MRI scan of the breast reveals two discrete areas of abnormality, which proved to be cancer



The New York Times, by Denise Grady  —  A new study has found that many women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published. But more widespread change may take time, experts say, because the belief in removing nodes is so deeply ingrained.

“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, which was published Wednesday in The Journal of the American Medical Association. The National Cancer Institute paid for the study.

Doctors and patients alike find it easy to accept more cancer treatment on the basis of a study, Dr. Morrow said, but get scared when the data favor less treatment.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of the whole breast, began declining in the 1980s after studies found that for many patients, survival rates after lumpectomy and radiation were just as good as those after mastectomy.

The trend reflects an evolving understanding of breast cancer. In decades past, there was a belief that surgery could “get it all” — eradicate the cancer before it could spread to organs and bones. But research has found that breast cancer can begin to spread early, even when tumors are small, leaving microscopic traces of the disease after surgery.

The modern approach is to cut out obvious tumors — because lumps big enough to detect may be too dense for drugs and radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places.

But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study.

The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.

The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years.

After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.

The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.

Dr. Armando E. Giuliano, the lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., said: “It shouldn’t come as a big surprise, but it will. It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Eventually, he said, genetic testing of breast tumors might be enough to determine the need for treatment, and eliminate the need for many node biopsies.

Two other breast surgeons not involved with the study said they would take it seriously.

Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said: “It’s a big deal in the world of breast cancer. It’s definitely practice-changing.”

Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said surgeons had long been awaiting the results.

“In the past, surgeons thought our role was to get out all the cancer,” Dr. Estabrook said. “Now he’s saying we don’t really have to do that.”

But both Dr. Estabrook and Dr. Port said they would still have to make judgment calls during surgery and remove lymph nodes that looked or felt suspicious.

The new research grew out of efforts in the 1990s to minimize lymph node surgery in the armpit, called axillary dissection. Surgeons developed a technique called sentinel node biopsy, in which they injected a dye into the breast and then removed just one or a few nodes that the dye reached first, on the theory that if the tumor was spreading, cancer cells would show up in those nodes. If there was no cancer, no more nodes were taken. But if there were cancer cells, the surgeon would cut out more nodes.

Although the technique spared many women, many others with positive nodes still had extensive cutting in the armpit, and suffered from side effects.

“Women really dread the axillary dissection,” Dr. Giuliano said. “They fear lymphedema. There’s numbness, shoulder pain, and some have limitation of motion. There are a fair number of serious complications. Women know it.”

After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

“Some prominent institutions wouldn’t even take part in it,” Dr. Giuliano said, though he declined to name them. “They’re very supportive now. We don’t want to hurt their feelings. They’ve seen the light.”

Soy Isoflavones & Thyroid



Soy foods, those derived from the soybean, contain compounds known as isoflavones. In the plant the soy isoflavones are bound to a sugar molecule creating a compound known as glycosides. Once ingested, the process of digestion releases the sugar portion creating an isoflavone aglycone that can trigger responses within the body. In addition to inducing mild hormone-like activity, isoflavones can affect thyroid function.


Thyroid Gland

Stimulated by thyroid stimulating hormone, TSH, produced by the pituitary gland, the thyroid gland absorbs iodine and combines it with the amino acid tyrosine to produce the two thyroid hormones — thyroxine also referred to as T4 and triiodothyronine, known as T3. The thyroid hormones then travel throughout the body to regulate each cell’s metabolism, the process by which oxygen converts into energy. Because thyroid hormones affect all cells, and therefore all bodily systems, problems with the thyroid can cause a variety of symptoms.

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Thyroid Problems

Thyroid problems are common, especially problems that cause hypothyroidism — too little thyroid hormone, or hyperthyroidism — too much thyroid hormone. Hyperthyroidism causes the body’s metabolism to increase resulting in weight loss, irregular heartbeat, sweating, nervousness and irritability. Hypothyroidism causes the metabolism of the body to slow down leading to obesity, joint pain, infertility and heart disease.


Effects of Soy

Soy isoflavones can inhibit the activity of the enzyme known as thyroid peroxidase, or TPO. Cells in the thyroid gland need TPO to extract the iodine from foods and produce thyroid hormones. Eating large amounts of soy products can therefore inhibit the production of thyroid hormones leading to hypothyroidism. In addition, the presence of isoflavones can cause the thyroid to become inflamed, a condition known as goiter, to allow for additional blood to flow through in an attempt to extract more iodine. However, the Linus Pauling Institute indicates that eating soy products fails to produce a negative effect on the thyroid gland as long as iodine intake remains sufficient.


Iodine Intake

In order to prevent soy foods from negatively affecting your thyroid be sure to consume enough iodine in your diet. The main source of dietary iodine is iodized table salt. Since the addition of iodine to table salt the incidence of iodine deficiency became rare in the United States and other developed countries, according to the University of Maryland Medical Center. The National Institutes of Health Food and Nutrition Board recommend that adults consume 95 mcg of iodine per day.


Soy and Thyroid Medications

If you suffer from hypothyroidism your doctor will likely prescribe synthetic thyroid hormones to boost the missing hormone levels and reduce symptoms. The soy isoflavones in soy food products may interfere with the absorption of the medication. To prevent this interaction, suggests taking the thyroid hormone on an empty stomach and waiting at least four hours before consuming soy products.


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About this Author

Stephanie Chandler is a freelance writer whose master’s degree in biomedical science and over 15 years’ experience in the scientific and pharmaceutical professions provide her with the knowledge to contribute to health topics. Chandler has been writing for corporations and small businesses since 1991. In addition to writing scientific papers and procedures, her articles are published on, and other websites.

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Soy Isoflavones & Hot Flashes

Soy Isoflavones & Hot Flashes



Hot flashes are one the most common symptoms of menopause, with three out of four menopausal women experiencing them. Traditionally, hot flashes have been treated with synthetic estrogen in the form of hormone replacement therapy, or HRT. More women are looking for natural alternatives to HRT because of the downsides of synthetic hormones. Research published in the October 2010 issue of the Journal of the American Medical Association found an increase in breast cancer in postmenopausal women who take the synthetic estrogen and progesterone contained in HRT. Soy isoflavones, found in the soy foods we eat, are believed to provide the same benefits as the estrogen that is naturally produced in the body.

Hot Flashes

The cause of hot flashes is still unknown, according to the North American Menopause Society. The sharp decrease in estrogen concurrent with menopause is believed to initiate a chain of reactions that begins in your hypothalamus, the part of the brain that controls body temperature. The hypothalamus reacts as if your body is too warm and triggers dilation of blood vessels near the surface of the skin. This dilation shows up as a flushed feeling or a hot flash.



Soy Isoflavones

Soy Isoflavones are chemical compounds called flavonoids that are found in soybeans. They are also called phytoestrogens, meaning plant-derived compounds with estrogen effects. When ingested, they function as weak-estrogens by binding to estrogen receptors. Your body has cells with estrogen receptors located in the reproductive organs, brain, liver and fat cells.

The three most common types of isoflavones in soybeans are called genistein, daidzein and glycitein. The chemical structure of these compounds is similar to estrogen, but they are not estrogen molecules. However, they are close enough that they will bind with estrogen-sensitive cells. This will give you the benefits of estrogen at a much lower potency and without the drawbacks of the synthetic hormones found in HRT.



Isoflavones are found in varying amounts in soybeans and soybean products. According to the U.S. Department of Agriculture-Iowa State University Database, soy flour is rich in isoflavones, with 177.89 mg per 100 g. Soy protein isolate is extracted from soybeans and contains 97.43 mg isoflavones per 100 g. Raw soybeans vary in the amount of isoflavones based on the type of soybean. Taiwan soybeans have 59.75 mg isoflavones per 100 g; Korean soybeans have 144.99 mg per 100 g and Japanese soybeans have 118 mg per 100 g.

Other soy products containing isoflavones are tofu, tempeh, miso, soy cheeses and soy yogurt.



Some women experience an improvement in the number and intensity of hot flashes after adding soy isoflavones to their diets. According to the February 2006 issue of the American Family Physician, soy isoflavones reduced hot flashes by 9 percent to 40 percent in some trials. However, not all women receive the same results. In Japan, a study of 1,106 women ages 35 to 54 with menopausal hot flashes found that soy isoflavones in the diet had a protective effect against hot flashes. The study was published in the American Journal of Epidemiology.



Always seek advice from a medical doctor before proceeding with soy isoflavone supplements and foods. Although menopause is a natural transition in life, talk with your health care professional about your specific conditions. Some women may have allergies to soy and should be evaluated by a medical professional.

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About this Author

Deila Taylor received a bachelor’s degree in biochemistry from Occidental College with graduate work at USC in pharmacology and nutrition as well as coursework at The East West School of Herbology. She is a small business owner in the alternative energy field.

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Peter B. Bach MD; Photo Credit: Marilynn K. Yee/The New York Times


Patient Journal

The Doctor’s Wife

  • Dr. Peter B. Bach writes about his wife’s breast cancer diagnosis and treatment.

The New York Times, by Peter B. Bach MD  —  A research study assistant slid the informed consent document for the clinical trial across the desk to us.

My wife, Ruth, sitting next to me, signed it. She was in treatment at Memorial Sloan-Kettering Cancer Center, where I am also a doctor and cancer researcher.

Ruth had flipped through page after page of the informed consent forms. They were peppered with frightening words like “death” and “cancer recurrence,” and caveats discussing horrifying reactions to the experimental treatment. I winced each time I saw a scary term go by.

The clinical trial she was joining would test a new treatment for her breast cancer. Some women in the study would get it, while others would get the old standard. But during the trial, none of us, not even the doctors conducting the research, would know who was getting which drug.

It was, essentially, a coin toss.

The trial, which wasn’t designed to help her or to harm her, haunted both of us. The truth was that the new treatment could turn out to be worse than the standard approach, and we would not know in time to stop it.

This hard reality of cancer research is often tucked away out of view, but we both sensed it every time her nurse hung the mystery bag in the chemo suite. It might be the study treatment, or maybe it’s just saltwater. And then it would start dripping in.

Ruth woke me one night with a rhetorical barrage about the reasons for randomization in clinical trial research.

“Why do they need to randomize patients so some people get the new treatment but others only get the standard?” she said. “Don’t you guys know after all these years what happens so you could just do a study where everyone gets the new treatment and see if they do better? Aren’t you wasting time not just using it?”

Even half asleep I could explain that randomized trials are the best way of determining if one treatment is better than another. But as I began talking, I realized she had drifted back to sleep, just as my medical students do in class. Her chest rose and fell with her breathing. The scar from her cancer surgery was fully healed. The skin on her face was relaxed.

The truth is that even though we always expect the new treatment to be better, sometimes it is not. If there are benefits, they are usually so small that they are perceptible only when added up over hundreds or sometimes even thousands of patients carefully compared with similar patients getting the standard treatment.

This depressing fact meant that even if Ruth was getting the new treatment, and it proved to be effective, it would probably be only a hair better. Not enough to really matter much.

And in clinical trials, the new treatment sometimes proves worse. Every time this happens people are surprised and some doubt the results, even though it happens regularly. For instance, thousands of women with breast cancer were subjected to complications, and some killed, because doctors were sure that high-dose chemotherapy followed by bone marrow transplant would be more effective than conventional chemotherapy approaches. Randomized trials showed the opposite.

Most doctors know by rote some of the other examples of treatments that failed: an operation that removed diseased parts of the lung and left the healthy part behind, a drug that made the heart rhythm look better after a heart attack, a monitor placed inside the lung vessels that helped monitor patients who were critically ill. Each time we were sure we were doing the right thing for patients, until randomized trials showed we were killing people.

Scientists call our progress in cancer treatment a gradual accretion of knowledge, but put in regular English it is a slow, grueling slog guided by a poorly functioning compass. Most randomized trials like the one Ruth joined don’t even ask particularly novel questions, and their findings are not breakthroughs worthy of newspaper headlines.

The studies tweak what we do as doctors, sometimes finding a little more benefit achieved with a little less harm. More often than not, they just find out that the new approach did not work out.

Of course this reality — this arduous slog — doesn’t match how cancer research is presented to the public, which sees flashy headlines using words like “breakthrough” and “new hope.”

As I watched Ruth sleep, I thought about the hundreds of thousands of women who had volunteered over decades for clinical trials, those who did well and those who didn’t. Their privacy protected by laws, the depth of their experiences reduced by statisticians to just a few numbers and figures in the pages of a medical journal.

Each study was a small contribution, paving the way a few feet forward or shutting down a detour that went in the wrong direction. Over time, what they contributed has helped us get a little better each year at treating breast cancer.

Signing up for a clinical trial is a remarkable act of bravery. The day before Ruth’s diagnosis she did not think of herself as a patient. She had no doctor in her life except me. And yet, when Ruth’s oncologist asked for her to sign up to be randomized, to let Lady Luck have yet another go at her, she did so.

Ruth knew he was asking her to do something for others even when she was overwhelmed by what was happening to her, to us. But it was the obvious choice, and she made it without hesitation, just as hundreds of thousands of women have before her.

Now, as she slept through another fitful night, she was helping to answer a question that would not matter to her, but would someday matter to a woman she would never meet.

Dr. Peter B. Bach is an attending physician at Memorial Sloan-Kettering Cancer Center in New York City. His essays, about his wife’s breast cancer, appear Tuesdays on the Well blog.

By Harvard Constitutional Scholar, Laurence H. Tribe

Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce. This includes authority over not just goods moving across state lines, but also the economic choices of individuals within states that have significant effects on interstate markets. By that standard, this law’s constitutionality is open and shut. Does anyone doubt that the multitrillion-dollar health insurance industry is an interstate market that Congress has the power to regulate?

Many new provisions in the law, like the ban on discrimination based on pre-existing conditions, are also undeniably permissible. But they would be undermined if healthy or risk-prone individuals could opt out of insurance, which could lead to unacceptably high premiums for those remaining in the pool. For the system to work, all individuals — healthy and sick, risk-prone and risk-averse — must participate to the extent of their economic ability.

In this regard, the health care law is little different from Social Security. The court unanimously recognized in 1982 that it would be “difficult, if not impossible” to maintain the financial soundness of a Social Security system from which people could opt out. The same analysis holds here: by restricting certain economic choices of individuals, we ensure the vitality of a regulatory regime clearly within Congress’s power to establish.

The justices aren’t likely to be misled by the reasoning that prompted two of the four federal courts that have ruled on this legislation to invalidate it on the theory that Congress is entitled to regulate only economic “activity,” not “inactivity,” like the decision not to purchase insurance. This distinction is illusory. Individuals who don’t purchase insurance they can afford have made a choice to take a free ride on the health care system. They know that if they need emergency-room care that they can’t pay for, the public will pick up the tab. This conscious choice carries serious economic consequences for the national health care market, which makes it a proper subject for federal regulation.

Even if the interstate commerce clause did not suffice to uphold mandatory insurance, the even broader power of Congress to impose taxes would surely do so. After all, the individual mandate is enforced through taxation, even if supporters have been reluctant to point that out.

Given the clear case for the law’s constitutionality, it’s distressing that many assume its fate will be decided by a partisan, closely divided Supreme Court. Justice Antonin Scalia, whom some count as a certain vote against the law, upheld in 2005 Congress’s power to punish those growing marijuana for their own medical use; a ban on homegrown marijuana, he reasoned, might be deemed “necessary and proper” to effectively enforce broader federal regulation of nationwide drug markets. To imagine Justice Scalia would abandon that fundamental understanding of the Constitution’s necessary and proper clause because he was appointed by a Republican president is to insult both his intellect and his integrity.

Justice Anthony Kennedy, whom many unfairly caricature as the “swing vote,” deserves better as well. Yes, his opinion in the 5-4 decision invalidating the federal ban on possession of guns near schools is frequently cited by opponents of the health care law. But that decision in 1995 drew a bright line between commercial choices, all of which Congress has presumptive power to regulate, and conduct like gun possession that is not in itself “commercial” or “economic,” however likely it might be to set off a cascade of economic effects. The decision about how to pay for health care is a quintessentially commercial choice in itself, not merely a decision that might have economic consequences.

Only a crude prediction that justices will vote based on politics rather than principle would lead anybody to imagine that Chief Justice John Roberts or Justice Samuel Alito would agree with the judges in Florida and Virginia who have ruled against the health care law. Those judges made the confused assertion that what is at stake here is a matter of personal liberty — the right not to purchase what one wishes not to purchase — rather than the reach of national legislative power in a world where no man is an island.

It would be asking a lot to expect conservative jurists to smuggle into the commerce clause an unenumerated federal “right” to opt out of the social contract. If Justice Clarence Thomas can be counted a nearly sure vote against the health care law, the only reason is that he alone has publicly and repeatedly stressed his principled disagreement with the whole line of post-1937 cases that interpret Congress’s commerce power broadly.

There is every reason to believe that a strong, nonpartisan majority of justices will do their constitutional duty, set aside how they might have voted had they been members of Congress and treat this constitutional challenge for what it is — a political objection in legal garb.

Laurence H. Tribe, a professor at Harvard Law School, is the author of “The Invisible Constitution.”


Laurence Henry Tribe (born in Shanghai, October 10, 1941) is a professor of constitutional law at Harvard Law School and the Carl M. Loeb University Professor at Harvard University. He also serves as a consultant for the law firm of Akin Gump Strauss Hauer & Feld.

Tribe is widely recognized as a leading liberal scholar of constitutional law[1] and as a practitioner before the Supreme Court of the United States. He is the author of American Constitutional Law (1978), a treatise in that field, and has argued before the U.S. Supreme Court 35 times.[2]



Tribe attended Abraham Lincoln High School in San Francisco, California. He holds an A.B. in Mathematics, summa cum laude from Harvard College (1962), and a J.D., magna cum laude from Harvard Law School (1966). Tribe was a champion policy debater at Harvard, and later a college coach and high school summer institute teacher.


Tribe served as a law clerk to Matthew Tobriner on the California Supreme Court from 1966-67, and as a law clerk to Potter Stewart of the U.S. Supreme Court from 1967-68. He joined the Harvard Law School faculty as an assistant professor in 1968, receiving tenure in 1972.

In addition to his record as a scholar, Tribe is noted for his extensive support of liberal legal causes. He has argued many high-profile cases, including one for Al Gore during the disputed U.S. presidential election, 2000. The U.S. Supreme Court ruled against Tribe’s client in Bowers v. Hardwick in 1986, holding that a Georgia state law criminalizing sodomy, as applied to consensual acts between persons of the same sex, did not violate fundamental liberties under the principle of substantive due process. However, he was vindicated in 2003, when the Supreme Court overruled Bowers in Lawrence v. Texas. He wrote the ACLU’s amicus curiae brief supporting Lawrence, who was represented by Lambda Legal.

Tribe continues to strongly support liberal political causes. He is one of the co-founders of the liberal American Constitution Society, the law and policy organization formed to counter the conservative Federalist Society.

He actively supported the candidacy of President Barack Obama and described Obama as “the best student I ever had,”[3] a phrase he also used to describe Kathleen Sullivan.[4] Alongside Harvard‘s Cass Sunstein, Tribe served as judicial adviser to Obama’s campaign.[5] In February 2010, he was named “Senior Counselor for Access to Justice” in the Department of Justice; he will lead an effort to increase legal access for the poor.[6][2]

Tribe also represented General Electric in its defense against its liability under Comprehensive Environmental Response, Compensation and Liability Act (“Superfund”), in which GE and Tribe unsuccessfully argued that the act unconstitutionally violated General Electric’s due process rights.[7]

Tribe also received the attention of the legal community for his comments to President Obama regarding the post-Souter Supreme Court nomination. Urging Obama to nominate Kagan to the Souter vacancy, Tribe argues strongly against the alternative of nominating Sonia Sotomayor:

Bluntly put, she’s not nearly as smart as she seems to think she is, and her reputation for being something of a bully could well make her liberal impulses backfire and simply add to the fire power of the Roberts/Alito/Scalia/Thomas wing of the Court on issues like those involved in the voting rights case argued last week and the Title VII case of the New Haven firefighters argued earlier, issues on which Kennedy will probably vote with Roberts despite Souter’s influence but on which I don’t regard Kennedy as a lost cause for the decade or so that he is likely to remain on the Court.[13]


Tribe has two children, Mark and Kerry, who are both nationally recognized visual artists.


A complete list of the 34 cases Tribe has argued in the U.S. Supreme Court as of the end of 2005 is as follows:


Central Park Lake, April 2011  —  The Conservancy has been honored for its restoration of the Lake by the New York chapter of the American Society of Landscape Architects.




The Central Park Conservancy is proud to have been recognized with a prestigious landscape architectural design award for the recent restoration of the Lake – one of the largest and most ambitious projects in the Park’s history.

Presented by the New York chapter of the American Society of Landscape Architects on March 31, the honor award recognizes the Conservancy for “superior professional accomplishment.” It is among the ASLA’s highest honors.

The 20-acre Lake is the largest of the naturalistic water bodies conceived by Frederick Law Olmsted and Calvert Vaux, the Park’s designers. Its restoration marked the last of the water bodies to be restored by the Conservancy in the course of the Park’s turnaround over the last 30 years.

The Conservancy began restoring the Lake and its surrounding landscapes in 2006 and substantially completed the project in 2010. The project aimed to restore the Lake to its former prominence as a signature landscape in the heart of Central Park; recapture inherent qualities that had been degraded or obscured over time; and improve the scenic quality of landscape.

Photos of the award-winning project and other recognized works will be on exhibit at the Horticultural Society of New York through April 22.