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Ford ’09 on the Americas

Ryan Ford ’09 has “A Prescription for Cooperation in the Americas“. One easy way to tell that this column began life as a paper for a Williams Political Science class (perhaps PSCI 202 with Professor Darel Paul) is that it uses the phrase “U.S. hegemony in the region” in the first sentence. Ford writes:

[President] Chavez has clearly demonstrated that the nations of Latin America are no longer willing to accept a subordinate role in the decision-making processes of the hemisphere, and he has fervently declared his dislike of “U.S. imperialism.” They have accepted democracy internally as promulgated by the United States, and they likewise want to be treated to democratic interactions between nations on the transnational level. If President Bush ever wants to see his Free Trade Area for Americas accepted and realized, he will have to learn to listen to and accept the input of Latin American states.

The essay is passable, but as with Kenny Yim’s, it lacks any sort of clear thesis. What point is Ford trying to make? One problem with not having a thesis is that it makes it much more difficult for the reader to contextualize the seemingly random assertions that Ford sprinkles throughout the piece. For example, why is it that Bush (or any American President) “will have to learn to listen to and accept the input” of folks like Chavez? Are they going to make nasty faces at him of he doesn’t? The whole beauty of being a hegemon is that, for the most part, you don’t really “have to” do anything. If you did, then your hegemony would be of a poor and pathetic kind.

Free trade is a perfect example. Although the US would like to include all the countries in the Americas, no one is going to worry too much if a thug like Chavez doesn’t want to play. For the most part, the US can just present each of the countries in the region with the same sort of choice that it gave to Mexico and then to Chile and then to countries like El Salvador. They can either trade more with us and grow rich or stay isolated and poor. Sure, they have a choice, but it is always within the frameword of the “neo-liberal rhetoric and program” that Ford seems to decry. (Again, it is hard from the essay to know if he is for or against more trade.)

The best summary of Ford’s view comes at the end:

[I]n order to gain acceptance for agreements like the FTAA, Bush must carefully design it in a way that incorporates Latin American feelings and keeps the interests of all nations in the hemisphere at heart. Not acting like a regional hegemony but supporting increased democratic consultation and consensus building is the best way for the United States to preserve the “democratic peace” of the Western hemisphere and continue to realize its interests, both political and economic, in Latin America.

The only problem with the first claim is that it just isn’t true. Although any trade negotiation involves some give-and-take, there is no doubt that the US does very little giving. In particular, increased free trade is all about shoving the Washington Consensus and Globalization down the throat of every poor country in the region.

Again, I don’t want to be too critical of Ford. Goodness knows that I could use a thesis statement every now and again. But too few writers, even Eph writers, take the time to make clear to their readers the point that they are trying to make and how all the supplied arguments support that point.

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Certainty

Stephen O’Grady ’97 has an insightful essay on certainty.

Many of you are probably less than shocked by this, given that our understanding of training regimens has made more than a few advances in the last 30 years, but for me it triggered a minor epiphany: much of what we know, is in fact wrong. From biology to gym to history, a substantial portion of what we are taught in our formative years is just plain incorrect. Some of the errors are intentional, some are not, but it’s impossible to argue that pretty much all of us are force fed large quantities of faulty data. Nor are the inconsistencies limited to education; how many times, for example, have health professionals changed their minds on whether or not eggs are healthy or unhealthy? First they’re good, then they’re bad, now, well, now I don’t even know if they’re good or bad, I eat them anyway. I’m sure each of you could come up with your own examples; when discussing this topic with a friend recently, they were immediately reminded of the very checkered history of medicine. Actively bleeding patients, after all, was a recommended and ardently believed in treatment for a variety of ailments well into the last century.

Read the whole thing.

The underestimation of uncertainty is a topic near and dear to my heart. My claim is that you should not be confident that the predictions of a reasonable expert won’t come to pass. In other words, if some experts think X and other argue Y, then a wise Eph has 95% confidence intervals that include both X and Y. But that is a rant for another day. Read O’Grady. You’ll learn something.

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Work To Be Done

Ethan Zuckerman ’93 provides an update on the One Laptop per Child project to be provide $100 laptop computers for all the poor children in the world.

In my earlier talk with Negroponte about the device, he suggested that one way to teach educators to use the laptop in the classroom was to send Kay around the world to teach small groups of teachers, who could go on to teach their peers. After this talk, I’m not buying it. It’s clear that there are amazing ways to use a laptop on every desktop as a teaching tool, and that a teacher like Alan could find countless ways to use such a device. But I also got the sense that it’s a subtle art to teach in this way and that it’s going to be far from obvious for most teachers how to approach this new device as anything other than a book.

I agree with Kay that the easiest challenges of the laptop are the hardware ones – indeed, I think these are the challenges Nicholas and team have done the best job of figuring out. I suspect the software – a version of Redhat Linux optimized for a diskless environment – is also well thought out. But the questions of UI, content and mentoring – as well as the challenges of distributing, servicing and financing these machines – strike me as tough challenges where there’s lots of work still to be done.

I wonder if there are any Ephs involved in this project? Zuckerman has provided some excellent coverage. I hope that he continues to do so.

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Puzzles

I want to get Eric Smith ’99 (and other Ephs) interested in my cool open source quantitative finance software project. But all he wants to work on is his stinkin’ puzzles! So it goes.

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Unrestricted Access

If you’re reading EphBlog over Christmas break, then you really must love our material. Great! We love it to. Here is the letter to the editor that I wrote for the Record in the fall.

The Record reported on Oct. 26 that “The results of the [alcohol] survey will be posted on the College Web site later this week. Access will be restricted to computers on the Williams network.” Although the College tried to restrict access, it has failed to do so as the contents are available on a blog.

Two questions: First, why does the College try to restrict access to documents that are of such broad interest to the community of past, current and prospective Ephs? (Another example is the College’s refusal to post its “Report on Varsity Athletics.”) The central value of a scholarly community is intellectual honesty and openness. Moreover, attempts to restrict access to any document which is simultaneously provided to many students and/or alumni are doomed to failure, as this example indicates. Better to make a virtue of the inevitability of public disclosure

Second, why does the Record act as lapdog to the administration in its attempts to hide the truth? The College sloppily made the report available to all in the first few hours of its release. Given this mistake, why doesn’t the Record provide an online copy to its many interested readers? If the New York Times came across a Pentagon report in a similar circumstance, you can be sure that the Times would make the document available to its readers. Back in the day, the Record took its journalist responsibilities much more seriously.

The Record edited out the link to the blog that I originally provided. I am not sure why.

No answers yet from either the Administration or the Record. None are expected.

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Rubin on Jeopardy?

So, I was watching Jeopardy tonight, and the winner was Peter Rubin –who looks to be Williams College class of 1997 Peter Rubin. Can anyone confirm or deny? A little quick research shows that Peter Rubin from Williams is a journalist in Brooklyn, as is the contestant Peter Rubin, so the odds seem pretty good.

I note that one poster on the Jeopardy message board — yes, I discovered there is such a thing, and yes, it is as scary as it sounds — opined:

“is it me or was peter the HOTTTest contestant ever?
my sorority is agreed.”

Yet another example of 97’er with both brains and brawn. If it is indeed the Eph Peter Rubin, be sure to watch tomorrow night to see if he can continue his two-game win streak!

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EphCOI Williams C

My EphCOI idea continues to go nowhere fast. Perhaps we might start off with an EphCOI about Williams C. David Kane ’58 reported a few months ago

Returning from North Carolina I found myself sitting next to a young lady on her way to her Junior Year in Seville, Spain. She turned out to be Lindsey Wu, Williams Class of 2007, daughter of Larry Wu, Williams Class of 1978. I told her of DHTK ’58, Brendon ’90, David ’88 and Ephblog. Turns out she also spent Freshman Year in Williams C.

Not too sure that she knew about Ephblog before our conversation, but I’m sure she’ll be checking it from an internet caf in Seville next week. So it looks like we have another COI group for you to identify, namely, students studying abroad. Could be there’s another COI beyond that, namely Williams C alums and, come to think of it, I was returning from a North Carolina visit to T.B. Jones, another Williams C alum of 50 years ago.

As Frank Uible would say, it’s time for the surface to air missles!

Other famous alums of Williams C include Fay Vincent ’60, Professor Layla Ali ’90, Bredon Kane ’90 and your humble blogger. (Hmmm. I guess that some of these alums are more “famous” than others.) Not-so-famous alumni include EphBlog author Lowell D. Jacobson ’03.

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Turning 40

One of the Unknowns in our Eph Blogroll is turning 40.

In the middle of our laughter about the “thirtysomething” reference, both Steve and I stopped middle snort and began to babble profusely about the show by that name that was on television in the late 80’s or early 90’s. Does anybody else remember that show about the two married couples and the two single people who were great friends in suburban Philly?

We couldn’t imagine being so old, so mature, so engulfed in home ownership, advising friends with marital problems, and single friends who wanted to be married. We never thought we would ever be like them. I find it quite interesting that an entire decade of my life has passed and I don’t recall thinking about that show once during our “thirtysomething” years. But I know exactly why I never thought about the show during the past ten years: We were living it out.

As have all the Ephs of our generation. Most of the class on 1988 is turning 40 about now. Happy Birthdays to us all.

But who is “GailNHB”?

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Spencer ’77 Trustee Status

JoAnn Muir kindly corrected some mistakes that I made in this overview of the board of trustees at Williams. She notes that:

Clayton Spencer was elected “Trustee” effective July 1, 2003, with a 5-year appointment. Please note that we no longer use the designation “Permanent Trustee.” The Trustees elect one “Term Trustee” and one “Alumni Trustee” each year (each serves a five-year term). All other Trustees elected in a given year are deemed “Trustees.” Term lengths for “Trustees” vary, with a maximum term of fifteen years. “Trustees” can be re-appointed at the end of their terms as long as they have not served for fifteen years.

This also answers some questions that I raised here. I am still a little confused, but have already spend enough time on this topic. It would be handy if the College made public the terms for each of the trustees. More transparency please. Thanks again to Muir for the clarification.

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Shout Out

Planning is moving forward with for our CGCL seminar (see above). Although I have enough discussants for the scheduled classes right now (and thanks to all the volunteers!), there are a couple of regulars — I am thinking especially of some of the participants in recent threads — who I haven’t signed up. So, consider this a shout out. EphBlog wants you!

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Conspiracy Theory

In an earlier thread, Daniel wrote:

After graduation I spent two years working as an admission officer at an elite small liberal arts college (not Williams, not in the NESCAC), and all I really have to add to your discussion is that nearly every conversation you have in this blog about admissions is infuriating; any demographic trend leads immediately to a largely baseless conspiracy theory (the leaps of logic astound me). As you continue, keep this in mind: the manifold goals and priorities of a given admission office are a lot to juggle and keep track of as you read and evaluate hundreds of individual applications and large scale patterns are difficult to see, especially given the uncertainty of yield.

Comments:

1) There would be a lot fewer conspiracy theories if the College were more transparent.

2) I count the quota for international students as a (real) conspiracy that we helped to uncover. Surely I was not the only reader of EphBlog who was surprised to know that Williams treats applicants from outside the US the way that Harvard/Yale/Princeton treated Jews 75 years ago.

3) Thanks to Daniel for taking the time to educate us. We need more informed commentary from people with actual admissions experience. One fine day, I will have some sources within the admissions department at Williams, in addition to Dick Nesbitt, of course. But that fine day is not quite here.

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Recipe

Surprising (to me), but the College is now advertising on its home page an easy link to the recent Alumni Review article on the admissions process. This has been on my to-blog list for a long time. There is much here that is interesting, much that is surprising and a little that is depressing. But more fun with all of this in the New Year.

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Berkshire Breeze

Laura Lim Prescott ’92 designed and knitted a sweater using a patter of her own creation, Berkshire Breeze.

The scarlet leaves reminds me of the autumns that I spent in the Berkshire Mountains while attending Williams College. The “Breeze” part refers to the lightness of the sweater and the fact that the lace makes wearing the sweater a little breezy.

Laura’s blog is beautifully done with many fine pictures. Eph knitters, from across the political spectrum, should be sure to visit regularly.

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Corley ’86 Weds

Richard Corley ’86 got married in Las Vegas in September. Corley is a captain with Pinnacle Airlines.

Congratulations to all.

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Memooshka

A great advantage of our more inclusive Eph Planet is that we now get Jenn Mattern, everyone’s favorite non-Eph Eph, mainlined, as it were.

If you don’t know what the hell I’m talking about, don’t feel bad. I don’t even know what I’m talking about.

Here’s a paragraph about memes for us new kids, plucked just for you from the cyberspace community garden: Yes. Right here. Click and learn. I could have linked to Wikipedia, but their meme entry reads like a philosophical dissertation, and as I always say, who needs that sort of thing when there are dirty diapers fermenting under the couch and dogs who need their phenobarbital.

But still, I’ve got memes on the brain. In Bloggerville, everybody’s tagging each other and meme-ing it up like gangbusters and making lists about the last ten potato-based foodstuffs they’ve consumed, or lists of where they were and what they were doing on each Groundhog’s Day since 1975.

Examples of such tagging among the Eph can be found in Dan Drezner ’90 and Sarah Hart ’02.

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Tenure News

One of the reasons that you read EphBlog is that we bring you the news before anyone else. Want to know who got (and didn’t get) tenure a few weeks ago?

Tenured
Laylah Ali ’90 (Studio Art)
Joe Cruz ’91 (Philosophy)
Liza Johnson ’92 (Art History)
Ileana Velazquez (Music)

Denied
Bojana Mladenovic (Philosophy)
James Teresco (Computer Science)
Annemarie Bean (Theater)

Not sure when the College will post a news release on this (and there is, as always, some chance that our sources are misinformed). Corrections and comments are welcome. I would be most interested to hear if any of the denied were excellent teachers (or any of the accepted were not). Williams has many great teachers. It still needs more.

UPDATES: Johnson’s class year added.

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Egalitarian Eph

What is the most complimentary article about an Eph to appear in the New York Times in 2005? I think this one.

Blizzards swept through Wall Street last week — bonus blizzards, that is. Henry M. Paulson Jr., chief executive of Goldman Sachs, received $37 million in shares and options. Richard S. Fuld Jr. of Lehman Brothers got $15 million in restricted stock, while John Mack, Morgan Stanley’s new chief executive, pocketed an $11.5 million stock grant for six months’ work.

But one Wall Street executive atop a fast-growing firm is saying no to the piles of pay that make corporate America’s world spin so splendidly. In a remarkable two-page letter to the chairman of his company’s compensation committee, this executive requested that he receive no increase in salary, zero stock options, a smaller bonus than last year and a piece of the company’s profit-sharing pie equal to that received by all employees. This, in a year when his company’s revenue grew by more than 40 percent.

Who is this magnanimous executive? Ethan Berman, founder and chief executive of RiskMetrics, a private company that was formed at J. P. Morgan Chase and spun out to private investors in 1998. RiskMetrics, based in Manhattan, helps institutions and corporations assess risk in their investments; it is owned by its employees and three private equity firms. It will generate revenue of $100 million this year.

Haven’t heard of Mr. Berman? That is not surprising: his company is small and he is no self-promoter. Unlike other executives uttering the bromide about how the team contributes to a company’s success, Mr. Berman not only says it, he also acts on it.

While Mr. Berman’s may not be a household name, his egalitarian executive pay philosophy is worthy of the spotlight. His letter to the board, outlining this philosophy, should be read by anyone who serves on a compensation committee. It should also be memorized by institutional investors, who too often let managers siphon wealth from their pockets.

Ethan Berman is Williams College, class of 1983. There is a lot of interesting material in the article (more excerpts below) as well as in Berman’s letter. Arthur Levitt ’53 also makes an appearence. Yet, I can’t resist using this hook an another excuse to mention my simple solution to the problems of excessive executive pay. More on that some other time.

Read more

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Diplomacy Training

The New York Times series on athletic recruiting at elite schools is excellent. (Guy Creese first blogged about it here.) Consider:

It is all about the coach’s list.

Haverford, a small, selective liberal arts college outside Philadelphia, competes in Division III, which prohibits athletic scholarships. But at many Division III institutions, including most of the nation’s small-college academic elite, athletes can measurably enhance their chances of acceptance by being included on a coach’s list for the admissions office.

The anxiety was laced with another dynamic: [lacrosse coach] Murphy was trying to figure out where Haverford ranked on each prospect’s list of colleges. He does not want to place a player near the top of his admissions list of about 15 if he believes a player’s top choices are Ivy League universities or Division III rivals like Swarthmore or Williams.

It would be great if the Record wrote some similar articles about Williams.

“It hurts my credibility with admissions if I push and scream for a kid to be admitted who ends up rejecting us,” Murphy said. “You want someone who wants you. Of course, the kids are saying the same thing about the coaches.”

This problem is solved to a big extent at Williams by funnelling tips through the early decision process. (Letters were mailed last week.) I think that many (most? almost all?) of the 66 tips are expected to apply early decision.

“My cellphone has 14 coaches’ numbers in the directory,” Bartlett said. “It’s fun, but it can be overwhelming. At times, I felt I could drown in it. The conversations with the coaches have been like something out of diplomacy training.”

Read the whole thing.

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Motherhood

Classmate and one of the original Eph Bloggers Kim Daboo ’88 has much to say on the wonders of having Three Dogs and a Baby.

To sib or not to sib. I’ve been thinking about the whole second baby thing for a while now. With my 40th birthday less than two months away, time’s a-wastin’.

One of my first thoughts after surviving Oliver’s delivery was utter amazement that some women go through it more than once. I was thrilled to have my son but my body felt like it had been through hell. My mother had five kids. The mind boggles. When I got over the initial trauma, and the area of my body known to my nurses as “the war zone” finally surrendered, I started to go back and forth in my head, many many many times a day, over whether Oliver should have a sibling.

Read the whole thing. Indeed, there is no more honest and heartfelt description of the trials and tribulations of motherhood in all of Eph Planet.

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Northern ’89 Christmas Card

Happy Holidays from the family of Sue Northern Lacy ’89!

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Better yet is the text inside the card.

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With four boys I would wager that Christmas morning in Sue’s house is quite the event . . .

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Photo ID, #33

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So many papers students write, so little time students have to pick them up. Well, this was the view inside Stetson last January — in this photo, four boxes of uncollected papers sit outside professors’ doors. Now that you are writing and handing in your papers, remember that they took work to write, and collect them in January! (“More friendly advice from your friends at EphBlog” — if I were David, I could say something like this.)

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First Years in Mission?

I didn’t see this one coming . . .

today Will Dudley emailed the CUL, forwarding an idea from Dean Rosemen concerning the proposed cluster housing. this is a paraphrase of his email, i didn’t leave anything out.

out of concern for not enough student leaders and ‘liasons’ in the each cluster, and some dissatisfaction with the Tyler renovations, she is considering having 4 clusters instead of 5.

She values the geographic unity of clusters and therefore is considering rearanging first year entries to be located in the frosh quad, like now, and in mission park, with Morgan becoming part of the easter row-house cluster (plus 2 from greylock), the berkshire quad’s 5 buildings becoming a cluster and lehman being joined to the dodd cluster (which will also contain tyler/thompson).

this idea is brand new to the CUL, as of today. there are several positives and negatives to this idea. the freshmen class would be much more unified, the clusters would be more geographic and larger. the tyler cluster’s housing options would also be much improved. negatives include, most notably the undesirability of current first year dorms fay, east and lehmen for upperclassmen (morgan will be renovated this summer) and the last-minute nature of the idea.

it is unclear how much say the CUL has in this new idea, since it is coming from Dean Roseman. the CUL is obviously not meeting until january, but i’m sure this topic will be on our minds (maybe more than we’d like) until then, so feedback is of course welcome – that’s what the blogs are for.

And feedback does indeed ensue.

On a personal note, my fellow social engineers (that would be you, Rob Chase) and I talked/plotted the possibility of having Mission filled with freshmen. Then (as now?) there was a real bifurcation of the class between the freshmen quad/Morgan/Berkshire. Everyone recognized that the East/Fayerweather folks got the short end of the stick. Moreover, the class stayed disjoint ever afterwards because of affiliation housing. Living in Greylock for three years, there were many classmates who lived in Mission that I almost never interacted with.

But that’s all boring ancient history. I am shocked that Dean Roseman would drop this bombshell on the CUL (and now on the campus) on December 15! There is nowhere near enough time (?) to even begin to evaluate this radical change in the proposal. Isn’t the co-op draw less than 2 months away? If I were in Williamstown, I would be buying Will Dudley a beer right about now . . .

This does reinforce my notion that Dean Roseman is a social engineer par excellence. She really does think that she, and she alone, knows best. The College has gone through a year’s worth of trouble and process. Just imagine how many meetings Dudley has attended, how many e-mails he has written. And now, at this late date, Roseman has a brand new idea! She couldn’t maybe have mentioned this to Dudley last spring . . . I am sure that he would have appreciated the heads up!

But, as a longtime proponent of free-agency, this represents one last chance to save the current system. Demand another year of study! Revive anchors away!

First years should be sure to read all about this never-ending debate in our handy summary post.

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“Slither”

This image is from a shoot for “Slither,” a student theatre performance a few weeks ago. Greta Wilson ’07 was painted gold and draped with live snakes as part of her performance. The set and costumes for this production were gorgeous, and it was awesome to document it.

You can see more photos here .

-Ben Rudick ’08 (first post! Woot!)

Random anecdotes: the boa used in the show came from a local museum. During the two weeks it was gone, there was sign on the cage saying, “If you want to see the snake, go to this show!” accompanying a copy of the show poster. Also, I purposely came early to the shoot, only to wander into the wrong show. I spent 45 minutes trying to figure out how live snakes were going to fit into a show about a perverted teacher (“Oleanna”).

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Goforth and Kant

Many undergraduates are studying hard for finals. Should they be? Reasonable Ephs may differ. I think that, instead, they ought to stay up all night trying to prove Kant’s categorical imperative.

That’s what I was doing 20 years ago. Actually, the above scribbling is by Chuck Goforth ’87, a frequent visitor to my junior year suite in Carter House. (Click for a larger image.) Outside of love notes to my then-girl-friend-now-wife, this is the piece of paper I treasure most from Williams.

For some reason, we had gotten into a debate about whether or not a failure to choose was immoral. Having been taught my philosophy by folks like Alan White and Laszlo Vernsenyi, I was fairly certain that Chuck couldn’t prove this, but it was endlessly fun to watch him try. We must have spent 8 hours on the topic, time that I “should have” spent studying for my Money and Banking final. Yet I argued instead of studying, talked instead of sleeping. Even then it was obvious that no one would ever really care whether I got an A or a B in ECON 367.

So, young Ephs in Williamstown, spend tonight talking with your friends, arguing about the politics of today or the philosophical debates of yesteryear. In a few short years you will find that, sadly, no one wants to stay up all night talking the deep talk anymore. Embrace the opportunities that you have right now.

Studying is overrated. Try proving the categorical imperative yourself.

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Let’s Make a Deal

A former college roommate called me with a probability question based on Let’s Make a Deal (yes, my friends are also geeks). The problem is commonly refered to as “The Monty Hall Problem” (after the host of Let’s Make a Deal) and has a clear solution.

My friend posed the question as follows:

Phase 1: Three doors are on stage and Monty asks you to guess which one the prize is behind. You select a door, say door #1. Monty opens an empty door that you did not pick, say door #2. Monty then asks if you would like to switch to door #3 or stay with door #1. Should you switch?

Phase 2: Suppose three people from the audience play the game at once and all three have to pick different doors. Suppose further that Monty reveals door #3 is empty and that player is eliminated. Should the people guessing door #1 and door #2 switch?

Phase 3: Suppose there are three people playing the game simultaneously, but they are unaware of each other’s presence. Should players switch doors?

Okay, so no one actually talks like that and I am paraphrasing my friend. But the gist of the question remain the same.

Have your answer?

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Festering Hole

David Ramos ’00, who has been a friend of EphBlog in the past, does not seem to want to spend anymore time with us.

But EphBlog’s latest spot of inanity — a couple of the regulars are foaming at the mouth about the idea of harsher sentences for hate crimes — is just too much. I’ve just added a strikingly silly entry to /etc/hosts so that I no longer go a’browsing down to that festering hole.

This is a shame. Ramos is precisely the sort of Eph who we want as a reader and contributor. I believe that this is the thread which festered. I blame Jeff Zeeman.

;-)

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Early Decision

The Early Decision letters should be mailed this week, perhaps tomorrow according to the nervous teenagers on College Confidential.

UPDATE: This post has been modified by request. The comments no longer make much sense, but they are left for historical interest.

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Cosgrove ’62 in WSJ Part 1

Williams Trustee Toby Cosgrove ’62 made the front page of the Wall Street Journal on Monday.

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The article, “Delicate Operation: How a Famed Hospital Invests In Device It Uses and Promotes” hits on many of the same themes as my critique of Cosgrove from February.

Since 2001, more than 1,200 patients at the prestigious Cleveland Clinic have had an operation aimed at correcting atrial fibrillation, a form of heart fluttering.

Doctors commonly call it the “AtriCure procedure,” after the maker of the equipment used in the surgery, a company called AtriCure Inc. In medical journals and at conferences, the Cleveland Clinic and its doctors have been leading advocates of the AtriCure procedure.

The Clinic’s relationship with AtriCure, however, goes deeper. A venture-capital partnership that the Clinic helped found and invested in owns about 4.1% of AtriCure’s stock, valued at about $7 million. The Clinic’s chief executive, heart surgeon Delos “Toby” Cosgrove, sat on AtriCure’s board of directors until March. He also invested personally in the fund and was one of the general partners managing it until, according to a Clinic spokeswoman, he cut his ties to the fund at the end of October.

Comments:

1) Love the “hedcut” of Cosgrove! It would be cool — in that obsessive EphBlog fashion that our readers know and love — to collect all the “dot-drawings” of Ephs that have appeared in the WSJ. Sounds like a project for Willipedia.

2) AtriCure is one of the companies that I mentioned in February. Advantage EphBlog!

3) Here are more quotes and commentary.

All this last spring came to the attention of the hospital’s conflict-of-interests committee, where famed cardiologist Eric Topol and blood specialist Alan Lichtin were among those who questioned the ties to AtriCure, according to people familiar with the situation. Dr. Cosgrove last week told Dr. Topol he was losing his top post at the Clinic’s medical school, a change that will take Dr. Topol off the conflict-of-interests committee and the Clinic board of governors. Dr. Topol also is an outspoken critic of Vioxx, the withdrawn Merck & Co. drug, and testified at a trial against Merck.

The Clinic ascribed Dr. Topol’s loss of his medical-school position — as provost and chief academic officer — to an administrative reorganization. Asked whether it was related to his criticism of Vioxx or of the Clinic’s ties to AtriCure, the Clinic spokeswoman said no. Dr. Topol had a conflicts issue of his own last year when an investment fund to which he was a paid adviser bet against Merck’s stock. He resigned that post.

“Famed,” eh? I would bet that Topol was a major source, perhaps the major source for this story. I bet that this is payback, either for the brouhaha last year or for Cosgrove’s actions in removing him (or both).

In an interview, Dr. Cosgrove said the Clinic favors the AtriCure procedure because it works and is safe, not because of any financial considerations. Clinic doctors and others have reported that nearly 90% of patients have normal heart rhythms six months after the procedure. Long-term data are sketchy.

The Food and Drug Administration has three times rejected AtriCure’s application to have its system approved for cardiac use, most recently earlier this year. Doctors may legally do the procedure anyway because the equipment is approved for “soft tissue” surgery. Though that category doesn’t include the heart, they may use it on the heart in what’s known as “off-label” usage. AtriCure says that all current use of its equipment is off-label.

Four patients are known to have died shortly after having the AtriCure procedure, at hospitals other than Cleveland Clinic. AtriCure didn’t notify the FDA — which requires companies to tell it of any “adverse consequences” related to their products — because it says it didn’t believe its equipment was to blame. Dr. Cosgrove said he wasn’t aware of the patient deaths.

As for the three FDA rejections of AtriCure applications for heart use, Dr. Cosgrove said much of the medicine practiced in the U.S. is off-label. “It’s the nature of what we do and how we learn,” he said. “The important thing is the candor by which you discuss results and failures.”

D’uh! We’re all for candor here at EphBlog. It would have been good if Cosgrove had demonstrated that a bit more clearly in February. (But, to be fair, Cosgrove might not have been so much concealing back then as clueless. Your typical doctor — and some of my best friends are doctors! — has a limited grasp on the concept of a conflict of interest.)

But the real shame is that Cosgrove is right about the underlying medicine. There is a common delusion that, for any given patient/condition, there is one “right” treatment that all (competent) doctors (and the FDA) would agree on. This just isn’t true. The sooner that people realize that competent doctors often differ on their treatment recommendations, both from each other and from the FDA, the better.

The Clinic’s full name is the Cleveland Clinic Foundation, and the fund took a name based on that: Foundation Medical Partners, or FMP. Dr. Cosgrove said in an interview that trustees approved his role at FMP, which is confirmed by the board chairman, Malachi Mixon. Dr. Cosgrove didn’t become the Cleveland Clinic’s CEO until last year.

At the fund’s launch in 2001, the Clinic was its largest investor, supplying $25 million of the $61 million raised from investors, known as limited partners. The Clinic is entitled to 38% of its profits. Dr. Cosgrove also invested in the fund personally. He became one of a handful of general partners managing the fund.

FMP uses its clinic tie to suggest to prospective investors that it has an edge in spotting promising young companies. A document for a second FMP fund now being organized notes that the Clinic’s “prominence, prestige, and sheer scale…prompt” many health-care entrepreneurs to seek to develop a relationship with the institution.

We mentioned a lot of this but the WSJ provides better details and, shockingly, called people up for comment. I guess we still have a lot to learn about this whole “reporting” thing.

The Clinic’s Drs. Cosgrove and Gillinov were among authors of a study published in the Journal of Thoracic and Cardiovascular Surgery of 513 AtriCure surgery patients at the Clinic in June. It found that 87% were free of atrial fibrillation after six months, declining to 72% after one year. The journal disclosed Dr. Gillinov’s tie to AtriCure — he’s a paid consultant to it — but not Dr. Cosgrove’s. Dr. Cosgrove said it was “an oversight on my part.”

Dr. Gillinov and another surgeon then at the clinic, Patrick McCarthy, co-wrote a favorable review of AtriCure’s technology in the Annals of Thoracic Surgery in 2002. The journal mentioned they’d been asked to become AtriCure consultants, which they later did. AtriCure granted each doctor options to buy 25,000 shares of its stock, it said in a June filing with the Securities and Exchange Commission.

Dr. Gillinov, through a clinic spokeswoman, said he declined the options offer. An attorney for AtriCure said Dr. Gillinov doesn’t own AtriCure options now, but “if it was in the prospectus, it was true then.” Dr. Gillinov is paid $10,000 a year as an AtriCure consultant, said Eileen Sheil, the spokeswoman for the Clinic. She said he had been paid more, but the Clinic forced him this spring to reduce it to conform to its guidelines.

The article’s tone is a bit misleading at this point. It is not a problem that doctors are engaged in research, that their research is used to make new products, or that companies make money from these products. It would be crazy to try to outlaw and regulate these relationships.

The central solution is disclosure. As long as everyone — patients, doctors, hospitals, insurance companies — knows who is getting paid for what, we can all use that information to decide on what is best for us and the people/institutions to whom we are responsible.

Last winter the Cleveland Clinic’s conflict-of-interest committee learned that the FMP venture fund was an investor in companies doing research at the Clinic, said committee chairman Guy Chisholm. He said the committee was informed by the hospital’s Institutional Review Board, headed by Dr. Lichtin. It had been told of the investment by a doctor who ran across the ties to AtriCure while researching the AtriCure procedure.

In my active fantasy life, I like to imagine that this unnamed doctor came across the information via EphBlog. The page in question certainly gets a lot of hits. Note that we are the number one result for “AtriCure and Cosgrove” on Google. But was this true last winter? Is this how the issue came to light? Hmmm. Possible, but unlikely.

[UPDATE: I have since confirmed that the original tip did not come from EphBlog or from the New York Times article of the same time period.]

Some committee members worried that the Clinic’s ties to AtriCure could color what patients were told when weighing treatment options. They also worried that their CEO’s roles at AtriCure and the venture fund that invested in the company created a conflict, said someone familiar with the panel’s discussions. At a minimum, the committee concluded, patients should be told of the Clinic’s and doctors’ financial ties, according to Dr. Chisholm, a Ph.D. researcher at the Clinic. He said many Clinic doctors and nurses conducting the research were unaware of the links.

Mr. Rein, Dr. Cosgrove’s investing partner said there is a natural tension at the Clinic between those who believe “all of this is a bunch of people trying to take advantage of patients” and those who believe the entrepreneurial efforts are part of a “virtuous cycle” where the clinic and patients both benefit from medical advances.

Correct. I am not one to side with the anti-business luddites of the medical/regulatory establishment who think that any connection between profit and care is the devil’s own IV drip. But praise of the “virtuous cycle” is not enough either. We need disclosure.

The conflicts committee began to look into the role of Dr. Cosgrove at FMP and AtriCure, and some members wrote a detailed list of questions to submit to him, say people familiar with the matter. Not long afterward, Dr. Cosgrove stepped down from AtriCure’s board and said he would give up his position as a general partner at FMP. Dr. Cosgrove said he wasn’t prompted to vacate the posts by conflicts-committee pressure but by his wish to avoid the perception of a conflict. He said he had already been thinking about the issue and what he should do about it before the committee raised it.

Among the questions the panel posed was how much he earned as a general partner at FMP and how much he got of fund profits. According to internal Clinic documents, the fund’s general partners were entitled to share an annual management fee of 2.75% of the money raised from investors, fees that total about $1.7 million a year. There were three general partners.

The fund distributes 80% of its profits to limited partners. Of the other 20%, a 6-percentage-point slice goes to the Clinic and a 14-point chunk is divided among the general partners.

Nice insider details! Once the conflicts committee got word of the problem, I like to think that someone came across our work on the topic. That would be way cool. The list of questions is certainly consistent with our commentary (but also with the sort of questions that any investments-savy observor would have).

I am not an expert on bio-tech funds, but my sense would be that this as an incredibly generous deal for Cosgrove and the other general partners, given that the Cleveland Clinic put up most (all?) of the investment funds. Indeed, I think that this is real evidence of insider-chicanery, of using the funds of the (non-profit) Cleveland Clinic for personal enrichment. At the very least, I would like to know who at CC negotiated this deal. I think that they were taken advantage of.

The fund’s profits are known as “the carry.” Mr. Rein said in an interview that Dr. Cosgrove was “compensated with carry,” but didn’t receive any of the management fees. Mr. Rein said the fund has made one distribution of profits and Dr. Cosgrove would have received a payment from that distribution. Later, however, Mr. Rein said that general partners hadn’t received any of the profits distributed by the fund so far, that only limited partners had.

Dr. Cosgrove said he was required to invest in the fund by virtue of his role as a general partner. Mr. Rein said the three general partners at the time the fund was created, including Dr. Cosgrove, put in a total of 1% of the total raised, or about $600,000. He said the fund lent them the money to invest.

Sleazy, sleazy, sleazy! Alas, this post has gone long enough. I hope to return to these issues at a later date. For the record, I do not think that Toby Cosgrove is a bad guy. I think that he, like many successful doctors/inventors/entrepeneurs, is too quick to believe that, because his intentions are good, no one should question his actions. That was probably true 10 years ago. It isn’t true today.

Further excerpts below.

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CGCL Draft Syllabus

Here is a very rough outline of our syllabus for CGCL II: The Diversity Initiatives, a follow-up to last year’s wildly successful virtual Winter Study seminar. What we need now are some discussants. As our volunteers (Richard Dunn ’02, Lee Altman ’93, Diana Davis ’07, Kevin Koernig ’05 and Lowell Jacobson ’03) from last year can tell you, this is a low stress job. We just ask you to read the assigned section of the report and write a brief blog entry on it. This can be as short or long, complimentary or damning as you like. A good discussant starts off a conversation that we can all then participate in.

Please e-mail me if you would like to be a discussant and indicate which day you would like to do. I am also welcome to suggestions about re-organizing the below to include other aspects of the Diversity Initiatives or to better spread out the material.

The report is available to everyone on campus and for those off-campus who go through the bother of requesting a login and password. Surprisingly, no one has followed the example of the Alcohol Report by posting a publicly available copy. Strange. How I am going to recruit outsiders, like Professor KC Johnson to participate, if they can’t read the report? Hmmmm.

Anyway, here is the tentative outline. As always, special thanks to James McAllister for participating in this project.

Tuesday, January 3: Introduction and Conclusion by President Morty Schapiro. Discussant:

Thursday, January 5: Student Input. Discussant:

Monday, January 9: Student Recruitment and Admission by Director of Admissions Dick Nesbitt. Discussant:

Wednesday, January 11: Student Experiences by Provost Cappy Hill and
Dean of the College Nancy Roseman. Discussant:

Friday, January 13: Curriculum by Professor Stephen Tifft. Discussant:

Monday, January 16: Faculty Recruitment, Retention and Satisfaction by John Gerry, Associate Dean of the Faculty. Discussant:

Wednesday, January 18: Alumni by Paula Moore Tabor,
Associate Director of Alumni Relations. Discussant:

Friday, January 20: Orientation and Ongoing Education by Gail Bouknight-Davis, Director of the Multicultural Center. Discussant:

Monday, January 23: College Procedures by Nancy McIntire, Assistant to the President for Affirmative Action and Government Relations. Discussant:

Wednesday, January 25: Consultants’ Report by Kimberly Goff-Crews, Dean of Students, Wellesley College, and Evelyn Hu-DeHart, Professor of History and Ethnic Studies and Director, Center for the Study of Race and Ethnicity in America, Brown University. Discussant:

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Purple Fingers

William Bennett ’65 asks everyone to turn their finger purple.

With our troops, with our allies, and with the brave Iraqis, we look forward to a new birth of freedom in Iraq; and want to do what we can to show our soldiers, our allies, and — most importantly — the Iraqis, that we stand with them as they stand for themselves.

Starting on Monday, December 12th, I — and tens of thousands of others across America — will be marking my right index finger with purple ink to show those in Iraq we support them. Based on suggestions from listeners on my nationally syndicated radio show, I — and we — are asking you (to the degree physically feasible) to make available an ink pad or marker at your check-out counters for your customers, to mark their fingers with ink as they leave your store.

Let us all look forward to a day when all men, women, and children can live in freedom. Until then, let us do what we can for those that we can.

Indeed. Will you be painting your finger purple? If so, drop us a photo. We love everything purple here at EphBlog.

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