A group representing U.S. pediatricians said last week that its members should pay special attention to the health care needs of immigrant children and support health insurance for all—regardless of legal status.

“It doesn’t make sense to have a policy that cares for kids but doesn’t care for other kids. They are kids. They don’t choose where to be born,” said Dr. Gilbert Handal, who co-authored the new policy statement from the American Academy of Pediatrics (AAP).

Approximately 18.4 million—or one in every four—U.S. children are foreign-born or have foreign-born parents, according to the AAP. While about 90 percent are born in the U.S., the pediatricians say all face unique obstacles in getting care.

“You have to look at the big picture and determine what is most beneficial for our future and our country.”

“Some of these barriers include poverty, fear and stigma, high mobility, limited English proficiency, little information or misunderstandings about how the U.S. health care system works, and lack of insurance and/or access to care,” says the statement published in the journal Pediatrics.

Making sure immigrant children grow up physically and developmentally healthy is in the national interest, says the AAP, because they represent such a large part of the economic and social future of the U.S.

“You have to look at the big picture and determine what is most beneficial for our future and our country,” said Handal, from Texas Tech University Health Sciences Center in El Paso.

The group said both pediatricians and the AAP should advocate for health insurance coverage for every child and individual living in the U.S. Those efforts, they say, should focus on expanding access to quality care and breaking down barriers to enrollment, such as waiting periods for insurance.

The group said pediatricians should also pay attention to the unique challenges immigrant children and families face when providing care, says the statement. For example, the AAP says doctors should have access to information on support programs as resources for at-risk children and families.

Doctors should also play a role in making sure children who are having a difficult time in school get the appropriate help, says the group. They should also promote diversity and inclusion of immigrants in the community.

“I think there is a recognition all around that the demographics are changing and we all around the country need to think about how we care for our immigrant community members,” said Dr. Francesca Gany, chief of the Immigrant Health and Cancer Disparities Service at Memorial Sloan-Kettering Cancer Center in New York.

IMMIGRATION PROCEEDINGS
The AAP also said children should not be separated from their families or home environments during immigration proceedings. Children, they also say, should not have to represent themselves.

In addition, the group says health care facilities should be safe places for immigrant families, and the facilities and its medical records should not be used in any immigration enforcement action.

Gany, who was not involved with writing the new policy statement, told Reuters Health government policy plays just as important of a role as pediatricians in improving immigrant health. “It’s both pediatricians owning and embracing (the recommendations) and equipping themselves with the skills, but also intervention from the policy level to make sure that’s doable,” she said.

Yesterday’s presidential address on the set of security policies collectively called the War on Terror contained lots of clear statements—and yet no one seems to agree on what, if anything, they meant.

Among the more detailed responses this morning was this statement from Human Rights Watch. The organization’s investigators have on several occasions won access to the Guantanamo prison, and the group has one of the more consistent track records on researching the legal issues surrounding unmanned vehicles, the so-called “drone war.”

In its summary, the group flags a fine, but potentially key legal point in Obama’s speech:

[Obama] failed to address the meaning of “imminence” when determining whether a terrorism suspect poses an imminent threat to the U.S., or explain how it determines combatant status. He also did not discuss the widely reported practice of “signature strikes”—attacks on people whose identities are unknown but who are deemed to be combatants by virtue of behavior or other “signatures” that do not necessarily meet international law requirements. Such attacks may be unlawful.

The rest of the organization’s analysis—agree or not, it’s one of the more substantive so far—is here.

Music, art, and dance therapy may relieve anxiety and similar symptoms among people with cancer, according to a new analysis of past studies.

Researchers who analyzed results from trials conducted between 1989 and 2011 said the benefits tied to creative arts therapies were small, but similar to those of other complementary techniques such as yoga and acupuncture.

“People with cancer very often feel like their body has been taken over by the cancer. They feel overwhelmed,” said Joke Bradt, a music therapist from Drexel University in Philadelphia. “To be able to engage in a creative process … that stands in a very stark contrast to sort of passively submitting oneself to cancer treatments,” Bradt, who wrote an editorial published with the new review, told Reuters Health.

“People have really broadened their perspectives on what is health and have moved beyond just the physical.”

The analysis included 27 studies of close to 1,600 people who were randomly assigned to receive some form of creative arts therapy or not, during or after cancer treatment. Patients with breast cancer or blood cancers—such as leukemia and lymphoma—made up the majority of study participants. Music, art, and dance therapy programs varied in how often sessions were conducted and over what time span. More than half of the programs did not involve counseling with trained therapists.

On the whole, people with cancer who were assigned to creative arts treatments reported less depression, anxiety, and pain and a better quality of life during the programs than those who were put on a wait list or continued receiving usual care. For example, in one 2010 study, listening to half an hour of familiar music cut reported pain levels at least in half for 42 percent of hospitalized patients, while just eight percent of those in a comparison group saw relief.

Cancer patients in creative arts therapy did not report being any less tired than those assigned to a control group. And most of the other benefits waned once therapy ended, the researchers reported this week in JAMA Internal Medicine.

The new paper was co-written by Christopher Morley of the ArtReach Foundation in Atlanta, whose goal is to use creative arts therapies to assist people affected by wars, violence, and natural disasters.

DISCUSSIONS ON THE TABLE
Lead author Timothy Puetz, from the National Institutes of Health in Bethesda, Maryland, said researchers have believed music and art therapy may help cancer patients “for a long time,” although rigorous studies have been lacking.

“People have really broadened their perspectives on what is health and have moved beyond just the physical,” he told Reuters Health. “More and more clinicians and certified creative arts therapists … they’re actually reaching out to each other now, and discussions are on the table to try to bring this type of therapy to cancer patients.”

The researchers agreed that more studies are needed to determine the most effective ways to integrate creative arts into the care of cancer patients.

Bradt said working directly with an arts therapist may be most helpful for some patients—but isn’t essential. People looking to refocus away from the anxiety of a cancer diagnosis and treatment can join a choir or an art class, for example. “We all know that music or art or just aesthetic beauty in general makes us feel better,” she said. “I do not want to underestimate the power of just the arts by themselves.”

The battle over hydraulic fracking of oil and natural gas has pitted land owners against each other. It has also creating divides between neighboring states such as Pennsylvania, Ohio, and New York. And now, after the Environmental Defense Fund joined a coalition of non-profits and oil companies called the Center for Sustainable Shale Development, fracking is also splitting the environmental community.

The Center for Shale Development advocates that oil and gas companies voluntarily adopt 15 performance standards. These cover wastewater disposal, fracking fluids, air pollution standards for drill engines, limits on gas flaring in the fields, and more. But this week 68 grassroots groups protested the Environmental Defense Fund’s move, arguing the big environmental advocacy organization had allowed itself to be “co-opted by industry interests,” and that it was engaged in “greenwashing.”

In a recent story for this magazine, I wrote about how the debate over fracking is a false dilemma; that until we regulate and tax the practice, all of the environmental and economic burdens will continue to fall on the people who live above the wells.

“To be sure, the potential for damage from fracking is something to take seriously, but after 60 years of using the technique in hundreds of thousands of wells, there are relatively few cases of groundwater contamination. So few that the EPA’s recent determination that Wyoming groundwater was affected by fracking stands out. A study in Pennsylvania affirms that methane appears to migrate into drinking aquifers—likely because of poor cement seals around well pipes. Though the industry has best practices for the seals, following them is voluntary in some states. I am not trying to imply that fracking is safe, but that its danger depends upon local geology, the competence of the drillers themselves, and—above all—effective regulation.

Which is an environmental issue we should be talking about. Effective regulation can reduce risky practices and encourage drillers to compete on safety rather than costs. Consider the oil tanker: thanks to legislation introduced after the Exxon Valdez disaster, we have dramatically reduced both the number and size of tanker spills. Anytime a tanker is loaded with oil, it runs the risk of a spill, but our high-energy lifestyle depends on our willingness to accept—and manage—these risks. And so tankers and barges now need to carry insurance for unlimited damages from an oil spill. Insurers, who have money on the line, have enforced best practices, which have reduced spills considerably. Yet for the moment, the regulation of fracking is progressing state by state, without the unified routine that was taken with transporters. At the federal level, meanwhile, there have been setbacks: the 2005 energy bill, for instance, exempted gas drillers from parts of federal clean water regulations.

…

Well-regulated, fracked natural gas could be a plus for the environment—particularly if it were coupled with a ban on coal. The extraction of coal via mountaintop removal is extraordinarily damaging to the environment. Power plants that burn coal emit more radiation into neighborhoods around them than do nuclear power plants, and fine particle pollution from coal-powered plants costs 13,000 lives a year, while producing an enormous quantity of greenhouse gas emissions. Coal, arguably, really does equal death. Fracking is not pretty, but there is more than one principled environmental conversation to have about it.”

Mark Brownstein, at the Environmental Defense Fund, wrote on the organization’s blog that the 15 voluntary standards proposed (by the Center for Sustainable Shale Development) need to go further. That’s certainly true; the list doesn’t deal with abandoned wells, for starters. Nor are voluntary practices any replacement for regulation and enforcement, but they are at least a step toward consensus and national regulation. (I’d love to see a tax included, too.) In some states, fracking is a Wild West, where anything goes and even following best practices is voluntary; that is simply grotesque and unfair. Through the Center for Sustainable Shale Development, Chevron, Shell, Consol Energy, and EQT Corporation have agreed to some self-policing. The holdings of these companies cover about eight million acres—not a small amount of land. The two smaller companies alone have 27,000 wells between them. No one wants to have one of those wells in their backyard, but wouldn’t you want the company that owns them to follow some rules, rather than none?

In March of this year, Congress voted to eliminate National Science Foundation funds for political science research, except for grants certified by the NSF director as “promoting national security or the economic interests of the United States.” Additional legislation (in draft), the High Quality Research Act, is designed to guard against “questionable projects” at NSF; it would subject NSF grants to an unprecedented level of congressional scrutiny.

Meanwhile, a bill is introduced to eliminate health economics research at the National Institutes of Health; in response, the NIH announces that it will conduct a “productivity review” of its social science program.

Federal statistics are not immune to new forms of congressional oversight. Last year, the House passed an amendment abolishing the American Community Survey—the nation’s source of statistics on dozens of social and economic conditions. The senate ignored the amendment, but it was revived and enlarged in April of this year, in a bill abolishing agricultural statistics and all Census Bureau surveys—the economic census, census of governments, etc. In this legislation the bureau exists only to conduct the decennial headcount that apportions congressional seats (and is used to redraw congressional and state legislative districts).

Although the social sciences and social statistics are the primary target, there are rumblings that federally supported science more generally is in need of greater accountability. In an April oversight hearing, the president’s science adviser, John Holdren, was asked why the two criteria to be applied to political science grants—national security and economic interests—were not “a good and proper filter” to apply to all sciences funded through NSF grants.

If the questions asked seriously misunderstand the basic workings of science, then the new science policy being shaped will derail a government-science partnership that has worked for more than a half-century.

What’s going on?

The nation’s basic science policy, more or less secure for six decades, is being upended, a result of two converging congressional concerns. One is specific to the social sciences—are they real sciences? The second, and much broader, is congressional concern with impact, productivity, pay-off, performance—what justifies science’s claim on public funds? Both concerns were on the table in 1945 when Vannevar Bush’s Science the Endless Frontier successfully argued the need for a National Science Foundation to channel government funds to university-based research. NSF did not initially include social sciences, but their importance quickly became too obvious to justify the omission. Social sciences were soon included under the NSF umbrella, subsequently at NIH, and steadily across various federal agencies, particularly extensive in public health, in intelligence and security, and in economic policymaking (note the “except for” clause in the 2013 legislation, on which more below, that otherwise eliminated political science funding at NSF).

The second concern—responsible use of public funds—was, in 1945, easily resolved. Fresh from its huge successes in World War II, American science received favored treatment by the government. Post-war science policy held that science would promote the national interest most productively if free of government control, though, of course, not free of public obligation. Science, solely concerned with truth seeking, did not need to be closely monitored, regulated, or directed. Its internal policing mechanisms, especially peer review, guarantees scientific integrity and its proven patriotic dedication to national well-being guarantees productivity.

By 1965, the late Don Price would write that this tacit agreement was short lived. The generalized trust in science was gradually replaced by incentives, oversight, and related institutional arrangements by which the government assures itself that publicly funded science meets the criteria of integrity and productivity. Principal-agent theory helps us see what the issues are. The principal—the government—lacks the expertise to produce knowledge it needs. It delegates to an agent—America’s research universities—the task of producing scientific knowledge. If the government trusts the integrity and productivity of its agent, nothing else is called for. The problem of science policy is solved.

If, however, the government worries that not all of the science benefiting from public funds is free of fraud or rent seeking, and worries even more that scientists are more focused on peer approval than in producing what society needs, it will monitor and create incentives to influence behavior in desired directions.

At its core national science policy reconciles, as best it can, the accountability of Congress for how public funds are spent with sufficient scientific autonomy to allow for serendipity, unexpected discovery, and unplanned outcomes. Congress, with some bumps along the way, has managed to reconcile accountability and autonomy since Price’s observation. The nation has benefited, enormously.

Today, strong voices in Congress are challenging basic features of a science policy that has served the nation well. The attack on social science and social statistics is one indication. More generally, however, there is a demand for metrics to assess the productivity or “broader impacts” of government’s investment in science, metrics that Congress could use to more closely manage government science programs. Productivity is a complicated concept. Certainly it involves cost-effective performance, but in government circles, productive knowledge is what meets the exacting criteria of “usefulness” to its public sponsors—that is, eventually, to the American taxpayer. It is the job of Congress to explain that tax dollars are being productively spent.

Asking the NSF, NIH, or the Census Bureau to provide persuasive rationales for their use of public funds is not itself a signal that the nation’s science policy is going off-track. But if the questions asked seriously misunderstand the basic workings of science, which is my claim, then the new science policy being shaped will derail a government-science partnership that has worked for more than a half-century.

How do I get from a congressional vote reducing the political science budget in the NSF to the claim that science policy dating to the 1950s is going off-track? The “except for” clause included by Senator Tom Coburn (R-Oklahoma) in legislation targeted to political science points to an answer. Congress authorized NSF funding of political science projects only if they are certified as promoting America’s national security or its economic interests. Congressman Bill Posey (R-Florida) suggests that these criteria are a proper filter for all of NSF science.

If Coburn’s “except for” clause were extended, as Posey suggests, to all scientific disciplines, the consequence is a science policy at risk of biasing research to near-term benefits; that weakens theory construction across the sciences; and which inserts congressional micromanagement into NSF’s peer review practices. In a recent Science magazine editorial I commented on these three risks. Space constraints there did not allow a more general treatment of science policy—which is what this essay offers, drawing on examples presented in the editorial.

NEAR-TERM BENEFITS
The phrase “basic vs. applied” science is a misleading guide to the way science is actually used. If we want a dichotomy, a much superior one distinguishes between scientific knowledge that is being used and scientific knowledge that will be used when conditions change. In the 1930s, the expertise of political scientists, historians, and economists working in China and Japan was of little use to the U.S. government. But early in World War II, social science knowledge about the Far East was in great demand. The Office of Strategic Services (OSS), America’s first intelligence agency, heavily recruited regional experts just as the CIA—the successor to the OSS—does today. Perhaps Coburn’s “except for” clause was in recognition that today there are hundreds of political scientists working in or consulting for the nation’s defense and security agencies.

With few exceptions, Congress has always understood the importance of both present- and future-oriented research. A well-known exception was the 1969 Mansfield amendment, which restricted the Department of Defense to research narrowly targeted to specific military missions. Had this restriction not been lifted, DOD-sponsored research in the 1980s that led to the Internet in the 1990s would have gone unfunded. Today, we cannot know how and when the science of the Higgs boson sub-atomic particle will prove useful. But conditions will change; the knowledge will be used.

Social science examples are plentiful. The theory of demographic transition was formulated before it proved central to the government’s huge investment in family planning to reduce population growth across the developing countries; early childhood learning was a theoretical breakthrough that subsequently shaped policy toward maternal health and pre-school programs; a quarter-century ago few could have predicted today’s growing influence of behavioral economics in microeconomic policies.

BUILDING SCIENTIFIC THEORY
The Coburn criteria undermine how science constructs its theories, without which there is no scientific explanation of anything. Coburn and Posey acknowledge that political science contributes to an understanding of national security and the economy; what they miss is why that is so. Research on nuclear proliferation or economic stagnation would produce, at best, descriptive and shallow explanations if pursued without attention to broad theory about how governments work, which in turn involves studying topics seemingly unrelated to security or the economy: bureaucratic inefficiencies, moral hazards, unintended consequences, organizational decision-making, coalition-building, and much more.

Science is not a series of discrete, unrelated projects. It is an interconnected enterprise, which is why research on schoolyard bullies can unexpectedly explain suicide bombers, or why studying government decision-making under uncertainty—for which a political scientist, Herbert Simon, received a Nobel Prize—is applicable to explanations of failed states, which in turn are home to terrorist cells.

A science policy that poses narrow questions gets narrow answers. This, I fear, is the likely consequence if Congress embraces the Coburn criteria, especially if it inserts itself into the actual choice of research projects.

CONGRESSIONAL MICROMANAGEMENT
Who decides whether a given NSF grant will promote national security or economic interest? Coburn assigns this responsibility to the NSF director, who is instructed to certify to congress that each NSF-funded political science project meets the criteria. If restricted to political science, its damage is real but limited. But if, as Posey suggests, it is broadened to all disciplines, perhaps migrating to NIH and other government science funding, it is a disaster in the making.

Congressional intimidation lurks in legislation that instructs the NSF director to certify individual grants. Trying to second-guess perceived congressional priorities can easily edge aside the search for excellence through peer review. The risk of marginalizing peer review is especially worrisome given the already insecure status of politically contested science, such as evolution, stem cells, climate change, and alternative energies. Members of Congress who believe that the executive branch should not try to pick winners and losers in the market economy should certainly realize that the legislative branch is poorly equipped to pick winners and losers in science.

GETTING BACK ON TRACK
Formulating a national science policy is a congressional responsibility. But when that policy misjudges basic features of how science works, it is the task of the nation’s science leaders to point it out—as have the president’s science adviser, the National Science Board, members of the National Academies of Science, and hundreds of others. It is easy to be tempted by the promise of metrics claiming that this-rather-than-that scientific investment will better promote national security or economic well-being. Only with hindsight will the nation realize how false this promise was.

Places have ambition. In this urban hierarchy, you aim to be New York, Los Angeles, or San Francisco. In the part of the Rust Belt west of the Cuyahoga River, Chicago is the city of dreams. In any development scheme, you pick a star and try to replicate it in your own backyard. “The Next Silicon Valley!” Yet all the schemes, placemaking, and tolerance overlook what makes a global city such as New York so great:

New York, on the other hand, will fight you every moment of every day. It will force you to justify your own existence and roll up the carpet while you’re still on it. It will throw every ounce of itself at you and ask you why you think you’re worthy of gracing the city with your presence. “I am monolithic,” New York screams as the subway whisks along Wall Street and no street alike under your feet “and your struggles mean nothing to me.” This is a city that feels no shame about trying to fucking kill you.

The salmon spawns of people will dull your willingness to engage in human contact. The cost of living will force you to question your appreciation for 3 a.m. Indian delivery. One day you’ll wonder why, in a city of a hundred billion people and a new restaurant/bar/hovel opening every six minutes, it’s so hard to make new friends, as you sit alone in the same bar waiting for the same group to arrive.

But New York is also exciting, and an adventure—and for some people it’s exactly what they need. That daily battle against the forces of the city itself, that justification of your own right to dream and find victories and even just exist forces them to fight for themselves—perhaps for the first time in their life. The city gives no quarter, but you learn to give no quarter in return. There is no “if you built it they will come” in New York—the city has too much to offer for it or anyone else to give a shit about your new project/restaurant/art gallery/crashspace/hackspace/jeans line/photography studio/bike repair shop.

I doubt this NYC is what Boston has in mind when trying to keep college graduates from leaving. Three a.m. Indian delivery in Cambridge won’t make the Big Apple any less enticing. If you want someone to give a shit about your pop-up market, move to Portland. If you want to be the best of the best, the best you can be and then some, you go to New York. All the awfulness be damned.

I’ll let Austin booster and entrepreneur Austin Gunter explain the allure of San Francisco:

San Francisco, on the other end [of the spectrum from Portland], is such an intensely driven city that you cannot help be swept up in what is going on all around you. That’s part of the point, and why I chose to move there. Practically everyone you meet in San Francisco has something awesome that they’re creating, and without realizing it, they help you get better just by being around you. San Francisco’s culture involves hustling and kicking the most ass possible, and you feel like a chump if you aren’t working as hard as everyone else.

San Francisco is a refinery. The city takes raw talent produced in Pittsburgh and makes it world class. Few places provide that kind of intensity, that level of personal economic development. That’s the attraction, not cool urban amenities.

Moving away from the intangibles, the Federal Reserve Bank of New York tackles the benefits of big city:

Theoretical research in urban economics suggests that the large and thick local labor markets found in big cities can increase the likelihood of job matching and improve the quality of these matches. These benefits arise because big cities have more job openings and offer a wider variety of job opportunities that can potentially fit the skills of different workers. In addition, a larger and thicker local labor market makes it easier and less costly for workers to search for jobs.

The theoretical research spells trouble if you aren’t sitting atop the urban hierarchy. Your town can build the latest High Line park. Such public spaces do not a thick local labor market make. The economic geography of aspiration includes talent producers and refineries. Austin produces talent. San Francisco refines it. Portland eats it, like cupcakes.

Michelle Legro runs a website called My Daguerreotype Boyfriend, a Tumblr where readers can submit photos of really attractive and long dead men. One of the men featured is this guy.

That’s Louis Lingg, the German anarchist partially responsible for the 1886 Haymarket Bombing. Haymarket started as a labor demonstration. When the police came in to break up the demonstration someone threw a dynamite bomb at them. Seven police officers, and four other people, were killed in the event. Investigators later discovered dynamite bombs in Lingg’s apartment. He was arrested and tried with seven other anarchists.

So the glories of American-grown, politically-based urban terrorism pretty much stem from this guy. But that doesn’t stop people from loving him. Commenters on the Lingg post at MDB include wherestheoffbutton, who wrote “I’d tap.” Marielvb added, “looks just like channing tatum!” On another website someone noted that Lingg was notably sexy “because of the simple fact that he makes anarchy look less neckbeardy.”

This looks familiar. One of the more unsettling aspects of the Boston Marathon Bombing has been the popularity of Dzhokhar Tsarnaev. He’s not a terribly sympathetic character. The note he apparently left in the boat where he was captured indicated that he believed the Boston victims to be “collateral damage” in the same way Muslims were killed in the American-led wars.

Nothing in his background indicates anything particularly evil or destructive, the most one can say about Tsarnaev is that he just kind of liked to smoke pot and hang out with his posse of Central European slackers at the University of Massachusetts-Dartmouth. Well, and that he was kind of attractive. As an ex-girlfriend said: “I met him standing outside a building and honestly, his face was enough to capture my heart. I walked right up to him and I was like, ‘Oh my God, you are adorable. Can we hang out?’”

As Paula Bloom wrote in the New Yorker:

Tsarnaev might not look particularly competent, but he is attractive—[law professor and blogger Ann] Althouse describes him as “a hot-looking young man.” Many studies have confirmed that individuals with attractive faces are judged to be happier, kinder, and more intelligent than their homelier counterparts; they are paid more, and are treated better in just about every venue of life. Experiments with simulated juries find that, when the victim of a crime is attractive, the defendant tends to get a longer prison sentence; if the defendant is attractive, he or she gets a lighter sentence. Even better for Tsarnaev, he is baby-faced: studies find that baby-faced individuals also tend to get lighter punishments, perhaps because they inspire parental warmth.

Well, perhaps. But this is actually a common feature of the world’s political assassins. Tsarnaev’s attractiveness is not unusual. If you want to be a terrorist, it’s not just necessary to be an ideological zealot unconcerned with legality or normative morality; it also helps to be fairly good looking. This concept of attractive guys as the world’s killers is, in fact, so common that the 2001 Ben Stiller comedy Zoolander posited that male models were behind all of the political assassinations of the last two centuries.

That’s very funny. What’s perhaps a little less funny is that the pretty boy assassin observation is technically accurate. And because they’re so often young men—older guys with mortgages and children aren’t often political terrorists; they have too much to lose—from unfortunate backgrounds, they tend to develop strange followings of teenage girls more than any other group.

Check out this Gawker piece about the Tsarnaev’s fans, the #FreeJahar girls.

“Jahar” is what Dzhokhar Tsarnaev’s friends and Twitter followers call him, and #FreeJahar is the hashtag banner around which thousands of people have rallied on Twitter, Tumblr, and Facebook to closely follow Tsarnaev’s case and share what they believe to be evidence of his innocence. [One fan explained that] “I do believe he is very cute, but that’s not the reason I am personally involved in this movement,” she emailed me back. “I am in this because I don’t believe its right to put a totally innocent person in jail for the rest of his/her life or even death penalty. I don’t care who it is, it just isn’t fair.”

Likewise, Gavrilo Princip, the 20-year-old man who started World War I by killing the heir to the throne of Austria-Hungary, the Archduke Franz Ferdinand, has some followers of his own. One admirer wrote of Princip that “not only did this saucy Yugoslavian Nationalist start the Great War, but he has the emotional eyes and the square jawline of a lady killer as well. The ‘stache ain’t bad, either.”

The killer as Internet rock star thing happens often. Rachel Monroe writes at The Awl that:

Tumblr turns out to be the perfect medium for a crush shrine, one that’s far more dynamic and interactive than a scrapbook or a bedroom wall. It allows posts and re-posts of pictures, quotes, gifs, and video clips while discouraging wider analysis or any sort of logical connection between content. Instead, the obsession acts as its own context. Every Internet trinket relating to the crush object—a photograph of his parents’ house, a doodle in the margin of his math homework, a yearbook photo, a stock photo of the gun he preferred, his autopsy report—is relevant, because a girl with a crush is omnivorous, and very, very hungry.

Or, perhaps more directly, teens crush on famous murderers in part because crushes are dumb. They’re not supposed to make sense.

The unattainable, mysterious crush appears to work entirely independent of the crush object’s actual personality or behavior. The famous killers are also crush targets because journalists publish all sorts of intimate details about the killers’ lives. One can easily find childhood pictures, family information, and minutiae about the killers’ leisure activities and food preferences, much like with that other group that’s overrepresented in the dreams of teenage girls, pop stars. Consider: Justin Bieber. And this is exactly the sort of thing that feeds crushes.

One might think that this development could be troublesome to authorities, but it mostly seems not to matter. There are no corresponding counter-efforts to make Dzhokhar Tsarnaev look bad, after all.

That’s because the sort of empathy these figures generate is a vague compassion for their lives and situations, not their actual cause. A frequent trend here is not sympathy for their beliefs but, rather, a conviction that these adorable young men can’t possibly be involved in such things; they must be innocent victims. It’s really too bad that such a nice boy got caught up in a terrible thing, cluck so many sympathizers. No one ever seems to think the thing they did is therefore justifiable or decent.

And do remember that their fan base mostly consists of teenagers. Not, you know, criminal masterminds.

A #FreeJahar writer does say of Tsarnaev that “I think he was wrongly blamed. I think its [sic] because he’s Muslim. And so far I haven’t seen any proof that he did it.” But then, FreeJahars also write stuff like “I bought this eyeshadow that was supposed to make Brown eyes pop and I gotta admit that it really did. I can’t stop looking at my own eyes lol.”

If they do feel passionate about this issue, that’s fine. They also seem to feel passionate about the band One Direction, police brutality, and their own nails. They’re hardly likely to organize in order to bust Tsarnaev out of jail. They’ve got homework to do.

As for Lingg, he and the six others conspirators were convicted and sentenced to death. One day before his scheduled execution, he “smuggled dynamite caps into his cell and bit them, destroying his jaw.” He died six hours later. But he lives on in the name of a French punk band, Louis Lingg and the Bombs. According to the group’s Facebook page, “the bombs they throw are musical.”

Two days ago, the New York Yankees, Manchester City, and Major League Soccer told us that New York was getting its own soccer team. They’ll be called New York City Football Club (NYCFC), which makes their intentions—note the “city”—clear, and the team will be majority-owned by Manchester City, with the Yankees as minority owners. Either way, it’s two of the world’s wealthiest sporting entities teaming up.

It’s exciting because everything in New York City ends up being exciting, and it’s exciting because it brings MLS to 20 teams; after 17 years of measured growth, it will be as large as all the major European leagues. And it’s exciting because New York doesn’t have a soccer team. (The New York Red Bulls play in New Jersey. More on them later.) Soccer continues to grow, and the Big Apple has it’s own team. It all seems good.

But it’s also kind of weird, isn’t it, when you step back? New York doesn’t have a soccer team. There are currently 19 top-tier soccer teams in America and none of them are in New York. That doesn’t seem like something you should be able to say.

So, a question: Will anyone actually care about NYCFC?

A BRIEF HISTORY OF the New York Red Bulls: they’re the least successful original franchise in MLS, making it past the quarterfinals in two of 17 seasons, still yet to win a trophy of any kind. The team started off named the New York/New Jersey Metrostars. (This was back when the league was really weird: the clock counted down, every tie game ended in a hockey-style shootout, the uniforms were ridiculously neon and unsymmetrical, and teams called “Wiz” and “Burn” existed. But it was soccer! In the U.S.! So no one cared.) They played on AstroTurf at Giants stadium, a football stadium in New Jersey. After a few years, the name was changed to just “Metrostars.” Then energy drink company Red Bull bought the team. (They own multiple soccer teams across the world. And no, that doesn’t make it any less bizarre.) They were re-named “New York Red Bulls” and given uniforms with two red bulls clashing heads on the front. They then built a soccer-only stadium, and it is gorgeous, intimate, and super-clean. It’s a totally modern joint, and perfect for what MLS (and presumably the Red Bulls) wants to be. Except, it’s in Harrison, New Jersey, a 45-minute train ride from the city.

The Red Bulls, then, are basically the manifestation of the energy drink the team is named after: flashy, expensive, initially exciting, but ultimately empty, unfulfilling, and probably not good for your health.

The team and the league will get more out of the city than they’ll be able to give back. New York is still New York without NYCFC.

There is a passionate group of people who care about the Red Bulls—and God bless them. Though the team’s attendance numbers are fine—around 18,000 per game (in a 25,000-seat stadium) for the past two years—they’ve been unable to drum up any real excitement in New York, despite employing Thierry Henry, who, though past his heyday, is one of the league’s best players and one of the best soccer players ever. That’s due in no small part to the stadium being so removed from the beating city and the fact that a lot of reasonable people can’t bring themselves to feel any connection with a team named after an energy drink.

The promise of another New York team was always more exciting than the team the city supposedly had.

NOW THE CITY HAS that team, and there are many reasons why it will be a hit. Soccer is as popular in New York City as anywhere else in the country. Pubs across Manhattan and Brooklyn are filled with fans up early to watch their favorite European teams play. Go to any park, and you’ll find a group of people kicking a ball around. And off-season friendly matches between European teams have done big attendance numbers, too. “Will Soccer Ever Make It in America?” was always a dumb question—and it’s not even a question anymore, especially in Manhattan.

Beyond the appetite for the sport, the new location, the wealthy (and seemingly well-intentioned) owners, and just the sheer size of New York—get a mini-fraction of New Yorkers to support NYCFC, and the stands will be close-to-full wherever they build the place—all seem reasons for optimism.

(Patrick Shields laid out plans for a stadium to be built on Pier 40 on the city’s west side, right on the Hudson. It’s beautiful and would be in the city: both impossible to ignore and easy to get to. However, it seems more likely that something gets built at Corona Park in Queens, which is a train ride outside the city proper, right around where the Mets play, and a slightly more-accessible mid-point for commuters from Long Island.)

These are all things you need for a franchise to be successful. We’ll define “immediate success” for a new franchise, which is what every MLS team is, as a reasonably successful on-field product and one that garners consistent and sizable fan support. The first part of this comes down to ownership and who they put in place. (There is a flexible salary cap in MLS, so things beyond having money are important.) And a winning team, presumably, engenders the second—and more important—part of this. People care about soccer in New York—but will they finally care about New York’s soccer team?

Although, the New York/New Jersey Metrostars/Red Bulls seemingly did everything possible not to catch on in New York City, it’s still there, looming like a neon warning sign. If fans wanted a soccer team to form around, they could’ve had one—but they didn’t, for a number of reasons.

THE BIGGEST AMERICAN SUCCESSES in MLS are Portland and Seattle. Neither team has won a title, and they’ve each been around for less than five years, but the Sounders average over 40,000 fans per game, while the Timbers averaged a sell-out for their first two years in the league. The teams tapped into already-existing and concentrated soccer cultures—both the Seattle Sounders and Portland Timbers have existed, on and off, in various leagues in various capacities since 1975—in devoted populations. Portland sold out games back then, and while the team didn’t actually play in MLS until 2011 (they were in a lower-level league before then), all those games still sold out. Their fan traditions—a lumberjack cuts a slab of wood off of a log every time they score a goal—extend back to the franchise’s beginning, and you’ll find references to Portland as “Soccer City USA” around that time, too. So, today, a Timbers game or a Sounders game is an event in those cities, and it’s possible specifically because of those cities. They give something to each other.

That’s not going to happen in New York. The team and the league will get more out of the city than they’ll be able to give back. New York is still New York without NYCFC.

All the sports franchises in New York are worth a ton of money—but that’s mainly because they’re in New York, and they’ve all been there forever, just like Portland. They’re not, really, roaring successes—and definitely not models for anything new. The Yankees are a monstrous empire—but the Knicks, Giants, Mets, and Jets are all legacy brands more than anything. The Giants, Rangers, Mets, Jets, and Islanders mean something to so many of their fans—and they’re important pieces of the American sporting landscape—because they’ve been around, and been around in New York, for so many years. And still, attendance is hit-or-miss on a game-to-game basis for most of the teams. Yet the larger fan base exists for all of them but only because you suck in so many fans when you’re around for as long as these teams have been.

That’s all impossible for a team that won’t start playing until 2015. There’s that vague-but-real soccer culture to tap into, but that’s as disparate and varied as the city itself. (The metropolitan area rarely, if ever, produces nationally relevant youth teams.) There’s a history of soccer clubs in the area—most notably the New York Cosmos, who have been revived and will play in a lower-level league this year—but that’s scattered and dotted with so many different names, too. (The Brooklyn Nets might be the best example for NYCFC, as they aligned themselves with something cool—Jay-Z, even though he’s gone—tapped into an already-there basketball culture, and turned disillusioned Knicks fans. Plus, they became a cultural thing before a game was ever played; NYCFC has two years and a ton of money to try to make that happen.)

And that’s maybe the biggest hurdle. MLS isn’t the highest level of soccer just yet—European leagues still have all the best players—so there seemingly needs to be some deeper devotion to the cause (supporting your city, supporting the sport, etc.) in order for the fans to turn out. New York cares about soccer in the general sense—it’s a cool, still very urban thing to be concerned with—but is it too difficult to bring all of that together into the support of just one team?

NYCFC doesn’t need to be the Sounders or the Timbers or any of the franchises it’ll be brushing shoulders with once the team gets up and running—because that’s impossible. The club just needs to create something for all these soccer people and all these New York people to rally around. Whether or not they will—even if it’s there, winning, not-in-New-Jersey, and impossible to ignore—that’s still a question without an answer.

Umesh Mishra thinks day in and day out about power conversion—the trillions of adjustments in voltage, frequency, and current made daily to deliver electricity from wall outlets to computers, TVs, virtually any electronic device. And he thinks about the gadgets that do the converting, mostly built using silicon. Collectively, those converters waste nearly as much power in the form of heat as all the energy produced by all the renewable sources in the United States.

On average, silicon-based converters are only 90 percent energy-efficient. The 10 percent that is lost dissipates as heat between a plug and whatever a converter is powering. That’s why cell-phone chargers are warm to the touch, external power adapters for laptops heat up, and data centers chockablock with thousands of computer servers need a lot of air-conditioning.

Mishra is on a quest to find a better way through gallium nitride, a mix of nitrogen and gallium, a rare silvery-white metal found in trace amounts in zinc and bauxite ores. As the CEO of Transphorm, a gallium-nitride-technology company in Goleta, California, he’s banking on the idea that the elusive material can reduce energy loss to as little as one percent. Other companies and institutions are working with gallium nitride, but Transphorm is among the first to work with the high voltages that could yield the greatest cost savings.

Silicon-induced energy loss costs the U.S. economy $40 billion every year. “It’s a huge problem, and it’s invisible.”

“When gallium-nitride technology manifests itself to its full potential, the savings could equal taking the West Coast off the grid,” says Mishra, with characteristic ebullience. He estimates that the silicon-induced energy loss costs the U.S. economy $40 billion every year. “It’s a huge problem, and it’s invisible,” he says. “It’s a tax you don’t explicitly pay, but you pay every time you use an appliance. You pay for energy at the outlet, including all the waste as well.”

Mishra has been working with gallium nitride for many of his 23 years in the engineering department at the University of California, Santa Barbara. (He was elected to the National Academy of Engineering in 2009 for this work.) The compound, first grown as a single crystal film in 1969, drew widespread notice in 1993 when it was used to create bright blue light–emitting diodes, invented by Shuji Nakamura (who joined the U.C. Santa Barbara faculty in 2000). Mishra co-founded Transphorm in 2007 with a former student, Primit Parikh, now the company president, to focus on gallium nitride. So far, the company has received $105 million in seed money from the Department of Energy’s Advanced Research Projects Agency, Google, and other public and private entities.

But dethroning silicon—the planet’s third-most-abundant element after iron and oxygen—is no easy feat. Gallium is exceedingly rare, and gallium nitride has to be grown atom by atom in a controlled environment; inside Transphorm, employees don clean-room suits to coax gallium-nitride crystals to reach a few microns thick atop silicon wafers, which are then cut into chips. Gallium nitride devices for power converters are produced by the thousands each week; silicon devices are made by the billions in that period. With no real economy of scale, Transphorm devices cost considerably more than their silicon-based counterparts.

Dennis Monticelli, a technologist at electronics giant Texas Instruments, says media and industry talk makes it sound like silicon’s days are over, but that’s not the case. “Gallium nitride has more upside to it,” he says, “but it’s less mature, and we don’t know how far it can go.” The company does maintain a relationship with Transphorm. Jim MacDonald, a product manager at Texas Instruments, likens gallium nitride to a high-performance Corvette: For the price, he says, most people will opt to keep their Chevy.

But when Transphorm demonstrates its devices at trade shows, some people refuse to believe their efficiency, says Carl Blake, Transphorm’s marketing director. “We get a few who say ‘That’s not possible. How are you cheating?’” And this motivates Mishra to keep working toward a future in which data centers the size of football fields handle 10 times more traffic, electric cars have downsized to a single radiator, and external laptop power adapters have vanished.

Migrants moving into a region stimulate economic growth. Newcomers demand more housing and local services, to name a few ways the inbound impact the economy. Over the course of the 20th century, the relationship between metros and migration transformed:

At the time of the Great Migration in the 1920s—when more than two million African Americans abandoned the South for industrial centers in other regions—less-educated individuals were more likely to migrate in search of better lives. Today, the opposite is true: The more education a person has, the more mobile he or she is. College graduates have the highest mobility of all, workers with a community-college education are less mobile, high-school graduates are even less and dropouts are the least mobile of all.

I’ve quoted this passage from economist Enrico Moretti before. During the early part of the century, the manufacturing boom attracted a flood of workers. See Pittsburgh. Metros needed bodies. During the late part of the century, regions attracted workers in order to fuel an innovation boom. See Portland. Metros needed minds. As Moretti details in his book, The New Geography of Jobs, more people were directly involved in the Manufacturing Economy than are directly involved in the Innovation Economy. The influx was a byproduct of the economic expansion. Now, the influx is vital to the economic expansion.

For Portland, regional planning and urban amenities comprise the economic development strategy. Build it and they (talent) will come. That’s quite different from the usual approach, which is job creation and the attraction of employment. People move to Portland for other reasons:

Portland has attracted many newcomers that have moved to the region without necessarily having a job. Housing prices increased because of high demand and as a result of a successful and prospering economy. These newcomers have added a lot of vitality and vibrancy to the Portland region, but often cannot afford modest places to live. The city of Portland is interested, not only to attract these groups, but also to retain them in the city, as this is considered to be essential for the city’s economic future. In this perspective, improving the provision of affordable housing can be seen as part of an economic development strategy that is directly related to issues of quality of life. However, the established companies such as Nike, Intel, etc., that benefit from this group’s presence, should have developed an interest to questions of affordable housing, but their efforts are still mainly directed toward improving education and workforce development infrastructure.

In Portland, there is a disconnect between the demand for housing and employment to pay for it. Meanwhile, industry (Nike, Intel, etc.) is keenly interested in talent production. Why? Because competition for knowledge workers is fierce. What Portland has done with regional planning and urban amenities can be replicated elsewhere, places with job-centric economic development strategies. Talent is dear, increasingly expensive.

Pittsburgh has been focused on “improving education and workforce development infrastructure” for decades. The metro does not depend on migrants to increase the quality of the workforce. In fact, Pittsburgh produces the talent that Portland desperately needs. There is a glut of knowledge workers who are relatively inexpensive, an attractive proposition for the likes of Nike and Intel.

Editor’s Note: The post originally appeared on The Fix, a Pacific Standard partner site.

The newest edition of psychiatry’s “bible” of diagnosis, the DSM-5, made its long-awaited appearance on May 18 at the opening of the American Psychiatric Association’s (APA) national conference in San Francisco. This revision of the DSM-IV took the APA more than a decade to produce, and unprecedented criticism dogged it most of the way.

Because of the unique role the DSM-5 plays in the diagnosis of addiction—and, as a result, its influence on the allocation of billions of dollars for research, prevention, and treatment—The Fix has devoted extensive coverage in recent months to the controversies. Now, with the book launched and the dust settling, we turn our attention to two questions about short- and long-term consequences, and what people with substance use problems stand to gain or lose:

• Will treatment for addiction become more accessible for more people?
• Will research into addiction produce more effective diagnostics and drugs?

THE PROMISES AND PERILS FOR TREATMENT
The DSM-5 arrives in the midst of a historic overhaul of the nation’s health care system under Obamacare (the Patient Protection and Affordable Care Act, or ACA). Together, the legislation and the diagnostics revision are likely to dramatically increase the number of Americans eligible for addiction treatment. But the noble goal of securing more care for substance users could have an unintended consequence, some experts warn: stretching an already-overwhelmed patchwork of services past their limits.

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Once Obamacare kicks in, as many as five million people with substance use disorder will be newly eligible for insurance, according to an Associated Press analysis. The quandary: In most states, patients already fill treatment centers to the brim. The worst-hit states have only one rehab or hospital bed available for every 100 people in need of inpatient care. The new arrivals could double the existing wait lists.

The DSM-5 revisions were based on the same health care research that shaped Obamacare, and will work in tandem with the legislation to encourage early intervention in substance use disorders, Charles O’Brien, MD, Ph.D., head of the University of Pennsylvania’s Center for Studies in Addiction and chair of the DSM-5‘s Substance-Related Disorders Work Group, told The Fix. By defining substance use disorder across a spectrum from “mild” to “moderate” to “severe,” the revision could add as many as 20 million more substance use diagnoses, Keith Humphreys, Ph.D., a Stanford psychology professor who served as a senior advisor on drug policy under Obama, told The New York Times.

That jump in diagnoses, paired with the ACA’s expansion of coverage, will present a formidable challenge to already-shrinking addiction services. And since the majority of new diagnoses will likely be people in the initial stage of disease, critics fear that the most severe cases most in need of treatment will lose out. “Our scarce [addiction] resources are already distributed in an irrational manner,” Allen Frances, MD, who headed the DSM-IV revision, wrote in Bloomberg News. “We badly shortchange those with clear disorders while overtreating essentially normal people.”

That alarm misrepresents the large-scale, long-term changes likely to result from the one-two punch of expanded insurance and diagnosis, Humphreys told The Fix. “I think that’s a misplaced concern and an old way of looking at things,” he said, because it fails to consider how Obamacare will transform the provision of addiction treatment. To be blunt, insured patients can pay medical bills, so the new health care law will make addiction profitable. That will move the bulk of substance use care from the realm of government funding to that of private enterprise.

Hospitals and other private health centers will realize that the millions of newly insured addicts represent a source of customers, which could prompt their rapid expansion, Humphreys said. In another benefit, the provisions will likely shift services away from residential and stand-alone programs toward outpatient and integrated care systems.

But in the short term, Humphreys admits, there will be lag time before these “market adjustments” take effect. “While it’s being figured out, some people will have a tougher time getting treatment,” he said.

The prospect of more accessible treatment for more people is based on two major changes in the ACA.

MEDICAID: Obamacare’s main strategy to cover most of the 30 million uninsured Americans is by an enormous expansion of this government program for the poor. (Health exchanges will allow uninsured people who do not qualify for Medicaid to shop for competing private insurers.) In the past, Medicaid covered only half of mental health and substance use services. New rules have extended that to two-thirds, and come January 2014, it will reach 100 percent.

PARITY: Under new “parity-plus” laws, health insurers will have to cover mental health and addiction care at the same rate as physical maladies.

But the Medicaid expansion may look better on paper than it works in reality. Why? Because the Supreme Court ruled last year that states have the right to restrict it. As a result, the effectiveness of the legislation will partly depend on whether or not states choose to implement the changes, said Susan Foster, MSW, vice president and director of policy research and analysis for the National Center on Addiction and Substance Abuse at Columbia University. Political agendas opposed to government spending appear to have shaped these choices, at least for the time being.

In additional changes, Obamacare relies heavily on cost-effectiveness—via prevention and early intervention—to bend the curve of runaway health care costs. And that’s where the DSM-5 links arms most closely with the new Medicaid requirements, thanks to the manual’s new “spectrum” approach to defining substance use disorder. The “mild” end of the DSM-5‘s substance-use spectrum will help health care providers identify patients at risk of, or in the first stages of, addictive behavior, O’Brien said. The DSM, in other words, will serve as a guide to help clinicians follow ACA mandates.

For example, a protocol called Screening, Brief Intervention, and Referral to Treatment (SBIRT) has shown success at halting substance use disorder before it gains much momentum. Yet insurers have refused to cover SBIRT, limiting the program’s actual use. Obamacare aims to change that, mandating that Medicaid and state-exchange insurance plans cover SBIRT as a prevention benefit provided by primary-care physicians and in hospital emergency rooms.

One thing is clear: A major transformation in addiction diagnosis and treatment is underway, replacing a system that offers enormous room for improvement.

“I think the DSM-5 and Obamacare should work well together, synergistically,” Humphreys said.

Yet this spectrum definition of addiction prompts dire predictions of critics like Frances, who say the change will increase diagnoses by, for example, turning “normal” binge drinking into a “substance use disorder” requiring treatment.

The research is mixed on whether or not that will happen. While an Australian study did, in fact, predict a shocking 62 percent increase in “alcohol use disorder” diagnoses under the DSM-5, two U.S. studies estimated much smaller increases (of 11 percent and five percent). “I doubt that the increase in diagnoses is going to be significant,” Foster told The Fix.

Patients identified on the “mild” end won’t compete for services with full-blown addicts, anyway, Humphreys said. The two groups will get different kinds of care from different kinds of providers, with primary care physicians expected to handle most issues for mild abusers. “Early intervention is not about sending the guy who drinks two days a week to rehab,” Humphreys said.

Instead, clinicians can tailor treatment to each patient depending on the severity of his or her problem—rather than lumping all substance users together, Foster said. People who want to get control of an early-stage disorder may be “prescribed” a choice among, or combination of, 12 Steps, behavioral therapy, and anti-craving medication, for example. By contrast, those with a severe substance use disorder may require inpatient treatment at a hospital. “The diagnostic criteria help people understand that addiction is a disease,” she said, “and that you have different levels of severity that call for different treatments.”

Whether or not the ACA and DSM-5 work as planned to increase the quantity and quality of health care for people with addictions remains to be seen. There are countless potential hurdles. But one thing is clear: A major transformation in addiction diagnosis and treatment is underway, replacing a system that offers enormous room for improvement.

THE BRAIN SCIENTISTS VS. THE MIND DOCTORS
Right before its birth, the DSM-5 suffered perhaps its biggest rebuke. The world’s largest psychiatric research organization, the National Institute of Mental Health (NIMH), rejected the very “validity” of the DSM’s approach to diagnosing mental illness.

The institute’s director Thomas Insel, MD, went beyond the now-familiar complaints that the manual includes too many disorders, or the wrong ones, announcing that the traditional use of symptoms as a basis for diagnosis is hopelessly outdated—and that the NIMH would do its best to usher that system to the exits. “The NIMH will be re-orienting its research away from DSM categories … and supporting … emerging [scientific] research [such as] genetic, imaging, physiologic, and cognitive data,” Insel wrote.

The dominance of the DSM system has hampered that research, Insel said, preventing scientists from pinpointing the real causes of psychological suffering.

Holding the biggest purse in mental health research, the NIMH’s decision will redirect the way money flows to addiction research—and, ultimately, how addicts are diagnosed and treated. The agency aims to replace symptom-based diagnoses with “biomarkers”—objective medical measures for psychiatric diagnosis that would be the mental health equivalent of blood pressure measures.

These markers, however, are currently little more than speculative. To discover them, the NIMH has launched its RDoC, or Research Domain Criteria project. While the NIMH won’t be “abandoning” the DSM immediately, the agency’s research money will increasingly go to studies that buck the DSM in favor of RDoC criteria, said Bruce Cuthbert, Ph.D., director of the NIMH’s Division of Adult Translational Research and Treatment Development.

Though the National Institute for Drug Abuse (NIDA) and National Institute of Alcohol Abuse and Alcoholism (NIAAA) handle most addiction-specific research funding, they cooperate with the NIMH on many projects, said Wilson Compton, MD, director of NIDA’s Division of Epidemiology, Services, and Prevention Research. The head of NIDA, Nora Volkow, MD, has led a veritable campaign to redefine substance use disorder as a brain disease best studied by the tools of neuroscience.

Coupled with Volkow’s priorities, the NIMH shift from soft to hard science will likely have a lasting effect on addiction research. “I wouldn’t be surprised if these other organizations don’t incorporate the new [RDoC] categories,” said Warren Bickel, MD, director of the Addiction Recovery Research Center at Virginia Tech Carilion Research Institute.

And that will change where the money for addiction research goes. Traditionally, to get funding, mental health studies have had to show their scientific validity by declaring which DSM-defined disorder they would investigate. Unfortunately, as Insel and many other scientists have said, mounting evidence suggests that DSM diagnoses simply don’t match up with what’s happening in patients’ brains.

The system suffers from two main blind spots, according to critics. First, the underlying causes of mental suffering do not fit neatly into labels like “schizophrenia” or “substance abuse.” Instead, these causes cut across many different DSM diagnoses. For example, malfunctions in what neurologists call the reward-circuit—the brain system that makes food, sex, alcohol, etc., pleasurable—occur in multiple disorders, including depression and addiction. Second, because the DSM lists so many criteria within each disorder, two patients can have completely different symptoms and yet receive the same diagnosis—as long as they meet the same number of criteria.

Addiction research is currently focused intensely on the brain’s pleasure pathway and the brain chemical dopamine, asking if it is the true seat of addiction disorders. But scientists admit that given the brain’s intricate complexity, the more they learn, the less they know. As the long as such biological causes of addiction remain a mystery, however, identifying precise targets and developing effective drugs are stymied.

RDoC-guided investigations won’t produce results that affect diagnosis for years. That means the DSM remains the best available choice for clinicians who need to diagnose real problems in real patients, Cuthbert said.

Others, like Randy Brown, MD, director of the Center for Addictive Disorders at the University of Wisconsin-Madison Hospitals and Clinics, worry that research realignments like RDoC—together with President Obama’s “Brain Initiative,” a public-private research partnership—will steer money away from studies that could offer here-and-now benefits. “What’s happening with the patient and the community has immense value,” he said, “more so, sometimes, than a lot of the neurophysiological approaches.”

Brown’s concern about the NIMH’s brain-centered approach echoes another recent, high-profile takedown of the DSM-5. The British Psychological Society (BPS) called last month for the abandonment of the DSM as an outdated collection of symptoms. But in their view, the problem stems from a focus on biology, including the neurological substrates that the NIMH wants to elevate. “The implicit theory [of the DSM] is one of biological reductionism,” said Steven Coles, a clinical psychologist and co-author of the BPS statement. “We can do far more than we do to focus on psychological and social aspects” ranging from bereavement to unemployment.”

Insel’s announcement still signals a shift, however, and the DSM won’t be around forever—on the research or diagnosis sides, Bickel said. “We’re moving into a bold, new future where the influence of the DSM is on the wane.”

For people battling addiction, that means a more scientific system in addiction care—someday. The future could see doctors analyzing MRI readings of your brain circuitry and tests of your genes to diagnose a substance use disorder. Only well-funded basic research will get us there, but until then, this much-maligned manual that is, after all, the repository of decades of psychiatric knowledge, will remain necessary.

No salt, low salt, salt free, heart-healthy salt substitution–any added salt will hurt your constitution. It reads like some bizarre, Seussian tale. Excepting that we’ve heard it not from the good Dr. Geisel but from the medical community and public health advocates everywhere. We watch as celebrity chefs take the salt elimination cooking challenge to prepare an “improved healthy” cuisine. Self-anointed “experts” cadge, coax, and cajole us to decrease our salt, or, more specifically, sodium intake. If that doesn’t work then the specter of heart attacks and strokes is unleashed upon us, along with a dash of fire and brimstone for good measure. It is, after all, clearly in our best personal and the greater public interest.

The hypothesis is sound and the supporting data is impeccable, right?

The theory goes as follows: Salt acts to make us retain fluid. When we retain more fluid it increases our blood pressure (albeit temporarily). Increased blood pressure is hypertension. Hypertension is a risk factor for cardiovascular disease like heart attacks and stroke. Heart attacks and strokes are bad. Therefore, hypertension is bad. Thus, sodium must be bad; A causes B which causes C, therefore A causes C. Get rid of A and you get rid of C—simple basic arithmetic, no? Reduce sodium intake and you will reduce blood pressure and thus reduce the incidence of stroke and heart attack. Reducing sodium intake is good—simple, effective, and undeniably the prevailing conventional wisdom these days.

Investigators followed over 3,500 participants for almost eight years. Surprisingly, those who ate less salt had the highest risk of dying; those who ate the most salt had the lowest mortality rate.

Except… one thing is missing.

The conclusive data—or any data-that definitively shows that cutting back on dietary sodium reduces mortality or significantly reduces cardiovascular morbidity. For over half a century, starting in the 1960s, there has been a vehement and salty exchange just out of public earshot involving respected scientists on both sides of this line. But with the advent of an aggressive public policy to reduce dietary sodium intake for presumed public health benefit and studies emerging suggesting negative consequences of a low-sodium diet, the clamor of dissension is heating up.

Public policy on salt dates back to 1977 when Senator George McGovern released Dietary Goals for the United States, a report that introduced the first national salt targets. This was set at three grams per day. The aforementioned theory of salt inducing hypertension quickly became science fact or urban legend, depending on your take of the data. A report from the surgeon general issued over a decade later highlighted this disparity. It acknowledged that the policy to restrict salt consumption had been implemented in the absence of studies that proved a low salt diet might prevent increases in blood pressure. Throughout the ‘80s the definitive answer remained elusive.

The Framingham Heart Study, a seminal trial following a cohort of Americans from Framingham, Massachusetts, since 1948, has yielded many landmark insights into cardiovascular risk, morbidity, and mortality. But the study failed to find any correlation between sodium and blood pressure (PDF). Another study in 1985 of over 8,000 men of Japanese descent found no relationship between sodium consumption and stroke. Halfway around the globe, over 7,000 Scottish men were studied, with the conclusion that “association between sodium and blood pressure is extremely weak.” In 1990, the director of nutrition at the Food and Drug Administration remarked in an Associated Press article that “there is no conclusive evidence that salt consumption causes hypertension; it’s only a hypothesis.”

Despite this lack of closure, in 2008, under Michael Bloomberg, “the New York City Department of Health and Mental Hygiene coordinated the launch of the national salt reduction initiative, a public-private partnership of more than 85 state and local health authorities and national health organizations that has set voluntary targets to lower salt levels in packaged and restaurant food,” according to the official New York City website (PDF). Two years later, in 2010, the Institute of Medicine recommended methods of sodium reduction in a report. The group had been asked to develop strategies for sodium reduction, not to evaluate whether sodium reduction was of any benefit, though that may have been the more important question. The Institute’s action plan was based on the presupposition that increased salt consumption caused significant harm. Based on this report, the director of the Centers for Disease Control and Prevention, Thomas Frieden, along with other professional organizations, including the American Heart Association, have moved forward with national campaigns like the Million Hearts initiative aimed at reducing sodium consumption. Programs like this, paid in part with tax dollars, aim to reduce sodium consumption by 20 percent despite any solid evidence for the return on investment.

In 2011, some experts involved in a rigorous scientific review of the studies done on salt remarked that it “is surprising that many countries have uncritically adopted sodium restriction, which probably is the largest delusion in the history of preventive medicine.” Despite this call for caution, “public health recommendations at global, national, and local levels have been nearly unanimous in asserting that the evidence is incontrovertible that salt consumption should be reduced (PDF).”

At the crux of the argument are two fundamental questions:
• Do low-sodium diets prevent hypertension?
• Would a population level decrease in salt consumption save lives (PDF)?

Answering these questions requires an evidence-based approach. Those who feel the current level of evidence is sufficient argue that more data collection will require too much time and money, costing us lives. However, it should be noted that over the last 45 years, while sodium intake has gone up, death from heart disease has continued to decline. Key tools for the successful implementation of evidence-based approaches include meta-analyses to identify effects that may not be apparent in individual smaller studies and the use of randomized clinical trials (RCTs) to help eliminate bias.

The first meta-analysis involving salt was performed in 1986. It found that lowering sodium intake may reduce blood pressure, particularly in people with pre-existing hypertension, but that the effect was extremely small. Subsequent meta-analyses delivered similar results.

Advocates for salt reduction believe that “guidance is based on the best available evidence,” as Sir Michael Rawlins, chair of the National Institute for Health and Clinical Excellence in the United Kingdom, notes. “The evidence may not, however, be very good and is rarely complete.”

These proponents for salt reduction also assume that there is no consequence to a low-sodium diet. This may not hold true; some amount of sodium is necessary for life. A low-sodium diet has some known negative effects. Significantly decreasing the salt in one’s diet increases renin secretion by kidney. Renin is associated with the development of hypertension and can contribute to the development of cardiovascular morbidities and mortality. Decreasing salt intake also increases aldosterone secretion by the adrenal gland, sympathetic nerve activity, and insulin resistance (the condition associated with Type 2 diabetes).

This is not all theoretical, either. In 2011, a study performed by the European Project on Genes in Hypertension (EPOGH) investigators sought to confirm that a reduction in salt intake would reduce the number of cardiovascular events. They followed over 3,500 participants for almost eight years. Surprisingly, those who ate less salt had the highest risk of dying; those who ate the most salt had the lowest mortality rate.

An even larger study was conducted that same year by a group at Canada’s McMaster University and published in The Journal of the American Medical Association. Over 30,000 people were tracked for about four years. The researchers examined low sodium intake (less than 2.3 grams), moderate intake (2.3 to seven grams), and high (more than seven grams). The moderate sodium intake group (which reflects the daily consumption of the average American at 3.4 grams) had the lowest risk of cardiovascular morbidity and mortality. A low level of sodium intake was associated with an increased risk of cardiovascular death and increased risk of hospitalization for heart failure. In addition, the low-sodium group had a 2.5 percent increase in their cholesterol and a seven percent increase in their triglyceride levels—changes not seen in the other groups.

Yet another meta-analysis examining 167 smaller studies drew similar conclusions. The study author, Niels Graudal of Copenhagen University Hospital in Denmark, concluded that “I can’t really see, if you look at the total evidence, that there is any reason to believe there is a net benefit of decreasing sodium intake in the general population.”

It “is surprising that many countries have uncritically adopted sodium restriction, which probably is the largest delusion in the history of preventive medicine.”

Finally, let’s consider two Cochrane reports, which generally consist of meta-analyses and RCTs and are considered a gold standard in delivering reviews of available data. The first, released in 2011, focused on people without hypertension. It found “no strong evidence” that sodium reduction reduced all-cause mortality. The second review, released the same year, also examined people without hypertension. The report concluded that all available evidence did not permit a determination as to whether a low-salt diet improved or worsened health. However, the authors concluded that “after more than 150 RCTs and 13 population studies without an obvious signal in favor of sodium reduction, another position could be to accept that such a signal may not exist.”

What we are learning is that the key may not lie in any absolute amounts, but in the ratio between sodium and potassium—the goal being to achieve a ratio ≤ 1. An alternative to the hypothesis that any health benefit is a result of sodium reduction is considering that any positive findings may arise because of increased potassium consumption. Sodium and potassium, which is often a component of salt substitutes, fresh fruit, vegetables, legumes, salmon, and chicken, exist in the body in a natural balance. Processing, however, affects the sodium to potassium ratio.

A 100-gram (about 3 1/2 ounces) serving of fresh pork, for example, contains roughly 60mg of sodium and about 340mg of potassium. But if you industrially process that into the average deli ham you end up with 920mg of sodium and only 240mg of potassium.

A study out of Sweden examined 10 previous trials looking at data from almost 270,000 people. They found that the higher the potassium intake, the less the risk of stroke. Another study, part of the third National Health and Nutritional Examination Survey (NHANES III), examined more than 12,000 people and found, over a 15-year period, that the group with the highest cardiovascular risk had a very high ratio of sodium to potassium in their diets.

This continues to be an area of intense inquiry.

WHAT DO WE KNOW?
We know that treating hypertension with medical therapy saves lives and reduces cardiovascular disease and complications. We know we need salt to live; 70 percent of our body is made up of salt water. We also know that, in the body, sodium exists in a balance with potassium. Potassium is another element necessary for proper functioning and is especially important from a cardiovascular perspective. We know that for most normotensive people sodium intake can vary tremendously from day to day without significant problems; even quintupling the amount of sodium ingested does not affect blood pressure adversely. The longest-lived people on Earth (and by some accounts the healthiest) are the Japanese, who routinely consume two to three times as much salt as the average American (whose salt consumption has been stable over the last three decades). We know that the effect of dietary sodium restriction, if any, on blood pressure appears extremely modest. And we know that significant sodium reduction has other potentially negative health consequences.

We do not know if salt reduction will result in a health benefit. We do not know the consequences of reducing the salt content of food. In the 1970s a campaign was initiated to reduce fat consumption among Americans. It has worked, and the percentage of fat in the American diet, even saturated fat, has continued to decline. But people ate more, which explains why obesity and diabetes are on the rise. Any manipulation of a system, whether by addition or subtraction, invokes to some extent The Law of Unintended Consequences—with possibly negative outcomes. Hormone replacement therapy (HRT) for post-menopausal women was based on the extrapolation of the desirable effects these hormones had on blood pressure and cholesterol levels (sound familiar?). It is no longer routinely prescribed due to the increased risks of heart attacks, breast cancer, and strokes associated with this therapy.

We cannot simply blame bad policy, especially if it is truly born of good intentions (and scientific ignorance) at the time of implementation. Policy, like science, is the purview of humankind and thus subject to our inherent flaws and growing pains. But to implement overarching public policy when good science raises serious concerns is to engage in public folly.

Over the past 24 hours, focus has turned to everything from Oklahoma’s economy to its geology to its plains culture to explain why the devastated suburb of Moore didn’t have “safe room” shelters in its buildings, including two destroyed elementary schools where at least seven children died.

But what about the school structures themselves?

“I’m told these schools were built in the 1960s,” said Bill Coulbourne, a structural engineer with the American Society of Civil Engineers. Coulbourne oversaw teams assessing damage after Moore’s previous tornado disaster in 1999. He was on-scene following the 2011 Joplin, Missouri, tornado, and helped write FEMA’s standards for safe rooms. He’s heading to Moore next week.

Plaza Towers elementary in Moore was apparently constructed in the late 1950s, of cinder blocks, according to published reports. Briarwood elementary was partially brick. (State education officials didn’t know its age, and local officials are impossible to reach from outside the area right now, for obvious reasons.)

At least one of the destroyed schools hails from an architectural era when the “little brick schoolhouse” of American myth gave way to materials that stretched public dollars further—but weren’t nearly as sturdy, and are difficult to improve without a costly teardown. “Certainly in the ’60s and ’70s and even the ’80s, engineers were required to get as much as they could out of the budgets,” said Coulbourne. “The roofs are steel, but they’re the lightest steel you could find.”

The result is that public schools from the second half of the 20th century were often built flimsier than the homes surrounding them. A 2011 survey of educational construction, Modern Schools: A Century of Design for Education, summed up the result:

In practical terms, the modern school as it developed in the United States at this time, was determined to have a number of practical and functional advantages over the traditional two- or three-story brick schoolhouse. To begin with, its lightweight construction, which utilized new building technologies, was less expensive and easier to build, and although its life expectancy was shorter, it was argued that schools needed to be rebuilt periodically anyway.

“The state still has a lot of fiscal responsibility in this,” said a FEMA spokesman. “States have rights, and the federal government isn’t going to go in and tell states how to manage their resources.” The Department of Housing and Urban Development press office said that “no federal standards” exist requiring American schools to meet a minimum definition of safety against any region’s natural disasters.

The building codes applied to schools are all local and engineers trying to save on scant budgets have enormous pressure to keep costs low. “School boards have to fund construction. Most of these buildings are built on bonds, funded by the community,” said Coulbourne. Balanced against asking for more bond issues on election day, and competing with the local police, fire, and libraries, most school boards will choose to live with the more or less workable structures they’ve inherited.

When money does come, retrofitting those ’60s buildings isn’t easy, Coulbourne said. But it is possible. Using a school’s corridors as shelters would be the best option, he said (they would remain uncluttered during normal use as passageways, and would be quick to access in a weather emergency). Shoring up three hundred square feet of passageway to survive a major tornado—a 20-by-80-foot corridor—would cost about $1.5 million, he estimated.

That’s not a hopeless amount of money. Oklahoma has in recent years received $57.6 million in assistance to construct “safe room” shelters under the federal Hazard Mitigation Grant program, according to a spokesman at FEMA, which administers it.

The problem is that just the one suburb hit this week, Moore—population 50,000—has 20 elementary schools. Retrofitting all of them would cost nearly as much as the state has received, total, from the FEMA program in its history. Those grants rarely cover all the construction costs, leaving local governments back at square one: balancing their part of the bill against other city services—or the price of textbooks. Yesterday, Oklahoma emergency officials said Moore’s city government hadn’t applied for one of the grants, despite being hit by large twisters twice before in the past 15 years.

The costs to retrofit old schools get even harder to pay after a disaster, because communities hit by tornadoes can lose massive chunks of their tax base. The 2007 Greensburg, Kansas, tornado disaster was smaller than this week’s events. But five years later, the small city still has only about half as many residents and businesses as before. “The local tax rolls take a beating,” said Coulbourne.

Relatively, buttressing the schools wouldn’t cost a lot of money, however. In 2011, a tornado the size of the one that hit Moore this week destroyed several elementary schools in Tuscaloosa, Alabama. Earlier this month, the Alabama state legislature approved part of the expected $44 million needed to rebuild just two of the schools. If Coulbourne’s ballpark numbers are close, creating a tornado shelter in a corridor of the new schools would amount to about five percent of the budget for each new building’s construction.

Can people be taught to act more altruistically? Newly published research, measuring both brain activity and behavior, suggests the answer just may be yes.

“Our findings support the possibility that compassion and altruism can be viewed as trainable skills rather than stable traits,” a research team led by Richard J. Davidson and Helen Weng of the University of Wisconsin-Madison writes in the journal Psychological Science.

Specifically, they report that taking a course in compassion leads to increased engagement of certain neural systems, which prompts higher levels of altruistic behavior.

Brain scans revealed “a pattern of neural changes” in those who received compassion training.

The researchers describe an experiment featuring 41 people, none of whom had any experience with meditation or cognitive behavioral therapy. All participated in a two-week training program that required them to follow guided audio instructions for 30 minutes each day.

Half received “compassion training,” in which they “practiced cultivating feelings of compassion for different targets (a loved one, the self, a stranger, and a difficult person)”. The others received “reappraisal training,” in which they “practiced reinterpreting personally stressful events” with the goal of lessening their negative emotional reaction.

At the beginning and again at the end of the two weeks, participants’ brains were scanned as they employed their assigned strategy (compassion or reappraisal) while they viewed a series of images. Many of the pictures depicted people suffering, such as a burn victim and a crying child.

Finally, at the end of the two weeks, all took part in an Internet “redistribution game,” in which they witnessed unfair behavior and had an opportunity to partially rectify it. They watched as a person given $10 gave only $1 to a victim who had no money. They were then told they could spend any portion of their own $5 allotment to compel the miser to double the amount he or she gave the victim.

Those who received the compassion training spent nearly twice as much of their own money to try to rectify the unfairness: $1.14, as opposed to 62 cents for those who had taken the emotional reappraisal strategy. “This demonstrates that purely mental training in compassion can result in observable altruistic changes toward a victim,” the researchers write.

The brain scans revealed “a pattern of neural changes” in those who had received compassion training, including “neural systems implicated in understanding the suffering of other people, executive and emotional control, and reward processing.”

“If the signal of other people’s suffering is indeed increased by compassion training,” the researchers write, this apparently compels them to “approach rather than avoid suffering, in order to engage in pro-social behavior.”

The researchers also found neural changes in members of the other group, but the effect was quite different: In their case, greater changes in certain key regions of the brain were linked with less willingness to give money.

Davidson, Weng and their colleagues point out these participants were trained to reduce personal stress and negative emotions, and speculate they may have achieved that goal by ignoring or dismissing the problem that was presented to them.

Previous research found compassion-oriented meditation can produce changes in the brain, but it was performed on Buddhist monks who were veterans of this practice. This study finds a mere two weeks of training can produce measurable results.

So if you long to be a warmer, more caring person (which, not incidentally, is good for your health), this research presents good news: At least to some extent, the choice is yours.

Your Greek yogurt just might be harming the planet, according to a story at Modern Farmer (which you should all be reading). So, Greek yogurt. You see it everywhere, and you probably even eat it, too. It’s healthy and tastes enough like nothing that you can make it taste good. But to make it healthy-enough, there’s a menacing byproduct called “acid whey.” As Justin Elliott writes:

For every three or four ounces of milk, Chobani and other companies can produce only one ounce of creamy Greek yogurt. The rest becomes acid whey. It’s a thin, runny waste product that can’t simply be dumped. Not only would that be illegal, but whey decomposition is toxic to the natural environment, robbing oxygen from streams and rivers. That could turn a waterway into what one expert calls a “dead sea,” destroying aquatic life over potentially large areas. Spills of cheese whey, a cousin of Greek yogurt whey, have killed tens of thousands of fish around the country in recent years.

This would maybe be OK—or still terrible, just on a tiny scale—if Greek yogurt wasn’t now Big Business.

The scale of the problem—or opportunity, depending on who you ask—is daunting. The $2 billion Greek yogurt market has become one of the biggest success stories in food over the past few years and total yogurt production in New York nearly tripled between 2007 and 2013. New plants continue to open all over the country. The Northeast alone, led by New York, produced more than 150 million gallons of acid whey last year, according to one estimate.

Greek yogurt companies are paying farmers to take some of the acid whey off their hands, and the farmers will feed it to cows or mix it in with fertilizer—but they can only do so much. A Cornell scientist also believes that it could be used in baby formula, but the scalability of that, too, is unclear. Others at the University of Wisconsin are working on ways to turn the acid into fructose. And one farmer is converting the acid into methane to then be used for energy, but he’s lost over a million dollars in the process.

Now go read the whole story. It’s great and contains the phrases “Yogurt Summit” and “the yogurt industry is highly secretive and competitive.”

And if you’re thinking, If Greek yogurt is such a huge industry, why can’t it help Greece’s economy?, well, Greek yogurt is “Greek” because it takes after the yogurt, which is traditional in Greece. Most of it, as the problems outlined in Elliott’s piece show, is produced in the U.S. Also: Greece has received over $300 billion in bailout funds, and things are still not all that great. Oh well!

UPDATE: Chobani sent me a statement on the acid whey issue. Here it is:

At Chobani, we are committed to being a good community partner. That includes finding responsible uses for whey, a natural byproduct of the process to create authentic strained Greek yogurt. We are constantly exploring the best ideas and options for beneficial whey use.

Right now, we choose to return whey to farmers, most of whom use it as a supplement to their livestock feed. Some is used as a land-applied fertilizer but only at farms that have nutrient management plans in place with the state environmental conservation agency. A small percentage is also sent to community digesters, where the whey is used to produce energy.