Jackson’s ‘Bad’ jacket, costumes sold at auction

LOS ANGELES (AP) — Costumes worn by Michael Jackson commanded hundreds of thousands of dollars at auction, and Lady Gaga was among the collectors.

Gaga tweeted Sunday that she bought 55 pieces in the sale administered by Julien’s Auctions and said she plans to keep the items “archived and expertly cared for in the spirit and love of Michael Jackson, his bravery and fans worldwide.”

Auctioneer Darren Julien said the jacket Jackson wore during his “Bad” tour fetched $ 240,000. Two of Jackson’s crystal-encrusted gloves sold for more than $ 100,000 each, as did other jackets and performance costumes.

The auction featuring the collection of Jackson’s longtime costume designers Dennis Tompkins and Michael Bush raised more than $ 5 million. Some proceeds benefited Guide Dogs of America and Nathan Adelson Hospice of Las Vegas.

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Online:

www.juliensauctions.com

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Novo Nordisk insulin Ryzodeg passes Japan review

COPENHAGEN (Reuters) – Denmark‘s Novo Nordisk, the world’s biggest insulin producer, said on Monday its Ryzodeg insulin had passed the first review by an advisory committee to the health ministry in Japan.

Novo Nordisk said in a statement it expected to receive marketing authorization for the treatment from the Ministry within a few months.

Price negotiations for another insulin, degludec, continued and were expected to be completed in the first quarter of 2013, the company said in the statement, adding the exact launch timing for Ryzodeg would be decided after a price listing for degludec.

(Reporting by Copenhagen Newsroom; Editing by Hans-Juergen Peters)

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Asian shares, euro rise after firm China PMI

TOKYO (Reuters) – Asian shares and the euro rose on Monday as further signs of a stabilizing Chinese economy boosted investor risk appetite, but gains were capped by worries that an impasse in U.S. budget talks could tip the world’s largest economy into recession.

European shares will likely track Asian shares higher, with financial spreadbetters predicting London’s FTSE 100 <.FTSE>, Paris’s CAC-40 <.FCHI> and Frankfurt’s DAX <.GDAXI> to open up as much as 0.5 percent. A 0.2 percent rise in U.S. stock futures also hinted at a firm Wall Street open. <.L><.EU><.N>

The euro hit a six-week high against the dollar at $ 1.3048 on an upbeat Chinese manufacturing survey, and jumped over 0.7 percent to a one-month high versus the Australian dollar to around A$ 1.2528.

The pace of activity in China’s vast manufacturing sector quickened for the first time in 13 months in November, with the final reading for the HSBC Purchasing Managers’ Survey (PMI) rising to 50.5 in November, further evidence that the economy is reviving after seven quarters of slowing growth.

“There is growing confidence that China’s economy bottomed in July-September, with signs of firmer external demand,” said Hirokazu Yuihama, a senior strategist at Daiwa Securities.

“Sentiment is supported because the gradual recovery in Asian economies comes against the backdrop of low interest rates environment, which won’t be changed anytime soon, so the recovery in risk appetite is likely to extend into next year,” he said.

Australia’s sluggish retail sales, labor demand and tame inflation raised expectations the Reserve Bank of Australia may cut interest rates at its meeting on Tuesday, lifting local shares <.AXJO> 0.57 percent to a five-week high earlier.

Japan’s Nikkei stock average <.N225> added 0.5 percent after reaching a fresh seven-month high earlier. <.T>

MSCI’s broadest index of Asia-Pacific shares outside Japan <.MIAPJ0000PUS> was up 0.1 percent after climbing as much as 0.4 percent earlier to a fresh nine-month high.

Hong Kong shares <.HSI> eased 0.2 percent after reaching intra-day highs on the year earlier. Shanghai shares <.SSEC> fell 0.3 percent, approaching their lowest in nearly four years hit last week. Indian shares <.BSESN> earlier rose to 19-month highs but gave up gains to inch down 0.3 percent.

The HSBC manufacturing Purchasing Managers’ Index (PMI) showed India’s manufacturing grew at its fastest pace in five months in November, boosted by strong export orders and a surge in output.

“The storm might have abated a little, but the outlook for equities in 2013 remains choppy,” said HSBC’s head of global equity strategy, Garry Evans in a research note.

“We conclude, however, that the global stocks will make modest gains in 2013, thanks to a combination of central bank action, earnings growth of about 10 percent, and some further rerating as investors slowly regain confidence in equities.”

ANXIETY GAUGE MIXED

Oil prices were underpinned by the firm Chinese data, tensions in the Middle East, involving Israel and Palestine, political unrest in Egypt and the conflict in Syria.

U.S. crude futures rose 0.3 percent to $ 89.14 a barrel and Brent added 0.4 percent to $ 111.63, while London copper gained 0.3 percent to $ 8,014.75 a metric ton (1.1023 tons).

Investors will now look at U.S. and European manufacturing reports due later in the session for clues about the global growth trend.

Uncertainty over whether Washington can avert the “fiscal cliff”, $ 600 billion worth of tax increases and spending cuts that will be automatically triggered in early 2013 unless Democrats and Republicans agree how to cut the deficit, kept investors nervous.

That uncertainty underpinned gold’s appeal as a safe-haven as spot gold edged up 0.3 percent to $ 1,719.34 an ounce.

“People are more cautious because there is no clear sign when the fiscal cliff will be solved,” said Brian Lan, Managing Director of GoldSilver Central Pte in Singapore.

The Euro STOXX 50 Volatility Index <.V2TX>, Europe’s widely-used measure of investor risk aversion, fell on Friday to lows unseen since mid-2007, while the CBOE Volatility Index <.VIX>, which reflects anxiety in the Standard & Poor’s 500 index <.SPX>, jumped 5.4 percent.

The euro’s limited drop on Friday after Moody’s cut the credit ratings on the European Stability Mechanism and the European Financial Stability Fund, may hint at its resilience.

Later on Monday, ahead of a meeting of euro zone finance ministers, Greece plans to unveil details of a bond buy-back crucial to efforts by foreign lenders to trim the country’s ballooning debt, hoping the terms will draw enough investors and unblock vital aid.

The dollar was down 0.1 percent against the yen at 82.26, but not far from a 7-1/2-month high of 82.84 yen touched on November 22.

Currency speculators in the latest week boosted short yen positions to the highest in more than five years, on expectations that an election on December 16 will usher in a new government that will press the central bank to aggressively ease monetary policy.

Defying rising equities, Asian credit markets were subdued, with the spreads on the iTraxx Asia ex-Japan investment-grade index little changed from Friday.

(Additional reporting by Hideyuki Sano in Tokyo and Rujun Shen in Singapore; Editing by Simon Cameron-Moore)

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Italy votes for center-left candidate for premier

ROME (AP) — Italians are choosing a center-left candidate for premier for elections early next year, an important primary runoff given the main party is ahead in the polls against a center-right camp in utter chaos over whether Silvio Berlusconi will run again.

Sunday’s runoff pits a veteran center-left leader, Pier Luigi Bersani, 61, against the 37-year-old mayor of Florence, Matteo Renzi, who has campaigned on an Obama-style “Let’s change Italy now” mantra.

Nearly all polls show Bersani winning the primary, after he won the first round of balloting Nov. 25 with 44.9 percent of the vote. Since he didn’t get an absolute majority, he was forced into a runoff with Renzi, who garnered 35.5 percent.

After battling all week to get more voters to the polling stations for round two, Renzi seemed almost resigned to a Bersani win by Sunday, saying he hoped that by Monday “we can all work together.”

Bersani, a former transport and industry minister, seemed confident of victory as well, joking about Berlusconi’s flip-flopping political ambitions by asking “What time did he say it?” when told that the media mogul had purportedly decided against running.

Next year’s general election will largely decide how and whether Italy continues on the path to financial health charted by Premier Mario Monti, appointed last year to save Italy from a Greek-style debt crisis.

The former European commissioner was named to head a technical government after international markets lost confidence in then-Premier Berlusconi’s ability to reign in Italy’s public debt and push through sorely needed structural reforms.

Berlusconi has largely stayed out of the public spotlight for the past year, but he returned with force in recent weeks, announcing he was thinking about running again, then changing his mind, then threatening to bring down Monti’s government, and most recently staying silent about his political plans.

His waffling has thrown his People of Freedom party into disarray and disrupted its own plans for a primary — all of which has only seemed to bolster the impression of order, stability and organization within the center-left camp.

A poll published Friday gave the Democratic Party 30 percent of the vote if the election were held now, compared with some 19.5 percent for the upstart populist movement of comic Beppe Grillo, and Berlusconi’s People of Freedom party in third with 14.3 percent. The poll, by the SWG firm for state-run RAI 3, surveyed 5,000 voting-age adults by telephone between Nov. 26 and 28. It had a margin of error of plus or minus 1.36 percentage points.

It’s quite a turnabout for Berlusconi’s once-dominant movement, and a similarly remarkable shift in fortunes for the Democratic Party, which had been in shambles for years, unable to capitalize on Berlusconi’s professional and personal failings while he was premier.

But Berlusconi’s 2011 downfall and a series of recent political party funding scandals that have targeted mostly center-right politicians have contributed to the party’s rise as Italy struggles through a grinding recession and near-record high unemployment.

Angelino Alfano, Berlusconi’s hand-picked political heir, seemed again exasperated Sunday after a long meeting with his patron over Berlusconi’s plans. News reports have suggested Berlusconi might split the party in two and re-launch the Forza Italia party that brought him to political power for the first time in 1994.

“We have to work to reconstruct the center-right, and reconstructing it means having a big center-right party,” not a divided one, Alfano said.

He added that Berlusconi didn’t say one way or another if he would run himself. “It’s his choice,” he said. “If there are any decisions in this regard, he’ll be the one to say so.”

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Follow Nicole Winfield at www.twitter.com/nwinfield

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Judge who named Starr to probe Clinton to retire

WASHINGTON (Reuters) – The conservative U.S. federal judge who helped to appoint Kenneth Starr as an independent counsel to investigate President Bill Clinton, prompting first lady Hillary Clinton to complain of a “vast right-wing conspiracy,” is planning a partial retirement in February.

The decision by Judge David Sentelle, an anchor of the conservative side of the federal judiciary, will open a fourth vacancy on a Washington, D.C., appeals court considered second in influence to the U.S. Supreme Court.

His semi-retirement, known as “senior status,” was disclosed on a judiciary website that monitors future vacancies.

President Barack Obama has faced difficulty persuading the Senate to confirm his nominees for the 11-judge U.S. Court of Appeals for the District of Columbia Circuit, which hears many cases arising from federal agencies.

Sentelle, who turns 70 next year, was a federal prosecutor and judge in North Carolina before President Ronald Reagan appointed him to the appeals court in 1987.

He was chief of a three-judge panel that in 1994 appointed Starr – a former appeals court judge – as the one to investigate President Bill Clinton over a real estate investment and other matters.

Starr’s investigation widened to include Clinton’s relationship with White House intern Monica Lewinsky, and led to Clinton’s impeachment by the House of Representatives.

Without mentioning Sentelle’s name, Hillary Clinton noted the judge’s ties to Republican senators in a 1998 national television interview in which she spoke about a conspiracy against her husband.

Starr released a statement calling her comments “nonsense.”

Known for direct, colorful questions to lawyers, Sentelle wrote a book, “Judge Dave and the Rainbow People,” based on his handling of a court case involving a gathering of hippies in the North Carolina mountains.

He did not immediately return a call to his chambers on Friday.

(Reporting by David Ingram; Editing by Howard Goller and David Storey)

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Asperger’s dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term “Asperger‘s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association‘s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide “defines what constellations of symptoms” doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it “shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care.”

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association’s board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger’s disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger’s families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term “autism spectrum disorder,” which already is used by many experts in the field. Asperger’s disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don’t talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger’s.

“To give it separate names never made sense to me,” Gibson said. “To me, my children all had autism.”

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won’t affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors’ guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won’t be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook “represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders,” Dr. David Fassler, the group’s treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization’s fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won’t be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual “seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 … there have been important advances in our understanding of the nature of psychiatric disorders.”

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group’s autism task force, said anyone who met criteria for Asperger’s in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don’t provide services for children and adults with Asperger’s, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don’t lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids’ who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term “gender identity disorder.” It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn’t a disorder and say calling it one is stigmatizing. The term would be replaced with “gender dysphoria,” which means emotional distress over one’s gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Talking Turkey at the Butterball Hot Line

On Thanksgiving morning, real estate agent Marty Van Ness woke up at 4 a.m. By 6 a.m. she was at the Butterball company test kitchen and offices in Naperville, Ill., where for the next eight hours she sat at a desk in a large, brightly lit room and, with the help of 59 other trained Butterball cooks, answered as many of the 12,000 calls to Butterball’s toll-free hot line as she could. Van Ness flipped through a four-inch-thick binder full of turkey tips and tricks and spoke in a cheerful, Midwestern voice to frantic would-be chefs wondering how to defrost, deep-fry, cook, baste, brine, or carve their holiday birds.

“Last year a man called me on Thanksgiving Day and said, ‘OK, I’ve got my frozen turkey ready to thaw and I have one question: What number should I set the dial to on my electric blanket?’ ” Says Van Ness, “I haven’t been stumped by a question in years, but that one—that one we had to get creative.”

Ever since its founding in 1940, Butterball has been at the top of the turkey game. Today it sells more than 1.3 billion pounds of turkey meat annually. If you cooked a turkey this holiday season, there’s a one in five chance the bird you bought was a Butterball. These days, the company isn’t focused so much on gaining new customers as cultivating loyalty among those it has.

So in 1981, Butterball experimented with the relatively new concept of a 1-800 number. It set up a toll-free hot line and staffed it with a handful of home economists. The company put the number on the little instruction packet that comes with each bird. “Toll-free numbers were just becoming popular, and they had no idea how many people would call,” says Linda Compton, Butterball’s director of consumer affairs. More than 11,000 customers did that first year, and the company has continued the practice ever since. Others have followed suit: Today you can ask Perdue or Foster Farms for help—Crisco even has a year-round pie hot line.

This year, Butterball’s Turkey Talk-Line is open from early November through Christmas Eve and is expected to serve more than 1 million people. Although most cooks still call, Butterball also answers e-mail and, beginning this year, questions on Facebook and Twitter. (This may prove to be a mixed blessing: On Butterball’s Facebook page there are about as many queries about cooking as there are screeds against eating meat and accusations of mistreatment of animals.)

Van Ness has been answering the Turkey Talk-Line since 1984, which means she has a wealth of both recipe tips (you can cook a frozen turkey without thawing it; it just takes two to three hours longer) and sociological insights, such as her observation that more men are calling than ever before.

She especially likes dealing with college kids cooking their first Thanksgiving dinners. “They’ll call me from the grocery store aisle and say, ‘OK, we have a turkey. What else do we need?’ And I’ll say, ‘Well, do you have a pan?’ ” A few years ago, Butterball made all its Turkey Talk-Line experts take a deep-frying course after customers kept accidentally setting their turkeys—and themselves—on fire.

Thanksgiving is understandably the busiest time for the Turkey Talk-Line, but Van Ness says more and more people are hosting their gatherings at unusual times of the month. “Family members live all over the country and almost everybody works, so they can’t always get together on the right day,” she says. Van Ness herself always eats her turkey on the correct day. After her eight-hour shift at Butterball ends, she drives home and takes a short nap before sitting down to a dinner her husband has prepared. “He has my direct number at work to call if he has any questions,” she says, “but after so many years, he’s gotten pretty good. These days, the only questions he asks are things like, ‘Where are the oven mitts?’ ”

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Cargo plane crashes in Brazzaville, 3 dead

BRAZZAVILLE, Republic of Congo (AP) — A cargo plane owned by a private company crashed Friday near the airport in Brazzaville, the capital of the Republic of Congo, killing at least three people, officials said.

The Soviet-made Ilyushin-76 belonged to Trans Air Congo and appeared to be transporting merchandise, not people, said an aviation official who requested anonymity because he was not authorized to speak to the media.

The plane was coming from Congo‘s second-largest city, Pointe Noire, and tried to land during heavy rain, he said.

Ambulances rushed to the scene in the Makazou neighborhood, located near the airport, but emergency workers were hampered by the lack of light in this capital, which like so many in Africa has a chronic shortage of electricity.

“At the moment, my team is having a hard time searching for survivors in order to find the victims of the crash because there is no light and also because of the rain,” Congolese Red Cross head Albert Mberi said.

He said that realistically, they will only be able to launch a proper search Saturday, when the sun comes up.

Reporters at the scene fought through a wall of smoke. Despite the darkness, they could make out the smoldering remains of the plane, including what looked like the left wing of the aircraft. A little bit further on, emergency workers identified the body of the plane’s Ukrainian pilot, and covered the corpse in a blanket.

Firefighters were trying to extinguish the blaze of a part of the plane that had fallen into a ravine. They were using their truck lights to try to illuminate the scene of the crash. Although the plane was carrying merchandise, emergency workers fear that there could be more people on board.

Because of the state of the road connecting Pointe Noire to Brazzaville, many traders prefer to fly the roughly 400 kilometers (250 miles).

Africa has some of the worst air safety records in the world. In June, a commercial jetliner crashed in Lagos, Nigeria, killing 153 people, just a few days after a cargo plane clipped a bus in neighboring Ghana, killing 10.

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Putin aide denies Russian president has health problems

TOKYO/MOSCOW (Reuters) – Vladimir Putin is in good health, his chief of staff said on Friday after Japanese media said Prime Minister Yoshihiko Noda had postponed a visit to Moscow next month because the Russian president had a health problem.

A former KGB officer who enjoys vast authority in Russia, Putin has long cultivated a tough-guy image, and health issues could damage that. His condition though has been questioned in some media since he was seen limping at a summit in September.

Three Russian government sources told Reuters late in October that Putin, who began a six-year term in May and turned 60 last month, was suffering from back trouble, but the Kremlin has dismissed talk that he had a serious back problem.

Putin’s health troubles stem from a recent judo bout, Belarussian President Alexander Lukashenko said this week.

Then on Friday Japanese news agencies Kyodo and Jiji reported that Prime Minister Noda talked about the delay of a visit planned for December in a meeting with municipal officials on the northern island of Hokkaido.

“It’s about (President Putin’s) health problem. This is not something that can easily be made public,” Jiji cited one of the officials as quoting Noda as saying.

But Putin’s chief of staff Sergei Ivanov denied there was any problem.

“Please don’t worry, don’t be concerned. Everything is in order with his health,” Putin’s said in Vienna, according to state-run Russian news agency RIA.

In an interview published on Friday in the popular Russian tabloid Komsomolskaya Pravda, Putin’s spokesman Dmitry Peskov said rumors about a spine problem were “strongly exaggerated”.

“He is working as he has before and intends to continue working at the same pace,” Peskov said.

“He also does not plan to give up his sports activities and for this reason, like any athlete, his back, his arm, his leg might sometimes hurt a little – this has never gotten in the way of his ability to work.”

Putin had been expected to make several foreign trips in late October or November, but they did not take place.

Putin is however due to visit Turkey on Monday and Turkmenistan on Wednesday.

Putin’s foreign policy adviser, Yuri Ushakov, made amply clear the Kremlin was displeased by the public discussion of scheduling by Japanese officials and denied that Noda’s visit had been postponed, saying no date had been set.

“It is just unethical to name the dates that were discussed. There were several: at first it was October, November, December, January … then we even shifted to February,” Ushakov said, adding that the sides eventually agreed tentatively on January.

He said the diplomatic process of agreeing dates for the visit should have been “hermetically sealed”.

Putin’s image as a fit, healthy man helped bring him popularity when he rose to power 13 years ago because of the stark contrast with his predecessor Boris Yeltsin, who was sometimes drunk in public and had heart surgery when president.

He has used activities like scuba diving and horseback riding to maintain that image.

On Friday, Putin met leaders of parliamentary factions in his Novo-Ogaryovo residence outside Moscow. He appeared in good health and was walking without any sign of a limp.

Likely to be on the agenda in talks between Russian and Japanese officials are energy cooperation and a decades-old dispute over islands north of Hokkaido known as the Southern Kurils in Russia and the Northern Territories in Japan.

(Additional reporting by Darya Korsunskaya; Writing by Tomasz Janowski and Steve Gutterman; Editing by Nick Macfie and Jon Hemming)

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The Economy of Surgery

When I was twelve, my sister and I accompanied my grandparents to their annual yoga retreat in the hilly ranges of southern India. We had never been before, but the summer heat was particularly blistering that year, so we persuaded our grandparents to take us along. I envisioned a blissful two-week vacation in a photogenic little hamlet, nestled among tea plantations, in temperatures that were thirty degrees cooler than on the mainland. It was just that, and yet, it was even less complicated than that.The mean age of folk at the retreat was 67. Bells sounded every morning at 3:30am, and everyone filed out of their cabins and to a little gymnasium in the center of the dwelling, where we all meditated for two hours to the sounds of sitar music and transcendental humming. Meals were served at strict hours three times a day, and consisted of boiled vegetables and grains, with not a lick of salt or spice. The library in the middle of this utopian dwelling held only spiritual and philosophical texts, not the Nancy Drew or Hardy Boys I hoped for. In the afternoons, there were a variety of classes offered – cooking lessons, devotional classes, music and instrumental classes, and yoga. My sister and I stopped by the latter occasionally, and were always put to shame by octogenarians holding themselves up in impossible poses, such as balancing their entire habitus on the tips of their fingers. I journaled in the evenings, writing each day about a new facet of human life that I’d observed. In the absence of stimulus, my dreams grew vivid and exceedingly detailed.Over the course of the two weeks, my sister and I grew quiet and reflective. It was then that we began an important switch in our minds, something that has lasted to this day. We began to see value in living leanly, economically, functionally. We began to separate needs from wants, and to discard the ornamentation.*Third year of medical school has finally brought me around to my surgery rotation: three months of waking up at 4am, stuffing my white coat pockets to the brim with gauze and tape, retracting skin and fat during long abdominal surgeries, and practicing suturing techniques on pig’s feet procured at the local Stop&Shop grocery market. It’s fast and exhilarating, and deeply satisfying. I was skeptical when I first heard that my preceptor’s favorite procedure of all time was draining a deep-seated abscess. But when I saw it being done in clinic, how a single stab of the thing blade led to the gushing of what felt like liters of pus, I couldn’t help but agree. What a joy to just go in and fix a problem so dramatically, reconstruct a failing human body in a matter of hours!During orientation on the first day of the rotation, two residents sat down and gave my classmates and me some hard advice. Surgery is a demanding rotation, they said, and it reflects the demanding residency ahead that awaits the select few. We could expect to go in while it is still dark out, and leave after the sun had set, almost every day. Residents and attendings can be rough around the edges, and may be gruff with you, even kick you out of their operating room if they feel like it, but it’s not personal. Or even if it is, we’ve got to shrug it off and keep it moving. Gone are the days of noon conferences and luxurious afternoon didactics, with their promise of free lunches and coffee. We were to eat when we can, sit when we can, sleep when we can.After an hour of such grim prognostications, my classmates and I took a break and debriefed our feelings with each other outside the bathrooms. Some were giggling nervously with panicked eyes, but most looked inspired. I too felt like I had voluntarily signed up for a warrior training program, and was feeling pretty zen about it. I saw it as a character-building experience: surgery was the time to cut out the silly frills, and embrace a leaner, meaner way of living. It was time to lose the pretty business casual outfits and fancy footwear of internal medicine, and trade them in for utilitarian scrubs and clogs. It promised to be a time of talking less and getting things done.*During a recent health management class, my classmates and I discussed the case of a medical center based in Seattle that benefited from industry principles gleaned from, of all places, the Toyota car manufacturing company. Toyota’s revolution as a manufacturing miracle began in the supply-scarce post-WWII Japan, when management was confronted with the challenge of meeting customer needs in the face of little spare capital to hold inventory as a buffer to fluctuating demand. The company then developed a set of principles focused on cutting muda or waste, while pursuing kaizen, or continuous self -improvement by way of complete intolerance for redundancy. Toyota integrated these principles into every step of production and management.For instance, Toyota emphasizes innovation on the shop floor by frontline workers to solve problems in production in real time. If a problem is discovered that cannot be fixed within the production cycle time, workers pull a cord that halts the entire assembly line and brings a senior supervisor to the scene. The management aggressively seeks ideas for improvement from employees, resulting in an average yield of close to a million ideas annually, 90% of which go on to be implemented.Analysts attribute Toyota’s success to its emphatic optimization of flow – information flow, physical flow of parts, and overall production flow, via standardized processes and continuous improvement. Standardized processes are ones that are streamlined to eliminate aberrations and unplanned redundancies. Waste, measured even in the seconds, is simply not tolerated, forcing a redesign of processes, again and again, which any employee can take on.In 2004, Toyota surpassed Ford Motors to become the world’s second-largest manufacturer of cars and trucks, surpassing the latter consistently in quality, dependability and value assessments. In turn, Ford began to take cues from Toyota, transforming its assembly-line system to similarly cut out waste.*There are two kinds of people in the world: surgeons, and everyone else.Really, what does it mean to live leanly? I rediscovered it in this rotation. A life in surgery isn’t for everyone, but such an experience is something I truly feel everyone should have. These past 6 weeks have been teaching me to think fast, move fast. They’ve been teaching me to suffice with less, be it food, sleep, or words of appreciation. They’ve been teaching me to appreciate the vulnerabilities of the human body – for no matter how exhausted or sleep-deprived I may feel, actually laying hands on the more tangible deficits of another’s is always startling and humbling. The end result is a beautiful dance, for surgeons and their assistants, working with their hands, rediscovering the grace of human movement, bring art back into medicine.I never leave the OR thinking that more is better. I watch instruments fly, I watch the players push and pull, cut and stitch, wash and dry, and I think about things like symmetry, precision, and above all, the beauty of economy.

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