Well: What Housework Has to Do With Waistlines

Phys Ed

Gretchen Reynolds on the science of fitness.

One reason so many American women are overweight may be that we are vacuuming and doing laundry less often, according to a new study that, while scrupulously even-handed, is likely to stir controversy and emotions.

The study, published this month in PLoS One, is a follow-up to an influential 2011 report which used data from the U.S. Bureau of Labor Statistics to determine that, during the past 50 years, most American workers began sitting down on the job. Physical activity at work, such as walking or lifting, almost vanished, according to the data, with workers now spending most of their time seated before a computer or talking on the phone. Consequently, the authors found, the average American worker was burning almost 150 fewer calories daily at work than his or her employed parents had, a change that had materially contributed to the rise in obesity during the same time frame, especially among men, the authors concluded.

But that study, while fascinating, was narrow, focusing only on people with formal jobs. It overlooked a large segment of the population, namely a lot of women.

“Fifty years ago, a majority of women did not work outside of the home,” said Edward Archer, a research fellow with the Arnold School of Public Health at the University of South Carolina in Columbia, and lead author of the new study.

So, in collaboration with many of the authors of the earlier study of occupational physical activity, Dr. Archer set out to find data about how women had once spent their hours at home and whether and how their patterns of movement had changed over the years.

He found the information he needed in the American Heritage Time Use Study, a remarkable archive of “time-use diaries” provided by thousands of women beginning in 1965. Because Dr. Archer wished to examine how women in a variety of circumstances spent their time around the house, he gathered diaries from both working and non-employed women, starting with those in 1965 and extending through 2010.

He and his colleagues then pulled data from the diaries about how many hours the women were spending in various activities, how many calories they likely were expending in each of those tasks, and how the activities and associated energy expenditures changed over the years.

As it turned out, their findings broadly echoed those of the occupational time-use study. Women, they found, once had been quite physically active around the house, spending, in 1965, an average of 25.7 hours a week cleaning, cooking and doing laundry. Those activities, whatever their social freight, required the expenditure of considerable energy. (The authors did not include child care time in their calculations, since the women’s diary entries related to child care were inconsistent and often overlapped those of other activities.) In general at that time, working women devoted somewhat fewer hours to housework, while those not employed outside the home spent more.

Forty-five years later, in 2010, things had changed dramatically. By then, the time-use diaries showed, women were spending an average of 13.3 hours per week on housework.

More striking, the diary entries showed, women at home were now spending far more hours sitting in front of a screen. In 1965, women typically had spent about eight hours a week sitting and watching television. (Home computers weren’t invented yet.)

By 2010, those hours had more than doubled, to 16.5 hours per week. In essence, women had exchanged time spent in active pursuits, like vacuuming, for time spent being sedentary.

In the process, they had also greatly reduced the number of calories that they typically expended during their hours at home. According to the authors’ calculations, American women not employed outside the home were burning about 360 fewer calories every day in 2010 than they had in 1965, with working women burning about 132 fewer calories at home each day in 2010 than in 1965.

“Those are large reductions in energy expenditure,” Dr. Archer said, and would result, over the years, in significant weight gain without reductions in caloric intake.

What his study suggests, Dr. Archer continued, is that “we need to start finding ways to incorporate movement back into” the hours spent at home.

This does not mean, he said, that women — or men — should be doing more housework. For one thing, the effort involved is such activities today is less than it once was. Using modern, gliding vacuum cleaners is less taxing than struggling with the clunky, heavy machines once available, and thank goodness for that.

Nor is more time spent helping around the house a guarantee of more activity, over all. A telling 2012 study of television viewing habits found that when men increased the number of hours they spent on housework, they also greatly increased the hours they spent sitting in front of the TV, presumably because it was there and beckoning.

Instead, Dr. Archer said, we should start consciously tracking what we do when we are at home and try to reduce the amount of time spent sitting. “Walk to the mailbox,” he said. Chop vegetables in the kitchen. Play ball with your, or a neighbor’s, dog. Chivvy your spouse into helping you fold sheets. “The data clearly shows,” Dr. Archer said, that even at home, we need to be in motion.

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Media Decoder Blog: SFX Entertainment Buys Electronic Dance Music Site

SFX Entertainment, the company led by the media executive Robert F. X. Sillerman, has agreed to buy the music download site Beatport, part of the company’s plan to build a $1 billion empire centered on the electronic dance music craze.

Mr. Sillerman declined on Tuesday to reveal the price. But two people with direct knowledge of the transaction, who were not authorized to speak about it, said it was for a little more than $50 million.

Beatport, founded in Denver in 2004, has become the pre-eminent download store for electronic dance music, or E.D.M., with a catalog of more than one million tracks, many of them exclusive to the service. It says it has nearly 40 million users, and while the company does not disclose sales numbers, it is said to be profitable.

The site has also become an all-purpose online destination for dance music, with features like a news feed, remix contests and D.J. profiles. Those features, and its reach, could help in Mr. Sillerman’s plan to unite the disparate dance audience through media.

“Beatport gives us direct contact with the D.J.’s and lets us see what’s popular and what’s not,” Mr. Sillerman said in an interview. “Most important, it gives us a massive platform for everything related to E.D.M.”

Since the company was revived last year, SFX has focused mostly on live events, with the promoters Disco Donnie Presents and Life in Color; recently it also invested in a string of nightclubs in Miami and formed a joint venture with ID&T, the European company behind festivals like Sensation, to put on its events in North America.

In the 1990s, Mr. Sillerman spent $1.2 billion creating a nationwide network of concert promoters under the name SFX, which he sold to Clear Channel Entertainment in 2000 for $4.4 billion; those promoters are now the basis of Live Nation’s concert division.

Matthew Adell, Beatport’s chief executive, said that being part of SFX could help the company extend its business into live events, and also into countries where the dance genre is exploding, like India and Brazil.

“We already are by far the largest online destination of qualified fans and talent in the market,” Mr. Adell said, “and we can continue to grow that.”

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India Ink: What the Rail Budget 2013-14 Means for Passengers

Indian Railways Minister Pawan Kumar Bansal presented the railways budget for the financial year 2013-14 in Parliament in New Delhi on Tuesday.

This was the first time in 17 years that a politician from the Indian National Congress made the railways budget speech, as the ministry has frequently been offered to allies in coalition governments.

The minister did not announce additional unpopular passenger fare hikes, as the fares were hiked last month, but he did announce increases to a score of other charges, which mean the overall price many passengers pay will increase.

Here are some of the measures which could impact the estimated 25 million people who ride the trains every day.

  • Supplementary fare charges will be increased, including ticket cancellation charges, tatkal (or last-minute booking) charges and super fast train reservation charges.
  • 26 new passenger trains will be introduced.
  • 67 new express trains will be introduced.
  • Frequency of 24 trains will be increased.
  • Online railway bookings will now be available nearly round-the-clock on the Indian Railways website, or from 12:30 a.m. until 11:30 p.m.
  • Improved online service support will allow 7,200 tickets to be booked per minute.
  • 120,000 users will be able to access the online system at any one time, an improvement over the existing 40,000 users.
  • Green initiatives on trains, including “bio toilets,” will be introduced.
  • There will be improvements in infrastructure and quality of food. Some trains will have wi-fi facilities.
  • The 152,000 positions now vacant in the railways will be filled.
  • Eight new units of the railway protection force, or R.P.F., will be introduced to improve the safety of women on trains, and 10 percent of the recruits will be women.
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    AP source: Tom Brady gets 3-year extension


    Tom Brady will be a Patriot until he is 40 years old.


    Brady agreed to a three-year contract extension with New England on Monday, a person familiar with the contract told The Associated Press. The extension is worth about $27 million and will free up nearly $15 million in salary cap room for the team, which has several younger players it needs to re-sign or negotiate new deals with.


    The person spoke on condition of anonymity because the extension has not been announced.


    Sports Illustrated first reported the extension.


    The 35-year-old two-time league MVP was signed through 2014, and has said he wants to play at least five more years.


    A three-time Super Bowl champion, Brady will make far less in those three seasons than the going rate for star quarterbacks. Brady currently has a four-year, $72 million deal with $48 million guaranteed.


    Drew Brees and Peyton Manning are the NFL's highest-paid quarterbacks, at an average of $20 million and $18 million a year, respectively.


    Brady has made it clear he wants to finish his career with the Patriots, whom he led to Super Bowl wins for the 2001, 2003 and 2004 seasons, and losses in the big game after the 2007 and 2011 seasons. By taking less money in the extension and redoing his current contract, he's hopeful New England can surround him with the parts to win more titles.


    Among the Patriots' free agents are top receiver Wes Welker and his backup, Julian Edelman; right tackle Sebastian Vollmer; cornerback Aqib Talib; and running back Danny Woodhead.


    Brady has been the most successful quarterback of his era, of course, as well as one of the NFL's best leaders. His skill at running the no-huddle offense is unsurpassed, and he's easily adapted to the different offensive schemes New England has concentrated on through his 13 pro seasons.


    The Patriots have gone from run-oriented in Brady's early days to a deep passing team with Randy Moss to an offense dominated by throws to tight ends, running backs and slot receivers.


    Brady holds the NFL record for touchdown passes in a season with 50 in 2007, when the Patriots went 18-0 before losing the Super Bowl to the Giants. He has thrown for at least 28 touchdowns seven times and led the league three times.


    Last season, Brady had 34 TD passes and eight interceptions as the Patriots went 12-4, leading the league with 557 points, 76 more than runner-up Denver.


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    Horse Meat in European Beef Raises Questions on U.S. Exposure





    The alarm in Europe over the discovery of horse meat in beef products escalated again Monday, when the Swedish furniture giant Ikea withdrew an estimated 1,670 pounds of meatballs from sale in 14 European countries.




    Ikea acted after authorities in the Czech Republic detected horse meat in its meatballs. The company said it had made the decision even though its tests two weeks ago did not detect horse DNA.


    Horse meat mixed with beef was first found last month in Ireland, then Britain, and has now expanded steadily across the Continent. The situation in Europe has created unease among American consumers over whether horse meat might also find its way into the food supply in the United States. Here are answers to commonly asked questions on the subject.


    Has horse meat been found in any meatballs sold in Ikea stores in the United States?


    Ikea says there is no horse meat in the meatballs it sells in the United States. The company issued a statement on Monday saying meatballs sold in its 38 stores in the United States were bought from an American supplier and contained beef and pork from animals raised in the United States and Canada.


    “We do not tolerate any other ingredients than the ones stipulated in our recipes or specifications, secured through set standards, certifications and product analysis by accredited laboratories,” Ikea said in its statement.


    Mona Liss, a spokeswoman for Ikea, said by e-mail that all of the businesses that supply meat to its meatball maker  issue letters guaranteeing that they will not misbrand or adulterate their products. “Additionally, as an abundance of caution, we are in the process of DNA-testing our meatballs,” Ms. Liss wrote. “Results should be concluded in 30 days.”


    Does the United States import any beef from countries where horse meat has been found?


    No. According to the Department of Agriculture, the United States imports no beef from any of the European countries involved in the scandal. Brian K. Mabry, a spokesman for the department’s Food Safety and Inspection Service, said: “Following a decision by Congress in November 2011 to lift the ban on horse slaughter, two establishments, one located in New Mexico and one in Missouri, have applied for a grant of inspection exclusively for equine slaughter. The Food Safety and Inspection Service (F.S.I.S.) is currently reviewing those applications.”


    Has horse meat been found in ground meat products sold in the United States?


    No. Meat products sold in the United States must pass Department of Agriculture inspections, whether produced domestically or imported. No government financing has been available for inspection of horse meat for human consumption in the United States since 2005, when the Humane Society of the United States got a rider forbidding financing for inspection of horse meat inserted in the annual appropriations bill for the Agriculture Department. Without inspection, such plants may not operate legally.


    The rider was attached to every subsequent agriculture appropriations bill until 2011, when it was left out of an omnibus spending bill signed by President Obama on Nov. 18. The U.S.D.A.  has not committed any money for the inspection of horse meat.


    “We’re real close to getting some processing plants up and running, but there are no inspectors because the U.S.D.A. is working on protocols,” said Dave Duquette, a horse trader in Oregon and president of United Horsemen, a small group that works to retrain and rehabilitate unwanted horses and advocates the slaughter of horses for meat. “We believe very strongly that the U.S.D.A. is going to bring inspectors online directly.”


    Are horses slaughtered for meat for human consumption in the United States?


    Not currently, although live horses from the United States are exported to slaughterhouses in Canada and Mexico. The lack of inspection effectively ended the slaughter of horse meat for human consumption in the United States; 2007 was the last year horses were slaughtered in the United States. At the time financing of inspections was banned, a Belgian company operated three horse meat processing plants — in Fort Worth and Kaufman, Tex., and DeKalb, Ill. — but exported the meat it produced in them.


    Since 2011, efforts have been made to re-establish the processing of horse meat for human consumption in the United States. A small plant in Roswell, N.M., which used to process beef cattle into meat has been retooled to slaughter 20 to 25 horses a day. But legal challenges have prevented it from opening, Mr. Duquette said. Gov. Susana Martinez of New Mexico opposes opening the plant and has asked the U.S.D.A. to block it.


    Last month, the two houses of the Oklahoma Legislature passed separate bills to override a law against the slaughter of horses for meat but kept the law’s ban on consumption of such meat by state residents. California, Illinois, New Jersey, Tennessee and Texas prohibit horse slaughter for human consumption.


    Is there a market for horse meat in the United States?


    Mr. Duquette said horse meat was popular among several growing demographic groups in the United States, including Tongans, Mongolians and various Hispanic populations. He said he knew of at least 10 restaurants that wanted to buy horse meat. “People are very polarized on this issue,” he said. Wayne Pacelle, chief executive of the Humane Society of the United States, disagreed, saying demand in the United States was limited. Italy is the largest consumer of horse meat, he said, followed by France and Belgium.


    Is horse meat safe to eat?


    That is a matter of much debate between proponents and opponents of horse meat consumption. Mr. Duquette said that horse meat, some derived from American animals processed abroad, was eaten widely around the world without health problems. “It’s high in protein, low in fat and has a whole lot of omega 3s,” he said.


    The Humane Society says that because horse meat is not consumed in the United States, the animals’ flesh is likely to contain residues of many drugs that are unsafe for humans to eat. The organization’s list of drugs given to horses runs to 29 pages.


    “We’ve been warning the Europeans about this for years,” Mr. Pacelle said. “You have all these food safety standards in Europe — they do not import chicken carcasses from the U.S. because they are bathed in chlorine, and won’t take pork because of the use of ractopamine in our industry — but you’ve thrown out the book when it comes to importing horse meat from North America.”


    The society has filed petitions with the Department of Agriculture and Food and Drug Administration, arguing that they should test horse meat before allowing it to be marketed in the United States for humans to eat.


    This article has been revised to reflect the following correction:

    Correction: February 25, 2013

    An earlier version of this article misstated how many pounds of meatballs Ikea was withdrawing from sale in 14 European countries. It is 1,670 pounds, not 1.67 billion pounds.

    This article has been revised to reflect the following correction:

    Correction: February 25, 2013

    An earlier version of this article misstated the last year that horses were slaughtered in the United States. It is 2007, not 2006.




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    DealBook: Confirmation Hearing for Mary Jo White Said to Be Scheduled for March

    Mary Jo White appears poised to face a Senate confirmation hearing next month, a crucial step for the former federal prosecutor on her path to becoming the top Wall Street regulator.

    Ms. White, whose nomination to lead the Securities and Exchange Commission has lingered for over a month, plans to testify in March before the Senate Banking Committee, three Congressional officials briefed on the matter said on Monday. The committee has not set a firm date for the confirmation hearing, the officials said, though lawmakers have tentatively scheduled her to appear the week of March 11.

    At the hearing, one official said, Ms. White will most likely join Richard Cordray, who is in line to become director of the Consumer Financial Protection Bureau. In January, when the White House nominated Ms. White to the S.E.C. spot, it reappointed Mr. Cordray to a position he has held for the last year under a temporary recess appointment.

    The Senate last year declined to confirm him in the face of Republican and Wall Street opposition to the newly created consumer bureau. Republicans are likely to voice similar skepticism at the hearing next month.

    While some officials have quietly expressed concerns about Ms. White’s role as a Wall Street defense lawyer, her nomination is not expected to face major complications. An S.E.C. spokesman did not immediately respond to a request for comment.

    The timetable laid out on Monday offers Ms. White additional weeks to prepare. Over the last couple of weeks, she has received multiple briefings from agency staff members about new securities rules and the structure of the stock market, an official said. The briefings will in part prepare her for the confirmation hearing, which is expected to cover a broad scope of topics.

    While Ms. White is a skilled litigator, she lacks experience in financial rule-writing and regulatory minutiae, a potential stumbling block for her nomination. Lawmakers also expect to raise questions about her movements through the revolving door that bridges government service and private practice. Some Democrats, a person briefed on the matter said, will question whether she is cozy with Wall Street.

    In private practice, Ms. White defended some of Wall Street’s biggest names, including Kenneth D. Lewis, a former chief of Bank of America. As the head of litigation at Debevoise & Plimpton, she also represented JPMorgan Chase and the board of Morgan Stanley. Her husband, John W. White, is co-chairman of the corporate governance practice at Cravath, Swaine & Moore, where he represents many of the companies that the S.E.C. regulates.

    (Ms. White has agreed to recuse herself from many matters that involve former clients, while her husband has agreed to convert his partnership at Cravath from equity to nonequity status.)

    Despite some reservations, she is expected to receive broad support on Capitol Hill. When President Obama nominated her last month, Senator Charles E. Schumer of New York was one of several Democrats to praise her prosecutorial prowess, calling her “tough as nails” during stints as a federal prosecutor in Brooklyn and as the first female United States attorney in Manhattan.

    While she handled some white-collar and securities cases, her specialty was terrorism and organized crime. As a federal prosecutor in New York City for more than a decade, she helped oversee the prosecution of the crime figure John Gotti and directed the case against those responsible for the 1993 World Trade Center bombing. She also supervised the original investigation into Osama bin Laden and Al Qaeda.

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    India Ink: On Kissing, Bollywood, and Rebellion

    Gardiner Harris’s recent piece in the New York Times made me do a double take, not just because of the attachment of the word “bombshell” before Katrina Kaif, which to me is somewhat like using “razor-sharp” as the defining adjective for President George W. Bush, but because of the cultural “Rubicon-crossing” significance attributed to a scene in “Jab Tak Hai Jaan:”

    A pivotal screen kiss reflected the changing romantic landscape here. Kissing scenes were banned by Indian film censors until the 1990s, and Shah Rukh Khan, a Bollywood heartthrob who is one of the world’s biggest movie stars, has been teasing Indian audiences in dozens of films since then by bringing his lips achingly close to those of his beautiful co-stars. But his lips never touched any of theirs until he kissed the Bollywood bombshell Katrina Kaif in “Jab Tak Hai Jaan,” which was released in December 2012.

    Mr. Khan tried to soften the impact by saying in a published interview that his director made him do it. But the cultural Rubicon had been crossed.

    As a longtime pop culture buff and dispassionate observer of screen-kisses, while I may agree with the author’s observation of Shah Rukh Khan’s lips historically tending toward those of his heroine’s but never quite getting there, like the limit of a function, I firmly dispute the notion that Mr. Khan’s tepid liplock has given the kiss the acceptability it did not have before. That’s because kisses have been in mainstream Indian movies since the late 1920s with reigning screen diva, Devika Rani’s kiss with her off-screen husband, Himanshu Rai, for a full four minutes in “Karma” (1933) being the veritable stuff of legends.

    It is true, of course, that Indian movies have had far more people chasing each other around the trees than kissing, and that is primarily because of the dictates of the dreaded censor board, the cheerless cinematic embodiment of the Nehruvian ideal of big-government intruding into every aspect of national life, which made directors move the camera away at strategic moments to two flowers touching each other.

    But around the time when I started watching movies, which was the mid-1980s, kisses and intimacy were very much part of big-banner Bollywood, be it in “Ram Teri Ganga Maili” (1985) or “Janbaaz” (1986) or “Qayamat Se Qayamat Se Tak” (1986) and the truly shuddering scene in “Dayavan” (1988) between the venerable Vinod Khanna and an upcoming actress by the name of Madhuri Dixit, a sequence responsible for many VCRs getting jammed due to excessive pausing and replaying (or so my unscientific survey tells me).

    Then of course, there was Aamir Khan establishing his reputation for commitment to detail and the embracing of variety by kissing Juhi Chawla in “Qayamat Se Qayamat” (1986) and “Love Love Love” (1986), Pooja Bhatt in “Dil Hai Ki Manta Naheen” (1991), Pooja Bedi in “Jo Jeeta Hai Sikander” (1992) and then Karishma Kapoor in “Raja Hindustani” (1997) for a full 40 seconds, if experts are to be believed.

    In the 2000s, there were movies that had 17 kissing scenes in them, and an actor by the name of Emran Hashmi had made kissing a calling card in each of his movies, earning the sobriquet “serial kisser.”

    I don’t want to keep on inserting citations to prior art — after all, this is not a journal paper — but my point is that by 2012, when “Jab Tak Hai Jaan” came to pass, Indian audiences had been quite desensitized to on-screen kissing.

    In other words, it is no big whoop. Or should I say, no big “mwah.”

    So if it’s not the influence of movies, why then do we see more public displays of affection (of which kissing is but one manifestation) in Indian cities today than say 10 or 20 years ago?

    Here is my explanation: The last decade or so has seen a social revolution in urban India. More men and more women are working together. There are more coeducational institutions than ever before. Social media have allowed people to find others with similar interests and points of view, subverting traditional social walls that prevent free interaction, and then they could keep in touch discreetly, through cellphones and instant messaging. (In my day, we had to use the single rotary phone kept in the living room, making it impossible to have a secret conversation.)

    As a result, there are more opportunities for meeting people and maintaining relationships. This naturally leads to more unmarried couples or couples that are not married to each other.

    Getting a room every time one wants to kiss one’s partner or hold hands is neither financially viable nor practically feasible. Budget hotels are loath to rent rooms to couples without proof of “marriage” because of the fear of police raids. Some even collude with crooked cops to do a bit of extortion, since couples are willing to pay to avoid being hauled to the police station. Being outside, in parks and deserted spaces, does not totally protect couples from the police, but at least it is better than being busted at a hotel.

    Hence what one sees as increased public displays of affection is merely the inevitable effect of an increasing number of young couples in urban India, who, because of an antiquated legal system with ill-defined notions of “public decency,” unfortunately find themselves unable to have safe spaces of their own.

    The biggest threat to their safety is not the police but young men described in Mr. Harris’s piece, those who “often sit and stare hungrily at kissing couples,” India’s increasingly angry and volatile class of getting-it-nots, those that desperately wish to have but do not, who see these displays of affection as arrogant flaunting of privilege. Many of these frustrated young men coalesce to form mobs of moral police, who then attack couples, especially women, in public places under the comforting banner of protecting Indian tradition.

    And so an important cultural battle rages on, in the parks and in pubs and in other common spaces, one that reflects one of modern India’s defining conflicts, that between ordinary people in pursuit of individual happiness and a legal and social system that insists on imposing, interfering and getting in their way — where a kiss is no longer just a kiss but a small symbol of unintentional rebellion.

    By the light of day, Arnab Ray is a research scientist at the Fraunhofer Center For Experimental Software Engineering and also an adjunct assistant professor at the Computer Science department of the University of Maryland at College Park. Come night, he metamorphoses into blogger, novelist (“May I Hebb Your Attention Pliss” and “The Mine”) and columnist. He is on Twitter at @greatbong.

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    ‘Bloodless’ Lung Transplants for Jehovah’s Witnesses


    Eric Kayne for The New York Times


    SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.







    HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.




    She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.


    The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.


    Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?


    By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.


    By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.


    “At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”


    Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.


    Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.


    Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.


    Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.


    “I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.


    She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.


    “I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”


    Cutting Risks, and Costs


    The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.


    But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.


    In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.


    “My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”


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    Haruhiko Kuroda Expected to Be Named Head of Bank of Japan





    TOKYO — A financial policy expert and harsh critic of the Bank of Japan’s efforts to combat deflation is set to be the government’s choice to take over the nation’s central bank.







    Toru Hanai/Reuters

    Haruhiko Kuroda is a harsh critic of the Bank of Japan’s track record on deflation.







    The official, Haruhiko Kuroda, a veteran of global financial circles and current head of the Asian Development Bank, will be nominated as the bank’s governor to take over next month, according to a ruling party lawmaker with knowledge of those plans.


    Prime Minister Shinzo Abe has instructed ruling party officials to start negotiating with opposition parties to clear the way for Mr. Kuroda’s appointment, which must be approved by a divided parliament, the lawmaker said.


    “This is a critical time for Japan’s economy, and we must avoid, at all costs, a failure to gain parliamentary approval for this appointment,” NHK, the public broadcaster, quoted Mr. Abe as telling ruling party executives Monday morning.


    With Mr. Kuroda at its helm, the bank could take much bolder steps to kick-start economic growth. Mr. Kuroda has publicly criticized the Bank of Japan for not going far enough to fight deflation, and has urged the bank to adopt inflation targets and to expand an asset-buying program to pump more cash into the Japanese economy.


    Mr. Kuroda’s global experience — as vice minister for international affairs at Japan’s powerful Finance Ministry from 1999 to 2003, and as president of the Manila-based Asian Development Bank starting in 2005 — could also help Tokyo navigate foreign criticism that its monetary policies are intended to weaken the yen to give Japanese exporters a competitive edge.


    The yen has weakened by over 10 percent in the last three months as Mr. Abe laid out his monetary agenda, pushing the outgoing central bank governor, Masaaki Shirakawa, to start taking a more aggressive monetary stance. But Mr. Abe had indicated that a change at the bank’s top ranks was needed to break with the bank’s cautious past. On Monday, the yen fell to a 33-month low.


    Kikuo Iwata, a professor at Gakushuin University in Tokyo and another vocal critic of the central bank, is set to be tapped for one of its two deputy governor spots, according to the lawmaker. Mr. Iwata is the author of several books, including “Stop Deflation, Now” and “Is the Bank of Japan Really Trustworthy?”


    Mr. Kuroda beat out a fellow former senior Finance Ministry official, Toshiro Muto, who had strong backing among both bureaucrats and local politicians but lacks the top-level global contacts. Mr. Muto was also viewed as being more cautious than Mr. Kuroda on monetary policy.


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    The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain


    Matt Rainwaters for Texas Monthly


    The Sherman grave of Andre Thomas’s victims.







    SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.






    The Texas Tribune

    Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.




    For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org






    Matt Rainwaters for Texas Monthly

    Laura Boren






    He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.


    He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.


    In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.


    Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.


    “You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”


    Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.


    At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.


    Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.


    He was on a mission from God, he said, to free their hearts of demons.


    Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.


    “It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.


    From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.


    bgrissom@texastribune.org



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