Thursday, November 17, 2011

The Treatment

Why is it so difficult to develop drugs for cancer?

by Malcolm Gladwell, New Yorker

In the world of cancer research, there is something called a Kaplan-Meier curve, which tracks the health of patients in the trial of an experimental drug. In its simplest version, it consists of two lines. The first follows the patients in the "control arm," the second the patients in the "treatment arm." In most cases, those two lines are virtually identical. That is the sad fact of cancer research: nine times out of ten, there is no difference in survival between those who were given the new drug and those who were not. But every now and again—after millions of dollars have been spent, and tens of thousands of pages of data collected, and patients followed, and toxicological issues examined, and safety issues resolved, and manufacturing processes fine-tuned—the patients in the treatment arm will live longer than the patients in the control arm, and the two lines on the Kaplan-Meier will start to diverge.

Seven years ago, for example, a team from Genentech presented the results of a colorectal-cancer drug trial at the annual meeting of the American Society of Clinical Oncology—a conference attended by virtually every major cancer researcher in the world. The lead Genentech researcher took the audience through one slide after another—click, click, click—laying out the design and scope of the study, until he came to the crucial moment: the Kaplan-Meier. At that point, what he said became irrelevant. The members of the audience saw daylight between the two lines, for a patient population in which that almost never happened, and they leaped to their feet and gave him an ovation. Every drug researcher in the world dreams of standing in front of thousands of people at ASCO and clicking on a Kaplan-Meier like that. "It is why we are in this business," Safi Bahcall says. Once he thought that this dream would come true for him. It was in the late summer of 2006, and is among the greatest moments of his life.

Bahcall is the C.E.O. of Synta Pharmaceuticals, a small biotechnology company. It occupies a one-story brick nineteen-seventies building outside Boston, just off Route 128, where many of the region's high-tech companies have congregated, and that summer Synta had two compounds in development. One was a cancer drug called elesclomol. The other was an immune modulator called apilimod. Experimental drugs must pass through three phases of testing before they can be considered for government approval. Phase 1 is a small trial to determine at what dose the drug can be taken safely. Phase 2 is a larger trial to figure out if it has therapeutic potential, and Phase 3 is a definitive trial to see if it actually works, usually in comparison with standard treatments. Elesclomol had progressed to Phase 2 for soft-tissue sarcomas and for lung cancer, and had come up short in both cases. A Phase 2 trial for metastatic melanoma—a deadly form of skin cancer—was also under way. But that was a long shot: nothing ever worked well for melanoma. In the previous thirty-five years, there had been something like seventy large-scale Phase 2 trials for metastatic-melanoma drugs, and if you plotted all the results on a single Kaplan-Meier there wouldn't be much more than a razor's edge of difference between any two of the lines. 

A Radical Rethinking of Thanksgiving Leftovers

by Mark Bittman, NY Times

Everyone (yes, literally) says that leftovers are “the best part of Thanksgiving,” but I’m not psyched for dry meat on bread with a ton of mayonnaise, or even that exotic alternative, cranberry sauce.

And yet. There you are with four pounds of turkey, a pile of meaty bones, cranberry sauce destined to hang around until February and your grandmother’s stuffing, which wasn’t easy to make. Oh, and mashed potatoes, an always-challenging leftover.

Fear not. Here are 20 (you read that right) handy-dandy minirecipes designed to stimulate both your overindulged appetite and your tryptophanned-out brain. Although they may need adjustments based on your original recipes — stuffing, for instance: cornbread or Pepperidge Farm? — the range is broad enough for you to find a few things that work.

TurkeyTURKEY
Turkey-Noodle Soup With Ginger
Cook chopped onion, carrot, celery, garlic and ginger in neutral oil until soft, then add chicken or turkey stock and bring to a boil. Cook pasta in boiling salted water until almost done; drain and stir it into the soup, along with shredded turkey; heat through. Garnish: Parsley or cilantro.

Stuffing
STUFFING
Eggs Baked in Stuffing
Pack a layer of stuffing into the bottom of a well-greased baking dish or ramekins. (If you have time for a layer of caramelized onions, even better.) Make indentations and crack eggs into them and sprinkle with grated Parmesan or other cheese; bake at 375 until the eggs are just set, 10-15 minutes.

Mashed Potatoes
MASHED POTATOES
Mashed-Potato Pierogi
Cook chopped onion and garlic in butter until soft; stir into mashed potatoes. Fill wonton skins with a spoonful of the potato mixture (don’t overstuff); fold over and seal the edges with a little water. Working in batches, sauté in butter, or steam, or fry in an inch or two of hot oil until golden brown. Garnish: Sour cream and chopped dill.

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Photos: Yunhee Kim for The New York Times. Food Stylist: Maggie Ruggiero. Prop Stylist: Megan Hedgpeth.
"We call these people riot police. They’re actually rioting police. I mean, they’re the ones who were inflicting the violence. And they’re doing, under the direction of the central government, exactly what the U.S. always criticizes other countries for. That is beating, rousting, [and] jailing anti-government demonstrators."

- Lew Rockwell

h/t RTAmerica
Photo: Robert Stolarik for The New York Times

Federal Prosecutions

Financial Industry

Everyone Else

[ed. Questions?]

Charts: Transactional Records Access Clearinghouse (TRAC), Syracuse University

The Science Behind Airport Body Scanners


[ed.  Just noticed today, TSA is backing away from an independent study to evaluate the health effects of scanners, relying instead on draft conclusions from the Inspector General of Homeland Security.] 

by Erica Swallow, Mashable

The first full body scanner was developed by Dr. Steven W. Smith, inventor of the Secure 1000 whole body scanner in 1992. Smith sold the scanner and associated patents to Rapiscan Systems, who now manufactures and distributes the device. Rapiscan is just one of three companies that manufacture commercial X-ray devices used as security scanning applications — the other two companies are Tek84 and American Science and Engineering.

If you’ve flown with a commercial airline in the past two years, you’ve probably encountered or heard news of full body scanners, which use either X-rays or millimeter radio waves to create a virtually nude image of a person’s body to identify any hidden objects, such as weapons or explosives, that the person may have concealed.

David J. Brenner, the Higgins Professor of Radiation Biophysics at Columbia University, explained quite simply in an interview with NPR late last year that “both [scanning technologies] work on the same basic principle of firing a beam of radiation at the individual and looking at what it’s reflected back, quite similar to radar or sonar, but in one case using millimeter waves, which are not so different from microwaves, in fact, and the other uses X-rays.”

Inventor Steven W. Smith explains backscatter X-ray scanning quite thoroughly in his 1993 patent for the technology behind the Secure 1000:
“A pencil beam of X-rays is scanned over the surface of the body of a person being examined. X-rays that are scattered or reflected from the subject’s body are detected by a detector. The signal produced by this scattered X-ray detector in then used to modulate an image display device to produce an image of the subject and any concealed objects carried by the subject.”
Each pixel in the processed image is determined by the intensity of the backscattered signal collected by the X-ray detector. Because heavy elements (like most metals) backscatter electrons more strongly than light elements (such as tissue, organic materials and plastics), they show up differently in the processed images. With current technologies, heavy elements show up darker, while light elements appear brighter — as a result, concealed weapons, which are often made of heavy elements, can be detected.

Millimeter wave scanning works in the same way, except it uses millimeter waves instead of X-rays. The basic difference between the two technologies is that millimeter wave radiation — unlike high frequency X-rays — is not genotoxic and cannot cause cancer.

Safety Concerns

So, what does the proliferation of these scanners mean for the safety of travelers undergoing full-body scanning?

Backscatter X-ray scanning has received the majority of attention when it comes to safety issues, because “as far as we know, there is no health hazard associated with the millimeter wave scanners,” Dr. Brenner told NPR. On the other hand, he notes, “We know that X-rays can damage DNA in cells, and we know that X-rays can ultimately produce cancer. So the concern is about the possibility of inducing X-ray-induced cancer in one of the individuals who’s scanned.”

No conclusive studies have been conducted that confirm that backscatter X-ray security scanners are safe for commercial use. Advocates for the use of the scanners believe that low-energy X-rays are of negligible risk to scanned travelers, but researchers protest that even very small doses of ionizing radiation is carcinogenic. The health effects of backscatter X-ray scanning remain under scrutiny, especially in scientific communities focused on cancer and imaging.

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Image courtesy of iStockphoto, Marchcattle

Wednesday, November 16, 2011

Teaching Good Sex


by Laurie Abraham, NY Times

“First base, second base, third base, home run,” Al Vernacchio ticked off the classic baseball terms for sex acts. His goal was to prompt the students in Sexuality and Society — an elective for seniors at the private Friends’ Central School on Philadelphia’s affluent Main Line — to examine the assumptions buried in the venerable metaphor. “Give me some more,” urged the fast-talking 47-year-old, who teaches 9th- and 12th-grade English as well as human sexuality. Arrayed before Vernacchio was a circle of small desks occupied by 22 teenagers, six male and the rest female — a blur of sweatshirts and Ugg boots and form-fitting leggings.

“Grand slam,” called out a boy (who’d later tell me with disarming matter-of-factness that “the one thing Mr. V. talked about that made me feel really good was that penis size doesn’t matter”).

“Now, ‘grand slam’ has a bunch of different meanings,” replied Vernacchio, who has a master’s degree in human sexuality. “Some people say it’s an orgy, some people say grand slam is a one-night stand. Other stuff?”

“Grass,” a girl, a cheerleader, offered.

“If there’s grass on the field, play ball, right, right,” Vernacchio agreed, “which is interesting in this rather hair-phobic society where a lot of people are shaving their pubic hair — ”

“You know there’s grass, and then it got mowed, a landing strip,” one boy deadpanned, instigating a round of laughter. While these kids will sit poker-faced as Vernacchio expounds on quite graphic matters, class discussions are a spirited call and response, punctuated with guffaws, jokey patter and whispered asides, which Vernacchio tolerates, to a point.

Vernacchio explained that sex as baseball implies that it’s a game; that one party is the aggressor (almost always the boy), while the other is defending herself; that there is a strict order of play, and you can’t stop until you finish. “If you’re playing baseball,” he elaborated, “you can’t just say, ‘I’m really happy at second base.’ ”

A boy who was the leader of the Young Conservatives Club asked, “But what if it’s just more pleasure getting to home base?” Although this student is a fan of Vernacchio’s, he likes to challenge him about his tendency to empathize with the female perspective.

“Well, we’ve talked about how a huge percentage of women aren’t orgasming through vaginal intercourse,” Vernacchio responded, “so if that’s what you call a home run, there’s a lot of women saying” — his voice dropped to a dull monotone — ‘O.K., but this is not doing it for me.’ ”

In its breadth, depth and frank embrace of sexuality as, what Vernacchio calls, a “force for good” — even for teenagers — this sex-ed class may well be the only one of its kind in the United States. “There is abstinence-only sex education, and there’s abstinence-based sex ed,” said Leslie Kantor, vice president of education for Planned Parenthood Federation of America. “There’s almost nothing else left in public schools.”

Across the country, the approach ranges from abstinence until marriage is the only acceptable choice, contraceptives don’t work and premarital sex is physically and emotionally harmful, to abstinence is usually best, but if you must have sex, here are some ways to protect yourself from pregnancy and disease. The latter has been called “disaster prevention” education by sex educators who wish they could teach more; a dramatic example of the former comes in a video called “No Second Chances,” which has been used in abstinence-only courses. In it, a student asks a school nurse, “What if I want to have sex before I get married?” To which the nurse replies, “Well, I guess you’ll just have to be prepared to die.”

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Photo: Olivia Bee for The New York Times

Matinicus 1916, George Wesley Bellows
via:

Salman Khan: The New Andrew Carnegie?

by Annie Murphy Paul, Time

Meet Salman Khan, your child’s new teacher. If you haven’t heard of Khan, rest assured that your son or daughter is in good hands. He has four degrees from the Massachusetts Institute of Technology (MIT) and Harvard. He got a perfect score on the math portion of his SAT. And he’s very experienced, having taught more than 85 million lessons to students all over the world.

Khan is the former hedge fund manager who set out to tutor his young cousin in math with a homemade video he posted online. From that modest beginning has grown the Khan Academy, a free online library of more than 2,700 videos offering instruction in everything from algebra to computer science to art history. Running the nonprofit academy is now Khan’s full-time job, and he plans to expand the enterprise further, adding more subject areas, more faculty members (until now, all the videos have been narrated by Khan himself) and translating the tutorials into the world’s most widely used languages.

Much attention has been paid to the use of Khan Academy videos in classrooms. Hundreds of schools across the U.S. have integrated his lessons into their curricula, often using them to “flip” the classroom: students watch the videos at home in the evening, then work on problem sets — what would once have been homework — in class, where there are teachers to help and peers to interact with. The approach is promising, and it may well change the way American students are taught.

The real revolution represented by Khan Academy, however, has gone mostly unremarked upon. The new availability of sophisticated knowledge, produced by a trusted source and presented in an accessible fashion, promises to usher in a new golden age of the autodidact: the self-taught man or woman. Not just the Khan Academy, but also the nation’s top colleges and universities are giving away learning online. Khan’s alma mater, MIT, has made more than 2,000 of its courses available gratis on the Internet. Harvard, Yale, Berkeley, Johns Hopkins and Carnegie Mellon are among the other elite institutions offering such free education. When Stanford announced last August that it would be opening to the online public a course on artificial intelligence, more than 70,000 people signed up within a matter of days. The course’s two professors say they were inspired to disseminate their lessons by the example of Salman Khan. Khan Academy’s own videos now go well beyond basic algebra to teach college-level calculus, biology and chemistry.

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Photos: Left; Steve Jurvetson: Right; Time Life Pictures/Getty Images

Helicopters and Boomerangs

[ed.  Manifestations of these phenomena are found in other parts of the world, too..In Japan, they use the charming euphemism parasite single.]

by Lawrence J. Cohen and Anthony T. Debenedet M.D., Time

As advocates of parent-child rough-and-tumble play, we have often bumped up against the bubble-wrapping tendencies of the helicopter parent. So when Merriam-Webster announced recently that helicopter parent is now a bona fide entry in their dictionary, we took notice. The concept — a parent who is overly involved in the life and safety of his or her child — surely predates the first known use of the phrase, in 1989. But official inclusion in the dictionary suggests that helicoptering is not just a fad that will go out of style. In fact, more and more parents seem to be in hover mode these days, but the trend is worth standing up to. Because the truth is that children benefit from precisely the opposite of helicoptering: rowdy, physical, interactive play — or roughhousing. Roughhousing between parent and child, not helicoptering, makes kids smart, emotionally intelligent, likable, ethical and physically fit.   (...)

For others, focusing too much on the future leads to a collapse, a giving up and dropping out of what seems like an impossible and exhausting ordeal. In the words of a “recovered” helicopter parent we know, “I finally got it when I realized all I wanted for my child was a manageable failure, a blip on the screen, a trip to the principal’s office — something to help him learn the art and beauty of imperfection and the fact that life goes on even when it isn’t exactly how we planned it to go.” These ideas bring to mind another term, boomerang child, which was also entered into the dictionary this year. A boomerang child is a young adult who returns home to live with his or her parents after college, usually due to financial reasons. Aside from the obvious economic factors, it’s possible that some of these boomerangers are the result of too much helicoptering, too much attention on the avoidance of falling or failing — and not enough attention on the excitement of risk or the wonders and dangers of the unknown.

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Photo: David Pollack / Corbis

Alécio Andrade París (Grand Palais), 1975
via:

Current Events: So What Exactly is a Technocrat Anyway?

by Joshua A. Tucker, Aljazeera

The sky is falling! The Euro is collapsing! What can we do? Look, up in the sky: it's a bird! it's a plane, it's... technocratic government!

Destined to save small and large European countries alike, we have now been graced with the sudden appearance of technocratic government as a deus ex machina in Italy, where economist Mario Monti has been named prime minister and Greece, where economist Lucas Papademos has been named prime minister. As the hero of our day - the technocratic government - is largely unknown to many of our readers, we summon the spirit of Greek drama for a brief dialogue on technocratic government:

Q: What's a technocratic government?

A: To answer this question we first need to be clear about how governments are formed in parliamentary systems, which are what we find in both Greece and Italy (and most advanced industrialised democracies outside of the United States). Unlike in presidential systems - where the president is largely free to choose the ministers he or she wants in the cabinet - in a parliamentary system the government must be approved by the parliament.

Often this will require the agreement of more than one political party, resulting in a coalition of parties to support the government. As part of this "coalition agreement", the heads of ministries (or what are called Secretaries in the United States) are allocated to the different parties, who place representatives from their parties as the heads of their respective ministries. Moreover, the parties agree on a "Prime Minister" to head the government, usually but not always from the largest party in the coalition. Most of the time, the identity of this "Prime Minister" - conditional on election results - is known during the election campaign.

Q: Ok, so what's a technocratic government?

A: Technically (no pun intended), a technocratic government is one in which the ministers are not career politicians; in fact, in some cases they may not even be members of political parties at all. They are instead supposed to be "experts" in the fields of their respective ministries. So the classic example is that the Finance Minister would be someone with an academic background in economics who had worked for years at the IMF, but has not previously run for elective office or been heavily involved in election campaigns.

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Photo: Reuters

More Mammoth (and Mysterious) Structures Found in China’s Desert


by Noah Shachtman, Wired

The internet lost its collective mind earlier this week, when a Reddit user stumbled across “what appears to be a monumental military/science experiment going on in a Chinese desert, visible on Google Earth.” But the strange and massive box of jagged lines wasn’t the only odd structure carved into the ground — and this week’s swarm of Google-spotters weren’t the first ones to take an interest in the region.

As former CIA analyst Allen Thomson notes, turning on the DigitalGlobe coverage layer in Google Earth shows all the various times the imaging satellite has been asked to inspect that part of the desert. (Here’s a screenshot, above.) “Starting in 2004, somebody has ordered many, many satellite pictures of it,” Thomson tells Danger Room. “Can’t have been cheap.”

Below are some of the strange things those satellite swoops photographed, which were then uncovered by Danger Room’s community of commenters.

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The Educational Lottery

by Steven Brint, LA Review of Books

Education is as close to a secular religion as we have in the United States. In a time when Americans have lost faith in their government and economic institutions, millions of us still believe in its saving grace. National leaders, from Benjamin Rush on, oversaw plans for extending its benefits more broadly. In the 19th century, the industrialist Andrew Carnegie famously conceived of schools as ladders on which the industrious poor would ascend to a better life, and he spent a good bit of his fortune laying the foundations for such an education society. After World War II, policy makers who believed in the education gospel grew numerous enough to fill stadiums. One by one, the G.I. Bill, the Truman Commission report, and the War on Poverty singled out education as the way of national and personal advance. “The answer to all of our national problems,” as Lyndon Johnson put it in 1965, “comes down to one single word: education.”

The American education gospel is built around four core beliefs. First, it teaches that access to higher levels of education should be available to everyone, regardless of their background or previous academic performance. Every educational sinner should have a path to redemption (most of these paths now run through the community colleges). Second, the gospel teaches that opportunity for a better life is the goal of everyone and that education is the primary — and perhaps the only — road to opportunity. Third, it teaches that the country can solve its social problems — drugs, crime, poverty, and the rest — by providing more education to the poor. Education instills the knowledge, discipline, and the habits of life that lead to personal renewal and social mobility. And, finally, it teaches that higher levels of education for all will reduce social inequalities, as they will put everyone on a more equal footing. No wonder President Obama and Bill Gates want the country to double its college graduation rate over the next 10 years.

The advance of the education gospel has been shadowed from the beginning by critics who claim that education, despite our best efforts, remains a bastion of privilege. For these critics, it is not that the educational gospel is wrong (a truly democratic, meritocratic school system would, in principle, be a good thing); it is that the benefits of education have not yet spread evenly to every corner of American society, and that the trend toward educational equality may be heading in the wrong direction. They decry the fact that schools in poor communities have become dropout factories and that only the wealthy can afford the private preparatory schools that are the primary feeders to prestigious private colleges. The Higher Education Establishment recognizes critics like these as family. They accept the core beliefs of the education gospel and are impatient only with its slow and incomplete adoption.

Other heresies are more radical, and thus more disturbing to settled beliefs about the power of education. One currently growing in popularity we might call “the new restrictionism.” According to the new restrictionists, such as the economists Philip Babcock and Mindy Marks, co-authors of the 2008 paper “Leisure College USA: The Decline in Student Study Time,” access to higher education may have gone too far. Our colleges and universities are full to the brim with students who do not really belong there, who are unprepared for college and uninterested in breaking a mental sweat. Instead of studying, they spend time talking on the phone, planning social events, chitchatting about personal trivia and popular culture, and facebooking. Faculty members demand less of these students, according to Babcock and Marks, both because they are incapable of doing more and because they will punish faculty members with bad evaluations if they are pushed to try harder. The students often consider courses that require concentration “boring” and “irrelevant.” They argue and wheedle their way into grades they do not deserve. The colleges, out of craven financial motives, do not squarely face the fact that not all of their students are “college material.” Worse, they cater to ill-prepared and under-motivated students, dumbing down the curriculum to the point where a college degree is worth less, in terms of educational quality, than a degree from one of the better high schools. Institutions at the tail end of academic procession are, as David Riesman once put it, “colleges only by the grace of semantic generosity.”   (...)

Another heresy, and a very old one, is the idea that schooling provides education for servitude rather than freedom. It crushes the spirit, rather than expanding it. It is easy to see the elements of truth in this critique: Schools do line students up in rows, make them raise their hands, set them on task after evaluated task, insist on discipline in the classroom, and reward the motivated conformists. The “free the students” heresy goes back at least to Rousseau; though popular among Romantics of all eras, it had a major resurgence in the 1960s, when Paul Goodman, John Holt, and Ivan Illich carried the “free the students” flag. For them, children are born creative and curious, only to have the schools drum out these natural dispositions in order to create good soldiers for “the system.”   (...)

John Marsh is a proponent of another old heretical sect: the “fool’s gold” group. These heretics specialize in debunking the social progress beliefs of the educational gospel. Although education does indeed lead to social mobility for some, Marsh argues, it cannot do so for most. For the working classes, a much better approach, he believes, would be to attack the proximate sources of inequality: tax laws that privilege the rich and labor laws that restrict the rights of unions and set the minimum wage below a decent living standard. “Given the political will,” he writes, “whether through redistributive tax rates, massive public works projects, a living wage law, or a renaissance of labor unions, we could decrease poverty and inequality tomorrow regardless of … the number of educated and uneducated workers.” Left to its own devices, he argues, expansion of the educational system will produce not social equality but credential inflation: the condition in which higher levels of education (or distinctive brands of education) are necessary to “buy” standards of living previously associated with lower levels (or generic brands) of education. As workers attain the bachelor’s degree, middle-class incomes become associated with the attainment of master’s or first professional degrees, and access to truly powerful opportunities requires attendance at an elite institution.   (...)

Finally, there is the “true educators” sect, to which University of Chicago professor of education Philip W. Jackson belongs. This group takes the standpoint of the Platonic form of education to inspire deeper appreciation of craft and, at least indirectly, to hold up a mirror to the deficiencies of our current system of schooling. For these heretics, upward mobility is beside the point; to dwell on such sociological factors is to neglect the true nature of education. What does “true education” look like? Drawing on Hegel, Kant, and Dewey, Jackson has an answer.

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Paul Newman, Decency Manifest

[ed.  Love letter to Paul Newman in text and pictures from the gals at the Hairpin.  And, really, who doesn't love Paul Newman?  One of the interesting things, beyond his movie career, was how successful he was as a race-car driver.]

by Anne Helen Petersen, Hairpin

So let’s set things straight: Paul Newman isn’t from Classic Hollywood. In fact, he’s not even scandalous — if anything, he managed to avoid scandal altogether, in a way that few stars have before or since. His star image was that of a genuinely talented actor, a kind man, a passionate philanthropist, and an absolutely devoted husband....

….who just happened to the most gorgeous thing on the planet. Sometimes I’ll say that a movie star is good looking, or sexy, or handsome, but I also realize that my opinion is subjective, and others might not find him to be so. But when it comes to Paul Newman, it is impossible not to find him attractive. He is objectively handsome. His blue eyes are un-unlikable.

What’s that you say? You don’t find Paul Newman attractive? You’re going to tell me so in the comments? You are a robot.

Usually the prettiest boys are the biggest assholes. If you went to high school or ever set foot in a fraternity, you know this to be true. But sometimes the prettiest boys don’t realize they’re pretty, and they somehow end up becoming decent human beings, getting really into car racing, making lots of pantry items, and using the profits from said pantry items to let kids go play en plein air. Paul Newman is one of those few and far between. Or, more precisely, his image is that of one of the few and far between — the guarantor that hotness and decency are not mutually exclusive.

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