Why Burgers Matter More than Burghers in Architecture

Nicoli Ouroussoff of The New York Times gushed about Jean Nouvel's planned pile of undulating metal on 53rd Street in Manhattan as "the most exhilarating addition to the skyline in a generation." Martin Filler, whose New York Review of Books dispatches are far more discerning, believes the stacked rectangles that Kazuyo Sejima and Ryue Nishizawa created for the New Museum of Contemporary Art on the Bowery is "one of those rare, clarifying works of architecture that . . . demonstrates the power of understatement more convincingly than any Manhattan structure since Ludwig Mies van der Rohe's Seagram Building was completed in 1958."

But for the vast hoardes of Americans who will never visit The Bowery in quest of edgy art, or who will never stroll past the Museum of Modern Art and the American Museum of Folk Art, to gaze at the Nouvel tower that will become their neighbor on 53rd Street, the signal moment in architecture for 2007 was arguably the announcement in December that the Burger King on the Route 12-A shopping strip in Lebanon, New Hampshire will be razed in May.

The Valley News reported this development on December 30, adding that the local Planning Board reacted with some consternation when the fast food chain asked for permission to replace its 5,400 square-foot eatery with a 2,200 square-foot one. It seems that even as the price of a gallon of gas climbs past $3.00, nobody wants to eat at Burger King anymore -- they want to grab their Whoppers at the drive through and snarf them down while their SUVs wallow in the Route 12-A traffic.

This is not to say that restaurants have grown unpopular -- quite the contrary. As the newspaper noted, the sit-down trade has largely been claimed by outfits one rung higher on the food chain -- places like Panera's and Chile's. So Burger King joins the White River Junction McDonald's, and the Wendy's across Route 12-A in West Lebanon, in opting for a drastically dessicated dining room. And, by the way, don't get the idea you'll be served faster if you eschew the creeping drive-through line, park and bolt inside. The time you will spend standing at the counter trying to get someone's attention, as the employees scurry about communicating with drive-through customers via their headphones, will give you plenty of time to reflect on the evolution of the fast-food industry.

If you happen to be waiting at the Burger King between now and May, take a moment and look to your left at the dining room because its demise will claim the only really interesting architectural space on the Route 12-A shopping strip. In a precinct of bland, big boxes, this semicircular room, with its muscular radial columns that curve their way to the ground, enclosed in a continous ring of windows, testifies to an earlier but now-concluded era.

It was a time when architects, even ones designing workaday buildings like Burger Kings, thought that new and different would be just swell. No fake mansards and faux lintels in the windows like the ones at the McDonald's next door; this hamburger emporium in its rotundity was apparently designed to evoke the chain's flame-broiled eponymous product itself.

Maybe the anonymous designer who conjured the West Lebanon Burger King was not thinking about Frank Lloyd Wright's Taliesin West as s/he conjured those mighty support beams. Perhaps the architect was not consciously emulating Marvin Goody, the guy who created the fabulous, circular Monsanto House of the Future that stood at Disneyland in California from 1957 to 1967. These ideas got into the national architectural DNA of the time -- and now they are gone, along with the optimism about the built world they reflected.

Now, in the everyday world regular people inhabit, as distinct from the fanciful dimension of museums and high-rises in Manhattan, a non-residential building is more often than not a mere support structure for the neon billboard, invisible kitchen and service portal that exist to service you while you remain in your vehicle. The destruction of the Route 12-A Burger King is a sad drama that is playing itself out in shopping strips everywhere, which is to say ubiquitously in the USA because shopping strips are America in the early 21st Century.

Whoppers and Quarter Pounders are rational consumer choices. The nutritional implications notwithstanding, it's terribly inefficient for every American household to manufacture meals in its isolated kitchen. It's lonely too, and so we venture forth into the public sphere in search of community and a meal prepared by people who do it for a living on the scale of mass production. In a better world, our architects and social planners would note this phenomenon and respond by creating new kinds of buildings to serve new kinds of communities that truly serve the yearnings of real people. The Cobb Hill Co-Housing Community in Hartland Four Corners is a noteworthy example.

But we are stuck in this world, in which the best architecture happens on behalf of museums and other institutions that attract the interest of the ultra-wealthy. Dartmouth College plans a Jorge Silvetti building that has every prospect of adding something hitherto unexperienced to downtown Hanover. Such projects, like the new Sejima and Nishizawa building on The Bowery, these projects are worthy being noticed. And so, at least for a few more months, is your friendly neighborhood Burger King.

Welcome to PFPFC -- New Feisty Patient Advocacy Group!

Greetings dear readers! Today, as a public service, we are turning the N1303K blog over to Mr. Ben Dover of Hanover, Hampshire. Mr. Dover is a healthy, 49-year-old male and patient of the General Internal Medicine Department of Dartmouth Hitchcock Medical Center. Mr. Dover writes:

2008 is the year I turn 50 -- and in the eyes of my healthcare providers and my health insurance company, I am about to become, for lack of a better expression, a pain in the ass.

Why bother with euphemistic terms for the anal orifice when the subject at hand is the grim reality that every 50-year-old faces? I refer to the medical necessity of an annual colonoscopy to screen for colon cancer.

As the half-century mark approaches, I have found myself uncharacteristically attentive to discussions of colonoscopy. And, as a result, what I have been given to understand is that, in reality, the colonoscopy (as distinct from the preparation for it, which I understand to involve drinking unpleasant things and much time on the toilet) is an unremarkable experience, thanks to the wonders of modern anesthetic care.

Uh oh! Today's New York Times brings the following revelation:

Aetna, one of the nation's largest private health plan managers, is the latest insurer to clamp down on the use of a powerful anesthetic during an increasingly common form of colon cancer screening.

The company will send a letter to doctors on Friday, saying that it plans to classify the drug as "medically unnecessary" for most such procedures. As of April 1, Aetna plans to stop paying for its use inthose cases.

The change by Aetna covers about 16.6 million members and comes on the heels of similar moves last year by WellPoint and six months ago by Humana. Other insurers say they have no plans to follow their lead,including UnitedHealthcare, which has 26 million members. Medicareleaves coverage up to local insurers that administer its plans, mostof which cover the anesthetic, propofol, only in high-risk cases.

Critics say Aetna's decision would be a step backward in the battle against cancer of the colon and rectum, which trails only lung andprostate cancer as a cause of cancer death among Americans, accordingto the federal Centers for Disease Control.

The anesthetic eliminates the discomfort of undergoing a colonoscopy,a procedure in which doctors explore the lower intestine to identify --and if necessary remove -- developing tumors before they become dangerous.

. . .

A recent book looking at such patterns and at overuse of medical products and procedures -- "Overtreated," by Shannon Brownlee --concluded that they inflate health care spending in the United Statesby at least 20 percent. With millions of colonoscopies performed each year and specialists advising all Americans over 50 to be screened, the proper use of thisanesthetic could become a multibillion-dollar point of contention.

Oh really? Memo to health care providers and health insurance companies: That "point of contention" starts with the leading edge of the first colonoscope aimed at my nether regions!

A check with the friendly neighborhood anesthesiologist revealed that many colonoscope-wielding internal medicine docs treat the procedure the way dentists treated drilling cavities when I was a kid. Remember those dark ages? When the dentist encouraged you to see how much pain you could stand before he brought out the novocaine, implying that such stoicism was a sign of good character (and also a way of avoiding the unpleasant anesthetic syringe, which the dentist was more than pleased to offer a glimpse of to you)?

In other words, according to the anesthesiologist (who spoke on condition of anonymity) your GI doc is likely to see how much pain you can "tolerate" before offering you any anesthesia, much less something like propofol (which, as the Times explained, is not itself an expensive drug, but requires the presence of an anesthesiologist or a nurse anesthetist, who then expect to get paid for their services). Is that the right way to treat patients in the wealthiest and most civilized nation in the history of the planet?

Wander up to 5 East at Dartmouth Hitchcock Medical Center and you'll pass the home of a program known as "CHaD Pain Free." CHaD is the Children's Hospital at Dartmouth and its "Pain Free" program is essentially an anesthesia clinic, founded by a pediatric anesthesiologist, Dr. Joe Cravero, whose hypothesis is that kids should have hospital experiences that are -- pain free!

Okay, call me a whiner, but I say: Why shouldn't grown up colonoscopy victims have pain-free visits to the hospital as well?

So I am ready to found a nationwide advocacy group called "Patients for Pain-Free Colonoscopies," or PFPFC. And our guiding principle is this: The next time your doctor tells you it's time to schedule a colonoscopy, tell them you want propofol and you don't want to be billed for it if your insurance company won't reimburse the cost.

It's time to grab the torches and pitchforks! Where will we stick them and how pain-free will it be? Depends on what happens to the propofol.

Norwich Isn't Hooterville, Even if Rob Edson Looks Like Eddie Albert

‘Twas the day before the night before Christmas – what better time for Valley News columnist Jim Kenyon to publish a dispatch that is so devoid of news, and so redolent of his need to vilify his home town of Norwich, as to achieve true self-parody.

Weeks and weeks ago, principal Rob Edson of the Marion Cross School announced that he would be leaving the helm of the Norwich elementary school at the end of the current academic year. The fact was duly reported in Kenyon’s paper, regurgitated now by Kenyon himself.

Surely there must be some scandal, intrigue or controversy involved, Kenyon seems to have resolved. But he apparently couldn’t find any. As far as anyone can tell, Edson simply decided he was tired of his job and prefers to do something else for a living. (Ordinarily, people in that position embark upon a confidential search for a new job prior to resigning, but that option isn’t open to Edson, in no small part because the Valley News thinks people who take important public sector jobs should forfeit their privacy.)

Indeed, the only real news in Kenyon’s column about Rob Edson is that the principal refused to return Kenyon’s phone calls. It is a positive development, suggesting that officials in Norwich have wised up and determined that they have nothing to gain by cooperating with Kenyon’s quest to make Norwich look like Hooterville (a fictitious sitcom town where wily farmers coexist with rich nitwits from away, for those too young to remember Green Acres).

“Norwich can’t keep a principal,” proclaimed Kenyon, even though Edson’s longevity hardly advances the hypothesis. Never one to let the facts get in the way of a good story, Kenyon trots out the sorry record that preceded Edson’s tenure, which involved four principals who failed to catch on. Thus, to make the Kenyonesque innuendo explicit, in this columnist’s opinion even a relatively generous $90,000 salary is inadequate to keep someone at the helm of the public school in a town of wealthy whiners.

Earth to Jim Kenyon: The world is full of thankless high-visibility jobs. They tend to pay better than positions that don’t involve overseeing zero-sum games like public school systems. The phenomenon is hardly unique to prosperous communities.

And by the way, Jim Kenyon, since you seem to appreciate innuendo: One would have thought that if 2007 taught you anything, it would be to ‘judge not lest ye be judged’ when it comes to relations between parents and their kids’ public schools.

Instead, 2007 made clear that Jim Kenyon essentially has only two columns, which he keeps writing over and over again. The first one identifies a nonprofit that is underfunded and largely unrecognized because it tends to serve downtrodden folks who are generally invisible. The second picks some successful local institution and, by consulting only with those who have an axe to grind, manages to make success look like failure.

Here’s a great new year’s resolution for Jim Kenyon: In 2008, stick to column no. 1.

Hey Maine! Do the Right Thing for CF Families!

“Failure to thrive” is a polite medical term for a nightmare scenario. Imagine being first-time parents of a newborn and, despite lavishing upon her about as much care and nurturance as a reasonably prosperous New Hampshire family can offer, watching your baby literally starving to death as her doctors insist they can find nothing wrong.

When this happened to us in early 2002, my wife took to turning on all the appliances in our house so that the noise would drown out the desperate wailing of our infant daughter. It was the only way this sorrowful but exhausted first-time mother could get any sleep.

Then it finally occurred to someone at the hospital to do a simple test, which readily showed that our daughter was born with cystic fibrosis. CF vies with sickle cell disease as the nation’s most common life-threatening inherited chronic illness. One in 26 people is a carrier of a CF gene; a child born to two carriers has a one in four chance of having the disease.

Our daughter is very fortunate. The day after her diagnosis, she began taking the digestive enzymes that were not reaching her small intestine, and the day after that she began thriving. Today she is a lively and beautiful kindergartener. The median life expectancy for people with CF has reached 38 years and is steadily growing, thanks to the splendid work of the Cystic Fibrosis Foundation and the CF centers around the country that work under the foundation’s aegis.

No New Hampshire family will ever again endure what we endured. In 2006, New Hampshire heeded the joint recommendation of the CF Foundation and the National Centers for Disease Control and Prevention to begin screening every child for CF at birth. We’ve since moved to Vermont, which will begin newborn screening for CF in March 2008. Nearly 40 states have now decided to screen for CF.

Unfortunately, my former home state of Maine refuses to take this step. The relevant agency, the Maine Center for Disease Control and Prevention, agrees that the scientific and public policy case is solid, but won’t add CF to its newborn screening program because the place is under a hiring freeze.

If I still lived in Maine, I would be storming the Bastille with torches and pitchforks over such bureaucratic stubbornness. While I don’t doubt that the Maine CDC could use more help, its New Hampshire counterpart added no new staff when CF became a successful part of its newborn screening program. Likewise, Vermont discerns no new personnel needs to start CF screening.

Maine is blessed with two excellent care centers accredited by the CF Foundation – at Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor. But they can’t help people who don’t know they have the disease. It is especially heartbreaking to read about people who aren’t diagnosed for years and years, because the scientific evidence is so solid: The earlier CF is diagnosed, the healthier and more long-lived a person is.

Ideally, these words would come from a Maine father rather than a Vermont one. But the Maine families who need newborn screening for CF don’t know it yet. In their name, I call on Dr. Dora Mills, the director of the Maine CDC, to do the right thing.

Recent advances in CF care are astonishing and offer every prospect of a fully effective treatment, if not an outright cure, well within my daughter’s lifetime. But the treatment, and the cure, cannot reverse the permanent and life-threatening lung damage that CF causes -- but that treatment from birth so significantly lessens.

The prospects for curing CF are so good that, in my view, on the day Maine starts screening newborns for cystic fibrosis, the last child will have been born in Maine who will eventually die of this awful disease. Until then, Maine babies will suffer as my daughter did and Maine itself will, in this sense, be failing to thrive.

Hyde Park Co-op

Follow this link to a really fine speech about the Hyde Park Co-op, the nation's oldest retail food co-op. Board member James Withrow offers a principled and pragmatic peroration about why the Hyde Park community should not give up on cooperation as a good business model for selling groceries.

Unfortunately it appears that the membership of the co-op, this speech notwithstanding, has overwhelmingly voted to sell out rather than press on through bankruptcy.

Rosemary Quigley (1971 to 2004)

Rosemary Quigley, whom I never met, was a Baylor University medical ethicist, trained as a lawyer, who died in 2004 as the result of having cystic fibrosis. I became a fan by reading her obituary in the Boston Globe.

That, in turn, led me to one of Rosemary Quigley's friends from high school, Rick Klau, via his blog. Rick, in turn, helped me connect with Rosemary Quigley's family, to which I wanted to offer my respect and admiration, in light of my personal interest in cystic fibrosis. Rick, I discovered, found his having facilitated that connection to be a remarkable moment in the history of his blogging, so much so that he commented on it publicly when making a presentation to a Lutheran group on the value of using the internet for building spiritual communities.

So I thought that the least I could do would be to comment on that in my own blog -- and, more importantly, post some words penned by Rosemary Quigley that I continue to think of as among the most inspiring sentiments I have ever read:

"These days I am often awake in the hours before sunrise. I wonder what future lives will inhabit my tiny studio apartment--who will read my copy of Gatsby, moderate debates on organ procurement, visit the hospice patient in the nursing home. And though I worry that I do not exist uniquely enough to make a tangible difference, I think enough of myself to believe the world will lose something without my verve. Disease has given me license to be outrageous and demanding; those who don't have the context for these characteristics cannot grasp me. I am discouraged by people who confer admiration on my most basic accomplishments; I seek supporters who never think I have done too much, who will push me further for as long as possible. I focus my spirit to outlast my withering body. Illness trumps the freedom to pick one's fights.

Like generations before me, I ponder my stunted legacy. Some say I am too young and vital to do so. But it is a soldier's preoccupation."

p.s. That's not Rosemary Quigley in the photograph -- it's my daughter, when she was four. she just turned six.

A Modest Proposal for Fixing Journalism in Northern New England

Nick Cafardo of the Boston Globe recently reported that “a National League playoff team gave its scouts a whopping $200 bonus for their good work,” adding: “We will not embarrass them by identifying the team.”

Though obviously trivial even as a sports story, this quip is noteworthy for how brazenly it brags of violating journalism ethics. Reporters are supposed to be agents of their readers, as opposed to doing the bidding of their sources, including officials of teams that don’t want to be publicly flogged as cheapskates. This kind of transgression is precisely what got Judith Miller in trouble when, as a New York Times reporter, she famously allowed herself to be co-opted by Dick Cheney henchman Scooter Libby.

That reporters now boast of failing to act in the best interests of their readers is evidence that print journalism is in a state of crisis. Nowhere is this more so than in northern New England. From Passamaquoddy Bay to Lake Champlain, newspapers grow smaller and less interesting. Many, like the dailies in Portland and Burlington, are cookie-cutter outlets of national chains. Most, even the independents, find themselves increasingly unable to afford covering their states and communities with any depth or insight. Thus, for example, the government agency that happens to employ me remains a goldmine of unreported news.

The thoughtful reportage that civic-minded people crave is not unlike the citrus fruit that some Dartmouth faculty families wanted but could not get in the 1930s. So, just as love of oranges led in 1936 to the founding of the Hanover Consumer Cooperative Society, love of truth should cause the establishment of a reader-owned, professionally run, regional daily newspaper that is organized as a consumer co-op.

Skeptical? Recall that one of our nation’s most venerable journalism institutions, which traces its roots to 1846, is a cooperative. I refer to Associated Press. As a former employee of AP, I can testify that in its heyday the organization was proud of its status as a cooperative and was a bastion of vigilant reporting that was fair and balanced (in the pre-Fox era when that phrase still retained its literal meaning).

These days, even AP is shaky, as evidenced by its politically motivated firing in 2006 of longtime Montpelier correspondent Christopher Graff. In 2007, AP appears to have taken up an authoritarian social agenda, as evidenced by big national stories implying that sexual abuse is rampant among public educators and that nontraditional families are cauldrons of domestic violence. Keep in mind that AP is a producer cooperative, owned not by readers but by member newspapers.

One person asked about the idea of a cooperative newspaper doubted that a democratically controlled journalism enterprise could avoid devolving into rank partisanship, presumably with the views of the majority party prevailing. Perhaps – but then we would be no worse off than New Hampshire is today, since its biggest daily newspaper has for decades been unabashedly oriented in one political direction.

My theory is that readers, as owners of their newspaper, would aim higher than the journalism of William Loeb. Call it faith in democracy, based on experience on the board of a $65 million/year consumer-owed business that competes successfully with supermarket conglomerates.

In reality, the real obstacle, for this and any other aspiring consumer co-op, is raising capital. People aren’t used to the idea of investing money to seek returns that are largely intangible. Such returns, in the form of truth, enlightenment and civic empowerment, would be bountiful for a reader-owned paper. Admittedly, it is probably an idea whose time has not yet come. But if the owners of this newspaper ever decide it is time to sell, remember that you read it here first.