A smooth-looking sailor winks joyfully while an auburn-haired lovely flicks a Bic and fires up a Camel for the lucky lad. Two lonesome, studly cowboys ride the range at the foot of the snowcapped Rocky Mountains, an iconic picture of the eternally young and eternally immortal Marlboro Man.
From the backs of magazines such as Details, Sports Illustrated and Road & Track, these ads regularly reach young testosterone-charged readers. And, from slick sailors to old cowboys, tobacco ads exert more influence than ever these days, according to marketing experts and psychiatrists. While the percentage of Americans who smoke has decreased in the past 35 years, the percentage of American teens who smoke has risen in the past 10, and skyrocketing smoking rates worldwide show no signs of slowing down.
This appears to contradict the common perception that the Marlboro Man and his ilk are on the ropes. (Even the ad described above shows a very small cowboy figure as compared with the full-page Marlboro Man close-up of yesteryear.) The latest round of legal jousting has forced tobacco companies, previously banned from television and radio, to recuse themselves from billboards and print advertisements in youth markets.
With one marketing arm tied behind their backs, Philip Morris, R.J. Reynolds and the other tobacco merchants have struggled with free-falling stock values and public outcry from anti-smoking advocates. Standard & Poor’s downgraded its recommendation on Philip Morris shares from “avoid” to “sell” on Dec. 28 because of the precarious position of the company.
Philip Morris and the other tobacco companies have passed only halfway through a brutal legal meat grinder that could cost them $200 billion or more in payments to the states over the next 25 years. And that could represent only the beginning of an endless litany of payouts that stretches ad infinitum. A Florida court now holds the key to what could be a painful $300 billion class-action payout to infirm smokers in the Citrus State — the first of what could be many other class-action lawsuits.
The decline of smoking in the United States has been long and slow. Since 1964, the percentage of Americans who smoke has dropped from 65 percent to 25 percent, according to the Center for Advancement of Health. Add to that a marked decline in cigarette purchases over the past year (which most economists say resulted from higher prices caused by legal fees and settlement costs) and the business of addicting citizens to cigarettes seems destined for doom.
Anti-smoking advocates attribute the past year’s declines and the long-term trend to more anti-smoking campaigns, rising health concerns and more expensive cigarettes. (The tobacco companies announced a 13-cent wholesale price increase the second week in January, the latest in a series of hikes.) On Jan. 19, virtually all the tobacco companies announced dramatically lower earnings due to declining consumption of the nic sticks in America and stagnant demand worldwide.
So why have a number of stock analysts started to claim that tobacco stocks are underpriced and a great buy? Why are more teens picking up the cancer sticks than in past generations? And why are anti-smoking activists in a huff about the numerous legal loopholes that they claim the tobacco companies are using to keep their business growing apace?
Although killing your customers is generally not a good business practice, the tobacco companies are expert marketers and smart businesspeople. And they appear poised for a solid business run in subsequent decades.
Witness the numbers. After decades of decline, the percentage of adult Americans who smoke is no longer going down, according to an article in the December Journal of the American Medical Association. On top of this, smoking rates outside the United States have skyrocketed and continue to climb, according to the World Health Organization.
“I think the tobacco industry is a very simple business,” says Bill Godshall, executive director of SmokeFree Pennsylvania and a leading expert on tobacco industry issues. “These guys can raise the price of cigarettes to 10 or 15 bucks a pack and they could still make a profit. People will pay $150 a day for their heroin or cocaine habits. So at $2 a pack, cigarettes are very underpriced.”
Most important for tobacco company shareholders, throughout the 1990s the percentage of U.S. teenagers who smoke has grown. According to the JAMA article, between 1991 and 1997 smoking prevalence among high schoolers increased from about 30 percent to 36.5 percent. These young smokers, in particular, represent the future of the tobacco merchants as dutiful customers who will not die of lung cancer in the near term.
“If the cigarette companies can get kids to start smoking at a young age, because cigarettes are so addictive, you are talking about getting a lifetime customer for your brand. So it is very important for cigarette brands to get a high percentage of the youth market. From an economic standpoint it makes perfect sense,” says Michael Siegel, an associate professor of public health at Boston University.
So how do tobacco companies hammer their brands home to the youth? Indirectly and masterfully through the mass media, according to Siegel and others. Siegel and Harvard Business School professor Charles King tracked placement of cigarette ads in 36 magazines between 1986 and 1994. Naturally, tobacco companies do not advertise in true youth publications like Seventeen or Teen People. But of the 36 publications studied, 15 were classified as youth magazines with significant readerships under age 18 (such as Details, Road & Track and Cosmopolitan). The two professors also tracked which brands were advertised where.
Their study discovered that although youth cigarette brands accounted for only 43 percent of the cigarette advertising pages in adult magazines during that time, brands popular with young people (Camel, Marlboro) made up nearly 67 percent of the cigarette advertising pages in the magazines that appealed to youth. Translation? Marlboro Man or Joe Camel is far more likely to show up in the pages of Road &Track or Sports Illustrated than in the pages of Ladies Home Journal. And those ads are more likely to push promo goodies like T-shirts, cigarette lighters and backpacks — gimmicks that ensnare high schoolers at greater rates than adults.
Furthermore, according to Siegel, those very same ads push specific buttons. “The imagery they use is so attractive to youth. They use images of freedom, independence and control with photos of attractive and sexy models — things that appeal to the basic core values of adolescents. Cigarette companies have mastered the use of those images,” says Siegel.
How powerful are these images? According to multiyear psychological surveys that tracked students through high school undertaken by professor John Pierce of the University of California at San Diego, media images played a major role in the decision to smoke of approximately 34 percent of teenage smokers. “We have shown that before they start smoking, the kids who really liked the advertising start changing their beliefs. They stop believing it’s harmful to smoke. And they start believing they can quit when they want to,” says Pierce.
For their part, the cigarette companies have vehemently denied that they are targeting youth with these advertisements. Likewise, they have denied that a new crop of vanity publications funded by tobacco companies and put out by old-line magazine houses like Hearst Corp. are aimed at teenagers. These vanity pubs make little mention of where the buck stops but prominently feature ads for cigarette brands like — no surprise here — Marlboro and Camel.
While most anti-smoking advocates doubt the veracity of these denials, they freely admit that the tobacco companies are doing a good job marketing. “Our conclusion is that because of the high exposure of youth to cigarette advertising in magazines, it should simply be eliminated. We don’t see any other way,” says Siegel.
Nor does the market mastery of cigarette czars stop at print. Despite legal stipulations against paid placements of cigarette brands in movies, Hollywood continues to spout smoke. In a study released in November, researchers at the University of California San Francisco found that smoking in the movies has steadily increased in the past decade. (Some activists whisper that this product placement is being paid for but the tobacco companies deny it.)
In films from the 1970s and 1980s, characters smoked once every 10 to 15 minutes. But in movies from the 1990s, characters used tobacco on average every three to five minutes. “As in tobacco advertising, tobacco use in the movies is associated with youthful vigor, good health, good looks, and personal and professional acceptance,” wrote the researchers, Stanton A. Glantz and Theresa F. Stockwell. Furthermore, Glantz and Stockwell recorded a rise in smoking among upper-class characters in the movies, something they believe heightens the subtle connection between being rich and lighting up.
Glantz and Stockwell could find no particular reason for the rise in smoking, but other experts have posited that it could be a circuitous logic by which studios make more mass media characters smoke in order to identify with youth, who are smoking more. Regardless, the effect is the same. “In an era in which the tobacco industry is finding traditional advertising media increasingly restricted, the appearance of tobacco use in motion pictures is an important mechanism to promote and reinforce tobacco use, particularly among young people,” write Glantz and Stockwell.
Restrictions like those called for by Glantz, Stockwell and Siegel are not in the cards, however. Congress likely shot its wad last year on failed tobacco legislation and hardly anyone, save John McCain (who proposed the tobacco settlement bill that was killed last year), is willing to touch the issue again. Score another point for the tobacco marketers. The legalese of the tobacco settlement with the states signed last year has left many advocates fuming.
“If you read the fine lines in the settlement, it says the tobacco companies cannot do anything to market to kids as long as kids are not their primary marketing target. If kids are only half of their market, that’s not marketing to kids legally. That’s why they advertise on the back cover of TV Guide or in the swimsuit issue of Sports Illustrated. They are adult magazines but everybody, including kids, reads them,” says Godshall.
While their marketing acumen and ability to find loopholes are beyond doubt, the tobacco companies have never been slouches with numbers, either. For example, tobacco industry bellwether Philip Morris has steadily bought back large chunks of its own stock, a possible sign that it believes its stock is undervalued and likely to go up at some point.
Analysts believe that Philip Morris can boost earnings per share from $3.17 in 1998 and $3.30 in 1999 to $3.68 in 2000, according to First Call earnings estimates from late January. Over the past five years, Philip Morris has averaged earnings growth of 14 percent. What’s more, despite a seemingly turbulent future, these same analysts believe that Philip Morris will average 13 percent annual growth in earnings over the long haul in spite of impending sanctions. That’s growth from an already eye-popping level of $46.7 billion in gross tobacco sales, according to BusinessWeek.
Meanwhile, the tobacco companies have steadily shifted more of their production offshore and out of the clutches of U.S. politics. On foreign soil these factories and marketing operations will run with few of the checks installed against them in the United States. Their move plays to the fastest growing markets for the tobacco companies in the third world and Asia, where the majority of the world’s 5 trillion-plus cigarettes produced each year are smoked.
The very resiliency of the tobacco industry rankles the anti-smoking crusaders who want to eliminate all advertising. But the glorious economics of addiction also have their benefits. “The industry can continue paying the costs of litigation and the court awards by merely raising the price of cigarettes. The stockholders can still get their dividends to the same amount and even higher. And less people will smoke. We think the industry can pay and pay and pay,” says Godshall.
“C’mon,” said the other professor, “tell us your nut graph.” I gave up and dropped the pad. “What’s a nut graph?” I asked. “He doesn’t know what a nut graph is!” someone shouted. The adjunct professor took pity. He tried again, gently. “In the article you are writing about the school,” he said. “What’s your null hypothesis?” My null hypothesis? My null hypothesis! My angle. My bias. My take. My … point … of … view! “My null hypothesis,” I said, “is that the Columbia Journalism School is all bullshit.” They paused. “That’s a good null hypothesis,” said one.
– From “J-School Ate My Brain” by Michael Lewis, New Republic, April 19, 1993.
Oct. 25, 1999 | Six years ago I was holed up in Santa Barbara, Calif., recovering from a year-long Central American surf tour and slowly reentering life via journalism poverty. Hoping to vault into the upper echelons of the Fourth Estate, I pondered taking a masters degree in journalism. But my visions of J-school were dashed upon reading a New Republic article by a rising media star named Michael Lewis. (Yes, the same Michael Lewis who wrote “Liar’s Poker,” the bestselling exposi of 1980s Wall Street.) According to “J-School Ate My Brain,” CSJ was worse than useless and the concept of J-school in general was highly suspect.
Imagine my surprise when Michael Lewis, now a famous journalist who draws million-dollar advance fees on his books, became visiting professor at the University of California at Berkeley’s Graduate School of Journalism. Lewis signed on to spend August 1998 through January 2000 there, spending some of that time finishing “The New New Thing,” his just-released book about Silicon Valley.
I asked Lewis what a noted J-school hater was doing teaching J-school. “I’ve been waiting for someone like you to call,” Lewis wrote in an e-mail to me. “I passed that piece out to the last class, to their great bemusement. Give me a buzz at the office later this week.”
The school’s dean, Orville Schell, had not read the article, nor was he aware of it. He seemed unconcerned. “What can I say? I think most journalism schools would eat my brain. I didn’t go to journalism school,” admitted Schell. “He’s an iconoclast and I think that’s good to have at a journalism school. Journalists are not necessarily institution-friendly. We really wouldn’t want it any other way.”
Lewis’ students found the article and the apparent hypocrisy more entertaining than troubling. “It was a funny article, which was sort of the point. It’s sort of one of those things where if you don’t laugh, you cry. Now that I have a job at Wired, it’s a lot funnier,” said student Brad King, who says he got his job in no small part thanks to Lewis.
Funny articles aside, the medicine Lewis is dishing out seems to be the best-tasting Kool-Aid at the J-school. After a steady diet of technical news writing, most students welcome with open arms the freedom of Lewis’ class. “At the J-school, it’s not very politic to think that you can have a career without paying your dues,” said Jessica Deeter, a second-year student in Lewis’ class. “The honorable thing to do seems to be to suck it up and do your two-year internship. Michael doesn’t buy into that religion. Frankly, it’s the first class where I feel I can write the way I want to write … He teaches from his own experience. And obviously, he is doing a lot of things right.”
In keeping with his attitude toward J-school, Lewis keeps his class grounded in the real world. He brings in a parade of venture capitalists and Silicon Valley notables to give their take on how the valley actually runs. This is the main purpose of the class, one that the students feel is both appropriate and well-executed. “I want to continue to live in the Bay Area. And there is a lot of material in Silicon Valley. So I feel like getting published in a national magazine … writing about Silicon Valley is very important,” said Laurie Wackler, who is currently taking Lewis’ class.
During the semester, Lewis’ students research and compose three articles about Silicon Valley topics, with the intention of publishing them. If the article merits it, Lewis will call the New York Times Magazine, Rolling Stone or Slate. Despite pep talks and phone calls, the class hasn’t managed to crack major publications with their articles (with the exception of one piece accepted in the New Yorker’s Talk of the Town section).
However, a few articles have caught the eye of some big-time editors thanks to Lewis. “Probably the biggest thing about J-School is contacts,” says King, who got article ideas read and rejected by editors at the New York Times Magazine and Rolling Stone with some help from Lewis. “Michael Lewis is a wonderful contact. I don’t look down upon that. This business is about who you know. And once you get to that person, you either have the talent or you don’t.”
So does anyone have anything bad to say about Michael Lewis? Apparently not. At worst, he seems a tough but fair editor with an ample but not obnoxious ego. “He does have an ego. Michael thinks highly of Michael and of Michael’s work,” says Deeter. “But that’s part of the confidence thing. It’s not unattractive. He opens himself up to criticism and he is completely likable. He’s a really nice guy. Face it, he makes a shitload of money and he’s living high on the hog. He’s married to Tabitha Soren. Life’s good for Michael Lewis.”
Indeed. Michael is rich and Michael mocks J-schools. So why is someone who finds J-schools objectionable and doesn’t need the money teaching at one? “I find it’s very valuable when I am trying to sort out what I think about a subject to have someone listen to me. My wife gets tired of it so it’s really nice to have this group of students. I can float thoughts and ideas and theories and see how they respond,” said Lewis.
In other words, the students are paying the University of California to help Michael Lewis write his book? “Yes, I think that’s not a bad description of one of the things that are going on here,” he admits with a laugh.
And what are the students learning in class? “Not journalism,” he admits. “I don’t have any great sense that the students are getting anything out of it. I don’t know what they are getting out of it. I do know that personally I like them and it’s been a lot of fun having them around. But I certainly would not like to defend the proposition that I am worth what I am paid. It’s not a lot.”
In fact, Lewis quickly and gleefully cops to the hypocrisy of his position. “I do realize it is a giant act of hypocrisy. I don’t think I can completely justify myself except that I did say in this article I was arguing against going to journalism school as a student. I don’t think I ever said it was a bad idea to go as a teacher,” he says, barely tongue-in-cheek.
What’s more, Lewis admits that his own experience, while inspirational, is far from instructive. “I would say that my experience is going to be next-to-useless for most people,” he says. “My formula is ‘OK, start by writing a No. 1 bestselling book.’ Once you have done that I can tell you how to manage your career.”
Despite his year teaching, Lewis still would advise his students to skip the degree. “I would tell them that experiences in the world are much more valuable than being in a classroom. I would say go wait tables,” says Lewis. “Do anything. And if you really feel the need to be in school, the best things to study are history, economics, law — subjects where there is actually a body of knowledge you can draw from.”
But don’t go to J-school. Not according to J-school professor Michael Lewis.
You are twitching, your vision is blurred and you can’t move the right side of your body. In other words, you are suffering an ischemic stroke - a blockage of an artery that normally brings blood to a portion of your brain. You could die or suffer significant brain damage as your brain cells starve for oxygen.
When they haul you into the ER, the doctor runs a few tests and sticks a needle in your arm. In the needle is an unlikely potion - the chemical equivalent of four cups of coffee and a nice glass of toasty red wine. That’s right, they are shooting you up with caffeine and alcohol.
Sound implausible? Not entirely, according to a University of Texas stroke research team from the Houston Medical School. The team, led by neurologist Dr. James Grotta, found that a mellow mix of caffeine and ethanol (alcohol) cut the damage to brain cells of laboratory rats as a result of stroke by more than 70 percent in some cases.
There are enough similarities between the biochemistry of rat brains and people brains to merit serious consideration of this counterintuitive remedy. According to their research, to be published in the scientific journal Neuropharmacology, this cheap and easy mixture regularly bested damage control efforts of more expensive and more dangerous pharmaceuticals. “It was the most powerful substance we tested in our laboratory,” says Dr. Jarek Aronowski, a neuroscientist who is part of the research team. “It was amazing how robust our findings were.”
Should we all carry a flask and a thermos of joe just in case? That’s probably premature for now, as Grotta and Aronowski themselves say. But should alcohol and caffeine turn out to be effective in humans, it could be a big deal. Here’s why. According to the Centers for Disease Control and Prevention, stroke is the third leading cause of death in the U.S. — 3.3 million Americans may suffer strokes each year and nearly 160,000 of them die. The after-effects of strokes cost tens of billions in medical care and lost wages each year and leave tens of thousands of Americans with impairments of speech, motor skills and other essential life functions. Strokes are becoming more common as more Americans age; strokes are likeliest in the elderly and people 55 years of age and greater suffer two-thirds of strokes. In other words, strokes are a major public health problem destined to grow even worse.
Despite large amounts of medical research, stroke treatment is still somewhat hit-and-miss. Often doctors have to wait for hours before they can decide on what treatment to use. In the case of ischemic strokes (when an artery is blocked; about 80 percent of all strokes are ischemic), doctors can often spot the clot with imaging equipment. Surgeons can sometimes clear the artery but this is a very risky procedure. There is an alternative, a drug called tPA that breaks up blood clots and restores blood flow. But tPA is very expensive and must be given within three hours of the stroke to be effective. Furthermore, tPA is not effective in all cases.
So doctors have continued to search for more effective anti-stroke drugs. One group of drugs they are testing is called neuroprotectors. These drugs, through mechanisms still poorly understood, insulate or safeguard brain cells during the nutrient and oxygen deficit of a stroke. This, in turn, reduces brain damage. Ideally, neuroprotectors would provide doctors a cushion of precious hours to treat the acute symptoms of the stroke without having to worry as much about immediately restoring blood flow to the brain. Neuroprotectors as a class are relatively new on the medical scene.
The caffeine and alcohol cocktail falls into the neuroprotector camp. As is common with other neuroprotectors, Grotta and his group do not understand the exact mechanisms that might be at work. “There are hundreds of (neurotransmitter) pathways that are affected by the stroke and probably all of these pathways are important to the pathology of the stroke. Even when we talk about the acute effects, there are at least 20 mechanisms that people speculate could be important but are not immediately interrelated,” explains Aronowski.
However, Grotta’s team did have a hunch that alcohol and caffeine might, at the very least, have an effect on strokes. For years, they had examined ischemic strokes in rats and tested various substances to see if they limited the death of brain cells. At the suggestion of his laboratory technician Roger Strong, Grotta decided to test caffeine and alcohol separately. Some studies have shown that moderate drinkers may enjoy a long-term reduced risk of ischemic stroke. So Grotta figured it might have an effect on acute stroke symptoms, as well. And caffeine interacts strongly with adenosine and glutamate neurotransmitter systems, both of which are closely tied into the brain’s response to stroke.
Initial tests of caffeine on the rats found it had no effect. And tests using alcohol on the rats found that it augmented rather than alleviated brain damage. But when the two were mixed in low dosages, they somehow teamed up to save considerable chunks of gray matter. “The striking thing to me isn’t just that it’s effective but how great the effect is. It really is very dramatic,” says Grotta. The treatment seemed most effective when applied a half-hour after the stroke. But even two hours after the stroke the combination managed to reduce brain damage in terms of volume by about 47 percent.
The prophylactic effect of the combination was somewhat ephemeral, however. The mixture did not save the brain cells of rats that had been regularly dosing on alcohol and caffeine before their induced stroke. “And if you give too much of either the alcohol or the caffeine, then the effect is lost. It’s a peculiar effect,” says Grotta, who cautions that another lab must replicate his results to ensure their validity.
As Grotta himself would admit, no one is suggesting that ERs start stocking wet bars with rum and cokes. And other neurologists are skeptical that buzz and booze treatment will translate. “I would not make much of this result. The rats were probably young, whereas most stroke victims are old. The rats were likely naive to alcohol and caffeine. But few adult stroke victims are. Furthermore the agents were given before or shortly after the experimental stroke. This is difficult to achieve in humans,” says Dr. Louis Caplan, a neurologist at Harvard University School of Medicine.
Even if another lab is able to validate Grotta’s results, getting funding for wide-scale clinical tests might be difficult. Drug companies with a vested interest in the outcome fund most of these clinical trials, which cost millions of dollars to run. But no drug company could hope to profit from a treatment using public domain substances like caffeine and alcohol. “Obviously no pharmaceutical company is going to fund a study of alcohol and caffeine since they won’t be able to make money from those substances,” says Grotta.
But the gatekeeper of the biz, the U.S. Food and Drug Administration, might be more inclined to approve trials for the caffeine and alcohol treatment than for most drugs due to the low and clearly non-toxic dosages involved. “I would imagine that if we would be able to successfully complete all the animal experimental work, this can be taken to clinical trials next year,” says Aronowski. And that’s when they can study the really big question of interaction with humans. “Even though ethanol and caffeine may be tolerated in those dosages in healthy humans, they may not be tolerable in stroke victims. That’s what we have to find out,” says Aronowski.
Sometime during pre-season football practice at the University of Utah on the third Sunday this August, a lineman took a wicked hit and checked out of the universe. Exactly when and how it happened, he can’t remember. In fact, the 285-pound athlete doesn’t remember much about that practice at all, nor about the hours before and afterward.
“I’m not sure when it happened because I kept playing on it. Then about three-quarters of the way through practice, I couldn’t do anything right. They pulled me out and started checking me,” he says. (The player’s name is omitted to protect the integrity of an ongoing scientific study.)
After further examination, the team trainers confirmed that the lineman had sustained a concussion. Then they did a strange thing: They gave him a battery of neurological tests. The tests were simple but mentally taxing drills — listening to a series of numbers and repeating them back in opposite order, listening to a group of words and trying to recall them several minutes later. Each drill is designed to utilize a different brain function and, by inference, to test the well-being of different parts of the brain.
Actually, this was the second time our dazed lineman endured these drills. Designed by psychologists Michael Collins and Mark Lovell of the Henry Ford Health System in Detroit, the battery of eight tests was part of an ongoing study that sought to gauge the long-term effects of concussions on college athletes. Since it began, 393 National Collegiate Athletic
Association Division IA football players have taken the tests in order to
track how quickly those who have sustained concussions recover their mental
faculties.
The results of the first data, which tracked 16 cases of concussions, were troubling. The data — published in the September issue of the Journal of the American Medical Society — indicated that players who endured multiple concussions may suffer long-term declines in brain functions. Even worse, players who had preexisting learning disabilities who sustained multiple concussions seem even more likely to suffer permanent impairments.
But most convincing of all is the data from those who reported two or more past concussions: Their initial baseline mental functionality tested markedly lower than that of their less-shook-up counterparts, who had reported sustaining only one or no past concussions.
“We found that athletes who had experienced two or more prior concussions in the past … performed significantly worse in tests in our battery relative to those who reported having one concussion or zero concussions. The two-or-more concussion group had deficits related to speed of information processing. They were not processing information as quickly as those people who had one or zero concussions,” says Collins. “It’s kind of like your Pentium III computer becomes a Pentium II computer or your 486 becomes a 386.”
Should college football players stop playing ball after one, two or three concussions? To be fair, the same question applies to any collegiate sport where concussions occur often. In addition to football players, soccer players and wrestlers sustain the injuries somewhat regularly. Still, football, with its nasty hits and unmatched explosive physical contact, is the king of concussion sports and thus a natural for concussion studies. According to Collins, about one in three college football players has experienced a concussion at some point during his pre-college or college career.
More people sustain concussions than you might think. The Centers for Disease Control and Prevention estimates that 1 million Americans with Traumatic Brain Injuries (TBIs) are treated and released each year from emergency rooms. Head trauma is a leading cause of disability in kids, adolescents and young adults. “It’s an epidemic,” says Joseph Bleiberg, a psychologist at the National Rehabilitation Hospital in Washington who is conducting a similar concussion study on the entire cadet population at West Point.
What exactly is a concussion? Think of the skull as an egg shell and the brain as the yolk floating within the egg white. If the egg shell gets spun or tilted but not shattered, the yolk inside is jostled. But outward signs that the yolk has moved are negligible. Similarly, the physical manifestations of Mild Traumatic Brain Injuries (MTBIs — read, concussions) are so subtle that CAT scans and MRI machinery can’t spot them.
The symptoms, too, are subtle and often pass beneath the radar. “There has been a tremendous misconception that a concussion is a loss of consciousness when an athlete gets knocked out,” says Collins. “However, there are many other signs that someone has had a concussion, like confusion, dizziness, loss of balance, fine-motor-coordination difficulties, personality change, headache, nausea and vomiting.”
And the players themselves are often in the dark. “Until I had mine, for me I can say I never knew exactly what a concussion was or what it did. I always thought you had to be knocked unconscious, like in a coma. I didn’t know you could be coherent and think you were all right even though you really weren’t,” admits the Utah lineman.
As it is, many athletes are loath to sit out. “Most athletes expect to play injured because the injuries are orthopedic. They expect to play with a sprained Achilles’ tendon or minor groin pull,” says Lovell. “The problem is when they apply that logic to the brain, because the brain is not like a muscle you can tape up and play on when it’s 75 percent. It is a non-renewable resource.”
So given this new data on concussions, what is the responsibility of the NCAA — a source of funding for some of Collins’ studies — and the universities to their football players?
In a few rare cases, Lovell believes athletes should not play. He claims that some “appear to be more concussion-prone than others.” Still, Lovell and Collins believe that in most cases, the number of concussions matters less than the recovery time allowed. “If an athlete sustains a concussion and the brain is given time to recuperate, we don’t feel there are going to be any long-term consequences … in most cases. It’s when the athlete sustains a concussion and then gets placed back in the playing field immediately thereafter [that] the brain jostles around more,” says Collins.
The initial findings of the study leave room for debate here — Bleiberg, the psychologist doing the West Point study, and others are concerned. “People who have had one concussion do OK. Once you have gotten two under your belt, you are starting to enter a different group of people,” says Bleiberg. “The literature clearly pointed in that direction. The JAMA papers were the frosting on the cake.”
In these groups that have sustained multiple concussions, after-effects are matters of degree — rarely do they mean life or death. Forget images of punch-drunk Muhammad Ali with shaking fists clamped at his sides. Think instead of days when you just can’t remember your locker combination, where you put your car keys. Or, for students, days when even easy answers to a physics test elude you — a possibility that Lovell and Collins touch on in their paper.
“The real-life effects are a reduction in mental efficiency — being unable to get as much mental work done per day as before. Getting tired more easily, being unable to concentrate for as long a period of time, making more mistakes,” says Bleiberg. “You almost always can still do what you used to be able do, but the quality is not quite as good.”
As it stands, far too little data exists for the NCAA to establish any specific guidelines on disqualification due to multiple concussions — although each year, a few players do get disqualified for this reason. Soon, Collins’ study may have the data to make these decisions more common.
At the very least, a concussion issues a wake-up call to many college athletes. “Right after it happened, I was a little scared. I didn’t know what was going on. My mind wasn’t working right and I didn’t know what the feelings were I was having and why I couldn’t think straight. Everything was so cloudy,” says the Utah lineman.
The research has motivated several other college football teams to participate in the study. Both Collins and Bleiberg are working on easy-to-use computerized models of their test batteries that would allow psychologists to take baseline readings of thousands of athletes. Bleiberg even plans to distribute his test as freeware on the Internet so people can take it at home.
The players who stand to gain the most are the ones at the smaller Division II and III schools — here trainers are likely to have less training in checking for concussions. Already the study has made a difference at the four participating schools. After taking the test, for example, the Utah lineman was held out for an additional two days.
And at Michigan State, the study helped trainers get a better idea of when a player should return to the field. “The study has helped us. Before, you went by the symptoms: headache, nausea, dizziness — but they can go away. They said they felt fine and we would let them go back,” says Michigan State trainer Sally Nogle. “Now we have a more sensitive test to check how they are functioning. There have been cases where we test them where we think, ‘Hey this is not normal yet.’ Hopefully it prevented the long-term problems.”
And with studies like this, players might gain a better understanding of what hit them. “I don’t know how many athletes I have worked with that have said, ‘Doc, what’s in the future. Am I going to have problems down the road? How many concussions are too many?’ We don’t have the information to provide to these athletes,” says Collins. “That’s really the impetus of the study.”
Still, given the very slight risk of death and relatively low grade of concussion after-effects, it’s likely that many players would keep playing after multiple concussions — even with this new information. “I love the game of football. I don’t think I would give it up even if I did have another concussion,” says the Utah lineman. “But I would try not to get hit in the head so much.”
In July 1998, the world’s scientists were stunned at an announcement from the University of Hawaii. As flashbulbs popped and reporters scribbled at a press conference in New York, Ryuzo Yanagimachi, eminent professor of anatomy and reproductive biology, announced that his three-man team had replicated successive generations of a cuddly black mouse named Cumulina.
The implications of their announcement were enormous. Unlike the Scottish researchers who cloned Dolly the lamb but had been unable to repeat their feat, the UH team had cloned dozens of mice that were verifiably genetically identical. Until the breakthrough, cloning in mammals and other higher organisms had been unreliable to the point of being nearly random despite numerous past attempts by top-flight researchers and a few unverified claims of success.
The breakthrough garnered major coverage from virtually every news organization. Biological duplication vaulted from the realm of science fiction into the realm of hard fact. Possibilities ranging from growing human organs to restoring extinct animals as in “Jurassic Park” were touted. The three members of the team — Yanagimachi, Anthony Perry and Teruhiko Wakayama — attained a rarified level of academic superstardom.
A year later the trio continues its magical science tour. All three are hot properties on the science conference circuit and the two younger members, Perry and Wakayama, have been bombarded with lucrative job offers from other schools.
But on July 27 Perry sued the University of Hawaii over intellectual property rights to genetic manipulation techniques related to their cloning breakthrough. Perry claims he owns the patent rights to some of these procedures, which could be worth millions of dollars in the private sector. The university says anything that happens in UH laboratories is theirs and that Perry was well aware of this.
The case is one of a handful of recent high-profile disputes over who owns the creative energies of the best brains in science. In an era when, more than ever before, a single good idea can be worth many millions of dollars, when researchers float from one lab to another on visiting fellowships and the traditional tenure relationships in academia are increasingly tenuous, ownership of intellectual property is a hot topic indeed. “The university claims because you are sitting in a building, anything you think about while you are in this building belongs to them,” explains Perry’s lawyer, Jeffrey Harris. “They are saying, ‘I own your mind.’ We are saying we don’t think that’s true.”
The saga of Tony Perry, then a graduate student and aspiring musician, began in 1996 when the young Brit applied for a research position in Yanagimachi’s laboratory at the UH medical school. That October, Perry hung up his saxophone, quit his band and left the British Isles for paradise. Yanagimachi’s lab provided him a rare opportunity. The Japanese researcher, long ensconced in Hawaii, is a formidable expert in reproductive sciences. As it turned out, Perry would also be working with Wakayama, another Japanese researcher widely considered to have one of the most brilliant young minds in the field.
The three occupied a shabby laboratory with no air conditioning, a leaky roof and decrepit equipment in a building shared with the UH food-service operations. While such conditions would have appalled most top-level researchers, Yanagimachi and his team made the best of it and enjoyed their brief obscurity. (Yanagimachi has actually claimed the hothouse may have contributed to the unprecedented success of his team’s experiments).
For two years they worked seven days a week, 12 to 15 hours a day. Slowly but surely they unlocked one of the major scientific puzzles of our time. After the initial cloning breakthrough, more discoveries continued to trickle out of the laboratory. Perry delved into transgenics. Whereas cloning involves replicating cells, transgenesis involves using cells and inserted strands of DNA to manipulate the genetic material of mammals. And everyone assumed that these technologies were quite valuable, perhaps worth millions upon millions some day should they prove useful in general terms to commercial biotech efforts.
During the first two years of their fellowships, Perry and Wakayama got nothing from the university. They received no health insurance or benefits, or any other assistance except use of the lab — a dubious gift at best. Perry lived off a grant from the European Molecular Biology Organization. Wakayama lived off a similar grant from a Japanese science organization. “We were paid into our own bank accounts. We were not really in the university at all,” relates Perry.
After their fellowships ran out in the fall of 1998, both were put on the UH payroll but neither was offered a tenured position — a fact scientists found puzzling considering the magnitude of the cloning breakthrough.
Meanwhile, a little-known biotech company named ProBio Inc. purchased the rights to technologies emerging from the laboratory. The firm, with roots in both Honolulu and Australia, had been introduced to university administrators by Perry. Under the agreement, ProBio would also control the technologies coming out of the lab for many years to come. For this, ProBio agreed to pay $400,000 annually and to give the university a percentage of future royalties and revenues derived from the cloning and other technologies.
But Perry’s view of ProBio and UH soured when, much to his distress, neither he nor Wakayama were included in the negotiations with ProBio. Their side was largely represented by the school’s senior vice president for research, professor Alan Teramura, a plant biologist.
In fact, Perry never saw the final licensing contract until May 7, more than five months after UH and ProBio signed. Perry says he feared that ProBio and the university lacked the contacts and the wherewithal to make the best use of his inventions. (Sources have said Wakayama is likewise dismayed but he has chosen not to speak to the press.)
Soon ProBio was having trouble paying its bills. It took out a loan from a state of Hawaii business development fund but still struggled to raise cash. That was no surprise. Serious bench research can expend cash at astonishing rates. It’s not unusual for even small startups to spend several million dollars each year on research that is not even close to being commercially viable. And Hawaii has been a tough place to raise substantial capital. Another promising biotech company, Neugenesis, moved to the San Francisco Bay Area last year after fund-raising in Hawaii proved impossible despite the fact that it had better connections than ProBio.
Amid these difficulties, Perry’s concerns boiled over. Early this year, he began to consider ways to assert his own rights to supersede the agreements that UH had signed on his behalf but without his consent. In April he entered into negotiations with UH that proved fruitless. The dispute also drove a wedge between Perry and Yanagimachi, who is also refusing to speak to the press about the matter.
In June, Perry and Wakayama formed their own biotech company, BiogeneSys. They enlisted the help of John Henry Felix, a city councilman with close ties to the medical establishment. Felix is chairman emeritus of the Salk Institute, the prestigious medical research center in San Diego. The company planned to commercialize techniques coming out of Perry and Wakayama’s work. Obviously, the university was not pleased. BiogeneSys posed a clear threat to the university’s control of this potentially valuable intellectual property. This set the stage for the lawsuit Perry filed in July.
Perry based his lawsuit upon the ideas of consent and fair warning. According to the filing, not only did the university not consult him on signing agreements but it never briefed Perry on intellectual property protocols or asked him to sign what some technology-transfer experts claim are boilerplate legal documents asserting the university’s ownership over intellectual property from the lab. “Every employee (involved in scientific research at the University of California) is supposed to sign a patent agreement. I think that’s true for most campuses around the country,” says Joel Kirschbaum, director of the Office of Technology Transfer at University of California San Francisco.
Not so at University of Hawaii. “Basically, we have a written policy which indicates that any work or invention conceived using UH facilities, equipment, personnel and or resources belong to the university. I think that’s common to most universities. We don’t have a written release,” says Teramura.
So far the reaction to the suit has been anger and surprise from UH. “The university last August had submitted a provisional patent for the intellectual property in question,” says Teramura. “That provisional patent was largely written by Dr. Perry on behalf of UH. It included three co-inventors. Those include Dr. Yanagimachi, Dr. Wakayama and Dr. Perry. This was last August. We had learned through Dr. Perry’s attorney in June that Dr. Perry had formed his own company and had taken out provisional patents for the same technique that we had already submitted two provisional patents for at the university.” According to Teramura, UH had offered to go to binding arbitration but Perry and his attorney declined. “I was shocked and disappointed that this is the way it turned out,” says Teramura.
To be sure, it is only fair that universities gain some of the largesse from the inventions of the people they employ and, to a large degree, shelter. “Our feeling is that if they are going to be using our resources then what they invent is probably ours. We ask them to also abide by similar policies. We are a state-funded institution. The buildings are provided with state money,” says UCSF’s Kirschbaum.
According to Kirschbaum, under the best circumstances a partnership exists where a university can take the new technology and put it in the hands of people who can turn the idea into money, ideally with significant benefit to society as well, in the form of new medical treatments or other improvements in life. Stanford, M.I.T., Harvard and the University of California are all considered standout players of this game, according to Kirschbaum and Perry himself. Professors often become millionaires from their percentages of such deals. Perry would have received 50 percent of royalties and licensing revenues that UH received from his invention, as per UH policy. This is a generous policy but it’s only as good as the alliances the university manages to build with commercial suitors and potential investors.
But what if this partnership goes wrong? Does a researcher — especially a visiting fellow who has worked off the payroll — have the right to take control of his or her intellectual property if it is being poorly managed? There is no clear consensus on this murky issue, just as there are no reliable numbers on the apparently increasing frequency of intellectual property fights.
Furthermore, when does the ownership of an idea begin? Can a university rightfully claim ownership of an idea that was begun earlier but merely perfected or refined in its labs? And does a university even want to create a climate where ideas are closely watched and tracked?
“There is a constant tension between the need to promote the exchange of ideas and the need to protect them. Sometimes it’s a fairly fine line that we have to walk. And we try to do the best that we can. People here are brought in to be independent thinkers, to work creatively and to take a lot of initiative. The licensing office is not a police force, nor should it be,” says Kirschbaum.
Perry fears that his future work could be subjected to restraints stemming from the past. “I can tell you Perry is primarily concerned about the technology and not the dollars. He wants to see his inventions hook up with the right people,” says Perry’s lawyer Harris.
Of course, dollars must have entered into Perry’s mind at some point. But regardless of whether the lawsuit is for money or for freedom, perhaps the saddest outcome of this affair is the likely breakup of a highly productive scientific partnership. Perry says he, Wakayama and Yanagimachi are a good team and, at the least, he and Wakayama wish to stay together. Whether there will be a rapprochement between Yanagimachi and Perry is likewise unclear.
Wakayama has accepted a tenured position at UH in a new institute to be headed by Yanagimachi. The university has said it will vigorously fight Perry’s lawsuit, although it claimed in a statement that it “… remains hopeful that this matter can be resolved quickly and amicably to the mutual satisfaction of all parties involved.”
Regardless, for Perry it would be quite difficult to return to UH after a lawsuit and public argument. “It’s a very, very stressful situation. I am a science guy and that’s what I want to do,” says Perry. “But, without consent, there has been an attempt to sell off a vigorous and productive part of our careers with implications for the foreseeable future and beyond. That’s just not right.”
On June 25, some of the world’s best astronomers gathered atop 14,000-foot Mauna Kea on the Big Island of Hawaii for a scientific love-fest. Representatives from Harvard, UC-Berkeley, the National Astronomical Observatory and the University of Hawaii showed up for the fun. With proud and solemn testimonials they unveiled the Gemini Telescope, the
latest big observatory on the planet’s premier place to stargaze.
People were outraged — or at least some were. The triumphal gathering belied a feud that has erupted over how Mauna Kea is to be managed in the new millennium. The Sierra Club and native Hawaiian groups did not attend the June 25 event. Environmentalists say star-struck scientists are trampling fragile ecosystems. Native Hawaiians say the astronomers
who run the mountaintop are desecrating a profoundly sacred place. For
their part, the astronomers admit some guilt in not listening to concerns, but also
claim they have been blindsided with criticism of projects that were
approved and started a decade ago.
Hanging in the balance is control of the planet’s most important
astronomical real estate. “Our people have this one mountain just for them and
[the scientists] are taking it over. That’s not right. And that mountain is so sacred.
It is one of a kind,” says Reynolds Kamakawiwioole, a native Hawaiian
activist and ardent opponent of further astronomical development. “The
saddest thing is, they never had a chance to sit down with the native
Hawaiians.”
In the Hawaiian language, Mauna Kea means “white mountain” — a reference to
the shining snowcap the summit wears several months out of the year.
According to the Hawaiian creation chant, the mountain comes from the
union of Papa, the Sky Father, and Wakea, the Earth Mother. Mauna Kea is also
considered the piko (bellybutton) of the world, according to
Polynesian myths recognized around the Pacific.
At the summit, winds whip up to 150 mph and the frigid air gets thin enough to necessitate oxygen masks for visitors; it is an inhospitable
slice of heaven. But consistently clear skies, scant light pollution and
the thinness of the air ensure that, with the right conditions,
telescopes and naked eyes alike can glean more from the night sky than from anywhere else in the world. (The only telescope that tops terrestrial scopes — and then only in certain parts of the electromagnetic spectrum — is the Hubble Space Telescope, which orbits the planet beyond the distortions of the
atmosphere.)
Since 1968, scientists have built 13 separate observatories on the summit
under auspices of a 65-year lease from Hawaii’s Department of Land
and Natural Resources. The lease assigned use of all the lands on Mauna Kea above
12,000 feet to the University of Hawaii, and created the 11,228-acre Mauna
Kea Science Reserve. The telescopes have cost nearly $1 billion to build, and tens of millions more are spent each year running them. The four newest
telescopes — the Gemini, the Japanese Subaru Telescope and the Keck I and II observatories — belong to a new class that boasts powerful
computerized optical systems and reflective mirrors wider than a two-lane highway.
These scopes have the capability to peer back to the very edge of time — as far back as14 billion light years ago, just after the Big Bang,. Collectively, they represent the majority of the planet’s high-end astronomical firepower. “It’s the largest collection
anywhere of large telescopes. It’s an unbelievable capability and a huge
step up in aperture,” says Robert McLaren, interim director of the UH
Institute for Astronomy. His institution has become a world power in
the field, thanks to observation time it receives on these telescopes as part of
the lease agreements. In recent months, Mauna Kea has emitted a steady
stream of groundbreaking astronomical discoveries and eye-popping images, which have brought the stars closer to Earth than ever before.
But the transition from pristine volcanic wasteland to stargazing nirvana
has not been without conflict. In the 1970s pig hunters, conservationists
and native Hawaiians questioned the impact of construction and vehicle
traffic. In the 1980s, the Audubon Society raised a ruckus about the
development of support facilities at the 9,600-foot level that overlapped
the habitat of the palila, an endangered Hawaiian bird. In 1995, the Sierra
Club and several native Hawaiian groups complained about trash on the
summit from telescope construction.
Along the way a deep resentment took shape. Native Hawaiians objected to the astronomers’ shiny mushroom domes, which shared the summit with more than 100 pre-contact shrines. “By having these things on Mauna Kea, whether it’s buildings, telescopes or antennas, at the
very pu’u or tops of the hills, you ruin the sanctity of the mountain as it
relates to the spirituality of native Hawaiians,” says Charles Kauluwehi
Maxwell, a native Hawaiian kahu (pastor) who has been a vocal
opponent of astronomical development.
What shook the Mauna Kea status quo irreversibly, however, was a scorching
State Legislative Auditor report delivered in February 1998. The report
slammed both the university and the state government for negligence on
Mauna Kea with regard to management of cultural sites and environmental
impact. According to the report, promises to hire security and enforcement
personnel to patrol the mountaintop had gone unfulfilled, as had a
promise to complete an archaeological survey of the summit for Hawaiian
cultural sites. Critical habitats had allegedly been damaged during
construction projects on Mauna Kea. “They had a land manager who was
signing documents and construction permits who had never been to the top of
Mauna Kea,” says Nelson Ho, a regional vice president for the Sierra Club
and a Big Island resident.
Although they admitted some culpability, the astronomers believed that they were
far from the devils the audit made them out to be. “We weren’t hearing the
message,” says UH’s McLaren. “The Hawaiians weren’t speaking out 10 years ago or even five years ago like they [are] today. Required permits for all of the telescope
projects were handled in public meetings. Until 1995, there was essentially
no real complaints or opposition in these meetings,” adds McLaren, who
also found fault with the auditor’s claims of environmental damage resulting from the astronomers’ activities. “It’s long on opinion and short on facts to back it up. It reads more like an editorial than an audit,” says McLaren.
University of Hawaii is not the first institution to face the
prickly issue of reconciling indigenous cultures with the needs of astronomers. The remote mountaintops that astronomers crave often prove to have been prime real estate for ancient cultures, who were likewise drawn by the clear views of the heavens. University of Arizona astronomers sought out Native American leaders for counsel before planning and building a telescope atop Mount Graham.
“For more than a decade now, we have been talking to the various tribes of
the Southwest and listening to what they want us to do,” says Buddy Powell,
assistant director of the University of Arizona’s Steward Observatory. Although
it took years of dialogue to build up trust, Powell believes that he now
enjoys a strong relationship with the native peoples. “While they have different areas of specific concerns, one thing that comes clear is: Treat the land with dignity and respect. Do not go up there and bulldoze wide spaces. The Great Provider provides the land for our living and for our life. But you must only use that which you
absolutely need.”
While it’s too late for UH to seek pre-construction counsel, a 23-person advisory
board has begun slogging toward consensus on a new development
plan for Mauna Kea. Its final plans will likely be presented to the
University of Hawaii Board of Regents later this summer. Although
representatives from the astronomy, environmental and native Hawaiian
communities are all present on the board, the year-long process of
closed-door meetings has drawn fire and distrust from those not included.
For their part, the astronomers say they
truly wish to be good neighbors. They have
agreed to a moratorium on further developments atop the summit until the
new management plan is worked out. They have agreed to reduce the parcel
subject to scientific development to 525 acres from the original 11,228, of which only 70 or 80 will likely be developed, according to McLaren. They have forsworn any
building that will affect cinder cones — significant geological formations
of cultural importance — on the summit. Part of the management plan also
provides for UH funding of a new management agency that will oversee the
environmental and historical preservation efforts. Finally, a board of
native Hawaiians will advise further developments on the mountaintop.
But the basic reins to Mauna Kea will remain in the hands of UH and the
Board of Regents, a problem for groups that had hoped to get a binding
stake in the final decision process. For some of the native Hawaiians
and environmentalists, the new management plan does not go far enough. They
argue that the existing telescopes and their sponsoring organizations
(which include the California Institute of Technology and the Smithsonian Institution) should cough up cash to help right the past
wrongs. “The whole process is a sham. The board is appointed and it’s not
binding. It’s like the missionaries all over again … These white
people come in and do what they want to do without asking anybody,” said
one Big Island source who is familiar with the issue and the players.
Will there ever be peace on the mountain? The prospects are grim. There are four
telescopes on Mauna Kea that are at least 20 years old and thus ripe for
replacement. And astronomy is moving toward either
far bigger telescopes, with even larger mirrors, or else arrays of smaller
telescopes (called interferometers) that take up considerable space. For
many native Hawaiians, even one more telescope on Mauna Kea will be too
much.
“I don’t think we are ever going to make everybody happy. But what we are
trying to do is have a better dialogue with some of these groups than we
have in the past. Many of the issues that are raised by the Hawaiian
community transcend Mauna Kea. Although Mauna Kea may just be a microcosm
of these issues, it is a big, visible symbol,” says McLaren.
