Brain Injuries Are Common in Battle. The Military Has No Reliable Test for Them.


Dave Philipps and Thomas Gibbons-Neff

U.S. troops at Ayn al Asad Air Base in western Iraq hunkered down in concrete bunkers last month as Iranian missile strikes rocked the runway, destroying guard towers, hangars and buildings used to fly drones.



© Sergey Ponomarev for The New York Times Ayn al Asad Air Base in western Iraq after an Iranian missile attack on Jan. 8. The number of service members experiencing symptoms associated with brain injuries has since topped 100.

When the dust settled, President Trump and military officials declared that no one had been killed or wounded during the attack. That would soon change.


A week after the blast, Defense Department officials acknowledged that 11 service members had tested positive for traumatic brain injury, or TBI, and had been evacuated to Kuwait and Germany for more screening. Two weeks after the blast, the Pentagon announced that 34 service members were experiencing symptoms associated with brain injuries, and that an additional seven had been evacuated. By the end of January the number of potential brain injuries had climbed to 50. This week it grew to 109.

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The Defense Department says the numbers are driven by an abundance of caution. It noted that 70 percent of those who tested positive for a TBI had since returned to duty. But experts in the brain injury field said the delayed response and confusion were primarily caused by a problem both the military and civilian world have struggled with for more than a decade: There is no reliable way to determine who has a brain injury and who does not.

Top military leaders have for years called traumatic brain injury one of the signature wounds of the wars in Iraq and Afghanistan; at the height of the Iraq war in 2008, they started pouring hundreds of millions of dollars into research on detection and treatment. But the military still has no objective tool for diagnosing brain injury in the field. Instead, medical personnel continue to use a paper questionnaire that relies on answers from patients — patients who may have reasons to hide or exaggerate symptoms, or who may be too shaken to answer questions accurately.

The military has long struggled with how to address so-called invisible war wounds, including traumatic brain injury and post-traumatic stress disorder. Despite big investments in research that have yielded advances in the laboratory, troops on the ground are still being assessed with the same blunt tools that have been in use for generations.

The problem is not unique to the military. Civilian doctors struggle to accurately assess brain injuries, and still rely on a process that grades the severity of a head injury in part by asking patients a series of questions: Did they black out? Do they have memory problems or dizziness? Are they experiencing irritability or difficulty concentrating?

“It’s bad, bad, bad. You would never diagnose a heart attack or even a broken bone that way,” said Dr. Jeff Bazarian a professor of emergency medicine at the University of Rochester Medical Center. “And yet we are doing it for an injury to the most complex organ in the body. Here’s how crazy it gets: You are relying on people to report what happened. But the part of the brain most often affected by a traumatic brain injury is memory. We get a lot of false positives and false negatives.”

Without a good diagnosis, he said, doctors often don’t know whether a patient has a minor concussion that might require a day’s rest, or a life-threatening brain bleed, let alone potential long-term effects like depression and personality disorder.

At Ayn al Asad, personnel used the same paper questionnaires that field medics used in remote infantry platoons in 2010. Aaron Hepps, who was a Navy corpsman in a Marines infantry company in Afghanistan at that time, said it did not work well then for lesser cases, and the injuries of many Marines may have been missed. During and after his deployment, he counted brain injuries in roughly 350 Marines — about a third of the battalion.

After the January missile attack, Maj. Robert Hales, one of the top medical providers at the air base, said that the initial tests were “a good start,” but that it took numerous screenings and awareness among the troops to realize that repeated exposure to blast waves during the hourlong missile strikes had affected dozens.

Traumatic brain injuries are among the most common injuries of the wars in Iraq and Afghanistan, in part because armor to protect from bullet and shrapnel wounds has gotten better, but they offer little protection from the shock waves of explosions. More than 350,000 brain injuries have been reported in the military since 2001.

The concrete bunkers scattered around bases like Ain al Assad protect from flying shrapnel and debris, but the small quarters can amplify shock waves and lead to head trauma.

The blasts on Jan. 8, one military official said, were hundreds of times more powerful than the rocket and mortar attacks regularly aimed at U.S. bases, causing at least one concrete wall to collapse atop a bunker with people inside.

Capt. Geoff Hansen was in a Humvee at Ayn al Asad when the first missile hit, blowing open a door. Then a second missile hit.

“That kind of blew me back in,” he said. “Blew debris in my face so I went and sat back down a little confused.”

A tangle of factors make diagnosing head injuries in the military particularly tricky, experts say. Some troops try to hide symptoms so they can stay on duty, or avoid being perceived as weak. Others may play up or even invent symptoms that can make them eligible for the Purple Heart medal or valuable veteran’s education and medical benefits.

And sometimes commanders suspect troops with legitimate injuries of malingering and force them to return to duty. Pentagon officials said privately this week that some of the injuries from the Jan. 8 incident had probably been exaggerated. Mr. Trump seemed to dismiss the injuries at a news conference in Davos, Switzerland, last month. “I heard they had headaches,” he said. “I don’t consider them very serious injuries relative to other injuries I have seen.”

In the early years of the war in Iraq, troops with concussions were often given little medical treatment and were not eligible for the Purple Heart. It was only after clearly wounded troops began complaining of poor treatment that Congress got involved and military leaders began pressing for better diagnostic technology.

Damir Janigro, who directed cerebrovascular research at the Cleveland Clinic for more than a decade, said relying on the questionnaire makes accurate diagnosing extremely difficult.

“You have the problem of the cheaters, and the problem of the ones who don’t want to be counted,” he said. “But you have a third problem, which is that even if people are being completely honest, you still don’t know who is really injured.”

In civilian emergency rooms, the uncertainty leads doctors to approve unnecessary CT scans, which can detect bleeding and other damage to the brain, but are expensive and expose patients to radiation. At the same time doctors miss other patients who may need care. In a war zone, bad calls can endanger lives, as troops are either needlessly airlifted or kept in the field when they cannot think straight.

Mr. Janigro is at work on a possible solution. He and his team have developed a test that uses proteins found in a patient’s saliva to diagnose brain injuries. Other groups are developing a blood test.

Both tests work on a similar principle. When the brain is hit by a blast wave or a blow to the head, brain cells are stretched and damaged. Those cells then dispose of the damaged parts, which are composed of distinctive proteins. Abnormal levels of those proteins are dumped into the bloodstream, where for several hours they can be detected in both the blood and saliva. Both tests, and another test being developed that measures electrical activity in the brain, were funded in part by federal grants, and have shown strong results in clinical trials. Researchers say they could be approved for use by the F.D.A. in the next few years.

The saliva test being developed by Mr. Janigro will look a bit like an over-the-counter pregnancy test. Patients with suspected brain injuries would put sensors in their mouths, and within minutes get a message that says that their brain protein levels are normal, or that they should see a doctor.

But the new generation of testing tools may fall short, said Dr. Gerald Grant, a professor of neurosurgery at Stanford University and a former Air Force lieutenant colonel who frequently treated head injuries while deployed to Iraq in 2005.

Even sophisticated devices had trouble picking up injuries from roadside bombs, he said.

“You’d get kids coming in with blast injuries,” he said, “and they clearly had symptoms, but the CT scans would be negative.”

He was part of an earlier effort to find a definitive blood test, which he said in an interview was “the holy grail.” But progress was slow. The grail was never found, he said, and the tests currently being developed are helpful for triaging cases, but too vague to be revolutionary.

“Battlefield injuries are complex,” he said. “We still haven’t found the magic biomarker.”

Why aren’t brain injuries taken seriously?

WWI helmets protect against shock waves

WHAT THEY CALL CONCUSSION OR SERIOUS BRAIN TRAUMA WAS ONCE KNOWN AS SHELL SHOCK AND LAST CENTURY DURING THE BIG ONE WWI IT WAS AN EXECUTABLE OFFENSE ON THE BATTLEFRONT FOR COWARDICE

SEE https://plawiuk.blogspot.com/search?q=WWI

SEE https://plawiuk.blogspot.com/search?q=SHELL+SHOCK

SEE https://plawiuk.blogspot.com/search?q=BATTLE+FATIGUE

Orangutan granted 'personhood' turns 34, makes new friend

WAUCHULA, Fla. (AP) — A orangutan named Sandra, who was granted legal personhood by a judge in Argentina and later found a new home in Florida, celebrated her 34th birthday on Valentine's Day with a special new primate friend.

© Provided by Associated Press This Feb. 15, 2020 photo courtesy of the Center for Great Apes shows an orangutan named Sandra in Wauchula, Fla. Sandra, who was granted legal personhood by a judge in Argentina and later found a new home in Florida, celebrated her 34th birthday on Valentine's Day with a special new primate friend. Patti Ragan, director of the Center for Great Apes says Sandra has “has adjusted beautifully to her life at the sanctuary” and has befriended Jethro, a 31-year-old male orangutan. (The Center for Great Apes via AP)

Patti Ragan, director of the Center for Great Apes in Wauchula, Florida, says Sandra “has adjusted beautifully to her life at the sanctuary” and has befriended Jethro, a 31-year-old male orangutan.


Prior to coming to Florida, Sandra had lived alone in a Buenos Aires zoo. Sandra was a bit shy when she arrived at the Florida center, which is home to 22 orangutans.

“Sandra appeared most interested in Jethro, and our caregivers felt he was a perfect choice because of his close age, calm demeanor, and gentle nature,” Ragan said in a news release. “Sandra still observes and follows Jethro from a distance while they are in the process of getting to know and trust each other. But they are living harmoniously in the same habitat spaces as they continue to gain confidence in their relationship.”

Judge Elena Liberatori's landmark ruling in 2015 declared that Sandra is legally not an animal, but a non-human person, and thus entitled to some legal rights enjoyed by people, and better living conditions.

"With that ruling I wanted to tell society something new, that animals are sentient beings and that the first right they have is our obligation to respect them," she told The Associated Press.

But without a clear alternative, Sandra remained at the antiquated zoo, which closed in 2016, until leaving for the U.S. in late September. She was in quarantine for a month at the Sedgwick County Zoo in Kansas before arriving in Florida.

On Friday, Sandra celebrated her birthday, complete with pink signs and wrapped packages. Jethro, who was once in the entertainment business, attended the party.

China’s Leader, Under Fire, Says He Led Coronavirus Fight Early On
Amy Qin




a group of people standing in front of a crowd posing for the camera: President Xi Jinping visiting a Beijing neighborhood this past week, in a photograph released by the state news agency Xinhua.Next Slide
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1/4 SLIDES © Pang Xinglei/Xinhua, via Associated Press

President Xi Jinping visiting a Beijing neighborhood this past week, in a photograph released by the state news agency Xinhua.

Under fire for its response to the coronavirus epidemic, China’s authoritarian government appears to be pushing a new account of events that presents President Xi Jinping as taking early action to fight the outbreak that has convulsed the country.


But in doing so, the authorities have acknowledged for the first time that Mr. Xi was aware of the epidemic and involved in the response nearly two weeks before he first spoke publicly about it — and while officials at its epicenter in the city of Wuhan were still playing down its dangers.

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That new account risks drawing the president, China’s most powerful leader in decades, directly into questions about whether top officials did too little, too late.


[Read the latest updates on the coronavirus epidemic here.]

In an internal speech published on Saturday, Mr. Xi said he had “issued demands about the efforts to prevent and control” the coronavirus on Jan. 7, during a meeting of the Politburo Standing Committee, the highest council of the Communist Party, whose sessions are typically cloaked in secrecy.

In the speech, he also said he had authorized the unprecedented lockdown of Wuhan and other cities beginning on Jan. 23.

“I have at every moment monitored the spread of the epidemic and progress in efforts to curtail it, constantly issuing oral orders and also instructions,” Mr. Xi said of his more recent involvement.

Mr. Xi’s advisers may have hoped that publishing the speech, delivered on Feb. 3. would dispel speculation about his recent retreat from public view and reassure his people that he can be trusted to lead them out of the epidemic. The virus so far has officially infected more than 68,000 people and killed more than 1,650 worldwide, the vast majority in mainland China.

“The overall tone of the speech appears to be defensive,” said Minxin Pei, a professor of government at Claremont McKenna College in California. “He wants to change the narrative, which until this point has been very unfavorable to the top leadership.”

Delivered at a meeting with top party officials, when the epidemic had already spiraled into a national crisis, the speech could expose Mr. Xi to criticism that he didn’t treat the initial threat urgently enough, and make it difficult for him to shift blame onto local officials for what many see as the government’s early mishandling of the epidemic.

The remarks also raise questions about what top leaders knew at the time and what instructions they issued based on that knowledge.


That Mr. Xi convened a meeting of China’s highest political body in early January indicates that the coronavirus was already being seen as a matter of high-level concern — making his subsequent silence even more conspicuous, experts say. An official account of the Jan. 7 Standing Committee meeting issued at the time by Xinhua, the state news agency, made no mention of a discussion of the coronavirus.


“It seems like he’s trying to indicate that ‘we weren’t asleep at the wheel,’” said Jude Blanchette, the Freeman Chair in China Studies at the Center for Strategic and International Studies. “But it comes off like ‘we knew this was a problem, but we weren’t sounding the alarm.’”

In the speech this month, Mr. Xi signaled his displeasure with lower-level bureaucrats for their “shortcomings” in implementing the party’s top-level directives.

In early January, officials in Wuhan were giving open assurances that human-to-human transmission of the virus was unlikely. Some government experts agreed.

“For now, it seems there is no clear evidence of human-to-human transmission,” Xu Jianguo, a senior expert on communicable diseases at the Chinese Center for Disease Control and Prevention, said in an interview in early January with Ta Kung Pao, a Hong Kong newspaper. “This shows that the threat level from this virus is limited.”

The new information places Mr. Xi’s involvement in fighting the epidemic much earlier than was previously known. His earliest public comment on the epidemic came on Jan. 20, when he gave brief instructions that were published in state media.

In the days after Mr. Xi’s Jan. 7 orders were issued, politicians in Wuhan met for the annual meeting of the city’s People’s Congress, its party-controlled legislature. Over that time, the Wuhan health commission’s daily bulletins on the outbreak said repeatedly that there were no new cases of infection, no firm evidence of human-to-human transmission and no infection of medical workers.

But signs were growing that politicians and government experts underestimated the potency of the new coronavirus. On Jan. 9, a 61-year-old man surnamed Zeng died — the earliest confirmed fatality from the virus. Already, some doctors in Wuhan hospitals were worried enough to warn friends and propose special wards for patients showing symptoms of infection.

Even after Mr. Xi made his first public remarks about the epidemic on Jan. 20, he mostly kept it at the bottom of his public agenda. On the day before the Lunar New Year holiday began in late January, he took the stage at the Great Hall of the People in Beijing and declared his success in guiding China through a difficult year — making no mention of the virus that was already spreading fear throughout the country.

As he spoke, Wuhan, a city of 11 million, was going into lockdown mode, in a desperate attempt to stop the virus from spreading.

Mr. Xi’s first public appearance after the lockdown of Wuhan on Jan. 23 came two days later, when he presided over a meeting of the Politburo Standing Committee.

“We’re sure to be able to win in this battle,” he proclaimed.

But in the days after, he all but disappeared from public view, emerging only a handful of times to preside over Communist Party meetings and to meet foreign visitors, including the director-general of the World Health Organization and Cambodia’s autocratic leader Hun Sen. In the meantime, he directed the country’s No. 2 leader, Li Keqiang, to lead the group handling the emergency, effectively turning him into the public face of the response.

For days, Mr. Xi’s absence from public view fueled speculation that he was trying to shield his own reputation by taking a back seat in the fast-unfolding crisis. In the past week, he has returned to center stage in an apparent effort to swat away such talk.

This past week, Mr. Xi went to a neighborhood center in Beijing, a hospital and a center for disease control in what state media billed as a visit to the “front line” of China’s efforts to combat the epidemic. He has yet to visit Hubei, the province at the center of the epidemic.

A few days later, Mr. Xi fired two top Communist Party officials in Hubei, a move intended to calm simmering public anger and contain the political fallout.

By publishing the Feb. 3 speech now, experts say, Mr. Xi appears to be staking his reputation on the outcome of the epidemic fight.

“What’s really interesting in the speech is there’s a lot of the word ‘I’ in it,” said Mr. Blanchette, of Center for Strategic and International Studies. “This is clearly putting himself at the center of Beijing’s response to this while also falling back on the old excuse of blaming cadres for longstanding pathologies of China’s political system.”

The Feb. 3 speech was published by Qiushi, or Seeking Truth, the Communist Party’s top doctrinal journal. It is rare for such an internal speech to be published in full so quickly.

In the speech, Mr. Xi described the efforts to end the epidemic as a “people’s war” and he singled out two key battlegrounds: Hubei Province, where the infections and deaths have been concentrated, and Beijing, the capital.

He also acknowledged that the epidemic and the fight to curtail it were likely to hurt the economy, slowing production and cooling trade.

In response, Mr. Xi said the government would provide financial support for businesses, help migrant workers return to their jobs and step up support for construction projects. He said the blow to consumer spending could be offset by encouraging spending in new areas, such as 5G phone networks, as well as online entertainment and education.

He also emphasized the importance of taking control of the narrative and winning over public opinion at home and abroad.

“There must be closer monitoring and assessment of opinion, proactively speaking out and giving positive guidance,” Mr. Xi said of Chinese public sentiment.

“Seize the initiative and effectively shape international opinion,” he added.

CLIMATE CHANGE
UK issues rare 'danger to life' warning over Storm Dennis
AFP







Slide 1 of 11: A woman struggles with an umbrella in strong winds on the Millennium Bridge, in central London, as Storm Dennis is causing a second weekend of disruption with bad weather wreaking havoc across the UK. (Photo by Dominic Lipinski/PA Images via Getty Images)Next Slide
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1/11 SLIDES © Dominic Lipinski/PA Images/Getty Images

As Storm Dennis sweeps in, the country is bracing itself for widespread weather disruption for the second weekend in a row. Experts have warned that conditions amount to a "perfect storm", with hundreds of homes at risk of flooding.(Pictured) A woman struggles with an umbrella in strong winds on Feb. 15 in central London, as Storm Dennis is causing a second weekend of disruption with bad weather wreaking havoc across the UK.

Slideshow by Photo Services


Storm Dennis swept across Britain on Sunday with the army drafted in to help deal with heavy flooding and high winds, officials warning it could be "life-threatening" in South Wales.

The government weather agency issued a rare red warning for the area, saying there was a risk of "significant impacts from flooding" that included a "danger to life from fast flowing water, extensive flooding to property and road closures".

Almost 200 flood warnings were in place early on Sunday, extending from Scotland's River Tweed to Cornwall in southwest England.

Winds of over 90 miles per hour (150 kilometres per hour) were recorded in Aberdaron, south Wales.

The Ministry of Defence had earlier deployed troops in West Yorkshire, northern England, which suffered badly from flooding caused by last weekend's Storm Ciara.

"Our armed forces are always ready to support local authorities and communities whenever they need it," said defence minister Ben Wallace.

British Airways and easyJet confirmed they had grounded flights, while two bodies were pulled from rough seas off the south England coast on Saturday as the storm barrelled in.

One of the men is assumed to have been the subject of a search triggered when an LPG tanker reported that one of its crew was unaccounted for.

He was last seen several hours earlier.

jwp/jxb

CLIMATE CHANGE
Mississippi braces for flooding amid cresting river

JACKSON, Miss. (AP) — Mississippi Gov. Tate Reeves declared a state of emergency Saturday amid predictions that a river running in the area around the state capital of Jackson could burst its banks and spark widespread flooding.

Forecasters believe the Pearl River will crest at 38 feet (11.6 meters) Sunday evening to levels not seen in decades, following days of torrential rains across the Southeast. Reeves said the state should prepare for “the third worst flood” in its history.

“This is a historic, unprecedented flood,” Reeves said via Twitter.
Parts of Jackson and suburban Ridgeland were under evacuation orders, and some people had already filled trucks with furniture and other belongings to get out. Reeves said more than 2,400 homes and other structures in and near Jackson could either be inundated or isolated by the rising waters. That includes 1,925 structures in Hinds County, 461 in Rankin County and 31 in Madison Count.

“Have a plan to protect yourself and a plan to protect your loved ones,” Reeves said.

Although the sun was shining Saturday in central Mississippi, Reeves and Mississippi Emergency Management Agency director Greg Michel said people in low-lying areas should not be complacent about leaving because the river was expected to crest at night and remain high for days, with rain in the forecast for Sunday and Monday.

“Do not wait until water gets into your house to evacuate,” Michel urged.

Officials were bracing for what could be the worst flooding in Jackson since 1983. Nicholas Fenner, a meteorologist with the National Weather Service in Jackson, said the Pearl River crested at 43.2 feet on April 17, 1979 — its highest level. The second-highest level occurred May 5, 1983, when the river got up to 39.58 feet. He also said there was between $500 million and $700 million worth of damage in 1979, which saw 15,000 people evacuated.

The area is currently under blue skies, but Fenner warned residents against complacency.

“Even though the weather has improved, the water will be rising soon. Don’t get lulled into a false sense of security,” he said.

Meanwhile, the Ross Barnett Reservoir is approaching capacity, which led officials to announce that they would begin slowly releasing water at 6 p.m. Saturday. WLBT-TV reported the move is an attempt to keep flooding to a minimum downstream, and to allow extra time for residents to get to higher ground.

John Sigman, manager of the Pearl River Water Supply District, had a phone conference with the National Weather Service and the Army Corp of Engineers on Friday. They said that areas north of the main lake have crested and were beginning to fall and described that as good news.

The crest at the reservoir is now expected Sunday morning. Officials told the television station they are holding their outflow right now at 65,000 cubic feet per second and will hold there for 48 hours, giving people downstream time to get out.



 Provided by Associated Press

The restrooms on the Madison County side of the Ross Barnett Reservoir Spillway Park are about the only structure still visible as floodwaters have covered both sides of the popular fishing and boat landing in central Mississippi, Friday, Feb. 14, 2020. The gates to the Ross Barnett Reservoir Spillway Park are chained closed as floodwaters have covered both sides of the popular fishing and boat landing in Rankin County, Miss., Friday, Feb. 14, 2020. On Sunday, the river is expected to crest at 38 feet. Only twice before has the Pearl River surpassed 38 feet — during the historic floods of 1979 and 1983. (AP Photo/Rogelio V. Solis)


A soccer complex in northeast Jackson, Miss., Friday, Feb. 14, 2020, is underwater from flooding. As of Friday afternoon, the Pearl River was at 35.48 feet, which is more than 7 feet above flood stage. (AP Photo/RoSolis)

The next deadly pathogen could come from a rogue scientist. Here’s how we can prevent that.

DNA synthesis is driving innovations in biology. But gaps in screening mechanisms risk the release of deadly pathogens.

By Kelsey Piper Feb 11, 2020

DNA synthesis and assembly, once expensive, is now cheap and widely used for critical biology research. Getty Images/fStop
This story is part of a group of stories called

Finding the best ways to do good.


In the past few years, something new has become possible in biology: cheaply “printing” DNA for insertion into a cell.

That means a scientist who needs a particular DNA sequence to, say, create new bacteria for research can now order that DNA sequence from a lab. That might seem like a niche technology — how many biologists need to custom-print their own DNA? — but DNA synthesis and assembly (as the “printing” process is called) are actually useful for an astonishing variety of research uses, and could have far-reaching implications for how we live. In labs around the world, tons of critically important, valuable biology research is advancing thanks to DNA synthesis, and things look likely to get even better as DNA synthesis gets even cheaper.

But as is often the case when a scientific field gets a lot better at what it does very quickly, progress in DNA synthesis has been so fast that coordination against bad actors has lagged. As a private individual, I can send a DNA sequence I’d like synthesized to dozens of labs around the world that can print it out and send it to me.

But what if I asked them to print for me the genetic code of the influenza that caused the 1918 flu that killed millions of people? What if I sent them the instructions for a new disease that I have reason to believe is dangerous? What if I was doing legitimate research, but my lab didn’t adhere to modern safety standards?

The answer is that a few DNA synthesis companies will send me what I asked for, with no screening to check whether they’re sending out a pathogen that ought to be carefully controlled. (Synthetic DNA is not a live virus, of course; I’d have to be a talented biologist with specialized knowledge, lots of resources, and access to expensive tools to use it maliciously.)

Some companies — including most industry-leading ones — do follow US guidelines that require a background check and also check the DNA sequence against a list of known hazardous ones and would stop me from making this dangerous order — but a recent report found no evidence of any laws requiring laboratories to follow those guidelines in any country in the world. Doing so adds some time and expense to the ordering process, so there is some incentive to cut corners.


That’s why many experts argue that we need to do better. Their proposals on how to fix the system vary, but they all agree on one thing: I shouldn’t be allowed to order myself the 1918 influenza or a new coronavirus off the internet and have it delivered to my home.

And to establish screening for DNA orders on a global scale will take large-scale international coordination — and so far, we have struggled to coordinate even for simpler countermeasures.
How DNA synthesis works

A few decades ago, researchers embarked on the Human Genome Project, which tried to determine the base pairs that make up all of human DNA. It was a 13-year project of enormous scope and complexity. The government had to invest billions of dollars to make it happen.

Since then, the world of genetics has changed. New technology has made us a lot better at scanning — and manipulating — DNA. It now costs about $1,000, instead of billions, to sequence a full human genome. Other critical aspects of genetics research are getting cheaper too.

Of particular importance? DNA synthesis.

When researchers wanted to produce copies of a DNA sequence they’re studying, they used to have no choice but to painstakingly clone an organism with the DNA they want, inserting or removing genes with splicing techniques. Now, that has changed. With today’s techniques, we can artificially build DNA sequences, adding one base pair at a time, in a lab.

The process is fairly cheap and getting cheaper — only about 8 cents per base pair added in this fashion — though it does still add up with something as big as the human genome. But for many smaller projects, getting the DNA you need synthesized is a viable option. If I have on my computer a sequence of DNA which I want to work with in the lab, I can send those instructions to a DNA synthesis service — and they’ll send back the DNA, ready for lab work.

Let’s consider a researcher who has modified the genome of a bacterium so that it will produce human insulin. Just a few years ago, it would have been expensive and an enormous hassle to get her DNA sequence “printed” — all of the base pairs attached in order — so that she could insert it into an organism and start her experiment. Just a few years before that, it would have been basically impossible.

But today, doing this is quite affordable. That’s amazing news for researchers, who can cheaply and quickly order DNA sequences online and get the DNA they asked for delivered straight to them at a reasonable price.

Let’s be clear: This is great news. Advances in our ability to synthesize DNA open lots of avenues for promising new research. Researchers can test custom sequences and arrive at a better understanding of gene sequences and what they do. Progress on this front will make for better medicine, better crops, and better production of proteins we need for industrial processes.

But there’s a critical security problem to be solved as DNA synthesis gets cheaper and easier.
Why screening for dangerous pathogens is hard

Since DNA can be both beneficial and dangerous, experts agree that screening should happen. But most countries don’t have laws or even guidelines on how to do it.

“DNA is an inherently dual-use technology,” James Diggans, who works on biosecurity at the industry-leading Twist Bioscience, told me. What that means is DNA synthesis makes fundamental biology research and lifesaving drug development go faster, but it can also be used to do research that can be potentially deadly for humanity. That’s the problem that biosecurity researchers — in industry, in academia, and in the government — are faced with today: trying to figure out how to make DNA synthesis faster and cheaper for its many beneficial uses while ensuring every printed sequence is screened and hazards are appropriately handled.


Where does policy stand on this? The US government has guidelines intended to prevent dangerous incidents, and If I went to a company like Twist, where Diggans works, and asked for a DNA sequence, they would conduct a background check to determine “Is the customer on a watchlist, are there reasons to worry?” Diggans told me. They’d ensure I had a license and ship only to a legitimate lab.

The next step? “Screen the sequence,” said Diggans — or check my request to compare it to known prohibited pathogens. If they noticed I was requesting a dangerous influenza virus, they would follow up with me to learn more about what I’m researching.

But not every company follows those guidelines (though most synthetic DNA is produced by companies that do abide by them, and the International Gene Synthesis Consortium polices its members). And the guidelines don’t cover short sequences, which are a growing share of biology research.

“The technology has kind of outpaced where the government regulators are,” Diggans told me.

So new screening — and new regulations backing the international use of that screening — is needed. The aim of a new screening regime should be to ensure that requests for DNA are checked to determine whether they contain prohibited, dangerous sequences, without adding too much to the expense of screening and without slowing down legitimate researchers, who should be able to access DNA for their projects cheaply and quickly.

“We have this window of time to get screening right,” Beth Cameron, who works on mechanisms for preventing illicit gene synthesis at the Nuclear Threat Initiative (NTI), told me. NTI is a nonprofit focused on global catastrophic risks and works to prevent attacks and accidents with nuclear, biological, and chemical agents. Last month in Davos, Switzerland, NTI and the World Economic Forum recommended a new international effort to establish a common mechanism for screening DNA orders. The report recommends creating a technical consortium to build and launch that mechanism for use by companies and labs around the world, with the goal of making screening a norm.

The Nuclear Threat Initiative also recommends establishing a new global entity focused on preventing biotechnology catastrophes — a place whose mission is to oversee DNA synthesis screening. Since diseases can spread around the world, and DNA synthesis can be located anywhere, strong international cooperation is needed. Lots of international organizations are working together, but there’s no good institution to coordinate it.
Changing the incentives for DNA synthesis research

Another focus for biosecurity researchers should be on changing the incentives for how research is currently conducted.

Why do some companies choose not to screen? Well, screening is expensive. Comparing extremely long sequences of letters to a large database of prohibited sequences requires a lot of computer runtime. If a potential problem is identified, an expert biologist is needed to suss out whether there’s a real issue. “As DNA screening has gotten cheaper,” Cameron told me, “screening becomes a larger percentage of the cost.”

That puts companies that are doing the right thing at a competitive disadvantage.

So here’s another idea: Make grants for biologists who do research with DNA synthesis contingent on using labs that follow screening guidelines. Most of the grants for DNA research actually comes from the US government. By mandating that scientists only buy their DNA from organizations that are employing state-of-the-art, agreed-upon screening procedures — otherwise they don’t get the grant — we can turn DNA screening from a competitive disadvantage into a competitive advantage, and hopefully drive more labs to get on board.


“Those research dollars should go to companies that screen responsibly,” Diggans told me. With research dollars only going to compliant companies, companies that currently do not screen as encouraged by the US guidelines would likely start complying with them.
New technical approaches to screening

Some researchers think the system could be improved along other dimensions as well.

Kevin Esvelt, at MIT, is one of them. Esvelt led early research on CRISPR gene drives, and he’s been thinking about misuse of biotechnologies for just as long.

He points at a key limitation of even the best proposed screening programs. In order for companies to know what pathogens to screen for, they need to have a database with the DNA sequences of all the dangerous biological agents we know of — so they can cross-check between that database and requests from customers.

But maintaining that database creates some problems. If a new pathogen is added to it, then any bad actor can see that it was added and knows it might be an interesting threat. If a bad actor wants to get dangerous DNA past the screening process, they can review the database and learn whether their sequence will be flagged. That’s why lots of secure systems do not make the details of what test you have to pass publicly available.

There are a few ways to solve this problem. One is to aim to design a comprehensive screening system that is safe even if people have full access to the database of potential hazards.

Esvelt’s proposed solution goes in the other direction, by arranging for the database to be secure and inaccessible. His proposal is the product of work by cryptographers as well as biologists. The line of research has a few elements.

Current DNA screening sometimes requires an expert to review a potential match and determine whether it’s a real match. This is expensive, takes up a lot of time, and requires a database of hazards.

Esvelt and the researchers he works with want to make some major changes. The key idea is that they want to develop a comparison system that counts only exact matches, instead of the “near-matches” counted under current systems. That’d reduce false positives and make it possible to automate screening. It’d also mean we don’t need to compare each new customer request with the full genome of every dangerous biological agent out there. Instead, we can pick some essential segments of dangerous biological agents — segments that those agents couldn’t function without. (We could also find alternate versions of those segments that are predicted to have the same functionality.)

That would ideally mean there’s less to screen for — making screening faster — without missing any dangerous pathogens the old method would have caught. And there wouldn’t be the need for a database of full sequences that could lead to disaster if it fell into the wrong hands. Instead, the database would be distributed and encrypted so no one could access it but everyone could compare sequences to it.
Getting serious about keeping DNA research safe and secure

Not every expert I spoke to was convinced that all the measures above were necessary — or even feasible to get international agreement on. Experts are divided about whether hash matching — Esvelt’s approach — would be an improvement on the current gold standard for screening, IARPA’s Fun GCAT. But all of them agreed that to make progress on DNA research security, screening needs to get faster, cheaper, and better coordinated.


Technological solutions will almost certainly be a significant part of the picture as we make DNA screening safe and cheap enough that it can be universal. (One complication to look out for: The technology is now arriving for biology labs to have their own “bench-top” DNA synthesis. These machines can be equipped from the outset to conduct screening. But if they’re released without any of the capabilities that would make screening possible, it’ll be very hard — perhaps impossible — to retrofit that in later.)

But legal and regulatory changes, and international cooperation, will have to be a significant part of the picture too. “It’s been about coalition building between companies like Twist, nonprofits, and governments internationally,” Diggans told me of Twist’s work on screening.

“Over the last two years, we have seen a tremendous sense of urgency from companies and technical experts in developing a global process,” Cameron said about the NTI Biosecurity Innovation and Risk Reduction Initiative. “But there’s a lot of work to make biosecurity a mainstream part of technology research and development.”

Any technical solution will only make the world safer to the extent that governments and research funders around the world can adopt it and help make it happen.

Trump’s 2021 budget proposal doesn’t stop at the border wall

Immigration detention and the immigration enforcement agencies would get a big boost.

By Nicole Narea@nicolenarea Feb 10, 2020

US President Donald Trump visits the US-Mexico border

fence in Otay Mesa, California, on September 18, 2019.

 Nicholas Kamm/AFP via Getty Images


President Donald Trump may be proposing trillions in spending cuts over the next decade in his 2021 budget request — but none of the cuts would affect the immigration enforcement agencies, which would instead get a significant boost.

The president would invest heavily in construction of his southern border wall, expanding immigration detention and staffing up the immigration agencies. It’s another way to show voters that he’s tough on immigration as he goes up for reelection.

During his time in office, Trump has built, layer by layer, impediments in Central America, at the border, in detention centers, and in the immigration courts that have made obtaining asylum nearly impossible.

And he has swept aside former President Barack Obama’s immigration enforcement priorities in favor of vastly expanding immigration detention and prosecuting every immigrant who crosses the border without authorization. The result is a punitive system that treats immigrants as criminals and places them in prolonged detention even if they don’t pose any danger to the public.

His budget proposal for the coming fiscal year would continue to advance that agenda.

The proposal includes $2 billion to construct an additional 82 miles of wall, which is likely to face pushback among the House’s Democratic majority. Trump has already constructed 101 miles of wall and plans to construct an additional 475 miles, according to the proposal, costing an estimated $18.4 billion and making it the most expensive wall of any kind worldwide.

Trump has sparred with Congress for years over funding for the wall, his signature campaign promise from 2016. It even led to a government shutdown in December 2018 after he refused to sign a funding bill that offered anything less than $5 billion for the wall. And after Congress refused to give him what he wanted, he sidestepped Democratic lawmakers and redirected military funds to border wall construction anyway with the Supreme Court’s blessing.


But this year’s funding request goes much further than just Trump’s border wall: It represents a massive expansion of the administration’s immigration enforcement apparatus, of which the wall is only a small part.

Trump would scale up immigration detention and the administration’s capacity to take migrant children into custody. He’s asking for $3.1 billion to increase the capacity of immigration detention centers to house 60,000 people at any given time, even though Congress had previously ordered him to decrease capacity to about 40,000 and the existence of viable alternatives to detention. And he wants $4 billion to care for unaccompanied migrant children once they’re transferred from immigration custody to the Department of Health and Human Services.

His budget proposal also calls for a total of $1.6 billion to significantly increase staffing across the immigration agencies. He would hire another 1,050 Border Patrol officials, more than 4,600 new US Immigration and Customs Enforcement officers, and 100 new immigration judges in an effort to drive down their over 1 million-case backlog and additional support staff.

He would also allocate a total of $126 million to support his Migrant Protection Protocols, also known as the “remain in Mexico” policy, under which more than 60,000 migrants have been sent back to Mexico to wait on a decision on their asylum applications in the US. The vast majority of that money would go to the operation of temporary tent court facilities in US border towns, where Democrats say migrants affected by MPP aren’t getting fair hearings.
What the administration could be funding instead

While immigration enforcement would get a big boost under Trump’s funding proposal, resources supporting immigrants would get slashed.

Most significantly, the proposal would cut foreign aid by 21 percent. It not only represents an abdication of the US’s obligations to aid Central American countries struggling with their own migration crises, but, as my colleague Alex Ward writes, it could actually deepen those problems.

Hundreds of thousands have fled violence and the lack of economic opportunity in El Salvador, Guatemala, and Honduras — collectively known as Central America’s Northern Triangle — over the past several years.

After Trump froze $450 million in aid to those three countries last year, more migrants from there started arriving at the US border. Last May, the number of migrants apprehended at the southern border, most of which were from Northern Triangle countries, peaked at 130,000 (though those numbers have since declined).

Eric Schwartz, the president of the refugee advocacy group Refugees International, said in a statement that the cuts to international and humanitarian aid defy bipartisan majorities in Congress and would be a “flight from US leadership” on helping the most vulnerable.

“The irony is that President Trump, Secretary [Mike] Pompeo, and others in the Trump administration continually boast about the generosity of the United States,” he said. “It’s high time that their actions match their words.”

Trump’s emphasis on immigration enforcement in his budget proposal also ignores other deficiencies in the immigration system that could be rectified with more funding.

For example, there’s a shortage of asylum officers and translators available to help process migrants at the border, many of whom are forced to live in dangerous, inhumane conditions in Mexico while they wait for an answer on their asylum applications. To deal with the shortage, the administration has instead resorted to appointing US Customs and Border Protection officers to conduct initial asylum screenings, which the American Civil Liberties Union has called a “blatant effort to rig the system against asylum seekers.”

Hiring more asylum officers could help shorten the time migrants have to wait and would improve their access to a fair, non-adversarial process.

There are also about 700,000 immigrants waiting for their naturalization applications to be processed for an average of 10 to 18 months — far longer than the six months they’re supposed to wait under immigration law. Immigrants in the military can have even longer wait times.

It’s no surprise that wait times have skyrocketed since Trump has increased vetting of all legal immigrants. But he hasn’t invested enough in beefing up staffing at US Citizenship and Immigration Services — the agency tasked with processing visa, green card, and citizenship applications — to keep up with the increased workload.

And that’s only a couple of examples of what Trump’s funding to immigration enforcement could do.

Bernie Sanders and Elizabeth Warren to Jeff Bezos: Overhaul Amazon’s “profit-at-all-costs culture”

Fifteen senators want Amazon to publish worker injury reports. Amazon wants them to come take a warehouse tour.

By Jason Del Rey@DelRey Feb 10, 2020, 6:30pm EST

Protesters hold anti-Amazon banners and placards at a protest against a new Amazon warehouse in France in January 2020. JEAN-CHRISTOPHE VERHAEGEN/AFP via Getty Images


Bernie Sanders, Elizabeth Warren, and 13 other Democratic US senators have a message for Amazon CEO Jeff Bezos: Change your business practices, or else.

In a public letter addressed to Bezos Friday, the senators urged Amazon to “overhaul [the] profit-at-all-costs culture at your company” and implement changes at the online retail giant. They also want Amazon to publish records of serious worker injuries.

“Amazon’s dismal safety record indicates a greater concern for profits than for your own workers’ safety and health,” the letter read.

The letter referenced safety records from Amazon’s warehouse network that appeared to show higher-than-average injury rates, even for the warehousing industry. Those rates were originally disclosed in a November article from the Center for Investigative Reporting’s Reveal group that was published in the Atlantic. Amazon argued at the time that the injury rates reflected its aggressiveness in recording injuries, and a spokesperson reiterated that stance in a statement on Monday.

The letter comes at a time when politicians, activists, and some of Amazon’s own employees have called Amazon out for the pace of work and labor conditions inside its warehouse and delivery networks. The criticism has become increasingly noteworthy as Amazon has expanded its reach into so many aspects of American life, from online retail to entertainment to the delivery of groceries and prescription drugs. Along the way, Bezos, the world’s richest man, has become a target for Warren and Sanders, who frame him and his riches as an example of capitalism gone awry.

“Nothing is more important to us than the safety and well-being of our employees,” Amazon spokesperson Kelly Cheeseman said. “OSHA is on the record as saying that underreporting of injuries is an industry-wide problem, and companies do this to keep their rates low — a former assistant secretary of OSHA estimated that 50 percent or more of severe injuries go unreported. Amazon does the opposite; we take an aggressive stance on recording injuries no matter how big or small. The invitation remains open for any of the Senators to come take a tour — last year over 300,000 people toured an Amazon fulfillment center and we appreciate that they took the time to learn the facts first-hand.”


Cheeseman confirmed to Recode that some of the senators who signed the letter have not taken Amazon up on touring one of its fulfillment centers. She declined to specify how many or which ones.

The letter, whose signatories also included Sherrod Brown (D-OH), Tammy Baldwin (D-WI), and Kamala Harris (D-CA), included seven other requests. One was to “reduce workers’ quotas and speed requirements,” and another asked Amazon to “cease including bathroom breaks as a ‘time off task,’” stemming from allegations that some Amazon workers have had to relieve themselves in bottles so their performance doesn’t suffer.

At least one of the requests — “Ensure workers ... have a guaranteed way to raise safety and health concerns” — appears to be one that Amazon already offers. On a visit to an Amazon fulfillment center last year, I observed a giant TV screen — called the Voice of Associate board — on which workers anonymously provided feedback to management. One of those pieces of feedback, highlighted in an episode of our Land of the Giants podcast about Amazon, was a worker telling management that they checked themself out of the hospital because they didn’t have someone to fill in for them. Cheeseman said these boards, whether digital screens or old-school whiteboards, are present in all Amazon warehouses.

The senators want a response by February 21.

News of the letter comes as Amazon’s head of communications and policy, Jay Carney, went on the offensive in a New York Times op-ed on Monday. In the piece, Carney argued that the company’s critics should acknowledge that “Amazon is doing many good things — for the economy, and for American workers.” Carney cited Amazon’s 2018 move to raise its minimum pay to $15 an hour as well as its Career Choice program, which “prepays up to 95 percent of tuition and fees — making it almost free for employees to learn new skills.”

He did not cite Amazon worker safety records.

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Why Utah is sending workers to Mexico to buy medicine

The state’s plan to send patients to Mexico to buy cheap drugs is an indictment of US health care.

By Dylan Scott@dylanlscottdylan.scott@vox.com Feb 10, 2020

The insurance plan for Utah government employees decided two years ago it had to do something to curb prescription drug costs. Its solution? Pay for workers to travel to Canada or Mexico to buy the same medications they’d been getting in the United States, just at much lower prices.

Today, the Utah insurer is saving hundreds of thousands of dollars a year on drugs for a handful of patients who need expensive medicines and make the trip abroad to get them. It’s not as much as they were originally hoping for, but enough that paying airfare plus a $500 bonus is still a worthwhile deal for the state to make.

Medical tourism is hardly a new phenomenon. Eight percent of Americans said in a 2016 Kaiser Family Foundation poll that they had purchased prescription drugs outside of the United States. US government surveys have estimated between 150,000 and 320,000 Americans annually name health care as their reason for traveling abroad. Lower costs are usually their motivation.

But to see it so deliberately deployed by a major health insurer as a cost-saving measure is unusual.

”While we have long heard stories of individuals or informal groups of patients crossing the border to buy cheaper drugs, it has not typically been a sanctioned part of the American health insurance system,” Caroline Pearson, senior fellow at NORC at the University of Chicago, told me. “The Utah ... example is the only case that I am aware of.”

Employers and health insurance plans are always looking for ways to cut costs, of course. That’s why they create provider networks in the first place.

Some employers will also send patients outside of their geographic area to high-quality health centers in the interest of lowering costs — according to the Kaiser Family Foundation, 16 percent of employers have utilized these so-called “centers of excellence” and of those firms, about one in five will pay for travel and lodging expenses.


”This is just the natural extension, I suppose,” Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, said. “It is really something that they’re paying people to do this — not just paying for it, but paying people to do it.”

In brief, here is how the Utah government employee program works:

Patients taking one or more of 13 specialty drugs are eligible to participate

They can travel to Vancouver, Canada, or Tijuana, Mexico, to buy their prescriptions

They still make their usual copayments only

The state health insurance plan covers the cost of their airfare, transportation to and from the airport, and lodging if necessary

The state will also pay the patients $500 cash for making the trip

The health insurer works with a Mexico-based pharmacy to arrange the purchases and coordinate travel. From a great Salt Lake Tribune story on the program:

Flying from Salt Lake City to San Diego International Airport takes about two hours. At the base of the baggage claim escalator in San Diego, Javier Ojeda greets first-time patients with a name placard and a driver.

“We never leave [patients’] side,” said Ojeda, general manager of Provide Rx, the pharmacy that works with Hospital Angeles to obtain and dispense specialty drugs for U.S. patients. Provide Rx also makes all travel arrangements, including a motor service staffed by bilingual drivers, who escort patients out of the airport and into a van for the short drive south.

Of course, the only reason it’s worth going through all this trouble for the patients and their insurer is drug prices in the United States are so much higher than anywhere else, including Mexico and Canada.

Here are the international price comparisons for the arthritis medication Humira, one of the 13 drugs that qualify for the Utah program, via a report from House Democrats:

House Ways and Means Committee

So you can see why Utah’s insurance plan is eager to find cheaper prices for these drugs. But it turns out they really needed the $500 cash incentive to get people to take advantage of it.

According to the Tribune, the state insurance plan actually already had a longstanding policy to cover travel costs for patients who journeyed to Tijuana to have certain procedures done (to the same hospital where they now go to get prescriptions filled), but nobody took them up on it. It was the $500 in cash that seemed to make the difference.

It’s important to maintain some context here: Only 10 patients have actually made the trip to Mexico to buy cheaper drugs (though, remember, these are specialty drugs for expensive conditions — they are by definition pretty rare). So it’s not as if Utah is suddenly sending people in droves across the border.

The relatively low uptake means the state has saved “only” $225,000 through the program, not the $1 million they were hoping for, per the Tribune. Still, whatever savings there are can be used to lower premiums for everybody.

This is not a sustainable model for curbing health care costs. There are concerns, like making sure the medications bought in Mexico are safe to use. Gellad pointed out to me that one of the eligible drugs, Enbrel, can increase the risk of infection, so putting those patients on a plane to travel abroad is a risk to be wary of.

But this might be the best of a bunch of bad options until the US gets its house in order.

Throughout the Tribune’s story, consultants who advise employers on international medical tourism are quoted. There aren’t many specifics, but there is clearly a whole cottage industry out there to help US patients find cheaper health care abroad. It is a subtle, or not so subtle, indictment of our current health system.

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Tech billionaires give away billions — but it’s just a small fraction of their staggering wealth

Things look dandy until you dig into the numbers.

By Theodore Schleifer@teddyschleifer Feb 11, 2020

On the surface, tech billionaires are very, very generous people.

But when you dig into the numbers, a more complicated portrait emerges.

New data collected by the Chronicle of Philanthropy offers the best yearly snapshot of the United States’ 50 biggest philanthropists, and it’s no surprise that technologists once again rank among the biggest givers. That’s because they’re also the country’s richest people.

And you need to put those two facts — the scale of their generosity and the scale of their bank accounts — side by side when assessing their commitments to charity. That’s an essential assessment given that billionaires often use their philanthropy to resist attempts by governments to tax more of their wealth, even as some leading Democratic presidential candidates like Sens. Bernie Sanders and Elizabeth Warren say they will tax the wealthy more if they’re elected in November.


Let’s not overgeneralize: Eric Schmidt, the largest tech philanthropist of 2019, gave $1.3 billion to charitable efforts. And while I have some concerns about the impact of the things Schmidt is funding, he committed about 9 percent of his net worth to the cause. That’s a lot.

Sheryl Sandberg has a net worth of $1.7 billion, meaning she devoted about 7.5 percent of her money to charitable causes with her $128 million in gifts.


But others on the tech philanthropy leaderboard? The headline figures are big, but they shrivel when put against their net worths.

Mark Zuckerberg gave just about as much as Sandberg to charity, but his $110 million is just 0.2 percent of his total assets, though a spokesperson for Zuckerberg’s personal philanthropy noted that it distributed $420 million in grants to nonprofits in 2019.

That’s 0.2 percent is the same percentage gifted by Sergey Brin, who ranked as the sixth-most generous tech philanthropist in 2019 (and he is putting money behind some innovative efforts).

Pierre Omidyar and Marc Benioff, who consistently rank among the industry’s most generous givers, sat in third and fourth place on the most recent list; both sent out about 3.5 percent of their net worths in 2019. (An Omidyar foundation has provided a grant to fund Recode’s Open Sourced project.)

And keep in mind, these are the country’s most generous donors. There are some major tech philanthropists who would make these donation rates seem like less of a pittance.

To be sure, donating hundreds of millions to charity — regardless of whether it’s motivated by tax reasons, spent on misguided projects, or buys them unmerited PR value — isn’t something that most people can boast of. So it’s easy for outsiders to attack them. But the percentage is important. Philanthropy journalist Marc Gunther points out that, dating back to the biblical notion of tithing, charitable gifts historically were weighed against the person’s resources.

And here’s the ultimate catch: Even as rich people strive to give away their money — some as part of intentional, well-meaning projects like the Giving Pledge — they keep getting richer.

For instance, consider Schmidt. Yes, he gave away $1.3 billion in 2019, cementing him as the country’s second-biggest philanthropist, regardless of industry. But his net worth grew by $3 billion during that same time period.

Brin and Zuckerberg both gave away $110 million in 2019. But Brin’s net worth grew by $14 billion, and Zuckerberg’s grew by $26 billion.

Needless to say, Zuckerberg’s charitable gifts are not making a dent in his attempt to part with all of his money before he dies. The same is true for most of the country’s biggest donors.