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Editor's Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, "Ask Phil," aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, "Get What's Yours for Medicare," and co-author of "Get What's Yours: The Revised Secrets to Maxing Out Your Social Security." Send your questions to Phil.

Michael: We were stunned to learn from my chiropractor that upon retiring and moving from my workplace health insurance to Medicare, the monthly chiropractic adjustments that I've viewed as a "medical necessity" for keeping crippling sciatica at bay over the last decade will no longer be covered. My chiropractor's office gave me details on why coverage was denied. But a friend tells me that his chiropractor deals with this issue by performing an "evaluation" at the beginning of each year (that my friend pays for), which results in a treatment plan for periodic, monthly visits (much like mine) that Medicare covers. What should I do?
READ MORE: Column: Social Security will reduce paper statements in 2017. Here's why it shouldn't
Phil Moeller: I wish I had a clear answer for you or could recommend a specific course of action.

Medicare pays for billions of dollars in uncovered medical services every year. Medicare also fails to pay for billions of dollars in covered medical services every year.

In theory, these things do not happen. But of course they do. "Medical necessity" is a governing concept of what Medicare will and won't cover, but it hardly lends itself to a universally agreed-upon definition or application. And this concept can be especially difficult to apply consistently in therapeutic situations.

From reading the materials you provided, my takeaway is that your chiropractor's office certainly appears to have based its position on a thorough review of relevant regulations. I do not know about the other chiropractor. However, even if that other office was wrong in its understanding, it's quite possible that Medicare would honor your friend's medical claim. If your chiropractor does not feel it's appropriate to file such a claim, it seems to me you are stuck with either doing the workaround the office suggests, paying for these treatments yourself, perhaps reducing the frequency of care or finding another chiropractor willing to file this claim with Medicare.

"Medical necessity" is a governing concept of what Medicare will and won't cover, but it hardly lends itself to a universally agreed-upon definition or application.

If you can convince your chiropractor to file a claim on your behalf and it is rejected, there is a well-established appeal process. However, the "win" rate for claimants is low, and the time frame for resolving appeals is measured in years, not months.

The American Physical Therapy Association may be able to help you with this matter. I often refer people to three consumer nonprofits that specialize in providing free assistance to people with Medicare problems: the State Health Insurance Assistance Program, the Medicare Rights Center and the Center for Medicare Advocacy.

Generally, the State Health Insurance Assistance Program is best at general consumer questions, while the Medicare Rights Center and Center for Medicare Advocacy are more appropriate for addressing the kind of complicated situation you face.

Laura: My husband was not collecting Social Security when he began getting Medicare, and his Part B premiums were $121.80 a month. I understand that this is the rate for people who are not collecting Social Security and having their premiums deducted from their Social Security payments. I'm told it has something to do with the agency's "hold harmless" rule, which limits Medicare premium increases so that net Social Security payments don't decline from one year to the next. I understand this. But when he began collecting Social Security last summer, didn't he join the hold harmless group? I thought his Part B premiums should have dropped to $104.90 a month then.
READ MORE: Column: Why is my Medicare Part B premium more than my husband's?
We got a letter from Medicare that his 2017 premiums would be $109 a month after this year's 0.3 percent cost of living adjustment went into effect. This confirmed that my thinking was correct about the $104.90 rate. However, we later got a statement from Social Security that it will be deducting $132 a month for Part B! We next went to our local Social Security office in person where the rep shockingly hadn't heard about the "hold harmless" rule and instead told us that the $132 was correct without being able to explain why. At this point, I don't know who else to ask since we've already contacted both Medicare and Social Security and haven't gotten consistent answers.

Phil Moeller: Your understandable confusion is a major reason why I think Medicare and Social Security need to get their heads together, scrap the hold harmless rule and come up with a better way for setting Medicare premiums. I applaud the notion of holding people harmless so that their Social Security payments don't decline from one year to the next. But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

First off, simply being held harmless does not mean your husband's Medicare premiums should have declined to $104.90 a month. That was the hold harmless rate that most enrollees had to pay in 2016, due to there being a zero cost of living adjustment last year.

His hold harmless "set" point is not $104.90 but $121.80, which is what he was paying when he began Social Security. Assuming your income does not trigger high-income surcharges, he will be held harmless for 2017. You can find more gruesome details here.

But the hold harmless rule as it presently exists is simply not equipped to deal with a world of persistently low inflation rates.

This means that his Part B premium should be $121.80 plus the amount of his 2017 cost of living adjustment, or COLA. Because the COLA for this year is only 0.3 percent, this means his Part B premium should be no more than $121.80 plus 0.3 percent of his 2016 Social Security benefit. For this to equal $10.20 - the difference between $132 and $121.80, his monthly Social Security benefit in 2016 would need to have been $3,400 a month! This nearly equals the maximum possible Social Security benefit of someone who began claiming benefits last year.

The $109 figure included in your letter from Medicare described the 2017 Part B premium that would be typically paid by a person who was held harmless last year and had been paying $104.90 a month. Again, this group would not include your husband.

I have no idea how Social Security came up with the $132 figure in the statement it sent you. I am guessing this is the Part B premium in 2017 for people who are not held harmless this year. However, Medicare says the number should be $134.

Whatever you wind up paying this year, you are not due any refund for 2016 payments as a result of your husband's enrollment in Social Security. Part B premiums are set for the entire year each January, and your husband's premium was accurate as of January of last year.

By now, you may already have passed out on the floor through a combination of shock, confusion and possibly outrage. You have my sympathy. Maybe you can turn to the uninformed Social Security representative for your smelling salts. Good luck with that!

Ron - Wisc.: I turn 65 in April 2017 and have no health issues and take no medications. I plan to enroll in a local health maintenance organization (HMO) Medicare Advantage plan without taking the drug coverage option. My only cost will be the Part B premium required. In the future, would I be able to add the drug coverage option for this same Medicare Advantage plan during annual open enrollment for plan changes? What penalties or restrictions might apply if I choose to add the drug plan option?

Phil Moeller: Most Medicare Advantage HMO plans include bundled-in drug coverage, so you should use the Medicare Plan Finder to see if there is a plan available where you live that will let you add a stand-alone Part D drug plan at a later date. You might need to get a separate stand-alone plan at first, and then you can find an acceptable MAPD (shorthand for Medicare Advantage Prescription Drug) plan and switch to it during your first available Medicare open enrollment period.

There will be a late-enrollment premium penalty for the Part D plan that equals 1 percent a month for each month you are late. With Part D plans averaging about $40 a month, this penalty would cost you slightly less than $5 a month for each year you are late. These are lifetime penalties, so you should do some sample calculations to decide on your best strategy.

Carol - Mass.: My husband died in 1986 at age 34, leaving me with a 4-year-old son. I collected benefits for my son and continued working full time. My son died in 1998. I immediately notified Social Security, and this benefit stopped. Unfortunately, I did not know for quite some time that I had over-collected for my son, because I was making too much money. I had no idea my salary affected this, and it was never explained to me when I went to the Social Security office to begin benefits for him. When the agency told me I owed it several thousand dollars, I contested, and they refused to reconsider the matter - quite rudely I might add. When I turned 66, they began deducting this money from my Social Security payments and said they would last for 10 years. Is it better for me to continue these deductions or to pay what I owe them in full?

Phil Moeller: I am sorry to hear about the tough road you have had to travel.
READ MORE: Column: Social Security needs to be reformed, not have its funding cut
In terms of economic theory, I think most experts would say that it would be better to let Social Security continue deducting $72 a month from your benefit payment than to pay them back in full right now. Under the concept known as "present value," a dollar is worth much more today than it would be in the future, because you could invest this dollar, and inflation will make it worth less in the future. Therefore, saving your current dollars would be the way to go.

Having said this, if for any reason your financial situation today is much better than it will be in the future, it could be better to pay the lump sum and then receive that $72 back every month when times might be leaner.

Melinda - Costa Rica: My husband and I live abroad and are residents of Costa Rica but are U.S. citizens. We receive health coverage through Costa Rica's national insurance. My husband will be 65 in July 2017 and receives Social Security benefits now. We realize that we are not covered by Medicare while we live outside the U.S., but that he must purchase Part B coverage or face late enrollment penalties. Can my husband delay in applying for either Part A or B Medicare when he is eligible at 65 until, or if, he returns to the U.S. and avoid Part B penalties?

Phil Moeller: I assume your husband is retired. If so, the clock will start ticking on his Medicare enrollment obligations when he turns 65. His initial enrollment period will be seven months long, beginning three months before his 65th birthday month and ending three months after. That will be the longest he can delay getting Part B without incurring lifetime late-enrollment penalties.

If you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

Having said this, if you plan to continue living outside the U.S. for several or more years, you should balance the savings of not paying Part B premiums against the cumulative expense of paying higher Part B premiums when you return to the U.S.

The late-enrollment penalty for Part B is 10 percent of your Part B premium for every complete year he is late in enrolling. The Part B premium this year for new enrollees is $134 month for most people, although higher-income enrollees will pay more.

To get a rough idea of the trade-off, let's assume he gets Part B with a five-year penalty. This would add 50 percent to his Part B premiums. He would be saving five years of premiums by not enrolling, so it would take him 10 years back in the U.S. before the penalty exceeded his premium savings.
Should Congress raise the Medicare and Social Security retirement age? Phil explores that question in his latest piece.

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Column: Why aren't my chiropractic appointments covered by Medicare?

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Editor's Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, "Ask Phil," aims to help older Americans and their families by answering their health care and financial questions.

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New app splits up dinner bill based on wage inequality

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The Equipay app, which started as a joke, calculates how much each person in a group should pay based on income inequality by race and gender.

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Understanding why you can be a psychopath and not know it at all.

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Jon Ronson: Strange answers to the psychopath test

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Is there a definitive line that divides crazy from sane? With a hair-raising delivery, Jon Ronson, author of The Psychopath Test, illuminates the gray areas between the two. (With live-mixed sound by Julian Treasure and animation by Evan Grant.)

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The Doubt Essential to Faith
"Hazleton calls for a new appreciation of doubt and questioning as the foundation of faith — and an end to fundamentalism of all kinds".

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Lesley Hazleton: The doubt essential to faith

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When Lesley Hazleton was writing a biography of Muhammad, she was struck by something: The night he received the revelation of the Koran, according to early accounts, his first reaction was doubt, awe, even fear. And yet this experience became the bedrock of his belief.

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Faith vs Tradition
Is it Islam or Culture
"Has the world's general idea of the Islamic faith focused too much on tradition, and not enough on core beliefs?"

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Mustafa Akyol: Faith versus tradition in Islam

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http://www.ted.com At TEDxWarwick, journalist Mustafa Akyol talks about the way that some local cultural practices (such as wearing a headscarf) have become linked, in the popular mind, to the articles of faith of Islam. Has the world's general idea of the Islamic faith focused too much on tradition, and not enough on core beliefs?

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Why do we not feel protected from a system where it is supposed to protect all communities?

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EL CAJON, Calif. -- Angry protests flared for the third straight night Thursday after a family attorney charged that an unarmed black man was unjustly killed by El Cajon police, and that officials were trying to sway public opinion by only releasing a single, favorable frame from video of the shooting.

Demonstrators contend that the officer was unduly quick to open fire and that the decision was at least in part racially motivated, notes CBS San Diego affiliate KFMB-TV.

"These senseless killings have to stop -- not just in El Cajon but in the entire country,'' community activist Estela De Los Rios remarked to the station.

Earlier in the day, Alfred Olango's family gathered with lawyers and religious leaders and urged people to continue demonstrating but implored them to do it peacefully to honor his memory.

Olango's anguished mother said her son was a good, joyful man who suffered a "mental breakdown" over the recent death of his best friend and needed compassion when police encountered him. Pamela Benge said her family had escaped strife-torn Uganda to come to the U.S. for safety and she asked why police didn't just shock her son with a stun gun or shoot him in the leg.

"He needed someone who was going to calm him down and then take care of the situation," she said, her voice thick with emotion and dark glasses covering her eyes. "Not to come and just finish his life."

Olango's sister had called police three times Tuesday to report that he was sick, "not acting like himself," and was walking in traffic. It took officers more than an hour to respond. Once they arrived, the shooting took place within about a minute.

Critics have questioned why personnel with special training to deal with the mentally ill were not dispatched after police received a report that Olango was behaving erratically, KFMB notes.

Police later said a Psychiatric Emergency Response Team clinician was on another call at the time.

Christopher Rice-Wilson of Alliance San Diego attributed what befell Olango to "three strikes'' -- being black, being mentally ill and not following orders.

"Black lives matter,'' Rice-Wilson said to KFMB. "And if a black life doesn't matter, then no life matters.''

Later, fewer but more violent protesters were in the streets for Thursday's third night of demonstrations.

Between 50 and 75 people marched through streets and blocked intersections until police used pepper-spray balls to break them up.

Some got into fights with drivers who were angry over blocked traffic, at times breaking car windows and in one case pushing a man off his motorcycle, police said. Some threw bottles at police.

Two men, ages 19 and 28, were arrested for failing to end an unlawful assembly, police said.

Authorities released a still frame from a bystander's video that showed the 38-year-old Olango with his hands together at chest level and pointed at an officer directly in front of him. Police Chief Jeff Davis said Olango refused to obey orders to remove a hand from his pants pocket and was shot after he swiftly drew an object from his front pocket and pointed at the officer in a "shooting stance."

The object turned out to be a 4-inch electronic cigarette, known as a vape pen.

A lawyer representing Olango's family said at a news conference that authorities were misinforming the public by only showing a single image from the video that supports the El Cajon Police Department's version of events.

"It's a wonderful way if you're litigating a case in the media," attorney Dan Gilleon said. "It fits a perfect narrative for them."

Family representatives demanded that the full video be shown.

The El Cajon mayor defended the decision to release the single frame, saying it accurately represented the situation the two officers faced.

"I thought it was way too incendiary to not release something," Mayor Bill Wells said.

Wells said he reached that decision with the police chief and District Attorney Bonnie Dumanis to release the image to counter reports from people saying Olango had his hands in the air and was begging not to be shot. Wells said the video footage did not show either of those things.

Wells said he met with leaders of the black community Thursday who told him releasing the video immediately could help prevent violence. Wells said he wants to talk to the district attorney to discuss why the video should not be released immediately.

The San Diego district attorney's office, which controls when videos of officer-involved shootings are released, said there is no time frame for when it will release the video.

The fatal shooting happened less than two weeks after black men were shot and killed by police in Tulsa, Oklahoma, and Charlotte, North Carolina, where violent protests broke out.

Police in both those cities have released videos of the shootings. A Tulsa officer was charged with manslaughter in the fatal shooting of a motorist.

Olango arrived as a refugee in 1991 and was twice ordered deported because of a 2001 conviction for selling cocaine, U.S. immigration authorities said.

But he was released from detention after his native Uganda refused to take him. A U.S. Supreme Court ruling bars detention of foreign nationals after six months if deportation is unlikely.

Immigration authorities took Olango into custody in 2009 after he served nearly four years for a federal firearms conviction in Colorado but were again unable to obtain travel documents.

Immigration and Customs Enforcement said Olango stopped reporting to officers in February 2015. Spokeswoman Virginia Kice did not know if officers tried to find him after that.

Olango's mother said the family came to the U.S. as refugees and she just wanted them to have a better, safer life.

"I wanted the children not to be running around, being in fear every night, sleeping in the bush," she said. "I thought a lovely, nice country like this would protect us."

She said she had grieved and prayed for other parents who had lost children in recent shootings by police in the U.S., but "didn't know that the next time it would be me." She now understands their suffering.

"There is nothing as painful," she said as family members stood nearby wiping tears from their eyes. "It is so much that you cannot swallow it. You try to swallow it, but the pain overweighs you. It is so bitter."

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Protests over police shooting near San Diego grow more violent

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EL CAJON, Calif. -- Angry protests flared for the third straight night Thursday after a family attorney charged that an unarmed black man was unjustly killed by El Cajon police, and that officials were trying to sway public opinion by only releasing a single, favorable frame from video of the shooting.

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Radicalization and a possible solution.
"I met a young Islamic scholar that would challenge my interpretations... verses which extremists cherry pick and mutilate the understanding of..."

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An inside look at Islamic extremism | Mubin Shaikh

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Is multiculturalism even possible?

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Wade Davis: Dreams from endangered cultures

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With stunning photos and stories, National Geographic Explorer Wade Davis celebrates the extraordinary diversity of the world's indigenous cultures, which are disappearing from the planet at an alarming rate.

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Stereotypes are born this way. Watch the video to realize its true nature.

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Please [contact us](https://www.ted.com/contact) and let us know what happened.

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Why you have an excuse to sleep in all day!

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For patients with serious brain injuries, there's a strong link between sleep patterns and recovery.

A study of 30 patients hospitalized for moderate to severe traumatic brain injuries found that sleep quality and brain function improved in tandem, researchers reported Wednesday in the journal Neurology.

Patients who still had low levels of consciousness and cognitive functioning would "sleep for a couple of minutes and then wake up for a couple of minutes," both day and night, says Nadia Gosselin, the study's senior author and an assistant professor in the psychology department at the University of Montreal.

But "when the brain recovered, the [normal] sleep-wake cycle reappeared," Gosselin says.

The results raise the possibility that patients with brain injuries might recover more quickly if hospitals took steps to restore normal sleep patterns, Gosselin says. Drugs are one option, she says. Another is making sure patients are exposed to sunlight or its equivalent during the day and at night rest in a dark, quiet environment.

"I think bad sleep can have bad consequences for brain recovery," she says.

The findings are consistent with other research showing that "sleep is essential to restore body and brain functions," according to an editorial accompanying the study. The editorial was written by Andrea Soddu of the University of Western Ontario, and Claudio Bassetti of University Hospital Inselspital Bern in Switzerland.

The authors also cite evidence linking sleep disorders to cognitive changes in patients with Alzheimer's disease.

The idea for the study came from something Gosselin observed in traumatic brain injury patients during her training as a neuropsychologist. "I saw them having trouble falling asleep during the night and trouble waking up during the day," she says.

So Gosselin enlisted the help of a graduate student, Catherine Duclos, and a team of researchers. The team studied patients at Hopital du Sacre-Coer in Montreal who'd been injured by a motor vehicle accident, a fall or a blow to the head.

Starting two to four weeks after an injury, the team tested the patients' level of consciousness and cognitive function. And all the patients wore devices on their wrists that tracked when they were sleeping and when they were awake.

The researchers hoped to learn whether an improvement in sleep patterns came before signs of brain recovery. What they found, though, was that sleep and brain function improved together, apparently in lock step.

That could be because better sleep simply helped patients perform better on tests of brain function, Gosselin says. But it's also possible that improved sleep was helping the brain heal, she says.

"We know that sleep is necessary for the generation of new neurons and new connections between neurons in the brain," she says.

Gosselin's lab is now looking to see whether better sleep really does help patients with brain injuries recover more quickly.

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As Sleep Improves, So Does An Injured Brain

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For patients with serious brain injuries, there's a strong link between sleep patterns and recovery. A study of 30 patients hospitalized for moderate to severe traumatic brain injuries found that sleep quality and brain function improved in tandem, researchers reported Wednesday in the journal Neurology.

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"Even before the leak, their were complaints about an odor of gas and symptoms of headache and fatigue."

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Patricia Larcara, who moved to Porter Ranch in 1989 to be near the mountains, said she still suffered headaches, fatigue and nausea in her home. She said officials assigned her to one place where she stayed for three months, then another 30 miles away. "I was so depressed," she said. "I wanted to have my golden years, golden.

__________________

Even before the leak, there were complaints about an odor of gas and symptoms like headaches and fatigue, said Matt Pakucko, who relocated for months along with Kyoko Hibino and their five cats. A group he helped found, Save Porter Ranch, had arranged for an area health study, but it was pre-empted by the catastrophe. The couple, who wore their gas masks while outside during the height of the leak, are among those pressing for a study to be completed and for the depot to remain shut down.

__________________

The effects of the fumes on residents varied widely - even on opposite sides of the street or within households - a result, residents said, of different sensitivities and dispersal patterns from the strong winds that whip down and around the hilly, winding streets. Some at the edge of the canyon felt nothing, while others miles away complained of rashes.

__________________

While the compromised well was actively leaking, residents received automated calls warning that an oily mist was wafting out of the canyon and that they should stay inside and avoid eating fruit from their trees. Jane Fowler, who had been considering selling her home, said she went into her pool one day to find the water slippery with oil. "My house no longer feels lovely," she said.

Correction: January 15, 2017

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The Long Reach of the Aliso Canyon Gas Leak

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Patricia Larcara, who moved to Porter Ranch in 1989 to be near the mountains, said she still suffered headaches, fatigue and nausea in her home. She said officials assigned her to one place where she stayed for three months, then another 30 miles away. "I was so depressed," she said.

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"Schools and work places are design for extroverts." Why are we expected to be extroverts?

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In a culture where being social and outgoing are prized above all else, it can be difficult, even shameful, to be an introvert. But, as Susan Cain argues in this passionate talk, introverts bring extraordinary talents and abilities to the world, and should be encouraged and celebrated.

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"Are you trying to be white, Bolu!?"

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From my first steps onto campus, I was determined to make my Nigerian parents proud and to seize the opportunities they had left their native country for. I had graduated high school in Newfoundland and Labrador, Canada's most eastern province, at the top of my class and as student body vice president. Being the single black student in a school of 600 had been immaterial to me. I had not developed a sense of black identity because, simply, I did not have to.

So here I was at the University of Western Ontario, the sole black on a dormitory floor made up mostly of white students from Toronto and a few ethnic minorities. It was, for most of us, the first time we were living away from home, and we spent time asking honest and sometimes naïve questions about one another, including ones about religion and race. It proved to be a safe, collegial space to check our biases. Or so I thought.

A few months in, we received an email notification that our exam grades were available. One by one, the pre-meds among us logged onto the reporting system to access our scores and, following the lead of one floor mate, shared them aloud. Each of us had already fallen prey to the paranoia that even a single mediocre grade would compromise our chances of medical school acceptance.

"76!" a friend proclaimed, appearing satisfied. "80" from my roommate. "74" from another. "72," lamented another. Then I nervously stepped up to enter my login. "94!" I declared in relief.

Most of the others donned looks of approval or surprise, while one, an Indo-Canadian business student, was notably shocked. "Are you trying to be white, Bolu?!" he jeered. The others laughed boisterously at the question.

I was confused. Surely, performing well didn't make me any less black, did it? This was the first time I saw myself as a racialized minority in the context of an educational institution. Some of my peers, it seems, were subscribing to the stereotype of black underachievement.

Throughout my undergraduate years I would hear comments of derision about "acting white." Coming from black and white colleagues alike, this quip was particularly common when I decided to pass up social activities to study. I would often succumb to peer pressure in the hope of fitting in, and I found myself second-guessing my dedication toward academics.

Similar experiences were described in the work of another man of Nigerian ancestry. In his 2003 book "Black American Students in an Affluent Suburb," John U. Ogbu, then a professor of anthropology at the University of California at Berkeley, described how black youth are often seen as betraying their cultural identities by aspiring to academic success.

After months of fieldwork in the affluent Shaker Heights suburb of Cleveland, he had developed what he called the "cultural-ecological theory of academic disengagement": The education gap between black and white students could be partly explained by students underperforming to avoid derision by their peers. It was indeed a controversial finding.

Dr. Ogbu, who died a few months after his book was published, classified immigrants like my family - those who chose to migrate to settler societies like Canada and the United States - as voluntary minorities who accepted many aspects of the culture they had chosen.

In contrast, he described involuntary minorities - indigenous people and those who came here as part of the slave trade - as suffering from marginalization and discrimination for multiple generations. Some of these individuals, he found, were less trusting of educational institutions, which they saw as part of the system that contributed to their historical disenfranchisement. They clung to manners of speech and dress that were distinct from the (predominantly white) mainstream and that fostered a disregard, even a disdain, for assimilation.

Dr. Ogbu's theories rang true at times in my own life as I continued to struggle with the balancing act: Would I slack off or go to the library in the evenings to pre-read for the next physiology lecture and risk being caught "acting white"? (It was Dr. Ogbu who popularized the phrase in the mid-1980s, to explain why black students might spurn behaviors associated with achievement.) How much would I have to lower the grades I reported to my friends when they would pry, to fit their preconceptions?

Both my grades and my identity were slipping.

But toward the end of my undergraduate years, I found myself spending time with other first-generation Canadians from Africa. Like me, many of them understood that agency and dedication would propel them farther than foreign names and pigmentation would pull them back. The doors that advanced education promised to open were a primary reason our parents emigrated to North America. My new friends and I were not trying to conform to what peers, strangers or society believed a black male should be.

I attended medical school in St. John's, Newfoundland and Labrador. Commonly, minority physicians-in-training report tremendous support from their communities. In his memoir, "Black Man in a White Coat," the African-American psychiatrist Dr. Damon Tweedy describes receiving positive and encouraging reactions when medical staff members saw the "young brother" sporting a white coat during his medical training at Duke in the late 1990s.

This would be the case for me as well.

Unfortunately, it is not always the case for others, who have the ability to succeed but succumb to social pressure. Minorities with aspirations of upward mobility have considerable barriers holding them back. Systemic factors like differential access to high-quality child care, lower socio-economic status overall and poorly funded schools account for much of the educational achievement gap between black students and the general population. Peer pressure should not be one of them.

Every step I took, from undergraduate training to medical school to competitive postgraduate training programs, yielded fewer and fewer colleagues of my complexion - a pattern documented in a recent article by Dr. Amit G. Pandya and other members of the American Academy of Dermatology diversity task force. It is for this reason that the academy runs a mentorship program that engages medical students of color in the hope of creating an ethnically diverse cohort of dermatologists.

The University of Toronto's Community of Support initiative recognizes the importance of a health care community that reflects the diversity of the Canadian population, with black and indigenous students a priority. Through its mentoring program I work with black students who aspire to become physicians. Many of them tell me that interacting with a physician who looks like them encourages them to continue their own journeys.

I tell them what my immigrant parents told me: to surpass expectations placed upon them by institutions, friends and themselves. Because achievement has no color.

Boluwaji Ogunyemi is chief dermatology resident at the University of British Columbia.

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When 'Black Like Me' Means 'White Like Them'

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From my first steps onto campus, I was determined to make my Nigerian parents proud and to seize the opportunities they had left their native country for. I had graduated high school in Newfoundland and Labrador, Canada's most eastern province, at the top of my class and as student body vice president.

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Humans are so obsessed with achieving perfection that now they want to design their own children.

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Paul Knoepfler: The ethical dilemma of designer babies

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Creating genetically modified people is no longer a science fiction fantasy; it's a likely future scenario. Biologist Paul Knoepfler estimates that within fifteen years, scientists could use the gene editing technology CRISPR to make certain "upgrades" to human embryos -- from altering physical appearances to eliminating the risk of auto-immune diseases.

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"More parents foot the bill for their child’s college education...this plan could backfire, saddling the child with the cost of the parents’ retirement."

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Some parents risk financial ruin taking on child's college debt

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More parents foot the bill for their child's college education, trying to give them a financial leg up after graduation. But for some, this plan could backfire.

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"Mainstream media, cued by corporate press releases, routinely claim that America’s schools are markedly inferior to schools in other developed nations."
If asked the question, "what do the kids learn in school?," one should answer things such as math, science, or English. However, the school systems seems to be focusing on getting the kids to reach the standard level in Common Core.

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The debate over the Common Core State Standards overlooks the broad problems inherent in the core curriculum that has been taught in schools for decades. Below Marion Brady explains. Brady has worked as a teacher, administrator, college professor, contributor to academic journals, textbook and professional book author, consultant to publishers and foundations, newspaper columnist.

By Marion Brady

Mainstream media, cued by corporate press releases, routinely claim that America's schools are markedly inferior to schools in other developed nations. The claim is part of an organized, long-running, generously funded campaign to undermine confidence in public schools to "prove" the need to privatize them.

Syndicated columnists, education reporters, editorial boards, and other opinion leaders interested in thoroughly understanding the campaign to privatize public schools should do two things. First, they should stop dismissing all the critics of the Common Core State Standards as Tea Party types opposed to change. As my books, articles, newspaper columns and blogs make clear, I argue that change is not only essential but decades overdue. What I oppose is superficial, dishonest change-change sold by misrepresenting the quality of what preceded the Common Core Standards, half-truths about the process that created the Standards, and hype that's radically over-selling their value.

Second, before taking a position, opinion leaders should examine the Sandia National Laboratory's Report, and read at least three books: The Manufactured Crisis, by David C. Berliner and David J. Biddle; Why is Corporate America Bashing Our Public Schools? byKathy Emery and Susan Ohanian, and Diane Ravitch's The Death and Life of the Great American School System: How Testing and Choice Are Undermining Education.

I'm an unequivocal supporter of public schooling, and think the historical record, fairly examined, justifies my support. This doesn't mean, however, that I think all was well with America's schools before corporate interests and politicians took control of them. Far from it. Educators have been handicapped for more than a century by a curriculum adopted to serve a too-narrow purpose-admission to college-and failure to address that curriculum's problems has made the institution vulnerable to destructive corporate and political manipulation.

Below are brief descriptions of some of the more obvious of those problems.
1. The standard core curriculum is stuck in the past.
Adopted in the late 19 th Century, the curriculum now shaping America's schools reflects the "big idea" of that earlier era-the factory system, standardization of parts, mass production, centralized decision making, and passive worker compliance.

None of those fit the present era. Social change has seen to that, and the rate of that change is accelerating. Change requires adaptation, and adaptation requires creativity, autonomy, exploitation of differing perspectives, and continuous questioning of authority.
2. The standard core curriculum is so inefficient it leaves little or no time for apprenticeships, internships, co-op programs, projects, and other ways of "learning by doing" (which is how most of us learned most of what we know).
How little most adults remember and use of what they once read and heard at the secondary level of schooling testifies to a level of inefficiency that wouldn't be tolerated in any other field or profession.

The main obstacle to efficiency is the assumption that the most important task is "covering the material" in the core curriculum. Given the Internet and ease of access to it, given the vast range of learner abilities, interests, and needs, given the inevitable obsolescence of much existing knowledge, and given our ignorance about what the future holds, stuffing kids' heads with what today's adults happen to know is less important than helping them develop knowledge-evaluating and generating skills. Those can be worked into the familiar curriculum without difficulty, but today's reformers, convinced that working longer and harder is better than working smarter, aren't interested.
3. The standard core curriculum gives thought processes other than recall short shrift, or no attention at all.
What gets tested, gets taught. Because, unlike all other thought processes, short-term memory can be measured with precision, traditional testing has emphasized it.

The ability to remember is, of course, important, but the main educational challenge-making better sense of real-world experience-requires the ability not merely to recall but to infer, generalize, hypothesize, relate, synthesize, value, and so on.

When we ask students to recall, evaluation of performance is based mostly on the quantity of their responses. But when they're asked to hypothesize or infer, their responses will differ both quantitatively and qualitatively. Do two "good" hypotheses equal four "fair" and seven "poor" hypotheses? What's a "fair" hypothesis? A "poor" one?

Recent tests take a weak stab at evaluating "higher order" thought, but the fact remains that machines can't evaluate original thought, and neither can humans using "canned" criteria. Limiting what's taught to what machines can measure isn't just demeaning, it's a recipe for societal disaster.
4. The standard core curriculum ignores vast and important fields of knowledge.
Give thought to the news of the day, or take a long view of human history, and it will be clear that the greatest threats to life, liberty, and happiness are conflicts stemming from differing value and belief systems within and between societies.

These systems-sometimes called "worldviews"-are the most important and useful thing we can know about ourselves and others, but the standard core curriculum lets learners go from kindergarten through graduate school without examining either their own worldview or those of others.

Neither are the young likely to study the principles of group dynamics (essential knowledge in the workplace). Or societal responses to loss of autonomy. Or the process of polarization. Or the close relationship of economies and group stability. Or the effects of technological change on human relationships. Or the role of emotion in selective perception. Or the dynamics of social change-just to begin a list of critically important knowledge that lies outside the usual curricular boundaries.
5. The standard core curriculum breaks knowledge-and the reality it seeks to explain-apart, ignoring its systemic, mutually supportive nature.
Understanding any major problem-war, poverty, oppression, crime, discrimination, resource depletion, energy sourcing, environmental degradation, taxation, labor-management disputes, corruption, international tensions, whatever-requires an understanding of links between myriad factors and forces. Because those factors and forces invariably cut across subject-matter boundaries, or deal with fields of knowledge not taught at all, the core curriculum fails to produce a citizenry intellectually equipped to cope with the problems it generates.
6. The standard core curriculum emphasizes secondhand rather than firsthand knowledge.
The new big deal in education is "informational reading"-reading that informs. Is it important? Of course. Should it be the main thing that kids do in school? No. Reading and interpreting text is only one of many ways to learn, and not the most important.

The most explosive period of learning occurs in the first years of life, before we learn to read. There are lessons in that fact that our fixation on reading, and our stubborn insistence that play, art, music, theater, dance, and so on, are "frills," keep us from understanding and appreciating.

Schools are still being built with classrooms rather than flexible workspaces. Schedules are still being imposed that keep kids in their seats and isolated from the larger world for most of every day. We're ignoring research and common sense about how humans learn.
7. The standard core curriculum costs a great deal to "deliver."
Failure to explore and exploit the merit of integrated study, use of "canned," commercial instructional materials rather than local resources, overuse of expensive technologies, excessive administrative costs, unnecessary testing and test prep, grade retention from inappropriate curricula and unreasonable pass-fail cut scores on standardized tests-these and other factors tied to an unexamined, taken-for-granted curriculum, waste time and money.

8. The standard core curriculum has no criteria establishing what new knowledge to teach, or what old knowledge to discard to make room for the new.

Knowledge is expanding at an ever-accelerating rate, but no agreed-upon aim, no overarching purpose, no philosophy, sorts through the near-infinite possibilities and constructs a coherent curriculum keyed to life as it's lived.

Today's reforms have us obsessing about the contents of school subjects, when the real challenge is figuring out how to use those tools (and subjects not now taught) to produce admirable people, thoughtful citizens, individuals able to capitalize on the potentials of humanness.

9. The standard core curriculum disregards the brain's need for order, organization, and pattern. The theory of learning that dominates traditional schooling is simple: "If you throw enough mud on the wall, some of it is bound to stick." A little does stick, of course, but not enough to justify instruction based on the theory.

The main problem is the brain's inability to cope with unorganized and disorganized information. School subjects organize information, but each one does so differently, and kids-lacking a "master" organizer to logically relate new knowledge to existing knowledge-store it in short-term memory, then erase it when the threat of testing no longer looms.
10. The standard core curriculum is silent on complex ethical and moral questions.
This is difficult territory, which is why it's unacceptable for the curriculum to ignore it.

-

Someone once said that moving the education establishment is harder than moving a Jell-O elephant. That's an apt observation, but it doesn't mean that change is impossible, just really hard.

As an administrator and consultant, I've been down the usual reform roads and found only one that actually changes, permanently, how most teachers teach. It verifies that what's common knowledge in management circles is true, that genuine, lasting change can't be imposed top down. If the process doesn't actively involve those whose thorough understanding and acceptance is necessary to make it work, it won't work.

In education, "those whose thorough understanding and acceptance is necessary to make it work" are teachers and kids. What do teachers and kids need to understand and accept?

1. An organized mind is more productive than an unorganized or disorganized mind.

2. School subjects use so many different information organizers the mind can't cope.

3. Systems theory simplifies the organization of knowledge.

4. Systems theory can be learned. Easily.

What do policymakers and school administrators need to understand and accept?

Flying the Standards! banner, the Business Roundtable has been the primary organizer and coordinator of the present thrust of education reform. They've focused on standards for school subjects because, they say (correctly), that standards drive everything else-curriculum, teacher training, and assessment.

Many educators and I believe the Business Roundtable isn't just wrong but spectacularly so. The standards coin has another side. The late authority on urban design, Jane Jacobs, in her book, Dark Days Ahead, summed that side up in just six words: "Standardization is the parent of stagnation."

What policymakers and administrators need to understand and accept is that standards keyed to a fundamentally flawed curriculum are fundamentally flawed (as, inevitably, are tests keyed to the standards),

The members of the Business Roundtable-rich, politically powerful, and speaking with one voice-will probably get their way. I'm suggesting a way around the creeping but inevitable stagnation that will follow. Adopting the Common Core State Standards doesn't preclude going beyond them by making use of systems theory. Neither does it preclude going beyond the educational performance of Shanghai, Finland, South Korea, or any other system of education anywhere in the world that arbitrarily and artificially fragments the study of reality without an integrating strategy.

Again- here's a link to a simple, free, adolescent-friendly tool for using systems theory as a "supra-disciplinary" organizer of knowledge.

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10 things wrong with what kids learn in school

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The debate over the Common Core State Standards overlooks the broad problems inherent in the core curriculum that has been taught in schools for decades. Below Marion Brady explains. Brady has worked as a teacher, administrator, college professor, contributor to academic journals, textbook and professional book author, consultant to publishers and foundations, newspaper columnist.

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With so many questions looming as to how to handle this threat and with the recent change of power in Washington, there is much to discuss. Unfortunately with current issues pertaining to the way our new President has been handling foreign affairs, the question is this. Is the President of the US genuinely trying to appease this conflict, or is he simply spreading division and adding fuel to the fire as well as benefiting this destructive theological empire known as ISIS?

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"We don't want them here," he said Friday.

Trump says the executive order is not a "Muslim ban," even though it bars citizens from seven predominantly Muslim countries from entering the United States for three months and gives preference to non-Muslim refugees.

"This is not about religion -- this is about terror and keeping our country safe. There are over 40 different countries worldwide that are majority Muslim that are not affected by this order."

But experts say almost every country with Muslims will be affected by the order, because it makes it easier for ISIS and Al Qaeda to recruit alienated young believers. That applies to the United States as well.

ISIS' goal is to divide the world into two camps: "the crusaders" and "the caliphate." No Christians living in Muslim lands; no Muslims living in Christian countries.

Its message to Western Muslims: You don't belong there. Come to the caliphate where you can live as a true Muslim.

"This revival of the Khilāfah gave each individual Muslim a concrete and tangible entity to satisfy his natural desire for belonging to something greater," ISIS said in a recent edition of its online magazine Dabiq.

In the same edition -- alongside interviews with ISIS fighters, articles praising "martyrs" and gruesome photos of its beheaded and burned victims -- ISIS argued that Muslims in the West are living in a "grayzone."

"Grayzones" are areas where Muslims practice their religion peacefully in non-Muslim countries. ISIS wants to eliminate these zones, in part by turning non-Muslims against their Muslim neighbors. Each terrorist attack chips away a little more grayzone, as Westerners marginalize Muslims, pushing them, ISIS hopes, into the caliphate's open arms.

"Muslims in the crusader countries will find themselves driven to abandon their homes for a place to live in the (caliphate), as the crusaders increase persecution against Muslims living in Western lands. ..."

In the United States, the vast majority of Muslims reject that message, but a few are inspired by it.

According to a study of 101 Americans charged with ISIS-related crimes, half were born in the country and most were citizens. Most were men under 30, one-third had converted to Islam. The vast majority expressed dissatisfaction with living in the United States, and 90% reportedly said they wanted to join the caliphate, perhaps heeding the call to surrender their lives to a larger cause, no matter how violent or quixotic.

"Overall, there is a sense of identity crises and alienation from society across a wide range of cases," the report says. "Anxieties over not fitting in, examples of personal isolation and social anger are frequent."

Those anxieties are often exacerbated, if not incited, by Islamophobia, said Sarah Lyons-Padilla, a social psychologist at Stanford University who has studied radicalization among young American Muslims.

American Muslims who felt hopeless, rejected and insignificant because of anti-Muslim discrimination were more willing to support extremist groups and causes, according to a study Lyons-Padilla led last year.

"ISIS would love to make all Muslims believe that the West is anti-Islam," the psychologist said. "When American politicians and citizens spread anti-Muslim rhetoric, be it through discriminatory policies or online trolling, they send the message that Muslims aren't 'real Americans' and that being Muslim is something to be ashamed of. In other words, they're basically helping ISIS recruit."

Counterterrorism officials agree.

In a recent Washington Post op-ed, retired US Army Gen. and former CIA Director David Petraeus said he has grown increasingly concerned about anti-Muslim rhetoric in the United States.

"As policy, these concepts are totally counterproductive," Petraeus said. "Rather than making our country safer, they will compound the already grave terrorist danger to our citizens. As ideas, they are toxic and, indeed, non-biodegradable -- a kind of poison that, once released into our body politic, is not easily expunged."

The number of American Muslims who radicalize is small, especially when compared with other Western countries, said William McCants, director of the Brookings Institution's Project on US Relations with the Islamic World.

Law enforcement experts estimate that about 250 Americans have tried to join ISIS, far fewer than the thousands who have flocked to Syria and Iraq from countries such as France and Belgium.

"I would argue that American Islam is doing something right in contrast to these other countries," McCants said.

Most American Muslims are integrated and feel content with their lives, in sharp contrast with many Muslims in Western Europe, according to the 2011 Pew Center report. Nearly 90% speak English fluently, and more than 8 in 10 are citizens. Most say they see no conflict between being a devout Muslim and living in a modern society.

Still, 81 Muslim-Americans were associated with violent plots in 2015, the highest annual total since 9/11, according to the Triangle Center.

Omar Suleiman, a popular cleric who lives in Dallas, said he has sparred with young Muslims attracted to ISIS' black-and-white theology. Often, they are first- and second-generation immigrants who have grown up with some discrimination and "a whole lot of other-ness and awkwardness," he said. They are angry young men, frustrated with dead-end careers, irked by clerics who refuse to address controversial topics and incensed about the suffering of Muslims overseas in the Palestinian territories and Syria.

"When they find that people aren't addressing their concerns in an authentic way, they fall prey to Internet radicalism," Suleiman said. "They become disconnected from the mosque and disconnected from the American Muslim community."

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why isis is celebrating trump's immigration ban - cnn.com

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Why ISIS is celebrating Trump's immigration ban

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"We don't want them here," he said Friday. Trump says the executive order is not a "Muslim ban," even though it bars citizens from seven predominantly Muslim countries from entering the United States for three months and gives preference to non-Muslim refugees. "This is not about religion -- this is about terror and keeping our country safe.

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These bloodthirsty and explicit odes to the exploits of narco traffickers and drug lords of Mexico openly glorify violence, narcotics and money.

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"While there are many factors that contribute to an engine’s efficiency, the primary factor that needs to be considered is the engine geometry itself."

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by Dr. Randy Herold
Engineer IV, General Atomics Aeronautical Systems

While there are many factors that contribute to an engine's efficiency, the primary factor that needs to be considered is the engine geometry itself. Not only does the overall size of the engine matter, but the aspect ratio of the engine cylinders-defined by the stroke-to-bore ratio-also matters. To explain why, one must consider three factors: in-cylinder heat transfer, cylinder scavenging and friction.

Simple geometric relationships show that an engine cylinder with longer stroke-to-bore ratio will have a smaller surface area exposed to the combustion chamber gasses compared to a cylinder with shorter stroke-to-bore ratio. The smaller area leads directly to reduced in-cylinder heat transfer, increased energy transfer to the crankshaft and, therefore, higher efficiency.

Cylinder scavenging-a two-stroke phenomenon in which the exhaust products in the cylinder are replaced by fresh air-is also strongly affected by the stroke-to-bore ratio in a uniflow-scavenging, opposed-piston, two-stroke engine. As the stroke-to-bore ratio increases, so does the distance the fresh air has to travel between the intake ports at one end of the cylinder and the exhaust ports at the other end. This increased distance results in higher scavenging efficiency and, as a result, lower pumping work because less fresh air is lost via charge short circuiting.

Engine friction is affected by the stroke-to-bore ratio because of two competing effects: crankshaft bearing friction and power-cylinder friction. As the stroke-to-bore ratio decreases, the bearing friction increases because the larger piston area transfers larger forces to the crankshaft bearings. However, the corresponding shorter stroke results in decreased power-cylinder friction originating at the ring/cylinder interface.

At Achates Power, we have conducted extensive analyses in all three areas in order to correctly identify the optimum engine geometry that provides the best opportunity to have a highly efficient internal combustion engine. In-cylinder simulations have shown that the heat transfer increases rapidly below a stroke-to-bore ratio of about 2, engine systems simulations have shown that the pumping work increases rapidly below a stroke-to-bore ratio of about 2.2 (because of the associated decrease in scavenging efficiency), and engine friction models have shown that the crankshaft bearing and power-cylinder friction values, for the most part, cancel each other out for our opposed-piston, two-stroke engine.

It should be noted here that in an opposed-piston engine-where there are two pistons per cylinder working in opposite, reciprocating motion-the "stroke" results from the combined motions of the two pistons and is roughly double the distance that one of the pistons travels in half a revolution. This fact allows an opposed-piston engine to have much larger stroke-to-bore ratios than an engine with one piston per cylinder without having excessively high mean piston speeds that are detrimental to inertial loading and friction.

For context, below is a plot of power density versus stroke-to-bore ratio of some current four-stroke engines designed for a wide range of applications. Note that all of the engines in the chart have cylinder heads, so the stroke describes the actual piston stroke. The data in the plot show a trend in which engines that require high power density-like those in race cars-have a small stroke-to-bore ratio, and engines that require high fuel efficiency-like those in heavy-duty trucks and marine cargo ships-have a large stroke-to-bore ratio.

The limiting factor in this relationship is the inertial forces origination from the piston motion. To achieve high power density, the engine must operate at a high engine speed (up to 18,000 rpm for the Formula 1 engine), which leads to high inertial forces that must be limited by using a small stroke-to-bore ratio. For applications that demand high efficiency, a long stroke-to-bore ratio is necessary and, again because of the inertial forces of the piston, requires a slower engine speed and lower power density. For the marine application that has a 2.5 m stroke, the engine speed is limited to 102 rpm.

In comparison, the Achates Power opposed-piston, two-stroke engine is being designed with a stroke-to-bore ratio in the range of 2.2 to 2.6. This range of stroke-to-bore ratio values allows us to create a highly efficient internal combustion engine while still having mean piston speeds comparable to engines currently available in medium- and heavy-duty applications. Any opposed-piston, two-stroke engine with a stroke-to-bore ratio below 2 will suffer from high in-cylinder heat transfer and poor scavenging, both of which act to reduce the engine's overall efficiency.

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Stroke-to-Bore Ratio: A Key to Engine Efficiency - Achates

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While there are many factors that contribute to an engine's efficiency, the primary factor that needs to be considered is the engine geometry itself. Not only does the overall size of the engine matter, but the aspect ratio of the engine cylinders-defined by the stroke-to-bore ratio-also matters.

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“An engine produces peak torque at the rpm where it is most efficient.” Big bore or big stroke? Which builds a better race engine?

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By David Reher, Reher-Morrison Racing Engines
"An engine produces peak torque at the rpm where it is most efficient."
Recently I've had several conversations with racers who wanted to build engines with long crankshaft strokes and small cylinder bores. When I questioned them about their preference for long-stroke/small-bore engines, the common answer was that this combination makes more torque. Unfortunately that assertion doesn't match up with my experience in building drag racing engines.

My subject is racing engines, not street motors, so I'm not concerned with torque at 2,000 rpm. In my view, if you are building an engine for maximum output at a specific displacement, such as a Comp eliminator motor, then the bores should be as big as possible and the stroke as short as possible. If you're building an engine that's not restricted in size, such as a heads-up Super eliminator or Quick 16 motor, then big bores are an absolute performance bargain.

I know that there are drag racers who are successful with small-bore/long-stroke engines. And I know that countless magazine articles have been written about "torque monster" motors. But before readers fire off angry e-mails to National DRAGSTER about Reher's rantings on the back page, allow me to explain my observations on the bore vs. stroke debate.

In mechanical terms, the definition of torque is the force acting on an object that causes that object to rotate. In an internal combustion engine, the pressure produced by expanding gases acts through the pistons and connecting rods to push against the crankshaft, producing torque. The mechanical leverage is greatest at the point when the connecting rod is perpendicular to its respective crank throw; depending on the geometry of the crank, piston and rod, this typically occurs when the piston is about 80 degrees after top dead center (ATDC).

So if torque is what accelerates a race car, why don't we use engines with 2-inch diameter cylinder bores and 6-inch long crankshaft strokes? Obviously there are other factors involved.

The first consideration is that the cylinder pressure produced by the expanding gases reaches its peak shortly after combustion begins, when the volume above the piston is still relatively small and the lever arm created by the piston, rod and crank pin is an acute angle of less than 90 degrees. Peak cylinder pressure occurs at approximately 30 degrees ATDC, and drops dramatically by the time that the rod has its maximum leverage against the crank arm. Consequently the mechanical torque advantage of a long stroke is significantly diminished by the reduced force that's pushing against the piston when the leverage of a long crankshaft stroke is greatest.

An engine produces peak torque at the rpm where it is most efficient. Efficiency is the result of many factors, including airflow, combustion, and parasitic losses such as friction and windage. Comparing two engines with the same displacement, a long-stroke/small-bore combination is simply less efficient than a short-stroke/big-bore combination on several counts.

Big bores promote better breathing. If you compare cylinder head airflow on a small-bore test fixture and on a large-bore fixture, the bigger bore will almost invariably improve airflow due to less valve shrouding. If the goal is maximum performance, the larger bore diameter allows the installation of larger valves, which further improve power.

A short crankshaft stroke reduces parasitic losses. Ring drag is the major source of internal friction. With a shorter stroke, the pistons don't travel as far with every revolution. The crankshaft assembly also rotates in a smaller arc so the windage is reduced. In a wet-sump engine, a shorter stroke also cuts down on oil pressure problems caused by windage and oil aeration.

The big-block Chevrolet V-8 is an example of an engine that responds positively to increases in bore diameter. The GM engineers who designed the big-block knew that its splayed valves needed room to breath; that's why the factory machined notches in the tops of the cylinder bores on high-performance blocks. When Chevy went Can-Am racing back in the '60s, special blocks were produced with 4.440-inch bores instead of the standard 4.250-inch diameter cylinders. There's been a steady progression in bore diameters ever since. We're now using 4.700-inch bores in NHRA Pro Stock, and even bigger bores in unrestricted engines.

Racers are no longer limited to production castings and the relatively small cylinder bore diameters that they dictated. Today's aftermarket blocks are manufactured with better materials and thicker cylinder walls that make big-bore engines affordable and reliable. A sportsman drag racer can enjoy the benefits of big cylinder bores at no extra cost: a set of pistons for 4.500-inch, 4.600-inch or 4.625-inch cylinders cost virtually the same. For my money, the bigger bore is a bargain. The customer not only gets more cubic inches for the same price, but also gets better performance because the larger bores improve airflow. A big-bore engine delivers more bang for the buck.

Big bores aren't just for big-blocks. Many aftermarket Chevy small-block V-8s now have siamesed cylinder walls that will easily accommodate 4.185-inch cylinder bores. There's simply no reason to build a 383-cubic-inch small-block with a 4-inch bore block when you can have a 406 or 412-cubic-inch small-block for about the same money.

There are much more cost-effective ways to tailor an engine's torque curve than to use a long stroke crank and small bore block. The intake manifold, cylinder head runner volume, and camshaft timing all have a much more significant impact on the torque curve than the stroke - and are much easier and less expensive to change.

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Tech Talk #53 - Big Bore or Long Stroke: Which Is Better?

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By David Reher, Reher-Morrison Racing Engines "An engine produces peak torque at the rpm where it is most efficient." Recently I've had several conversations with racers who wanted to build engines with long crankshaft strokes and small cylinder bores. When I questioned them about their preference for long-stroke/small-bore engines, the common answer was that this combination makes more torque.

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"“I think there is some risk involved having a supermodel in an ad,” he says. “That’s going to be beloved by many and questioned by a few.”

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Donald Trump appeared in a Super Bowl ad five years ago, where he was outsmarted by a Century 21 agent. This time you won't find President Trump in the ads, though his unmistakable shadow will loom over them.

84 Lumber, a leading supplier of building materials, has a 90-second Super Bowl spot that will air just before halftime. You won't see the original version unless you go online. M.J. Brunner Inc., the agency that created the ad, says 84 Lumber seeks to present itself as a company looking for good employees, no matter where they come from. The ad's original imagery included a wall - and the agency says FOX asked it to go back to the drawing board.

Trump will have been president for little more than two weeks on Super Bowl Sunday, and ad experts say the mere fact of his administration will be felt in some of the pricey commercials, though in ways more subtle than the explicit example of 84 Lumber.

Robert Thompson, director of the Bleier Center for Television and Popular Culture at Syracuse University, points to a country that is polarized by a bruising election campaign and a simmering anger that lingers in the land.

"We are obviously in a very tense social moment," Thompson tells USA TODAY Sports. "Most advertisers are not going to want to do something that could be provocative to a large part of a population that's in an already provoked state."

Some brands have released their ads early. None so far feature the sort of brazen, sexually charged vibe made famous years ago by web-hosting company GoDaddy, though some are mildly naughty.
MORE SUPER BOWL ADVERTISING COVERAGE
There's a spot where a housewife lusts after a muscled CGI version of Mr. Clean - gyrating as he mops - but it soon develops her fantasy is really her rumpled hubby, made sexy by the mere act of housework. And there is a Yellow Tail wine spot, which will air in 85% of the country through local ad buys, that blends suggestiveness with playfulness.

In that one, a brand spokesman called Yellow Tail Guy and his animatronic kangaroo named Roo are at the beach where they run into Aussie-born supermodel Ellie Gonsalves in her white bikini.

"Want to pet my Roo?" the guy asks.

Tom Steffanci, president of Deutsch Family Wine & Spirits, U.S. importer and marketer of the Australian wine, believes the scene plays as funny without crossing the line. "We did think that the Super Bowl was a good stage for that line," he says.

Political climate was never a consideration because the creative direction of the ad campaign was set long before election day. Steffanci says bigger brands with bigger budgets may be agile enough to make late changes, but his and others are not.

"I think there is some risk involved having a supermodel in an ad," he says. "That's going to be beloved by many and questioned by a few."

Though Thompson wonders about predictions that "there's not going to be as much frat-boy humor, with outrageous sexiness, this year. I have a hard time figuring out: Which side are they trying not to offend?"
TOGETHER APART
Shawn McBride, executive vice president, sports, at Ketchum Sports and Entertainment, says the tone of the times is often reflected in Super Bowl ads. Budweiser's Clydesdales bowing before the New York skyline after 9/11 is a shining example. But in those days the country was united in its grief. Today it is deeply divided in its politics.

"I don't think we'll see ads as provocative as we've seen maybe years prior," McBride says. "That's just not the temperature of the country right now. You don't want to come across as tone deaf to the audience you're trying to reach."

That doesn't mean there won't be loud, brassy ads, as per usual. But Tim Calkins thinks brands will try their best to stay on safe ground in fractious times, especially in an era when social media affords the offended a means to complain instantly and harshly.

"There is no question that Super Bowl advertisers are thinking about Trump and thinking about polarization," says Calkins, clinical professor of marketing at Northwestern University's Kellogg School of Management. "All of these Super Bowl advertisers are trying to resonate and trying to break through, but I think they will work very hard to be safe."

Deep Root Analytics, a media analytics firm, says its research suggests the best way for Super Bowl advertisers to appeal to the broadest cross-section of viewers is through what it calls Americanism - a focus on the USA. But even that approach comes with some risk these days, Syracuse's Thompson says, given Trump's cry of America First.

Budweiser will have an ad that tells the immigrant story of its cofounder, Adolphus Busch. When the ad's Busch arrives in 19th Century America he hears catcalls in the streets. "You're not welcome here! Go home!"

That offers echoes of today's America. Side note: Trump's grandfather Frederick also immigrated from Germany in the 1800s.

Donald Trump was featured in a CENTURY 21 ad in 2012. (Photo: Century 21 Real Estate LLC)
HUMOR HELPS
Super Bowl viewers who watch the ad for Avocados from Mexico may wonder if the guacamole they're snacking on will soon cost more, as the Trump administration has floated the possibility of a tariff on imported Mexican goods to pay for the wall that 84 Lumber can't show.

"We don't get into those political situations," says Alvaro Luque, president of Avocados From Mexico, who says the main goal of his marketing organization is brand messaging. This year's avocado ad has Jon Lovitz; last year's had Scott Baio, who'd later be notable as a Trump backer. Would Baio's comic cameo have worked this time?

"No, probably not," says Jay Russell, chief creative officer of GSD&M Advertising. "It's a different year."

Russell figures humor, always a go-to for Super Bowl ads, will be especially important this time. "I think you're going to see a lot of pure, funny escapism," he says.

Celebrities are usually a safe way to go, but not always. Tom Brady, who will appear in an Intel ad, says he is a friend of Trump's, though he doesn't want to talk about it. ("I'm not talking politics at all," he said at Monday's NFL media availability.) Lady Gaga is headliner of the halftime show sponsored by Pepsi Zero Sugar and will appear in regional Super Bowl ads for Tiffany's; she famously held aloft a "Love Trumps Hate" sign outside Trump Tower after the election.

Michael Brunner, chairman and CEO of the agency that produced the 84 Lumber ad, says it respected FOX's decision and restructured the ad, which he calls a launching pad for his client's 2017 recruitment campaign.
MORE SUPER BOWL COVERAGE
"The reality is we live in a very politically charged environment," Brunner writes by email. "Because of that, brands are having to think long and hard about whether or not they want to take a side. I don't think that means we should stay away from anything controversial, though. If everyone else is playing it safe, those that take a risk have an opportunity to stand out even more."

Mark Tutssel, chief creative officer worldwide for Leo Burnett, thinks most companies won't take such risks.

"I'm sure we'll have one or two cases of people using that subject matter to create content," he says. "But I think by and large the major iconic brands that play an important part in the Super Bowl will be on point and produce work that is worthy of the moment."

Mercedes is one such iconic brand. Its Super Bowl ad, directed by the Coen Brothers, is an homage to Easy Rider, the counter-culture film that came out in 1969, at another time of deep division in America. Joe Namath's New York Jets won Super Bowl III on January 12 of that year. Richard Nixon was inaugurated eight days later.

The spot is fabulously funny: Bikers in a bar, Born to Be Wild as the soundtrack - and Peter Fonda as the punch line. He starred as a shaggy antihero in Easy Rider, rebelling against a conformist, consumerist society in the Age of Nixon.

Now, grown old in the Age of Trump, he rides off in a Mercedes-AMG GT Roadster in the fourth quarter of the Super Bowl, the high holy day of American consumerism.

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Super Bowl ads toned down by Trump's shadow?

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Donald Trump appeared in a Super Bowl ad five years ago, where he was outsmarted by a Century 21 agent. This time you won't find President Trump in the ads, though his unmistakable shadow will loom over them. 84 Lumber, a leading supplier of building materials, has a 90-second Super Bowl spot that will air just before halftime.

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"The path to better medicine is paved with accidental yet revolutionary discoveries. In this well-told tale of how science happens, neuroscientist Rebecca Brachman shares news of a serendipitous breakthrough treatment that may prevent mental disorders like depression and PTSD from ever developing. "

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Rebecca Brachman: Could a drug prevent depression and PTSD?

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The path to better medicine is paved with accidental yet revolutionary discoveries. In this well-told tale of how science happens, neuroscientist Rebecca Brachman shares news of a serendipitous breakthrough treatment that may prevent mental disorders like depression and PTSD from ever developing. And listen for an unexpected -- and controversial -- twist.

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"On top of class work and homework, athletes are working a full-time job."

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"A $25,000 scholarship may seem like a lot of money, but it really only covers the basics."

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There has been major discussion recently if college athletes should or shouldn't be paid while they are in school. The first thing opponents say is, "They're already getting a scholarship! That's more than anybody else! Don't be greedy!"

Fine, let's not be greedy and look at how much a scholarship is actually worth. On average, a full Division 1 scholarship is $25,000 per year.

"That's $100,000 over four years!"

Yes it is, but most athletes don't last at a school for the whole four years. Once you get a sport involved, there are politics, injuries, and a call to the office to tell the player, "Thanks, but we don't need you on this team anymore." Many players will get a scholarship for a year or two, then transfer to a different school which turns out to be a better situation.

A $25,000 scholarship may seem like a lot of money, but it really only covers the basics. It covers thousands of dollars in mysterious, unknown university fees, tuition, housing, a meal-plan and multiple hundred-dollar textbooks. Some players, if they come from a low-income household, get a few hundred dollars each semester from Pell Grants which enables them to buy chicken soup instead of chicken-flavored ramen.

Contrary to what all the opponents believe, being an athlete is a full-time job. On a typical day, a player will wake up before classes, get a lift or conditioning session in, go to class until 3 or 4 p.m., go to practice, go to mandatory study hall, and then finish homework or study for a test.

For a little extra money to see a movie or go out to dinner once a week, my freshman roommate worked a job at the university, earning about $7/hour. He would work his butt off all day, with two or sometimes three basketball training sessions, plus classes and homework, and go to that job for a few hours late at night. He would come back exhausted, but he needed whatever money they would pay him.

However, once the season started up, he couldn't work that job anymore. We were on the road all the time, even gone for two straight weeks at one point. The teachers let us do our work from the road, but the job wasn't going to pay you just because you were playing basketball on a road trip. The team gave us meal money (about $7 per meal) so we could get chips and condiments with our sandwiches, but anything else was considered an NCAA violation.

The point of this is that a scholarship doesn't equal cash in a player's pocket. Even with any type of scholarship, college athletes are typically dead broke. But how much do the top NCAA executives make? About $1 million per year.

Who else makes money off these near-professional level athletes?

First, their own coaches. Many coaches earn at least $100,000 per year to coach one of the major sports like baseball, basketball, or football at a school. These coaches will receive bonuses for getting to the playoffs, winning championships, or breaking school records. You know what athletes receive as a bonus? Nothing.

Second is the NCAA. Recently, the NCAA and CBS signed a $10.8 billion television agreement over 14 years. The NCAA is also considered a non-profit company.

Third, the athletic programs. Universities bring in hundreds of thousands or even millions of dollars to their athletic programs each year. Through donations, ticket sales, media rights, advertising, and anything else with a price tag, these athletes are symbols for their school and their program. If a school makes a huge scientific achievement, they will be in the newspaper for a few days. The athletic teams, however, are in the newspaper the entire year.

The flip side of this is that not all sports teams are profitable. For example, some less popular teams like swimming, tennis, or volleyball don't earn the university much money, and the bigger sports like basketball and football make up for the lost revenue. So why would we pay athletes if entire teams are struggling to survive?

We would pay athletes because when President Theodore Roosevelt helped create the NCAA in 1906, he had no idea what it would grow into. At first, it was a great place to watch athletes play sports while making sure the rules were being followed. But now in the 21st century, the NCAA is a billion dollar company. Why hasn't anything changed? Because the decision makers have the mentality of, "This is the way it's always been." They're scared to make amendments, even when it's necessary.

I'm not saying we should be paying athletes $5,000 or even $10,000 per semester. If each athlete got $2,000 paid over the course of the semester, this would give them some spending cash and an opportunity to start managing their money. Most athletic programs can't afford to pay athletes on their own, so the NCAA and their executives need to figure out a way to start compensating their golden geese.

Athletes earn their schools hundreds of thousands of dollars, increase enrollment, and if they do well, provide a recruiting piece for generations. Top NCAA executives are getting $1 million per year while an athlete can't earn $50 from signing a few autographs.

Let's open our eyes to what's really going on. The NCAA "prevents student-athletes from allowing their likeness to be used for promotional purposes."

There's only one thing I can say to this: Why?

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There has been major discussion recently if college athletes should or shouldn't be paid while they are in school. The first thing opponents say is, "They're already getting a scholarship! That's more than anybody else! Don't be greedy!" Fine, let's not be greedy and look at how much a scholarship is actually worth.

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Where do you stand in the workforce?

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In an extended interview Kathleen Gerson, a Sociology professor at New York University and the author The Unfinished Revolution sheds light on the findings of a new World Economic Report on the gender gap around the world.

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Where do American women stand in gender equality?

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In an extended interview Kathleen Gerson, a Sociology professor at New York University and the author The Unfinished Revolution sheds light on the findings of a new World Economic Report on the gender gap around the world.

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Human-Pig embryo, is science too advanced?

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Using stem cell technologies, researchers generated human cells and human tissues in the embryos of pigs and cattle. Their research appeared in the journal Cell.

Despite this milestone, integrating cells from human and animal species is proving difficult, and developing human organs remains at a considerable distance, said Dr. Jun Wu, a staff scientist in the gene expression laboratory at the Salk Institute and first author of the research.

"Species evolve independently, and many factors dictating the developmental programs might have diverged, which makes it difficult to blend cells from one species to a developing embryo from another," Wu said. "The larger the evolutionary distance, the more difficult for them to mix."

Or as senior author Juan Carlos Izpisua Belmonte, a professor in Salk's gene expression laboratory, sees it, "To try to imitate nature is not that easy."

Building block experiments

The project began with the research team attempting to prove that it could grow one animal's organ cells within a different species of animal. This is known as a chimera -- specifically an interspecies chimera, an organism containing cells from two or more species.

They began with two closely related species: rats and mice.

To create a rat-mouse chimera, the scientists began by creating a mouse embryo without a pancreas.

Similar work had been done before by other scientists, notably Hiromitsu Nakauchi, now at Stanford, who bred mutant mice that lacked a pancreas and then grew a rat pancreas inside a mouse.

In the current study, Belmonte, Wu and their colleagues used gene-editing techniques known as CRISPR/Cas9 to generate mice embryos lacking a pancreas. Then they inserted rat stem cells that contained a gene for the pancreas into these mutant embryos.

Once implanted, the stem cells developed into a rat pancreas within a mouse embryo that ultimately (and importantly) grew into a healthy mouse with a normal lifespan. Taking their idea a few steps further, the researchers used the same method to develop rat eyes and rat hearts within mice embryos.

"We demonstrated the robustness of this system," Wu said. By "genetically disabling" the mouse host, they proved it was possible to generate rat organs within a host species.

Unexpectedly to the researchers, the mice delivered bonus organs after the injection of rat stem cells: gallbladders, which are present in mice but not in rats.

"This suggests that rats lack a gallbladder not because of an inherent genetic deficiency of rat cells," Wu said. Instead, "embryonic niches" may be orchestrating the tissues and organs that develop and grow within each animal species.

After the rat-mice experiments, the team turned its focus to human stem cells.

Small but significant

They began by generating different types of human induced pluripotent stem cells -- when adult cells are turned back into stem cells -- and inserting them into pig embryos. Pigs were used because both the size and the development time for their organs are more similar to our own than, say, rats.

Next, the team members implanted these embryos into sows. To test the safety and effectiveness of their work, they stopped the experiment at four weeks.

Human cells within some of the embryos had begun to specialize and turn into tissue precursors, they discovered. However, the success rate and level of human stem cell contributions in pigs was much lower than with the rat-mouse chimeras.

Wu cautioned that the research is in its very early stages, and with many challenges ahead, the development of human organs within animals may not be possible for some time.

Though the experiment with human stem cells was interrupted at 28 days, it remains the first reported case in which human stem cells have begun to grow within another species. So it is a small but significant step toward the ultimate goal of growing human organs in animals, said Insoo Hyun, an associate professor of bioethics and philosophy at Case Western Reserve University.

"They just wanted to see if the cells would survive during gestation, and they did, and they kind of migrated here and there to various sites, except the brain, which is interesting," said Hyun, who was not involved in the research.

Hyun, who worked on developing international guidelines for the International Society for Stem Cell Research, said the Salk Institute researchers appear to be staying within international ethical boundaries.

"The next step would be then to see if they can get better at localizing where the human cells develop and, ideally, getting to organ genesis," he noted.

Ethical concerns

"The interesting thing is, it was not funded by American taxpayer money," Hyun said, at least not directly. The primary funding came from private Spanish sources.

One reason for this is the US National Institutes of Health examined chimera science in a 2015 workshop and "accompanied that with a pause" on funding of a "very narrow subset of animal human chimera research," said Carrie D. Wolinetz, the institutes' associate director for science policy.

This subset consists of scientists introducing human cells into animal embryos at a very early stage.

"There has been the use of human-animal chimeras in biomedical research for a very long time. We've introduced human cells into animal models to create models of human diseases and used them as research tools for decades now," Wolinetz said.

"But over time, what we've seen -- as stem cell technology has advanced and as gene editing technology has advanced -- we've seen the ability to create more sophisticated animal-human chimeras at a much earlier stage of embryonic development," she said.

The reason, then, the National Institutes of Health suspended funding was over ethical concerns.

The chimeras used in biomedical research have been created, typically, by putting the human cells in at a later stage of development: at the fetal stage or even after birth. At these stages, scientists have a lot more control in that the cells stay where they are put, and they don't "drift all over" the animal's body, explained Wolinetz.

In these new experiments, human cells are being introduced at a much earlier stage of development, when the cells are still sorting themselves out within the embryo.

"In particular, people were concerned about human cells populating the brain of the animal or the germline of the animal," Wolinetz said. In the first case, the animal might be humanized; in the second case, the animal might pass human genes on to its offspring.

As Hyun frames it, the ethical question is this: "If you up the biological contribution of the human stem cells, are you also somehow turning them morally into a human-like thing with human rights?" He noted, though, "It's so difficult to know how you would actually address that." It's not measurable.

"I would argue, as long as you are avoiding the brain, or there's not a significant change to the brain, of structure and possible functioning, then I don't think you even need to go down that philosophical path," he said. Though as a philosopher, it might be "fun" for him, it's not a wise or practical thing to do for policy.

Instead, Hyun said, you want to stick with measurable criteria such as seeing a drop in animal function from the beginning of an experiment to the end. "The emphasis should still remain on animal welfare," he said, as it is currently for any kind of animal research.

Meanwhile, Wolinetz said the National Institutes of Health is hoping to finalize its policy on chimera research very soon in order to get back into the business of funding appropriate projects.

"We would like to make sure exciting research can go forward," she said, "but also make sure that we've got an appropriate oversight system so we can make sure it's proceeding responsibly."

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Using stem cell technologies, researchers generated human cells and human tissues in the embryos of pigs and cattle. Their research appeared in the journal Cell. Despite this milestone, integrating cells from human and animal species is proving difficult, and developing human organs remains at a considerable distance, said Dr. Jun Wu, a staff scientist in the gene expression laboratory at the Salk Institute and first author of the research.

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GMO Labeling, is it too much information?

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After years of bitter debate and legislative stalemate over the labeling of genetically modified ingredients, a compromise proposal sailed through Congress in breathtaking speed over the past three weeks.

The House of Representative passed the measure on Thursday with solid support from both Democrats and Republicans. It now goes to the White House, where President Obama is expected to sign it.

Within a few years, consumers will be able to find out whether any food in the supermarket contains GMO ingredients. But they won't necessarily see that information on the package. Instead, consumers may have to scan a "QR code" - those little square codes that you see on airline boarding passes - to get that information.

Neither side in the labeling battle sounded completely satisfied. "I don't think that it's the best bill that we could have, but it's the best bill we could pass," says Richard Wilkins, a Delaware farmer who is president of the American Soybean Association, which opposes mandatory GMO labels.

"We're not supporting the final bill, because it does allow companies to use the option of a QR code," says Scott Faber, from the Environmental Working Group, which supports mandatory labels.

Congress was forced into this compromise by Vermont, which passed its own GMO labeling law. It went into effect this month.

Faber says mandatory labeling is necessary in order to provide consumers the information they need to ensure "that their values are reflected in their food dollar."

Food companies and farm groups, meanwhile, are convinced that pro-labeling groups are simply trying to use labels to drive consumers away from GMOs - a tactic that worked in Europe.

"Their first step was to require a mandatory label, and their second step was to force those products out of the marketplace," Wilkins says.

Wilkins also says mandatory labeling of GMOs suggests that those foods are inferior or unsafe, which is simply not true. The U.S. Food and Drug Administration has said labeling isn't necessary because GMO foods aren't any different than regular ones.

This is why food companies and farm groups lobbied Congress to ban mandatory GMO labeling laws, including the one in Vermont. That previous proposal passed in the House, but not the Senate, where Michigan Sen. Debbie Stabenow - the ranking Democrat on the agriculture committee - dug in her heels against it.

In the end, the two sides settled on a compromise that does nullify Vermont's law, but still requires a form of GMO labeling.

Under this compromise, food companies will have to reveal whether products contain GMO ingredients, but they won't have to print it on the package label. Instead, they can make that information available through a QR code. Shoppers would have to scan it with their smartphones. Small food companies also have the option of printing a website URL or a phone number that customers can call for more information.

The proposal opened up sharp divisions among groups that had previously presented a united front in favor of GMO labeling. Some critics condemned the compromise as a " betrayal," a " sham" and " inexcusable."

Yet the Organic Trade Association, which supports GMO labeling, decided to support the compromise, in part because the law includes some special benefits for the organic industry. It includes, for instance, a provision that allows organic food companies to label their products as non-GMO.

The Just Label It coalition, which includes the Environmental Working Group and a long list of food companies, declared the bill a victory of sorts, even while refusing to support it. "It's not an insignificant achievement that a Republican Congress has decided to mandate a national GMO disclosure on every food package that contains genetically engineered ingredients," says Scott Faber.

At the same time, the GMO labeling battle isn't over. For one thing, the law leaves many details of the new labeling scheme to be worked out by the U.S. Department of Agriculture. These include, for instance, whether refined products like soy oil or sugar from beets will need to be labeled. While they are made from GMO crops, the final product doesn't contain any genetically modified material, such as proteins or DNA.

Gary Hirshberg, chairman of the Just Label It coalition, released a statement sayin that "the fight for national mandatory GMO transparency now shifts to USDA and to the marketplace, where companies should think twice before they remove GMO labels from their packages."

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Congress Just Passed A GMO Labeling Bill. Nobody's Super Happy About It

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After years of bitter debate and legislative stalemate over the labeling of genetically modified ingredients, a compromise proposal sailed through Congress in breathtaking speed over the past three weeks. The House of Representative passed the measure on Thursday with solid support from both Democrats and Republicans.

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Is One-Size-Fits-All Health Insurance a good option for such a diverse country?

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A co-worker struggling to make ends meet comes to you with a problem. The price of admission to a dear colleague's retirement party at an upscale establishment is beyond her means, though not yours.

You both feel obliged to attend. She'd rather bring some refreshments to a conference room than spend what she cannot afford on a lavish event. You like the idea of a grand send-off for your retiring colleague. There can be only one party.

A similar, underrecognized conundrum arises in health insurance. Both you and your less fortunate co-worker are obliged under the law to obtain coverage (which you both want anyway).

But you differ in what you'd prefer to pay for. A high-level manager who makes, say, $200,000 per year is probably willing and able to pay more for health care than someone who makes $50,000.

Unfortunately, neither person really has a choice because the plans all cover "medically necessary" care, meaning any care that offers a clinical benefit. That includes lots of expensive and technologically sophisticated care that is no better, or only slightly better, than cheaper alternatives. You may be just fine paying for high-tech care of marginal value. For your colleague of more modest means, it's a stretch.

Consider, for example, treating prostate cancer with proton-beam therapy. It's more expensive than alternatives like intensity-modulated radiation therapy, but isn't proven to be any better. If given the choice, many people - especially those with lower incomes - might rather buy health insurance plans that exclude high-cost, low-value treatments.

The trouble is that insurers rarely sell those sorts of plans. Even insurers that try to exclude a particularly expensive and unproven technology from coverage are often rebuffed by legislatures and the courts.

This one-size-fits-all approach to insurance coverage disproportionately hurts low-income people, many of whom might reasonably prefer to devote their scarce dollars to housing or their children's education. To some extent, subsidies and other monetary adjustments can mitigate this problem. Medicare and Medicaid, for example, are financed in large part out of federal income taxes. And within the Affordable Care Act marketplaces, lower-income people receive subsidies that cover some of their costs.

People who receive coverage through their employers, however, don't get that kind of help. Perversely, employer-sponsored health insurance is more highly subsidized for the rich than the poor. The subsidy comes in the form of an exclusion of health-insurance premiums from taxation. Since income tax rates are progressive - that is, the rich pay a higher rate of income tax than the poor - lower-income families get less of a benefit.

But both high-wage and low-wage workers at the same company are effectively forced into the same plans. To qualify for the tax exclusion, federal law requires that companies offer the same plans to all or most of their employees, with no consideration for the variable demand for health care. Employees then pay for their fringe benefits by taking home lower wages - and a flat, across-the-board cut in wages burdens low-wage workers disproportionately.

In theory, the labor market could adjust in ways that might lessen the problem: Low-income workers, for example, could demand higher wages for being forced into plans that are more expensive than they'd prefer. These would have to be made up by reducing the wages of high-income workers, something it's not clear they would accept. There's no evidence that labor markets actually work this way.

"The notion that labor markets perfectly offset the varying preferences for health insurance among workers by giving higher wages to those who value health insurance less is a comforting but crazy idea," said Amitabh Chandra, a Harvard economist.

The problems with one-size-fits-all insurance run deeper. In some insurance markets, like those for small businesses in Massachusetts, employees across companies are pooled together and pay the same premium. A recent report from the Massachusetts attorney general showed that workers in companies that receive health care at less expensive hospitals effectively subsidize those at comparable companies who receive care at more expensive ones.

The uniformity of insurance plans also affects the pace and composition of technological innovation. To extend our party metaphor, if everyone - even those who preferred simpler events - were effectively forced to pay for any retirement party, regardless of how lavish, we'd see, and pay for, retirement parties of ever-escalating extravagance.

In much the same way, medical innovators respond to the size of the market for new technologies. The fact that health plans routinely cover all medically necessary care sends an " if you build it, we will pay for it " signal. Innovators are not getting the right signals, the right incentives, to develop high-value or cost-saving treatments. It's more lucrative, instead, to develop pricey new therapies, even if they offer only marginal clinical benefits. The result is lots of new treatments that don't provide much bang for the buck.

Those new treatments pose a continuing challenge to efforts to bend the cost curve. Economists have long known that technology is the primary driver of escalating health expenditures. Indeed, in 2012 medical technologies that were not offered a decade earlier accounted for almost a third of Medicare spending delivered by physicians and outpatient hospital departments.

What's to be done? Managing technological innovation would require us to consider policy changes that would have been unthinkable a generation ago. "The tax code could be restructured to make extravagant health insurance less appealing," Mr. Chandra suggested. Employers might then offer health plans that appealed more to low-income workers.

The Cadillac tax on expensive health plans, which is scheduled to go into effect in 2020, is a step in that direction, but according to Mr. Chandra doesn't go far enough. And it is unpopular across the political spectrum. Other ideas - like incorporating cost-effectiveness criteria into Medicare and private plan coverage criteria - are sure to prompt disagreement.

Contentious solutions they may be. But as the cost of health care and health insurance rises, it won't be a party for politicians feeling more pressure from consumers.

A version of this article appears in print on , on Page A3 of the New York edition with the headline: One-Size-Fits-All Insurance Hurts Low-Wage Workers. Order Reprints | Today's Paper | Subscribe

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The Problem With One-Size-Fits-All Health Insurance

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A co-worker struggling to make ends meet comes to you with a problem. The price of admission to a dear colleague's retirement party at an upscale establishment is beyond her means, though not yours. You both feel obliged to attend. She'd rather bring some refreshments to a conference room than spend what she cannot afford on a lavish event.

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Should the U.S. reconsider their health care options?

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Global innovators are doing high-quality $1,800 heart surgery. Why aren't we paying attention?

In Bangalore, India, heart surgeons perform daily state-of-the-art heart surgery on adults and children at an average cost of $1,800. For the record, that's about 2% of the $90,000 that the average heart surgery costs in the United States. And when it comes to the quality of the heart surgery, the patient outcomes are among the best in the world.

I visited India during Thanksgiving week to meet with Dr. Devi Shetty. He's the heart surgeon who served as personal physician to Mother Teresa and now runs Narayana Health, with 20 hospitals in India. I wanted see what the United States could learn from medical innovations undertaken halfway around the world, and how he achieves these impressive clinical results at such a low price.

The high quality and low cost represent the type of disruptive innovation that has impacted nearly all industries in the United States, and should serve as a wake-up call for American doctors and hospitals. Disruption is what we call it when lower-priced alternatives to current products and services are introduced. Each time, the incumbents in the field scoff at them and dismiss their long-term impact, only to be blindsided when after a decade these companies dominate.

Ask most Americans about obtaining their health care outside of the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate. Of course, that's exactly what Yellow Cab thought about Uber, Kodak thought about digital photography, General Motors thought about Toyota and Borders thought about Amazon.

To date, doctors and hospitals have been spared the pain of disruption. But that day is ending, and I predict that even people looking for it to happen are gazing in the wrong direction. They expect disruption to be led by companies like Google and Apple or maybe entrepreneurial start-ups. Based on my time in India, they should be looking globally.

Most families in India have no health insurance, and often need to borrow the money to pay for surgery. When it costs $1,800 for heart surgery, Shetty can offer it to only so many children. But if it costs less, he can save more lives. He and the people working in his hospitals are driven to transform health care to save lives.

The day I was there, the teams of surgeons performed 37 heart surgeries on adults and children, including one heart transplant. That translates into about 900 procedures a month, or about what most U.S. university hospitals do a year. His success results from a combination of high volume, advanced technology and a focus on people and performance.

In surgery, the experience of the surgeon and the team are the best predictors of superior clinical outcomes. As you might imagine, given the huge volume of procedures his team performs each day, his hospital's results are exceptional. And contrary to what Americans may assume, the entire surgical experience is cutting edge, and beyond what is available almost anywhere in the United States.

For example, clinicians use a sophisticated electronic health record they developed, with the information stored on an iPad. Unlike nearly all U.S. EHR systems, the application is so intuitive that minimal physician or nurse training is required. The operating rooms themselves have huge windows leading to protected gardens designed to allow natural sunlight to enter and spur creativity.

The bedside monitoring equipment links with a central computer system, allowing clinical leaders like Devi to measure each day how long it took a physician to intervene for a potentially urgent medical problem. In the United States this often exceeds an hour at night and on the weekend. In India it was eight minutes. The disruptive innovation he has implemented isn't just lower cost, it's also higher quality.

The hospital's focus on people was widely evident. Embroidered on the white coats of doctors, nurses and staff was the question, "How can I help you?"

Its research facility matched the best university hospitals, with tens of thousands of fully sequenced DNA specimens, and a place to store cancer tissue from today, to be tested against the discoveries of tomorrow. Unlike many in the U.S., it was fully integrated with clinical practice, focusing on the questions and opportunities raised by the treating physicians. Next door was the lab focused on nanotechnology, and down the hall, one working on a vaccine to prevent heart attacks.
POLICING THE USA: A look at race, justice, media
Devi took me to Biocon, a drug manufacturing company with its visionary chairman and managing director, Dr. Kiran Mazumdar-Shaw. The manufacturing machines were identical to those used by companies in the U.S. and the cleanliness matched the best in the world. The company's products were some of the most sophisticated in medicine, including biosimilar drugs for the treatment of cancer, inflammation and arthritis. But one stood out in particular, and that was insulin.

The medication had identical action to what's sold in the U.S. And its preloaded syringes, with a sophisticated calibrating mechanism, were more accurate in dose than any I've seen. What was most remarkable was the price - less than 10% of what it costs Americans with diabetes today. The combination of massive scale and appropriate pricing accounted for the 10-fold difference.

The U.S. can continue for a few more years to provide inefficient medical care and tolerate exorbitantly priced drugs. But at some point, insurance companies will start offering patients and their families all-expense-paid trips around the globe, and maybe even $5,000 to use in the duty-free shop after their surgery and medical treatment are complete.

Most American doctors and hospitals see India as far away, and as a result, underestimate the dangers they face from global disruption. They assume that people won't be willing to travel halfway around the world for surgery. And they may be right. But before they become too complacent, they should look to the Grand Cayman Island, with its seven-mile white sand beach and tourist culture. There Shetty is building a 2,000 bed hospital for a population of more than 50,000 citizens. Maybe it's just a coincidence that by airplane Florida is less than an hour away.
Robert Pearl is CEO of The Permanente Medical Group and a clinical professor of surgery at Stanford University. You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @USATOpinion and in our daily Opinion newsletter. To submit a letter, comment or column, check our submission guidelines.
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U.S. health care needs a wakeup call from India: Column

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Global innovators are doing high-quality $1,800 heart surgery. Why aren't we paying attention? In Bangalore, India, heart surgeons perform daily state-of-the-art heart surgery on adults and children at an average cost of $1,800. For the record, that's about 2% of the $90,000 that the average heart surgery costs in the United States.

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Biopics seem to make so much money at the box office, but are they accurate or just another form of entertainment?

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Mario Anzuoni/Reuters

Updated |​ Straight Outta Compton is enjoying an extended run of box office dominance, but viewers will learn little from the N.W.A biopic about Dr. Dre's history of violence against women.

R&B singer Michel'le now saysthat Dre was physically abusive toward her during their six-year relationship-sending her to the hospital at least once and permanently damaging her ribs-but she isn't outraged that side is not depicted in the film.

"I'm not upset that they didn't put me in the movie," Michel'le told Newsweek. "No, not at all. I'm not upset.... It's their movie, right? Their money."

On Tuesday, rapper and former TV host Dee Barnes wrote about the time she was allegedly brutally beaten by Dr. Dre in 1991 in an essay for Gawker. That incident isn't depicted in Straight Outta Compton, and Barnes's piece prompted a public reckoning about the misogyny F. Gary Gray's movie arguably glosses over.

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On Wednesday, Michel'le (born Michel'le Toussaint) spoke to Newsweek about the violence she says she suffered at Dre's hands in a different, domestic context. "What he did to her and what he did to me are two different things," Michel'le said. "I was his fiancée." Michel'le spent much of the early 1990s in a relationship with the rapper and former N.W.A member, performed on Death Row Records releases and had a son with the rapper in 1991.

"He told me he loved me, so I don't think I understood it, but he was abusive, mentally and physically," Michel'le said. "I didn't know any better, because my father never told me he loved me. When you find a guy that wants to be with you all the time, you think that's love, right? I had to make my own world."

Michel'le alleges that during their relationship, Dre kicked her and broke her ribs, injuring her in such a way that her ribs didn't heal properly and leaving a lump on the left side of her body that won't go away. She says he sent her to the hospital on at least one occasion during this period.
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Michel'le has previously said Dr. Dre tried to shoot her. In an interview with hip hop video site VladTV earlier this week, she said: "I was just a quiet girlfriend who got beat on and told to sit down and shut up."

Representatives for Dr. Dre didn't provide comment about these allegations of abuse, but the rapper alluded to them in a recent interview with Rolling Stone, saying that he "made some fucking horrible mistakes in my life" and that "all the allegations aren't true [but] some of them are." Dr. Dre pled no contest to misdemeanor battery in a 1992 lawsuit filed by Dee Barnes, but has never been criminally charged in association with Michel'le's allegations.

On Friday, Dr. Dre apologized "to the women I've hurt" in a statement to The New York Times, saying that he regrets his mistakes and has changed in the past 25 years.

Michel'le told Newsweek that she hasn't actually watched the Compton movie yet, but wants to see it. Despite the one-sided story, Michel'le is "elated" that the movie has been made, because it has "brought back an era and a time when we had fun, we were creative, we made creative music."

Asked about Barnes's essay, she said: "I think she deserves her own apology. I understand the stories they told me about it, but I try to just be like, 'Wow, I hope she's OK.' It's hard when you get beat. You can't understand it until you get beat."

The Los Angeles Times reported that the Barnes incident was included in an early draft of the Straight Outta Compton script but was later removed. Michel'le seemed unsurprised that the narrative glossed over less admirable parts of the N.W.A story. "I think what they did was they displayed what they [wanted]," she said. "When you have money and power, you do what you want, and I can't tell you what they should have done. No, I can't. They do what they want to do."

Michel'le still records music and has an EP coming out soon. She's also planning to publish a book. She hasn't spoken to Dr. Dre in years, but she remains grateful for the relationship because it brought her her son, Marcel.

"This [violence] wasn't told in the story because it shouldn't have been, because it's their story," Michel'le added. "And this is my story."
This article has been updated to reflect an apology statement from Dr. Dre.

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Michel'le on 'Compton' and Being Abused by Dr. Dre

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Updated |​ Straight Outta Compton is enjoying an extended run of box office dominance, but viewers will learn little from the N.W.A biopic about Dr. Dre's history of violence against women. R&B singer Michel'le now saysthat Dre was physically abusive toward her during their six-year relationship-sending her to the hospital at least once and permanently damaging her ribs-but she isn't outraged that side is not depicted in the film.

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"I think the reality is that writing code and building a product and then building a company actually is not a glamorous enough thing to make a movie about. So you can imagine that a lot of the stuff they probably had to embellish and make up." - Mark Zuckerburg

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Q&A with Mark - Today Mark Zuckerberg took part in his... | Facebook

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Today Mark Zuckerberg took part in his first public Q&A. Watch the full video here.

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Are you reading fake news?

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Google, democracy and the truth about internet search

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Tech-savvy rightwingers have been able to 'game' the algorithms of internet giants and create a new reality where Hitler is a good guy, Jews are evil and... Donald Trump becomes president