cushion down the road when health problems or the need for long-term care arise.

To encourage employees to choose a high-deductible option, many employers put money into employees’ accounts or match part of the workers’ contributions. High deductibles, though, can pose problems for people who cannot afford the out-of-pocket costs associated with the plans. For a low-income family earning $25,000 a year, for example, the out-of-pocket costs of a high-deductible plan would eat up an estimated 15 percent of the annual household budget, according to a Kaiser Family Foundation report.

What’s more, low-income families don’t benefit from the tax breaks associated with health savings accounts the way middle- and high-income earners do.

Even if you can afford the costs, the loopholes that insurers often weave into these plans to reduce premiums can mean that even after your deductible is met, you may not have the coverage you need to handle a serious illness or accident.

“For most people, a high-deductible plan is basically a bet against yourself,” said Ms. Stoll. “You’re betting that you won’t get sick and you won’t have an accident. But isn’t that exactly what insurance is supposed to be? A bet that something might happen, and if it does you’ll be protected?”

Whether you are considering a high-deductible policy because you are healthy and don’t think you need much coverage or you want the tax-sheltered savings account or you simply cannot afford anything else, you need to carefully consider the following.


It is not always simply because the deductible is high. There may be other cost-reducing limitations on the plan as well. If the premium looks too good to be true, look for one of these lurking loopholes:

A cap on lifetime coverage. It is hard to even estimate what you will need over your lifetime in health care coverage. But when you are looking at this number, keep in mind that the average hospital charge for an appendectomy is $22,000, and the average charge for a hip replacement is $40,000. You do not want a lifetime coverage cap that is going to be exhausted quickly by one or two long hospital stays or by extended outpatient care for a chronic illness.

A cap on doctor visits. Some severely restrictive plans will cover only a handful of doctor visits a year after the deductible is met. Others charge a big co-payment for every doctor visit. Still others will not even start to cover doctors’ visits unless they occur after a hospitalization — which, as Gary Claxton, a vice president at the Kaiser Family Foundation, points out, is basically a hospital-only policy.

A cap on hospitalization costs. Again, consider those hospital costs. Is the policy you are considering going to get you through? Mr. Claxton has seen policies that so severely restrict hospitalization that they will not pay for the first day you are admitted. “That’s the day when you’re most likely to have the most costs,” he said. “Think of it: You’re admitted to the E.R., you have surgery and you spend the night in the I.C.U., and none of it is covered.”

Other high out-of-pocket costs. Just because you have met your deductible doesn’t mean you are done spending money. High co-payments of 20 percent or more on doctors’ visits, prescription drugs and hospitalizations can add up quickly. With some of these policies, Mr. Claxton says, you will pay an extraordinary amount in out-of-pocket costs, sometimes as much as $10,000.


Consumers need to read the policies carefully. “But it’s not easy to know what is adequate coverage and what isn’t,” Mr. Claxton said. “I’ve been in this business for years, and I still wouldn’t know what, say, a reasonable cap on physical therapy for a stroke victim would be, or what a cap on radiation services would mean for a cancer patient.”

If you use a Web site like ehealthinsurance.com, you can find out more about each price quoted by clicking on “plan details” and reading carefully, looking for the categories listed above. If you do not find the specifics you need, call the insurer’s customer service department and ask.

In addition to researching and comparing policies on the Internet and by phone, Ms. Stoll suggests enlisting the help of a well-recommended insurance broker or agent who specializes in high-deductible plans, to help you wade through the really fine print. If you are comparing plans offered by your employer, your benefits department will be able to answer questions and provide copies of the policies.


Your goal is to apply only for the policy you think you are most likely to get. The drawbacks to being turned down are too great to submit applications to many insurers, hoping for the best deal.

The prices you see on the Internet or hear quoted by an agent are not necessarily the premium you will pay. To get that number, the insurance company needs to know your age, weight and other personal details and look at your medical history — a process known as underwriting.

If you are turned down for a policy for any reason, that information can be shared among insurers and be used to deny you future coverage. The more policies you apply for, the more likely you are to be turned down by at least one of them, and the more likely you are to have the damaging information in your files. Avoiding this trap is good advice, says Ms. Stoll, whether you are applying for high-deductible or traditional health insurance.


High-deductible plans that can be linked to a health savings account must adhere to federal regulations that include limits on out-of-pocket costs and the amount of the deductible. It is usually clear on most insurance Web sites whether a plan is eligible for linking to a savings account. If you have any doubts, call the insurance company’s customer service department and ask.


Because people with high deductible plans are less likely to seek routine preventive treatment — risking costly problems later on — some insurers have included basics like an annual physical and certain preventive prescription drugs.

These plans often come with slightly higher premiums, though. So you will need to calculate whether the extra coverage is cheaper than what you would pay out of pocket for preventive care.

* By WALECIA KONRAD; May 30, 2009

In mid-May, British Global Services announced 15,000 job cuts, while Japan’s Sony continued cutting 16,000 jobs. Here in the U.S., 5.7 million jobs have been lost since the recession began in December 2007. To cite one example, Caterpillar, the heavy equipment manufacturer, is moving to lay off more than 20,000 workers. These days such mass layoffs are sadly unsurprising, but are they ethical?


The Argument
They are not, at least until more benign tactics have been exhausted. Caterpillar may not simply pile a bunch of unwanted workers into a van, drive across town, drop them on the doorstep of a flourishing company, ring the doorbell and run away. (All right: these days there are no flourishing companies, but wouldn’t it be lovely if there were?)
To deprive thousands of people of their livelihood can have a catastrophic effect on them, their families and their communities. For a company to get through a recession, suffering may be unavoidable, but ethical management means minimizing that hardship, spreading the pain equitably and bearing some responsibility for its consequences.

Although the law limits the duties employers have to employees, ethics sets a different standard. Caterpillar’s workers have existed for years — sometimes generations — in profound dependence on the company. (No work, no food.) In accepting and profiting from this relationship, Caterpillar (i.e., its stockholders) incurs moral obligations to those workers. In hard times, it may not simply say: find another job. There are no other jobs, or surely not enough of them.

Mass layoffs relegate people to the status of disposable objects. A company can mothball its welding robots (although I hear the new models can wake themselves up and contact some kind of killer robots of the future who will travel back in time and terminate us all). But people are not machines. Many ethical systems mandate that you do not treat a person like a thing. You must regard other people as full human beings with the same moral rights as you. And that must include the right to make a living.

This is not to assert that Caterpillar can never downsize. Companies must be able to shrink as well as grow, to adjust to changing circumstances. (A restaurant with fewer customers needs fewer waiters.) But prudent staffing must be part of an ongoing strategy, not a panicky response to an economic downturn.
It’s easy to say that some must perish so others can survive, if you are sure to be among the survivors. (It is worth noting that Jim Owens, Caterpillar’s chief executive officer, the person ultimately responsible for these layoffs, made $9.77 million last fiscal year. His total compensation over the past five years is $25.89 million. That’s some comfy survival.)

Before adopting the ethics of the overcrowded lifeboat, before tossing thousands of non-millionaires over the side, gentler — and more equitable — methods must be tried. Everyone’s hours might be reduced, diffusing the pain. Dividends to stockholders can be eliminated. Pay cuts can be instituted company-wide, with the deepest reserved for the highest paid (that is, those most able to endure them). To its credit, Caterpillar has done some of this, trimming some executive pay by up to 50 percent, less for other management and support staff, and offering buyouts to some employees.

(Caterpillar is also to be commended for posting cool videos of its construction gear in action, like this backhoe loader and these wheel excavators. Even more amazing video can be found here, of another sort of caterpillar, the Hickory Horned Devil. It is a wonder of nature, nearly as wondrous as the expression on the face of Motorola’s co-C.E.O. Sanjay Jha. His compensation in 2008? $104 million. In late April, Motorola announced plans to lay off 7,500 people.)

It’s no defense of mass layoffs to argue that the worst effects will be mitigated by the social safety net. Indeed, “safety net” is a misleading analogy, one that evokes individual failure — a tumbling tightrope walker — rather than events over which no single worker, however good her balance (or spangly her costume), has much control.

What’s more, that net is badly frayed, particularly when compared to programs in other advanced industrial democracies, where extended unemployment pay, for example, means laid-off workers can still shop in local stores, keeping the store’s staff on the job and buffering the effects of nationwide downturns.

Benefits vary, but most European countries provide 60 percent to 80 percent of a worker’s lost salary — the average is just over 50 percent in the U.S. — and most ensure that workers and their families preserve their health benefits if they lose their jobs. Even with more generous benefits, mass layoffs would still be a slapdash response to a changing economy, jolting to companies and bruising to workers, their families and their communities. When a C.E.O. is earning tens of millions a year, we can ask for more sophisticated — and humane — management.

If Caterpillar is to relegate legions of employees to the care of the public, it may not simply echo Ebenezer Scrooge: “Are there no prisons? Are there no workhouses? Is there no COBRA?” Instead, it must use its considerable political clout to ensure that those programs are robustly funded, hardly a priority either for Caterpillar or its confreres among the Fortune 500. That is, if Caterpillar is to deprive thousands of people of a livelihood, it must either provide for their basic needs or see that the public can do so. To do neither is to dodge a moral obligation.

* By Randy Cohen May 26, 2009

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Happy days are here again for the embryonic stem cell (ESC) research community, or at least they should be. The day after Barack Obama was inaugurated as president in January, the U.S. Food and Drug Administration green-lighted an application from Geron Corporation to pursue the first phase I clinical trial of an ESC-based therapy (in this case, for spinal cord injury).

President Obama, who ran on a pro-ESC research platform, cannot take credit for that regulatory first, which was largely a coincidence of timing. But he has already made good on his promise to lift the burdensome restrictions on federally funded ESC studies imposed by his predecessor in 2001.

Laboratories receiving federal money are once again free to work on the cell lines of their choice (with some important restrictions).
So scientists at last mostly have what they have been asking for. And the public should now prepare to be disappointed.

Perhaps “disappointed” is an overstatement, but a realistic recalibration of expectations is surely in order. The problem with turning a scientific issue into a political football is that the passionate rough-and-tumble of the game can leave the science itself rather scuffed.

When opponents of ESC research likened it to genocide and Nazi concentration camp experiments, its proponents countered by emphasizing how irreplaceable ESCs were and how miraculous the cures arising from them could be. Whether or not those claims wandered into rhetorical excess, at least a few false hopes and misimpressions have probably been left behind.

To address the most obvious one first: practicable ESC-based therapies are years away. The upcoming tests of Geron’s paralysis treatment, for example, will look only at how safely it is tolerated by patients; tests of its effectiveness are further off.

The therapeutic cells helped mice to partially recover from spinal injuries, but in humans they might fail to do the same or, worse, might induce tumors. It will take time to find out. New drugs often take five to nine years to progress from phase I testing to market.
Moreover, many if not most of those future therapies based on ESC research may not actually involve ESCs. Patients, after all, will not be able to supply embryonic cells directly from their own body.

Therapeutic ESCs would either have to come from immunologically matched stockpiles (the equivalent of blood banks) or be cloned for each patient individually. Both solutions would involve technological and legal headaches. Using adult stem cells or others reprogrammed for versatility from a patient’s own tissues may therefore prove much easier. (Adult stem cells are indeed already used to treat some blood-related and orthopedic disorders.)

Opponents of ESC research may howl that these facts only vindicate their long-standing position that it would be better simply to concentrate on adult stem cell therapies. But the hard-fought campaign against restricting ESC research was well worth it: ESCs will most likely be essential for developing sophisticated stem cell therapies of any kind because they offer the best clues to how the body naturally grows, repairs and regenerates demandingly intricate tissues.

Anyone who thinks that the public debate over ESCs is nearing an end is also in for a rude awakening. In March, 10 out of 18 members of former president George W. Bush’s Council on Bioethics issued a press release criticizing the Obama administration’s policy as unethical.

Days after the president’s executive order, the Georgia State Senate approved the Ethical Treatment of Human Embryos Act, which would bar the deliberate creation of embryos for ESCs. Expect more of the same.

Stem cell research continues to be a pawn in a larger political game being fought over abortion, women’s reproductive autonomy, and the tension between individual rights and notions of public morality. And that fact, however inescapable, may be the most disappointing one of all.

Note: This article was originally published with the title, “Reality Check for Stem Cells”.Editors S.A. 27 may, 2009

The murder of Dr. George Tiller, who was shot to death as he stood in the foyer of his church in Wichita, Kan., on Sunday morning, was a reprehensible act of domestic terrorism directed toward the dwindling cadre of physicians who risk their safety to perform legal medical procedures.

Dr. Tiller’s death, the fourth killing of an American abortion provider since 1993, was the first since 1998 when a sniper gunned down Dr. Barnett Slepian in his home in the Buffalo area. For Dr. Tiller, and physicians like him, the threatening protests and incidents of violence and harassment never really stopped.
For his principled devotion to women’s health and constitutionally protected rights, Dr. Tiller was the target of protests at his clinic, his house and his church. In 1986, his clinic was bombed, and, in 1993, an abortion opponent shot him in both arms. He was forced to fend off trumped up legal challenges aimed at shutting down his operations. Last month, vandals attacked his clinic. Nevertheless, he somehow persevered in a state that is one of the battlegrounds in the fight to restrict abortion.
Responding to Dr. Tiller’s slaying, President Obama expressed shock and outrage and said that profound differences over issues like abortion “cannot be resolved by heinous acts of violence.” Mr. Obama recently called for Americans to find common ground on reducing the need for abortions. In that spirit, abortion opponents should refrain from the “baby killer” rhetoric that inflames an already heated debate.
Attorney General Eric Holder says the United States Marshal Service will begin protecting certain abortion clinics and doctors. Mr. Holder should consider taking the additional step of revitalizing the National Task Force on Violence against Health Care Providers that former Attorney General Janet Reno established during the Clinton years. There must be a sustained focus by federal and state officials to prevent further acts of violence and intimidation. If it turns out that additional laws are needed, Congress should take action.

Over time, the combination of anti-choice restrictions and ongoing harassment by protest groups even short of violence have served to make abortions harder and harder to obtain. That trend must be stopped.

* EDITORIAL New York Times (NYT), June 2, 2009

THERE is no abuse of government power more egregious than executing an innocent man. But that is exactly what may happen if the United States Supreme Court fails to intervene on behalf of Troy Davis.

Mr. Davis is facing execution for the 1989 murder of an off-duty police officer in Savannah, Ga., even though seven of the nine witnesses have recanted their testimony against him. Many of these witnesses now say they were pressured into testifying falsely against him by police officers who were understandably eager to convict someone for killing a comrade. No court has ever heard the evidence of Mr. Davis’s innocence.

After the United States Court of Appeals for the 11th Circuit barred Mr. Davis from raising his claims of innocence, his attorneys last month petitioned the Supreme Court for an original writ of habeas corpus. This would be an extraordinary procedure — provided for by the Constitution but granted only a handful of times since 1900. However, absent this, Mr. Davis faces an extraordinary and obviously final injustice.

This threat of injustice has come about because the lower courts have misread the Anti-Terrorism and Effective Death Penalty Act of 1996, a law I helped write when I was in Congress. As a member of the House Judiciary Committee in the 1990s, I wanted to stop the unfounded and abusive delays in capital cases that tend to undermine our criminal justice system.

With the effective death penalty act, Congress limited the number of habeas corpus petitions that a defendant could file, and set a time after which those petitions could no longer be filed. But nothing in the statute should have left the courts with the impression that they were barred from hearing claims of actual innocence like Troy Davis’s.

It would seem in everyone’s interest to find out as best we can what really happened that night 20 years ago in a dim parking lot where Officer Mark MacPhail was shot dead. With no murder weapon, surveillance videotape or DNA evidence left behind, the jury that judged Mr. Davis had to weigh the conflicting testimony of several eyewitnesses to sift out the gunman from the onlookers who had nothing to do with the heinous crime.

A litany of affidavits from prosecution witnesses now tell of an investigation that was focused not on scrutinizing all suspects, but on building a case against Mr. Davis. One witness, for instance, has said she testified against Mr. Davis because she was on parole and was afraid the police would send her back to prison if she did not cooperate.

So far, the federal courts have said it is enough that the state courts reviewed the affidavits of the witnesses who recanted their testimony. This reasoning is misplaced in a capital case. Reading an affidavit is a far cry from seeing a witness testify in open court.
Because Mr. Davis’s claim of innocence has never been heard in a court, the Supreme Court should remand his case to a federal district court and order an evidentiary hearing. (I was among those who signed an amicus brief in support of Mr. Davis.) Only a hearing where witnesses are subject to cross-examination will put this case to rest.


Although the Supreme Court issued a stay of execution last fall, the court declined to review the case itself, and its intervention still has not provided an opportunity for Mr. Davis to have a hearing on new evidence. This has become a matter of no small urgency: Georgia could set an execution date at any time.

I am a firm believer in the death penalty, but I am an equally firm believer in the rights and protections guaranteed by the Constitution. To execute Troy Davis without having a court hear the evidence of his innocence would be unconscionable and unconstitutional.
By BOB BARR, NYT, June 1, 2009

Bob Barr served in the House of Representatives from 1995 to 2003 and was the United States attorney for the Northern District of Georgia from 1986 to 1990.

Overload is a real problem. There is a danger that even the most decent of people can grow numb to the unending reports of atrocities occurring all around the globe. Mass rape. Mass murder.

Torture. The institutionalized oppression of women.
There are other things in the world: a ballgame, your daughter’s graduation, the ballet. The tendency to draw an impenetrable psychic curtain across the worst that the world has to offer is understandable. But it’s a tendency, as Elie Wiesel has cautioned, that must be fought.

We have an obligation to listen, for example, when a woman from a culture foreign to our own recalls the moment when time stopped for her, when she was among a group of women attacked by soldiers:
“They said to us: ‘If you have a baby on your back, let us see it.’ The soldiers looked at the babies and if it was a boy, they killed it on the spot [by shooting him]. If it was a girl, they dropped or threw it on the ground. If the girl died, she died. If she didn’t die, the mothers were allowed to pick it up and keep it.”
The woman recalled that in that moment, the kind of throbbing moment when time is not just stopped but lost, when it ceases to have any meaning, her grandmother had a boy on her back. The grandmother refused to show the child to the soldiers, so both she and the boy were shot.

A team of female researchers, three of them physicians, traveled to Chad last fall to interview women who were refugees from the nightmare in Darfur. No one has written more compellingly about that horror than my colleague on this page, Nick Kristof. When I was alerted to the report that the team had compiled for Physicians for Human Rights, my first thought was, “What more is there to say?”

And then I thought about Mr. Wiesel, who has warned us so eloquently about the dangers inherent in indifference to the suffering of others. Stories of atrocities on the scale of those coming out of Darfur cannot be told too often.

The conflict has gone on for more than six years, and while the murders and mass rapes have diminished, this enormous human catastrophe is still very much with us. For one thing, Sudan has expelled humanitarian aid groups from Darfur, a move that Susan Rice, the U.S. ambassador to the United Nations, recently told Mr. Kristof “may well amount to genocide by other means.”

Hundreds of thousands of people have been killed in the conflict and the systematic sexual attacks on Darfuri women have been widely reported. Millions have been displaced and perhaps a quarter of a million Darfuris are living in conditions of the barest subsistence in refugee camps along the Chad-Sudan border.

The report by Physicians for Human Rights, to be released officially on Sunday (available at darfuriwomen.org), focuses on several dozen women in the Farchana refugee camp in Chad. The report pays special attention to the humanity of the women.

“These are real people with children, with lives that may have been quite simple, but were really rich before they were displaced,” said Susannah Sirkin, a deputy director of Physicians for Human Rights.
The conditions in the refugee camps are grim, made worse by the traumas that still grip the women, many of whom were witnesses — or the victims — of the most extreme violence.
“I don’t think I was prepared for the level of just palpable suffering that they are continuing to endure,” said Dr. Sondra Crosby, one of the four interviewers. “Women were telling me they were starving. They’re eating sorghum and oil and salt and sugar.”

Dr. Crosby and her colleagues had a few crackers or cookies on hand for the women during the interviews. “I don’t think I saw even one woman eat the crackers, even though they were hungry,” she said. “They all would hide them in their dresses so they could take them back to their children.”

The women also live with the ongoing fear of sexual assault. According to the report, rape is a pervasive problem around the refugee camps, with the women especially vulnerable when they are foraging for firewood or food.
“It is so much easier to look away from victims,” said Mr. Wiesel, in a speech at the White House in 1999. “It is so much easier to avoid such rude interruptions to our work, our dreams, our hopes.”

But indifference to the suffering of others “is what makes the human being inhuman,” he said, adding: “The political prisoner in his cell, the hungry children, the homeless refugees — not to respond to their plight, not to relieve their solitude by offering them a spark of hope is to exile them from human memory. And in denying their humanity, we betray our own.”

By BOB HERBERT, NYT, May 30, 2009

Photographs of Iraqi prisoner abuse which U.S. President Barack Obama does not want released include images of apparent rape and sexual abuse, Britain’s Daily Telegraph newspaper reported on Thursday.

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The images are among photographs included in a 2004 report into prisoner abuse at Abu Ghraib prison conducted by U.S. Major General Antonio Taguba.

Taguba included allegations of rape and sexual abuse in his report, and on Wednesday he confirmed to the Daily Telegraph that images supporting those allegations were also in the file.

“These pictures show torture, abuse, rape and every indecency,” Taguba, who retired in January 2007, was quoted as saying in the paper.


He said he supported Obama’s decision not to release them, even though Obama had previously pledged to disclose all images relating to abuses at Abu Ghraib and other U.S.-run prisons in Iraq.

“I am not sure what purpose their release would serve other than a legal one,” Taguba said. “The sequence would be to imperil our troops, the only protectors of our foreign policy, when we most need them, and British troops who are trying to build security in Afghanistan.

“The mere depiction of these pictures is horrendous enough, take my word for it.”

The newspaper said at least one picture showed an American soldier apparently raping a female prisoner while another is said to show a male translator raping a male detainee.

Others are said to depict sexual assaults with objects including a truncheon, wire and a phosphorescent tube.

The photographs relate to 400 alleged cases of abuse carried out at Abu Ghraib and six other prisons between 2001 and 2005.

LONDON, (Reuters) –
May 27, 2009
(Reporting by Luke Baker; Editing by Jon Boyle)

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no fotos de torturados