Architects: Newton rezoning is “driven by ideology” and an attempt to “unzone” the city

Lots of people have reached out after my post last week, “Upzoning” in Newton: A tool to turn over the city from one class of people to another? In addition to reading comments by various city councilors on the Newton rezoning process, someone also shared with me a letter to the Newton City Council Planning and Zoning Committee. The letter was written by a group of architects who were originally recruited by the mayor, the city’s planning department, and some city councilors to help review the rezoning proposals and add their professional opinions and recommendations.

It appears rezoning in Newton has been severely undermined. I am going to post the public document in its entirety, as the committee chair has yet to post the PDF on the official city website (even if it were available, it would be hard to read, especially on mobile devices – a chronic problem for most official city documentation, incidentally). The letter is long, but I have bolded some parts which I believe are particularly important, and encourage people to leave comments at the bottom of this page:

September 30 2020

Members of the Newton City Council Planning and Zoning Committee:

Over the past several months, many of us have been providing assistance to the Planning Department with analysis of the impact of its proposed rezoning plan. We have been encouraged to provide this assistance by planning department staff, many city councilors and the Mayor in recognition of the detailed knowledge and expertise we bring to evaluating the effects of zoning on housing development from design, construction cost and home owner perspectives. As architects, builders and residents of Newton, we are committed to help maintain the quality of life in our city as zoning is being reconsidered. Despite challenges to our businesses and personal lives caused by the pandemic, we have provided significant time and effort to analyze both the macro effects of the rezoning plan as well as its impact on homeowners by applying the proposed rezoning to numerous renovation and new construction projects which we have worked on for Newton residents over the past several years.

During numerous online meetings, we have presented detailed analysis of built projects to planning staff and we have shown that the vast majority of these projects would not be permissible under the current rezoning proposal. The projects we analyzed reflect a diverse range of improvements and building programs which are typical across the City. Specifically, we have presented projects that reflect renovation and additions undertaken by homeowners as well as projects that involve restoration of historic properties. In addition to the analysis of specific projects, we have also provided many examples where the proposed zoning would on a broad scale increase the number of homes that would not conform to the new dimensional requirements. Despite our efforts to help inform decisions regarding the impact of the proposed zoning, we have seen no evidence that our work is being considered. In fact, changes to the proposal that have been made over the past few months have ignored issues demonstrated by our project analysis and have instead made some elements of the plan more prescriptive and restrictive. In view of the Planning Department’s failure over several months to meaningfully answer questions and concerns, respond to evidence provided by numerous building professionals or provide its own probative analysis, we reluctantly have concluded that the proponents of rezoning have no intention of considering facts and evidence of the potentially broad, negative impact that this plan could have on homeowners, the aesthetic character of the city and potentially on property values. In short we feel our time and expertise is being wasted. 

Many of us have been concerned about this process from the outset given that no detailed analysis was undertaken to identify specific issues with current zoning so that the new “form based“ approach could be properly evaluated. Form-based zoning imposes a highly prescriptive approach to housing design and has been adopted predominantly in dense urban communities like Somerville. It is clearly ill suited to communities like Newton with a very diverse housing stock and varied lot sizes. Given the drive to force fit form-based zoning to the actual built environment, the Planning Department is now calling it a “hybrid” of form based zoning. Nonetheless, we made a genuine effort to improve on the original proposal rather than reject it summarily given the many problems that were obvious from its inception. The problems with the metrics of the rezoning proposal are only exacerbated by the most recent change that would allow multi family development by right across the city. Combined with the elimination of minimum lot sizes and allowing some additions in setbacks by right, the lack of restrictions on multi-family seems to effectively “unzone” the city, rather than reduce non conformity, make development more predictable, or retain the character of neighborhoods. The Zoning and Planning Committee’s “3rd straw vote goal” approved at its April 27, 2020 meeting was as follows: “Context: Preserve and protect what we like in our neighborhoods. Encourage new development to fit in the context of our neighborhoods and villages.” The current plan clearly conflicts in many important ways with the objectives the Committee adopted just a few months ago.

With this background in mind, these are our primary concerns with the current proposal:

  • We have examined numerous built and proposed projects and find these new proposed controls are significantly more restrictive and more complex than current controls. New side and rear yard setbacks will create more non-conformity in existing structures. For example, the side yard requirements imposed by the new R1 zone for much of Waban results in most homes being non-conforming. The new lot coverage definition that now includes driveways compounds the problems. The resulting non conformity will severely restrict and discourage homeowners across the city from improving their homes with additions that reflect contemporary living requirements and market expectations to retain property value. Such projects also facilitate improved energy conservation as well.
  • The proposal to remedy increased non-conforming conditions by allowing certain additions by right in the new more restrictive setbacks would likely be struck down in the courts and defies the most basic purpose of zoning in the first place. Shouldn’t property owners at least be able to expect that there will be no construction allowed in setbacks, at least not without a variance?
  • The elimination of FAR in favor of foot print restrictions is another significant issue. The footprint restrictions are based on the median of what currently exists in contrived neighborhood zones based on the pattern book prepared by Sasaki. The problem with this methodology is that over 90% of homes in Newton were built before 1960 which means that this most critical standard of footprint limits is based on characteristics of housing built over the last hundred years, not current and future housing requirements. In many the data used reflects homes [text missing]
  • The removal of minimum lot size is an enormous and unnecessary paradigm shift that promotes more vertical than horizontal homes. As is the case with all the dramatic changes in this plan, no study has been presented which evaluates the impact of such a significant change to land use in the city. If we want a mechanism to allow existing non conforming lots to be buildable, we can simply add a provision to our existing code with whatever stipulations we find appropriate and subject the approval to issuance of a special permit.
  • Minimum lot frontage has also been significantly reduced. Combined with the removal of minimum lot size, this one change could allow certain neighborhoods in our city to be significantly transformed. If this is adopted, developers as of right could more easily take down a house on a larger property, subdivide that land, and put up two houses on lots that do not meet current requirements. In fact, subdivision of existing lots should not be the primary concern. The incentives under lower frontage requirements without lot size minimums to assemble adjacent conforming and non-conforming lots to create two legal lots will certainly spur property speculation and encourage more demolition of homes, a central problem that rezoning was supposed to address. 
  • One of the late additions to this proposal was the global change to eliminate single family zones. As proposed, existing homes could be subdivided into up to six units by right. This would certainly affect density, green space, and parking issues. It could also create new infrastructure demands on schools, streets and sanitation. If there is a desire to increase housing options through such a change, its adoption should require extensive community discussion, and an independent review of legal issues and its and economic impact. We also believe that abutters should be able to weigh in on multi family conversions by requiring a special permit when such conversions are proposed . 

We believe that based on the evidence we and others have presented, the proposed zoning plan disregards many of the original goals of the City Council for updating the city’s zoning code. As the proposal has evolved, it has become increasingly clear that it is being driven by ideology and not an evidence-based approach to updating and improving the city’s land use policies. The lack of objective quantitative analysis of issues with current zoning by the Planning Department is unacceptable in a city which touts its high standards for transparency and professionalism. 

Moreover, to advance such dramatic changes to our neighborhoods at a time when the public cannot effectively participate because of the pandemic is divisive, cynical and unnecessary. Is this what we envisioned for a process toward improved zoning? There are simply too many changes in this proposal that are so diametrically opposed to the controls currently in place. Does such unstudied dramatic change to land use make sense now? 

We believe that strategically-targeted incremental modifications to the Zoning Code would be a much more effective way to improve and rectify problems on the ground. Changing all the controls will create chaos, driven by conflicting policy objectives and too many unforeseen consequences. Conversely, if we improve the current code based on clear objectives and analysis, the results are likely to be far better. We can modify the Code to strategically improve what is on the ground with modest modifications that help preserve neighborhoods and can allow for reasonable and controlled growth. 

We hereby request an opportunity to present our analysis and conclusions at a ZAP meeting as soon as it can be scheduled. Such a presentation will allow a more detailed and dynamic discussion of the many substantive concerns that have been raised by us and many other residents with the proposed rezoning. We encourage other professionals who may be working privately with members of the Committee to make their views public and participate.

Thank you for your consideration.

Respectfully,

Steven Garfinkle

Peter Sachs, Architect

Marc Hershman, Architect

Robert Fizek, Architect

Stephan Hamilton, Architect

Schuyler Larrabee, Architect

William Roesner, Architect

About one week after this group sent the letter, three city councilors (Marc Laredo, Lisle Baker and Pamela Wright) sent a memo to Deborah Crossley (the committee chair) and cc’ing the mayor, senior city planners, and the city solicitor. It requests the following:

  1. The Zoning and Planning Committee should hear dissenting views directly from a group of local architects who recently wrote that they have been excluded from the group advising the Planning Department about its zoning proposals;

  2. The Zoning and Planning Committee should be advised by the Law Department how homes which might become nonconforming under the proposed new zoning can be protected or find relief if changes need to be made;

  3. The Zoning and Planning Committee should have an opportunity to discuss the current Planning Department proposals, including whether alternatives involving our current zoning code should be considered.

More details are in the memo, which is available on the city website (in PDF form). But one section of the memo from the three councilors stood out (emphasis mine):

As an institutional matter, we remain troubled by the manner in which this entire process is proceeding. While we appreciate the expertise that the Planning Department brings to this effort, it is the City Council, and not the Planning Department, that needs to debate the merits of any proposal and decide how to proceed. Instead, we have had repeated presentations by staff with questions that they want answered in order for them to work on their proposals.

The decision whether to continue to use Floor Area Ratio (FAR) as a check on oversized residential construction is a good example. While the Department offered a brief written response about FAR in the attachment A to its last memorandum dated September 25, the Committee itself has not had a chance to discuss whether to discard this tool that originated from a prior Planning Department’s advice. If FAR it does not work well presently, are there ways to modify it so it can be improved? What are the experiences of other communities that use FAR? Have any other communities adopted FAR and then abandoned it? If so, why?

The same types of questions need to be asked of other elements discussed in the September 30 architects’ memorandum. These are key policy decisions that need to be made by the Council initially through the Committee, not by staff, with thoughtful deliberation after considering all points of view. Instead, what we appear to be doing is assuming the new framework is sound, and responding to questions about the details. This strikes us as backwards, especially since the original idea of fixing some specific issues such as oversized construction and front-facing garages has been superseded by this grand redesign for Newton zoning that the Department, but not yet the Council itself, has endorsed.

In summary, policy about zoning ends and means should be explicitly decided by the Council, not implicitly by the Planning Department. A way to begin frame that decision is to provide the members of the Zoning and Planning Committee, on behalf of the Council, some time to discuss the current Planning Department proposals, including whether alternatives involving our current zoning code should be considered.

I alluded in my last post to some of the tactics used by developers to undermine local democracy in Newton, such as providing huge cash injections to “grassroots” groups that support high-density housing. The developers (Northland) won the vote as a result.

Another side of this trend is the tactics used by some of our own elected officials and the city planning department to steamroll opposition and discussion. A few years back, it was holding neighborhood feedback sessions (“Hello Washington Street“) in which the mayor, planning department officials, and highly paid consultants made a big show of listening to local residents in West Newton and Newtonville about the plans. After the sessions were over, they promptly turned around proceeded to ram through the high-density plan that they and big developers wanted all along.

Now we’re seeing a situation in which architects have been invited to participate in the discussion. Guess what: their well-articulated concerns have also been ignored. Does anyone see the pattern here?

What’s going on now should be setting off alarm bells across the city, in every neighborhood. “Upzoning” or “unzoning” (or whatever you want to call it) will primarily benefit developers, not residents. Any house that can be torn down, chopped up, and divided into overpriced multifamily units will be. The result: more luxury apartments, condos, and townhouses that are out of reach to all kinds of ordinary people, including:

  • Seniors and disabled people living on fixed incomes
  • Teachers, firefighters and other public workers
  • Recent immigrants
  • Young people who grew up in Newton trying to move back to their hometown
  • Anyone earning the Massachusetts median income of ~$77,000 per year or less

Just as we’ve seen at Trio Newton (studio rentals starting at $2,600 per month) and 28 Austin Street (rents starting at $3,700/month for a 2-bedroom apartment), a sheen of affordable housing will be tacked on to these projects to give the appearance that officials are, as Councilor Jake Auchincloss once claimed in an election flyer, “holding developers’ feet to the fire.”

I’ll close with the same excerpt from The Newton Villages Alliance newsletter that I quoted last week:

The proposed overhaul of Newton’s zoning code for higher density will lead to a transformation of Newton to a much more expensive, congested, urban environment. In the process, well-financed property speculators will be the winners and existing residents the losers as investment capital pours into our community for the sole purpose of extracting as much profit as possible.

Comments are welcome below.

“Upzoning” in Newton: A tool to turn over the city from one class of people to another?

Rezoning is in the news again in Newton. I have deliberately avoided most of the coverage. Developer kingpins aided by pliant politicians and high-density CODS housing activists always seem to get what they want around here. Local elections are undermined by millions in developer-funded PR campaigns and outright cash injections to pro-development activist groups, while local residents protesting the luxury developments are ignored, demonized, and even publicly bullied by an elected city councilor.

After the dust settles, we’re inevitably left with thousands of units of luxury housing that do nothing to bring down housing costs in the city of Newton.

Hundreds of luxury apartments have already been thrown up in Newtonville. They include 28 Austin Street, the parcel across from the Newtonville Star Market which the former mayor and city councilors agreed to lease to the developer for just $1,050,000 for 99 years, over the protests of Newtonville residents. The 28 Austin Street website now boasts “luxury boutique living,” starting at $3,700 to rent a 1,050 square feet apartment:

28 Austin Street Newtonville apartment priceAcross the Pike, developer Robert Korff of Mark Development didn’t have to rip up a signed agreement with neighbors and local councillors like he did for Riverside. Instead, the former mayor and the Newton-Needham Chamber of Commerce helped get him what he demanded, again over the objections of neighbors.

This piece of commentary in the local newspaper summed up what everyone now knows: Dumping thousands of units of luxury housing is a tool of wealth creation for developers. It does nothing to reduce housing costs in Newton:

The belief that more housing will add affordability for Newton is a false premise as well. A look at Boston, Cambridge, Somerville, South Boston, East Boston, Charlestown, Waltham, Watertown tells us all we need to know: large developments drive up land prices, drive up rents and make naturally affordable housing less available and less affordable. It creates a tiered class with subsidized housing for those who qualify, and expensive housing for everyone else. These are the facts and wishful thinking doesn’t change this reality.

Here are the facts concerning the former Orr block. The low-cost apartments and small businesses on Washington Street in Newtonville were quickly demolished to make way for Korff’s new replacement for the Orr block, Trio Newton. The work is wrapping up now. Have housing prices dropped as high-density housing activists have promised, because hundreds of new units are now being added to the supply?

No! If anything, it’s gotten more expensive to live in Newtonville. The facts are in the numbers. On Google, Trio promotes “luxury apartments in Newton.” Click through to the Trio website, where the least expensive option is apparently $2,600 per month to rent a 600 square foot studio!

Good luck if you’re a senior on a fixed income, a new immigrant, disabled, or a young person who grew up in Newton and wants to move back to your home town. Using the 30% rule of thumb for housing costs, excluding utility costs, and generously assuming Korff isn’t stacking additional fees on top of the listed rental prices at Trio Newton, you would need an annual income of $104,000 to afford the least expensive studio apartment.

At nearby 28 Austin Street, a young family would need an income of at least $144,000 to rent the cheapest 2-bedroom apartment (1,050 square feet). The most expensive (1,365 square feet) 2 bedroom unit, at $7,500 per month, would require an annual income of $300,000.

Note that the median household income in Massachusetts is $77,378, according to the U.S. Census Bureau.

The development battle has now turned to single-family housing. The mayor, city planners, developers, and some city councilors want to abolish single-family housing, by “upzoning” wide swathes of neighborhoods currently filled with existing single-family homes and convert them to luxury condos and townhouses by right.

It will happen in Newton Corner. The Lake. Newtonville. West Newton. Auburndale. Newton Lower Falls. Newton Upper Falls. And so on.

If you thought the first wave of Newton tear-downs that eviscerated the stock of older, small single-family homes in the city was bad, wait until the new plan gets underway. Don’t think for a second that the vast majority of multifamily units under such a scheme would be built for anyone other than those who can afford, as 28 Austin puts it, “luxury boutique living.” The remaining working class and middle class households in the city of Newton will be pushed out, while the developer class will be left laughing all the way to the bank.

The Newton Villages Alliance got things right in its latest newsletter, noting:

The proposed overhaul of Newton’s zoning code for higher density will lead to a transformation of Newton to a much more expensive, congested, urban environment. In the process, well-financed property speculators will be the winners and existing residents the losers as investment capital pours into our community for the sole purpose of extracting as much profit as possible.

For a taste of what’s to come, check out this video which chronicles the failure of upzoning in Austin.

Why the Harvard Extension School still struggles with reputation

Someone posed an interesting question on an earlier blog post about Harvard Extension School degrees. JJ asked:

I found out that the Extension has been more than 100 years since 1910. Here comes to a question: Is that enough to build the reputation? How come people are still having the same arguments? Why there are still employers who think it’s fraud when someone leaves out “Extension” on their resume?

Here’s my answer to the first question about building a good Harvard Extension School reputation.

Until about 30 years ago, there were relatively few Extension School degrees granted – maybe a few dozen every year, including the now-defunct associates degree. The focus of the degree programs was far more limited, particularly for the graduate degrees. There were almost no students from outside the Boston area. This was before the World Wide Web, so you had to come to campus to attend class, which limited the student body to those living within driving range or using public transportation.

If there aren’t many graduates from a university, it’s very hard to build a reputation. That’s not just a Harvard Extension School issue, it’s true for many small colleges or small programs within larger university settings.

Things started to change in the 1980s and 1990s when Dean Michael Shinagel took over the program and implemented major updates and launched new programs. Collectively, these efforts changed the Extension School from a sleepy continuing education program to one of the larger degree-granting schools within Harvard University.

He expanded online education and degree options for the ALM program beyond traditional liberal arts and science concentrations, including areas that Harvard faculty had never taught, such as journalism and digital media. (The ALM Management and IT programs have been particularly successful, graduating thousands of people in the past 10 years.)

Shinagel also ramped up the ability for non-Harvard faculty to teach for credit, added prerecorded Harvard College classes for credit online, and increased the number of online classes allowed for the degree programs. The result has been an explosion of students and graduates, particularly since 2000. (If you’re interested in learning more about the history of the Extension School and the changes he led, I recommend his book The Gates Unbarred.)

The reputation of the school among students and alumni is fantastic. Here’s what I wrote 12 years ago, after finishing my ALM History degree:

The course offerings in a few liberal arts fields are superb. Harvard has a large number of extremely talented faculty who are used to working with very bright colleagues and students, and the university has world-class libraries and other facilities. The rich Extension School course catalog reflects these factors. It is a wonderful feeling to browse through the course offerings before the semester starts, seeing what’s available and who’s teaching certain sections. …

The quality and rigor of the ALM/Liberal Arts program attracts high achievers. In my graduating class, there were successful professionals as well as students who had completed their undergraduate and earlier graduate degrees at Harvard, Yale, Cornell, Georgetown, and the University of Pennsylvania.

Those who are unprepared for serious study won’t get very far. Some prospective degree candidates assume that the experience will be akin to a typical continuing education program. They quickly learn otherwise. While anyone can take a class at the Extension School, students who want to study for a degree have to prove they can walk the walk before they are admitted.

Unfortunately, the reputation of the Harvard Extension School in the eyes of the public is not as good. This is partly because of a large number of HES grads who don’t acknowledge they went to the Extension School. If successful grads don’t publicly state they attended Harvard Extension School, how can the public know their educational background includes years of study at the Extension School?

A related issue: people who deliberately misrepresent themselves as Harvard College or Harvard Business School students and get caught, as well as high-profile graduates who tout “Harvard University” on their resumes and then are identified as HES grads, which to many outsiders looks like misrepresentation or fraud. These cases bring down the reputation of the school. I’ve written about the misrepresentation issue extensively on “What employers think about Harvard Extension School degrees,” and I’ll end this post the same way:

HES grads should be proud of what they have accomplished and be proud to list “Harvard Extension School” on their resumes. If enough people do so and do as well in their careers as they did while at HES, the reputation of the Harvard Extension School will grow … making it easier for all Extension School grads to leverage ALB and ALM degrees to advance their careers.

Fortunately, the tide is starting to turn. I see more and more people willing to emphasize their Harvard Extension School degree or teaching credentials, and there is definitely more student pride. If these trends continue, the reputation of the Extension School will improve.

 

 

Response to “Before coronavirus, Newton development was booming. Now what?”

I sent the following letter to The Boston Globe and editor Brian McGrory after this article by John Hilliard was published on March 24, 2020. The Globe didn’t publish the letter, so I am publishing it here.

The world is facing a devastating health and economic disaster. But for Newton developer Robert Korff, everything remains “on track” for a summer 2020 opening for his Trio apartment complex, with its wine bar, dog-washing stations, and other luxury amenities.

Let’s ask some hard questions about the spate of high-end developments planned for Newton, which were not addressed in the article:

  • Now that entire sectors of the local economy have collapsed, what are the implications for jobs, salaries, and retail activity, and by extension, demand for expensive residential and commercial real estate?
  • Will the rents at these developments be lowered, or more affordable housing be made available to the legions of people who have lost their jobs?
  • What are Mayor Fuller and the Newton-Needham Chamber of Commerce doing to encourage landlords, banks, and developers to reduce rent and mortgage payments for residents and small businesses directly impacted by sickness or layoffs?

Longer term, Newton’s political leaders need to stand firm to prevent developers from exploiting changed economic conditions to demand additional concessions and benefits. Korff and his development partners have a track record in this regard, ripping up the negotiated 2013 Riverside agreement with the city and local residents after claiming the original plan wasn’t profitable enough. This gambit, encouraged by the mayor and many city councilors, more than doubled the size of the planned development over the objections of local residents.

It’s precedents like this that open the door for developers to extract even more favorable rights in a post-coronavirus world.

Tips for publishers as coronavirus hammers bookstores, libraries, and Amazon

It’s too early to tell the health impact of coronavirus/COVID-19, but the economic impact has already devastated countless small businesses and the people they employ. The book industry, already in decline, as been hammered by the closure of bookstores (including the venerable Powell’s in Portland) and libraries, as well as Amazon’s announcement to restrict shipments of non-essential items. The pain will get worse as layoffs spread throughout the economy and a recession takes hold. I own and operate a small publishing business, and here’s some advice I have for my fellow indie publishers.

Health and safety

One of the first things business owners need to do is make sure their own workers are safe, as well as the suppliers and contractors they interact with.

Review working arrangements and protocols to make sure that potential points of contact are reduced to reduce the chance of coronavirus infection and shipments can be safely handled. For instance, normally I deal face-to-face with one of my suppliers for payments and receiving shipments. Starting this week, we’ve switched to online payments and I have them leave boxes on the loading dock for me to pick up myself (see image, below). I use disinfectant to wipe down boxes and packages before bringing them inside.

loading dock books coronavirus

Also try to help with people’s emotional health. People are isolated and need more human contact, even if it’s just a voice on the phone. For colleagues and partners, give them a call instead of sending an email, text, or Slack message. Set up a pleasant home office — a small investment in a small desk, a comfortable office chair, an external monitor, and even a plant can make a difference.

Preparing for recession

PowerPoint Basics In 30 Minutes, second editionThe pandemic struck just as I was preparing to launch our latest book, the second edition of Angela Rose’s PowerPoint Basics In 30 Minutes. I normally have a press release, reviews, and a social media campaigns to accompany the launch, but for this book I didn’t bother. It’s hard to get excited about live presentation software when events have been cancelled and people are sheltering at home.

I’ve taken a number of steps in the past week to prepare for a prolonged recession. I started by reviewing last year’s P&L to get a better understanding of costs, expenses, and revenue this year. When I met with my accountant about a month ago, before the COVID-19 pandemic, I thought a 15% increase in revenue was likely. Now I am planning for at least a 30% decrease based on preliminary sales data from Amazon as well as news that libraries and bookstores are closing and won’t reopen for some time. I am assuming revenue related to events and consulting will drop by more than half in 2020.

There will need to be some cuts. Payroll is frozen for myself and my single employee, and I have told some of my suppliers that orders will be smaller or more spread out for the next 3-6 months. I have also taken steps to reduce advertising and promotional expenses. For instance, I went into Amazon Advertising and immediately cut the daily budgets and bid levels for several campaigns.

Advertising budgets during a coronavirus recession

However, I am not shutting down campaigns completely. There are still people out there searching for books, and advertising can help give my titles more visibility. Moreover, as other publishers including large New York publishing houses pull back their own marketing budgets, I predict bid levels on auction-based advertising platforms like Amazon Advertising, Google Ads, and Facebook Advertising will drop sharply. This will make certain types of campaigns more cost effective and better able to generate a return on investment.

There are other opportunities. I have several publishing brands, and one of them, IN 30 MINUTES guides, has lots of titles related to software, including Google Drive & Docs In 30 Minutes and cheat sheets for Microsoft Office. The crisis has made it clear that technology is needed more than ever to manage remote work, distance learning, and personal collaboration, and these guides and references help meet that need. I have launched several new online advertising campaigns targeting people who may find themselves working from home and need to quickly get up to speed with G Suite, Microsoft Office, and Dropbox.

Other people will be looking to escape the depressing news cycle about disease and layoffs. This could be an opportunity for fiction publishers.

These changes are not the final word on 2020 planning. But I hope these steps will help my business weather the storm over the next few months.

 

As sole donor of the “Yes” campaign, Northland’s deep pockets try to steamroll Newton’s democracy

I’d never thought I’d see this happen: Washington-style corporate donations sleazing their way into Newton’s grassroots democratic processes. The Northland Investment Corporation’s approach to getting its way on Needham Street in Upper Falls sets a terrible precedent for all future elections in Newton, in which winners may be decided by which side (or which candidate) has the biggest corporate sponsor.

Signs that something amiss in Newton came in the mail starting in January. Thousands of local residents have been sent multiple copies of glossy fliers like this one:

Northland Newton vote flier

There have also been sizable ads in the Newton Tab and on social media. My wife even received a text message urging her to vote yes to support Northland Investment Corporation’s proposed luxury development on Needham Street.

Our home received a half-dozen such fliers. I am a publisher, and know that full-color mailers printed on glossy card stock are not cheap. I wondered how “Yes for Newton’s future,” the ostensibly grassroots group supporting the developer’s vision, was able to pay for all of that printing. Could the group have that many ordinary citizens mailing in checks?

Nope. It turns out that nearly $320,000 came directly from Northland Investment Corporation. The Boston Globe has more details. In fact, as noted by the Globe, Northland Investment Corporation is “Yes for Newton’s Future” sole donor.

Northland’s atrocious record in New Haven

It must be noted that Northland Investment Corporation does not have a good record of behaving like a friendly corporate neighbor. According to media reports, it played dirty — real dirty — in another real estate deal where outsized profits were on the table.

In 2008, Northland purchased a 301-unit development in New Haven. By 2016, Northland had managed the property so badly it was condemned by both HUD & the city. HUD inspections of the Northland-managed housing found 1,015 health & safety violations. More than half were life-threatening violations, including broken smoke detectors.

In a lawsuit filed on behalf of residents, a Yale expert found that poor conditions at the Northland-managed property in New Haven led to asthma in nearly half of children living there.

How could any company in good conscience do something like this to ordinary people living in the units it controlled? According to the lawsuit, Northland Investment Corporation deliberately carried out “demolition by neglect” of the property with the goal of razing the site and turning it into a profitable venture.

In a way, it should come as no surprise that Northland Investment Corporation is demanding special rights to build 800 units — most of them luxury apartments — on an old industrial parcel adjacent to an already overcrowded Needham Street. Just as in New Haven, outsized profits are at stake. If a $320,000 corporate cash injection translates into enough “Yes” votes, Northland Investment Corporation stands to make tens of millions of dollars in additional profit on its Needham Street plans. Maybe even more.

The ROI for Northland will be off the charts. The damage to Newton’s democracy will be irreparable.

 

The map that shows how Newton will vote on the Northland development

I spotted this in my Facebook feed earlier today: A map (created by Rightsize Newton) showing the location of the more than 5,000 Newton voters who signed the petition late last year which is leading to the upcoming Northland referendum. The map is almost certain to reflect voting patterns on March 3:

northland referendum newton map 2020

Northland is a 22-acre development project planned for Newton Upper Falls, adjacent to the heavily used Needham Street commercial area. It represents a massive profit opportunity for the developer, Northland Investment Corp., which wants to maximize the value of its land by squeezing as much high-rent, luxury real estate into the parcel as possible.

Northland represents something else entirely to people who live, work, and attend nearby schools.

The area has long-standing traffic problems going back many decades. It’s been that way since I was growing up in Newton in the 1970s, and still is today when I pass through for shopping or business. The addition of 800 additional units of mostly luxury housing and more than 100,000 square feet of new retail space will make the situation far worse for anyone using Needham Street/Highland Avenue or living/working nearby.

The impact on local public schools will also be significant, despite promises from Northland Investment Corp. and its political allies — the mayor and the following city councillors (this image is being circulated by a pro-developer group, Yes for Newton’s Future. Note that it was paid for by Northland Investment Corp.):

Does anyone remember the debacle with Avalon Bay on Needham Street? Hundreds of units were built, with the developer and political supporters (including some names in the list above) promising minimal impact on Newton Public Schools — perhaps a few dozen additional students, they said.

What actually happened: Countryside Elementary grew to more than 500 students. It was bad. Crowded classrooms, hallways used for aftercare and music class, and added costs to hire staff, spend more on maintenance, and carry out the inevitable school redistricting.

Increases in traffic and school enrollment as well as other infrastructure investments required to satisfy Northland Investment Corp.’s profit motives represent real costs for Newton. This is not only something for thousands of households in Newton Upper Falls and the Highlands to worry about, either. It will impact every taxpayer in the city, as school budgets rise, delays impact businesses and residents, and the costs of maintaining more heavily used public infrastructure rise sharply.

It should therefore come as no surprise that support for the anti-Northland petition was so strong city-wide. Some might think that this is a “local village” issue, with most people against Northland Investment Corp.’s development plans hailing mostly from Upper Falls and Newton Highlands, and perhaps a smaller number from north side neighborhoods disproportionately impacted by the massive developments planned for Riverside and “Hello Washington Street.”

The map shows that support for “No to Northland” actually extends across the city, including Newton Center, Oak Hill, Newton Corner, and Chestnut Hill.

Incidentally, announcing that you oppose the current plans by Northland Investment Corp. is not pleasant. You get called names on social media (see Newton NIMBY vs. CODS). The deck is stacked against you in supposedly neutral debates. It’s even possible to get bullied in public by an elected city councillor in the pro-Northland Investment Corp. “Yes” camp.

Despite these attacks and misrepresentations, it should be noted that not one of the “No to Northland” supporters cares about preserving disused industrial and commercial lots. What they’re rightly concerned about is the scale of the project, its impact on an already overwhelmed village, and the costs that households across the city will be forced to bear if a politically connected developer is yet again allowed to profit at the expense of Newton residents.

New post:

As sole donor of the “Yes” campaign, Northland’s deep pockets try to steamroll Newton’s democracy

 

Updated my Excel Basics book for Excel 2019

Earlier this month I released a revised version of Excel Basics In 30 Minutes. This is the third edition of the book. The first, published in 2012 under a slightly different title, showed users how to use Excel 2010 (for PCs) and Excel for Mac (which was then a very different software product). The second edition, published in 2015, covered Excel 2013. A few years later, I updated the second edition for Excel 2016 as well as Excel Online and the mobile apps for iOS and Android.

Now it’s 2020. Besides refreshing the book for the latest desktop version of Excel (Excel 2019, part of the Office 365 suite), I also made a few other changes that were a bit more significant.

Streamlined Excel examples

I built the first edition around the story of three colleagues in a sales department, and how Excel could be used to track their sales and earnings. Through these examples, I introduced basic Excel concepts, including:

  • Functions
  • Formulas
  • Formatting data
  • AutoFill
  • Charts
  • Filtering and sorting data
  • Static cell references

The problem: the chapter on projecting sales was simply too complicated, and describing how to hide and manipulate data for different people was distracting. In the new edition of my Excel book, I only project the earnings of one of the colleagues in that chapter and simplify the step-by-step instructions and screenshots:

Excel Basics in 30 Minutes sorting exampleExplaining the Excel mobile apps

Before starting the new edition of Excel Basics In 30 Minutes, I hoped to be able to expand the sections on the Excel mobile apps for iOS and Android.

I quickly discovered that the apps, while very full-featured, are really hard to use with a touch-screen interface. This is particularly true for phones, where a lot of taps are required just to change a single cell.

The reason, of course, is the fact that most Excel spreadsheets are complicated, with lots of cells and columns and buttons and commands. It was designed for the keyboard and mouse, often requires accessing files that aren’t stored or exported locally (such as .csv files and charts). Shoehorning the user interface and features into a touch-screen device is really hard to do.

Excel iOS autosum example

So, while the book does explain how to use certain Excel features on small-screen devices (the example above shows Excel AutoSum for iOS), for many of the examples I advise people to use the desktop versions of Excel 2019 for Windows and macOS.

Excel alternatives: Google Sheets and Excel Online

One very popular feature of Excel Basics In 30 Minutes since the first edition is the inclusion of instructions for Google Sheets, a free Excel alternative. Readers and reviewers constantly remark about how helpful it is to be able to use Sheets with the book, either because they can’t afford Excel or their office or school uses G Suite (the Google equivalent of Microsoft Office). I’ve updated the latest edition of the book for Google Sheets, which hasn’t changed much since the last book update.

Excel Online has changed quite a bit. In 2018, when the last update to the second edition of the book was published, Excel Online was pretty bare-boned — almost a grudging freebie made available to counter the threat of Google Sheets. As of 2020, the Excel Online interface has been really improved, and there are a bunch of new features that weren’t there before, including filtering.

If you’re interested in learning more about the third edition of the book, check out the official website, excel.in30minutes.com:

Excel Basics book website screenshot 02102020

BIDMC Medical Grand Rounds: Major Advances in Gastroenterology & Hepatology: A Half-Century Retrospective

J. Thomas Lamont MD giving presentation

I recorded audio of the following presentation by my father at Beth Israel Deaconess Medical Center in Boston in January 2020 and later worked with him to incorporate the slides and post it as a video. The video not only gives a history of major developments in gastroenterology from 1965-2020, but also gives insights into how crucial discoveries and paradigm shifts (including those in other fields) can upend the established order. A transcript is included below.

Medical Grand Rounds: Major Advances in GI & Hepatology: A Half-Century Retrospective.

Presented by J. Thomas Lamont, MD (Rabb Professor of Medicine at Harvard Medical School). Sherman Auditorium, Beth Israel Deaconess Medical Center, Boston, January 9, 2020.

Watch the video here

Introduction by Nezam H. Afdhal, MD:

The Zetzel Visiting professor lecturer this year is Professor Thomas Lamont, who is, as you all know, the Emeritus Chief of Gastroenterology at BIDMC. Tom started his career at UCLA, where he did his residency, and then has the dubious distinction of having worked at every teaching hospital in the Boston area, except Tufts.

After his fellowship at MGH was on the Faculty at Harvard Medical School until 1980, when he became the chief of GI at Boston Medical Center. He then came to BIDMC to be the Chief of Gastroenterology in 1996. His career has spanned major achievements in all areas of gastroenterology. Many of you don’t know this, but he was one of the first people who worked out how gall stones developed in the gallbladder.

He published a paper that was the cover of Nature that illustrated why the stomach does not digest itself due to the interactions of mucins and the effect of acid on the mucin structure within the stomach. At BIDMC he and his research team worked on the mechanism of action of the toxins for C. difficile. These are just some of his scientific advances. He is a clinician, still sees patients today, and is a well sought after teacher, and has educated innumerable fellows and faculty. He’s been a mentor to many. He’s been a great friend to the GI division here at BIDMC. His lecture this morning is going to be a look back at what has happened in the 50 years of Tom’s career in gastroenterology. ,

Dr J. Thomas Lamont, MD:

This is the UCLA Medical Center where I was an intern in 1965. During my training there I thought that the wisdom and knowledge that I was taught was really top level. Looking back now, I realize that all of it has been wiped away, or superseded by new knowledge .What I was taught then was thought to be state of art, but eventually the bulk of it was discarded and replaced by more accurate and improved medical science

I used to think, and a lot of people believe that discoveries are incremental, that knowledge is added like bricks to a wall which you gradually build. But in fact scientific discoveries are primarily revolutionary not incremental. There’s a paradigm shift which is a radical change in the way we do things. It’s often disruptive, a word borrowed from technology, where the new discovery or invention blows up whatever was there before. Later in the talk I’ll show you some examples of disruptive discoveries and inventions in the field of Gastroenterology.

A major feature in the field of scientific discovery is resistance from the establishment. I can tell you that Boston has a very powerful medical establishment, and the resistance to some of what I’m going to show you was quite robust. So, if you’re interested in this topic, there’s a very important small book, about 100 pages long, by Thomas Kuhn called “The Structure of Scientific Revolutions”. Kuhn championed the concept of paradigm shift, in which scientists have to move away from something that has been accepted for a long, long time. And the new paradigm replaces the original paradigm, which eventually fades away.

For example, an original paradigm in GI was, “excessive gastric acid secretion causes duodenal ulcers”. This paradigm is what we thought up until about the late ’80s. But then we gradually learned that in fact Helicobacter pylori infection is the cause of the majority of duodenal ulcers.

Here is an overview about some of the major discoveries I’m going to talk about. There’s dozens of things that could be discussed at a talk like this, and I’m not even sure I’ll be able to get through the ones I put in the timeline here. I’m going to start with fiberoptic endoscopy, because I think that had the biggest influence on our specialty, and defined what it is today. The discovery of H2 acid blockers was a major advance, followed around the same time by the discovery of the role of Helicobacter, and the invention of proton pump inhibitors. The major discoveries in Hepatitis C virus infection have taken us to the point where this disease is now curable .

If you were a patient in 1820 in Italy, your doctor might approach you with one of these instruments, and it would certainly put the fear of God in you. You can imagine that this urethroscope might be quite uncomfortable. especially as the procedure was performed without pre-medication or sterility.

The GI tract is curvy. That’s the problem with these early endoscopes: they’re not flexible but rigid. Illustrated hers is the type of gastroscope that was still in use in Los Angeles when I was an intern. You can see the gastroscope there over Dr Schindler’s right arm. On his right is Mrs. Schindler who attended every endoscopy and who assisted in moving the patient’s head. During the procedure the patient’s neck would be hyper-extended to allow introduction of the metal endoscope. As you know the esophagus is straight; that’s the only reason why this technique worked at all. The scope couldn’t go around any curves and it was really quite a difficult and even brutal test.

These metal sigmoidoscopes were in daily use up until about 1985 or even 1990 at Boston teaching hospitals. We used plastic scoped that were disposable and every GI fellow and internal medicine residents learned how to do proctoscopy for colon cancer screening.

In 1842 a critical experiment establishes that light could be bent. As shown here a bead of light is transmitted through a tank of water, and you can see that the light follows the curvature of the water as it exits the container. The light actually bounces or is refracted off the side of the column of water. The next big discovery was the development by Narinder Singh Kapany of fiber optic cable, which eventually replaced metal cables and had a huge impact on the field of telecommunications.

Kapany and colleagues then had the idea that extremely thin flexible glass fibers could transmit endoscopic images. This was picked up by Basil Hirschowitz, a native of south Africa, who in 1953 was a GI fellow at the University of Michigan. He was already trained in endoscopy in England before he went to Michigan. Hirschowitz was trained in the Schindler type of endoscopy that I showed you earlier, but he realized that this older technology was difficult and dangerous because of the rigidity of the Schindler scope.

Hopkins and Kapany published a paper in Nature entitled “A Flexible Fiberscope Using Static Scanning.” What they reported was a flexible endoscope that transmitted light through 10,000fiberglass rods that were slightly bigger than a hair. The exciting new and innovative aspect of this paper was the fact that the endoscope was flexible, and that when the scope was bent the image was not distorted.

Hirschowitz heard about this paper from a cardiology resident who had heard about it at journal club in London. Hirschowitz flew to London, met Kapany and Hopkins in a pub, and discussed their invention. They were very encouraging to Hirschowitz and gave him a few glass fibers to take back to Ann Arbor. Hirschowitz returned to his fellowship at Michigan and built the first fiberoptic gastroscope with help from Larry Curtis and Wilbur Peters who were physicists. After a few years of trial and error, they produced the first gastroscope

GI doctors in the audience will notice there’s no wheels on this first scope, so it’s not steerable. It’s a side-viewing scope which makes it really difficult to insert. compared to what we have today, it is not very practical or useful. But this invention marked the beginning of fiberoptic endoscopy.

Hirschowitz, like a lot of fellows and young researchers in science, first tested the device on himself in February 1957. He managed to control his own gag reflex, passed through his esophagus and looked around in his own stomach. He then scoped a patient indicated on the slide as patient #2. A most remarkable aspect of this discovery was that it was not supported by grants and was carried out by a GI fellow, and two physicists who worked very hard to create this incredible advance.

Dr Hirschowitz then linked up with American Cystoscope Manufacturing Inc. an American device company that made rigid Urologic scopes who produced this first commercial fiberoptic gastroscope. Again, it had no wheels to allow steering, but it had an air channel and the optics were good enough to allow examination of most of the stomach. Hirschowitz himself published this seminal paper in Lancet in May of ’61 that described his experiences in a series of patients he examined with the new scope. In the next to last sentence he challenged the existing paradigm. “The conventional gastroscope ( Schindler gastroscope) has become obsolete on all counts.”

The invention of endoscopy was not a hard sell. Some of the other things I’m going to talk about later were met with strong opposition, but fiberoptic flexible endoscopy was widely and quickly accepted. By the time I was a GI fellow in 1971 and into the early ‘1980s gastroscopes had was being taught at all the Boston teaching hospitals. The opposition was not to the scope itself, but rather to the idea of fellows leaving the laboratory and learning what sounded like a surgical technique.

Certain research-oriented professors at Harvard were somewhat opposed to this. One of my mentors said to me,, “Once they taste blood, they’re gone forever.” He meant that once GI fellows had used the scope to diagnose a GI bleeder they would lose their interest in basic research.”

The impact of fiberoptic endoscopy on practice was massive. Currently about 100-million endoscopies performed a year in the United States, about two thirds of them by GI doctors. Flexible fiberoptic endoscopy has had important impact worldwide in many medical and surgical fields.

This slide compares how we treated common GI diseases at UCLA in 1965, and how we handles these conditions currently. For example patients with GI bleeding that did not respond to antacid therapy typically went to surgery. Nowadays we manage this situation with proton pump inhibitors, and if bleeding continues or is torrential then we manage the situation endoscopically. Variceal hemorrhage was a fearsome occurrence in the mid 1960s and if persistent life-threatening was referred for a portocaval shunt. Currently this operation is seldom performed here, and we rely almost entirely on endoscopic control of variceal bleeding and radiologic placement of portocaval shunts or TIPS.

Management of obstructive jaundice was very difficult because we did not have any imaging studies to examine the bile ducts. Sometimes we resorted to so- called steroid whitewash especially if you were afraid of doing an laparotomy. This involved administration of corticosteroids for a week. If the jaundice improved then it was likely not mechanical obstruction but hepatitis or some other form of cholestatic jaundice for which surgical exploration was not required. Treatment of achalasia typically required either a forceful dilatation of the lower esophagus which was quite dangerous or a surgical myotomy. Currently we can perform a myotomy through the endoscope to treat achalasia at our hospital .

Now I’d like to tell you about a few advances in endoscopy that have been made here in our division. new approach is called molecular endoscopy where the scope can analyze tissue from tumors using laser light scattering.

This approach was developed here by clinical investigators in our GI unit working with Professor Lev Perelman a physicist in the GI division who specializes in photonics. Dr Perlman and colleagues hand-built this equipment which includes a scanner that goes through the biopsy channel of the endoscope. This allows a laser beam to be aimed at the epithelial lining of the esophagus and then measures reflected light from the wall of the esophagus. As the scope is withdrawn the instrument turns so it’s like an internal CT scan of the esophagus, except it’s spectroscopy. The reflected light ia analyzed to detect dysplasia more accurately than the optical techniques and biopsy.

Here is some information on the first prospective randomized clinical study on artificial intelligence to improve colon screening for cancer. This work is being carried out here by Tyler Berzin and Jeremy Glissen-Brown, one of our fellows, and was just published in Gut. They report the ability of artificial intelligence developed through game technology, to assist a physician doing a screening colonoscopy. The main quality outcome of a screening colonoscopy is adenoma detection rate or ADR.The goal is o find all the adenomas and take them out and prevent future development of colon cancer. The arrows indicate the polyp detection rate, or PDR, using routine optical colonoscopy at 29% vs 45 %with the assistance of artificial intelligence. This innovative technology will have huge impact on the ability of endoscopy to find and remove colonic polyps, and will improve our ability to prevent colon cancer.

S Mel Wilcox, the division director at the University of Alabama, where Dr. Hirschowitz spent his career, stated that it Basil Hirschowitz created the field of modern gastroenterology. When I started my training, GI was a reflective, diagnostic, minimally invasive specialty similar to endocrinology. Now the field is closer to urology or ENT than it is to some medical specialties.

I’d like to turn now to story of discovery that started in Australia. Pictured here: a medical resident, the tired-looking fellow on the left. He was working in the Royal Perth Hospital and asked his boss, the head of the GI unit, if he could help him find a suitable research project. — He was becoming interested in gastroenterology, had a curious mind, and was keen to explore although up to then he had never done any research. His boss referred him to Robin Warren, shown here on the right, an assistant professor of pathology at the hospital.

Barry went over one afternoon and sat down with Dr Warren to examine pathology slides that Warren had been collecting from GI patients with gastritis and ulcers. Warren was especially interested in this silver stain of a spiral bacteria that was present in the stomach. Warren recognized that this organism had been described for at least 100 years. But so far it had not been identified or named, and its role in diseases like gastritis and ulcers was unknown to medical science.

Barry Marshall realized that some of the patients that Robin Warren was telling him about were his own patients. He had learned fiberoptic endoscopy, and he was performing biopsies on these same patients and knew their medical histories. So this clinical connection lit a spark, and the two of them teamed up and made a remarkable discovery. What they did was to simply correlate this finding with the presence of active chronic gastritis. They published their first paper, a brief letter to the editor in Lancet in 1983t, which described a series of their patients with active gastritis and the present of this curved bacillus in their stomachs.

They went on then to make further correlations between the curved bacilli and peptic ulcers and eventually gastric cancer. This discovery was innovative and totally new. and was met with huge resistance by the medical establishment. The notion that peptic ulcer was an infectious disease met with near universal rejection. I actually remember the journal club in a Boston teaching hospital near here where this was first presented. The discovery was universally rejected by most of us in attendance. The problem was that in certain parts of the world, 80% of the population were infected. How could something that common be a cause of a disease like peptic ulcer that only occurs in, say, 1% of the population?

Barry Marshall wrote in his note cards and some of his later publication “Everyone was against me, but I knew I was right.” So who was against him? The acid mafia, a powerful group of senior investigators who championed the idea that hydrochloric acid was the key to formation of stomach ulcers. When we were residents and fellows we had to know a lot about gastric hydrochloric acid secretion. So those who believed in the primacy of stomach acid were definitely strongly opposed to these Australian upstarts, Marshall and Warren.

Listed here are Koch’s postulates; the last two are particularly important in establishing the infectious etiology of a given disease. The pure culture, when inoculated into the experimental animals, must reproduce the disease.” “Microorganisms must be recovered from the diseased animal.”

In this instance the experimental subject was Barry Marshal himself He swallowed a pure culture of Helicobacter pylori that he had isolated from one of his patients that he had previously biopsied and cured. So he knew that the strain was treatable and curable. He drank the culture of H pylori and over the next several weeks developed severe acute Helicobacter infection with nausea, vomiting, and severe dyspepsia. He stated that his halitosis was so bad, that his wife told him that he had to sleep on the couch. After the infection was established he treated himself with the anti-Helicobacter therapy and completely recovered. His experiment was soon published in the Medical Journal of Australia in 1985.

Eventually the etiologic role of H pylori in stomach diseases was established without a shadow of doubt. That doesn’t mean that acid doesn’t play an important role in ulcer formation, An old dictum was, “No acid, no ulcer.” That’s pretty much true.

You can easily cure ulcers with proton pump inhibitors. But if you want to cure an ulcer permanently then you have to eradicate Helicobacter. In this study in the New England Journal patients with active duodenal ulcers and Helicobacter infection were first “cured” with, in this case with Tagamet for two weeks, and then they were randomized after the Tagamet was finished to either antibiotics for two weeks to get rid of the Helicobacter or placebo.

You can see here a huge separation of these curves. Without eradication of the H Pylori infection by antibiotics, most patients had recurrence of their ulcers by the end of the study. Many other studies like this finally established the important causative role of this pathogen.

Helicobacter pylori is probably one of the most common infections world wide; in some countries the prevalence overall is about 60- 80%. For example, in Bangladesh about 80% of children are infected by age 5, particularly in areas with poor access to clean food and water. The peptic ulcer rate is about 10% and it turns out to be the cause of a number of important diseases of the stomach and duodenum that are shown on this graphic.

About 100% of patients with Helicobacter get some form of gastritis. It’s not the only cause of gastritis but it’s a major one. Eventually, with chronic, lifelong infection, gastric atrophy may occur. This leads to achlorhydria and in some patients to pernicious anemia with vitamin B-12 deficiency. It’s thought that the majority of stomach cancers result from chronic infection with H pylori. This states that about 1% of infected patients will get gastric cancer. That’s an over-estimate; it’s more like 1 in 1,000, or perhaps even less than that. Infection is also the cause of MALT lymphoma which can be cured by treatment of Helicobacter without chemotherapy, and without removal of the stomach. As already discussedH pylori accounts for the majority of gastric and duodenal ulcers.

Marshall and Warren were finally justified in 2005 when they won the Nobel Prize for Medicine. A couple of blokes from Australia who had not done a lot of research at all, with very little support. they used equipment and tools that were right at hand. This seems to be a study that could have been performed by almost anyone. But they were the first, and their persistence in the face of heavy opposition payed off.

The medical treatments we had for peptic ulcer in the mid 1960s and right up to about mid-’70s was actually very limited and not very effective. The mainstay of medical therapy was antacids. House officers and trainees were expected to know the properties of antacids very well, including doses, and their side effects. We sometimes used a special treatment called the Sippy diet” which consisted of two ounces of cream every half hour alternating with an 30 to 60 ml of an antacid. But a large number of the patients developed severe and semi-acute atherosclerosis from the fat so it was finally abandoned.

At this hospital William Silen and colleagues developed a very unique approach to acute stress ulcers of the stomach with GI hemorrhage in patients in intensive care units. He and his colleagues published a report in a major medical journal that described a technique to reduce the acidity of the stomach. An NG tube was placed in the stomach and the pH was measured. Antacids were instilled through the NG tube to bring the pH above four. This technique was a common treatment for bleeding stress ulcers in that era just prior to the development of effective drugs to block gastric acid secretion.

When antacid therapy failed to heal ulcers and stop bleeding we then turned to surgery. The first thing was to cut the vagus nerve, a vagotamy, and then remove the distal half of the stomach to remove the ulcer and reduce some of the acid-producing cells in the antrum, and then hook up the small intestine. As you can see it’s not very physiologic. There were many side effects. And every GI fellow and house officer had to know the side effects of ulcer operations that were so frequent after these types of operations.

The introduction of acid-blocking drugs truly changed everything. Again there was some push-back from the establishment. Editorials appeared in the New England Journal from internists and surgeons decrying the overuse of acid blocking drugs across America. A quick survey of the in-patient service at Yale New Haven Hospital revealed that 56% of the patients were on an acid blocker. Some of us commented, “Why so low?” Perhaps these meds were over-used but their effectiveness and clinical impact justified widespread use.

Show here is a simplified diagram pf receptor-mediated control of hydrochloric acid secretion. It was known for many years that histamine could strongly stimulate gastric acid secretion. But it was thought that there must be a special receptor for histamine which eventually was called the “histamine 2 receptor.” The gastrin receptor was thought to be a major regulator, and then finally the vagus nerve through acetylcholine, all of them having separate receptors with somewhat different transduction mechanisms. The ultimate step in the acid secretion pathway was the proton pump which secretes a hydrogen ion into the lumen of the gastric gland in exchange for a potassium ion.

Smith, Kline & French started an acid blocker discovery program in 1964 under the leadership of James Black who had already invented and developed propranolol. He was a lead investigator in receptor-mediated physiology and was also an experiences medicinal chemist.

His research team at Smith, Kline & French in the UK finally developed cimetidine, the first billion dollar drug, which hit the market in ’76. It was a blockbuster drug. I was just starting my career as a faculty member and I remember the AGA Digestive Disease Week at that time was all about Tagamet. They were everywhere with it. People were just a-buzz about this new drug. So it was a pretty easy sell except for the over-use that I mentioned.

James Black and colleagues at Smith, Kline & French studied the histamine molecule and then made critical modifications. Substitution of the methyl group on the imidazole ring created an agonist. So that was actually the first discovery. Once you have an agonist — and it did not stimulate H1 receptors — so they knew that they were onto something. It took them about six years to develop this molecule, an H2 blocker which is Tagamet. They had a couple of earlier ones which were very effective but when they tested on patients caused agranulocytosis and pancytopenia. So there were a few missteps but in general it was a very successful campaign.

James Black was awarded the Nobel Prize in 1988 for his discovery of two major drugs: propranolol and H2 acid blockers. He shared the prize with Gertrude Elion and George Hitchings. for their drug development of purine analogs that were used successfully to treat a number of important diseases including autoimmunity, transplant rejection ,infections and gout.,

I would like to say a few more words about Dr. Gertrude Elion. She was born in Brooklyn, went to Hunter College where she started at age 15 and graduated summa cum laude. She then decided to go to graduate school for a PhD. but could not get into a chemistry doctoral program. She was told at one interview by the head of the laboratory, “You might be qualified but you would be a distraction in a lab full of men.”

She then worked for the A&P supermarket company testing the acidity of pickles. Dr Elion finally joined Burroughs Wellcome in 1944 at age 26 as an assistant to George Hitchings with whom she shared the Nobel Prize. She never received a Ph.D, but was awarded many honorary Ph.D.s including one from Harvard

Elion and Hitching developed these drugs two of which, mercaptopurine and azathioprine were used in gastroenterology. They developed the antibiotic trimethoprim, acyclovir, and the others listed there. These are all actually still in use in some form or another. All of these novel drugs were based on modifications of the purine molecule.

When I read about Gertrude Elion I became curious about how many women won the Nobel Prize. Of the 943 Nobel laureates awarded since 1901, only 53 were women. And the graphic shows by 20-year segments that the number of women awardees is slowly rising. In the last 20 years from 2001 to o 2018, the number has increased from previous 20 year segments. The trend is in the right direction and I suspect it will improve over the next 50 years.

Hepatology in the mid 1960s was not very well developed. I can basically summarize what we had then as nothing. We could measure AST and ALT, bilrubin, and Alkaline Phosphatase, and prothrombin time and albumin. We had no imaging, of any kind. As I mentioned before we frequently resorted to exploratory laparotomy as a major diagnostic test.

There were few effective treatments for cirrhosis. I remember one of my teachers I think in residency or perhaps for the fellowship saying that the prognosis of a patient with cirrhosis when you have a complication such as bleeding, ascites or infection was about the same as a person with stage 4 metastatic lung cancer which at that time was not very treatable. Our knowledge of viral hepatitis was quite limited. We used descriptive terms for such as infectious hepatitis, short incubation hepatitis, post-transfusion hepatitis, and several other designations which weren’t very useful.

Shown here is a timeline of post-transfusion hepatitis, a major clinical problem in the post war era as blood transfusions was widely accepted and became well-organized. The first big improvement in the rate of post-transfusion hepatitis was the discovery of the Australian antigen by Baruch Blumberg about 1970, a discovery which allowed screening of donor blood. The rate of post-transfusion hepatitis in the United States in 1965 was about 22%. So the blood supply was not very clean. A big issue then was heavy reliance on professional blood donors, about 40 % of whom were infected with a hepatitis B or C. .

Screening of donated blood for virus infections picked up with anti-HIV testing because some of those donors were affected by hepatitis viruses as well. the next step in screening ALT and AST to screen donated blood. The final step in making the blood supply safe was the introduction of screening for HCV in the 1990s.

The HCV story started with the discovery at the NIH of the so-called non-A, non-B hepatitis which subsequently was re-named hepatitis C. The virus was identified in 1989, and this led to the development of a screening test for test blood donors. Interferon therapy started in the early ’90s and then the big revolution in the last 20 years occurred around 2014 with approval of direct acting anti-viral drugs. It is predicted that HCV will eventually disappear about 2030.

These four researchers found a single clone of DNA in a sample of blood from a patient with nonA nonB post-transfusion hepatitis. This seminal discovery eventually led to isolation of the HCV, followed by complete genetic sequencing.

The global burden of HCV is huge disease, with about 2% of the world’s population being infected. This map shows the geographic distribution:: the redder the color the more prevalent the infection.

Initial infection with HCV can produce a number of different outcomes. The unusual thing about hepatitis C is the very high rate of chronic hepatitis. We learned that about 20% of acutely infected patients recovered but about 80% developed chronic infection with serious complications. including cirrhosis and hepatocellular carcinoma developing decades after infection, usually in individuals who were asymptomatic.

This slide shows a timeline of the treatment starting on the left in the early 90s with interferon, first for six months, then for 12 months. And then the addition of ribavirin which increased clearance from the blood of HCV. And eventually introduction of pegylated interferon, and finally the current agents of choice, the direct acting anti-viral drugs. Currently about 100% of people with infection can be cured by these powerful medications.

A lot of the clinical research on HCV eradication has taken place here at BIDMC, much of it under the leadership of Nid Afdhal and his colleagues who published this paper in the New England Journal in 2014. This landmark study was the first randomized trial demonstrating cure of HCV infection with all oral direct acting antiviral therapy with these two DAAs, together known as Harvoni. Currently, we’re at the point where this condition can be cured. These new drugs have revolutionized our approach to this silent killer.

Howard Gruber was a psychologist who studied the processes and backgrounds of discovery and invention. He wrote: “The power of the beauty of science,” I think you can substitute “medicine” there, “do not rest upon infallibility, which it has not, but on corrigibility, without which it is nothing.” Corrigibility, or correctability derived from the Latin word corrigere, “to correct.” I have shown examples of how previous medical paradigms have been corrected and replaced. As I mentioned at the beginning of my lecture most of what I learned about Gastroenterology in my early training at UCLA has been corrected. And the same will happen to you. So what you’re learning now is as correct as we can make it, but eventually it will be replaced. So stay tuned.

For more information, see the video of the slides (includes audio). J. Thomas Lamont MD’s bio.

A message to Harvard Extension School students who can’t stand this blog

Recently, a current Harvard Extension School student (using an @g.harvard.edu email address, which is available to Extension School students) has been harassing me on Twitter and via email, accusing me of being a bully, ridiculing my career, and demanding that I delete this blog. He further claims HES students hate me.

When challenged to back up this assertion with evidence, he would only state that “a high level person” directed him to read my blog, which he further said is “negatively impacting the HES community.”

I felt it would be a good opportunity to share with him (and others) a little bit of the history behind this blog, and explain why I will never give in to the haters who pop up from time to time.

First, it’s worth noting that the malcontents are in the minority. My two Harvard Extension School blogs (Harvard Extended and Ipso Facto) have been viewed well over 1 million times since 2005. People come to the blogs because they find them informative and helpful. I’ve personally answered hundreds of questions from prospective students. A few have even circled back after graduating to thank me.

Second, a lot of the content on these blogs praises the schools and individual programs. I’ve always made a point of highlighting some of the best aspects of the Harvard Extension School, including access to top-notch Harvard faculty and research opportunities. To see examples, read the final post on the Harvard Extended blog, or What’s the Harvard Extension School post-bacc really like? I also defend the Harvard Extension School on Twitter and in communications with the media and highlight positive aspects of the school that aren’t that well-known:

Harvard Extension School TAP

But along with highlighting the good, I have also called out problems with the Extension School. This is where the haters come in.

Ten years ago, it was for criticizing the Extension School’s aggressive expansion into online education. I got a lot of grief for that.

More recently, it’s been for calling out students and alumni who deliberately obfuscate their association with the Harvard Extension School:

Some graduates don’t want to admit they attended the Harvard Extension School, because of the stigma associated with the part-time program. Other Extension School graduates deliberately take advantage of the “Harvard University” label to mislead people into thinking they attended the highly selective College or GSAS programs. Indeed, every few years in The Crimson there are reports of Extension School students (matriculated or not) insinuated or outright claiming to be College students to other people at Harvard. It happens all the time.

That post alone has scores of comments from Harvard Extension School students and alumni that are critical of my stance. However, most offer reasoned rebuttals. I publish these comments for everyone to see.

Not everyone behaves like an adult, though. They personally insult me, demand that I delete posts they don’t like, and generally behave in an immature manner.

Here’s what the haters don’t get:

  • The blog posts consist of my opinions and observations based on facts.
  • I don’t make stuff up, and I stand by everything I write.
  • I don’t take orders from anyone to delete my blog or stop talking about issues that are important to me. This includes not only posts about the Harvard Extension School, but also other topics including those relating to the Fessenden School and real estate development in Newton.
  • When I make a mistake, or new facts come to light that cause me to change my opinion, that will be acknowledged in the post in question (look for strikethrough text or updates) or in the comments to that post, or sometimes in a follow-up post that is linked to the original.
  • People are welcome to post comments that disagree or question my stance on a particular issues. As long as they don’t contain foul language, personal attacks, hot air, or spam, I generally publish the comments.

In addition, it’s worth noting that, unlike many of the haters, I proudly list my Extension School affiliation on the blog and my LinkedIn profile.

If the haters can’t stomach the idea of publicly stating the fact that they attend or graduated from the Extension School, or are furious that someone would dare to call out those who pretend to be College or HBS students/alumni, then they should seriously consider whether the Harvard Extension School is a good fit for them.

One more thing: At the heart of any good college or grad school experience is exposure to ideas, concepts, and ways of thinking that may be novel or go against existing belief systems. If a student’s first instinct upon reading an opinion or set of facts that he or she doesn’t like/agree with is to harass the author and demand that those opinions or facts be deleted, then that person may not ready for any serious course of study, whether at the Harvard Extension School or elsewhere.