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Trump’s Choke Artist / Can AI Cure Cancer?

PAIN KILLERS

20.10.2017

How the VA fueled

THE OPIOID CRISIS and destroyed the lives of thousands of vets

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INTERNATIONAL EDITION

OCTOBER 20, 2017 _ VOL.169 _ NO.14

FEATURES PILL PILE­ON

BJARTE RE T TEDAL /GET T Y

Researchers in Texas found a nearly 400 percent rise in overdoses and suicidal behavior by Iraq and Afghanistan war veterans given too many psychotropic and opiate medications.

COVER CREDIT

Photograph by Levi Brown for Newsweek

16 Thank You for Your Service The VA killed thousands of vets and fueled the national opioid crisis by recklessly throwing pills at a problem

For more headlines, go to NEWSWEEK.COM

BY ART LEVINE

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EDITOR _ Bob Roe EXECUTIVE NEWS DIRECTOR _

INTERNATIONAL EDITION

OCTOBER 20, 2017 _ VOL.169 _ NO.14

Kenneth Li

CREATIVE DIRECTOR _ Michael Goesele NEWS DIRECTOR _ Cristina Silva DEPUTY EDITOR _ R.M. Schneiderman OPINION EDITOR _ Nicholas Wapshott

EDITORIAL

DEPARTMENTS In Focus

Periscope

04 Tehran, Iran

08 Politics

Burning Orange 06 Kuala Lumpur, CHARACTER TRAITS

The Walking Dead and Game of Thrones have been distilled into a triad of fascists (like Thrones’s Negan, below) vs. freedom fighters vs. the undead.

Mnuchin Impossible?

Malaysia Panda Express

11 India

Morovis, Puerto Rico Waiting to Exhale

14 Disruptive

Hawija, Iraq Smoke Show

Sacred Chow Samson’s Next Haircut

Breaking News Editor _ Gersh Kuntzman Acting London Bureau Chief _ Robert Galster National Editor _ John Seeley Politics Editor _ Matt Cooper Culture Editor _ Mary Kaye Schilling Science Editor _ Jessica Wapner Deputy Culture Editor _ Nicholas Loffredo Social Media Editors _ Adam Silvers,

Valeriia Voshchevska Senior Editor _ Siobhán Morrin Production Editor _ Jeff Perlah Copy Chief _ Elizabeth Rhodes Copy Editors _ Bruce Janicke, Kelly Rush, Joe Westerfield Associate Editor _ Eliza Gray Associate News Editor _ Orlando Crowcroft Contributing Editors _ Max Fraser, Owen Matthews, Matthew Sweet Executive Editor, TV, Film & Digital _ Teri Wagner Flynn Video Producer _ Jordan Saville ART + PHOTO

Horizons 34 Wildlife

Wisdom of the Flock 36 Medicine

The Artificial Miracle 38 Health

A Scarier Zika 41 Science

Little Big Problem Culture

Director of Photography _ Diane Rice Contributing Art Director _ Mike Bessire Associate Art Director _ Dwayne Bernard Digital Imaging Specialist _ Katy Lyness Production Manager _ Helen J. Russell WRITERS

Tufayel Ahmed, Meghan Bartels, Ryan Bort, Nina Burleigh, Anthony Cuthbertson, Teddy Cutler, Melina Delkic, Janissa Delzo, Janine Di Giovanni, Dana Dovey, Kurt Eichenwald, Sean Elder*, Jessica Firger, Joseph Frankel, Conor Gaffey, Emily Gandette, Julia Glum, John Haltiwanger, Michael Hayden, Kristin Hugo, Abigail Jones, Celeste Katz, Max Kutner, Jason Le Miere, Graham Lanktree, Josh Lowe, Sofia Lotto Persio, Tim Marcin, Melissa Matthews, Douglas Main*, Kevin Maney*, Jack Moore, Alexander Nazaryan, Tom O’Connor, Hannah Osborne, Callum Paton, Maria Perez, Tom Porter, Bill Powell, Greg Price, Chris Riotta, Tom Roddy, Winston Ross*, Linley Sanders, Josh Saul, Roberto Saviano*, Zach Schonfeld, Damien Sharkov, Kate Sheridan, Harriet Sinclair, Jeff Stein, Robert Valencia, Janice Williams, Stav Ziv (*Contributing)

42 Music

Young Man With a (Weird) Horn 44 Books

Super Petty 46 Television

Apocalypse Maybe 48 Parting Shot

Mohammad Javad Zarif

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In Focus

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THE NEWS IN PICTURES

O C T OBE R 20, 2017

TEHRAN, IRAN

EBR AHIM NO RO OZI/AP PHOTO

Burning Orange Talk about fire and fury. On September 27, mourners at a large state funeral burn a portrait of President Donald Trump. The deceased, Mohsen Hojaji, was a young soldier in Iran’s Revolutionary Guard who was beheaded by the Islamic State group (ISIS) in Syria.

The funeral came at a time of growing uncertainty between the U.S. and Iran over their nuclear accord. → E B R A H I M N O R O OZ I

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CO UNTERC LO C KWISE FROM TOP LEFT: VINC ENT T HIAN/AP PHOTO; R AMON ESPINOSA/AP PHOTO; REUTERS

In Focus

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O C T OBE R 20, 2017

KUALA LUMPUR, MALAYSIA

MOROVIS, PUERTO RICO

HAWIJA, IRAQ

Panda Express

Waiting to Exhale

Smoke Show

For the past two years, Nuan Nuan, seen here on October 5, has been living under special care at the Giant Panda Conservation Center. But this eucalyptus-loving cuddle monster will soon be freed to her natural habitat in China’s Sichuan province.

Her impending departure has been hard for her longtime caretaker, Dr. Mat Naim Ramli. “I took care of her at night,” he told The Straits Times. “I will visit her in China.”

The Puerto Rican National Guard delivers food and water on October 7. Weeks after Hurricane Maria hit, life has not returned to normal. In the countryside, food and water are scarce, and even in cities, the storm destroyed the power grid, forcing most to rely on generators. Those who can leave are moving to the United States.

As Jorge Duany, a professor at Florida International University, told The New York Times: “It’s going to be a stampede.”

Shiite militias run for cover during an attack by the Islamic State group near Hawija, Iraq, on September 30. The militants have earned a reputation for fierce fighting—and refusing to surrender. But that reputation is crumbling, much like the cities ISIS once held. As coalition troops continue to defeat the militants across Iraq and Syria, more and more of them are putting their weapons down.

The war, it seems, is almost over.

→ VINCENT THIAN

→ RAMON ESPINOSA

→ REUTERS

NEWSWEEK.COM

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Periscope

NEWS, OPINION + ANALYSIS

FORECLOSURE KING

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DREW ANGER ER/GET T Y

Changing the tax code is among the hardest jobs in Washington. But Mnuchin’s image problems have made his task even more difficult.

O C T OBE R 20, 2017

“I invested early in Google and Facebook. Now they terrify me.”» P.14

POLITICS

Mnuchin Impossible?

Steven Mnuchin wants to change the tax system, but the treasury secretary’s plan may self-destruct before the end of the year been working the Sunday news circuit, not only steven mnuchin is ac customed to advocating for the tax plan but—because loyalty criticism. For years, he was known as “the is so important to Trump—defending the presiforeclosure king” on Wall Street, where he amassed dent’s comments about NFL players taking a knee an estimated $300 million—much of it by profitduring the national anthem. “It’s almost like he’s ing from the Great Recession (after the fact). But the ventriloquist and the dummy at the same in August, just days after the deadly rally in Chartime,” chided The Daily Show’s Trevor Noah. lottesville, Virginia, Mnuchin—the U.S. treasury Mnuchin has been optimistic about passing secretary—faced unprecedented pressure from the embryonic plan to eliminate deductions and an unlikely source: his alma mater, Yale University. lower tax rates in hopes of stimulating economic President Donald Trump had equated the racist, tiki growth.

But changing the tax code is one of the torch–wielding extremists at the rally with those hardest things to do in Washington—and this who showed up to protest against them. And a group administration has failed at less arduous tasks— of 300 Yale alumni asked the treasury secretary, who such as repealing Obamacare. Changing the is Jewish, to resign. “You are better than this,” they tax system involves huge trade-offs, and you’re wrote. Mnuchin’s response? He defended Trump in bound to piss off one powerful group or anothglowing terms, vowing to stay on and “reform taxes.” er—from the real estate lobby to retirees.

The fight to change the tax code is the biggest Consider Tom Reed, a popular Republican issue facing Congress, and it will likely define the congressman from upstate New York. He sits on 54-year-old’s career in Washington. Mnuchin is the powerful House Ways and Means Committee, the administration’s point man on what has bewhich writes tax laws. When he spoke to Newsweek come a must-win issue for the president. Trump in early October, he had met with the treasury seccame into office with a Republican-controlled retary—and he was impressed with House and Senate, but he’s failed his dealmaking chops. But like many to persuade Congress to pass anylawmakers, the congressman is eager thing save for an embarrassingly BY to protect the deductions that are small number of confirmations important for his constituents— and stopgap spending measures. So MATTHEW COOPER like the ones for state and local now it falls to Mnuchin, who has @mattizcoop

NEWSWEEK.COM

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Periscope

POLITICS

taxes that are slated for elimination in the proposal. So if Mnuchin can’t find a way to offset enough of them, Reed and others may balk.

There is, however, precedent for Mnuchin to succeed. In 1986, James Baker, the secretary of the treasury under Ronald Reagan, guided a massive tax revision through Congress.

It not only passed with a wide majority but slashed rates and eliminated deductions. Baker provided tons of details to Congress about what he wanted in the plan. He was even present as the Ways and Means Committee marked up the bill.

Mnuchin almost certainly won’t be involved at that level. And the treasury secretary is starting from a weaker position than Baker. In 1984, Reagan won the most lopsided election in American history. One of his promises was to change the tax code, and it still took Baker and his predecessor, Donald Regan, two years to get the bill they wanted. Trump, won by a narrow margin and remains unpopular. He didn’t run on rewriting tax laws, and Mnuchin has been given only a few months to pass something viable.

Another disadvantage Mnuchin has: His tax proposal is a harder sell than Baker’s. The 1986 plan cut rates for individuals but largely raised them for businesses. Mnuchin’s—at least according to the outline the Trump team and GOP leaders released in September—is brimming with corporate tax cuts. Supporters note that the world economy is far more competitive than it was during the Reagan era, and with the U.S. corporate rate at 35 percent, many companies have relocated abroad or squirreled away money in foreign offices. Lowering corporate rates could help overall economic growth, but it’s sure to be less popular. In a recent

poll, only 39 percent of respondents said they wanted such a cut. And while Mnuchin’s plan does slash individual rates, the biggest breaks go to the very wealthy, while actually raising taxes on the poorest Americans, from 10 to 12 percent. Even Trump was reportedly angry about that, though he later seemed placated when he learned the proposal would double the standard deduction, in part to offset the higher rate.

Mnuchin has image problems that aren’t helping his tax effort. Over the summer, his wife had to apologize for lashing out at an Oregon mom who had criticized her on Instagram for bragging about designer clothes as she stepped off a taxpayerfunded jet. Later, it emerged that a top Mnuchin aide may have violated government ethics rules by accepting a private plane ride from a billionaire investor. And in the wake of Health and Human Services Secretary Tom Price’s resignation over his private charter travel, Mnuchin reportedly racked up $800,000 in trips on military aircraft. He had also inquired about using a government jet for his honeymoon (he ultimately paid his own way). None of this looks good for a man who bought subprime mortgage lender IndyMac for $1.6 billion in 2009 with a group of billionaire investors, then sold it more

10

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“It’s almost like [Mnuchin’s] the ventriloquist and the dummy at the same time.”

than double after profiting from foreclosures and loan modifications.

Private jet travel isn’t the treasury secretary’s only optics problem either. Mnuchin made boatloads of money in hedge funds, and one question about his plan is whether it will repeal the loophole that allows these funds to pay a low 15 percent rate on their massive earnings. During the campaign, Trump said he was for scrapping it—“The hedge fund guys are getting away with murder”—but ending the loophole wasn’t mentioned in Mnuchin’s outline.

Democrats will rejoice if the Trump team’s idea of “reform” means zillionaires get taxed at lower rates than their secretaries. And Mnuchin’s Treasury Department has made the optics worse. In September, it took a study down from its website showing that much of the corporate tax cut would wind up benefiting the wealthy.

Beset by criticism, the bill’s chances don’t look good. It can make it through the House, where Republicans have a wide majority. But it’s going to be harder in the Senate.

Rand Paul, the Kentucky Republican senator, has attacked Mnuchin’s outline for not cutting taxes enough.

GOP Senator Bob Corker of Tennessee is worried it would raise the deficit. And moderate Democrats, like Senator Joe Manchin of West Virginia, say the proposal is tilted too heavily in favor of the wealthy.

Mnuchin may wind up settling for a smaller, more modest plan— one that simply cuts taxes and eliminates deductions. It might not be the “reform” that Trump and his treasury secretary promised.

But at this point, getting anything through Congress would be a win for the White House.

O C T OBE R 20, 2017

INDIA

Sacred Chow In India, Hindu vigilantes are attacking Muslims in the name of protecting cows. So why won’t the government stop them?

ALL ISO N JOYCE/GET T Y

THE FOR HEIFER WAR Members of a vigilante group on a patrol for smugglers in Ramgarh, India, in November 2015.

in a barn in haryana, a state in northwest India, more than a dozen men are preparing for a night they might not survive. Around them stand injured heifers, many with broken limbs. The air reeks of urine and feces, and in a bowl on the ground, maggots writhe in rotting flesh a vet has cut from one of the cow’s wounds.

The men, however, are unfazed.

They call themselves the Gau Putra Sena, or the Son of Cow army, and their life’s mission is to protect cows.

In front of them stands their leader, a Hindu militant named Sampat Singh.

Tonight, he’s dressed in white and showing me two snub-nosed pistols under the dim lights. Soon he and his group will cluster along the nearby highways, stopping and inspecting trucks that might be carrying cows to slaughter. If the drivers refuse to cooperate, the vigilantes will chase them down and force them to stop—even if it means opening fire.

Doing so, Singh says, is simply a matter of upholding the law. In Haryana, as in most of India, it’s illegal to kill cows, an animal sacred in Hinduism. The state even forbids driv-

ers from transporting cows to legal slaughterhouses elsewhere in the country. Singh won’t tell me whether his men have ever shot anyone, but he says smugglers have deliberately run over and killed five of his men.

As the sky blackens, Singh and his men head for their cars. They’re ready to combat the smugglers. “Jai shri Ram,” they chant. “Victory to the god Rama.”

BY

HIGH STEAKS MIRREN GIDDA @MirrenGidda

In June, a data journalism organization called

NEWSWEEK.COM

11

Periscope

INDIA

IndiaSpend reported that vigilantes had killed at least 28 people since 2015. Many of the victims, the mobs claimed, were planning on killing or eating cows. Two months after IndiaSpend published its findings, a crowd killed two Muslim men who were transporting the sacred animals.

Of all the victims killed by the vigilantes, more than 80 percent are Muslim. Unlike Hinduism, Islam doesn’t prohibit eating cows, and among Hindu extremists, rumors have spread that Muslims are secretly killing the animals. Because Muslims dominate India’s buffalo meat industry, the largest in the world, Hindu extremists say they are using the facilities to slaughter cows—something the slaughterhouses deny.

Decades of bloodshed between followers of the two religions have only added to the tension. And as the cow-related violence has increased, organizations including Amnesty International and Human Rights Watch have condemned India’s government, saying it has encouraged the vigilantes by overlooking some of their crimes. The groups allege that some officials within the ruling, Hindu nationalist Bharatiya Janata Party (BJP) condone and support what the vigilantes do.

The BJP swept to victory in 2014, under the leadership of current Prime Minister Narendra Modi, who erroneously accused the previous government of ruining India’s dairy industry by providing subsidies to people who slaughtered cows. He promised to protect the country’s beloved bovines, and his rhetoric seemed to resonate with some voters.

A year after his victory, the vigilante killings began, and they’ve worsened.

One of the most brutal came on April 1, when a Muslim dairy farmer named Pehlu Khan was driving home

to Haryana with two milking cows in tow. Vigilantes stopped him and accused him of taking the animals to slaughter. Ignoring his papers, which showed he had permission to transport the animals, they attacked Khan and his two sons. Armed with belts and hockey sticks, they beat him so badly they broke 12 of his ribs. Footage taken by witnesses during the assault appears to show one of the attackers repeatedly kicking Khan in the head as he lay on the ground.

Some of the vigilantes grabbed a can of gasoline and prepared to set him on fire before police arrived and prevented a public burning. Two days later, Khan died in hospital.

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BUFFALO SOLDIERS

On our way to the checkpoint in Haryana, Singh, the vigilante leader, receives a call from another member of his group. They’d seen a truck, the man says, that appeared off balance, a sign that it might have been carrying animal cargo. The vigilantes tried to wave the vehicle down, but the driver had sped past, causing Singh’s men to chase after him and then block his path. Singh orders his driver to head toward the truck, which is parked by the side of the road near the checkpoint.

Within minutes, we arrive to see the sweating driver standing in front of it, sweating, surrounded by the vig-

Armed with belts and hockey sticks, they beat Khan so badly they broke 12 of his ribs.

ilantes. They shine their flashlights inside the truck. Seven buffaloes peer back—four adults and three calves crammed in between the van’s walls.

Singh walks over to the driver and questions him about the animals, asking for his identification papers. After a few minutes, Singh lets him go. “Next time you load them, do it carefully,” Singh adds, gesturing to the truck. “We wouldn’t want to have to react.”

The driver gets away, but others haven’t been so lucky. Cow vigilantes have beaten up people for legally taking buffaloes to slaughter, and even stolen the animals. Others have allegedly demanded bribes to allow drivers to pass. The repeated assaults have led to a reduction in trade at India’s buffalo markets, because drivers are afraid of vigilante violence.

Despite the threat they pose to this multibillion-dollar industry, India’s cow vigilantes often continue to act with impunity. In Haryana, where Singh operates, his men carry out their searches with official approval.

At a second checkpoint we visit, two policemen wait alongside the vigilantes, the blue lights of their patrol car flashing. They don’t seem bothered that the vigilantes are armed, and they do nothing to interrupt their work.

“All the checkpoints are designed with the help of police,” Singh says. “The Haryana police department completely supports us in this.”

Sometimes the authorities play an even more active role. Right after the attack on Khan, police charged him and his two sons with illegally transporting cows and causing them harm.

(Officers later filed charges against Khan’s attackers, arresting seven men, five of whom are out on bail.) A senior BJP official even tried to place some blame on the dead man. Gulab Chand Kataria, the home minister for Rajasthan—the state where Khan

O C T OBE R 20, 2017

COW­INCIDENCE?

CLO CK W IS E F RO M TO P: B U R HA AN K IN U/H IN DUSTAN TI M E S/GE T T Y; AL LI S ON J OYCE /G E T T Y; E NR IC O FA B IA N/ THE WASHI NGTO N PO ST/G E T T Y I MAG E S

Of all the victims killed by the vigilantes, more than 80 percent are Muslim. Unlike Hinduism, Islam doesn’t prohibit eating cows.

died—falsely accused him of being a cow smuggler and described the vigilantes’ actions as mere “manhandling.”

After heavy criticism, Kataria said the vigilantes were wrong to use violence but had good intentions.

Prime Minister Modi has criticized the cow-related violence. But he has been careful not to mention the high number of Muslims targeted in the attacks. His opponents say this omission is reminiscent of the Gujarat riots when Modi was chief minister of that state. On February 27, 2002, a train fire killed 57 Hindus, which Modi blamed on

Pakistan’s security services. Soon Hindu mobs rampaged through the state, attacking Muslims. Around 1,000 people died in the violence, for which many said Modi bore some responsibility. (The U.S. State Department banned him from entering the U.S. in 2005 because of his alleged role in the riots.) In 2013, Modi gave a controversial interview to Reuters in which he said he felt saddened by the attacks in the same way one would if he were in the passenger seat of a car that ran over a puppy.

Now that he is prime minister, Modi might be choosing his words

more cautiously, but critics say his antipathy toward Muslims is apparent.

(Modi did not respond to requests for comment.) In May, the government declared a nationwide ban on the sale of cattle for slaughter—a definition that includes cows, buffaloes and camels. (Opponents of the ban say the latter two animals were included so the BJP wasn’t accused of passing a religious law.) Two months later, the country’s Supreme Court blocked the legislation, saying it would affect the livelihoods of too many people— most of them Muslim. In response, the BJP announced it would redraft the bill and try to pass it again.

Critics of the ban say the government wrote it to appease its hard-line Hindu supporters who would like to see the destruction of India’s meat industry and the Muslims who profit from it. These Hindu nationalists helped Modi to victory in 2014. Now rumors are spreading among local media that Modi might hold India’s next general election in 2018, bringing it forward a year to capitalize on his strong approval ratings. If he does, he’ll be relying on his conservative base to carry him to another victory.

In Haryana, Modi can count on one man’s support. It’s 3 a.m., and Singh remains at the checkpoint, waiting with his men as the trucks continue to roll past. He’ll stay out for another hour before returning home to his wife and his 4-year-old daughter. Of all of India’s political parties, Singh believes only the BJP understands why he stays out till dawn. They are the only ones who will protect their sacred cows, and the people who defend them.

MIRREN GIDDA reported from India for Channel 4’s documentary series Unreported World. The episode on India’s cow vigilantes airs October 20.

NEWSWEEK.COM

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Periscope

DISRUPTIVE

Samson’s Next Haircut Blockchain might be the little engine that could topple Amazon, Apple, Facebook and Google

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NEWSWEEK.COM

Samson-like companies should tremble, because some new fringe technology is about to come at them with barber shears. In 1998, when the U.S. Justice Department brought antitrust charges against Microsoft, Bill Gates’s company utterly dominated desktop computing. By the time the antitrust suit was settled in 2001, early internet applications were gnawing at the supremacy of Microsoft’s Windows, Office and Explorer. Turns out Mi– crosoft would’ve been humbled if the government had done nothing.

Like then, it can be hard today to imagine how our mighty superpowers could be threatened. Apple reigns as the most valuable American company, and Alphabet, Facebook and Amazon are in the top six. Governments worry about their power: Google and Facebook were marched before Congress to testify about how their services might have been used to turn the last election in Donald Trump’s favor. Google is battling European Union antitrust rulings. Amazon gets accused of wrecking retailers such as Sears and Macy’s. Meanwhile, Franklin Foer’s new book, World Without Mind, captures the growing sense that the four “knowledge monopolies,” as he calls the companies, have all but subjugated humanity. “We are the screws and rivets in their grand design,” he writes.

No company is going to challenge much as many of us love any of the big four head-on. Microsoft Apple, Alphabet (née Google), proved the folly of that when it spent Facebook and Amazon, we’re increassomething like $10 billion trying to ingly hearing politicians, activists convince us to switch to its Bing search and even tech veterans say they have engine. Let me know if you ever hear turned into menacing monopolies. someone say they’ll settle an argument They are too powerful, know too much,

by Binging the topic. Instead, the conwillfully crush whole tender always arises industries and, apparfrom some perplexing technology favored by ently, can easily get hoodBY winked by Russians. the nerdiest nerds. Now Such fear and loaththat technology seems KEVIN MANEY ing means all those @kmaney to be blockchain.

O C T OBE R 20, 2017

LE E WO O D GATE/GET T Y (2)

Someone will set up a blockchain social network that gets all the rules right and becomes an attractive alternative to Facebook.

Over the past six months, technologists have come to believe that blockchain—a version of the tech that brought us bitcoin—can be used to build entirely new kinds of networked platforms, and these platforms can be embedded with incentives that could suck users, developers and partners out of the massive orbits of Apple, Alphabet, Facebook and Amazon.

Jeff Stewart, a partner in blockchain investment company Urgent, tells me to think of it this way: Apple, Alphabet, Facebook and Amazon each essentially created an economy. Users contribute something—like content, money (by buying stuff), personal information or thimblefuls of their souls—and get a service or product in return. Developers build apps in the economy; retailers sell stuff; brands advertise.

A whole lot happens to enable commerce within that economy, but the company that built it sets the rules, decides what apps or partners live or die, reveals only what it wants to or legally must—and then reaps almost all of the rewards. In one sense, these economies are fantastic. Who among us wants to give up the gadgets, instant answers, long-lost friends and cheaply delivered stuff brought to us by the four giants? Yet this model super-concentrates power and wealth, and that can be harmful—like, for instance, if we want a healthy middle class.

Blockchain holds the promise of building similar economies that are more like cooperatives—owned by

all who participate or invest. A blockchain is a set of operational rules, encoded in software. The rules can handle transactions and contracts, set up so that if I do something to contribute, I automatically get something in return. The blockchain is run on computers all over the world, coordinated by the rules in the software—it’s not trapped in one company’s data centers. This is how bitcoin works. No one owns or controls the bitcoin ecosystem. The software runs on machines distributed everywhere and keeps track of every transaction.

Let’s say you wanted to create a blockchain social network to rival Facebook. Some people might use their computers to help run the system, and they’d get paid for that. If you put up content, you’d get paid for that.

If you buy ads, you’d pay for them with digital currency that would then flow to the contributors. “Now you have a bunch of people incented to make this ecosystem work and contribute to it, opening up innovation,” Stewart

says. Oh, and if you create some app or service that catches on, there’s no overlord that might decide it will offer the same thing and destroy you.

Such a collective version of Facebook, the thinking goes, would give users and developers more control.

You could set your own rules on how much privacy to give up, or how much you’d get paid by every person who listens to the music you post. At some point, someone will set up a blockchain social network that gets all the rules right and becomes an attractive alternative to Facebook.

Can an online collective work?

That’s how Wikipedia got built. If it had been set up in the blockchain era, it could’ve had rules that let editors and writers get paid, perhaps charging users a penny for each article read and automatically dispersing the funds.

This year, there’s been markedly more activity around blockchain economies. Stewart and others have set up funds to invest in them. In October, a company called Steemit launched a blockchain-based system for published content. Each story can be attached to its own set of rules for how much the author will get paid and other rewards for, say, curating or sharing the content. Much more like Steemit is coming. If you Google (or Bing!) “blockchain news,” you’ll see experiments popping up in Ukraine, Bahrain, China, Malta and across industries from banking to sports.

None of these are going to leave any big-tech CEOs homeless on San Francisco’s Market Street. All these years after getting chastened by antitrust actions and the internet, Bill Gates is still a multibillionaire, and Microsoft remains one of America’s most valuable companies. But in technology, hegemony never lasts, and somewhere out in the blockchain universe, the revolution is incubating.

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OPIOIDS

L AT E O N E SU M M E R N I G H T I N 2 0 1 4 , K E V I N K E L L E R B RO K E I N TO H I S B E ST F R I E N D ’S H O M E .

Keller was a U.S. Navy vet wracked with constant pain, and because his right arm had been crippled by a stroke, he had to use his left hand to scrawl a note of apology to his buddy: “Marty, Sorry I broke into your house and took your gun to end the pain! FU VA!!! Can’t take it anymore.” He then drove to his nearby Veterans Affairs outpatient clinic in Wytheville, Virginia, and pounded on the locked doors of the medical office, probably out of frustration or as a final protest, since the facility had been closed for hours. Keller then put the barrel of his friend’s 9 mm pistol to his head and shot himself.

Grieving friends told The Roanoke Times that Keller couldn’t handle how the VA was weaning him off painkillers. His doctors had told him cutting back would extend his life, but Marty Austin, whose gun Keller stole that night, told the paper, “He did not want a longer life if he was going to be miserable and couldn’t do anything because of the pain.”

Suicides like Keller’s and the widespread despair behind them are yet another tragic element of a national opioid crisis blamed for most of the 64,000 fatal drug overdoses a year. Opioids, mostly illegally obtained counterfeit pills and heroin, now account for 63 percent of all drug deaths in the U.S., with fatalities climbing at an astounding rate of nearly 20 percent a year. In fact, the estimated number of drug deaths in 2016 topped the total number of soldiers killed in the Iraq and Vietnam wars. There’s a grim irony in that statistic, because the Department of Veterans Affairs has played a little-discussed role in fueling the opioid epidemic that is killing civilians and veterans alike. In 2011, veterans were twice as likely to die from accidental opioid overdoses as non-veterans. One reason, as an exhaustive Newsweek investigation—based on this reporter’s book, Mental Health, Inc.—found, is that for over a decade, the VA recklessly overprescribed opiates and psychiatric medications. Since mid-2012, though, it has swung dangerously in the other direction, ordering a drastic cutback of opioids for chronic pain patients, but it is bungling that program and again putting veterans at risk. (It has also left untouched one of the riskiest classes of medications, antipsychotics— prescribed overwhelmingly for uses that aren’t

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I am going CRAZY because of the pain and burning up with anger at the VA.”

approved by the Food and Drug Administration (FDA), such as with post-traumatic stress disorder.)

A key role in spreading opiate use was played by Purdue Pharma, the OxyContin manufacturer convicted of hiding the drug’s addictive properties. It gave $200,000 to the VA pain management team that essentially turned the VA into its propaganda arm, according to secret corporate documents obtained

by Newsweek. The team helped develop the initial VA– Department of Defense guidelines that concluded opiates “rarely” cause addiction. A 2001 budget plan outlining Purdue’s marketing schemes hailed “additional corporate initiatives and partnering efforts [that] were very successful with the Veterans Administration” and other major health organizations in promoting the phony campaign, “Pain: The 5th Vital Sign.”

Today, the number of patients affected by the VA’s swinging opiate pendulum is staggering: 60 percent of veterans who fought in the Middle East and 50 percent of older veterans have chronic pain. Since 2012, though, there has been a 56 percent drop to a mere 53,000 chronic pain VA patients receiving opioids—leading to swift, mandated cutoffs regardless of patient well-being and with virtually no evidence that it’s a safe approach. For a taste of the kind of indifferent care vets with chronic pain are getting, consider Marine veteran Robert Rose. He is now mostly confined to a wheelchair, suffering from severe spine, neck and knee injuries from his military service—but until he was cut off from opioid pain medications last year (despite not abusing them), he didn’t need a wheelchair and was able to play with his grandkids and build finely crafted woodworks. The primary care

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PAINFUL GOODBYE

Austin, above, lost his best friend, Keller, when he took his own life in July, leaving behind a suicide note, left. Keller apparently couldn’t handle how the VA was weaning him off painkillers.

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‘Don’t Fix the Problems’ in a ceremony in the east room of the white House in late June, President Donald Trump signed a law making it easier for the Department of Veterans Affairs to remove bad employees and protect

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BITTER PILLS

The parents of Simcakoski show a text from their son. At right, his wife and daughter. A former Marine, Simcakoski was taking 16 different VA-prescribed drugs before he died.

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DA RR E N HAU CK /C E NT E R F O R INV E STI G AT IVE R E PO RT IN G (3)

doctor at the Mountain Home, Tennessee, VA Medical Center told a hobbled, diabetic Rose and his wife during an office visit in May, “You should continue smoking, as it will help you with the stress and frustrations you are dealing with now. And you should continue to drink Mountain Dew, as the sugar molecules will attach to the pain receptors and block the pain you are experiencing without pain medications.”

Rose is ignoring that advice and raging against how he and other veterans are being treated—and mistreated: “I am going crazy because of the pain and burning up with anger at the VA, the [Centers for Disease Control and Prevention] and [the Drug Enforcement Administration (DEA)] for what they’re doing to so many Americans and veterans.”

whistleblowers. He was joined by his new Veterans Affairs secretary, Dr. David Shulkin, and Sergeant Michael Verado, who lost his left arm and leg to an improvised explosive device in Afghanistan in 2010, but had to wait 57 days for a properly fitted prosthetic and over three years for the VA to correctly equip his home with accessibility equipment—making him a living symbol of the agency’s wait-time scandals.

“In just a short time, we’ve already achieved transformative change at the VA—and believe me, we’re just getting started,” the president declared.

“For many years, the government failed to keep its promise to our veterans. Veterans were put on secret waitlists, given the wrong medication, given the bad treatments and ignored in moments of crisis for them. Many veterans died waiting for a simple doctor’s appointment. Yet some of the employees involved in those scandals remained on the payrolls….

Today, we are finally changing those laws to help make sure that the scandal of what we suffered so recently never, ever happens again—and that our veterans can get the care they so richly deserve.”

To some VA critics, Trump’s selection of Shulkin to head the agency makes it unlikely that significant changes will be made. “For veterans who voted for Donald Trump, this is going to feel like a bait and switch,” says Benjamin Krause, founder of DisabledVeterans.org. “Keeping Shulkin will keep a host of flunkies and criminals who should have been part of the whole ‘drain the swamp’ promise.”

The fetid VA swamp has been spreading for years under the last three VA secretaries, including Shulkin. It’s an institution long notorious for vicious retaliation against whistleblowers and a penchant for falsehoods, obfuscation and delay, as well as rampant cover-ups of unsafe and sometimes deadly conditions—or even fraud—by the VA’s watchdog agencies. This is all kept from view by what some longtime employees call “the code”— the institutional silence and protection offered wrongdoers. Likening it to the mob’s “omertà,” one high-ranking VA administrator, who insisted on anonymity, tells Newsweek, “You don’t break ‘the code,’ or your career is over…. It’s a fearful environment.”

“The code,” that VA official says, “is designed to do this: don’t fix the problems.”

Shulkin’s media office declined repeated requests for an interview with the VA secretary by this reporter to discuss the rampant problems at the

OPIOIDS

VA, but he has made some progress in cleaning up the department—while demonstrating a shrewd feel for public relations. The Boston Globe reported in mid-July that the highly rated (by the VA) Manchester, New Hampshire, VA hospital had to close an operating room because exterminators couldn’t get rid of flies, and thousands of patients couldn’t make appointments for vital, sometimes life-saving, treatments because of a breakdown in scheduling specialized care outside the VA. Whistleblowers had been complaining about this for years, to no avail, but a few hours after the Globe story broke, Shulkin removed the two top administrators.

But even this response was more symbolic than substantive. Many other shocking abuses have been ignored by Shulkin and his predecessors. In 2016, 34 whistleblowers turned to the Scripps News Washington Bureau and its Cincinnati TV affiliate, WCPO, to report such problems as surgeons allegedly being pressured to use blood- and bone-splattered instruments as “sterilized” by the Cincinnati VA hospital’s then–acting chief of staff, Dr. Barbara Temeck. Those complaints were backed by hundreds of dangerous incidents chronicled in internal documents given to Scripps. (Temeck has denied the allegations, although she was demoted after Scripps

They are essentially prescribing HEROIN pills.”

reported that she improperly prescribed opiates to the wife of her regional supervisor.) The VA’s investigators didn’t interview any of the whistleblowers quoted in the press and concluded that there were no safety problems at that VA Medical Center, a position Shulkin’s VA still holds.

All told, nearly 2,000 VA whistleblowers were forced in fiscal year 2016 alone to appeal to an independent federal agency, the Office of Special Counsel (OSC), to protest retaliation while reporting fraud or unsafe conditions—more than the next four problematic federal departments combined. As The Boston Globe reported in September, these employee complaints included nursing home residents at the Bedford, Massachusetts, Veterans Affairs Medical Center allegedly being starved of food for hours or left to lie naked in bed amid the squalor of soiled sheets.

Shulkin has established a new office given a mandate to protect whistleblowers, but that hasn’t yet halted the retaliation. “I don’t know of a single instance when a VA employee has been held accountable for harassing whistleblowers,” says Krause.

This turf-protecting has perhaps been most apparent in the VA’s belated response to the national opiate crisis it helped usher in. The VA doesn’t even keep an accurate count of how many veterans have died of legal or illegal drug overdoses, even though it officially launched an Opioid Safety Initiative in 2013 that has brought the VA’s opiate prescribing down 30 percent. Nor does it regularly monitor opiate use by its patients who seek legal or illegal drugs outside the VA. The VA overmedication epidemic, which wasn’t on the reform priorities list Shulkin released in May, has become especially urgent because of its apparent link to the 20 suicides a day of veterans in the U.S. Even those earlier VA figures may be a gross understatement. When the VA released in September state-by-state data, it showed, for example, that Arizona had a suicide rate as high as 53.6 per 100,000 across all age groups, nearly 40 percent higher than what the VA was reporting nationally.

These troubling suicide rates—at least double the civilian rate—haven’t been stemmed by all the VA’s suicide-prevention efforts (including the slowly improving crisis line, 1-800-723-8255). For Arizona veterans between 18 and 34, the suicide rate was an astonishing 76.8 per 100,000, twice as high as the national rate for all veterans. The average

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THE PAIN MERCHANTS

For over a decade, the VA recklessly overprescribed opiates. Since mid-2012, it has swung dangerously in the other direction, ordering a drastic cutback of opioids for chronic pain patients, again putting veterans at risk.

DA RR E N HAU CK /C E NT E R F O R INV E STI G AT IVE R E PO RT IN G

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suicide rates were especially high in some rural areas across the country, the new VA report said.

Even if the VA has done relatively little to reform prescribing, it’s becoming more evident that medications play some role in all these tragedies. For instance, a 2016 study by researchers at the South Texas Veterans Healthcare System found a nearly 400 percent increase in overdoses and suicidal behavior by Iraq and Afghanistan war veterans given too many psychotropic and opiate medications, a practice known as “polypharmacy”—receiving five or more drugs affecting the central nervous system. Another recent study of veterans’ suicides between 2004 and 2009 found that the suicide rate was twice as high for those patients receiving the highest doses of opioids compared to low doses, although no causal link was established for the meds.

This drug free-for-all has gotten so bad that Republican Senator John McCain of Arizona reintroduced a bill called the Veterans Overmedication Prevention Act. It demands that the VA commission an independent study to analyze all the suicides and accidental overdoses of veterans who have died in the last five years, and itemize all medications they received. McCain said in May that the ultimate goal is to “ensure doctors develop safe and effective treatment plans for their veteran patients.” Given the reality of today’s VA and its past failures, that worthy goal seems unlikely to be achieved anytime soon.

The VA hasn’t fully acknowledged its role in the alarming opiate addiction rates among veterans. A 2012 JAMA (formerly the Journal of the American Medical Association) study showed that veterans with mental health disorders and PTSD were three times more likely to receive opioids for pain diagnoses than other veterans. “They are essentially prescribing heroin pills; the effects of these opiates are indistinguishable from heroin, and the VA jumped on this campaign to encourage highly addictive prescribing,” says Dr. Andrew Kolodny, co-director of Brandeis University’s Opioid Policy Research Collaborative. In Huntington, West Virginia, a city so gripped by addiction that 28 people overdosed from heroin in a four-hour period last year, the local VA prescribes take-home opiates to roughly 18 percent of its patients—a rate that’s about 230 percent higher than the national average for all adult male patients. When told about this figure, Kolodny said, after a shocked pause, “Wow!

These are medically caused ADDICTIONS by the VA. The chickens are coming home to roost.”

That’s very problematic.” He then added, “These are iatrogenic—medically caused—addictions by the VA. The chickens are coming home to roost.”

In West Virginia and most other states, the VA worsened the nation’s opioid crisis by essentially ignoring it—the VA didn’t even start reporting all patients getting opiates to state databases until the end of 2015, a delay that allowed those patients to do more doctor-shopping and drug-dealing to and with civilians. VA pharmacies were finally compelled to share prescribing records by a federal opioid abuse law passed in July 2016, but by the end of last year, 18 state VA programs still weren’t reporting.

In May 2016, the board chairman of the American Academy of Family Physicians wrote a letter to Shulkin, then head of the VA’s health agency, the Veterans Health Administration, pleading for the department to impose mandatory opiate reporting on all VA programs. Speaking more than a year later, the AAFP’s president, Dr. John Meigs, tells Newsweek his organization has still not heard back from Shulkin or anyone else at the VA. “Prescription drug– monitoring programs are among the important vehicles for preventing patients from abusing opioid medications and, as such, are a cornerstone of the American Academy of Family Physicians’ advocacy on dealing with this epidemic,” he declares.

The disaster is likely to worsen under the Trump administration because of its assaults on Medicaid and Obamacare; this affects veterans as well, since fewer than half of the nation’s 22 million veterans receive their care from the VA. (In late August, the administration left no doubt it wanted to destroy the Obamacare marketplaces by announcing it would cut by 90 percent the advertising needed to promote enrollment and slash funds by 40 percent for helpful “navigators” to help people sign up for the program.) Nearly as troubling, the looming denial of care is aggravated by the suicides, overdoses and illegal use of opioids that are all compounded by draconian new federal pain medication restrictions on chronic pain patients. So when New Jersey Governor Chris Christie’s federal opioid commission released its initial report at the end of July calling for swift federal action, his home state newspaper, the Newark Star-Ledger, pointed to the ”elephant in the room.… The obvious fact that Donald Trump’s team is striving as hard as it can to gut Medicaid and make it even more difficult to get

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treatment.” (Trump referred to the opioid crisis as a “national emergency” on August 10, but the federal government hasn’t yet taken the steps needed to invoke emergency powers that could allow for more spending or loosen bureaucratic restrictions on providing medication-assisted addiction treatment, such as Suboxone, which cuts overdose fatalities.)

‘What if He Were Your Son?’ in 2013, after the center for investigative reporting (CIR) exposed skyrocketing rates of opiate prescribing by the VA, some of its physicians told a House veterans subcommittee they were pressured to prescribe the addictive painkillers—even to patients they hadn’t examined. Dr. Pamela Gray, a primary care physician fired from the Hampton, Virginia, VA hospital, said, “There are multiple instances when I have been coerced or even ordered to write for Schedule 2 narcotics when it was against my medical judgment.” VA officials deny there were any systemic problems in their prescribing practices, yet in May 2014, the VA inspector general found that clinicians were ignoring guidelines for safe take-home opiate prescribing, with one out of 10 chronic pain opioid users also receiving benzodiazepines in the course of a year—and 92 percent got them at the same time. This is a flagrantly dangerous mixture that the federal government flagged as a lethal combination—while the FDA has recently added new warnings that it could cause “respiratory depression, coma and death.”

And that’s what happened to Marine Corps veteran Jason Simcakoski, who was taking 16 different VA-prescribed opiates, benzodiazepines, an antipsychotic and other sedating drugs before he died. By the time he checked himself into the Tomah, Wisconsin, VA’s inpatient psychiatric unit in the summer of 2014 for help with anxiety and a pill addiction, VA leadership had known for years that there were deadly overprescribing problems there. But they didn’t begin to address the crisis until the CIR broke this story in January 2015: “Opiates handed out like candy to ‘doped-up’ veterans at Wisconsin VA,” leading to the deaths of over 30 veterans. The story laid out how opiate prescribing had quintupled since Dr. Michael Houlihan—nicknamed by vets “the Candy Man”—became chief of staff in 2005, while the number of patients served dropped. Nationwide, opiate prescribing increased

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Veterans died of drug overdoses at TWICE the rate of civilians.”

270 percent across the VA system since 9/11, CIR discovered, while the patient load had increased less than 40 percent by 2013. The latest guidelines at the time for sensible opiate prescribing were routinely ignored at Tomah and many other VA facilities, and Houlihan’s reckless prescribing was exacerbated by his penchant for terrorizing any clinician and staffer who opposed him. This was especially notable in his firing of a psychologist who had objected to the excessive doping of patients, then faced relentless harassment from his supervisor—and later killed himself after he lost his job.

Noelle Johnson, a Veterans Affairs pharmacist fired from Tomah after she refused to fill highdosage opiate prescriptions, notes that the VA’s archaic software didn’t flag any dosage or interaction warnings for the 1,080 morphine pills in 30 days she was pressured to prescribe a patient with “psychological pain.” She says, “My bosses tried to strong-arm pharmacists.” She adds that she got the same kind of pressure at her new post with the Des Moines, Iowa, VA. Although it was obvious that Jason Simcakoski was an addict, the VA kept shipping him bagfuls of opiates and benzos and antipsychotics, and he was also dosed with the stimulants Adderall and Ritalin, which worsened his mood, behavior and insomnia. His doctors prescribed those for a questionable diagnosis of attention deficit hyperactivity disorder, just one of at least a dozen or so diagnoses slapped on him over the years, along with bipolar personality disorder and PTSD. “With all these medications, he went downhill real fast,” says Jason’s father, Marvin Simcakoski.

His weight ballooned from 180 to 250 pounds, and he was too ashamed to go into a restaurant on those rare days he went into town—he’d only order food from drive-thru windows. Near the end, he couldn’t even bend down to tie his shoes.

When Jason died in August 2014 of what the local medical examiner called “mixed drug toxicity,” he had just been obeying his doctors’ orders: He was already taking 14 different medications, including high-risk opiates, benzodiazepine tranquilizers and the sedating antipsychotic Seroquel. Yet just two days before his death, Jason was also given Suboxone, an opiate typically used to reduce dependence on other narcotics. This was soon followed by a powerful migraine medication, Fioricet, that posed

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THE GRAVELY ILL

A soldier in places ags at graves in Arlington National Cemetery. The VA doesn’t even keep an accurate count of how many veterans have died of legal or illegal drug overdoses.

a risk of respiratory failure or death when combined with Suboxone and several of his other drugs. He was ingesting this drug cornucopia despite the well-known dangers of potentially fatal interactions between Suboxone and all three benzodiazepines he was taking—Valium, Restoril and Serax—and with some of his other high-risk medications.

Marvin Simcakoski told a joint congressional field hearing on the Tomah scandal in March 2015 that he’d spent years trying to save his son, but he says his fears were dismissed by VA doctors as ignorant second-guessing. “I was always told that I wasn’t their patient, even though I was his dad, who truly cared about him a lot more than they did!”

His voice quaking with an anger, he added, “What I would like to know is, if Jason was their son, would they have had him on all of these meds?”

After that congressional hearing, the VA announced it was conducting a criminal investigation; that probe and other investigations led to a few Tomah medical officials getting vilified in the press, and eventually facing employment sanctions. Houlihan was fired more than a year after Jason died, but he was practicing medicine until January 2017, when he agreed to surrender his license as part of a deal with state regulators to drop their investigation of him.

Jason’s father and widow took their campaign against the VA’s medication practices to D.C. They worked with Democratic Senator Tammy Baldwin of Wisconsin on legislation to curb and monitor opiate overprescribing, and appeared at a news conference in June 2015. The Jason Simcakoski Memorial Opioid Safety Act was signed into law in July 2016.

Heather hopes the bill will save lives, but she and other VA critics know there are weaknesses in the new plan to rein in overmedication: weak oversight of staff, worsened by the VA’s electronic records and drug-interaction alerts that too often fail to work, and on-screen drug warnings that are widely ignored. In 2015, the VA paid over $1 million to the widow of former paratrooper Ricky Green, who died after getting his opiates and tranquilizer dosages cranked way up after back surgery. The VA pharmacists admitted under oath that their software hadn’t flagged the higher dosages or that Green had a sleep apnea condition that fatally interacts with the drugs.

The VA’s entire make-shift health software system—known as VistA—is so bad Shulkin announced in June that the VA was purchasing a brand-new

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MALIGN NEGLECT

The VA’s overmedication epidemic wasn’t on the list of reform priorities Shulkin, above, released in May. And the disaster is likely to worsen under the Trump administration because of its assaults on Medicaid and Obamacare.

BREAKING THE CODE

In VA hospitals all over the country, dissidents such as Marine Corps veteran Coleman, right, with his children, are still punished for trying to save lives or fight fraud.

commercial system at an estimated cost of $16 billion; it’s based on one recently bought by the Defense Department so that, in part, as their electronic health records are rolled out, they can be shared seamlessly, but that won’t necessarily fix the problems with the VA’s pharmacy software. Even more troubling, Chris Miller, the department’s executive in charge of modernizing the Pentagon’s software using the same contractor as the one hired by the VA was then sent over to advise the VA, but he fled, appalled over mismanagement, within weeks of his appointment in early June. “The people problems are not resolved and the user problems are not resolved just because you have a new tool coming on board,” a VA official says. “The people problems are at the core of the demise of the VA.” That’s one reason no one knows how many vets have been killed by accidental prescription overdoses in the past decade, although a handful of rigorous studies suggest the death toll is in the thousands. One of the very few scholarly reports

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on accidental overdose deaths of veterans, done

by University of Michigan and VA researcher Amy Bohnert in 2011, used 2005 data to conclude that 1,013 patients receiving VA services died annually through unintentional overdoses, mostly from prescription medications. At that time, legal opioids, present in nearly a third of the accidental overdose deaths, were the most common substances involved, while non-narcotic psychiatric drugs and sedatives were involved in 22 percent of the deaths she studied. (Across all civilian and military populations, legitimately manufactured opioid medications account now for only 15 percent of opioid fatalities.) When the Austin-American Statesman looked at Texas records in 2012, nearly 20 percent of all deaths of veterans getting VA benefits they studied were due to mostly accidental overdoses of prescription drugs—not from suicides.

Despite the Tomah and other tragedies, veterans continued to die from overdoses in VA hospitals and residential treatment facilities, sometimes abetted by drug-peddling employees—while the agency failed to accurately track the drug-related deaths of veterans. The Lowell Sun reported last year that two veterans grappling with addictions who lived in VA residential facilities in Massachusetts died of opiate overdoses within weeks of each other. Their deaths are now the focus of a VA criminal investigation into drug dealing by a ring of employees and patients at the hospital. Administrators initially denied anything was amiss, and the AfricanAmerican whistleblower who helped expose the alleged drug ring revealed in February that he had been demoted, and harassed by colleagues—including finding on his desk a teddy bear with a noose around its neck and the sign, “Go home or die.”

The one thing the VA is very good at is throwing PILLS at the problem.”

opiate medication use among veterans, as well as suicides from pain-wracked veterans in poorly monitored withdrawal. (Even with new opioid guidelines, the number of veterans with opioid-use disorders increased 55 percent from 2010 to 2015.)

Although the VA boasts that those tougher guidelines have led to a decline of nearly a third in opiate prescribing, it doesn’t track veterans who have turned to heroin and illegal prescriptions as a result of the cutbacks—or notice the devastation this crackdown is causing. It has become increasingly clear that too many VA doctors are focusing on taking patients off opioids without offering appropriate addiction counseling or addressing how they’re needlessly hurting all the chronic pain patients they’re taking off these meds. “They’re not focusing on patientcentered care; they’re focusing on numbers,” one VA staffer says. At one point, this employee says, a doctor in a major VA medical center was spotted crying in the hallway because he was obligated by administrative fiat to kick a chronic pain patient off opioids in a way that he knew would hurt his patient.

Even when patients realize they’re endangering themselves, the VA’s clinicians too often don’t offer much meaningful help. Take Mallory Dinkel, an Air Force infantry soldier who had her leg and hips

Lethal Cutbacks following the tomah overprescribing scandal, the VA said it would follow tougher new DEA guidelines on opiate prescribing that, some advocates say, harm patients with legitimate pain issues. That’s in part because those patients are now required to see their doctors in person once a month for refills—a near-impossible task because of the backlog and delays throughout the VA system. Equally troubling, the crackdown on opiate prescribing—a swing from one dangerous extreme to another—may be contributing to an increase in heroin and illegal

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severely damaged in an attack on her Humvee in Kuwait in 2004, but returned for multiple combat tours in Iraq before being medically discharged in 2013. Grappling with PTSD and a poorly understood form of chronic pain, complex regional pain syndrome, she stepped up her rotating use of prescription morphine, Percocet and other drugs until she was forced in January 2016 to quickly unwind all opioids. “It was awful: I was constantly vomiting, sweating, having migraines and getting the shakes,” she says, unable to move from her couch for two weeks except to crawl to the bathroom. “Nothing was mentioned about addiction, and I didn’t get treatment.” All she got before going cold turkey on her own—despite the risks of sudden withdrawal without medically supervised tapering—were two one-hour classes on the dangers of opiates and how to inject herself with naloxone to prevent overdoses. “The VA didn’t do a thing,” she says, turning to costly, unproven ketamine infusion treatment for depression and pain relief through a family friend’s center that she can no longer afford. “I’m battling on my own now.”

Can’t Stop, Won’t Stop the callous indifference of both the va and Congress to the overmedication crisis has only recently started to change, and that’s just for opiates, not antipsychotics. What has gotten worse in the last decade is the VA’s determination to hide the truth. The Senate governmental affairs committee’s Republican majority, for instance, concluded in May 2016 about the Tomah VA Medical Center debacle: “The overprescription, retaliation, veterans’ deaths, and abuse of authority at the Tomah VAMC did not occur in a vacuum. Veterans, employees, and whistleblowers tried for years to get someone to address the problems. The Tomah VAMC is a microcosm of both the VA’s cultural problems with respect to whistleblower retaliation and the VA Office of Inspector General’s disregard for whistleblowers.”

These whistleblowers are notably skeptical about the various reform and accountability gestures such as public waiting lists offered by Shulkin. Take Shea Wilkes, then a mental health administrator at the Shreveport, Louisiana, VA hospital who was busted back down to social worker after, in 2014, he exposed 37 wait-time deaths among those people on a secret mental health waiting list of 2,700 patients. While noting that the VA has now seem-

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You don’t break the ‘code,’ or your career is over...

It’s a FEARFUL environment.”

ingly been able to provide some same-day crisis mental health services, as promised, he says that all too often patients can’t get prompt, regular counseling: “The one thing the VA is very good at is throwing at the problem.”

In VA hospitals all over the country, dissidents such as Brandon Coleman are still punished for trying to save lives or fight fraud. He is a bearded, blunt-talking addiction therapist formerly with the Phoenix VA and a disabled Marine Corps veteran who severely shattered the bones of his left foot during a training accident at Camp Pendleton that led to nine failed surgeries, and he felt he had to file a formal federal whistleblower complaint in December 2014 over the maltreatment of veterans at that notorious VA hospital. With his past as a meth addict who came close to shooting himself in 2005, he was alarmed that the understaffed ER was allowing suicidal or homicidal patients in crisis—often brought over by addiction counselors—to simply wander off. One patient killed himself in the parking lot after being ignored by the staff.

“It crushes me when a veteran successfully commits suicide,” he says—and since 2011, at least six of the addicts he counseled killed themselves before he was pushed out of his job early in 2015. “There are

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OPIOIDS

dozens and dozens who commit suicide in the Phoenix area each year,” Coleman says. After going public with his concerns in January 2015, a specialized yearlong outpatient program he ran in the evenings for addicted veterans with criminal convictions was shut down by Phoenix VA administrators, he was forced to take administrative leave, and he was investigated for purportedly threatening a colleague.

In May 2016, the independent OSC sided with Coleman. It gave him a generous financial settlement that allowed him to pay off all his debts and help his kids buy a home and cars. He was reinstated as an addiction specialist at an outpatient clinic unaffiliated with the Phoenix system, and he was able to restart his life-changing program for addicted vets.

During more than a year of forced leave, he became an informal leader of the nation’s countless VA whistleblowers. He sums up his travails this way: “I kicked the VA in the nuts, and I won my case.” Today, he rides around in a prized new classic car, a blue 1968 Mustang, with a license plate that reads, “THX VA.” Coleman may now be in a position to stop the abuse of whistleblowers—he’s a staff member of the new VA whistleblower protection office. While his appointment is perhaps the most positive indicator yet that the VA might try to reform, that’s a heavy

THE CANDY STORE

A view of the VA hospital in Tomah, Wisconsin.

The VA didn’t even start reporting all patients getting opiates to state databases until the end of 2015.

burden to place on him. He’s gotten well over 50 calls and emails from desperate staffers turning to him for help since his appointment was announced.

For example, one new test case Coleman and his colleagues are reviewing involves an MIT-trained Tomah VA engineer, Jae Pak, who was fired after trying to halt an allegedly shoddy, unsafe series of delayed hospital repair projects—by a company friendly with administrators—that were way over budget.

He faced a spurious disorderly conduct charge (the case was dismissed). Equally troubling, critics say, he was forced out under the watch of a new Tomah hospital director, Victoria Brahm, and a new regional VA chief, Renee Oshinski, who both, while at regional headquarters allegedly downplayed for nearly a decade the prescribing and retaliation campaign led by Houlihan, Senate investigators found; the officials claimed they responded appropriately.

One added weapon for reform could be a new bill moving slowly through Congress designed to quickly discipline or remove administrators who harass whistleblowers. It is named after Christopher Kirkpatrick, the psychologist who killed himself after being driven out of his job at Tomah for protesting deadly prescribing.

For now, patients at VA sites such as the Phoenix and St. Louis hospitals (where the chief of psychiatry, Dr. Jose Mathews, was forced out in 2013 after reporting that suicidal patients were ignored by staff) continue to see honest, dedicated clinicians and other employees get punished.

What Coleman will do about such alleged retaliation and cover-ups remains to be seen. With a quick search on Google News, it seems there’s a new retaliation or health scandal reported every few days, although most never get much media attention. So even before Coleman’s appointment was publicly announced, he told Newsweek: “I still get two to four calls a week from VA whistleblowers I have never met who are crying, scared and losing their careers all for merely telling the truth. It has not stopped because the VA has never been made to stop.” → Adapted from the new book Mental Health, Inc.: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens, by Art Levine. © by Art Levine, 2017. Published by The Overlook Press, Peter Mayer Publishers, Inc., OverlookPress .com. All rights reserved.

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Antipsychotic Reaction

saw her husband alive, Sergeant Eric Layne was dozing on their couch with the TV on. That was in January 2008. Because of his mounting outbursts of rage and paranoia since returning from Iraq, psychiatrists at two Veterans Affairs hospitals had been prescribing him increasing doses of a drug cocktail for post-traumatic stress disorder that included the powerful antipsychotic Seroquel.

Although not approved by the FDA for such “off-label” uses, Seroquel is among the most prescribed drugs in its class and at its peak brought in more than $5 billion a year for its manufacturer, AstraZeneca, despite side effects ranging from diabetes to sudden cardiac arrest.

Eric kept complaining of headaches and tremors—concerns that were discounted by the VA medical staff— while he gained weight, had trouble breathing and was so oversedated that, Janette says, he had become a “zombie.” Two weeks after he returned from a specialized inpatient PTSD program that increased his medication, he was dead. “All these doctors and medics and Ph.D.s kept telling us that he was fine,” Janette says. “We trusted the doctors.”

Critics of the VA estimate that more than 400 combat veterans and other military personnel have died suddenly after being overmedicated with PTSD “cocktails.” These fatalities aren’t systematically monitored or studied.

The few military and VA inquiries into this issue have largely blamed these mysterious deaths on suicides and natural causes—or, in a few cases, on some inexplicable “drug toxicity.”

During the same post-9/11 years that antipsychotic prescribing increased at the VA, it was in the early stages of an initiative to cut down on prescribing for PTSD patients receiving potentially addictive benzodiazepines such as Klonopin, Xanax and Restoril. Meanwhile, the department allowed the use of Seroquel to jump more than 770 percent between 2001 and 2010, although, according to the Associated Press, the number of patients increased only 34 percent.

Over $1.8 billion was spent by the VA from 2001 through the first half of 2015 on the two most prescribed antipsychotics for PTSD, Risperdal and Seroquel, although they were never proved effective or even approved by the FDA for use with the disorder. Seroquel remains the most heavily prescribed antipsychotic in the VA system, with nearly 800,000 prescriptions annually.

All of AstraZeneca’s marketing of Seroquel for off-label uses, as the Justice Department found when it reached a $520 million settlement with the company in 2010, has continued to pay off. The drug remains off-label for PTSD, anxiety, insomnia and depression in youth, but virtually no one in the VA appears to be paying attention. As a psychiatrist at the Huntington VA hospital tells this

BJARTE RE T TEDAL /GET T Y

THE RECKLESS OVERPRESCRIBING OF ANTIPSYCHOTICS IS CREATING A DEADLY COCKTAIL FOR TOO MANY VETS

HE LAST TIME JANET TE LAYNE

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OPIOIDS

reporter, “The drug companies pushed these new drugs for everything from alopecia to hemorrhoids to lumbago.”

That push ignored the data. “The evidence for using antipsychotics with PTSD patients isn’t very good, and the potential side effects can be deadly,” says Dr. J. Douglas Bremner, the chief of Emory University Medical School’s Clinical Neuroscience Research Unit.

Part of the VA’s reluctance to rein in the high-risk, off-label prescribing of antipsychotics traces back to “the code,” but also to the undue influence of the drug industry. Some of the earliest work that pushed Seroquel on veterans came from Dr. Mark Hamner, the director of psychopharmacology research and PTSD clinical care at the Ralph H. Johnson VA Medical Center in Charleston, South Carolina. With support from AstraZeneca, he researched a series of longunpublished studies boosting Seroquel.

AstraZeneca was apparently so pleased with Hamner’s work that it funded directly or served as a “collaborator” with the VA on two additional 12-week studies on Seroquel for PTSD symptoms.

For nearly a decade or more, the studies’ outcomes were known only to Hamner and, presumably, AstraZeneca. Retired Brigadier General Dr. Stephen Xenakis, a pioneering PTSD researcher who reviewed Hamner’s studies for Newsweek, thinks he knows why the results weren’t made public for years: “AstraZeneca clearly delayed publishing because

the data in general is weak.” Hamner denied that his ties to the company played any role in his publishing delays.

The drug industry and VA officials have kept veterans and their families ignorant about many of the dangers posed by these psychiatric medications.

Seroquel and other antipsychotics can induce sudden cardiac arrest that, although a rare side effect, often causes brain death in under five minutes.

Atypical antipsychotics have been identified in over 100 studies since the 1990s as perhaps the single riskiest class of drugs for inducing a particularly dangerous form of arrhythmia. Dr. Fred Baughman, a retired California-based neurologist who launched a campaign raising alarms about Seroquel-related deaths in West Virginia, was blunt in his many press releases and letters to medical journals, starting in 2008: “There is an epidemic of sudden deaths occurring throughout the U.S. military.”

His determination to discover what led to the medication-linked deaths didn’t seem to be matched by the VA’s Office of the Inspector General, which concluded there was no link between Seroquel and other leading antipsychotics with sudden cardiac death in its report on the death of Eric. All of the inspector general’s work ignored the most salient medical research and the VA’s prescribing guidelines in place since 2004. “They turned a blind eye to the medical consensus,” says Baughman

of the inspector general’s report.

The most telling sign of a cover-up, he contends, is the failure to mention the most thorough review then available: an Expert Opinion on Drug Safety journal review, published several months before the inspector general’s report. “It took an overt act of omission to miss this article,” he says, noting how widely it was cited in the medical literature.

Xenakis, the former Army psychiatrist, is just as blunt: “They cherry-picked the studies.” The VA’s Office of the Inspector General declined to reveal what medical guidelines or scientific research was reviewed before releasing its report.

Dr. Grace Jackson, a former Navy psychiatrist and author of Rethinking Psychiatric Drugs, says after reviewing the inspector general’s report and White’s prescription history, “This is a whitewash that sanitizes [White’s] medical records.

It’s a complete embarrassment. The way these drugs were used was overkill.”

Nearly a decade after the inspector general ignored the drugs’ cardiac dangers, the VA’s new Psychotropic Drug Safety Initiative, modeled in part on its opiate campaign, still hasn’t flagged the cardiac risk of Seroquel, the agency’s most prescribed antipsychotic.

“It’s outrageous,” Xenakis says of this omission. “People are talking about reform in the VA, but with these kinds of things, it really exposes how far we have to go to change basic practices, culture and attitudes.” — ART LEVINE

There is an epidemic of SUDDEN DEATHS

occurring throughout the U.S. military.”

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SCIENCE, TECHNOLOGY + HEALTH

W I L D LIFE

Wisdom of the Flock Pigeons are much smarter than we think

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can pigeons multitask? the question may seem odd, but answering it revealed a surprise about the birds who share our streets and dropped bagels: They are not only capable of multitasking but are sometimes better at it than we texting-and-walking humans. Birds lack a neocortex, layers of tissue in the brain thought to play a role in advanced functions, explains Christian Beste, who studies psychology at Ruhr-University Bochum, in Germany. Researchers had long believed animals without a neocortex couldn’t handle higher-order cognitive processes, such as problem-solving. But studies began contradicting that notion. Ravens, for example, rival apes in their ability to barter and use tools.

Beste and his colleagues wanted to know just how sophisticated bird brains are, so they gave humans and pigeons a range of similar exercises. In some, the subjects had to alternate between tasks, like pressing different keys on a keyboard in response to a flashing light.

In others, participants had to suddenly stop a task and redirect their attention. The pigeons were just as adept as the humans at alternating between tasks, and when the exercise involved refocusing on an entirely new task, the pigeons did so more quickly. They were better at integrating additional chores into a given sequence.

Why the difference? Beste and his colleagues think the way the brains of pigeons are organized explains the ease with which they stopped and shifted focus.

Specifically, the distance between neurons in pigeon brains is much shorter than that in humans, which may explain their faster reaction time.

That added speed may be an advantage for pigeons, says Beste. If a pigeon is pecking away at a piece of corn and spots a predator, shifting quickly from eating to flying away could save its life.

The results also hold a message of caution for human readers. On a cognitive level, Beste says, no such thing as multitasking exists. Although we may think we are doing two things at once (walking and scrolling, texting and driving, working and tweeting), we are actually toggling between two tasks very quickly.

Even pigeons can’t really BY multitask, says Beste. So by no means should they attempt to JOSEPH FRANKEL @josephfrankel text and fly.

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Horizons

In the exercises, the pigeons were just as adept as humans at alternating between tasks.

Horizons

MEDICINE

The Artificial Miracle From in vitro to in silico: AI’s search for cancer cures

four out of 10—that’s how many Americans the National Cancer Institute estimates will be diagnosed with cancer at some point.

While 33 percent of those patients won’t live longer than five years, giving them precious little time to find effective treatments, it takes over a decade to bring new cancer drugs to market. The process involves animal testing, human trials and regulatory review—a gantlet through which less than 7 percent of experimental medicines successfully pass. Is it any wonder, then, that there are less than

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2,000 Food and Drug Administration-approved pharmaceuticals on the market? Not 2,000 cancer treatments—2,000 drugs for all diseases.

Insilico Medicine, a Baltimorebased biotech research company, hopes to revolutionize drug development by slashing the time necessary for research with the help of artificial intelligence (AI).

In a study published in the medical journal Oncotarget, a team led BY

by Insilico Medicine details their approach.

ARVIND DILAWAR

Essentially, researchers built two computer networks (together known as generative adversarial networks, or GANs). One suggests new molecules that may have cancer-fighting properties; the other eliminates those suggestions based on known treatments.

“It’s better to explain with an analogy from art,” says Polina Mamoshina, a research scientist at Insilico Medicine. If cancer drugs were works of art, she says, the first network would be an art student attempting to copy them, and the second network would be an art expert flagging forgeries.

Each time the student’s work gets called out as a forgery, the student must get better at copying the original; each time the student’s work gets better, the expert must work harder at spotting forgeries.

Relating that back to GANs, as the first network keeps trying to “trick” the latter into accepting new molecules as legitimate drugs, both better learn what cancer treatments should look like. Once they’re through testing each other, the networks can be used to vet compounds for their cancer-fighting potentials. In this way, the team from Insilico Medicine screened 72 million chemicals from a public database.

Among the compounds selected by the GANs were 60 patented cancer treatments—meaning that the networks were able to accurately identify these medicines and that the other compounds they selected were likely worthy of further study.

Compared with standard in vitro (test tube) experimentation, this

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FIGHTING SMART Insilico Medicine is expanding its research into the molecules its AI networks have identified as having cancer-fighting potential.

in silico (computer-tested) method is exponentially faster. Instead of beginning the search for a new cancer treatment with a million compounds that have potential, researchers could, in just one month, narrow the pool of candidates to the 100 most promising leads.

This approach not only fosters faster drug development but is more cost-effective research too. Each experimental medicine that fails to make it through the development process is a loss of several million dollars’ worth of labor and resources.

A study from the Journal of Health Economics estimates that the costs associated with failed drugs adds more than $1.6 billion to the cost of each successful one. With fewer, more promising leads, researchers

could save millions, perhaps billions.

But not everyone is confident about the applications of in silico testing. Mamoshina acknowledges that many cancer researchers who work with more traditional biological and chemical methods are unfamiliar with AI, which can breed doubt.

“To them, it’s a black box,” she says.

“It’s really challenging to understand, which is why they’re really skeptical.”

As with other cutting-e dge

This approach not only fosters faster drug development but is more costeffective research too.

technologies, hype may also be fueling the progress in—and setting the potential pitfalls for—Insilico Medicine. Olexandr Isayev, an assistant professor at the University of North Carolina whose lab focuses on developing methods of AI-assisted drug discovery, acknowledges that there may be too much excitement over a technology that has yet to provide any material results. “Most published papers, including this one, are purely computational,” he says. “Unfortunately, some predictions could be wrong. I really would like to see the first experimental confirmation of ‘AI-discovered’ molecules.”

As would Insilico Medicine, which continues to develop GANs. Rather than licensing out the technology in a sort of software-as-a-service model, the company is expanding research into the molecules the networks have identified as having cancer-fighting potential. Once these compounds pass through traditional in vitro testing, they will be licensed out to pharmaceutical companies for further regulatory review and, if all goes well, marketing. This past August, it was announced that Insilico Medicine is partnering with pharmaceutical giant GlaxoSmithKline to begin implementing some of its new research techniques.

Insilico Medicine’s belief in this approach is reflected in its decision to license the drugs it discovers, rather than the tools of discovery themselves.

Yet for the company to prove that AI can in fact eliminate the guesswork involved in early drug discovery, Insilico Medicine will have to head back to the lab—and the test tubes.

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Horizons

HEA LTH

A Scarier Zika A single mutation may make the virus more devastating to newborns

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the abnormally small heads and developmental havoc. Children seen among children infected with microcephaly may have seizures, with the Zika virus have haunted hearing loss, difficulty seeing or movmany of the people who live in regions ing, and may not learn to sit, stand or walk at the same rate as other where mosquitoes carry the pathogen, children. They may also have intelincluding the U.S., South America, lectual disabilities. At least 3,000 Africa and Southeast Asia. It turns out children around the that a single genetic world have been born change in the virus may with microcephaly or be responsible.

BY another Zika-related The defect, known as microcephaly, wreaks brain birth defect.

KATE SHERIDAN all kinds of physical @sheridan_kate Microcephaly was

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F RO M LE F T: U E SL E I M A RCE L IN O/R E U T E RS ; © CA I YA NG /X I NH UA /AL AM Y

“[Zika] will come back at some point.

I can’t tell you when, but it will come back.” not always a common birth defect in children affected by Zika, and the problem may have gone unnoticed during earlier outbreaks because fewer infected women were pregnant. But as the epidemic changed—expanding in Brazil, most notably—the problem became more noticeable, says Dr. Michael Diamond, an infectious diseases specialist at the Washington University School of Medicine in St. Louis. “[Zika] will come back at some point,” says Diamond. “I can’t tell you when, but it will come back at some point. And if it comes back, are we going to be in the same place that we were last time—with nothing—or are we going to continue to study it, understanding it might come back worse than it is now?”

A group of Chinese researchers led

by Cheng-Feng Qin, a virologist at the Beijing Institute of Microbiology and Epidemiology, wondered if the virus had mutated, becoming more virulent and damaging to the developing human brain. To test this theory, he separated newborn mice into four groups and injected one of four different strains of the virus into their brains. One strain was associated with a 2010 outbreak; three strains were isolated during the outbreak from 2015 to 2016. He also tested the virus on human brain stem cells.

Mice infected with one particular strain, called VEN/2016, developed brains that were far smaller than those of mice infected with other strains. Their brains were also

smaller after being infected with a virus created to carry just one of the newer mutations found in VEN/2016.

That mutation changed one component of a protein called prM. The single genetic abnormality alters the course of the disease. “This specific mutation can indeed make the virus more aggressive,” says Alysson Muotri, who researches the Zika virus at the University of California, San Diego, but was not involved in the new paper.

The breakthrough, published last month in Science, could be crucial for the treatment of future outbreaks. Although concerns over Zika have diminished since last year, the

BABY STEPS Cheng-Feng Qin, right, led, a group of Chinese researchers who found evidence that, at one point, the Zika virus became more aggressive.

problem has not disappeared. With so many areas in North America now covered in stagnant floodwaters, questions linger about what impact recent storms could have on the transmission of the virus. The new finding is a first step toward knowing how and why the Zika virus causes birth defects—and which forms of the virus might be particularly dangerous.

Although the results of Qin’s research were strong, the methodology left many researchers with questions. Injecting the virus straight into a mouse’s brain is not the usual path the virus takes to a developing fetus.

In most cases, a mosquito bites a pregnant woman, then the virus spreads through her body and crosses the placenta to reach the womb. “[Injecting it] inside the brain, it works. The question is, Does it work outside the brain?” says Jean Pierre Schatzmann Peron, an

NEWSWEEK.COM

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OUTBREAK With so many areas in North America now covered in stagnant floodwaters, questions linger about what impact recent storms could have on the mosquito-borne virus.

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HEALTH

immunologist at the University of São Paulo in Brazil.

The answer may be no. The mutated protein identified in Qin’s study is found on the surface of the virus. That might make it more “visible” to the mother’s immune system, enabling the body to attack the invader before it reaches the fetus.

Exactly why this mutation makes the virus work differently is unclear, says Schatzmann Peron, and it may not be the sole perpetrator. The more aggressive Zika virus could be exacerbated by other issues that make an infant even more susceptible to microcephaly.

“This [mutation] can change the biology of the virus, but it doesn’t fully explain what’s going on,” says Muotri. Environmental factors, the person’s genetic background and previous exposure to other viruses or vaccines could all be involved. “It’s not only about the viral genetics,” says Muotri. “There are probably other factors that play a role.”

Qin and his team are now searching for those factors, but Diamond says other approaches are also needed.

Ideally, he says, scientists would use similar experiments with monkeys or chimpanzees, allowing the virus with this mutation to infect the animals from mosquitos and then watching how it affects fetal development.

Though the mosquito that spreads Zika can be found in several European countries, according to the World Health Organization, the risk for people who don’t travel outside of Europe has stayed relatively low.

Just over 2,000 cases of Zika were reported across Europe in 2016, nearly all of which were associated with recent travel.

But as Diamond points out, the virus could re-emerge anytime, and we need to be prepared.

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CLO CK W IS E F RO M TO P: N ACHO D O CE / R E U T E RS ; S CI E NCE PHOTO L I BR A RY RF/GET T Y; N ELSON ALMEIDA/AFP/GET T Y

Horizons

actual size

SCIENCE

BRID G ET TE JAMES/GET T Y

Little Big Problem Bedbugs may be traveling the globe via dirty laundry

clothing attracts bedbugs, parasitic insects that ind their meals by following human scents.

William Hentley and colleagues wanted to know if our dirty laundry plays a role in the travels of bedbugs.

They instructed volunteers wear white cotton T-shirts and socks. Three hours later, the researchers sealed the clothing in ziplock bags, then washed half the sets. Each set of clothing was then put into clean duffel bags.

The experiment used two rooms, identical except that one had elevated levels of carbon dioxide to simulate the presence of a human. The researchers released bedbugs into the rooms. According to the study, published online last month by Scientific Reports, bedbugs were twice as likely to end up in the bags with unwashed clothes than in those containing clean clothes. The elevated carbon dioxide level, which should have fooled the bugs into behaving as if a human was present, was not as strong a draw as dirty laundry.

Because travelers tend to return home with bags full of worn clothing, suitcases are “potential ‘vehicles’ for passive dispersal,” the authors write. Sweat and volatiles—chemicals that evaporate at room temperature, often sending scents wafting through the air—release human odor that, the researchers explain, “may therefore Thanks To The advenT of inluence host-searching behavior in cheap travel, bedbugs are thrivbedbugs.” That’s a scientist’s way of saying that dirty clothes are an ideal ing. Little research has been done to understand how best to prevent these free international light for bedbugs. bloodsuckers from boarding transThose wary of bringing home bedcontinental flights and returning bugs might do their laundry before home with travelers, but you might getting on a plane. “Careful management of holiday want to take a hard look clothing may be an at your smelly socks. important strategy in Researchers from BY Britain’s University of the prevention of bringShefield had reason to ing home bedbugs,” the JESSICA FIRGER suspect that unwashed @jessfirger researchers conclude.

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Culture

HIGH, LOW + EVERYTHING IN BETWEEN

MUSIC

Young Man With a (Weird) Horn

CO URTE SY O F CHRISTIAN SCOT T

By reimagining jazz, Christian Scott aTunde Adjuah is both honoring and saving it

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KAPOW! WHAM! SPLAT! Fifty years of DC vs. Marvel Comics » P.52

christian scott atunde adjuah always of an ambitious and socially insightful expression hated the trumpet. Really hated it. But of his jazz vernacular, what he calls his “Centennial growing up in 1980s New Orleans, where music Trilogy,” three albums commemorating the 100-year was one of the few ways a kid could get out of his anniversary of the first jazz recording, “Livery Staple neighborhood, the instrument he preferred was Blues,” from the Original Dixieland Jass Band. Adjuah already taken. Adjuah is the nephew of renowned and his band are at the Blue Note for a final night of saxophonist Donald Harrison Jr., and “I knew that sold-out shows in support of this installment, The if I played the saxophone, I probably wasn’t going Emancipation Procrastination, recorded in just six on the road,” he says. “My uncle still would have days but in the works since he was 14. When he was trained me at home. But if I played the trumpet, I growing up, his musical elders would say, “When you was going to be onstage getting the actual lessons.” guys get to be adults, the century mark will be up,” By 16, he was a bona fide prodigy, and in the Adjuah says. “What are you going to do? How are more than two decades since, the 34-year-old has you going to create beauty out of this moment, how won awards, toured the world and released close are you going to spark a musical dialogue that will to a dozen acclaimed albums, beginning with his last another century? Are you good enough? Are you self-titled debut in 2002. One thing never changed, valiant enough? I began the work in that moment.” though. “I hate the fucking sound of the trumpet, His experiences as a teenager, in the Upper Ninth man. It’s fucking terrible.”

Ward, further shaped his music. “I’ve seen white peoSo Adjuah ditched it and invented something ple enduring food insecurity. I’ve seen black people better. We’re talking in the upstairs green room enduring the same things. They view each other as of the legendary Blue Note Jazz Club their nemesis, even though they’re the in New York’s Greenwich Village, and same people,” he says. “As a social construct, race exists, but it doesn’t, man. he’s explaining what he calls his “B-flat BY instruments,” which look a bit like There’s not Homo sapiens Africans.“ RYAN BORT space-age weapons. Such innovation is a In time, Adjuah began to find the @ryanbort natural extension of Adjuah’s unorthoterm jazz “limiting,” so he created a new dox music. Along with fellow jazz musiname, “stretch music,” for a sound free of artificial and arbitrary boundaries, where Kurt cians Robert Glasper and, more recently, Kamasi Cobain is as much of a blues musician as Muddy Washington, he has been at the forefront of a genWaters. And, he says, “if I can blur or obliterate eration of musicians tearing down the boundaries between genres, with elements of rock, hip-hop the spaces between genres, which are the cultural and electronic music flowing into jazz recordings expressions of the [races] that we’ve carved up, then and vice versa. Among others, Adjuah has collabowhat am I saying about the people?” rated with Thom Yorke and Mos Def; Glasper and Later that night, as he stood on the Blue Note Washington worked with Kendrick Lamar on the stage before a beguiled and diverse crowd—Asian, Grammy-winning 2015 album To Pimp a Butterfly. white, black and everything in between—you Adjuah’s sounds are recognizable—a modificacould see evidence of Adjuah’s hopeful philosophy tion of traditional jazz, with familiar elements— on their faces. “I’ve never met anyone who doesn’t but he welcomes myriad influences, from trap beats like sounds,” he’d said earlier. “There’s nothing more powerful than the potential music has to to samba rhythms to polka. “Jazz is the original fusion music,” Adjuah says. “Bringing all of this in be able to heal people, and to get people past that junction. I think we’re going to do it.” is the essence of it; the traditional tenets are to constantly search, to look for new terrain, new vernacular and new ways of communicating. But we were The third and final installment of the Centennial up against this notion that it had to be one way.”

Trilogy, The Emancipation Procrastination, is out Adjuah is about to release the final installment October 20 on Adjuah’s label, Stretch Music.

NEWSWEEK.COM

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Culture

BOOKS

Super Petty Slugfest takes readers inside the decades-long beef between DC and Marvel comics

it began as a playground argument for reed tucker, who can remember schoolyard battles over which was better, Marvel or DC comics, or whether Hulk could whup Superman. But the idea for a book about the creators of his childhood heroes didn’t come until 2016, when Time Warner– owned DC Entertainment threatened to release its long-awaited superhero movie Batman v. Superman on the same day as the Disney-owned Marvel Studios blockbuster Captain America: Civil War. The internet exploded.

Tucker’s resulting Slugfest digs into decades of rivalry between these comic-book behemoths, beginning with DC inventing the superhero in 1938, with Superman, followed quickly by Marvel’s debut of the Human Torch in 1939.

Competition deepened in the ’60s, when Marvel’s Stan Lee introduced the superhero to the sort of real-world anxieties college students could relate to. By the mid-’80s, with DC’s reboot of Batman and the limited release of Watchmen, those worlds—on page and behind the scenes—got very dark indeed.

We spoke to Tucker about Slugfest a month before Marvel and DC face off in theaters again, this time with Thor: Ragnarok and Justice League.

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Did your appreciation for comics grow as you worked on the book?

Oh, for sure. It’s hard to convey how marginalized comic books have been for most of their existence. They were considered trash, disposable. In the ’50s, Congress held hearings about the detrimental effects of reading them. So it’s amazing to me to see that comics are now [entrenched] in mainstream culture.

Superheroes dominate the box office BY and TV—which is even crazier when you conCRAIGH BARBOZA sider many of the early @Bboy88

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characters were dashed off quickly by journeymen writers and artists who never imagined their work would survive beyond the month the issue was on newsstands. But they created something so cool, so appealing and compelling, that here we are decades later enjoying this stuff, albeit often in media outside of comic books.

FROM LEFT: TIM GA INEY/AL AM Y; C OURTESY OF SLUGFEST

Even Martin Scorsese is directing a Joker origin movie! What accounts for the profound obsession we have with superheroes?

Part of it is that superheroes are treated in a mature fashion on screen, whereas previously they were considered kiddie fare. The head of DC in the ’70s, Jenette Kahn, used to pitch to Hollywood, only to be told superhero movies wouldn’t appeal to anyone but children and mentally stunted adults.

Studios laughed at a serious Batman film. Today’s studio executives grew up in the ’80s and ’90s, after comics had become smarter and more sophisticated. The bar was raised

by Alan Moore’s Watchmen in 1986 and Frank Miller’s Batman: The Dark Knight Returns that same year [both are DC]. First-rate visual effects help.

DC and Marvel are fiercely protective of their brands. What happened when you approached them about the book?

Very politely, they were having no part of it. I guess I understand, though the subject’s not all that controversial.

You still managed to interview 75 people, including Marvel’s Stan Lee and artist Neal Adams, who helped reimagine Batman as a violent, brooding vigilante. Is there anyone you would have liked to speak to that you didn’t?

Bill Jemas. He was Marvel’s president in the early 2000s. He came from a

job with the NBA and loved rivalries, and he was determined to ramp up the feud. It resulted in the ugliest period in Marvel vs. DC’s history. Jemas even wrote a 2002 comics series, Marville.

Ostensibly, it was a parody of Superman, but the sole reason was to bash the competition. The opening page in issue No. 1 reads, in part, “Marvel’s Distinguished Competition (DC Comics) is run by a man named Paul Levitz who fights a never-ending battle to keep his business obscure.” It’s hard to believe Marvel published that.

What else surprised you?

There were several instances of spying

Marvel always had a more laid-back culture.

DC was buttondown—somebody described the offices as out of Mad Men.

over the years. The best was probably in 1971, when DC suspected one of its employees was leaking secrets to fanzines and Marvel. The head of DC launched an honest-to-God counterespionage operation, code-named Blockbuster, in which he created a fake memo about the company’s plans to publish gigantic 500-page comics. He then left it in his outbox.

Sure enough, the spy took the bait, and soon there was talk over at Marvel of doing 500-page comics.

Marvel and DC had creative ways of undermining each other. For example, Marvel introduced a character in 1964 called Wonder Man that ticked off DC, who thought it sounded too close to Wonder Woman. So Marvel agreed to kill off Wonder Man. Then DC unveiled a hero called Power Girl just a few years after Marvel introduced Power Man, so Stan Lee exacted payback by reviving Wonder Man. One of the few times the companies collaborated, weirdly enough, is on the trademark for the word superhero. DC and Marvel filed jointly for ownership and still sue people who try and use it.

There were also “talent wars,” vying for stars like Wolverine co-creator Len Wein, who died last month.

Yes. During the boom years—the late ’80s and early ’90s—some top writers and artists were raking in millions.

X-Men writer Chris Claremont literally bought a plane!

Before they were acquired by conglomerates, the houses had very distinct cultures. Where would you have wanted to work?

No contest: Marvel. They’ve always had a more laid-back culture, with wrestling matches and silly string fights in the hallways. DC was button-down. Somebody described the offices as out of Mad Men.

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Culture

T E L E VISION

Apocalypse Maybe TV’s ratings monsters The Walking Dead and Game of Thrones are staggering toward oddly similar ends walkers, walls and crossbow crusaders. All of humanity bifurcated into a good-vs.-evil, winnertake-all main event while a greater existential threat—the zombie apocalypse—looms. Add to that a callous indifference on the part of showrunners to killing off (and then occasionally resurrecting) a beloved main character. As the October 22 Season 8 premiere of The Walking Dead approaches, we wonder if AMC’s megahit is not Game of Thrones with a more penurious per-episode budget.

The Walking Dead premiered on Halloween night, 2010, and has since become the most-watched series in cable television history.

Five months later, Game of Thrones made its debut on HBO and has since whacked The Sopranos as the mostwatched show ever on premium cable.

For the first few years of their existence, the shows seemed to have BY little in common besides their massive audiences JOHN WALTERS and roots in fantasy. @jdubs88

Dead, after all, was set in a contemporary, post-apocalyptic American South. Thrones was set in the fictional land of Westeros, which bears a passing resemblance to Britain, in an age of iron. Thrones was rife with clandestine alliances, brothels, interwoven royal lineages, giants, dragons and Dothraki.

Dead promulgated a far simpler plotline: Stay together and don’t get bitten.

Superficial links existed. How many other shows feature a crossbow, the weapon of choice for Dead’s heroic Daryl (Norman Reedus) and a toy for Thrones’ sadistic boy king Joffrey (Jack Gleeson)? And yes, a murder tool for Joffrey’s impish uncle Tyrion (Peter Dinklage).

Glenn (Steven Yeun), one of Dead’s

FUNNY, I FELT FINE THIS MORNING

Walking Dead, above, meet frozen dead: GOT’s Night King, left. Royal pains Negan and Cersei, right, both alive...for now.

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CLO C KWISE FRO M LE FT: C OU RT ESY OF HBO ; FR ANK O CKENFE LS 3/AM C; COURTESY OF HBO; FRANK O CKENFELS 3/AMC

most popular characters, fell into a zombie mosh pit at the end of one episode only to re-emerge in the next unscathed (are there vegan zombies?), while multiple Thrones characters have overcome stabbings, drowning and greyscale, only to return. Lord of Light? More like deus ex machina.

In the past two seasons, however, the shows have begun to approach a point of convergence, albeit from opposite directions. Since Season 6, Dead has promoted a malevolent gang of fascists, the Saviors, as the most direct threat to Sheriff Rick and his posse, while relegating “walkers” (i.e., zombies) to a relative supporting role. Meanwhile, across the Narrow Sea, the Lannisters have brokered a truce with the Targaryen-Stark alliance, while Thrones’ zombies, the Night King-led white walkers, sweep down toward Winterfell like a Category 5 hurricane.

Looking for a sadistic ruler with a thirst for pain?

Negan, meet Cersei (one man’s Lucille is another woman’s Mountain).

The comparisons are manifold.

Looking for a sadistic ruler with a thirst for inflicting pain? Negan, meet Cersei (one man’s Lucille is another woman’s Mountain). How about a reluctant but resolute leader who is also a bastion of integrity? Sheriff Rick and Jon Snow. Hulking gingers fighting for the good guys? Sergeant Abraham and Tormund. Bad ass, blade-wielding heroines? Michonne, meet Brienne of Tarth.

At their cores, both shows have been distilled into a triad of fascists vs. freedom fighters vs. the undead.

The last group is a relative force of nature, an implacable juggernaut that is not vulnerable to desertions or betrayal but is also incapable of heroism. Who will win out? Will an alliance be forged between each show’s two human factions before it is too late? Forget winter; for both series, Season 8 is coming.

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Illustration by B R I T T S P E N C E R

P A R T ING SHOT

Mohammad Javad Zarif on the surface, iran’s foreign minister, mohammad javad zarif, has little in common with Donald Trump. Zarif is a bookish, Americaneducated diplomat who chooses his words carefully. But like Trump, the Iranian emissary is a prolific tweeter and avid dealmaker. As he once put it, “The art of a diplomat is to conceal all turbulence behind his smile.”

Over a 20-month period that culminated in closing a deal in July 2015, Zarif played a dominant role in Iran’s most famous international agreement— the one concerning its nuclear program. Because of Trump, that deal could fall apart. In his address to the U.N. General Assembly in September, the selfproclaimed “master negotiator” called the agreement “one of the worst and most one-sided transactions” in history. By October 15, he reportedly will claim that Iran is not complying with the deal. In late September, we asked Zarif who was the better dealmaker, himself or the president. “I guess he is,” the Iranian foreign minister said. “I don’t know. I’m modest.”

“The art of a diplomat is to conceal all turbulence behind his smile.”

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You are on the record as saying you are not open to renegotiating the nuclear deal. Doesn’t that potentially put Iran on a collision course with the U.S.?

That wouldn’t be the first time. We’re not putting ourselves on a collision course with anybody. Others may be putting themselves on that course.

And I believe they are putting themselves on a collision course with the international community. Every aspect of the deal had been fully and repeatedly renegotiated before we reached an agreement. Everybody else who participated in…[it] knows that if we reopen the deal to negotiation, we would be reopening Pandora’s box, which would be impossible to close again.

Trump prides himself on being a great dealmaker. You have been called a master negotiator.

Are you familiar with his book The Art of the Deal? In it, the president implies that he enjoys negotiating, almost like it’s a hobby. How does that translate to the Iranian nuclear agreement?

I’m familiar with the man who’s written the book. I’ll look at it [The Art of the Deal]. Believe me, maybe making real estate deals is fun and considered a hobby, but negotiating international agreements is no fun.

It’s much more complicated than that. I hope President Trump won’t learn that the hard way.

—Susan Modaress and Adla Massoud

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