TIME health

How Mark Cuban, Mark Zuckerberg and Other Powerful Tech Execs Stay in Shape

Dallas Mavericks v Houston Rockets - Game Two
Bob Levey—Getty Images Dallas Mavericks owner Mark Cuban at the 2015 NBA Playoffs on April 21, 2015 in Houston, Texas.

From running to surfing

Highly successful people often push themselves both inside and outside the office.

Though it can be difficult to find time to exercise when you’re working around the clock, several tech executives have found techniques, routines, or sports that resonate with them and help them grow.

Here’s a look at what the CEOs of Facebook, Microsoft, and others do to stay in shape.

Facebook CEO Mark Zuckerberg works out three times a week.

Zuckerberg said in a recent Q&A session on Facebook that he made sure he worked out at least three times a week. Sometimes he even takes his adorable puppy Beast along with him on his runs.

Here’s what Zuckerberg said when Arnold Schwarzenegger asked him about his workout habits:

Staying in shape is very important. Doing anything well requires energy, and you just have a lot more energy when you’re fit … I make sure I work out at least three times a week — usually first thing when I wake up. I also try to take my dog running whenever I can, which has the added bonus of being hilarious because that basically like seeing a mop run.

GoPro CEO Nick Woodman loves to surf.

Woodman, the highest-paid CEO in the United States last year, fell in love with surfing when he was just 8 years old. In college he joined a fraternity located on the beach, and he surfed with his friends multiple times per day. Woodman still loves to surf, and that is reflected in the office environment at GoPro, according to CBS News.

Microsoft CEO Satya Nadella is an avid cricket player.

Cricket is more than just a sport and a hobby for Nadella, who took over as the CEO of Microsoft in 2014. It taught him valuable lessons that influence how he runs Microsoft.

“Growing up in India, my dream as a boy was to play cricket professionally,” he told Geekwire. “The sport had a very rich heritage at my school and I went on to play school and junior cricket as a bowler (right arm off spin). At a certain point, I realized that I had reached my limit and luckily discovered my next passion in engineering and technology!”

Square CEO and interim Twitter CEO Jack Dorsey goes hiking in his spare time.

Dorsey has an intense schedule. He sticks to a rigid routine that amounts to an 80-hour workweek, as CNN Money reported back in 2011.

But he takes Saturdays off, which is when he finds the time to squeeze in some physical activity. He goes hiking on Saturdays, while Sundays are for “reflection, feedback, and strategy.”

Sebastian Thrun, the former Googler credited with building the company’s “moonshot” factory, is a dedicated cyclist.

Thrun, who now leads his own education company called Udacity, is an avid road cyclist who regularly completes 100-mile bike rides, according to Fast Company. He also snowboards and kite-surfs, and he has run half a dozen marathons.

Google cofounder Sergey Brin is an adrenaline junkie.

Brin, who now serves as the president of Google’s new parent company, Alphabet, is a daredevil at heart. Gymnastics, high-flying trapeze, springboard diving, ultimate Frisbee, and hockey are just a few of Brin’s favorite hobbies. Brin tried out many of these sports when he studied at Stanford, where he met fellow Google cofounder Larry Page. He has been known to bring Googlers to athletic complexes that offer these types of activities for team bonding experiences.

Billionaire tech investor Mark Cuban gets at least an hour of cardio per day.

Cuban, a regular host on the ABC reality show “Shark Tank” who owns the Dallas Mavericks, incorporates cardio workouts into his everyday routine. He told The Dallas Morning News:

I try to do cardio for at least an hour, six or seven days a week, knowing I’ll miss a day or two now and then because of travel. I do elliptical and the stair gauntlet; play basketball; and take kickboxing and Latin fusion aerobic classes at Lifetime Fitness.

Former Cisco CEO John Chambers runs 2 to 4 miles almost every day.

Chambers, who served as the CEO of Cisco for 20 years until last month, described how running helped him unwind when speaking with The Wall Street Journal:

I jog to … stay in shape, but also because I like to eat. For the first part I think of something personal or in business that’s on my mind, and for the last part I just enjoy it.

Apple CEO Tim Cook is in the gym at 5 a.m. every morning.

Cook is a self-described fitness nut, as Adam Lashinsky wrote in his profile of Cook for Fortune earlier this year. He wakes up around 4:30 or 5 a.m. daily to get to the gym several times a week, according to The Wall Street Journal.

Tesla and SpaceX CEO Elon Musk exercises about twice a week.

When you work nearly 100 hours each week, finding time to exercise can be really difficult. But Musk says he finds time once or twice a week to squeeze in a cardio workout on the treadmill and lift weights, according to Auto Bild TV.

Alexa von Tobel, CEO of LearnVest, goes to the gym almost every day and brings coworkers with her.

In LearnVest’s early days, von Tobel focused so much on her business that she didn’t go to the gym or visit the doctor regularly. But now she goes to the gym almost every day.

“I’m healthier, I’m happier, I sleep better. And all of that is important,” she told Business Insider in a previous interview. “When my life is better, my company is better.”

Sometimes she brings coworkers along with her for a meeting.

“I do my workouts in the morning, and often I’ll take someone from my team,” she told Fast Company. “The person I’m meeting with can pick the class, whether it’s a spin or barre class, or going for a power walk. It’s hard to run and talk — I haven’t mastered that yet.”

Mint.com founder Aaron Patzer runs and lifts weights.

Aaron Patzer believes physical activity is crucial to being successful.

“You cannot work 14 hour days without getting a good workout in as a break,” he told Men’s Health.

In addition to lifting weights, running, and rock climbing, Patzer also loves climbing trees, which he has been doing since age 3.

This article originally appeared on Business Insider.

More from Business Insider:

MONEY philanthropy

Remember the Ice Bucket Challenge? Here’s What Happened to the Money

Ken Little, VP Engineering at Tumblr, Katherine Barna, Head of Communications at Tumblr, and Lee Brown, Head of Global Sales at Tumblr accept the ALS Ice Bucket Challenge during the ringing of the opening bell at the NASDAQ MarketSite on August 21, 2014 in New York City.
Astrid Stawiarz—Getty Images Ken Little, VP Engineering at Tumblr, Katherine Barna, Head of Communications at Tumblr, and Lee Brown, Head of Global Sales at Tumblr accept the ALS Ice Bucket Challenge during the ringing of the opening bell at the NASDAQ MarketSite on August 21, 2014 in New York City.

Last summer's viral phenomenon raised well over $100 million.

One year ago, icy water inundated the Internet in what may have been the online equivalent of the largest chain letter ever—the ALS Ice Bucket Challenge. In endless autoplaying Facebook videos, people hoisted buckets filled with ice water, announced their philanthropic intentions, and upended the buckets over their heads. Breathless, they would nominate a few friends, demanding that they do the same upon penalty of a charitable donation to ALS.

The Ice Bucket Challenge was immensely successful—a break-the-Internet phenomenon that spread all the way up to President Obama. But with this barnstorming success came an undercurrent of critical skepticism. Were people actually following through with donations? Was the campaign saying it was better to be cold and wet than a charitable giver? Was the stunt overshadowing the actual disease? Was the whole thing actually raising meaningful awareness?

Twelve months down the road, here’s where things stand.

How much money did the campaign bring in?

According to the national chapter of the ALS Association (ALSA), the challenge brought in a staggering $115 million. Participants also donated an additional $13 million to the association’s regional branches. As you might expect, these kind of numbers were unheard of for the ALSA—the charity’s Form 990 filings show they brought in $23.5 million in 2013.

How much has been spent so far, and on what?

The ALSA reports it has spent around $47 million of the $115 million raised thus far, with two-thirds allocated toward research in five different areas: gene discovery, disease model development, identification of biomarkers, clinical trials, and drug development. Some 20% of the money has been spent on patient and community services; the remaining 11% has gone to education, fundraising, and processing fees.

According to Charity Navigator’s Acting COO Tim Gamory, the ALSA has been very forthcoming about its spending, which it put into an easy-to-read infographic as well as an exhaustive, detailed list. “We commend them for making information really transparent on their site,” he told Money in a phone interview.

Is it bad that only $47 million of the $115 has been spent so far?

Charity Navigator gives a firm no. While the intensity of the Ice Bucket Challenge had the trendy spike of a disaster-relief effort, Gamory notes that it’s important to remember there wasn’t actually a disaster that brought ALS to the public consciousness, but rather an independent viral sensation. “[The ALSA isn’t] a disaster organization; they’re trying to solve a problem that isn’t going to take a year or two,” he said. “It’s good to be thoughtful to determine the greatest impact.”

Since ALS is a disease with no known cure, the fight against ALS is largely focused on research. Eradication is more of a priority than palliative care, seeing as the disease is 100% fatal. In interviews with Charity Navigator, multiple chapters of the ALSA described spending plans of up to three years, because research often gets paid out over multiple years. And since one study frequently begets another, smart spending is even more important.

What concrete accomplishments can ALSA point to?

Direct patient and community services have produced most measurable results, since patient care is immediate and concrete. For example, the Palm Beach Post reported that the ALS Association Florida Chapter was able to hire a bilingual regional care manager.

Some progress has been made thanks partly to Ice Bucket Challenge research funding. Working with Ice Bucket money, researchers from Johns Hopkins University identified a protein that fails in the cells of most ALS patients, and showed that if they repair the protein, the damaged cell can heal.

“I remember reading a lot of stories about people complaining that the ice bucket challenge was a waste and that scientists weren’t using the money to do research,” said lead researcher Jonathan Ling in a Reddit AMA interview. “I assure you that this is absolutely false. All of your donations have been amazingly helpful and we have been working tirelessly to find a cure.”

It can takes years or even decades for researchers to find scientifically proven treatments, let alone cures for deadly diseases, so donors may have to be patient to see what other results the ALSA-funded research yields. As Gamory stressed, “The key is following up with them year after year to see how this money isn’t just spent but the outcomes from the spending.”

Lots of money was raised, but what about awareness?

During the campaign, various people raised concerns that participants were more more caught up in the viral sensation than the cause, giving less money than a typical donor and often without even knowing much about the disease. “Some people didn’t even know about ALS—it just became Ice Bucket Challenge,” said Gamory. “So it would be interesting to see data as far as what people actually know. I can tell you from our site, the searches for ALS went up a ridiculous amount, from around 500 to 68,000 in August. And then it went right back down.”

According to Gamory, there are two kind of donors, those who are deeply engaged in the cause, giving over many years, and those who respond to the social media wave. “As far as any longer term impact on those donor people who were exposed, it’s questionable,” said Gamory. “Many of the donors were flash-in-the-pan.”

Even if most donors don’t know what the letters “ALS” stand for or anything about the illness, it’s hard to look a $115 million gift horse in the mouth.

Poll: If You Could Make Enough Money to Live, Would You Go Freelance?

TIME health

How Rudeness Affects Medical Professionals and Their Patients

Disruptive physicians can harm the performance of those around them

When someone makes a nasty quip, cuts us off in traffic, ignores our suggestions or takes credit for our work, we get mad, sad and even angry. Rudeness, even just little, can really hurt. We know these reactions can be harmful, both to ourselves and those around us, but recent research suggests that the emotional reactions we have to rudeness tell only half of the story. There are cognitive effects we are not even aware of. In fact, this is what I study – how experiencing rudeness can damage performance by affecting our thinking and decision-making.

For example, in a recent study, my colleagues and I found that when people experience rudeness, they unknowingly become biased toward rude interpretations of social interactions. In other words, when we experience rudeness, we tend to think others are being rude to us as we go forward.

Rudeness has also been shown to draw cognitive resources away from individuals, causing them to perform worse and make more mistakes: for example, not remembering details of a conversation.

If you are writing up a report or making a hamburger for dinner, the costs of mistakes are inconvenient. Imagine if you are a doctor working on an infant in a NICU? Suddenly, the costs of simple mistakes caused by rudeness become much bigger. Shockingly, this is exactly what we found in a new study – rudeness causes medical teams to perform worse, and ultimately this could have huge costs for patients.

Disruptive behaviors in medical settings

When researchers think about ways to improve the performance of doctors and nurses, they typically focus their studies on procedures, devices, and medicines that can improve the ways we treat illness and injury. But there is more to good performance than better procedures or better devices.

Recently, researchers have started to explore what they call disruptive behaviors – behaviors that make it harder for people to work together or communicate – in medical settings. Often these studies focus on negative interactions between doctors and nurses.

Sometimes referred to as disruptive physicians, doctors who treat nurses poorly can cause nurses to become stressed about their jobs and have lower job satisfaction. There is some evidence that disruptive physicians can harm the performance of those around them. But can they really harm patients? That is what we wanted to find out.

Often disruptive behaviors involve major negative interactions, like screaming at a nurse or harshly insulting a colleague. However, other research suggests that simple incivility can have very harmful effects. So, in addition to exploring whether disruptive behaviors can harm medical team performance, we also sought to explore whether an encounter as minor as incivility could be disruptive.

Disruptive docs make their colleagues perform worse

To find out if and how rude physicians harmed patients, we conducted an experiment in a simulated neonatal intensive care unit (NICU). The experiment involved 24 medical teams (one doctor, two nurses on each team) in Israel that completed a simulation where they had to correctly diagnose a newborn whose condition was declining rapidly.

In the simulation, the baby in the NICU had necrotizing entrocolitis (NEC), an inflammation in the intestines, which can lead to tissue death. NEC is rapidly progressing condition that can quickly result in death if not treated quickly. Teams were not told of the infant’s condition prior to the simulation – they had to diagnose the condition themselves.

We chose NEC for the simulation because it progresses so fast, and the proper treatment requires quick and accurate diagnosis and treatment. The effects of rudeness in this type of setting would be readily detectable.

Before the simulation started, the teams received a welcome message from an experienced physician who was watching the procedure. In half of the teams, during this welcome message, the doctor said that he had not been very impressed with the performance of medical professionals in the country in which this experiment was taking place, thus offering a very slight bit of incivility prior to the start of the experiment. After the medical teams had completed the simulation, we had three independent judges (who didn’t know we were studying the effect of incivility) rate the performance of the doctors and nurses.

The results were staggering and frightening. The groups that were exposed to the rude comment did far worse in the simulation. A simple insult from a third party virtually destroyed the performance of the participants. Both their diagnostic skills and their performance suffered dramatically – meaning not only did they have a harder time figuring out what to do, but that even when they knew what to do, they had a harder time doing it.

A small slight can be a pretty big deal

This study shows that the consequences of simple negative social interactions can be catastrophic. Most people’s attitude toward rudeness is that it’s not that big a deal and people will “get over it.” More and more, researchers are finding that this isn’t true – this study shows that in certain contexts the consequences of rudeness can be deadly.

This is especially troublesome due to the fact that these behaviors are very common – a 2010 study suggested that nearly two-thirds of operating room staff had witnessed these behaviors in the OR, and more than half said they had been on the receiving end of these types of behaviors.

However, this conclusion is not limited to doctors. Imagine a similar situation for truck drivers – simply being cut off by a driver can cause a deadly accident down the road. Maybe you should think twice before you weave around that semi next time you’re driving to the beach.

This article originally appeared on The ConversationThe Conversation

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Diet/Nutrition

8 Best All-Natural Cereals for Weight Loss

Healthy ways to start your mornings

Bad news, cereal lovers: It’s about to get harder to start your day with a rich, comforting bowl of tartrazine.

Wait…you didn’t know you were enjoying tartrazine each morning? If you eat boxed cereal, you probably are. It’s a food dye, also known as Yellow #5, that’s been linked to concentration disorders in children, and it’s found in many brightly colored cereals, like Kellogg’s Froot Loops. And after years of pressure from Eat This, Not That!, Kellogg’s finally just announced that it was eliminating all artificial colors and flavors from its cereals, meaning you’ll soon have to go without your daily dose of Red #40, Blue #1 and other chemicals not found in nature.

The company is giving itself until 2018 to make the switch, but if you want to cut down on the contents of your morning chemistry set, and enjoy a metabolism boost in the meantime, there are plenty of options available right now. The food lab at Eat This, Not That! magazine has identified the best all-natural cereals in the supermarket. They may not have a cute cartoon character on the front or a prize at the bottom, but they will fuel your day right and help you reach your weight-loss goals—before noon!

  • 1. 18 Rabbits Veritas Granola

    280 calories, 16 g fat (5 g saturated), 20 mg sodium, 6 g sugar, 6 g protein (per 3 oz)

    Fit a healthy dose of chocolate into your morning—without buying the Count Chocula. Flavored with cacao nibs, 18 Rabbits Veritas Granola is also naturally sweetened with maple syrup and honey, and features a wide variety of seeds and nuts that you don’t always find in granola (which accounts for the slightly high fat content)—like pumpkin seeds, hazelnuts, and sesame seeds. One cup of pumpkin seeds contains twice as much protein as an egg and is high in iron, potassium, phosphorus, magnesium and immune-system-boosting zinc.

  • 2. McCabe’s PB & Chocolate Granola

    420 calories, 27 g fat (4.5 saturated), 210 mg sodium, 12 g sugar, 15 g protein (per 3 oz)

    Ditch the Reese’s Puffs in favor of McCabe’s PB & Chocolate Granola, a terrific substitute for a sugary cereal or a great sweet afternoon treat. They use semi-sweet chocolate to dial-down the carb overload, and, like the 18 Rabbits brand above, the oats are sweetened naturally with maple syrup rather than white sugar. If you’re watching your calories, enjoy a smaller 1 ounce portion for only 140 calories a bowl.

  • 3. Erewhon Crispy Brown Rice

    110 calories, 0.5 g fat (0 g saturated), 160 g sodium, >1 g sugar, 2 g protein (per 1 cup)

    Sure they may go “snap, crackle, pop” but these 100 percent whole-grain, gluten-free puffs are a more nutritious choice than the big blue box—because they’re made from brown rice. People who ate three or more daily servings of whole grains (such as oats, quinoa and brown rice) had 10% less belly fat than people who ate the same amount of calories from processed white carbs (the white stuff: bread, rice, pasta), according to a Tufts University study. This low-sugar cereal carries a slightly nutty flavor and pairs well with strawberries or raspberries.

  • 4. Arrowhead Mills Oat Bran Flakes

    140 calories, 2.5 g fat (0 g saturated), 80 mg sodium, 3 g sugar, 5 g protein (per 1 cup)

    “I always start my day with 3/4 cup of bran flakes with skim milk and 1/4 cup of berries,” says Heather Mangieri, RDN, a board certified sports dietetics specialist. “I’m a very active person, so it’s important that I kick off my day with a healthy dose of complex carbohydrates to fuel my morning. Bran flakes are a low-calorie, easy and inexpensive way to get many of the vitamins and minerals I need, including 100 percent of my daily iron.” The cereal also provides her five grams of fiber, “which helps keep me regular,” she adds. “It’s one of the only boxed foods that I eat, but I eat it every single day—even on vacation.”

  • 5. Shredded Wheat Spoon Size Wheat ’N Bran

    160 calories, 1 g fat (0 g saturated), 0 g sodium, 0 g sugar, 4.8 g protein (per 1 cup)

    In addition to serving up the perfect serving of hunger-quelling protein and fiber in every bowl, Wheat ’n Bran—made from, you guessed it, whole-grain wheat and wheat bran— also provides 20 percent of the day’s phosphorus, a mineral that plays an important role in how the body uses carbs and fats. It also helps the body make protein.

  • 6. Arrowhead Mills Puffed Wheat

    60 calories, 0 g fat, 0 mg sodium, 0 g sugar, 3 g protein (per 1 cup)

    If you workout in the morning, the best way to aid muscle growth and recovery is with a 2:1 ratio of low-fiber carbohydrates and protein, says Jim White RD, ACSM HFS, owner of Jim White Fitness and Nutrition Studios. That’s why he recommends “eating something like a cup of wheat puff cereal with half a banana, a dash of cinnamon and one cup of skim milk.” The milk’s protein helps rebuild muscle that was broken down and the simple carbohydrates help restore muscle glycogen that was lost during training, he explains. Replenishing the stores can boost future workout performance—a key component to sculpting a trimmer figure. All that from puffed wheat!

  • 7. Pacific Foods Organic Steel Cut Oatmeal Unsweetened

    160 calories, 2 g fat (0 g saturated), 240 mg sodium, 0 g sugar, 5 g protein (per container)

    Most packaged oatmeals are calorie-bombs of powdered sugar disguised as a nutritious breakfast. But each serving of Pacific Foods’ Organic Steel Cut Oatmeal packs a solid helping of protein and fiber, and even the most decadent of the line’s 5 flavors, Maple & Brown Sugar, still comes in at just 11 grams of sugar. Plus, steel-cut oats are the least processed, and have fewer calories and less sugar than rolled oats. The grab-and-go package makes it easy to toss in your bag and heat up quickly at the office.

  • 8. Amy’s Organic Multi-Grain Hot Cereal Bowl

    190 calories, 1.5 g fat (0 g saturated), 300 mg sodium, 12 g sugar, 4 g protein (1 cup)

    We also endorse this brand of oats—and any kind of oats, as long as they’re free of processed sugars. Oats are rich in a type of soluble fiber called beta-glucan and the anti-inflammatory compound avenanthramide—which, together, help prevent against obesity-related health problems including heart disease and diabetes. One 10-year study in the American Journal of Public Health found that eating one serving of oatmeal two to four times a week—like this Amy’s Hot Cereal Bowl—resulted in a 16 percent reduction in risk of type 2 diabetes. And Amy’s has more fiber and half the fat of Quaker’s Old Fashioned Oats.

    This article originally appeared on Eat This, Not That!

    More from Eat This, Not That!

MONEY health

Vaping Is 95% Healthier and 40% Cheaper Than Smoking

man smoking e-cigarette vaping
Martina Paraninfi—Getty Images/Flickr

The pack-a-day smoker can save around $1,200 per year by vaping.

The CDC and various health organizations don’t want to endorse smoking or nicotine consumption in any form, so it’s understandable that they’ve emphasized first and foremost that e-cigarettes are bad for people.

According to a new study published by Public Health England on Wednesday, however, vaping is actually 95% less harmful than their smouldering counterpart.

The study, which was not funded by the tobacco lobby but rather the U.K.’s Department of Health, also noted that around half of the general public falsely assumed vaporizers and e-cigarettes were as unhealthy as a pack of Lucky’s, and that there’s no evidence vaporizers lead to smoking. In fact, the report suggested e-cigarettes as a useful tool to help people quit smoking.

What the report doesn’t mention is that jumping on the e-cig train could save considerable money compared to traditional smoking. According to NerdWallet, disposable e-cigarettes will mug you an average of $1,387 per year if you’re a pack-a-day smoker—considerably less than the $2,569 equivalent yearly cost of the real thing. While it’s still enough to make a dent in your budget, the savings could be critical for many, since tobacco use is higher among among people at a lower socioeconomic status.

If you really want to get that cost down, you can sacrifice some convenience and buy a reusable vape with liquid refills, getting the cost down to about $500 to $600 per year—an average savings of over $2,000. Well, it could save you that, plus a couple decades on your life.

Of course, smokers would save the most–and enjoy the best health and longest lives–by kicking the habit in all forms.

TIME vaccines

Here’s How the Anti-Vaxxers’ Strongest Argument Falls Apart

In session: The vaccine court—like vaccines themselves—stands by to help
Education Images; UIG via Getty Images In session: The vaccine court—like vaccines themselves—stands by to help

Jeffrey Kluger is Editor at Large for TIME.

The anti-vaxxers have been misrepresenting an important, if little-used, law

Scientists have long since learned to roll their eyes at politicians—especially when the topic is vaccines. Chris Christie and Rand Paul have both blundered into trouble with their support of vaccine opt-outs, a position that puts them at odds with virtually every medical authority on the planet. On Aug. 13, Carly Fiorina echoed a similar theme when she questioned “esoteric immunizations” like the HPV vaccine—which is a strange way to describe a shot that can save a woman’s life. All that, however, is just campaign-season noise.

Less noticed but perhaps more damaging was the moment in late July when Florida Republican Bill Posey rose on the floor of the House of Representatives and raised what has long been the anti-vaccine crowd’s biggest argument: the existence of a “Vaccine Injury Court.”

It’s at that point that the conversation often stops. The court—a federal panel that adjudicates payments to what the anti-vaxxers call “vaccine-injured children”—has long been the kryptonite, the dropped mic, the rapped gavel of any rational discussion of vaccine safety.

And no wonder: Since 1988, when the National Vaccine Injury Compensation Program (VICP) began, more than 16,000 claims have been considered and a whopping $3.18 billion have been awarded to families alleging some kind of harm from vaccines. That sounds awfully damning, and in this case, unlike in so many other cases, the anti-vaccine crowd isn’t just making stuff up. The numbers are real and the federal government is the first to admit it.

But the anti-vaxxers are utterly wrong in their interpretation of what the numbers mean. And in fact, the numbers prove that vaccines are as safe as the medical community says they are. Understanding why that’s so means going beyond the tired alarmism and looking at the facts.

The Court, Then and Now

The “vaccine injury court” is more properly known as the Office of Special Masters, which itself is a division of the United States Court of Special Claims. The special masters were created as part of the VICP, an act passed by Congress in 1986 and signed into law by President Ronald Reagan in 1988. It is a fundamental part of the anti-vax canon that the court is a closely held secret, established by Washington but kept as quiet as possible, lest the public catch wise to the fact that hush money is being paid to injured families.

“It is obvious that the government does not want to publicize the existence of the [court],” reads one website that is typical of the conspiracy wing, “because the more Americans learn that there are vaccine injuries and deaths … the more they may start to question the safety of vaccines.”

That, no surprise, is nonsense. The law was well-publicized at the time of its passage and is even better publicized today, thanks to a website set up by the Department of Health and Human Services (HHS), which not only explains the court in depth, but also provides the names and contact information of lawyers in all 50 states and offers detailed assistance in filing a claim.

The purpose of the court is to reckon with the reality that while vaccines are every bit as safe and life-saving as health authorities say they are, no drug or medical procedure is entirely without risks. Since many millions of children get vaccinated every year, even a few bad outcomes could subject the drug-makers to a storm of liability suits. Some claims might be legitimate, but far more could be frivolous or even fraudulent. Either way, the endless litigation could drive up the costs of vaccines.

In order to ensure that vaccines would be as affordable and available as possible, Congress thus created the VICP, establishing a trust fund for awards financed by an excise tax of 75 cents on every vaccine administered. Under the program, cases are adjudicated on a no-fault basis, with attorneys for the government and attorneys for the families arguing before one of eight special masters. The goal is to settle the matter as quickly and fairly as possible, though petitioners (the no-fault system avoids the word “plaintiffs”) who are unhappy with the special master’s ruling are free to take their case to the traditional civil court system.

The standard the petitioners must meet to recover any award is a comparatively low one—the “preponderance of the evidence” rule of civil law, rather than the “beyond a reasonable doubt” requirement of the criminal court system. In practice, that standard has been even more liberally construed in the vaccine court than it is in ordinary civil court, a fact that generally benefits the petitioners. More frequently still, things don’t go that far. In 80% of all cases brought since 2006, the parties settle, meaning that the petitioner recovers an award with no determination being made about whether the vaccine even caused the claimed harm.

“Settlements are not an admission by the United States or the Secretary of Health and Human Services…that the vaccine caused the petitioner’s alleged injuries,” says the HHS website. Claims may be settled for a lot of reasons, including “a desire by both parties to minimize the time and expense associated with litigating a case to conclusion; and a desire by both parties to resolve a case quickly and efficiently.”

Even without blame being established, the billions the government has handed over in payouts since the VICP was created does seem to suggest that a whole lot of people are being harmed. But that is not the case. From 2006 to 2014, approximately 2.5 billion doses of vaccines were administered in the U.S. In that time, a total of just 2,976 claims were adjudicated by the special masters and only 1,876 of those received compensation. Divide that number by the vaccine dose total and you get less than a one in a million risk of harm. Going all the way back to 1988—before the flu vaccine became part of the recommended schedule of vaccines—a total of 16,038 claims have been adjudicated and 4,150 have been compensated, bringing the total payouts up to the $3.18 billion figure.

To the anti-vaxxers, the low number of claimants spells its own kind of trouble. Divide overall payout by the relatively few injured parties and you get $766,265 per petitioner. The government wouldn’t hand over that kind of cash unless the injuries people do sustain are severe, right? Wrong.

Flooded With Injury Claims

The website of the U.S. Centers for Disease Control and Prevention (CDC) is very clear about any possible injury or side-effect that could possibly be caused by a vaccine (giving the lie to yet another anti-vaxxer claim that those risks are being covered up). The large majority of the possible problems are minor and transient—a fever, a short-term allergic reaction, soreness at the site of the injection. There is the possibility of autoimmune reaction too, in which the body effectively attacks itself, though the science is still vague on what role, if any, vaccines can play in that. Other possible problems include simple injury to shoulder, when the vaccine needle penetrates the bursa—the sac of cushioning fluid that protects the joint. For many of these problems, the claimants are adults, not kids.

In rare cases, severe neurological reactions have been observed too, but that very rarity makes it impossible to determine if they were caused by the vaccine or were a mere coincidence in timing. Still, the no-fault rule of the VICP doesn’t seek proof of causation, which means that claims like this are covered—and those are the ones that drive up the overall average.

“In cases in which there is a lifetime injury, the award will be the equivalent of many millions of dollars,” says New York-based attorney Robert Krakow, who has represented petitioners in hundreds of vaccine injury claims. “It could be $20 million over a lifetime.” Just three such claims a year—out of the many millions of vaccines administered annually—0ver the course of the 27 years the VICP has been in effect can account for half of the total dollars spent on awards.

No surprise, since the rise of the anti-vax fringe, the VICP has been inundated. In 1998, the year U.K. physician Andrew Wakefield published his fraudulent paper linking the MMR vaccine to autism, just 325 injury claims were filed, 181 were dismissed and 144 were compensated. In 2010, Wakefield’s fraud was exposed, his paper was withdrawn and he was stripped of his license to practice medicine in the U.K. But the anti-vax hysteria had been unleashed, driven in part by anti-vaccine drum-bangers like Jenny McCarthy. The following year, 1,637 claims were filed. In 2012, that figure rose further, to 2,702. The number of awards granted increased as well, but still remained in the low triple digits—266 in 2011 and 263 in 2012.

Certainly, vaccine science is not fixed, and different circumstances lead to different law. The case of Hannah Poling, the 9-year-old Georgia girl who, in 2008, received a $1.5 million award when the court agreed that vaccinations contributed to her later-onset autism, rocked the medical community and only worsened the anti-vax panic. But Poling was a special case; she was suffering from an underlying disorder of the mitochondria, or the energy-processing organelle in the cells. This made her vulnerable to any oxidative stress that could, in theory, be caused by vaccines. Mitochondrial disorders are increasingly being cited in vaccine court claims, but the conditions are not common and are poorly understood. “The belief is that the vaccine triggers a decompensation,” says Krakow, “but this is controversial.”

What’s not controversial is the far bigger picture, which is that medicine has never been about eliminating all risks, but about minimizing and balancing and coolly considering them. Childhood diseases are a manifest danger, capable of sickening hundreds of thousands or even millions of kids each year. Vaccines, which offer powerful—if imperfect—protection, all-but eliminate that peril. Yes, they introduce a tiny bit of their own risk, but they still leave children far safer than they otherwise would be. For the literal one in a million who are harmed, the VICP stands by to help. For the rest, it’s the vaccines themselves that do the helping.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

Planned Parenthood Will Survive—Some Women May Not

A sign hangs in the offices of the Planned Parenthood Federation of America in New York City.
Mario Tama—Getty Images A sign hangs in the offices of the Planned Parenthood Federation of America in New York City.

Women will lose access to vital, sometimes life-saving, health care when states defund Planned Parenthood

Responding to five shocking videos released by the Center for Medical Progress, government officials in Louisiana, New Hampshire and Alabama have moved to defund Planned Parenthood. Now the White House has entered the fray, warning these states that defunding may break the law.

Through a network of affiliated clinics, Planned Parenthood provides health care services to millions of women across the country, especially low-income and young women who have few options for care.

The latest controversy will negatively impact these women’s access to essential services, but Planned Parenthood itself will survive the firestorm.

A political storm

The videos purport to show that Planned Parenthood profits from the unethical sale of fetal tissue. Detractors argue that the videos prove that leaders in the organization have a “cavalier” attitude toward the sale of this tissue.

Whether these videos are true – and factcheck.org raises some questions – they have tremendous political legs. Aside from state action to defund the organization, presidential candidates from Scott Walker to Hillary Clinton have weighed in on the controversy.

But, while the videos are a hot media topic, they are nothing new.

Every six months or so, for the past several years, a heavily edited video has surfaced, throwing practices at Planned Parenthood into question.

The videos always seem to shock. But, as a scholar of the social and political histories of pregnancy and birth, I can say that their presence shouldn’t surprise us.

Planned Parenthood, the organization, has long been a political lightning rod.

Controversial origins

Margaret Sanger founded what would become Planned Parenthood in 1916.

Contraceptives were then illegal nationwide, and even providing information about them could land someone in jail. Sanger spent 30 days in prison after opening a birth control clinic in Brooklyn, New York.

At that time, the idea of a “planned pregnancy” was revolutionary. Sanger and her contemporaries saw reproductive autonomy as an essential part of women’s liberation.

Detractors often point to Sanger’s ties to eugenicist movements as a way to discredit the organization, which was officially founded in 1952. This paints her politics with too broad a brush.

Sanger was, indeed, on the side of so-called “positive eugenics.” She believed that healthy, planned pregnancies would lead to healthier babies and children, and that birth control could reduce problems associated with overpopulation worldwide. She did use racializing and alienating language in her private correspondence. But, there is nothing in her record to indicate she desired, as some allege today, to use abortion as a means to genocide, or as a plot to disempower, coerce, or control poor women and women of color.

A decades-long fight

Anti-choice advocates have engaged in a decades-long fight to limit access to women’s right to abortion.

Planned Parenthood, one of the only national organizations ready to help women with that access, makes an obvious target.

But Planned Parenthood does far more than provide abortion services for women. In fact, only 3% of Planned Parenthood clients procure abortions from their clinics.

Many more women use Planned Parenthood for sexual health reasons other than abortion: for birth control, Pap smears, HIV testing, sexual health counseling and prenatal care.

The fact that abortion is what garners attention, when 97% of Planned Parenthood’s activities focus on something else, should make us ask why there is so much hysteria over Planned Parenthood’s presence in the states.

The answer might be that 3% of clients receiving abortion services is still too many for pro-life activists to accept. The fact is that this 3% makes Planned Parenthood the single largest provider of abortion in the United States.

But defunding Planned Parenthood also limits women’s access to birth control – access that actually reduces rates of abortion.

If you want fewer abortions, keeping Planned Parenthood open would be a better strategy.

So why might politicians want to restrict access to safe, effective birth control? Being able to plan and avoid pregnancies by using birth control empowers women to enjoy their sexuality. And why might politicians want to dissuade women from that?

A fiery defense

In a fiery speech on the Senate floor in defense of Planned Parenthood, Elizabeth Warren argued that opposition to women’s reproductive freedom is old-fashioned and regressive.

As Rickie Solinger, historian of women’s sexuality and the politics of birth control in the United States, has argued, when women’s independence is facilitated by their ability to time pregnancy and childbirth, that independence is seen as “fearsome.” It is seen as a rejection of motherhood as the pinnacle of women’s lives, Solinger persuasively argues.

By providing women access to safe and affordable birth control and abortion, Planned Parenthood enables women to be fearsomely free in determining the trajectory of their lives. Being able to plan and avoid and terminate pregnancies allows women to work for pay outside the home when they need or want to. It allows women to leave bad relationships and stay in good ones. It allows women access to education and promotions and other opportunities that, in 2015, are still constrained when women reproduce.

When legislators in Alabama, New Hampshire and Louisiana vote to defund Planned Parenthood, they are participating in a politics that would ask us to return to second-class citizenship. They are parroting a rhetoric that expresses fear of women’s sexuality. And they are engaging in actions that will deny women access to vital health care, reduce rates of abortion and improve maternal lives.

Moves to defund Planned Parenthood are disturbing for how regressive they are, and for how much they harken back to times when women had far fewer rights.

But, the organization has weathered many storms. And, ironically, these shock videos tend to motivate women (and the men who support and love them) to defend their doctors and their decisions.

Donations up

Donations to Planned Parenthood, for example, have increased since these videos were released. Some donations were even made in honor of anti-choice politicians.

But the fact is that women – especially poor women, young women and women of color – will lose access to vital, sometimes life-saving, health care when states defund Planned Parenthood.

The organization will live on. Some women may not.

This article originally appeared on The ConversationThe Conversation

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

This Is America’s Most Lethal Animal

bees climate change
Getty Images

It is estimated that about two million Americans have allergies to insect stings

Animal attacks have been in the news a lot. Late last year, a 22-year-old student in New Jersey was killed by a black bear he had been photographing. This summer, swimmers off the coast of North Carolina have suffered a record number of shark attacks, several of which resulted in amputations. And early in July, a 28-year-old Texas swimmer who ignored warning signs was killed by an alligator.

Of course, not all human-killing animals are so large. Each year, dozens of Americans die due to bites by venomous snakes, lizards and spiders. Other small animals such as ticks and fleas, though not naturally outfitted with their own lethal weaponry, can nonetheless kill by transmitting deadly infections, such as Powassan virus.

Worldwide, the animal responsible for by far the greatest number of human deaths is just such an insect that transmits a deadly infection: the mosquito. The World Health Organization estimates that over 600,000 people die each year after being bitten by mosquitoes bearing the deadly malaria parasite. Happily, however, deaths from mosquito-borne diseases are much rarer in the U.S.

Operating with a biologist’s definition of an animal – an organism with specialized sense organs that responds rapidly to stimuli – one creature has proved to be far more lethal to Americans than all other animal species combined: human beings. Each year in the U.S., the Centers for Disease Control counts over 16,000 homicides and over 41,000 deaths from suicide and self-inflicted injury.

Yet among nonhuman animals, the creatures that cause more American deaths than any other are bees and wasps. In a typical year, nearly 100 American deaths are caused by bee stings. In fact, this number probably represents an underestimate, since some bee sting deaths are erroneously attributed to heart attacks, sun stroke and other causes.

The impacts of bee stings can differ widely. Two weeks ago, a five-year-old girl attending a birthday party in my backyard was stung three times, leading to tears but no permanent damage. Last week, an acquaintance of mine from work, a man in his 50’s with a known allergy to bee stings, lost his life after being stung by a bee.

To the vast majority of people, a bee sting is not life-threatening. Experts say that the average adult can safely withstand more than 1,000 bee stings. Of course, fewer stings could prove dangerous to an infant or small child. What makes stings deadly is generally not the toxicity of bee venom itself but an allergy developed as a result of prior stings.

It is estimated that about two million Americans have allergies to insect stings. Signs of a severe allergic reaction include difficulty breathing, hives, swelling of the face, throat, or mouth, anxiety, rapid pulse, and a drop in blood pressure. Death can result in as little as 10 minutes. Individuals with severe allergies are often advised to carry injectable epinephrine (commonly called an EpiPen), to be administered immediately after a sting.

Anyone who has ever been stung knows how painful it can be. The pain is due primarily to a component of bee venom known as melittin, a small protein that interferes with the normal function of cell membranes. Another component of bee venom, histamine, can cause the affected area to become swollen, red, warm and itchy.

Some have speculated that melittin may someday be used for therapeutic purposes. For example, it inhibits the bacterium that causes Lyme disease and can suppress the infectious agents involved in a number of sexually transmitted diseases. For the moment, however, most human encounters with melittin are strictly painful.

Some bees cannot sting. Male bees, for example, do not have stingers, which makes sense when you know that a bee’s stinger is in fact a modified form of an organ insects use to deposit eggs. And in most situations, bees are unlikely to attack. Generally they do so only when provoked, such as when a lawn mower disturbs a hive.

One reason bees are disinclined to sting is the fact that, at least among honey bees, doing so often kills the bee. Their stingers are barbed, and the deeper then penetrate into the skin, the more likely they are to become lodged there. When the bee pulls away, it tears away part of its abdomen, typically causing death within minutes.

On the other hand, when the hive is threatened, bees may launch what appears to be a coordinated attack. This is facilitated by the release of alarm pheromones, which attract other bees to the location. Once such an attack commences, they may continue to sting until the offender has left the scene or died.

A routine bee sting requires no specific treatment, although there are a number of approaches that can provide symptom relief. The first order of business is to remove the stinger, in order to limit the amount of venom received. The best way to do this is by scraping it off with a fingernail. Squeezing the sac will only inject more venom.

Generally speaking, it is a good idea to wash the affected area with soap and water. If the hand is involved, rings should be removed prior to the development of swelling. Swelling can be reduced with an icepack and over-the-counter antihistamines, which can also help with itching. Medications such as aspirin or ibuprofen can relieve pain, though it is important to heed their warning labels.

Though bees take the crown as America’s most lethal animal, they are not naturally aggressive creatures, and when they attack, they do so in defense against a perceived threat. The key to avoiding bee stings is to steer clear of hives and nests, operate motorized equipment such as lawnmowers with care and avoid swatting at them when they are in the vicinity.The Conversation

Richard Gunderman is Chancellor’s Professor of Medicine, Liberal Arts, and Philanthropy at Indiana University-Purdue University Indianapolis

This article was originally published on The Conversation. Read the original article.The Conversation

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

At Least Donald Trump Started a Conversation About Menstruation

It's a global health problem that needs attention

Donald Trump did the girls and women living in developing world a great favor this week. He got menstruation – the taboo of all taboo words in polite society – onto the front page of the Sunday New York Times. That doesn’t happen every day. In fact, it’s quite possible that hasn’t happened more than a few times since the newspaper was founded in 1851.

Trump’s comment about Fox News anchor Megyn Kelly that she “had blood coming out of her eyes, blood coming out her wherever” was offensive. But it brought the topic of menstruation to the forefront of our daily conversation – at least for a media nanosecond.

So let’s use this moment to have a serious discussion about it.

Every single day, girls around the world get their menstrual periods for the first time, and many of them living in Africa, Asia and Latin America lack adequate information, guidance and support about what is happening to their bodies. Many of these girls see menstrual blood on their underwear for the first time and think they are dying or seriously ill, but are too afraid, embarrassed or ashamed to ask for help.

Menstruation is a real bona fide health issue. It’s not an afterthought of child development or insignificant to a growing girl’s sexual and reproductive health.

If girls don’t have resources for proper menstrual hygiene management (MHM) like practical information, a safe and private place to change a menstrual cloth or pad and water for washing at school, they may miss class, or stop going entirely. Decades of evidence indicate that educating girls improves the overall health of their communities.

But the ongoing taboo around talking about periods makes it hard to find solutions to the challenges girls in low-income countries face. It also hinders the global efforts to address these challenges and bring menstruation into the realm of global health and development.

A period is a scary thing when you don’t know what it is

Since 2004, my colleagues and I have been exploring the topic of menstruation in low-income countries of the world (Tanzania, Ghana, Ethiopia, Cambodia and Pakistan) and conducting research on the problems girls face the first time they get their menstrual period and then have to manage in girl-unfriendly (or rather, menstrual-unfriendly) school environments.

We have found girls who think they are dying or have a serious illness the first time they get their period. We have talked with girls who have to leave school in the middle of the day in order to find a private, clean space to change their sanitary materials.

Other girls have reported the difficulty of getting practical guidance on how to manage their periods with predominantly male teachers in the school or female teachers who are too shy to talk about such a taboo topic.

For a girl who might feel embarrassed or ashamed about her period, sitting in a classroom where boys and girls sit very close together at one desk may raise fears about menstrual blood odor.

Some schools may have rules that require children to stand up when answering questions (what if there is a bloodstain on your clothing when you stand up?). As one rural Ethiopian girl reported:

My menstruation started when I was in class and everyone started to laugh. This is the reason that I stopped going to school.

Many of the schools in the countries where we have done research, especially in rural areas, predominately have male teachers. How many girls would feel comfortable asking a male teacher to be excused? And what if the school lacks adequate toilets and water?

It’s not easy to participate in class when there is no place to change a cloth, a pad or other material to get through the school day. This is the case in about 50% of the least developed countries in the world. Or as one girl in the Philippines reported in an Emory University and UNICEF led study on MHM there:

I want to have a CR [bathroom] just for girls, girls who are menstruating separate from the boys…Because the boys might see a blood stain on the toilet bowl.

There is a growing body of research that highlights the seriousness of this problem. Colleagues at other universities, at UNICEF and at many nongovernmental organizationshave also been exploring this issue in other countries.

UNICEF, UNGEI (the UN Girls Education Initiative) and the Canadian government, for example, are supporting a 12-country research project to document the menstrual hygiene management barriers that girls face. Their motivation is that millions of vulnerable girls in low-income contexts need to be healthy and educated: their gender should not impede participation in school.

Getting your period at school shouldn’t be a big deal

This shouldn’t be hard to solve. We just need to learn about the best solutions.

What are the most cost-effective interventions to use in school environments to make sure girls know about menstruation and other body changes? What’s the best way to improve the water and sanitation facilities for both girls and female teachers? What’s the most effective way to assure there are affordable sanitary cloths, pads or other materials available to girls?

The problem is that implementing these solutions is complicated. Overcoming gender discrimination at schools that don’t provide for girls’ (and female teachers’) needs is a hurdle. Ultimately, implementing solutions depends on governments, schools, parents and donors recognizing it is an important issue – and one that can be talked about and addressed.

Teaching girls about menstruation

Although many efforts have been made to include sexual and reproductive health curricula in schools over the last decade, the topic of puberty and menstrual hygiene management in particular has often not been included.

Grow & Know, Inc, a small nonprofit that I founded, develops puberty books with girls and for girls in low-income countries in partnership with local ministries of education, UNICEF and other key stakeholders.

Our first book was designed in Tanzania, with the content then adapted through participatory research conducted with girls in new countries. Book orders have subsequently been made, for example, by the ministries of education in Ghana, Ethiopia and Cambodia.

Other organizations such as Save the Children and UNICEF are engaged in similar efforts in countries such as Nepal, Uganda and Malawi.

In parallel with this information outreach, UNICEF, WaterAid and other organizations are working in many countries – together with local institutions – to focus attention on the inadequate water and sanitation facilities in schools in Bangladesh, Zambia and Nepal.

And, finally, numerous social entrepreneurial organizations are providing more affordable sanitary materials, such as SHE in Rwanda, AfriPads in Uganda, and ZanaAfrica in Kenya.

Break the taboo

The key is to start talking openly about this issue.

As musician and Harvard Business School graduate Kiran Ghandi pointed out after running the London Marathon without a tampon:

I ran with blood dripping down my legs for sisters who don’t have access to tampons and sisters who, despite cramping and pain, hide it away and pretend like it doesn’t exist. I ran to say, it does exist, and we overcome it every day.

Menstruation is, after all, totally normal. So let’s break the taboo and not wait for the next time a celebrity starts bloviating to talk about menstruation again.

This article originally appeared on The ConversationThe Conversation

TIME health

This Is How Legionnaires’ Disease Got Its Name

Aug. 16, 1976
TIME The Aug. 16, 1976, cover of TIME

It all goes back to an American Legion convention in 1976

The news that Legionnaires’ disease has killed a dozen New Yorkers this summer—and that an inmate at Rikers Island has been diagnosed as well—has put the illness in the headlines and hospitals. Luckily, these days, most people who experience symptoms can be treated successfully with antibiotics.

But that wasn’t the case when the disease was first discovered. Not only did Legionnaires’ prove fatal to many affected by its first notable outbreak, but those victims didn’t even know what was making them sick.

The legionnaires after whom the disease is named were attendees at an American Legion convention in Philadelphia in July of 1976. They were veterans like Ray Brennan, Frank Aveni and Charles Seidel, who went to an ordinary meeting, fell ill shortly after with chest pains and high fevers, and died not long after. They had spent time all over the city, eaten in restaurants and traveled home in a variety of ways. In a cover story that August about the “disease detectives” who were trying to find “the Philly killer,” TIME captured the panic that resulted from the outbreak. The magazine noted many friends and neighbors of John Bryant Ralph, another Legionnaire, did not attend his funeral for fear his disease might be catching.

For many Americans, the Philadelphia outbreak was the first time they were aware of the work done by the Centers for Disease Control, a then-obscure organization that went to work trying to figure out what was killing the Legionnaires:

Like police work, most medical sleuthing is done in the field by the “shoe leather” epidemiologists, some from the state’s public health service, others from the CDC. They crisscrossed the state to interrogate every one of the stricken Legionnaires and the families and friends of the deceased. Their quest: a common denominator, a set of experiences that would link all the victims, such as meals taken together, rooms in the same hotel, exposure to similar contamination. Their method: careful questioning and cross-referencing.

“Hello, I’m part of the medical team investigating this weird disease,” said Dr. Stephen Thacker, 28, as he sat down beside Thomas Payne’s bed in Chambersburg Hospital. “How do you feel? When did you first feel sick? Where did you eat and stay in Philadelphia? When did you arrive there? When did you leave? Did you go to the testimonial dinner? Or the go-getter’s breakfast? Did you go to the hospitality rooms for the state commander or other officials? Did you have any contact with pigs?”

In some ways the detectives’ legwork raised more questions than it answered. A check of the hotels at which the conventiongoers had stayed revealed no outbreak of the mysterious illness among employees who had come in contact with the Legionnaires. The investigators could find no evidence that any of the victims had been exposed to pigs, which have been implicated as the animal reservoir for the swine-flu virus. Nor could the disease detectives explain another apparent contradiction: why some people developed the disease, while others, who ate the same meals, drank the same drinks or shared their rooms during the convention, did not.

The disease remained elusive. “There’s an outside chance we may never find out the cause,” CDC Director David Sencer told TIME. “I think we will. But there are times when disease baffles us all. It may be a sporadic, a onetime appearance.”

Eventually, the initial outbreak tapered off and, though nearly 200 had become ill and 29 had died, fear tapered off too. It was clear that whatever it was, it wasn’t spreading—but, though public interest waned, the CDC kept working. It wasn’t until months later that the mystery was actually solved.

“Five months after the convention, [CDC microbiologist Joseph McCade] took another look at some red sausage-shaped bacteria and concluded that they were the culprits,” TIME later explained, in a 1983 cover story about the CDC. “They had festered in the water of the hotel’s cooling tower and had been carried through the air as the water evaporated.”

Read the 1976 cover story, here in the TIME Vault: Tracing the Philly Killer

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