New top story from Time: U.S. Task Force Reconsiders Daily Low-Dose Aspirin Use for Preventing Heart Attacks in Adults Over 60

Older adults without heart disease shouldn’t take daily low-dose aspirin to prevent a first heart attack or stroke, an influential health guidelines group said in preliminary updated advice released Tuesday.

Bleeding risks for adults in their 60s and up who haven’t had a heart attack or stroke outweigh any potential benefits from aspirin, the U.S. Preventive Services Task Force said in its draft guidance.

For the first time, the panel said there may be a small benefit for adults in their 40s who have no bleeding risks. For those in their 50s, the panel softened advice and said evidence of benefit is less clear.
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The recommendations are meant for people with high blood pressure, high cholesterol, obesity or other conditions that increase their chances for a heart attack or stroke. Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, a primary-care expert at Tufts Medical Center.

Aspirin use can cause serious harms, and risk increases with age,’’ he said.

If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.

Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.

The task force previously said a daily aspirin might also protect against colorectal cancer for some adults in their 50s and 60s, but the updated guidance says more evidence of any benefit is needed.

The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.

The independent panel of disease-prevention experts analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a re-analysis of older research prompted the updated advice, Wong said.

Aspirin is best known as a pain reliever but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses—mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.

Dr. Lauren Block, an internist-researcher at Feinstein Institutes for Medical Research in Manhasset, New York, said the guidance is important because so many adults take aspirin even though they have never had a heart attack or stroke.

Block, who is not on the task force, recently switched one of her patients from aspirin to a cholesterol-lowering statin drug because of the potential harms.

The patient, 70-year-old Richard Schrafel, has high blood pressure and knows about his heart attack risks. Schrafel, president of a paperboard-distribution business, said he never had any ill effects from aspirin, but he is taking the new guidance seriously.

Rita Seefeldt, 63, also has high blood pressure and took a daily aspirin for about a decade until her doctor told her two years ago to stop.

“He said they changed their minds on that,’’ recalled the retired elementary school teacher from Milwaukee. She said she understands that science evolves.

Wong acknowledged that the backtracking might leave some patients frustrated and wondering why scientists can’t make up their minds.

“It’s a fair question,’’ he said. ‘’What’s really important to know is that evidence changes over time.’’


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

New top story from Time: Amazon Announces Indefinite Remote Work Policy—But Not For a Vast Majority of Its Workers

(SEATTLE) — Amazon said Monday it will allow many tech and corporate workers to continue working remotely indefinitely, as long as they can commute to the office when necessary.

The new policy was announced in a blog post and is a change from Amazon’s previous expectation that most employees would need to be in the office at least three days a week when offices reopen from the COVID-19 pandemic in January.

The Seattle Times reported Monday’s message was signed by Amazon CEO Andy Jassy and said company directors will have discretion to allow teams that they manage to continue working remotely.

“We expect that there will be teams that continue working mostly remotely, others that will work some combination of remotely and in the office, and still others that will decide customers are best served having the team work mostly in the office,” Jassy wrote.

Most of the online retail giant’s more than 1 million global employees cannot work remotely because they perform their duties in the company’s fulfillment and transportation division, grabbing orders and delivering them to customers.

But about 50,000 tech and office employees work at the company’s sprawling headquarters downtown Seattle campus and in the city’s South Lake Union neighborhood. Their absence will hurt nearby restaurants and other businesses.

Amazon’s update to its return-to-work policy followed similar moves from other big technology companies. Microsoft announced last month that it had postponed reopening its offices indefinitely.

New top story from Time: IMF Board Keeps Georgieva as Chief After Data Scandal Review

Kristalina Georgieva will remain as head of the International Monetary Fund after the lender’s board reviewed accusations that she improperly influenced a World Bank ranking of China’s business climate.

The fate of Georgieva—a Bulgarian economist and the first person from an emerging-market nation to run the IMF—had been in limbo since Sept. 16. That’s when a report written by law firm WilmerHale and commissioned by the World Bank, her previous employer, asserted that she pressured subordinates to boost China’s position in the bank’s influential “Doing Business” report.

“The executive board considered that the information presented in the course of its review did not conclusively demonstrate that the managing director played an improper role regarding the Doing Business 2018 Report when she was CEO of the World Bank,” the fund said in a statement following board deliberations Monday.
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“Having looked at all the evidence presented, the executive board reaffirms its full confidence in the managing director’s leadership and ability to continue to effectively carry out her duties.”

Even with the backing, the allegations against Georgieva and her subsequent fight for her job threaten to overshadow the annual meetings of the two institutions—which kicked off in Washington Monday—at a time when both are tasked with supporting economies through the Covid-19 pandemic.

The accusations will likely also impact Georgieva’s remaining time at the IMF, which is expected to deliver unbiased analysis and serve as an honest broker and tough advice-giver among governments, especially those seeking its aid.

‘Legitimate’ Concerns

The U.S.—the largest shareholder in both the IMF and World Bank—had called the allegations regarding Georgieva’s time at the World Bank “serious,” and debated calling for her resignation, Bloomberg News reported last week. Other major shareholders had held back from voicing support pending the outcome of the IMF’s internal review.

On Monday, the U.S. decided that the allegations ultimately didn’t warrant removing Georgieva, a move that helped clear the way for her to stay.

However, Treasury Secretary Janet Yellen told Georgieva in a call Monday that the law firm’s report “raised legitimate issues and concerns.”

“Accordingly, the U.S. believes proactive steps must be taken to reinforce data integrity and credibility at the IMF,” the Treasury said.

The executive board, with 24 directors representing 190 member nations, had been racing to reach a decision, after hours of discussions over multiple days with both WilmerHale and Georgieva.

Georgieva, the World Bank’s chief executive officer from 2017 to 2019, denied the allegations, telling the IMF board that the report did “not accurately characterize my actions” nor “accurately portray my character or the way that I have conducted myself over a long professional career.”

Allegations ‘Unfounded’

In a statement released by her public-relations firm late Monday, Georgieva thanked the IMF board and said it agrees with her “that the allegations were unfounded.”

“Trust and integrity are the cornerstones of the multinational organizations that I have faithfully served for more than four decades,” she said.

The multitude of pressing concerns facing the global economy along with the lack of appetite for a change of leadership likely swayed thinking on the matter, said Alicia Garcia Herrero, chief economist for Asia-Pacific with Natixis SA and who previously worked for the IMF.

“My impression is that the board realizes this is not the right time to jump on another horse,” she said. “Europeans might be worried about losing their driving seat if Georgieva needs to leave. China surely finds Georgieva a relatively benign MD. The U.S. has enough on its table and the emerging world needs the IMF now.”

Still, some U.S. lawmakers are unhappy.

“Georgieva’s continued tenure as head of the IMF would weaken the credibility of the institution and future decisions will be shrouded in a cloud of uncertainty,” Representative French Hill, an Arkansas Republican, said in an emailed statement.

A French Finance Ministry official said a review of the WilmerHale report didn’t provide details on precise elements to call Georgieva’s conduct directly into question, which is why France has supported her.

Another European official, who asked not to be named, said countries including France and the U.K. were among those still behind the IMF chief because they don’t see clear evidence against her.

France has traditionally had a big say in who gets to be IMF managing director. Five of its chiefs have been French, and even when the country didn’t secure the top job, it played a pivotal role in determining who did.

New top story from Time: Reluctant Towns, Cities and States Are Being Dragged Into Court to Fix Sidewalks for People With Disabilities

From her Baltimore dining room, Susan Goodlaxson can see her neighbor gardening across the street. But while other neighbors stop to chat, Goodlaxson just watches from the window. She uses a wheelchair, and there isn’t a single curb ramp on her block.

If the 66-year-old wanted to join, she’d have to jump her wheelchair down the 7.5-inch curb and risk a fall. Ditto if she wanted to wheel over to the library, a trip that would require riding in the street to avoid rampless curbs and broken sidewalks.

“I don’t feel like it’s asking too much to be able to move your wheelchair around the city,” Goodlaxson says.
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Federal law backs her up. Since 1990, the Americans with Disabilities Act (ADA) has required government entities to provide people with disabilities access to programs and services enjoyed by their nondisabled peers. That includes sidewalks and curb ramps that make it possible to safely cross the street.

In Baltimore and many other communities across the U.S., there has been widespread noncompliance with this part of the law.

“An awful lot of [communities] have either disregarded their obligations under the ADA or made it the last priority,” notes Tom Stenson, a lawyer with Disability Rights Oregon, a nonprofit advocacy group. “There’s a culture throughout America of not taking the needs of people with disabilities seriously.”

In Baltimore, just 1.3% of curb ramps meet federal standards, according to the city’s own figures. In Oregon, about 9% of corners maintained by the state transportation department are compliant. San Jose, California, counted 27,621 corners with faulty or nonexistent curb ramps. Boston estimates fewer than half of its curb ramps are compliant.

In recent years, there’s been a flurry of class-action lawsuits, including one filed against Baltimore in June, with Goodlaxson among the plaintiffs.

Philadelphia was sued in 2019 over the condition of its sidewalks. Chicago was sued the same year for failure to install audible pedestrian signals, more than a decade after settling a suit over curb ramps. In 2018, Atlanta was sued. A survey there determined that only 20% of sidewalks were in sufficient condition to be used by people in wheelchairs or motorized scooters, and about 30% had curb ramps. Seattle settled a class-action suit in 2017. San Francisco and Long Beach, California, were sued in 2014 to make their sidewalks more accessible to wheelchairs.

New York City and its transit authority have faced repeated major ADA lawsuits, some alleging the same lack of accessibility for people with disabilities that was supposed to be addressed in a lawsuit that was filed in the 1990s and later settled.

Los Angeles settled what is believed to be the largest of these suits in 2015. Its problems with sidewalks and curb ramps were so widespread that the city estimated it would cost $1.4 billion and take 30 years to get into compliance. In the years leading up to the suit, the city wasn’t allocating money for sidewalk repairs, for the ADA or otherwise, even while paying out millions in injury claims.

In all, hundreds of jurisdictions have faced lawsuits or entered settlement agreements after failing to meet ADA requirements for pedestrians and mass transit users.

The sheer number of noncompliant sidewalks, curb ramps, pedestrian signals and subway stations illustrates the challenges for people with disabilities. It also leaves cities in a legal and financial squeeze, with the average curb ramp costing between $9,000 and $19,000. When the court requires a jurisdiction to build thousands of them to catch up, budgets are often strained.

Ignoring the ADA

The ADA and the 1973 Rehabilitation Act resulted in significant changes that improved access and accommodations for people with disabilities. The ADA is clear that people with disabilities have the same right to pedestrian infrastructure as anyone else.

There are requirements covering a curb ramp’s width, slope and other specifications. Even a 1-inch lip can be too high for a wheelchair user to navigate. A slope that is a few degrees too steep can tip someone to the ground. Sidewalks that are crumbling, pothole-filled or otherwise obstructed—with utility poles, for example—force wheelchair users into the street for a dangerous ride.

No one expected the ADA to fix all these problems immediately. Under the law, new sidewalks must be built for accessibility. As for existing sidewalks, a federal appeals court in 1993 ruled that curb ramps must be installed or regraded when the road is altered—say, when it’s repaved.

Yet by 1999 it was clear that many jurisdictions were ignoring the law. The U.S. Department of Justice began enforcement efforts, entering into settlement agreements with more than 200 noncompliant jurisdictions representing every state since 2000.

Still, compliance lags.

Officials in Baltimore, New York and Los Angeles declined to comment for this article. Tony Snyder, manager of the Oregon Department of Transportation’s (ODOT) ADA program, says that siloed funding sources, strict regulations and costs have been among the hurdles over the years.

“It wasn’t that ODOT doesn’t value accessibility,” he says. While fewer than 10% of the state’s ramps meet standards, a lot of noncompliant ramps are nonetheless “usable.”

Kelly Lynch, deputy director and general counsel for the Montana League of Cities and Towns, an association that represents 127 municipal governments, agrees that costs can add up. She’s been working to help fellow Montanans—and, she hopes, officials in other jurisdictions across the country through the National League of Cities—find a path toward full accessibility, even if the steps are incremental.

Some changes, including educating road crews on the rules, are relatively simple. But a bigger problem is a widespread lack of spending on the nation’s infrastructure. “Our streets are falling apart, and so are our sidewalks,” Lynch says.

In August, the Senate defeated an amendment by Sen. Tammy Duckworth (D-Ill.) to a $1 trillion infrastructure bill that would have required state and local entities to describe how they would use federal dollars to improve accessibility for people with disabilities and for underserved communities. Sen. Pat Toomey (R-Pa.) called Duckworth’s amendment “politically correct virtue signaling” and argued that transit agencies don’t need that kind of federal oversight.

On top of the broader infrastructure issues, many officials don’t fully understand the ADA or its requirements, Lynch believes. And as the mother of a disabled son, she says there’s another big factor at play: “People still discriminate against people with disabilities.”

As for Baltimore, Goodlaxson says she repeatedly called the city asking for curb cuts and sidewalk repairs. She remembers a crew coming to look at the sidewalks—and then nothing happening. Advocacy organizations tried to negotiate with city officials, hoping to get Baltimore’s infrastructure brought into compliance on a timetable. When that didn’t work, they filed suit.

Most of these kinds of ADA cases begin similarly, with negotiations long before lawsuits. Some jurisdictions settled quickly and worked hard at improvements. Other cases go less smoothly. Oregon’s transportation department, which was also sued, is in danger of missing its construction deadlines under the settlement. Some repairs had to be redone because they still fell short of ADA requirements.

Sometimes cities try to get cases thrown out of court by pointing to the 1993 appeals court decision and arguing there’s no evidence the road has been altered since then, so ADA requirements haven’t kicked in. In New York, the transit authority argues in an ongoing lawsuit that while wheelchair users can’t ride, say, three-quarters of the city’s subways because there are no elevators, they can instead take the bus.

Some jurisdictions fight bitterly. Los Angeles spent five years in court before agreeing to settle. Linda Dardarian, one of the plaintiff’s attorneys, says that cities don’t fully recognize sidewalk and curb ramp accessibility as a civil right. “They have viewed it as just another maintenance obligation, [like] grooming street trees.”

When the case was settled, the judge ordered Los Angeles to pay nearly $12 million to cover the other side’s legal fees and costs, on top of the estimated $1.4 billion it will cost to come into compliance.

Under these settlements, repairs often stretch a decade or more, and the city or town typically must pay for surveys, measurements and disability consultants to ensure compliance.

From the plaintiffs’ point of view, the challenge of these lawsuits is that there isn’t a huge hammer to hold governments accountable.

“If you don’t build the ramps, the penalty is you have to build the ramps,” says Stenson of Disability Rights Oregon, which provided legal representation to a plaintiff in the Oregon transportation department suit.

For those who can easily get around town, the issue can be invisible.

Goodlaxson didn’t see the problem until she began using a wheelchair five years ago, after surgery for a brain tumor. She remembers seeing people riding their wheelchairs in the street, thinking, “that doesn’t look safe. But I didn’t give it any more thought.”

Now, she realizes “people are terrified, but they can’t do it any other way.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

New top story from Time: There’s No Definitive List of Roman Empresses. Their Individual Stories Still Matter

A line-up of busts or paintings of the first twelve Roman emperors is one of the commonest decorations in up-market houses in Europe and the United States. Most are not actually ancient Roman, but modern versions created over the last few hundred years, attempting to capture the distinctive “look” of these famous, or infamous, dynasts, from Julius Caesar (assassinated 44 BCE) to Domitian (assassinated 96 CE). They are so familiar that most of us walk straight past them in museums and galleries, without a second look.

Not so with their wives. In the modern world we have been used to spotting female power-wielders or villains, as the power behind throne—whether Nancy Reagan whispering in Ronald’s ear, or Ivanka Trump in the ear of her father. But what of ancient Rome and Roman versions of female imperial power? What do we think of Roman “empresses”? Is there a model for power among the women of the Roman hierarchy? Many of us thrilled to the wicked Livia (wife of the emperor Augustus) in the BBC/HBO’s I, Claudius. But where are the women in our view of Roman power?
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It has proved next to impossible for modern artists (or ancient ones for that matter) ever to create a convincing lineup of Twelve “Empresses” to match the Twelve Caesars. It is true that a number of female relatives sit alongside the ancient busts of emperors in the Room of the Emperors in the Capitoline Museums in Rome, and in the overall design of the 16th century “Camerino dei Cesari” at Mantua (decorated by Titian and Giulio Romano) some of the dynastic gaps between the generations were filled with small roundels of the emperors’ wives and mothers. But there is no Suetonius—the second century biographer who wrote the lives of the Twelve Caesars—to define anything like an orthodox set of imperial women. Even if you restrict the focus to the wives only, there are many more empresses than emperors (almost every emperor married several times); and, apart from changing fashions in hairstyles, there is no ancient “look” to distinguish one from another. The familiar modern groups of the Twelve Caesars, whatever their fuzzy edges, substitutions and misidentifications, are usually exactly that: Caesars only.

Read more: Mary Beard on SPQR, Ancient Rome and the Migrant Crisis

Occasionally an adventurous modern artist did attempt a series of empresses to parallel the men, whether out of a sense of symmetry, completeness or maybe a desire to introduce an erotic touch to the otherwise austere imperial landscape. But it was less easy than it must have seemed. The problems become clear in the most famous and influential such series to have survived, from the hand of the engraver Aegidius Sadeler in the early 17th century. For Sadeler had already created a hugely successful series of twelve emperors, mostly copied from Titian’s paintings in the Camerino dei Cesari, But he did not stop there. He also produced twelve matching imperial women to make a complete set of 24, in couples.

Sadeler’s source of inspiration for this has long been a puzzle. There is no original artist named on the prints of the women (unlike the acknowledgement to Titian on those of the men). So did Sadeler devise them himself, in order to get both sexes in? Or, if he copied them, where were, or are, the originals? There have been all kinds of suggestions. But finds in the archives at Mantua and elsewhere make it now virtually certain that these figures ultimately go back to a set of imperatrici (empresses) painted in the 1580s by a local artist, Theodore Ghisi, to complement Titian’s Caesars—and installed in their own room, the “Camera delle Imperatrici,” somewhere in the palace. How this was laid out, even where exactly it was, and what happened to the paintings is largely a matter of guesswork. All we now know of them comes from Sadeler’s prints.

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In some ways, they were a close match with the emperors. The women were shown as the same distinctive three-quarter-length figures. They were also replicated, in several series of frankly undistinguished oil paintings that have turned up all over Europe, and more appealingly in other media too. Their faces were included among the tiny enamels on an elaborate binding in a copy of Suetonius’s Twelve Caesars; and the image of Sadeler’s Augustus on one teacup in the British royal collection was matched by his Livia in the center of the saucer (modestly concealed, or firmly obliterated, when the cup was in its place). But there were some telling differences too.

The emperors are distinctive individuals. Not the empresses. All but one of these imperial women in their flouncy frocks look more or less identical; it would be very hard to tell, say, Petronia (wife of Vitellius), from Martia Fulvia (wife of Titus), just on appearance. The fact that there was usually more than one wife to choose from and other marital complications (to put it euphemistically) only added to the problems. These complications lie behind the one and only distinctive character in the lineup. For the emperor Otho had had just one wife, early in his life, Poppaea, who later married the emperor Nero. Presumably in order to avoid the difficulties that this might cause in his set, the artist chose to omit Poppaea altogether, to depict a later wife of Nero (a different, but related, Messalina), and in the case of Otho to substitute his mother for a wife. Her standout appearance is simply down to the fact that she is represented as much older than the others.

It is almost as if the project to construct a series of twelve “empresses” ended up exposing the fact that it was impossible to do so on the same terms as the men. It foundered on the routine similarity between them, on simple confusions about who was who, and on the lack of any distinctive ancient “look,” for the later artists to discover, follow or adapt. There was, however, another side to it. Western artists may have found it next to impossible to recreate a systematic authentic lineup of the Twelve Caesars in female form. But beyond the gaps, uncertainties and identikits (and perhaps partly liberated by them), as far back as the Middle Ages, they enjoyed re-imagining the colorful tales found in Roman writers of these women’s power and powerlessness, as individuals; they used and embellished ancient anecdotes, satire and gossip about particular villains and heroines to expose the corruption of empire and the tragedies of its innocent victims. They have produced some brilliant, if chilling, re-creations of the dynamics of Roman autocracy, through a female lens, although with more than the occasional hint of misogyny. Their empresses appear in different guises, from sexual predators to blameless paragons.

Read more: Rome Didn’t Fall When You Think It Did. Here’s Why That Fabricated History Still Matters Today

Painters have repeatedly returned to the figure of Nero’s mother Agrippina, reputed to have been her son’s lover and eventually murdered by him. A particularly nasty series of medieval images shows Nero, wine glass in hand, presiding over the dissection of his mother’s corpse (looking for her womb, it was said, and the source of dynastic power); others show the emperor just gazing, lasciviously, at her body. Another favorite has always been Messalina, Agrippina’s predecessor as the wife of the emperor Claudius: memorably shown by Aubrey Beardsley striding out from the palace for a night out (the story was she challenged the prostitutes of Rome to a contest to discover who could have sex with the most men), and equally memorably killed by a hit-squad sent by Claudius. Popular too, but as a symbol of virtue, was Agrippina’s mother, also called Agrippina (but of a very different character), who forever cherished the memory of her husband Germanicus, supposedly poisoned on the orders of his uncle, the emperor Tiberius; she became a symbol simultaneously of wifely loyalty, and the domestic cruelty of the imperial court.

Some of the tales lying behind these images may now be as unrecognized by most of us as the more arcane byways of the Old Testament (and they may never have been part of people’s ordinary everyday repertoire). But it takes only a little decoding to see how artists were using, and cleverly adapting, them to offer sharp reflections on the role of women in the hierarchy of power. Artists might have been defeated by the line-up of the twelve, but they did use individual empresses to open a window onto the corruption at the very heart of the empire.

Adapted from TWELVE CAESARS: Images of Power from the Ancient World to the Modern by Mary Beard. Copyright © 2021 by Board of Trustees, National Gallery of Art, Washington. Reprinted by permission of Princeton University Press

New top story from Time: John le Carré’s Silverview Is Not the Defining Final Chapter of a Literary Career

When John le Carré died last December, his obituarists struck a common theme: here was a master spy novelist who, despite selling millions of books and having his work adapted for television and film, never received the recognition he deserved as a literary giant.

Over six decades, le Carré drew upon his brief career in British intelligence to chronicle the decline of the U.K. as a global power and critique what he saw as an arrogant and corrupt Western neo-imperialism, typically through the perspective of those in the “secret world” of spying. His archetypal heroes were not James Bonds or Jack Reachers but often disillusioned men driven by moral values they are not certain they still believe in. What compels people to serve their country, or betray it, was a consistent theme in his work.
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But just as Graham Greene—another former spy turned novelist—divided his work into “entertainments” and serious fare, so can one separate le Carré’s output (a formidable 26 novels over 60 years) into weightier and lighter groups. Into the former you might put the Karla trilogy of Tinker Tailor Soldier Spy, The Honourable Schoolboy and Smiley’s People, or the semi-autobiographical A Perfect Spy; into the latter you could place one-off bagatelles like Absolute Friends or The Mission Song.

Read More: John le Carré: A Most Elusive Man

Le Carré’s final published novel, Silverview, out Oct. 12 in the U.S., also fits into the latter group. Barely 200 pages long, the book weaves together the stories of Julian, who has left a high-paid job in the City of London to become a bookseller, Edward, an enigmatic Polish wheeler-dealer he befriends, and Proctor, a British intelligence official hunting down the source of a leak. Left behind when le Carré died, the book was shepherded to publication by his son Nick Cornwell, who says in an afterword that the process was more like retouching a painting than completing a novel.

For the reader, Silverview more resembles a jigsaw puzzle. Le Carré was always a superb plotter, and here he deftly arranges a mosaic of seemingly unrelated events and conversations that cohere into a full picture only as the book comes to an end. The narrative rewards yet demands close attention; unless you happen to note the make of a car driven by a mysterious unnamed woman introduced fairly early on, for example, events toward the book’s end might prompt some head-scratching.

Yet frustratingly, Silverview also feels unfinished—not in its narrative, but in the bits in between major plot points. Le Carré’s keen observational style and grasp of psychological depth seems muted here. Characters and locations feel only sketched out; the central character of Julian, the bookseller, is especially thinly drawn. The motive for the act of betrayal at the book’s center is never explained by the character responsible for it and only guessed at by others. Once you’ve completed the puzzle, it somehow feels as if some pieces are still missing.

The real mystery of Silverview is why le Carré never published it during his lifetime. In his afterword, Cornwell says his father began writing the book around 2013 yet the manuscript was “never signed off.” His theory is that Silverview’s portrayal of the secret service as fragmented and directionless hit too close to home for his father’s comfort, especially as a former employee himself. But le Carré’s portrayal of the secret services has never been flattering—from the clubby, greying “Circus” of his Cold War-era novels to more recent portrayals of a divided, corrupt establishment more concerned about impressing the “cousins” in America than upholding national values.

Did he suspect, then, that the novel was bad? Again, it seems unlikely—Silverview is a perfectly serviceable thriller, even if it is comparatively unambitious. Perhaps le Carré recognized that he was reaching into an overly familiar bag of tricks. Proctor, the aging spymaster looking long into the past to investigate a turncoat, has a similar task to that of George Smiley in prior novels (like Smiley, he even has an offstage wife whose fidelity he questions). And Julian is the latest in le Carré’s long line of civilian naïfs drawn into the shadowy world of intelligence, from The Little Drummer Girl to The Russia House to Our Kind of Traitor.

Silverview, then, is more a drinkable blended whiskey than the vintage single malt le Carré completists might have been hoping for. But readers needn’t look far for a better capstone to his body of work when they can pick up A Legacy of Spies, the 2017 book that concludes the Smiley saga with understated elegance, and draws a throughline from the curdled patriotism of Britain in the Cold War era to the crude nationalism of today. Not only is it a compelling read, but it is also the strongest argument for le Carré as the literary lion that he undeniably was.

New top story from Time: The Seven Secrets of Indra Nooyi’s Success

Indra Nooyi struggles to be heard over the sounds of outdoor dining, midtown traffic, and a fountain gushing down the wall. That’s clearly rare for the former PepsiCo CEO—so she beckons the restaurant’s owner and asks if he can shut off the water.

He obliges, and Nooyi proceeds to regale us, a table of female journalists at the helm of various New York media, with anecdotes from her just-released book, My Life in Full: Work, Family, and Our Future.

The whole lunchtime interaction—assess problem, determine what’s in your control, improve outcome, go forth with grace—is signature Nooyi. Her book delves even further into this exacting style punctured by compassion, loyalty, and deep relationships that get results.
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I confess to having studied Nooyi for a long time now. I’ve watched her interviews, live and on YouTube, during my own career trajectory. A manager training I once attended spent hours dissecting Nooyi’s ability to peer around corners and lead a company through change. Then there’s the South Asian connection: a member of our own community ascended to a Fortune 50 company who proudly credits her childhood in Chennai and the role of extended family in making it all possible. For years, my people proudly (and wrongly) asserted that the 65-year-old executive wears a sari in the boardroom.

Thankfully, her book debunks the myth: After feeling like a misfit in oversized polyester outfits, she chose the traditional Indian dress for an internship interview, landed the job, and donned the sari for the rest of the summer. Eventually, she transitioned to Western attire, and her sartorial choices gained style and confidence as her career progressed.

Read more: A Woman of Color Cannot Save Your Workplace Culture

Back stories like that are the hallmark of this part memoir, part clarion. We’ve heard a lot from Nooyi over the last two decades, talks distilled into tweetable headlines and soundbites on work-family balance. As a woman of color, a mother of two girls, an immigrant success story, she describes feeling almost a moral obligation to show up at speeches, panels, awards ceremonies, seminars, and guest lectures during her 12-year tenure as CEO. Life in Full stitches it all together and offers the context sometimes only possible in hindsight.

The fast-paced narrative is as much a blueprint to getting ahead at work as an appreciation of the friends and family along for the journey. I found seven themes in particular surfaced repeatedly, together buoying Nooyi’s remarkable life:

It’s okay to love work.

Perhaps in all the reams written on the juggle, especially for women, the part that often feels shafted is the work itself. Nooyi’s love of the job—from walks on factory floors to battles with activist investors—is so apparent and infectious. Anyone who has fist-pumped after an excellent quarter or convinced a supervisor to implement their strategy will love the gusto with which Nooyi both throws herself into the work and celebrates wins.

She also uses wonky but relatable examples to explain how to predict and embrace change in the bigger picture. Nooyi recounts walking into supermarkets and Walmarts to assess Frito-Lay packaging and placement on shelves and watching parents and kids at birthday parties shunning soda as precursors to PepsiCo’s focus on healthier products. She also remembers working long hours and skipping vacation to dive into the guts of a billion-dollar-plus proposal to overhaul enterprise software, and why it is so important for leaders to understand all aspects of what they are approving.

Sharing the love of the work with the ones you love feels necessary and important, especially for children to understand why their mom is away: She loves you, but she also loves her work.

It’s okay to talk about your family at work.

Similarly, Nooyi seemingly effortlessly centers family in the workplace. There are subtle but important examples; for years, she kept a dry-erase board in her office just for the kids. Everyone from her bosses to her assistants helped in times of crisis, such as by offering to do school pickup.

There are also the ways Nooyi recognized the families of her staffers. She recounts writing letters to the parents of colleagues to thank them for their role in their child’s stellar performance. These “report cards,” she says, were beloved and drew loyalty from staff and their families. She also thanked the spouses of her direct reports, and notes, “these letters released a lot of emotion.”

Hire experts.

Over and over, Nooyi finds herself in jobs or situations where she lacks expertise in an industry or product. It’s how she responds, also over and over, that is so brilliant. She doesn’t BS her way through presentations; she turns to experts.

Nooyi matter-of-factly mentions that after she went to Motorola, two community college professors came twice a week to her office, one to explain how automobiles work and the other to discuss “solid-state physics and electronics.”

You see how this instinct serves her well over time as she moves to PepsiCo. There, she turns to experts in design, science, and technology. Eventually, she hires a chief scientific officer, saying the role can help reduce salt in chips and add whole grains to Cheerio’s. But more importantly, she says, “science could be at the heart of reimagining the global food system.”

Men have a role to play.

At critical junctures in Nooyi’s career, men have preemptively jumped in and offered their support. When her father was dying, one boss offered six months paid leave. Importantly, the men initiated such support, she says, because “as a young consultant, I had zero leverage in asking for any kind of benefit that would help me through a difficult time.”

When she was pregnant and working as a consultant, she recounts: “For my last meeting with Trane, Bill Roth, the CEO, chartered two planes to bring his entire executive team to our offices in Chicago. The meeting would typically have happened in his own boardroom, but I was nine months pregnant and couldn’t travel. Bill wanted me to be part of BCG’s final presentation to his company.”

You can sense their immense respect for her at the root of the life-changing gestures. But imagine if such accommodation were the norm and not the exception. Would more women stay in the workforce?

Similarly, Nooyi praises her father-in-law and husband for their lack of adherence to Indian tradition around gender roles. After marriage, her father-in-law said to her: “Indra, don’t give up your job. You have all this education, and you should use it. We will support you in any way we can.”

Leave the crown in the garage.

Nooyi repeatedly says being a mother is one of her most cherished roles. But one night, after being named president of PepsiCo, she comes home and her mother orders her to go get milk. Nooyi is annoyed, feeling like she can’t even revel in this newfound title and success. Her mother responds: “You may be the president or whatever of PepsiCo, but when you come home, you are a wife and a mother and a daughter. Nobody can take your place. So you leave that crown in the garage.”

Such humility might not be expected of men, but Nooyi accepts this as a small price to keep peace on the home front. Another subtle point in the anecdote: Nobody will be as honest or hard on you as your mother.

Care needs to be prioritized by everybody right now.

While the brunt of the book dwells on Nooyi’s journey, she issues a call for action—rooted in deep study of states, companies, and countries with more family-friendly policies— for both prioritizing and training care workers like never before. Both in the book and in her lunch with journalists, Nooyi cites concern about two related crises. Women leaving the workforce and choosing not to have children, she says, will be disastrous for the economy, citing Japan as an example of our potential fate. She writes: “We must expand the future-of-work conversations that dwell on robotics and artificial intelligence to include another critical dimension of our success: how to shift our economies to better integrate work and family and ensure that women get equal pay and share power.”

Purpose is everything.

I have written reams during the pandemic on how purpose is the single most important motivator for the modern workforce. Nooyi was early to this trend. Her transformation of PepsiCo rested on a concept called “Performance with Purpose.” She writes: “PwP would transform the way PepsiCo made money and tie our business success to these objectives: Nourish. Replenish. Cherish.” Purpose translates, thus, not just to business objectives but life itself.

Over the last year, retirement from PepsiCo a distant memory, Nooyi was working endless hours on a Covid task force. Her mother—the same woman who’d once said to leave the crown in the garage—seemed to have a change of heart. The need for home and work to accommodate each other might be more needed than ever. “You are someone who wants to help the world and not many people are like you,” her mother said. “I don’t think you should worry about the house so much. You have to give back as much as you can.”

New top story from Time: Biden Is Expelling Migrants On COVID-19 Grounds, But Health Experts Say That’s All Wrong

Despite sharp criticism from top officials and allies within the Democratic Party, President Biden is continuing to expel hundreds of thousands of migrants arriving at the United States-Mexico border, using a specialized public health order that allows officials to circumvent the normal trappings of immigration procedure, including asylum interviews.

The Biden Administration defends the use of the order, called Title 42, arguing that summary expulsions are “necessary,” due to “the ongoing risks of transmission and spread of COVID-19.”

But a growing cacophony of top public health experts are calling foul.

There’s no evidence that a policy allowing for mass expulsions prevents the spread of COVID-19, they argue. And it may, in fact, have the opposite effect: by rounding up and detaining hundreds of thousands of migrants in large groups, Customs and Border Patrol (CBP), which does not offer COVID-19 testing for migrants, may actually be stoking the transmission of the disease. Migrants often spend days and weeks in crowded facilities before they’re transported and expelled.
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“The Title 42 order fuels the pandemic,” says Julia Koehler, Assistant Professor of Pediatrics at Harvard Medical School and a pediatric infectious disease specialist. “It does not promote public health. It is opposing public health.”

Raul Gutierrez, a pediatrician in the San Francisco Bay Area and co-chair of the American Academy of Pediatrics’ (AAP) Council on Immigrant Child and Family Health, describes Title 42 as “lacking any public health justification.” It “actually might be threatening public health and safety for asylum seekers,” he adds. “I don’t think that there’s a defensible public health reason to keep Title 42 in place.” AAP has also called for the CDC to end the use of Title 42.

The Trump Administration first invoked Title 42 in March 2020, as COVID-19 infections began skyrocketing in the U.S. But the Biden Administration has seized upon the order with renewed enthusiasm, using it to expel nearly twice as many people as the Trump Administration did.

According to TIME’s analysis of a CPB database, from March 2020 to December 2020, the Trump Administration used Title 42 to expel roughly 395,000 migrants; from February 2021 to August 2021, the last month for which data is available, the Biden Administration has used Title 42 to expel nearly 700,000.

An unprecedented use of Title 42

ACLU, Texas Civil Rights Project, RAICES, the Center for Gender & Refugee Studies and Oxfam America have brought a class action lawsuit before the U.S. District Court for the District of Columbia, arguing that the Biden Administration’s use of Title 42 is in violation of federal immigration law because it bars asylum seekers from the right to seek protections in the U.S.

The Biden Administration argues that Title 42 is a public health measure, governed by the U.S. Centers for Disease Control and Prevention (CDC), rather than an immigration measure.

“Title 42 is a public health authority, not an immigration authority, and its continued use is thus dictated by the CDC,” the agency said in an Oct. 4 public statement. “[The Department of Homeland Security] will continue to defer to public health experts on decisions related to Title 42 while continuing to develop safe, legal, and orderly pathways for migration.”

Both Koehler and Monette Zard, the director of the Program on Forced Migration and Health at Columbia University’s School of Public Health, say that because the Biden Administration altered Title 42 to exempt unaccompanied migrant children and some family units, it is now an immigration policy masquerading as a public health policy.

Read More: The Biden Administration Promised ‘Immediate’ Aid to Haitian Deportees. It Has Yet to Arrive

“There are hundreds of thousands of other travelers crossing every single day that are not subject to any kind of public health measure,” Zard says. “The danger with Title 42 is it creates and feeds the rhetoric which suggests that migrants are the vectors here, and there is really no evidence to suggest that and it’s unlikely that that’s the case.”

Title 42 was passed in 1944 as part of the Public Health Service Act. Under the order, the CDC can temporarily suspend the “introduction of persons into the United States when the [CDC] Director determines that the existence of a communicable disease in a foreign country or place creates a serious danger of the introduction of such disease into the United States.”

The order has never been used in this way before, nor was it intended as an immigration tool, says Stanford Law professor Lucas Guttentag. In April 2020, he wrote that “never before—in over seventy-five years,” had this measure been a “substitute or mechanism for regulating admission under the immigration laws or for authorizing a noncitizen’s deportation or return to their home country.”

On Oct. 6, Koehler and several colleagues sent a letter to CDC Director Rochelle Walensky asking her to end the use of Title 42. “This order has no basis in science,” they wrote. “The order does not protect Border Patrol agents, migrants or the American public from COVID-19…Instead, your order reinforces a dehumanizing trope of migrants as vectors of disease.” More than 300 medical professionals across the country signed the letter.

The Program on Forced Migration and Health has also written several similar letters since Title 42 was invoked. In a Sept. 1 letter to the CDC, DHS and the Department of Health and Human Services (HHS), the agency that oversees the care of unaccompanied, more than 40 professors and medical experts said Title 42 “continues to unethically and illegally exploit the COVID-19 pandemic to expel, block, and return to danger, asylum seekers and individuals seeking protection at the border.”

Zard says the CDC has not responded to any letters from the Program on Forced Migration and Health, including one from Dec. 2020 that offered suggestions for how the government could continue asylum access while mitigating against COVID-19.

“We were prepared for the Biden administration to need a couple of months, maybe three months,” Zard tells TIME, adding that she and the members of the program believed the Biden Administration was working in good faith. “But that belief in that good faith has waned very, very considerably…I think there’s no question now that these measures could have been put in place, there’s just not the political will to do so, and it’s shameful.”

Crowded detention facilities, crowded camps

There has been no scientific research conducted on the question of whether Title 42 has affected the spread of COVID-19, according to both Zard and Katherine McCann, a senior program officer at the Program on Forced Migration and Health. A CDC spokesperson did not answer TIME’s questions on whether the agency was studying the impact internally.

A DHS spokesperson says the agency refers anyone in their custody who is exhibiting symptoms to local health systems for appropriate testing, diagnosis and treatment. CBP does not offer COVID-19 testing before expelling migrants unless they show signs of illness.

Zard says she tells colleagues often that those who work in public health need to set the record straight, “that this is not being done in our name…[Title 42] is really not being done to serve a public health objective.”

New top story from Time: Afghanistan Faces a ‘Make-or-Break Moment,’ U.N. Chief Says

UNITED NATIONS — Warning that Afghanistan is facing “a make-or-break moment,” the United Nations chief on Monday urged the world to prevent the country’s economy from collapsing.

Secretary-General Antonio Guterres also appealed to the Taliban to stop breaking its promises to allow women to work and girls to have access to all levels of education.

Eighty percent of Afghanistan’s economy is informal, with women playing an overwhelming role, and “without them there is no way the Afghan economy and society will recover,” he said.

He said the U.N. is urgently appealing to countries to inject cash into the Afghan economy, which before the Taliban takeover in August was dependent on international aid that accounted for 75% of state spending. The country is grappling with a liquidity crisis as assets remain frozen in the U.S. and other countries, and disbursements from international organizations have been put on hold.
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“Right now, with assets frozen and development aid paused, the economy is breaking down,” Guterres told reporters at U.N. headquarters in New York. “Banks are closing and essential services, such as health care, have been suspended in many places.”

The U.N. chief said that injecting liquidity to prevent Afghanistan’s economic collapse is a separate issue from recognition of the Taliban, lifting sanctions, unfreezing frozen assets or restoring international aid.

Guterres said cash can be injected into the Afghan economy “without violating international laws or compromising principles.” He said this can be done through U.N. agencies and a trust fund operated by the U.N. Development Program as well as non-governmental organizations operating in the country. He added that the World Bank can also create a trust fund.

Leaders of the world’s 20 largest economies — the G-20 — are holding an extraordinary meeting to discuss the complex issues related to Afghanistan on Tuesday. On the issue of “the injection of liquidity in the Afghan economy,” Guterres said, “I think the international community is moving too slow.”

The Taliban overran most of Afghanistan as U.S. and NATO forces were in the final stages of their chaotic withdrawal from the country after 20 years. They entered the capital, Kabul, on Aug. 15 without any resistance from the Afghan army or the country’s president, Ashraf Ghani, who fled.

Guterres pointed to promises by the Taliban since the takeover to protect the rights of women, children, minority communities and former government employees — especially the possibility of women working and girls being able to get the same education as boys.

“I am particularly alarmed to see promises made to Afghan women and girls by the Taliban being broken,” he said, stressing that “their ability to learn, work, own assets, and to live with rights and dignity will define progress.”

However, Guterres said “the Afghan people cannot suffer a collective punishment because the Taliban misbehave.”

He said the humanitarian crisis in Afghanistan is growing, affecting at least 18 million people, or half the country’s population.

Guterres said the U.N. has been engaging the Taliban every day on the safety and security of its staff, unhindered humanitarian access to all Afghans in need, and human rights — especially for women and girls. “Gender equality has always been an absolute priority for me,” he said.

As an example, the secretary-general said, the U.N. has been engaging the Taliban province by province, to ensure that the U.N.’s female humanitarian staff have unimpeded access, and “we will not give up.”

In September, Guterres said, the U.N. reached agreement with the Taliban on freedom of access for women staffers in six provinces, up from three at the beginning of the month. It reached “partial agreement” in 20 provinces, up from 16 on Sept. 1, and no agreement in four, down from six at the beginning of the month, he said. It hasn’t been able to engage in four provinces.

While humanitarian assistance saves lives, it won’t solve the country’s crisis unless an economic collapse is avoided, Guterres said.

“Clearly, the main responsibility for finding a way back from the abyss lies with those that are now in charge in Afghanistan,” he said.

Nonetheless, he warned, “If we do not act to help Afghans weather this storm, and do it soon, not only they but all the world will pay a heavy price.”

New top story from Time: Latest Tests Bring Israel a Step Closer to Commercial Drones

TEL AVIV, Israel — Dozens of drones floated through the skies of Tel Aviv on Monday, ferrying cartons of ice cream and sushi across the city in an experiment that officials hope provided a glimpse of the not-too-distant future.

Israel’s National Drone Initiative, a government program, carried out the drill to prepare for a world in which large quantities of commercial deliveries will be made by drones to take pressure off highly congested urban roads. The two-year program aims to apply the capabilities of Israeli drone companies to establish a nationwide network where customers can order goods and have them delivered to pick up spots.
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The project, now in the third of eight stages, is still in its infancy and faces many questions about security and logistics.

“We had 700 test flights at the start of this year and now we are close to 9,000 flights,” said Daniella Partem, from Israel Innovation Authority, a partner in the drone initiative.

Israel is a global leader in drone technology, with much of its expertise rooted in the highly technologized military. Many of the 16 companies participating in the drone initiative have links to the military.

According to Partem, the initiative was inspired by the halting effect that COVID-19 had on the transportation of medical supplies in early 2020.

An early stage tested the transport of medicines and blood plasma by drones. The initiative has since carried out wider tests in three different urban districts in Israel and hopes to promote legislation that would allow drones to be widely used through an app that customers and clients can use.

Israel’s population of 9.3 million people is largely packed in in urban centers, with major cities like Tel Aviv and Jerusalem suffering from high levels of road congestion. Access to Israel airspace is highly regulated by security officials, and flying a drone requires a permit from the Israeli Civil Aviation Authority.

The initiative faces many obstacles. Officials will have to ensure that drones can handle flights through turbulent weather conditions and that the skies can be quickly cleared in case of war or emergency. There are also issues of privacy.

“Once you have a drone that actually takes photos or videos you create a totally new dimension of privacy invasion,” said Tehilla Shwartz Altshuler, digital technology expert and fellow at the Israel Democracy Institute, a think tank in Jerusalem.

The drone initiative has already tried to address such concerns by using cameras that can help the machine land, but don’t have the resolution to take detailed photos.

The drone initiative has worked in cooperation with the aviation authority since its first flight tests in January. Five more tests are planned over the next 14 months.

“One day, we will have drone-powered taxis in the sky,” said Yoely Or, co-founder of Cando Drones, one of the companies that participated in Monday’s experiment.