Cambridge 02138

Drug costs, tuition and financial aid, toxins and learning


Great article by Craig Lambert on "The Way We Eat Now" (May-June, page 50), the best I have read on the subject, period. And we have the food pyramid up on the refrigerator.

William P. O'Donnell '55
Saratoga Springs, N.Y.


Lambert uses body mass index as an indicator of overweight and obesity. BMI, however, is merely a ratio of (weight) to (height squared), and as such is questionable on at least two basic grounds.

The BMI calculation makes no distinction between lean body mass (e.g., muscle) and less healthful fat tissue. Thus, as is often noted, top competitive athletes may have BMIs that are well into the "obese" range.

In addition, the BMI formula does not reflect the effect of scaling. (Mass of an object increases as the cube of its linear dimension. For example, using standardized units, a cube with a height of one has a mass of one; a cube with a height of two has a mass of eight.) Since BMI is a factor of the square — rather than the cube — of height, it's skewed to generate higher results for taller individuals as compared to shorter subjects.

Does Lambert maintain that BMI is the best available measure of obesity?

David Myatt '74
Bethesda, Md.


Craig Lambert responds: While there is no perfect measure of overweight and obesity, BMI is the most widely used, widely accepted index, and can be calculated readily with only minimal data. Furthermore, BMI has been empirically validated, in that its correlation with fat mass (adjusted for height) assessed by other means is very high. This is because the large majority of weight variation in a typical population is due to variation in fat mass, not muscle mass.



Jonathan Shaw's "The Deadliest Sin" (March-April, page 36) is full of interesting information, including a very surprising chart on page 40 showing that in 2002, the states with the highest percentage of obese adults were Mississippi, Alabama, and West Virginia. The same three states, along with Michigan, were in the same position in 1991.

Mississippi, Alabama, and West Virginia are relatively poor states. According to the Statistical Abstract of the United States for 2002, they ranked respectively 50, 42, and 49 in per-capita income in 2001. It is hard to believe that their citizens can afford to sit around noshing in air-conditioned rooms. This is especially implausible for rural, mountainous West Virginia.

Is there a connection between poverty and obesity? It might be that people in impoverished areas cannot readily buy a healthy selection of food and are pushed to eat starchy fillers. There might be some more elusive connection to attitudes and emotional stress.

Christopher J. Henrich, Ph.D. '68
Red Bank, N. J.


Jonathan Shaw responds: Researchers have hypothesized that pyschological, physiological, and environmental factors may play a role. Poverty-induced stress may even change the way food is metabolized and stored as fat. Steven Gortmaker, professor of society, human development, and health at the School of Public Health, says, "The issue is complex. One would expect extreme poverty to lead to low relative weight (e.g., as in parts of the world where famine appears regularly). And there are still populations in the United States where there are regular problems in obtaining enough to eat. But the observation about these states is correct, and there is the clear need for better research to understand the causes of this evident energy imbalance — high rates of obesity in populations with a high prevalence of household poverty."



Howard Gardner does well to research the ethical dilemmas of young workers but understates the other side of the equation, the accountability of their employers. To quote David Wilkins ("Good Work," a review of Making Good, by Gardner et al., May-June, page 21), "to satisfy their editors' need to win the 'ratings war,' young journalists are pressed to report sensationalized stories that they believe distort the truth and add little to the public debate." Most of us would agree that employers wield as much decision-making power as their employees (if not more). To assert otherwise suggests that the average U.S. business is cooperatively owned and operated.

Ira Braus, Ph.D. '88
West Hartford, Conn.



Michael Ignatieff's astonishing statement about eighteenth-century intellectual history, "human rights came out of the European Enlightenment and Rousseau" ("Harvard Portrait," March-April, page 64), sums up what is wrong with his philosophy, with Harvard's, and with the Left's in general.

The modern idea of human rights in fact grew out of the Protestant Reformation in northern Europe, in particular the Dutch revolt against Spain begun in the sixteenth century and the Puritan revolution in England of the seventeenth (which led to the settlement of New England and to the founding of Harvard). Those movements were based more or less consciously on the model of the Roman republic, and of the Greek city-states which preceded it. Those movements grew in long and bloody struggle against the neo-primitive idea of absolute monarchy, in which only the ruler has rights, while the people have only obligations.

What Rousseau brought to the table in the eighteenth century was a new rationale for rescinding individual rights and imposing tyranny. Instead of personal submission to a monarch, he preached individual submission to "society," a social contract. In his new formulation, not the monarch but "society" had a monopoly on rights.

Yet "society" is just a hypothetical construct with no real existence. After Rousseau, anyone who could seize power by force or guile, and then claim to speak for society, for "the people," needed no other form of legitimacy. From this abstraction came the most abominable string of mass-murdering tyrants in history: Napoleon, Andrew Jackson, Lenin, Stalin, Hitler, Mao, Saddam Hussein, and dozens of other monsters. To identify "human rights" with this thread of modern history is to turn the phrase into an obscenity, a curse. Which is exactly what Ignatieff and the rest of the Left have done.

Bernard Levine '69
Eugene, Ore.

Michael Ignatieff replies: I find this absurdly ideological. First of all, I am an old-style civil-rights liberal, not a member of the Left as your correspondent so ingeniously assumes. Second, I have the same problems with Rousseau as he does, but I hope I am a better historian. It's a tired old cliché to derive the entire nineteenth- and twentieth-century history of tyranny from Rousseau, but this line of argument simply won't do. He can't be blamed for Stalin, that odious ogre. As for the Protestant Reformation, by all means. Human rights derives from the broad river of European revolt against tyranny, and Protestantism is a central source of it, together with remembered republicanism and anything else your correspondent wants to mention. His account of the story is fine by me. What I can't stand is this ridiculous use of complex history to settle the correspondent's contemporary political scores. For heaven's sake, lighten up.



My disappointment in the decision of the Committee on College Life to approve the self-described "pornographic" undergraduate magazine H-Bomb ("Brevia," May-June, page 75) is tempered only by my appreciation for what a well-chosen name the new publication will have. While the search for weapons of mass destruction continues around the world, we live daily in the presence of such a weapon in our society. Pornography debases and commodifies its subjects, exposing them to the risk of violence, and fuels a sexual addiction from which, in my work, I continually see people struggling to get free. For students at an elite institution, a jaunt into the world of pornography may be nothing more than "titillation," but those without their privileged background and advantages will find that if they follow this high-profile example, they may be trapped and exploited for a lifetime.

Rev. Dr. Christopher R. Smith '80
East Lansing, Mich.



Thanks for your enlightening articles on the government's plans for Medicare drug coverage (much the best explanation I've read) and on ways to achieve better health insurance for the non-elderly uninsured and under-insured ("Medicare Solutions — and Problems," by Joseph P. Newhouse, and "Covering the Uninsured," by Katherine Swartz, May-June, pages 33 and 36).

Prescription drug coverage should be available to all, not just Medicare and Medicaid populations. Big Pharma's profit margins, after R&D, are the highest of any industry's in this country. Reasonable price controls — reduced, say, to what Canadians pay — probably wouldn't put a significant dent in resources for R&D, but might just curtail advertising to consumers. Result: less demand for unnecessary prescriptions, and savings to taxpayers.

Polly Miller '58
Nyack, N.Y.


Swartz does an excellent job of describing the plight of the 43 million Americans who lack health insurance, plus the millions more who are underinsured, plus the millions more who worry about losing their insurance. Swartz informs us that a major problem with current insurance policies is that it's riskier to insure individuals than groups. Consequently the cost of insurance for individuals, rather than groups, is very high — unaffordable by the poor and even by many members of the middle class.

To solve these problems, Swartz offers several possibilities, including assumption of some of the risk by the federal government. I'm surprised, however, that she doesn't suggest complete takeover of health insurance by the federal government. A single-payer national health-insurance program would put all U.S. citizens into a single risk pool, thus reducing risk per individual to the lowest possible value. Furthermore, another group of Harvard scholars — Drs. Stephanie Woolhandler, David Himmelstein and Marcia Angell of Harvard Medical School — along with Dr. Quentin D. Young, writing last year in the Journal of the American Medical Association, calculated that the savings that would accrue from eliminating the administrative costs and profits associated with multiple private health insurers (about $200 billion annually) would be more than sufficient to provide health insurance to all currently uninsured Americans. Health insurance would become a right of citizenship, and our anxieties regarding the availability and affordability of insurance would disappear.

Single-payer national health insurance is no longer politically unacceptable. And, although the private health-insurance industry would be a loser if the United States were to switch to national health insurance, most other sectors of the economy would be winners. For example (according to an article by Danny Hakim in the New York Times, July 15, 2003), General Motors now spends about $1,200 per automobile to purchase health insurance for its employees. In other industrialized nations, manufacturers are free of health-care costs.

Joel A. Huberman '63
Buffalo, N.Y.



I have read ("Allston Planning," January-February, page 52; and see page 58 of this issue) that there are serious plans afoot to move the School of Public Health to the anticipated Allston campus. To take a public-health school that is located in the medically rich milieu of the Longwood area and move it miles away is, well, bizarre.

Think what will happen. Public-health students and faculty will be separated from the Countway Medical Library, they will be distanced from all the wonderful seminars that take place in the medical area, and they will be separated from the Medical School. I know students and faculty would be able to hop on a bus, but it won't be the same; in fact, it will be drastically different.

Colman M. Herman, M.P.H. '92, P '94
Dorchester, Mass.


The recent financial-aid initiative taken by the College to help low- and middle-income students ("Class-conscious Financial Aid," May-June, page 62) is a good first step, but it does not address the problem that created the need for such aid in the first place. Tuitions have increased at a more rapid rate than the consumer price index (CPI) over the past 30 years. From 1990 to 2000, for example, tuitions increased 1.7-fold compared to a 1.3-fold increase in the CPI. During the same period, endowment per student more than tripled, to approximately $1 million per student. Wouldn't lower tuitions be a more effective way of attracting low- and middle-income students than a direct financial-aid program?

In addition to using a greater percentage of the endowment to keep tuitions low, the University needs to match the structural changes that have occurred in the private and public sectors in order to provide education on a more cost-effective basis. By structural change, I mean a reduction in the amount of capital required to educate a student and a reduction in the amount of administrative cost per student. Such changes would permit the University to keep reduced tuitions, as a percentage of costs, at its historical 50-percent level and, I believe, result in better education for students from all economic sectors of society.

Stuart Ray '66, M.B.A. '70
Nassau, Bahamas



That the life of a human being begins at conception is an elementary fact of biology, resoundingly confirmed by modern genetics, rather than an idiosyncratic belief that "some people and certain religious groups hold" ("Stem-cell Science," May-June, page 59). Although it has become fashionable to disregard this inconvenient truth, no scientifically coherent alternative account of when a human life begins has been developed.

If the Harvard Stem Cell Institute were truly committed to thinking deeply about the ethics of embryonic stem-cell research, it would begin by squarely confronting the fact that the beings that it destroys in the course of harvesting stem cells are living members of the species Homo sapiens in the same remarkably early phase of human life that the rest of us passed through.

M. Edward Whelan III '81, J.D. '85
President, Ethics and Public Policy Center
Washington, D.C.


Editor's note: For many points of view on stem-cell research, see "Stem-Cell Science."



There is an error in an advertisement on page 29 of your May-June issue. What is labeled as Giverny, France, is really Villandry, the Loire château famous for its extensive Renaissance boxwood gardens. In the foreground is the garden of love.

James R. Johnson '41
Damariscotta, Me.


Editor's note: The garden of love depicts (clockwise from lower left in that photograph) tragic love, tender love, passionate love, and fickle love, representations that become clearer when the boxwood is interplanted with flowers. In tragic love, for instance, the daggers that pierce the heart are filled with red in season.



Much as I have enjoyed and benefitted from Jennifer Hochschild's earlier work, her review of Abigail and Stephen Thernstrom's No Excuses: Closing the Racial Gap in Learning ("Minding the Gap," March-April, page 23) is as flawed as the book she's criticizing. My own work on toxins, brain chemistry, and learning puts these issues in a different perspective that urgently needs attention.

Lead poisoning affects educational performance. Recent experimental research has confirmed the harmful effects of blood lead on IQ even when the level of lead is below the traditional danger threshold of 10 micrograms/deciliter. Many attention-deficit children have been found to carry high levels of lead and other toxins, which suggests that neurotoxicology may explain what has been called a virtual epidemic of hyperactivity. Moreover, lead and other toxins can increase rates of asthma and other health and behavioral problems.

There are objective reasons for between-group differences in standardized test scores that are influenced by greater uptake of toxins due not only to the child's social environment or development, but to genetics. Within the "racial" category of children identified as black, for example, exposure to toxins can combine with poverty to produce striking deficits, especially where the poverty is linked with living in old housing, which is likely to have lead paint and old plumbing fixtures.

My own work shows that two chemicals widely used in public water supplies (hydrofluosilicic acid and sodium silicofluoride) further increase this differential vulnerability. Data show the practice of using these untested toxins, which harm all children but have more serious effects on minorities, is a serious case of environmental injustice. Such chemical factors in the environment have independent effects that are more easily remedied than the psychosocial factors that have so long been the focus of attention. Knowledge of the way brain chemistry can cause learning disabilities, poor impulse control, and substance abuse makes it time to consider brain science and toxicology when implementing education policies in the United States.

Roger D. Masters '55
Rockefeller professor emeritus, Dartmouth College
Hanover, N.H.



I love your idea to sample the book Harvard A to Z (May-June, page 42) via its "vowel chapters." But I suggest (100 percent facetiously) that, when organizing this way, you should sometimes include Y.

Matthew Skelly


Editor's (unfacetious) query: How many other English words are there that use all the vowels in order?


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