Tag Archives: the new yorker

Is Solitary Confinement Torture? From Atul Gawande and the New Yorker

Punishment Cells

Punishment Cells. From: Page 257 of part II of Vlas Mikhailovich Doroshevich «Sakhalin (Katorga)», Moscow. Sytin publisher, 1905.

Thanks to longform.org for spotlighting another thought-provoking piece by Dr. Atul Gawande in the New Yorker. The tag line is: Hellhole: The United States holds tens of thousands of inmates in long-term solitary confinement. Is this torture?

Dr. Gawande’s reporting builds a strong case for “Yes.” Some interesting bullet points:

  • America holds at least 25,000 inmates in solitary confinement in Supermax prisons
  • More than a century ago, the U.S. Supreme Court considered banning solitary confinement
  • A 2003 analysis of Arizona, Illinois, and Minnesota found that levels of inmate-on-inmate violence were unchanged after their supermax prisons opened
  • The state of Maine has more inmates in long-term solitary than does all of England

Supermax prisons and the long-term isolation of large numbers of inmates, Dr. Gawande notes, is only a decades-old concept in the American prison system. However, in the 1890 SCOTUS case, Medley vs. U.S., the court takes note of a solitary confinement system in Philadelphia back in 1787. The conditions and consequences, noted more than two centuries ago, aren’t much different than what Dr. Gawande describes today:

The peculiarities of this system were the complete isolation of the prisoner from all human society, and his confinement in a cell of considerable size, so arranged that he had no direct intercourse with or sight of any human being and no employment or instruction….

A considerable number of the prisoners fell, after even a short confinement, into a semi-fatuous condition, from which it was next to impossible to arouse them, and others became violently insane; others still committed suicide, while those who stood the ordeal better were not generally reformed, and in most cases did not recover sufficient mental activity to be of any subsequent service to the community.

It became evident that some changes must be made in the system, and the separate system was originated by the Philadelphia Society for Ameliorating the Miseries of Public Prisons, founded in 1787.

Following the standard journalistic narrative, Dr. Gawande leads with his best anecdote and ends with his second-best. The entire piece is a must read, but the last anecdote is particularly astonishing. Gawande describes the case of Robert Felton, who spent 14 years of his 36 years on earth in solitary confinement. The isolation drove him crazy, Gawande writes, and Felton tried so many times to set his cell on fire with a lightbulb that “the walls of his cell were black with soot.”

Gawande writes about one of his last meetings with Felton. Felton had just found out the prison director who kept him in solitary confinement had just been convicted of bribery (from lobbyists, a sidestory that would probably illuminate why America holds on to certain prison strategies regardless of effect) and sentenced to two years in prison:

“Two years in prison,” Felton marvelled. “He could end up right where I used to be.”

I asked him, “If he wrote to you, asking if you would release him from solitary, what would you do?”

Felton didn’t hesitate for a second. “If he wrote to me to let him out, I’d let him out,” he said.

This surprised me. I expected anger, vindictiveness, a desire for retribution. “You’d let him out?” I said.

“I’d let him out,” he said, and he put his fork down to make the point. “I wouldn’t wish solitary confinement on anybody. Not even him.”

Read Dr. Gawande’s story in the New Yorker.

What does China *really* know about cutting-edge technology, anyway?

Left: a Seagate factory in Wuxi, China

A couple of anecdotes to remember before accepting the conventional wisdom that all China is good for is mass-producing (or copying) non-Chinese tech products (i.e. iPhones):

From Seymour Hersh’s recent New Yorker piece examining the hype of cyber-warfare:

A few weeks after Barack Obama’s election, the Chinese began flooding a group of communications links known to be monitored by the N.S.A. with a barrage of intercepts, two Bush Administration national-security officials and the former senior intelligence official told me. The intercepts included details of planned American naval movements. The Chinese were apparently showing the U.S. their hand.

“The N.S.A. would ask, ‘Can the Chinese be that good?’ ” the former official told me. “My response was that they only invented gunpowder in the tenth century and built the bomb in 1965. I’d say, ‘Can you read Chinese?’ We don’t even know the Chinese pictograph for ‘Happy hour.’ ”

And today’s New York Times, on a Chinese research center building a supercomputer that outclocks the current one by 40 percent.

Modern supercomputers are built by combining thousands of small computer servers and using software to turn them into a single entity. In that sense, any organization with enough money and expertise can buy what amount to off-the-shelf components and create a fast machine.

The Chinese system follows that model by linking thousands upon thousands of chips made by the American companies Intel and Nvidia. But the secret sauce behind the system — and the technological achievement — is the interconnect, or networking technology, developed by Chinese researchers that shuttles data back and forth across the smaller computers at breakneck rates, Mr. Dongarra said.

“That technology was built by them,” Mr. Dongarra said. “They are taking supercomputing very seriously and making a deep commitment.”

The Chinese interconnect can handle data at about twice the speed of a common interconnect called InfiniBand used in many supercomputers.

“Letting Go” – The New Yorker’s Atul Gawande, on giving up life to live

Trinity Church Cemetery

Trinity Church Cemetery

Dr. Atul Gawande’s latest New Yorker piece is described as another examination on on what’s behind the cost of health care, but it serves more as a lesson on how to both cope with the finality of death and to appreciate life.

It took me several times to get through it, and luckily I wore my sunglasses in the subway so I wouldn’t look like some snob getting teary-eyed over his iPad.

The opening (and ultimately, closing anecdote) is about an ill-fated patient of Dr. Gawande’s, a Sara Thomas Monopoli, who discovers she has incurable cancer 39 weeks into her first pregnancy. Dr. Gawande describes Monopoli’s long struggle to stay alive, with taking a series of experimental drugs with harsh side effects; at one point, she hides the fact that she’s lost feeling in her hands and had double vision for two months, for fear her treatment would be stopped.

Gawande’s sprawling piece ends up being kind of a travelogue of his journey of accepting death for his patients. He believes, as do most people, that hospice care is meant to hasten death, even though at least one survey of terminal cancer patients found that those who elected for intensive care had similar survived no longer than those who entered hospice care.

As Gawande puts it:

Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.

Gawande relates this to the current health care crisis by pointing out a 2004 Aetna study in which policyholders expected to die within a year could choose hospice services and have all the other treatments. The hospice care was so appealing, apparently, that these patients spent far less time in hospitals and ICUs, even though they didn’t have to give up any options. Costs fell by nearly 25%

The benefits of accepting fate are not just monetary. Gawande writes that by many objective metrics, patients who seriously discussed end-of-life care ended up suffering less:

Two-thirds of the terminal-cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive-care unit. Two-thirds enrolled in hospice. These patients suffered less, were physically more capable, and were better able, for a longer period, to interact with others. Moreover, six months after the patients died their family members were much less likely to experience persistent major depression.

In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation, and to spare their family anguish.

I can’t think of many other journalists who I respect more than Dr. Gawande. Besides having incredible eloquence as a writer, he’s a respected professional in the field he covers. His book “Complications,” nearly made me quit journalism to try med school – it was that fascinating of a look into how terrifying, yet intellectually challenging, it would be to be an ER surgeon – until I realized it would be a long, uphill slog for someone who never took a college level biology class.

Atul Gawande

Atul Gawande

Gawande has had at least two other notable pieces. One, related to the subject of “Complications,” was how a checklist consisting of steps as simple as reminding doctors to wash their hands was saving a staggering number of patients from post-surgical infections. And the second, about how one town in Texas managed to have the highest, by far, health care costs per capita. The article reportedly caught President Obama’s eye during the health care overhaul.

Both are instructive essays on the complexity of health care. “Letting Go” is less so, perhaps because there are no cost-benefit studies that would convince either death-panel-fearing-Tea-partiers or an insurance-company-demonizers that the health care system would ever be right to compel a patient to give up treatment.

But as a collection of tragic anecdotes, “Letting Go” really shook me and at least made me remember to appreciate what’s good in life. Maybe that’s Gawande’s ulterior strategy all along, to convince the reader to place enjoying life over prolonging it, and by doing so, maybe, get both.

Another New Yorker piece (h/t/ longform.org), written in 2001 by Gary Greenberg, also examines the moving line between life and death, and in particular, how where the line is drawn has been influenced by the demand for organs. With the concept of “brain death”, organs can be retrieved in a more viable state, as opposed to waiting until the heart stops beating. But doctors and ethicists (I assume today, as well as in 2001) are still arguing about the different kinds of brain death, and even those who accept it, they still have to train themselves to think of a warm, breathing body as “dead”:

“It took us years to get the public to understand what brain death was,” [Howard M. Nathan, who heads an organ-procurement group] said. “We had to train people in how to talk about it. Not that they’re brain dead, but they’re dead: ‘What you see is the machine artificially keeping the body alive . . .’ “ He stopped and pointed to my notebook. “No, don’t even use that. Say ‘keeping the organs functioning.’ “

And if you’ve got even more time to spend reading life-or-death longform pieces, I’ll pitch this 13,000-word Pulitzer-winning piece by my ProPublica colleague, Sheri Fink. The subject is how doctors at a New Orleans hospital may have been to quick to euthanize a group of patients while desperately waiting for rescue after Katrina.

The overarching theme, as it is in the New Yorker articles mentioned here, is what makes a life worth living/saving, and can doctors make that decision when patients can’t?


“Is she dying?” one of the sisters asked me. I didn’t know how to answer the question. I wasn’t even sure what the word “dying” meant anymore. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die.


He wanted to show that the higher-brain rationale, which holds that living without consciousness is not really living—and which the President’s commission rejected because it raised questions about quality of life which science can never settle—was the sub-rosa justification for deciding to call a brain-dead person dead. He wanted to make it clear that these doctors were not making a straightforward medical judgment but, rather, a moral judgment that people like Matthew were so devastated that they had lost their claim on existence.


According to Memorial workers on the second floor, about a dozen patients who were designated as “3’s” [a triage category for patients thought to be close to death] remained in the lobby by the A.T.M. Other Memorial patients were being evacuated with help from volunteers and medical staff, including Bryant King. Around noon, King told me, he saw Anna Pou holding a handful of syringes and telling a patient near the A.T.M., “I’m going to give you something to make you feel better.” King remembered an earlier conversation with a colleague who, after speaking with Mulderick and Pou, asked him what he thought of hastening patients’ deaths. That was not a doctor’s job, he replied. Patients were hot and uncomfortable, and a few might be terminally ill, but he didn’t think they were in the kind of pain that calls for sedation, let alone mercy killing. When he saw Pou with the syringes, he assumed she was doing just that and said to anyone within earshot: “I’m getting out of here. This is crazy!” King grabbed his bag and stormed downstairs to get on a boat.

Fries and Flavor

For your Friday reading pleasure, a 2001 Atlantic article (adapted from his “Fast Food Nation“) by Eric Schossler on Why McDonald’s Fries Taste So Good:

The taste of a french fry is largely determined by the cooking oil. For decades McDonald’s cooked its french fries in a mixture of about seven percent cottonseed oil and 93 percent beef tallow. The mixture gave the fries their unique flavor — and more saturated beef fat per ounce than a McDonald’s hamburger.

In 1990, amid a barrage of criticism over the amount of cholesterol in its fries, McDonald’s switched to pure vegetable oil. This presented the company with a challenge: how to make fries that subtly taste like beef without cooking them in beef tallow. A look at the ingredients in McDonald’s french fries suggests how the problem was solved. Toward the end of the list is a seemingly innocuous yet oddly mysterious phrase: “natural flavor.” That ingredient helps to explain not only why the fries taste so good but also why most fast food — indeed, most of the food Americans eat today — tastes the way it does.

Malcolm Gladwell of the New Yorker apparently wrote about the same subject area in 2001, concentrating more on McDonald’s attempts to make healthier versions of its food (remember the McLean? (sub-parenthetical thought: there’s far fewer Googlable articles about the McLean than I thought there would be, given its notoriety))

My favorite part of Schossler’s article is his exploration of the flavor chemical industry, by which one drop of something like methyl-2-pyridyl ketone can make a jelly-bean taste like popcorn.

Some excerpts:

A nose can detect aromas present in quantities of a few parts per trillion — an amount equivalent to about 0.000000000003 percent…The quality that people seek most of all in a food — flavor — is usually present in a quantity too infinitesimal to be measured in traditional culinary terms such as ounces or teaspoons. The chemical that provides the dominant flavor of bell pepper can be tasted in amounts as low as 0.02 parts per billion; one drop is sufficient to add flavor to five average-size swimming pools. The flavor additive usually comes next to last in a processed food’s list of ingredients and often costs less than its packaging. Soft drinks contain a larger proportion of flavor additives than most products. The flavor in a twelve-ounce can of Coke costs about half a cent.

How to make something taste like a strawberry:

A typical artificial strawberry flavor, like the kind found in a Burger King strawberry milk shake, contains the following ingredients: amyl acetate, amyl butyrate, amyl valerate, anethol, anisyl formate, benzyl acetate, benzyl isobutyrate, butyric acid, cinnamyl isobutyrate, cinnamyl valerate, cognac essential oil, diacetyl, dipropyl ketone, ethyl acetate, ethyl amyl ketone, ethyl butyrate, ethyl cinnamate, ethyl heptanoate, ethyl heptylate, ethyl lactate, ethyl methylphenylglycidate, ethyl nitrate, ethyl propionate, ethyl valerate, heliotropin, hydroxyphenyl-2-butanone (10 percent solution in alcohol), a-ionone, isobutyl anthranilate, isobutyl butyrate, lemon essential oil, maltol, 4-methylacetophenone, methyl anthranilate, methyl benzoate, methyl cinnamate, methyl heptine carbonate, methyl naphthyl ketone, methyl salicylate, mint essential oil, neroli essential oil, nerolin, neryl isobutyrate, orris butter, phenethyl alcohol, rose, rum ether, g-undecalactone, vanillin, and solvent.

The difference between natural and artificial flavors:

A natural flavor is not necessarily more healthful or purer than an artificial one. When almond flavor — benzaldehyde — is derived from natural sources, such as peach and apricot pits, it contains traces of hydrogen cyanide, a deadly poison. Benzaldehyde derived by mixing oil of clove and amyl acetate does not contain any cyanide. Nevertheless, it is legally considered an artificial flavor and sells at a much lower price. Natural and artificial flavors are now manufactured at the same chemical plants, places that few people would associate with Mother Nature.

Also, there’s a bit about how food-coloring is about as important as flavor to how humans perceive taste:

Food coloring serves many of the same decorative purposes as lipstick, eye shadow, mascara — and is often made from the same pigments. Titanium dioxide, for example, has proved to be an especially versatile mineral. It gives many processed candies, frostings, and icings their bright white color; it is a common ingredient in women’s cosmetics; and it is the pigment used in many white oil paints and house paints. At Burger King, Wendy’s, and McDonald’s coloring agents have been added to many of the soft drinks, salad dressings, cookies, condiments, chicken dishes, and sandwich buns…

Flavor researchers sometimes use colored lights to modify the influence of visual cues during taste tests. During one experiment in the early 1970s people were served an oddly tinted meal of steak and french fries that appeared normal beneath colored lights. Everyone thought the meal tasted fine until the lighting was changed. Once it became apparent that the steak was actually blue and the fries were green, some people became ill.


Grainger had brought a dozen small glass bottles from the lab. After he opened each bottle, I dipped a fragrance-testing filter into it — a long white strip of paper designed to absorb aroma chemicals without producing off notes. Before placing each strip of paper in front of my nose, I closed my eyes. Then I inhaled deeply, and one food after another was conjured from the glass bottles. I smelled fresh cherries, black olives, sautéed onions, and shrimp. Grainger’s most remarkable creation took me by surprise. After closing my eyes, I suddenly smelled a grilled hamburger. The aroma was uncanny, almost miraculous — as if someone in the room were flipping burgers on a hot grill. But when I opened my eyes, I saw just a narrow strip of white paper and a flavorist with a grin.

Speaking of flavor, one of the more interesting angles I got out of the New York Times recent investigation into the food industry’s efforts to combat salt limits is how integral that compound is to making many foods taste good, from cookies to coffee. The industry argues that with less salt, they’d need better ingredients to keep a food’s flavor. Good reading if you have even more time to read about food today:

Even as it was moving from one line of defense to another, the processed food industry’s own dependence on salt deepened, interviews with company scientists show. Beyond its own taste, salt also masks bitter flavors and counters a side effect of processed food production called “warmed-over flavor,” which, the scientists said, can make meat taste like “cardboard” or “damp dog hair.”

…As a demonstration, Kellogg prepared some of its biggest sellers with most of the salt removed. The Cheez-It fell apart in surprising ways. The golden yellow hue faded. The crackers became sticky when chewed, and the mash packed onto the teeth. The taste was not merely bland but medicinal.

“I really get the bitter on that,” the company’s spokeswoman, J. Adaire Putnam, said with a wince as she watched Mr. Kepplinger struggle to swallow.

They moved on to Corn Flakes. Without salt the cereal tasted metallic. The Eggo waffles evoked stale straw. The butter flavor in the Keebler Light Buttery Crackers, which have no actual butter, simply disappeared.

Bon Appetit!

Hat-tip to Longform.org; if you haven’t bookmarked this Instapaper-friendly site, do it. It’s made my gratuitous purchase of an iPad almost worth it.

Haitian: “That’s life…and life, like death, lasts only a little while” (New Yorker)

Edwidge Danticat in this week’s New Yorker has a haunting short essay about his cousins in the Haitian earthquake’s aftermath. The magnitude of that disaster has been too hard to read about on a daily basis, but this obituary has the emotion of a thousand death reports.

The closer:

Everyone sounded eerily calm on the phone. No one was screaming. No one was crying. No one said “Why me?” or “We’re cursed.” Even as the aftershocks kept coming, they’d say, “The ground is shaking again,” as though this had become a normal occurrence. They inquired about family members outside Haiti: an elderly relative, a baby, my one-year-old daughter.
I cried and apologized. “I’m sorry I can’t be with you,” I said. “If not for the baby—”
My nearly six-foot-tall twenty-two-year-old cousin—the beauty queen we nicknamed Naomi Campbell—who says that she is hungry and has been sleeping in bushes with dead bodies nearby, stops me.
“Don’t cry,” she says. “That’s life.”
“No, it’s not life,” I say. “Or it should not be.”
“It is,” she insists. “That’s what it is. And life, like death, lasts only yon ti moman.” Only a little while. ♦

“Haiti, the earthquake, and my family”