THE NATIONAL ACADEMIES NATIONAL ACADEMY OF SCIENCES NATIONAL ACADEMY OF ENGINEERING NATIONAL ACADEMY OF MEDICINE NATIONAL INFOCUS infocusmagazine.org Tobacco, Age Limits, and the Illicit Market A Course for Ocean Science Research Signals Intelligence and Bulk Data Collection Spring/Summer 2015 vol. 15 number 1 For more than 150 years, the nation has turned to the Academies for independent, objective advice on issues that affect people’s lives worldwide. Additional information about the National Academies of Sciences, Engineering, and Medicine and their work Credits: Cover: (clockwise from upper right) ©Saša Prudkov/iStock/ can be found at <national-academies.org>. Thinkstock; ©Wavebreak Media Ltd./Thinkstock; ©Stephan Kerkhofs/Hemera/Thinkstock Page 1: (clockwise from upper left) ©kieferpix/iStock/Thinkstock; The National Academies In Focus features broad ©Zoonar RF/Thinkstock; ©Fuse/Thinkstock; ©Wavebreak Media Ltd./Thinkstock coverage of the Academies’ activities. We welcome Page 2: (from top) Photo courtesy the Academies’ Arab-American Frontiers of Science, Engineering, and Medicine program; your comments on the magazine; e-mail us at Japanese Prime Minister Shinzo Abe and National Academy of Sciences President Ralph J. Cicerone, April 30, 2015, at <[email protected]>. the Academy with several U.S. leaders in the fields of sci- ence, engineering, and medicine, photo by Cable Risdon Page 3: ©Vance Vasu/Illustration Source In Focus (ISSN 1534-8334) is published by Page 4: ©Stockbyte/Thinkstock Page 5: ©Food Collection/Superstock the National Academies, 500 Fifth St., N.W., Page 6: ©timkaekler/iStock/Thinkstock Page 7: ©Highwaystarz-Photography/iStock/Thinkstock Washington, DC 20001. Subscription (three issues): Page 8: ©Fanatic Studio/Illustration Source $10; Canada and foreign, $12 (U.S. currency only). Page 9: ©Zoonar RF/Thinkstock Page 11: ©mychadre77/iStock/Thinkstock Subscription address: In Focus, P.O. 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Cicerone, April 30, 2015, at the Academy with several U.S. leaders in the fields of science, engineering, Box 8009, Aston, PA 19014. and medicine, photo by Cable Risdon THE NATIONAL ACADEMIES INFOCUS Volume 15 Number 1 infocusmagazine.org FEATURES CONTENTS HEALTH & SAFETY ENVIRONMENT & RESOURCES 3 Medical Misnomer 9 Climate Intervention New name and Manipulating the climate through diagnostic criteria certain technologies not viable at present needed for Chronic Fatigue Syndrome 3 5 White Potato Should Be Allowed on the WIC List Once maligned, potatoes may help reduce nutritional shortfalls 9 EDUCATION & SOCIAL ISSUES 11 Sea Change Setting the course for the next decade of 6 The U.S. Tobacco Trade ocean science research Reports examine age regulations and the illicit market ENGINEERING & TECHNOLOGY 12 The Future of Manufacturing Strengthening innovation, productivity, and workforce training in the U.S. 6 8 The Postdoctoral Experience A reality far from ideal 14 Bulk Collection of Signals 12 Intelligence Are there feasible alternatives? SPRING/SUMMER 2015 1 15 Spotlights National Academy of Sciences Ambassadors for Science and Ralph J. Cicerone, President Engineering Diane E. Griffin, Vice President Pittsburgh program brings expertise Bruce Darling, Executive Officer and evidence to local decision making James Hinchman, Deputy Executive Arab-American Frontiers Program Officer CONTENTS A unique opportunity for building Kenneth R. Fulton, Executive Director scientific bridges National Academy of Engineering Charles O. Holliday Jr., Chair C.D. Mote Jr., President Corale L. Brierley, Vice President Alton D. Romig Jr., Executive Officer National Academy of Medicine Victor J. Dzau, President 18 Clyde Behney, Acting Executive Officer 20 Brief Takes • Inspiring a New Generation of Engineers • Prime Minister of Japan Speaks at NAS In Focus is prepared by the Office of News and Public Information. 23 New Publications 21 Executive Director: William Skane In Focus Editor: Valerie Chase Staff Writers: Sara Frueh, William Kearney, Dana Korsen, Lauren Rugani, Jennifer Walsh Original Design: Francesca Moghari 2 THE NATIONAL ACADEMIES INFOCUS yalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a Mdisease that has sparked consider- able public debate for years. Doctors are often skeptical about the condition or have difficulty diagnosing it. And those affected feel frustrated and dismissed, on top of the debilitating symptoms they experience. & SAFETY HEALTH In fact, diagnosis has always been a prob- lem; less than one-third of medical schools include ME/CFS-specific information in the curriculum. Sixty-seven percent to 77 per- cent of patients diagnosed with the disease said it took more than a year to receive Medical a diagnosis; of these, about 29 percent said it took more than five years. Experts estimate that 84 percent to 91 percent of Misnomer people with ME/CFS are undiagnosed, and as many as 2.5 million in the United States NEW NAME AND DIAGNOSTIC may suffer from the disease. In addition, the direct and indirect economic costs of CRITERIA NEEDED FOR ME/CFS to society have been estimated at $17 billion to $24 billion annually. CHRONIC FATIGUE A recent report from the Academies concluded that ME/CFS is a legitimate, SYNDROME serious, and complex systemic disease that frequently and dramatically limits the activities of affected individuals. The I believe that the words “Chronic study committee that authored the report recommended new diagnostic criteria that Fatigue” are the kiss of death. Who in address the needs of health care providers, this over-wrought, stress-driven society patients, and their caregivers. isn’t “fatigued” a good deal of the time? “Diagnosing ME/CFS is often a chal- lenge, and seeking and receiving a What people don’t get is that this fatigue diagnosis can be frustrating due to the for people like me keeps me in bed for skepticism of health care providers about days at a time and prevents me from these patients and the serious nature of their disease,” said committee chair Ellen doing everyday errands and even Wright Clayton. “The new diagnostic cri- simple house tasks on some days. teria will make it easier for clinicians to — Comment submitted to the study committee recognize and accurately diagnose patients SPRING/SUMMER 2015 3 in a timely manner, as providers and the pub- well as allow a large lic. The term “myalgic percentage of currently encephalomyelitis” was undiagnosed patients to also deemed inappropriate receive appropriate care.” by the committee, because If the diagnostic criteria myalgia, or muscle pain, is not a are met following an appropriate core symptom of the disease, and because history, physical examination, and medical there is inconclusive evidence of brain work-up, physicians should diagnose ME/ inflammation in ME/CFS patients. It sug- CFS, the committee said. gested renaming the disorder to Systemic Diagnosis requires that a patient have Exertion Intolerance Disease (SEID), which three core symptoms: captures the characteristic that any exer- • A substantial reduction or impairment tion can adversely affect several organ sys- in the ability to engage in pre-illness levels tems and other aspects of patients’ lives. of activities that is accompanied by often The committee also noted that more profound fatigue of new or definite onset, research on ME/CFS is needed — espe- not the result of ongoing excessive exertion cially given the number of people affected and not substantially alleviated by rest — because too little is known about the causes, development, and progression of • The worsening of patients’ symp- the disease, or about effective treatment. toms after any type of exertion — such as Future research could lead to findings that physical, cognitive, or emotional stress — refine the diagnostic criteria and under- known as post-exertional malaise standing of ME/CFS subtypes. A multi- • Unrefreshing sleep disciplinary group should re-examine the At least one of the two following mani- proposed criteria after five years or sooner festations is also required: if firm evidence supports the need for modification. — Jennifer Walsh • Cognitive impairment Beyond Myalgic Encephalomyelitis/Chronic Fatigue • The inability to remain upright with -Syndrome: Redefining an Illness. Committee on the symptoms that improve when lying down Diagnostic Criteria for Myalgic Encephalomyelitis/ — known as orthostatic intolerance Chronic Fatigue Syndrome, Board on the Health of Select Populations, Institute of Medicine (2015, 304 pp.; ISBN These symptoms should persist for at 978-0-309-31689-7; available from the National Academies Press, tel. 1-800-624-6242; $55.00 plus $5.00 shipping for least six