Ten Things You Need to Know Today: 11 June 2022 | The Week UK

‘Fool’ Andrew in new debt battle

The Duke of York has been described as a “fool” after he became caught up in another £1.6m debt battle. The Telegraph said the “business debt” is owed to a Swiss couple who are understood to have placed a freezing order on his Verbier ski chalet. The Duke is said to be disputing the amount owed, but does not deny the unpaid debt. A French socialite who sold the chalet in 2014 to the Duke and Sarah, Duchess of York, but later sued them over an outstanding £6.7m debt – said: “He is an absolute fool and I just cannot understand how he goes about his life.”

CNN Exclusive: 'We control them all': Donald Trump Jr. texted ...

Former President Donald Trump speaks on May 28, 2022 in Casper, Wyoming. The rally is being held to support Harriet Hageman, Rep. Liz Cheneys primary challenger in Wyoming.

FILE - In this Jan. 6, 2021 photo, Donald Trump supporters participate in a rally in Washington, near the White House. (AP Photo/John Minchillo, File)

Barr: Trump to blame for people going to the Capitol

Attorney General William Barr participates in a press conference at the Department of Justice along with DOJ officials on February 10, 2020 in Washington, DC.

LOS ANGELES, CALIFORNIA - JUNE 09: U.S. President Joe Biden gestures as he speaks at a session of the CEO Summit of the Americas hosted by the U.S. Chamber of Commerce on June 09, 2022 in Los Angeles, California. The CEO Summit entered its second day of events alongside the Summit of the Americas, which is hosting leaders from across the Western Hemisphere. (Photo by Anna Moneymaker/Getty Images)

Bannon to Garland over Jan. 6 hearings: Indict Trump and we'll impeach you

AUSTIN, TEXAS - MAY 14: Former U.S. President Donald Trump speaks during the American Freedom Tour at the Austin Convention Center on May 14, 2022 in Austin, Texas. The national event gathered conservatives from around the country to defend, empower and help promote conservative agendas nationwide.

Haberman on how Trump is setting up his defense to Jan. 6 hearings

ATLANTA, GA - JANUARY 08: U.S. President Donald Trump on field during the national anthem prior to the CFP National Championship presented by AT&T between the Georgia Bulldogs and the Alabama Crimson Tide at Mercedes-Benz Stadium on January 8, 2018 in Atlanta, Georgia. (Photo by Kevin C. Cox/Getty Images)

Toobin: SCOTUS says this is history, we're dealing in the present

WASHINGTON, DC - JANUARY 26: The U.S. Supreme Court building on the day it was reported that Associate Justice Stephen Breyer would soon retire on January 26, 2022 in Washington, DC. Appointed by President Bill Clinton, Breyer has been on the court since 1994. His retirement creates an opportunity for President Joe Biden, who has promised to nominate a Black woman for his first pick to the highest court in the country.

See George Conway's reaction to new photos of Pence hiding on Jan. 6

Honig: Donald Trump Jr. texts go 'right to the heart' of election scheme

Donald Trump Jr. talks to the press before the arrival of his father President Donald Trump during a rally at the Van Andel Arena on March 28, 2019 in Grand Rapids, Michigan. Grand Rapids was the final city Trump visited during his 2016 campaign.

Washington CNN —

Two days after the 2020 presidential election, as votes were still being tallied, Donald Trump’s eldest son texted then-White House chief of staff Mark Meadows that “we have operational control” to ensure his father would get a second term, with Republican majorities in the US Senate and swing state legislatures, CNN has learned.

In the text, which has not been previously reported, Donald Trump Jr. lays out ideas for keeping his father in power by subverting the Electoral College process, according to the message reviewed by CNN. The text is among records obtained by the House select committee investigating January 6, 2021.

“It’s very simple,” Trump Jr. texted to Meadows on November 5, adding later in the same missive: “We have multiple paths We control them all.”

Video Ad Feedback 04:16 - Source: CNN See ex-Trump official's reaction to Trump Jr.'s 'revealing' texts

In a statement to CNN, Trump Jr.’s lawyer Alan S. Futerfas said, “After the election, Don received numerous messages from supporters and others. Given the date, this message likely originated from someone else and was forwarded.”

Immediately before his text to Meadows describing multiple paths for challenging the election, Trump Jr. texted Meadows the following: “This is what we need to do please read it and please get it to everyone that needs to see it because I’m not sure we’re doing it.”

The November 5 text message outlines a strategy that is nearly identical to what allies of the former President attempted to carry out in the months that followed. Trump Jr. makes specific reference to filing lawsuits and advocating recounts to prevent certain swing states from certifying their results, as well as having a handful of Republican state houses put forward slates of fake “Trump electors.”

If all that failed, according to the Trump Jr. text, GOP lawmakers in Congress could simply vote to reinstall Trump as President on January 6.

“We have operational control Total leverage,” the message reads. “Moral High Ground POTUS must start 2nd term now.”

The text from Trump Jr. is revealing on a number of levels. It shows how those closest to the former President were already exchanging ideas for how to overturn the election months before the January 6 insurrection – and before all the votes were even counted. It would be another two days before major news outlets declared Joe Biden the winner on November 7.

The text also adds to a growing body of evidence of how Trump’s inner circle was actively engaged in discussing how to challenge the election results.

On March 28, Judge David Carter, a federal judge in California, said that Trump, along with conservative lawyer John Eastman, launched an “unprecedented” campaign to overturn a democratic election, calling it “a coup in search of a legal theory.”

George Terwilliger, an attorney for Meadows, declined to comment for this story. A spokesperson for the House select committee declined to comment.

Foreshadowing the Trump campaign strategy

In the weeks following the 2020 election, Trump and his allies eventually filed more than 60 unsuccessful lawsuits in key states, failing to convince the courts that his claims about a stolen election were justified, or uncover any evidence of widespread voter fraud.

They also called for various recounts based on those same unfounded voter fraud claims. A number of states conducted recounts in the months after the election, though none of them revealed any fraud substantial enough to have changed the outcome of the vote in any state.

While Trump Jr. was publicly pushing various voter fraud conspiracy theories and generally casting doubt about the results in states like Pennsylvania and Georgia, his text to Meadows reveals there were other ideas being discussed privately.

Video Ad Feedback 01:48 - Source: CNN Trump-endorsed candidate asked about January 6. Watch what happened next

Specifically, Trump Jr. previews a strategy to supplant authentic electors with fake Republican electors in a handful of states. That plan was eventually orchestrated and carried out by allies of the former President, and overseen by his then-attorney Rudy Giuliani.

In his text to Meadows, Trump Jr. identifies two key dates in December that serve as deadlines for states to certify their electoral results and compel Congress to accept them. Though the dates are largely ceremonial, in his text Trump Jr. appears to point to them as potential weaknesses to be exploited by casting doubt on the legitimacy of the election results.

Seeking Trump electors

Trump Jr.’s November 5 text to Meadows came as similar notions of faithless electors were starting to percolate publicly on conservative social media. Trump Jr. sent the text to Meadows at 12:51 p.m., just minutes after conservative radio host Mark Levin had tweeted a similar idea and suggested state legislatures have final say on electors.

If secretaries of state were unable to certify the results, Trump Jr. argues in his text to Meadows that they should press their advantage by having Republican-controlled state assemblies “step in” and put forward separate slates of “Trump electors,” he writes.

“Republicans control Pennsylvania, Wisconsin, Michigan, North Carolina etc we get Trump electors,” Trump Jr. adds.

Trump Jr.’s text, however, refers to an untested legal theory that state houses are the ultimate authority in elections and can intervene to put forward a different slate of electors than those chosen by the voters, when in reality this is a ceremonial process and the outcome is essentially a foregone conclusion.

Video Ad Feedback 00:58 - Source: CNN Trump dangles pardons for Jan. 6 rioters while teasing 2024 run

The Justice Department and the House committee are both investigating the fake electors plot within the context of what unfolded on January 6 and Trump’s broader effort to overturn the election.

The strategy floated by Trump Jr. is similar to what was outlined by former Texas Governor and Trump Energy Secretary Rick Perry, who texted Meadows on November 4 suggesting three state legislatures ignore the will of their voters and deliver their states’ electors to Trump.

“HERE’s an AGRESSIVE (sic) STRATEGY: Why can t (sic) the states of GA NC PENN and other R controlled state houses declare this is BS (where conflicts and election not called that night) and just send their own electors to vote and have it go to the SCOTUS,” Perry’s text message read.

A spokesman for Perry told CNN at the time that the former Energy secretary denies being the author of the text. However, multiple people who know Rick Perry previously confirmed to CNN that the phone number the committee has associated with that text message is Perry’s number.

‘We control them all’

Trump Jr. also texts Meadows that Congress could intervene on January 6 and overturn the will of voters if, for some reason, they were unable to secure enough electoral votes to tip the outcome in Trump’s favor using the state-based strategy.

That option, according to Trump Jr.’s text, involves a scenario where neither Biden nor Trump have enough electoral votes to be declared a winner, prompting the House of Representatives to vote by state party delegation, with each state getting one vote.

“Republicans control 28 states Democrats 22 states,” Trump Jr. texts. “Once again Trump wins.”

“We either have a vote WE control and WE win OR it gets kicked to Congress 6 January 2021,” he texts Meadows.

In a series of memos in early January, conservative lawyer John Eastman proposed a variation of that idea.

Eastman’s memo laid out a six-step plan for Vice President Mike Pence to overturn the election for Trump, which included throwing out the results in seven states because they allegedly had competing electors. In fact, no state had actually put forward an alternate slate of electors – there were merely Trump allies claiming without any authority to be electors.

Eastman, who has been subpoenaed by the House select committee and is fighting to keep some of his records secret from investigators, was accused by Carter of likely engaging in a criminal conspiracy with Trump to overturn the election.

“Dr. Eastman has an unblemished record as an attorney and respectfully disagrees with the judge’s findings,” his attorney Charles Burnham said in response to the judge’s ruling.

Trump Jr. pushes Meadows to fire Wray and install loyalist at FBI

Trump Jr. ends his November 5 text by calling for a litany of personnel moves to solidify his father’s control over the government by putting loyalists in key jobs and initiate investigations into the Biden family.

“Fire Wray; Fire Fauci,” he texts, referring to FBI Director Christopher Wray and White House coronavirus adviser Anthony Fauci. Trump Jr. then proposes making former acting Director of National Intelligence Ric Grenell interim head of the FBI and having then-Attorney General Bill Barr “select Special prosecutor on HardDrivefromHell Biden crime family.”

As Trump refused to concede in the days and weeks after the 2020 election, rumors swirled that he was still considering firing Wray, along with several other top officials with whom he had grown frustrated.

Trump and his allies sharply criticized Wray for failing to produce information that they claimed would be harmful to the President’s political enemies, including Biden. CNN previously reported that the prospect of Trump firing Wray hung over the FBI for weeks, dating to before Election Day.

While Wray remains in his post and Barr resigned in mid-December 2020 without naming a special prosecutor to investigate the Bidens, Trump Jr.’s text underscores just how precarious the situation at DOJ was in the immediate aftermath of the election.

The same is true for Trump Jr.’s recommendation that Meadows replace Wray with Grenell, someone who not only lacked the usual qualifications to lead the FBI but also had a proven track record of doing the former President’s bidding.

After serving a controversial three-month stint as Trump’s acting intel chief, Grenell hit the campaign trail in late 2020 to help promote Trump’s unfounded claims of widespread voter fraud and support his legal challenges in a key swing state: Nevada.

On November 5, Biden held a slim lead over Trump in Nevada but appeared poised to win the state’s six electoral votes. That same day, Grenell and Trump campaign officials announced they were filing a new lawsuit to “stop the counting of illegal votes” but provided no evidence to support their claims of rampant fraud.

This story has been updated with new details of a text message Trump Jr. sent to Meadows.

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Ryan Nobles
Zachary Cohen
Annie Grayer

Weed and psychosis: Does high THC lead to suicide, schizophrenia?

Early one morning in March, Madison McIntosh showed up on his day off at the Scottsdale, Arizona, driving range and restaurant where he worked. The 24-year-old sat in his car until the place opened, then wandered around all day, alternating between gibberish and talk of suicide as co-workers tried to keep him away from customers.

When he was still there 12 hours later, the manager contacted McIntosh’s father in Las Vegas, who called police and rallied other family members states away to converge at the young man’s side.

They found a shell of the once-star baseball player. For months, he’d been vaping a potent form of THC, the ingredient in marijuana that makes people feel high, and staying up all night. He swung wildly between depression and euphoria.

The family rushed McIntosh to Banner Behavioral Health Hospital, where staff psychiatrist Divya Jot Singh diagnosed him with cannabis use disorder and a "psychotic disorder unspecified.”

Singh expects to make McIntosh’s diagnosis official soon. If he remains off pot and symptom-free a year after the episode, the psychiatrist can say with certainty he suffered from “cannabis-induced psychosis.”

"What shocked me is that I had never heard of it," said McIntosh’s dad, Rob. "All you hear is all these proponents of legalization of pot without thought to the risks and the consequences."

A number of physicians and parents are pushing back against the long-held assertion of users and advocates that marijuana is a safe, benign and even beneficial drug.

Those sounding the alarm include the nation’s "mental health czar," as well as doctors in Colorado, California and Massachusetts where marijuana is legal for recreational use. They say the facts are irrefutable: Excessive use of high-THC pot and concentrated oil is linked to psychotic episodes that in some cases develop into full-blown schizophrenia.

There is great disagreement over the strength of the science linking pot and psychosis. Advocates on either side of the marijuana debate have different interpretations of the connection reported in a National Academies cannabis study in 2017 and other studies. In March, The Lancet, a British medical journal, reported a two to five times higher risk of psychotic disorders for daily consumers of high-THC marijuana compared with people who never used.

Arguments surround how much of the illness is preceded or worsened by the drug use, how often marijuana is used in response to it and whether the psychosis would have occurred anyway.

"At the end of the day, you can’t make a causal statement," said Ziva Cooper, research director of the UCLA Cannabis Research Initiative and a member of the National Academies panel. "You need to have some biological premise to show that this kind of exposure causes psychotic disorder."

The federal government and other health officials say the type of psychosis McIntosh experienced and other psychiatric disorders are clearly tied to the drug.

"It is time for Americans to understand there are substantial risks with marijuana," said Elinore McCance-Katz, the Department of Health and Human Services' top mental health official. “This is not the government making up data."

‘Settled science’

McCance-Katz taught at Yale and Brown universities and held senior posts for state substance abuse agencies before joining HHS under the Obama administration as the Substance Abuse and Mental Health Administration chief medical officer.

She pointed out that hospitalizations more than doubled for serious mental health disorders among 18- to 25-year-olds nationally from 2012 to 2018. She cited a study in July that shows a 77% increase in suicide deaths from 2010 to 2015 among Colorado 10- to 19-year-olds with marijuana in their systems.

The data on cannabis-induced psychosis, she said, demands the government both speak out and manage fears. Among people who use marijuana, 10% to 20% will develop a marijuana use disorder and "be at risk for these other kinds of mental and physical adverse events," she said.

"That’s not the majority, that’s the minority of people who use marijuana, but here’s the problem: We don’t know who they are a priori (in advance),” McCance-Katz said. "We do not want to exaggerate the risks."

Many marijuana users and industry officials say that’s precisely what the Trump administration is doing.

They pointed to other studies, including one by Columbia University professors in the journal Drug and Alcohol Dependence that showed cannabis use disorder dropped significantly across all ages reporting daily or almost-daily cannabis use from 2002-2016.

Longtime marijuana legalization advocate Mason Tvert said millions of Americans are rightly skeptical about warnings of the dangers of cannabis use, given it's the most widely used illicit substance in the country.

"When people claim that smoking a joint will lead to psychosis, many consumers are going to write that off, and as a result are going to write off other warnings," said Tvert, who led Colorado's first-in-the-nation cannabis legalization effort in 2012 and works for Denver-based VS Strategies.

Die-hard marijuana advocates strongly push back against news reports that suggest cannabis might have made someone sick, often criticizing such coverage as hearkening back to the days of “Reefer Madness,” the 1936 film that purported to show the drug's dangers.

When Surgeon General Jerome Adams included the link between cannabis and psychosis in his advisory in August on marijuana's effect on the "developing brain,” he was trashed and threatened on Twitter. Alex Berenson, a former New York Times business reporter who wrote the book “Tell Your Children: The Truth about Marijuana, Mental Illness and Violence,” was widely condemned for his warnings of the drug's dangers.

Tvert said legalization advocates want research conducted without bias or political motivation. It’s an area, he said, where the federal government has little credibility.

"That's what happened for decades,” he said. “The federal government spread misinformation and exaggerated the risks so much that people just started ignoring all the warnings."

McCance-Katz said it was not a difficult decision at HHS to include the link between marijuana and psychosis in the surgeon general's advisory.

"This has been settled science," she said. "This is something that has been known for many years, yet there has been virtually no attention paid to it."

‘Marijuana killed my soul’

Clay Whiting deals with a lot of parents and other family members at Scripps Mercy Health hospital in San Diego, where he is an emergency room physician. In the past month, he said, he's had back-to-back ambulances carrying young people experiencing psychosis after trying marijuana for the first time.

Since the drug was legalized in California last year, Whiting said, "we see people every shift now" because of marijuana, including some experiencing violent vomiting known as hyperemesis. The incidents led to the term "scromiting," to describe people screaming and vomiting at the same time.

"Greater access means great trials by younger people," Whiting said.

USA TODAY interviewed a dozen parents whose children suffered psychotic episodes – some of which led to schizophrenia – related to their marijuana use. Several of the children died by suicide.

Andrew Zorn of Phoenix was 14 when he started smoking marijuana daily in high school, said his mother, Sally Schindel. He was about 25 and working on his community college degree when he told his mother something was going on in his brain. He tried to read and study, but his mind seemed to disappear on him, she said.

Zorn was diagnosed with “severe cannabis use disorder," bipolar disorder and borderline personality disorder with auditory hallucinations, paranoia and anxiety.

“In a roomful of people, in the midst of conversation, his eyes would just go somewhere else,” Schindel said. “He later realized it was marijuana use causing that, but from that time on, it just grew and grew to where he was more and more disabled.”

Zorn ended up taking his own life. In a suicide note, he wrote, “I want to die. My soul is already dead. Marijuana killed my soul + ruined my brain.”

McIntosh's problems started when his time at Scottsdale Community College ended without being drafted or recruited by a four-year school.

Mourning the loss of a 16-year baseball career, the 20-year-old started vaping THC to feel better. It didn’t work. A report released in October that analyzed 83 studies found marijuana is not effective for the treatment of depression or other mental illnesses. Many physicians say it increases the risk and severity of depression and thus the chances of suicide.

In the weeks leading up to McIntosh’s hospitalization, his brother and roommate, Morgan, grew worried and called their father. McIntosh was staying up all night, he reported, and at 6 a.m. was still awake "doing weird things.”

McIntosh doesn't remember that time, but the day in March at the driving range is clear. He felt "out of it, delusional" and thought people were following him. "I was pretty scared," he said. "I didn’t know where I was at."

When Rob McIntosh and his wife, Marie, Madison's stepmother, arrived at 3 a.m. from his home in Nevada, he said his son seemed “possessed.”

“He was seeing double rainbows and insisting, 'I’m good, Dad.' It was lunacy," he said.

After McIntosh was released from the hospital last spring, he said he stopped using marijuana "cold turkey." He moved to Texas for a while and sold home security systems before returning to Arizona to do similar work in the Phoenix suburb of Mesa.

He’s no longer suicidal or tempted to use marijuana. "I know what I put myself through and my family through," McIntosh said. "I want to help other people any way I can."

'Think this through'

In May, more than 40 Massachusetts doctors, psychiatrists, pediatricians and other public health professionals urged the state to add psychiatric risk warnings to marijuana packaging and to prohibit most advertising.

The group cited research in The Lancet that found the use of high-THC marijuana increased risk of first-time psychosis by 50% in Amsterdam. Members said the more potent a drug, the higher the risk.

“Just as not all tobacco use causes cancer, not all marijuana/THC use causes the negative effects; however, the risk is substantial enough to require policies which discourage use,” the group's report said.

The state's Cannabis Control Commission rejected most of the health professionals’ recommendations.

"People say, 'This is only THC, and THC is harmless.’ That’s the assumption we all have to question," said Sharon Levy, a group member and pediatrician who heads the Adolescent Substance Use and Addiction Program at Boston Children's Hospital. "I don’t think it’s harmless at all."

She noted growers look to use the highest THC strains and companies make even higher-concentrated products, including gummy bears, oils and waxes, some with up to 90% THC.

“This is a business-driven framework, not a public health one,” Levy said. “There are very serious questions on this front.”

The psychotic side effects of marijuana are used to bolster arguments on both sides of the legalization debate. They find common ground in the need for more testing and studies.

Because marijuana remains a Schedule 1 controlled substance, the federal government strictly limits who can conduct research. Though Canada and Israel permit far more research access, approvals to study marijuana's benefits can take years in the USA where government-grown marijuana is tightly controlled.

Tests by marijuana legalization advocates found the federal government's testing supply can be 10%-15% weaker than cannabis sold in state-licensed dispensaries. In the past 20 years, average pot potency has tripled, from 4% THC in 1995 to 12% in 2014, according to federal testing.

It’s possible to buy a marijuana flower that’s more than 35% THC. Concentrates like those vaped by McIntosh can contain up to 90% THC.

Jim Carroll, director of the White House Office of National Drug Control Policy, said he talks to the Drug Enforcement Administration daily and pushes the agency and the FDA to "open up research" and make it possible for those who want to study medical uses of marijuana to obtain the type they want to study. The DEA announced plans to register more qualified marijuana growers for the research program, but Carroll told the USA TODAY editorial board this month legislation might be needed.

More research and stricter regulation would improve both the quality and the fact-based promotion of cannabis, said Scott Krakower, the assistant unit chief of psychiatry at Zucker Hillside Hospital in Queens, New York. The information would help legislators better determine if the benefits of legalization outweigh the risks.

He said many marijuana users are familiar with the possibility that smoking cannabis can cause paranoia, and paranoia is a textbook definition of an episode of psychosis, along with hallucinations and a distorted sense of reality.

"I think the biggest problem is that people think THC is a panacea cure for conditions, and they use an exorbitant amount of it" despite a lack of research to back that up, Krakower said.

Tvert acknowledged cannabis use comes with risks, which is in part why his legalization efforts focused on regulating marijuana like alcohol. It requires a delicate balance.

“We do need these potential harms conveyed, but we need them conveyed in a way that is credible and based on evidence,” he said.

McCance-Katz isn't taking a public stand on whether more states should legalize marijuana for medical or recreational uses, although her skepticism is apparent when she puts quotes around the word "medical" as it applies to marijuana.

"It’s really important the government be responsible and say, ‘You need to know this and think this through before you decide to use.'" she said. "That’s all we want."

If you or family members are struggling with issues mentioned in this story and you would like to connect with others online, join USA TODAY’s "I Survived It" Facebook support group.

U.S. smoking warning made history, saved lives

Liz Szabo

USA TODAY

Smoking rates have fallen 59%25 since the Surgeon General%27s report was released in 1964

The tobacco industry continues to spend more than %248 billion a year on marketing

More than 3%2C000 kids try their first cigarettes every day

Health advocates are marking the 50th anniversary of the 1964 Surgeon General report on smoking with a call for more aggressive action to protect people from tobacco.

That landmark report, along with subsequent Surgeon General reports on the addictive power of nicotine and the dangers of secondhand smoke, led to a sea change in the country's attitude toward tobacco. Smoking rates have dropped by 59%, and many communities now ban smoking in public places.

No other single report has had this large of an effect on public health, says Thomas Frieden, director of the Centers for Disease Control and Prevention.

"I can't think of anything else that has come close," says Theodore Holford, a professor at the Yale University School of Public Health.

But with so much evidence of the harms of smoking — which causes cancer, heart attacks, strokes and a multitude of other illnesses — some advocates say the country needs to go much further.

"The 50th anniversary of the Surgeon General report should be a catalyst to say, 'We can't wait another 50 years to end death and disease caused by smoking,' " says Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group.

Nearly 42 million Americans still smoke, according to the CDC. More than 5 million people around the world die each year of smoking-related illnesses, according to an editorial by physicians Steven Schroeder and Howard Koh in Tuesday's Journal of the American Medical Association.

Every day, more than 3,000 teens pick up their first cigarettes, says Robin Koval, president and CEO of Legacy, an anti-smoking advocacy group created by the 1998 Master Settlement Agreement between tobacco companies and state attorneys general.

In some ways, combating tobacco is even more challenging than fighting infectious diseases, Frieden said in an interview. Frieden noted that more people would have stopped smoking if not for aggressive efforts by the tobacco industry to keep people addicted.

"I spent over a decade working on tuberculosis control," Frieden said. "But tuberculosis doesn't have a lobby working against tuberculosis-control measures."

The tobacco industry continues to work hard to keep people using its products, spending more than $8 billion a year on marketing in the USA alone, according to Schroeder and Koh's editorial.

In a related editorial, Frieden notes that new products, such as electronic cigarettes, present both opportunities and risks. Some health leaders say electronic cigarettes — which contain nicotine but no tobacco — may help smokers quit. But Frieden says he's concerned that e-cigarettes could increase the number of people addicted to nicotine by attracting kids. Frieden is also concerned that e-cigarettes could lead some smokers to avoid quitting, by allowing them to feed their habits even in smoke-free areas.

Yet, health advocates also note that the cultural landscape around smoking has changed enormously since the 1960s.

Back then, passengers could smoke on any plane, and flight attendants distributed free cigarettes along with meals. School kids sculpted ash trays for Mother's Day presents.

Tobacco companies formed one of the most powerful industries in the world, employing stars such as Ronald Reagan, Humphrey Bogart and Louis Armstrong to sell their products.

Today, tobacco companies are "convicted racketeers," says Stanton Glantz, a professor at the University of California-San Francisco, referring to the 2006 ruling by U.S. District Judge Gladys Kessler, who found that tobacco companies defrauded the American people by lying about the health risks of smoking.

UCSF's archive includes 82 million pages of tobacco-industry documents, revealing cigarette makers' strategies for marketing to children and the fact that they knew that cigarettes caused cancer and nicotine was addictive.

The surgeon general in 1964, Luther Terry, described the report's effect as a "bombshell."

At the time, and for decades afterward, the tobacco industry tried to "poke holes" in research documenting the harms of smoking, Frieden says.

With the surgeon general's report, "this was the first time that the government was saying, 'No. There is no doubt that smoking causes cancer,' " Frieden says.

The report's conclusions — based on more than 7,000 documents — were almost immediately accepted by nearly everyone, except for the tobacco industry, Myers say.

American attitudes toward the safety of smoking changed quickly.

In 1958, only 44% of American believed smoking caused lung cancer, according to a Gallup survey. By 1968, that percentage had risen to 78%.

Congress acted, as well.

In 1965, Congress passed legislation requiring the now-familiar "Surgeon General's warning" on cigarette packages, although it took six years to implement. In 1971, cigarette makers stopped advertising on TV.

"The tobacco industry thought they were just going to be crushed," says Glantz, author of a history of the tobacco industry called The Cigarette Papers. "The government and others didn't have the nerve to do what the tobacco industry had feared, which is come up with major regulation. ... Politics has always saved the tobacco industry."

The tobacco industry also fought fiercely to protect its business, says Glantz, likening the battles over smoking to "trench warfare." For years, he notes, the tobacco industry funded bogus research suggesting that cigarettes and secondhand smoke were safe.

Smoking rates briefly rose in some of the first few years after the Surgeon General report's release, as the tobacco industry ramped up advertising to women and minorities, says Mark Pertschuk, a long-time anti-tobacco activist and director of the advocacy group Grassroots Change.

It was another surgeon general, C. Everett Koop, who "really got us where we are today," says Otis Brawley, chief medical officer of the American Cancer Society.

In 1986, Koop issued a Surgeon General report on "involuntary smoking," or secondhand smoke, that provided the scientific basis for protecting non-smokers from tobacco, Brawley says.

"When people realized that smoking hurts more than just the smoker, that's what led to change," Brawley says.

Flight attendants such as Kate Jewell — forced to breathe smoky, recirculated air during long plane trips — began to call for smoking bans on plane flights. Jewell recalls brown water dripping from the air vents. "It was so smoky, you couldn't see from one end of the cabin to another," Jewell says.

Long before the research was completed, Jewell says she and her fellow flight attendants knew that secondhand smoke was toxic. Jewell, whose career spanned 1970 to 2007, recalls keeping her airline uniform in the garage, because it smelled too awful to allow in her home.

"I would pull into the garage and strip down before I went into my house, because I didn't want to bring that into my house," says Jewell, 64, of Orcas Island, Wash.

In 1989, Congress banned smoking on domestic flights. Communities across the country began banning indoor smoking, as well.

As fewer Americans smoked, the tide began to turn toward cleaner air.

The tobacco industry's image took a beating in the 1990s, with the leak of industry documents showing that cigarette companies had hidden evidence that nicotine was addictive, Glantz says.

But the industry hasn't gone away.

Tobacco companies continue to oppose tobacco taxes and smoking bans. They're also still fighting implementation of the 2006 racketeering ruling, which required them to fund ad campaigns acknowledging that they lied about the addictiveness of nicotine, Glantz says.

"That is still being fought in the courts to this day," Glantz says. "The industry is still out there being as aggressive as (it) can be."

R.J. Reynolds, one of the leading tobacco companies, declined to comment.

David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris, said his company welcomes regulation. Sylvia said Altria has no interest in marketing to kids, and simply hopes to sells its cigarettes to current smokers.

"The reason that tobacco remains such a problem isn't because the American public has failed to respond" to the surgeon general's warning, Myers says. "It's because the tobacco industry has used its economic, scientific and political might."

The tobacco industry has made technological improvements in cigarettes, for example, to make them less harsh, so that new smokers don't cough as much as in the past. That makes cigarettes more appealing to kids and first-time users, Myers says. The industry continues to sell menthol-flavored cigarettes, as well, which mask the harshness of tobacco with a minty flavor. "Fifty years later, cigarettes look sleeker, but they are no safer," Myers says.

Myers and others say they're disappointed that the Food and Drug Administration has not yet banned menthol cigarettes, although Congress has given it the power to regulate tobacco.

Food packaging contains dangerous chemicals, report says - CNN

(CNN) Alarming levels of dangerous chemicals known as PFAS were discovered in food packaging at a number of well-known fast-food and fast-casual restaurants and grocery store chains, a new report found.

The highest levels of indicators for PFAS were found in food packaging from Nathan's Famous, Cava, Arby's, Burger King, Chick-fil-A, Stop & Shop and Sweetgreen, according to an investigation released Thursday by Consumer Reports.

Often called "forever chemicals" because they do not break down in the environment , PFAS are used in food packaging to prevent grease and water from soaking through food wrappers and beverage cups. PFAS can also be found in the ink used to print logos and instructions on food containers.

The new report comes more than two years into the Covid-19 pandemic, when the public has relied heavily on takeout and grocery deliveries.

The US Centers for Disease Control and Prevention calls exposure to PFAS (per- and polyfluoroalkyl substances) a " public health concern ," citing studies that found the human-made chemicals can harm the immune system and reduce a person's resistance to infectious diseases.

"There is evidence from human and animal studies that PFAS exposure may reduce antibody responses to vaccines," stated the CDC and the Agency for Toxic Substances and Disease Registry . "More research is needed to understand how PFAS exposure may affect illness from COVID-19."

More than 100 food products tested

The Consumer Reports investigation collected 118 food packaging products sold by 24 companies in the tristate area of New York, New Jersey and Connecticut. It tested those products for organic fluorine -- a marker for PFAS. Researchers then sent samples of products with the highest levels to an independent laboratory that could perform more specific tests, said Michael Hansen, senior staff scientist for advocacy at Consumer Reports.

Regulatory limits for how much PFAS food packaging should contain can vary greatly. In the US, there are no federal limits, leaving action up to the states. Connecticut, Maine, Minnesota, New York, Vermont and Washington have passed bills banning intentional use of PFAS in food packaging, but haven't yet specified a limit, according to Consumer Reports. In January 2023, a new law in California will set the limit at less than 100 ppm (parts per million).

However, Denmark set a much lower regulatory limit of 20 ppm with great success, said Xenia Trier, a chemicals, environment and human health expert at the European Environment Agency.

"In Denmark we've seen both a decrease in noncompliance by industry from 60% to about 30% and a decrease in levels of PFAS in packaging products over the past 10 years," Trier told CNN. "It does work to set limits and enforce them. It is possible to find alternative solutions and if one manufacturer can make packaging without PFAS, then it should be possible for everybody to do it."

The Consumer Reports investigation found the highest indicators for PFAS -- 876 ppm and 618 ppm -- in two types of bags for sides at Nathan's Famous restaurants.

High indicators of PFAS (in the 500s) were also found in a Chick-fil-A sandwich wrapper and in fiber bowls at Cava, a Mediterranean restaurant chain.

Indicator levels in the 300s and 400s were found in a bag of cookies at Arby's, bamboo paper plates at Stop & Shop, and in a bag for both cookies and French toast sticks at Burger King.

Levels of PFAS indicators in the 200s were found in a Sweetgreen paper bag for focaccia, additional items at Cava, and in bags for french fries, cookies and Chicken McNuggets at McDonald's.

However, all of the companies listed had additional food packaging that tested at levels below 200 ppm. Four companies -- Arby's, Nathan's Famous, McDonald's and Stop & Shop -- also sold food in packaging that had no detectable levels of PFAS, the report said.

The Consumer Reports investigation did not test packaging from every food product sold at each company.

"I would not urge consumers to take these brand names and only go to this one or that one, as this investigation only looked at just over 100 products," said Graham Peaslee, a professor of physics, chemistry and biochemistry at the University of Notre Dame in Indiana.

"However, this will hold industry's toes to the fire, so in that sense, I think it's a valuable report," he added. "Measuring and saying PFAS is there and it's dangerous gets people's attention, and companies tend to avoid attention like that."

Health impact of PFAS

PFAS chemicals are in many products: nonstick cookware, infection-resistant surgical gowns and drapes, cell phones, semiconductors, commercial aircraft and low-emission vehicles. The chemicals also are used to make carpeting, clothing, and furniture resistant to stains, water and grease damage.

In use since the 1950s, PFAS are chemicals most Americans have "in their blood," especially perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA)," according to the Agency for Toxic Substances and Disease Registry , which is charged with protecting the public from hazardous substances.

In the Consumer Reports investigation, the most common chemical found in the food packaging that was tested was PFOA, with PFOS coming in fifth, according to the report.

In addition to impacts on the immune system, the Agency for Toxic Substances and Disease Registry said studies in humans and lab animals have found links between certain PFAS chemicals and an increase in cholesterol levels, alterations in liver enzymes, a higher risk of developing kidney or testicular cancer, small reductions in infant birth weights and an additional risk of high blood pressure in pregnant women.

"PFAS have also caused birth defects, delayed development, and newborn deaths in lab animals," the agency state d , while adding "not all effects observed in animals may occur in humans."

As environmental groups and the public began to take notice of the health impacts of the chemicals, manufacturers started to voluntarily phase out the use of PFOS and PFOA in the US. Between 1999 and 2014, blood levels of PFOS in Americans had declined by more than 80% and blood levels of PFOA had declined by more than 60%, the Agency for Toxic Substances and Disease Registry stated.

However, "as PFOS and PFOA are phased out and replaced, people may be exposed to other PFAS," the agency continued. Newer versions of PFAS in food packaging appear to be absorbed by food more readily than the older versions, according to a 2016 study

Studies in Denmark have shown that PFAS do "migrate from the paper into the food," Trier said. "Even though it was not 100%, we still saw substantial transmission. In general, transmission from packaging to food is increased as the temperature of the food rises and the time spent in wrapping materials increases."

Industry response

by Toxic-Free Future and Safer Chemicals Healthy Families. Those reports found "harmful" levels of PFAS in fast-food packaging and in nearly two-thirds of takeout containers made of paper, like those used at self-serve salad buffets and hot bars. The Consumer Reports investigation mirrored results of reports in 2018 and 2020 by Toxic-Free Future and Safer Chemicals Healthy Families. Those reports found "harmful" levels of PFAS in fast-food packaging and in nearly two-thirds of takeout containers made of paper, like those used at self-serve salad buffets and hot bars.

In response to the 2018 report, Whole Foods became the first grocery chain in North America to publicly commit to remove PFAS from takeout containers and deli and bakery paper. Other companies have followed suit, including Ahold Delhaize, Albertsons, Amazon.com, Cava, Chipotle, Freshii, McDonald's, Panera Bread, Sweetgreen, Trader Joe's and Wendy's, according to Toxic-Free Future.

In the new investigation, Consumer Reports tested 13 food packaging products from retailers that had previously committed to phasing out PFAS. Seven of the 13 had levels of PFAS above 20 ppm, the report said.

Burger King, which had high levels of PFAS in three of six products tested, had not made a public commitment to phase out PFAS, according to Consumer Reports. Early Thursday, parent company Restaurant Brands International announced it will globally phase out any "added" PFAS from "guest-facing packaging materials" at the Burger King, Tim Hortons and Popeyes brands "by the end of 2025 or sooner."

Nathan's Famous, which Consumer Reports said also has not made a public commitment to reducing PFAS, told CNN the company had begun phasing out the bags. "One of our goals in this complete package redesign is to reduce PFAS," said Phil McCann, vice president of marketing at Nathan's Famous. "Full transition will be complete by December 2022."

Chick-fil-A told CNN it had been on a four-year journey to phase out PFAS: "Chick-fil-A has eliminated intentionally added PFAS from all newly produced packaging going forward in our supply chain. While some legacy packaging may still be in restaurants, it is expected to be phased out by the end of this summer," the company tweeted Wednesday

Cava, which had previously pledged to reduce PFAS but had five out of six products with indicators between 200 ppm and 548 ppm, told CNN that "due to a multitude of factors related to the pandemic, and especially global supply chain shortages, the transition to eliminating added PFAS, which began in August of 2021, is taking longer than planned. Our teams are working with our suppliers to complete the transition within the year."

A McDonald's spokesperson said less than 7.5% of the company's global food packaging contained added PFAS at the end of 2020 and said the company was continuing its search for alternative materials that offered proper grease-resistant barriers, with a goal of reducing deliberately added PFAS by the end of 2025.

Sweetgreen told CNN the company was "proud to share that we are currently in the process of rolling out new PFAS-free focaccia bags that will be available in all Sweetgreen locations by the end of Q2."

Jennifer Brogan, director of external communications and community relations for Stop & Shop, told CNN the company could "confirm that these Nature's Promise brand plates have been removed from all store locations."

A spokesperson from Arby's told CNN in an email that the company has "minimal packaging materials containing PFAs and is on track to have PFAs removed from all packaging products by the end of 2022."

Actions the public can take

Experts say people who want to avoid PFAS in their takeout and food delivery packaging should favor companies that have pledged to remove the chemicals.

Take food out of the container as soon as you receive it, and never reheat food in its original container. Instead, remove your food and heat it in ceramic or glass containers, Trier said.

The Consumer Reports investigation found some of the highest levels of PFAS were in paper bags (192.2 ppm) and molded fiber bowls and trays (156.8 ppm). Paper plates tested at 149 ppm, and food wrappers and liners came in at 59.2 ppm.

Don't be fooled by "environmentally friendly" claims -- they don't guarantee a product is PFAS-free. When Consumer Reports tested those products, some had levels of PFAS above 100 ppm, and most had some detectable levels, the report said.

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Experts also suggest reducing the frequency of takeout meals to once a week or less, and recommend that people instead make food at home.

Texas elementary school shooting live updates: Beto confronts Abbott

UVALDE, Texas – Gov. Greg Abbott said the gunman in a school shooting sent social media messages about his intentions half an hour before the deadly rampage.

Shortly after his revelation, former congressman Beto O'Rourke confronted Abbott over "doing nothing'' about gun violence, adding a chaotic element to a Wednesday news conference addressing the attack at Robb Elementary School that left 19 children and two teachers dead Tuesday.

The gunman sent Facebook messages about 30 minutes before the rampage that he was going to shoot his grandmother, then that he had shot the woman, and finally that he was going to shoot up an elementary school, Abbott said. Facebook said the messages were private texts.

Abbott said there was no other "meaningful forewarning of this crime,'' emphasized the need for mental health services and said of the victims' families, "what they need now more than ever is our love.''

When Abbott was about to hand the microphone to another speaker, O'Rourke, a Texas gubernatorial candidate, approached the stage with a call for action. O'Rourke was the U.S. Representative for the El Paso area when a gunman killed 23 people during a 2019 shooting at a Walmart in that city.

Before being escorted away, he said: "This is on you until you choose to do something different. This will continue to happen. Somebody needs to stand up for the children of this state or they will continue to be killed just like they were killed in Uvalde yesterday.''

The massacre took place in a fourth-grade classroom and was the state's deadliest school shooting in modern history and the nation's third mass shooting within weeks. Authorities identified the gunman as Salvador Ramos, 18, but revealed no motive. They said he was killed by law enforcement.

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Horror, death in classroom

The killer entered the classroom, locked the door and started shooting, said Lt. Christopher Olivarez of the Texas Department of Public Safety. Officers arriving on the scene began breaking windows around the school trying to evacuate children and teachers. Olivarez said a tactical team forced its way into the classroom and faced gunfire but was "able to shoot and kill that suspect.’’

Besides those killed, at least 17 people were wounded, and officials have said the death toll could rise. Olivarez did not know how many students were in the room when the shooting started but said it normally would hold 25-30 kids.

"A typical classroom setting, where you have mass groups of children inside that classroom all together, with nowhere to go," Olivarez said. “It just shows you the complete evil of the shooter."

Biden says allowing teens access to an AR-15 rifle 'violates common sense'

Before signing an executive order on policing Wednesday, President Joe Biden questioned laws that allow teenagers access to an AR-15-style rifle like the one authorities said the shooter used in Tuesday's massacre at Robb Elementary School in Uvalde, Texas.

"The idea that an 18-year-old could walk into a store and buy weapons of war designed and marketed to kill, it's just wrong,'' Biden said. "It just violates common sense. ... "Where's the backbone? Where's the courage to stand up to a very powerful lobby?"

Biden said he and first lady Jill Biden will soon travel to Texas to meet with grieving families, adding that the whole nation should offer support.

"And we must ask when in God's name will we do what needs to be done to, if not completely stop, fundamentally change the amount of the carnage that goes on in this country," he said.

Biden also used his remarks to push for Senate confirmation of his nominee to lead the Bureau of Alcohol, Tobacco, Firearms and Explosives -- Steve Dettelbach, who testified earlier Wednesday before the Senate Judiciary Committee.

-- Francesca Chambers

Gunmaker draws scrutiny – shooter bought one of its rifles

Gun manufacturer Daniel Defense, which saw its sales spike after the 2012 Sandy Hook massacre, is coming under scrutiny following the shooting at a Texas elementary school because the gunman purchased one of the company's rifles and brought it to Tuesday's attack.

Though Daniel Defense is largely shielded from civil liability by the 2005 Protection of Lawful Commerce in Arms Act, such cover has been pierced recently and the company may face years of expensive litigation, not to mention public backlash.

Families of the Sandy Hook victims successfully sued Remington, the producer of the Bushmaster XM15-E2S semi-automatic rifle used in the assault. In February, the gunmaker agreed to a $73 million settlement in the case, which hinged on marketing materials targeted at young men as proof of masculinity and fears of having your “man card” revoked. Daniel Defense’s marketing and the focus on “tactical” and combat gear could invite civil action.

-- Nick Penzenstadler

What do we know about the victims?

Nineteen children and two teachers were killed in the shooting, Texas Department of Public Safety Lt. Chris Olivarez said. A U.S. Border Protection agent, one of several responding to the scene, shot and killed the gunman, a senior Department of Homeland Security official told USA TODAY on Tuesday night.

All the children were fourth graders, and their names are starting to come out, along with the identification of two longtime teachers who were among the victims, Eva Mireles, 44, and Irma Garcia.

The deceased students include:

Uziyah Garcia, whose age is not confirmed; Xavier Lopez, 10; Jose Flores, 10; Amerie Jo Garza, 10; Lexi Rubio, 10, and Eliahana Cruz Torres, whose age is not currently known.

University Health, a hospital in San Antonio, reported Tuesday evening that it had four patients: a 66-year-old woman in critical condition; a 10-year-old girl in critical condition; a 10-year-old girl in good condition, and a 9-year-old girl in good condition. By nightfall, many families were still waiting for updates, hoping to hear that their children were in a hospital in Uvalde or San Antonio.

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Schools on alert across the nation

Schools around the country increased security as a precaution. Schools in Washington, D.C., Atlanta, Virginia, Maryland and Florida were among those offering counseling.

In Connecticut, where the 2012 Sandy Hook Elementary School shooting killed 20 first graders and six educators, state police said they were sending extra troopers to schools Wednesday, although no specific threats had been received.

“This assault on the most innocent of our citizens is deeply disturbing and heartbreaking,” Connecticut state police Col. Stavros Mellekas said in a statement. “At this time, our focus will be on protecting all school populations here in our state.”

Guns were bought legally

The suspect legally purchased two AR platform rifles at a local gun shop, one on May 17 and the other May 20, said state Sen. John Whitmire, based on a briefing from state police. One of the rifles was left in the truck the gunman crashed shortly before the shooting, the other was found in the school with the suspect, Whitmire said. A week ago he had purchased 375 rounds of 5.56 ammunition. The suspect was not wearing body armor but only a plate carrier with no ballistic armor inside, Whitmire said.

The grim task of identifying victims

Uvalde does not have its own medical examiner, so Justice of Peace Eulalio Diaz was called upon to identify the victims. Families waiting at the Civic Center for news of their children provided DNA swabs to authorities to aid in the identification process.

“We know everybody,” Diaz said, reflecting on how his children in 8th and 12th grades will be marked by the tragedy. “We know children who were there.”

Diaz lamented the lack of mental health resources in Uvalde and that the shooter had not received help.

“We’ve talked for years about mental health facilities nearby… we don’t have anything,'' he said. "This child was probably suffering from something that was never diagnosed. The way you get diagnosed here is you end up in jail. This kid never made it to jail.”

– Martha Pskowski

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A neighbor dies in the carnage

Looking across the street at a brown house, Javier Rangel, 57, remembered the young girl who used to play out front. Rangel lives a few blocks from Robb Elementary, where the girl was a student. He said her father posted to Facebook on Tuesday night that she was among the dead.

“This has hit us bad, knowing they were young kids just starting their lives,” said Rangel, a truck driver. “We never thought it would happen in this little town. I used to see her riding her bike, playing with her sisters. That poor little girl.”

– Trevor Hughes

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In their honor:Uvalde gathers for vigil to mourn 19 children, two teachers killed in shooting

Small town of Uvalde left 'stunned and shocked'

Dan Young, shaded beneath his rancher's hat, came to Uvalde's civic center to assist with child counseling in the wake of the tragedy, a retired counselor recruited for duty by the local child advocacy he once worked for. Young gets down on the floor and does puzzles with kids.

"I'm able to calm their parents," he said. "The kids, that's the easy part. We just sit down with them and play. That's all they want to do, is play. And forget."

Laura Donaldson, a Bible class teacher at Crossroads Community Church, moved to Uvalde – pop. 16,000 – some 26 years ago because she wanted the peace and quiet of a small town. Until this week, she said, it had mostly stayed that way -- except for the occasional border-patrol chase speeding through. "We're only an hour from the border," she said.

When news of Monday's shooting broke, "We were all stunned and shocked," she Donaldson said. "I was at my sister's, and we didn't know the extent. We didn't want to think the worst, but it just kept getting more devastating."

-- Marc Ramirez

Sandy Hook parents urge 'bold action'

Nicole Hockley and Mark Barden, co-founders and CEOs of Sandy Hook Promise, each had a son killed in the Sandy Hook Elementary School shooting spree that killed 26 a decade ago, including 20 children. They issued a statement saying they are "sickened under the weight of our sadness as we watch another community of families suffering their worst nightmare." And they called on everyone to urge elected officials to pass legislation that protects children.

"This can be done while upholding second amendment rights," the statement said. "Now is the time to take bold action – as a country, how much longer can we stand by while innocent children continue to be killed?”

Survivors and relatives of victims of the Sandy Hook massacre in 2012 thought that attack would "would wake up the country," said librarian Mary Ann Jacob. "Unfortunately, I was wrong."

A field trip, hugs and chaos

Juan Torres and his family live a few blocks from both the school and the home where authorities say they gunman lived. Torres' wife grew up in Uvalde, and their two young children attend school here, although at different campuses than where the shooting took place.

Torres said he was returning to the city from his construction job Tuesday when he heard about a school shooting on the radio but assumed it was elsewhere. Then he saw the helicopters hovering over his neighborhood. His daughter had been to San Antonio on a field trip, and teachers texted parents to let them know they could pick up their kids at a rest stop on the outskirts of town.

"I ran out of here so fast, drove down there at like 120 mph and grabbed her, hugged her so hard," Torres said. "It's all been a bunch of chaos."

– Trevor Hughes

Where did the shooting take place?

Authorities say the gunman walked into Robb Elementary School in Uvalde, about 85 miles west of San Antonio, around 11:30 a.m. Central Time and opened fire. Uvalde is home to about 16,000 people and is located about 75 miles from the Mexican border. About 82% of the city's population is Latino, according to the U.S. Census Bureau.

Robb Elementary, part of the Uvalde Consolidated Independent School District, has an enrollment of just under 600 students. The district initially put all campuses on lockdown after gunshots were fired, and it canceled all district and campus activities, after-school programs and events.

Public officials react to the shooting

President Joe Biden in a Tuesday night news conference decried “another massacre” that had left parents in unfathomable pain: “To lose a child is like having a piece of your soul ripped away,” he said. Biden also called for a renewed push for gun control measures, lamenting the lack of progress despite repeated shootings.

“Why are we willing to live with this carnage?” he said. “Time to turn this pain into action.”

Abbott directed that the Texas flag be immediately lowered to half-staff across the state from Tuesday until Saturday in memory of the people who lost their lives in the school shooting.

"The first lady and I extend our prayers of comfort to the survivors and the families of the victims, and we will continue to keep them in our thoughts and prayers," Abbott said.

'ENOUGH IS ENOUGH':Biden calls on lawmakers to take action after Uvalde school shooting

Texas mourns another mass shooting

In the last five years, Texas has been the scene of mass shootings that killed more than 85 people. Worshippers during a Sunday sermon, shoppers at a Walmart, students on a high school campus and drivers on a highway have been the targets. The state’s conservative, Republican-controlled government is unlikely to restrict gun access despite the carnage. Last year, gun laws were actually loosened after a gunman at a Walmart in El Paso killed 23 people in a racist 2019 attack that targeted Hispanics.

“I can’t wrap my head around it,” said Democratic state Sen. Roland Gutierrez, whose district includes Uvalde. “It’s disturbing to me as a policymaker that we have been able to do little other than create greater access to these militarized weapons to just about anyone who would want them.”

Contributing: Megan Menchaca, Austin American-Statesman; N'dea Yancey-Bragg, Trevor Hughes, Chris Kenning, USA TODAY; The Associated Press

Trump campaign officials, led by Rudy Giuliani, oversaw fake ...

Phil Mickelson of The USA tees off the 14th hole during day three of the PIF Saudi International at Royal Greens Golf & Country Club on February 05, 2022 in Al Murooj, Saudi Arabia.

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Toobin: SCOTUS says this is history, we're dealing in the present

WASHINGTON, DC - JANUARY 26: The U.S. Supreme Court building on the day it was reported that Associate Justice Stephen Breyer would soon retire on January 26, 2022 in Washington, DC. Appointed by President Bill Clinton, Breyer has been on the court since 1994. His retirement creates an opportunity for President Joe Biden, who has promised to nominate a Black woman for his first pick to the highest court in the country.

US President Donald Trump's personal lawyer Rudy Giuliani speaks to supporters from The Ellipse near the White House on January 6, 2021, in Washington, DC. - Thousands of Trump supporters, fueled by his spurious claims of voter fraud, are flooding the nation's capital protesting the expected certification of Joe Biden's White House victory by the US Congress. (Photo by Brendan Smialowski / AFP) (Photo by BRENDAN SMIALOWSKI/AFP via Getty Images)

Washington CNN —

Trump campaign officials, led by Rudy Giuliani, oversaw efforts in December 2020 to put forward illegitimate electors from seven states that Trump lost, according to three sources with direct knowledge of the scheme.

The sources said members of former President Donald Trump’s campaign team were far more involved than previously known in the plan, a core tenet of the broader plot to overturn President Joe Biden’s victory when Congress counted the electoral votes on January 6.

Giuliani and his allies coordinated the nuts-and-bolts of the process on a state-by-state level, the sources told CNN. One source said there were multiple planning calls between Trump campaign officials and GOP state operatives, and that Giuliani participated in at least one call. The source also said the Trump campaign lined up supporters to fill elector slots, secured meeting rooms in statehouses for the fake electors to meet on December 14, 2020, and circulated drafts of fake certificates that were ultimately sent to the National Archives.

Trump and some of his top advisers publicly encouraged the “alternate electors” scheme in Pennsylvania, Georgia, Michigan, Arizona, Wisconsin, Nevada and New Mexico. But behind the scenes, Giuliani and Trump campaign officials actively choreographed the process, the sources said.

One fake elector from Michigan boasted at a recent event hosted by a local Republican organization that the Trump campaign directed the entire operation.

“We fought to seat the electors. The Trump campaign asked us to do that,” Meshawn Maddock, co-chair of the Michigan Republican Party, said at a public event last week that was organized by the conservative group Stand Up Michigan, according to a recording obtained by CNN.

Listen to Meshawn Maddock describe the Trump campaign’s involvement in the fake elector plot at a recent speech in Michigan “[Matt Maddock] fought for investigations into every part of the election we could. He fought for a team of people to come and testify in front of the committee. We fought to seat the electors. Um, the Trump campaign asked us to do that – under a lot of scrutiny for that today. My husband has, he’s suffered for that a little bit in Lansing because it’s not very popular, but you know when you represent the whole state of Michigan and that’s what I see it now. I realize that even though you’re going to vote for somebody to be your next state representative, your next state senator, the truth is, this body of people, they represent all of us.

Maddock was also one of the 16 Trump supporters from Michigan who served as fake electors and signed the illegitimate certificate that was sent to the National Archives.

“It was Rudy and these misfit characters who started calling the shots,” a former Trump campaign staffer said. “The campaign was throwing enough sh*t at the wall to see what would stick.”

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Integral to the Jan 6 plan

The scheme was integral to Trump’s plan to get then-Vice President Mike Pence to throw out Biden’s electors and replace them with the GOP electors on January 6 when Congress counted the electoral votes. It has also come under renewed scrutiny by the January 6 select committee and state attorneys general, raising questions about the involvement of Trump’s campaign and whether any laws were broken.

Committee chairman Rep. Bennie Thompson of Mississippi told reporters Thursday the panel is looking into whether there was a broader conspiracy or involvement from the Trump White House in the creation or submission of these fake electors.

“That’s a concern” Thompson said.

In its subpoena letter sent to Giuliani on Tuesday, the House committee specifically references his efforts to convince state legislatures to overturn election results. The document cites Giuliani’s comments from December 2020 in which he publicly urged lawmakers in Michigan to award the state’s electoral votes to Trump.

One of the pro-Trump electors from Pennsylvania, Sam DeMarco, told CNN there was a last-minute dispute, where the state’s GOP electors pushed Trump campaign officials to add legal caveats to the fake certificate to say they were only electors-in-waiting, if Trump’s legal challenges prevailed.

The fake documents from Pennsylvania and New Mexico ultimately contained these caveats, but the documents from the other five states explicitly claimed, falsely, that the pro-Trump electors were the rightful electors.

It’s not clear that any of the fake electors themselves participated in strategy sessions with top Trump campaign brass. But both Maddock from Michigan and DeMarco from Pennsylvania have said they were in direct contact with members of the Trump campaign.

Many of the players involved in the scheme, including Maddock, stand by their actions and are still pushing the lie that the 2020 election was stolen. Giuliani, a Trump spokesperson and a representative from Stand Up Michigan did not respond to CNN’s requests for comment.

Advancing the lie that the election was stolen

After Trump failed to stop battleground states from certifying Biden’s victory, Trump campaign officials, led by Giuliani, launched its parallel effort to disrupt and undermine the Electoral College process. This included publicly promoting false claims of fraud, while quietly exploring the fast-diminishing avenues to overturn the results.

Trump hoped Republican legislators from the seven battleground states would replace Biden’s authentic electors with the rogue GOP slate, and that Pence would seat those electors during the joint session of Congress on January 6.

Vice President Mike Pence and House Speaker Nancy Pelosi preside over a Joint session of Congress to certify the 2020 Electoral College results after supporters of President Donald Trump stormed the Capitol earlier in the day on January 6, 2021. J. SCOTT APPLEWHITE/AFP/POOL/Getty Images

A source familiar with the situation told CNN that Pence was concerned about the possibility of “alternate electors,” and his team carefully worded what he said that day during the Electoral College certification to recognize only the legitimate electors.

One of the sources with direct knowledge of the scheme, a former Trump campaign staffer, told CNN that Giuliani worked closely on the seven-state stunt with Christina Bobb, a correspondent for the pro-Trump propaganda network One America News.

Many of Giuliani’s unhinged conspiracies about the 2020 election found a home at OAN. And in a deposition last year as part of a civil lawsuit, Giuliani said Bobb was “very active in gathering evidence” as “part of the legal team” working for Trump’s campaign during the presidential transition.

Bobb reached out to a top Arizona legislator about supposed voter fraud, according to emails obtained by the government oversight group American Oversight through a public records request. In the December 4, 2020, email Bobb said she was sending the message on Giuliani’s behalf. The emails flesh out how Trump’s team was trying to press state legislatures to overturn the results.

Bobb didn’t respond to messages seeking comment about the pro-Trump electors.

“They were all working together. Rudy, John Eastman, and Christina Bobb, in tandem, to create this coverage for OAN, to advance the Big Lie,” the former Trump campaign staffer told CNN.

While mainstream news outlets covered the Electoral College proceedings, which cemented Biden’s position as President-elect, OAN focused on the rogue electors and voter fraud myths.

The Washington Post first reported new details about the role of Giuliani and Bobb.

Battleground Michigan

Republicans in Michigan were central to the effort to try and overturn the election results and Meshawn Maddock – along with her husband State Rep. Matt Maddock – were instrumental to the effort inside the state.

The Maddocks have deep ties to Trump. The former president has endorsed Matt Maddock in his bid to be Michigan House leader. Maddock tweeted a photo last year of an article written about his campaign that Trump had signed, and added, “Matt, I am with you all the way.”

In the months leading up to January 6, Matt Maddock consistently pushed Trump’s lie about the election. In early December 2020, Matt Maddock and other state GOP lawmakers in Michigan held a series of hearings seeking to validate unfounded claims of widespread voter fraud – prompting a personal visit from Giuliani.

When the effort to convince state legislators in Michigan to block Biden’s electors ultimately failed, Maddock was among the GOP lawmakers from five states who sent a letter to Pence on January 5, urging him to delay certification of the electoral votes. Pence refused to go along with the plan.

Meshawn Maddock is equally close to Trump and is still peddling the lie that the election was stolen.

Along with being an elector, she also helped organize buses to take GOP activists to Washington for protests around January 6 and took part in the march to the US Capitol. She later disavowed the violence that came after the march.

Maddock was named co-chair of the Michigan Republican Party one month after January 6. But as she is gaining prominence, her role as a fake elector is also attracting legal scrutiny.

Attorney General of Michigan Dana Nessel, center, is escorted to the entrance of the Michigan State Capitol on December 14, 2020 in Lansing, Michigan, on the day electors would meet to certify the electoral college vote. Elaine Cromie/Getty Images

“Under state law, I think clearly you have forgery of a public record, which is a 14-year offense, and election law forgery, which is a five-year offense,” Michigan Attorney general Dana Nessel, a Democrat, told MSNBC last week, about the fake certificates signed by pro-Trump electors.

No one, including Meshawn Maddock, has been charged with any crimes related to the scheme.

“This is nothing more than political prosecution of convenience led by Dana Nessel,” said Gustavo Portela, MIGOP Communications Director, when asked about Maddock’s comments and role as a fake elector.

Hedged language in Pennsylvania

The documents from Georgia, Arizona, Michigan, Wisconsin and Nevada explicitly stated, falsely, that the GOP electors were the rightful electors, representing 59 electoral votes.

But the documents from Pennsylvania and New Mexico contained clauses saying that the Trump supporters were electors-in-waiting, in case a court or some other proceeding later ruled that they were the “duly elected and qualified electors.”

If anything, this provided a veneer of legal protection for Trump supporters who were trying to exploit the Electoral College process to overturn an election.

Demarco, who was one of the state’s pro-Trump electors, and is the chairman of the Allegheny County Republican Committee, told CNN he and other alternate electors signed the certificate at the Trump campaign’s request but first demanded the language be changed to make clear it was not intended to contest the will of voters in that state who voted for Biden.

The hedging language was included at the last moment as the Trump campaign had concerns, and questioned whether the change was appropriate in the immediate lead-up to December 14, according to a Trump campaign staffer with knowledge of the matter.

Ultimately the Trump campaign acquiesced. But the internal debate shows that even some of Trump’s strongest allies were concerned about the attempts to overturn the 2020 election.

Pennsylvania Attorney General Josh Shapiro speaks with people as he awaits a speech from U.S. President Joe Biden at Mack Truck Lehigh Valley Operations on July 28, 2021 in Macungie, Pennsylvania. Michael M. Santiago/Getty Images

The office of Pennsylvania Attorney General Josh Shapiro, a Democrat, said in a statement that they looked into the matter but concluded that the fake certificate was not an illegal forgery.

“These ‘fake ballots’ included a conditional clause that they were only to be used if a court overturned the results in Pennsylvania, which did not happen,” the statement said. “Though their rhetoric and policy were intentionally misleading and purposefully damaging to our democracy, based on our initial review, our office does not believe this meets the legal standards for forgery.”

Concerns about democracy

Democratic lawmakers, state officials, and Biden himself have roundly condemned the fake electors plot. Biden brought it up at a news conference Wednesday when asked about his stalled voting-rights bills in Congress.

“I never thought we would get into a place where we were talking about… what they tried to do this last time out – Send different electors to the state legislative bodies to represent who won the election, saying that I didn’t win but the Republican candidate won,” Biden said. “I doubt that anyone thought that would happen in America in the 21st century, but it is happening.”

President Joe Biden answers questions during a news conference in the East Room of the White House on January 19, 2022. Chip Somodevilla/Getty Images

The coordinated nature of these fake elector efforts and the rising power of Big Lie-promoters in Republican circles has concerned voting rights organizations across the country.

Nancy Wang, executive director of the Michigan-based Voters Not Politicians, said her group was founded in 2016 to address redistricting and voting access, but Trump’s attempt to overturn the 2020 election spurred her group to focus on countering anti-democratic efforts at large.

“This is existential. This about the very fundamental institutions of our government - whether we can vote at all, whether we have any power whatsoever,” Wang said. “It is a completely different time that we are facing in 2020 and 2022. It really feels urgent. It is a battle of a completely different kind. It is massive, it is coordinated at a national level. It is much more threatening.”

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Madeleine Albright, first female US secretary of state, dies ...

(CNN) Madeleine Albright, the first female US secretary of state and who helped steer Western foreign policy in the aftermath of the Cold War, has died. She was 84 years old.

The cause was cancer, Albright's family said in a statement Wednesday.

Albright was a central figure in President Bill Clinton's administration, first serving as US ambassador to the United Nations before becoming the nation's top diplomat in his second term. She championed the expansion of NATO , pushed for the alliance to intervene in the Balkans to stop genocide and ethnic cleansing, sought to reduce the spread of nuclear weapons, and championed human rights and democracy across the globe.

Below is a statement from the family of @Madeleine : pic.twitter.com/C7Xt0EN5c9

President Joe Biden paid tribute to Albright in a lengthy statement Wednesday , calling her a "force" and saying working with her during the 1990s while he was on the Senate Foreign Relations Committee was among the highlights of his Senate career.

"When I think of Madeleine, I will always remember her fervent faith that 'America is the indispensable nation,'" said Biden, who ordered flags at the White House and all federal buildings to be flown at half-staff in Albright's honor.

"Few leaders have been so perfectly suited for the times in which they served," Clinton said in a statement. "As a child in war-torn Europe, Madeleine and her family were twice forced to flee their home. When the end of the Cold War ushered in a new era of global interdependence, she became America's voice at the UN, then took the helm at the State Department, where she was a passionate force for freedom, democracy, and human rights."

Clinton later told CNN's Wolf Blitzer that he had recently spoken with his former top diplomat.

She "spent the entire conversation talking about how Ukraine had to be defended and that we had put a lot of those who said we had made a mistake to expand NATO -- she said (Russia's) not going after NATO yet," Clinton said on "The Situation Room."

"She just wanted to support whatever we could do to back Ukraine. And that's all she wanted to talk about. She was happy. She was upbeat," he added. "And she didn't want to venture into her health challenges. She said, 'I'm being treated, I'm doing the best I can. The main thing we can all do now is to think about the world we want to leave for our kids.'"

Albright was a face of US foreign policy in the decade between the end of the Cold War and the war on terror triggered by the September 11, 2001, attacks, an era heralded by President George H.W. Bush as a "new world order." The US, particularly in Iraq and the Balkans, built international coalitions and occasionally intervened militarily to roll back autocratic regimes, and Albright -- a self-identified "pragmatic idealist" who coined the term "assertive multilateralism" to describe the Clinton administration's foreign policy -- drew from her experience growing up in a family that fled the Nazis and communists in mid-20th century Europe to shape her worldview.

She saw the US as the " indispensable nation " when it came to using diplomacy backed by the use of force to defend democratic values around the world.

"We stand tall and we see further than other countries into the future, and we see the danger here to all of us," she told NBC in 1998. "I know that the American men and women in uniform are always prepared to sacrifice for freedom, democracy and the American way of life."

Perhaps most notable were her efforts to bring about an end to violence in the Balkans, and she was crucial in pushing Clinton to intervene in Kosovo in 1999 to prevent a genocide against ethnic Muslims by former Serbian leader Slobodan Milosevic. She was haunted by the earlier failure of the Clinton administration to end the genocide in Bosnia.

The breakup of communist Yugoslavia into several independent states, including Serbia and Montenegro, Slovenia, Croatia, Bosnia-Herzegovina and Macedonia, in the 1990s generated savage bloodshed unseen on the continent since World War II. The term "ethnic cleansing" became synonymous with Bosnia, where Serb forces loyal to Milosevic tried to carve out a separate state by forcing out the non-Serb civilian population.

The Clinton administration did not intervene until the massacre at Srebrenica in 1995, when Serbs killed 8,000 Muslim men and boys, which led to the US-brokered Dayton Peace Plan. But when Milosevic then tried to move his ethno-nationalist plan to Kosovo , the Clinton administration gathered a coalition to stop him doing there what he had gotten away with in Bosnia.

Albright accused Milosevic of creating " a horror of biblical proportions " in his "desire to exterminate a group of people" -- Kosovo's Muslim majority. She came under heated criticism in Washington at the time, with some calling the NATO airstrikes "Albright's War" while others accused her of misjudging Milosevic's resolve. To that end, Albright said in 1999, "I take full responsibility along with my colleagues for believing that it was essential for us not to stand by and watch what Milosevic was planning to do," adding that "we cannot watch crimes against humanity."

Ultimately, the US-led coalition did stop Serbian aggression, and Kosovo declared independence in 2008.

Rwandan genocide among Albright's greatest regrets

Photos: Madeleine Albright's life in pictures Madeleine Albright, seen here in 1997, was the first woman to serve as US secretary of state. Hide Caption 1 of 36 Photos: Madeleine Albright's life in pictures A young Albright sits with her father, Josef Korbel, in this photo circa 1945. Korbel was a Czech diplomat, and the family escaped Czechoslovakia 10 days after the Nazi invasion. Hide Caption 2 of 36 Photos: Madeleine Albright's life in pictures Albright, center, works on the newspaper staff at Wellesley College in Massachusetts. She graduated in 1959 and later received a master's degree and a Ph.D from Columbia University. Hide Caption 3 of 36 Photos: Madeleine Albright's life in pictures In 1988, Albright worked as a senior foreign policy adviser for Democratic presidential candidate Michael Dukakis. She also worked for Walter Mondale's unsuccessful campaign in 1984. During the Jimmy Carter administration, she was a White House staff member and congressional liaison for the National Security Council under Zbigniew Brzezinski. Hide Caption 4 of 36 Photos: Madeleine Albright's life in pictures Albright, as the US ambassador to the United Nations, casts a vote in 1993. She was confirmed shortly after the election of President Bill Clinton, who she also advised during his campaign. Hide Caption 5 of 36 Photos: Madeleine Albright's life in pictures Albright presents a poster from the World Conference on Women as she meets with Myanmar political leader Aung San Suu Kyi in 1995. Hide Caption 6 of 36 Photos: Madeleine Albright's life in pictures Albright reaches out to a Burundian orphan while visiting the country in 1996. Hide Caption 7 of 36 Photos: Madeleine Albright's life in pictures Albright is sworn in as US secretary of state in 1997. Hide Caption 8 of 36 Photos: Madeleine Albright's life in pictures Albright looks over at North Korea during a visit to the border village of Panmunjom in 1997. Hide Caption 9 of 36 Photos: Madeleine Albright's life in pictures Albright puts on a jacket as she visits the US Naval Academy in 1997. Hide Caption 10 of 36 Photos: Madeleine Albright's life in pictures Albright's red outfit stands out in a sea of suits as she poses with other foreign ministers during a NATO meeting in Lisbon, Portugal, in 1997. Hide Caption 11 of 36 Photos: Madeleine Albright's life in pictures Albright has lunch with US troops serving in Bosnia in 1997. Hide Caption 12 of 36 Photos: Madeleine Albright's life in pictures Albright greets well-wishers in Ho Chi Minh City, Vietnam, in 1997. She was the first US secretary of state to visit the city since the Vietnam War. Hide Caption 13 of 36 Photos: Madeleine Albright's life in pictures Albright talks with a member of the FBI while visiting the site where a US embassy was bombed in Dar es Salaam, Tanzania, in 1998. Hide Caption 14 of 36 Photos: Madeleine Albright's life in pictures Albright wipes away a tear as she and the Clintons attend a memorial ceremony for US citizens who were killed in an embassy bombing in Kenya in 1998. Hide Caption 15 of 36 Photos: Madeleine Albright's life in pictures Albright is interviewed by John F. Kennedy Jr. for George magazine in 1998. Kennedy co-founded the magazine. Hide Caption 16 of 36 Photos: Madeleine Albright's life in pictures Albright talks to US Brig. Gen. John Craddock, commander of the US troops that would be taking part in the Kosovo implementation force in 1999. Albright was crucial in pushing President Clinton to intervene in Kosovo to prevent a genocide against ethnic Muslims by former Serbian leader Slobodan Milosevic. Hide Caption 17 of 36 Photos: Madeleine Albright's life in pictures Albright testifies before the Senate Foreign Relations Committee in 1999. The committee was conducting hearings on the Comprehensive Nuclear Test Ban Treaty that the Senate would be voting on. Hide Caption 18 of 36 Photos: Madeleine Albright's life in pictures President Bill Clinton is surrounded by Albright and others in 2000 while signing bipartisan legislation normalizing trade relations with China. Hide Caption 19 of 36 Photos: Madeleine Albright's life in pictures Albright prepares to testify before a House committee in 2000 about how Russian President Vladimir Putin rose to power. Hide Caption 20 of 36 Photos: Madeleine Albright's life in pictures Albright shares a toast with North Korean leader Kim Jong Il at a dinner in Pyongyang, North Korea, in 2000. Albright left office in 2001 after President Clinton's second term ended. Hide Caption 21 of 36 Photos: Madeleine Albright's life in pictures Albright visits a polling station in Abuja, Nigeria, in 2007. She was heading a delegation of election observers from the US-based National Democratic Institute. Hide Caption 22 of 36 Photos: Madeleine Albright's life in pictures Albright speaks to a guest at the unveiling of her official portrait in Washington, DC, in 2008. Hide Caption 23 of 36 Photos: Madeleine Albright's life in pictures Albright and presidential candidate Barack Obama attend a roundtable discussion on foreign affairs in 2008. Hide Caption 24 of 36 Photos: Madeleine Albright's life in pictures Albright visits with students in Chicago in 2012. The city was hosting a NATO summit the next month. Hide Caption 25 of 36 Photos: Madeleine Albright's life in pictures Albright helps plant a tree at a botanical garden in her native city of Prague, Czech Republic, in 2012. Hide Caption 26 of 36 Photos: Madeleine Albright's life in pictures Obama presents Albright with the Presidential Medal of Freedom in 2012. "As the first woman to serve as America's top diplomat, Madeleine's courage and toughness helped bring peace to the Balkans and paved the way for progress in some of the most unstable corners of the world," Obama said in his remarks. Hide Caption 27 of 36 Photos: Madeleine Albright's life in pictures Albright plays the drums while attending the Thelonious Monk International Jazz Competition in 2012. Hide Caption 28 of 36 Photos: Madeleine Albright's life in pictures Albright, second from left, joins other secretaries of state at the groundbreaking ceremony for the US Diplomacy Center in 2014. From left are Hillary Clinton, Albright, Henry Kissinger, John Kerry, James Baker and Colin Powell. Hide Caption 29 of 36 Photos: Madeleine Albright's life in pictures Albright talks with Ukrainian presidential candidate Petro Poroshenko at a meeting in Kyiv, Ukraine, in 2014. Hide Caption 30 of 36 Photos: Madeleine Albright's life in pictures Albright shows off her sneakers with Olympic athlete Angela Ruggiero as they attended an alumni weekend at Wellesley College in 2014. Hide Caption 31 of 36 Photos: Madeleine Albright's life in pictures Albright was known for wearing brooches or decorative pins to convey her foreign policy messages. More than 200 of them were part of the "Read My Pins" collection. Hide Caption 32 of 36 Photos: Madeleine Albright's life in pictures Albright attends the Glamour Women of the Year awards in 2015. She was a past honoree. Hide Caption 33 of 36 Photos: Madeleine Albright's life in pictures Albright speaks at the Democratic National Convention in 2016. Hide Caption 34 of 36 Photos: Madeleine Albright's life in pictures Actor George Clooney embraces Albright at the United Nations headquarters in 2016. They were attending a Leaders Summit for Refugees. Hide Caption 35 of 36 Photos: Madeleine Albright's life in pictures Albright attends the funeral for former US Secretary of State Colin Powell in 2021. Hide Caption 36 of 36

The effort contrasted with the Clinton administration's opposition to international action to stop the 1994 genocide in Rwanda. At the time that Albright was representing the US at the United Nations, the Clinton administration, haunted by the military fiasco in Somalia a year earlier, argued for withdrawing the majority of UN troops from the country in the early days of the genocide. The ensuing planned slaughter of primarily ethnic Tutsis, as well as some moderate Hutus by Hutu extremists, would leave at least 800,000 dead.

Years later, Albright would call it her "greatest regret from that time."

Late in Clinton's second term, Albright also participated in unsuccessful talks to foster peace between the Israelis and Palestinians, which were followed by a second explosion of violence in the region. She was also part of the effort to coax North Korea to abandon its nuclear program by engaging with Kim Jong Il, an effort that was abandoned by George W. Bush.

Albright's tenure as secretary of state also saw the al-Qaeda bombings of US embassies in Kenya and Tanzania, which killed 224 people. She called the attack the "toughest day" of her tenure but would reject criticism that it should have prompted tougher US action against the terror group that would later carry out the 9/11 terror attacks.

"It would have been very hard, pre-9/11, to have persuaded anybody that an invasion of Afghanistan was appropriate," Albright told the 9/11 Commission in 2004. "I think it did take the megashock, unfortunately, of 9/11, to make people understand the considerable threat."

When pressed by the commission about the argument that the Clinton administration lacked actionable intelligence, Albright said "we used every single tool we had in terms of trying to figure out what the right targets would be and how to go about dealing with what we knew."

But she also expressed frustration about the reluctance to push ahead with military force against al Qaeda and Osama bin Laden.

"From my perspective, the Pentagon did not come forward with viable options in response to what the president was asking for," Albright said.

Lifelong opponent of totalitarianism

Born Marie Jana Korbelova, the daughter of a Czechoslovakian diplomat, in Prague in 1937, Albright escaped then-Czechoslovakia with her family 10 days after the Nazi invasion. Her experience growing up in communist Yugoslavia and then fleeing to the US made her a lifelong opponent of totalitarianism and fascism. She was raised Roman Catholic, though she later converted to Episcopalian, and learned later in life about her family's Jewish heritage.

Albright graduated from Wellesley College in 1959 and was married to Joseph Albright from 1959 until 1983, when they divorced. They had three children, twins Anne and Alice in 1961 and Katharine in 1967. She attended Columbia University for her master's degree and Ph.D., which she completed in 1976 before launching on a decades-long career in government service and foreign affairs work under different Democratic politicians and causes.

Albright was aware of her role as a trailblazer and often spoke of the challenges of being the first woman to lead the State Department.

"I think that there were real questions as to ... whether a woman could be secretary of state. And not just in terms of dealing with the issues, but in terms of dealing with the people, especially in hierarchical societies. ... I found, actually, that I could do that," she told CNN in 2005. "And people, I think, now can understand that is perfectly possible for a woman to be secretary of state, and I am delighted that there is second one," a reference to then-Secretary of State Condoleezza Rice.

Throughout her career, Albright was known for wearing brooches or decorative pins to convey her foreign policy messages. When she found out that the Russians had bugged the State Department, she wore a large bug pin when she next met with them. When Saddam Hussein referred to Albright as a snake, she took to wearing a gold snake pin; when she was called a witch, she proudly brandished a miniature broom. When she slammed as "completely un-American" acting Director of US Citizenship and Immigration Services Ken Cuccinelli's suggestion that only immigrants who can "stand on their own two feet" are welcome in the United States, Albright wore a Statue of Liberty pin.

Following her tenure as secretary of state, Albright served as chairwoman of the National Democratic Institute for International Affairs in Washington from 2001 to her death, and she taught at Georgetown University. She was also a prolific author, penning several books, including a memoir in 2003 entitled "Madam Secretary." She also worked in the private sector for a time.

In 2012, Albright received the Presidential Medal of Freedom from President Barack Obama, who said her "toughness helped bring peace to the Balkans and paved the way for progress in some of the most unstable corners of the world."

A forceful voice on foreign policy in retirement

Throughout her retirement, Albright continued working for democracy around the world and speaking about US policy, leveling particularly harsh criticism toward President Donald Trump, whom she called "the most undemocratic president in modern American history."

In a New York Times op-ed written last month just before Russia's invasion of Ukraine, Albright argued that Russian leader Vladimir Putin would be making "a historic error" and warned of devastating costs to his country.

"Instead of paving Russia's path to greatness, invading Ukraine would ensure Mr. Putin's infamy by leaving his country diplomatically isolated, economically crippled and strategically vulnerable in the face of a stronger, more united Western alliance," Albright wrote.

Asked by USA Today in August 2020 how she defined courage, Albright replied , "it's when you stand up for what you believe in when it's not always easy and you get criticized for it."

"It took me a long time to find my voice. But having found it, I'm not going to shut up," Albright said. "I'm going to use it to the best of my ability in terms of making sure that democracy is our form of government and that those around the world that want to live in a democracy have a possibility to do so."

This story has been updated with additional reaction and details.

Inside America's secretive biolabs

Alison Young and Nick Penzenstadler, USA TODAY

Vials of bioterror bacteria have gone missing. Lab mice infected with deadly viruses have escaped, and wild rodents have been found making nests with research waste. Cattle infected in a university's vaccine experiments were repeatedly sent to slaughter and their meat sold for human consumption. Gear meant to protect lab workers from lethal viruses such as Ebola and bird flu has failed, repeatedly.

A USA TODAY Network investigation reveals that hundreds of lab mistakes, safety violations and near-miss incidents have occurred in biological laboratories coast to coast in recent years, putting scientists, their colleagues and sometimes even the public at risk.

Oversight of biological research labs is fragmented, often secretive and largely self-policing, the investigation found. And even when research facilities commit the most egregious safety or security breaches — as more than 100 labs have — federal regulators keep their names secret.

Of particular concern are mishaps occurring at institutions working with the world's most dangerous pathogens in biosafety level 3 and 4 labs — the two highest levels of containment that have proliferated since the 9/11 terror attacks in 2001. Yet there is no publicly available list of these labs, and the scope of their research and safety records are largely unknown to most state health departments charged with responding to disease outbreaks. Even the federal government doesn't know where they all are, the Government Accountability Office has warned for years.

A team of reporters who work for the USA TODAY Network of Gannett newspapers and TV stations identified more than 200 of these high-containment lab facilities in all 50 states and the District of Columbia operated by government agencies, universities and private companies. They're scattered across the country from the heart of New York City to a valley in Montana; from an area near Seattle's Space Needle to just a few blocks from Kansas City's Country Club Plaza restaurant and shopping district.

High-profile lab accidents last year with anthrax, Ebola and bird flu at the Centers for Disease Control and Prevention and the discovery of forgotten vials of deadly smallpox virus at the National Institutes of Health raised widespread concerns about lab safety and security nationwide and whether current oversight is adequate to protect workers and the public. Wednesday the Department of Defense disclosed one of its labs in Utah mistakenly sent samples of live anthrax -- instead of killed specimens – to labs across the USA plus a military base in South Korea where 22 people are now being treated with antibiotics because of their potential exposure to the bioterror pathogen. As many as 18 labs in nine states received the samples, the CDC said Thursday.

"What the CDC incidents showed us ... is that the very best labs are not perfectly safe," says Marc Lipsitch, a Harvard University professor of epidemiology. "If it can happen there, it certainly can happen anywhere."

Some people find little reassurance that nobody was sickened in the CDC accidents or in the historically low numbers of serious infections among lab workers generally, or that infections spreading into communities surrounding labs have been rarer still.

"Many of us think that's really a matter of good fortune," said Beth Willis, who chairs a citizen lab advisory panel in Frederick, Md., home to one of the nation's largest high-containment research campuses at the Army's Fort Detrick.

The country's best labs have robust safety programs, said Kenneth Berns, co-chair of a panel of outside lab safety advisers currently examining biosafety at CDC and other federal labs. Yet the systemic safety problems identified at the CDC's prestigious labs have raised questions about what's happening elsewhere. "It's a matter of some concern," said Berns, a distinguished professor emeritus of molecular genetics and microbiology at the University of Florida.

The consequences could be devastating if accidents were to occur with lab-created strains of deadly influenza viruses that are purposely engineered to be easier to spread than what's found in nature, said David Relman, a microbiology professor at Stanford University who is a federal adviser on lab safety and a past president of the Infectious Diseases Society of America.

"You're talking about something that has the ability to take off, and we could not be confident of being able to contain it," he said.

Relman said that not enough is known about the state of safety at labs that perform infectious disease research but emphasized that the kinds of labs drawing concern are the same ones the public needs to discover important new treatments and vaccines. "We have to find some happy blend of minimized risk and enhanced benefit," he said.

At the high-containment labs identified by USA TODAY, experiments are underway involving drug-resistant tuberculosis, exotic strains of flu, the SARS and MERS viruses, plague, anthrax, botulism, ricin and the Ebola and Marburg hemorrhagic fever viruses, according to interviews and more than 20,000 pages of internal lab safety records and incident reports obtained from labs across the country.

Studies are also being done on a wide range of bioterrorism pathogens that are less known to the public, such as the agents that cause exotic diseases like tularemia, Q fever and melioidosis. Still others are focused on pathogens that pose serious economic risks to agriculture, such as foot-and-mouth disease, brucellosis and "mad cow" disease.

At a few labs, experiments have been done with strains of flu and other viruses purposely made to be more dangerous in studies that seek to understand how they might mutate naturally. White House science advisers called for a temporary halt of that kind of "gain of function" research last fall while expert scientific panels spend the next year studying its risks and benefits.

The research at BSL-3 and BSL-4 labs — which use special equipment, negative air pressure and numerous safety and security procedures — seeks to better understand how organisms cause disease and ways to protect against them. It's the kind of work that the public doesn't give much thought to until people with Ebola arrive on planes in the United States from an outbreak in Africa, or the current avian flu outbreak forces farmers to kill millions of chickens raising the specter of higher egg prices.

It's impossible to obtain a full accounting of lab accidents or lab-acquired infections because there is no universal, mandatory requirement for reporting them and no system to analyze trends to assess emerging biosafety risks and disseminate lessons learned on a regular basis.

The Federal Select Agent Program, which inspects and regulates the subset of research labs that experiment with about four dozen types of pathogens deemed to pose bioterror threats, requires labs to report potential exposure or release incidents, as well as thefts or losses of specimens.

From 2006 through 2013, labs notified federal regulators of about 1,500 incidents with select agent pathogens and, in more than 800 cases, workers received medical treatment or evaluation, limited public data in program annual reports show. Fifteen people contracted laboratory-acquired infections and there were three unintended infections of animals, according to the reports, which do not identify labs and mostly provide aggregated counts of incidents by type. Reported incidents involve events ranging from spills to failures of personal protective equipment or mechanical systems to needle sticks and animal bites.

The program, jointly run by the Centers for Disease Control and Prevention and the U.S. Department of Agriculture, refuses to release copies of detailed incident reports, citing a 2002 bioterrorism law.

Incident records the USA TODAY Network obtained directly from individual labs provide a window on the kinds of mistakes that happen. An animal caretaker in Georgia was potentially exposed to a bird flu virus that kills 60% of the people it infects when a defective respirator hose supplying purified air detached from its coupling in September. A researcher in Wisconsin was quarantined for seven days in 2013 after a needle stick with a version of the same H5N1 influenza virus. A lab worker in Colorado failed to ensure specimens of the deadly bacterium Burkholderia pseudomallei had been killed before shipping them in May 2014 to a co-worker in a lower-level lab who handled them without critical protective gear. None of the workers was infected.

The public and the lab community tend to learn only about the rare instances of serious or fatal lab infections, which sometimes are published as case reports in scientific journals or make national news.

In 2009, Malcolm Casadaban, a University of Chicago scientist with an underlying medical condition, died from an infection with a weakened strain of plague bacteria. In 2012, 25-year-old researcher Richard Din died after being infected during vaccine research involving Neisseria meningitides bacteria at a lab inside San Francisco's VA medical center. Both of their deaths involved research in biosafety level 2 labs, where pathogens are considered to be less dangerous than those worked with in high-containment labs.

Din, who became a researcher to cure diseases like the cancer that killed his mother, developed a fever and started feeling dizzy while out to dinner with friends. He had no idea how serious his symptoms were, his friends and family told USA TODAY. By morning, Din was covered in a splotchy rash and could barely talk, recalled Lawrence Tsai, who raced to Din's apartment to help.

Tsai carried his friend down two flights of stairs and drove him to the hospital. "His body was very hard, very straight," Tsai said. "Only his eyes were open. He could not say anything."

A few hours later, Din was dead. And Tsai said he and his friends were told they, too, were at risk and needed to take antibiotics because of their close contact with him. The bacteria that killed Din can spread from person to person by direct contact with respiratory secretions. About two dozen emergency room workers also were treated with antibiotics as a precaution, according to a presentation about the case at a scientific conference. Nobody else was sickened.

Federal workplace safety investigators, who investigated because the case involved a death, said Din died because the VA failed to adequately supervise and protect workers in the research lab. Among the "serious" issues they cited: Din and other workers in the lab were manipulating specimens of the dangerous bacteria out on tabletops — not inside protective biosafety cabinets that would have reduced potential exposures to droplets or splashes. The lab also failed to train workers about warning signs of infection, violation records show.

Although lab-created outbreaks that spread to people or animals in the surrounding community are rare, they have happened.

"That's what you would worry about," said Gigi Kwik Gronvall, of the UPMC Center for Health Security, an independent think tank that studies biosecurity and epidemics. "But even then the consequences up to now have been limited to the very close contacts of the person who was infected."

A small, deadly outbreak of severe acute respiratory syndrome in China in 2004 was traced to lab workers at the National Institute of Virology in Beijing. In 2007, an outbreak of foot and mouth disease among cattle in England that required herds to be slaughtered was blamed on leaking drainage pipes at a nearby research complex.

In Louisiana, tests are underway to make sure a deadly bioterror bacterium hasn't colonized the soil and water around the Tulane National Primate Research Center near New Orleans. Late last year, the bacteria got out of one of the center's BSL-3 labs, likely hitching a ride on workers' clothing, sickening two monkeys that lived in outdoor cages and later infecting others. Tulane will spend the next five years testing its outdoor monkey colony as well as wildlife and feral cats around the 500-acre facility to ensure the bacteria haven't contaminated the environment. The CDC and Tulane say they think the bacteria spread only inside the center's buildings, and so far tests outdoors have not detected the bacterium, Burkholderia pseudomallei, which can cause severe and difficult-to-treat illness in people and animals infected by coming into contact with contaminated soil or water.

On a global scale, a lab accident is considered by many scientists to be the likely explanation for how an H1N1 flu strain re-emerged in 1977 that was so genetically similar to one that had disappeared before 1957 it looked as if it had been "preserved" over the decades. The re-emergence "was probably an accidental release from a laboratory source," according to a 2009 article in the New England Journal of Medicine.

However, most pathogens studied in labs, unlike the flu, don't spread easily from person to person. Often, to become infected a person needs to have direct contact with a pathogen, which is why lab workers are most at risk, experts said. For example, people can become infected with anthrax by inhaling the bacterium's spores, but once sickened they are not contagious, according to the CDC.

"I don't think the public needs to be too concerned," said Marian Downing, president of the American Biological Safety Association. "There are multiple levels of checks and balances in place."

Beyond accidental lab-associated outbreaks, federal auditors consider the deliberate theft and misuse of a deadly pathogen to be one of the most significant risks of biolab research. That's what the FBI says happened in the 2001 anthrax letter attacks that killed five and sickened 17. Bruce Ivins, a biologist and anthrax researcher at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Md., was the perpetrator, the FBI concluded.

The GAO, the investigative arm of Congress, has issued repeated warnings since 2007 that the proliferation of BSL-3 and BSL-4 laboratories has increased the aggregate risk of accidental or intentional releases of viruses, bacteria or toxins.

No single agency tracks the overall number or location of these labs, the GAO has said. Little is known about high-containment labs working with dangerous pathogens such as tuberculosis, the MERS virus and others that aren't on the select agent list and tracked by the Federal Select Agent Program.

National standards for constructing and operating these kinds of labs are lacking, which means labs vary by local building requirements. While voluntary guidance exists for safe lab design and operations, the GAO has found it is not universally followed.

The documents obtained by USA TODAY show power failures at BSL-3 labs at Texas A&M University repeatedly resulted in the labs losing their negative air pressure during 2013, a key safety feature that is among several used to keep pathogens contained inside the lab. The CDC's labs in Atlanta also have had airflow problems over the years, the newspaper previously reported.

"The public is concerned about these laboratories because exposing workers and the public to dangerous pathogens, whether deliberate or accidental, can have disastrous consequences," the GAO's Nancy Kingsbury told Congress at a hearing on the CDC lab incidents last summer.

Lab regulators at the Federal Select Agent Program — whose departments often fund the research they oversee — would not grant interviews despite repeated requests since last year. The program oversees about 262 organizations that operate BSL-3 and eight organizations that operate BSL-4 labs.

The two federal agencies that jointly run the program — the CDC and USDA — operate their own labs, which have been involved in recent high-profile incidents.

"We believe the current system of inspecting/overseeing laboratories is adequate, but we are always open to continued improvements," the CDC said in an emailed statement. USDA officials also declined to be interviewed.

Lab safety officials at the National Institutes of Health, a major research funding agency that operates its own labs and helps set national biosafety guidelines, also declined interview requests.

"There is no 'zero-risk' proposition in the conduct of research," the agency said in a statement. "NIH works extremely hard to minimize all research-related risks."

More than 100 labs experimenting with potential bioterror agents have been cited by regulators at the CDC and USDA for serious safety and security failings since 2003, USA TODAY has learned.

Yet so much of select agent oversight is cloaked in secrecy, making it difficult to assess regulators' effectiveness in ensuring safety. In several instances, troubled labs and even federal regulators appeared to misrepresent the significance of the government's enforcement efforts.

Since 2003, the CDC has referred 79 labs for potential enforcement actions by the U.S. Department of Health and Human Services' Office of Inspector General. It has levied fines against 19 of them totaling more than $2.4 million, the CDC said in response to questions.

Some are repeat offenders. Five labs have had "multiple referrals" for enforcement actions, the CDC said. Two labs have been kicked out of the program, and five labs have been suspended from doing any select agent research, the agency said.

Which labs repeatedly failed to address safety problems? The CDC won't name names — not even for the two labs kicked out of the select agent program. The CDC and its regulatory partners at the USDA say the 2002 bioterrorism law requires keeping this information secret.

Yet earlier this year, the CDC publicly announced its suspension of the Tulane National Primate Research Center — after the center's accidental release of a bioterror bacterium became publicly known and was the subject of news reports. The CDC said it balances the public's right to transparency with the risk posed by information being made available to those who might use it to threaten public health or security.

Currently seven labs are under the extra scrutiny of a federal select agent lab performance improvement program, the CDC said. The program is offered as a voluntary alternative to suspension or other regulatory action, the agency said, for labs with a "repeated failure to correct past observation, biosafety and security concerns" or failures to comply with extra security requirements for work with "Tier 1" select agents. Tier 1 agents are those deemed to pose the greatest risk of deliberate misuse with the most significant potential for mass casualties or devastating economic effects.

While under scrutiny of the program, an individual researcher or project must halt the research that has been found in violation, but other select agent research at the institution generally is allowed to continue, the CDC said.

Thirty-three labs have been put on performance improvement programs since 2008, CDC said. Their names are secret too.

Dozens more labs have faced regulatory actions from the USDA, which takes the lead overseeing select agent labs primarily working with animal or agricultural pathogens. The USDA says it has conducted 48 investigations that have resulted in $116,750 in fines.

The USDA said all of its enforcement records about these fines are required to be kept secret because of the 2002 bioterrorism law. The USDA did release a spreadsheet it says documents its actions, but the agency redacted almost all the information on it: lab names, violation types and even dates. Only a few references to warning letters and fines were spared the agency's black marker.

The Federal Select Agent Program says no law or regulation bars the labs themselves from discussing their select agent research. And universities and other research institutions routinely publish their research on select agent pathogens in scientific journals.

Registered labs just aren't supposed to share details of specific security measures, such as locations of keys and codes, that would give access to pathogens. The CDC and USDA said there is nothing that prohibits labs from releasing information or answering questions about any regulatory problems they've had. Yet few were willing to readilydiscuss violations or failed inspections.

Labs at the University of Hawaii-Manoa are among those in the federal performance improvement program, at least as of January, records obtained by USA TODAY show. Although the secrecy provisions of the 2002 bioterrorism law apply only to certain federal agencies, officials at the state-run university cited that law among its reasons for denying requests for records about safety violations and the performance improvement program.

The university inadvertently confirmed that its Honolulu labs had been put in the performance improvement program in records it filed in January with Hawaii's Office of Information Practices, which is deciding USA TODAY's public records appeal. The university wrote that being put on a PIP is something it is "proud" of.

"We do not believe entering into the program is an embarrassment, we think it should be showcased, but that would be improper because as participants in the Federal Select Agent Program, we are obligated to keep this information private," the university wrote to the appeals agency, adding that it "has been an exemplary participant in the Federal Select Agent Program."

University of Hawaii officials declined to be interviewed.

Last year, two labs agreed to pay fines handed down by the HHS Office of Inspector General for select agent violations, records show.

A lab that federal officials would describe only as an "Arizona research university" agreed in 2014 to pay a $165,000 fine for failing to keep accurate inventory records for select agents and not having biosafety procedures adequate for the risks associated with the pathogens they worked with. The lab, the USA TODAY Network's reporting found, was Northern Arizona University in Flagstaff. Lab director Paul Keim said the issues date back to 2010 when the university had difficulty keeping up with changing federal regulations. Since then the university's labs have passed several inspections, he said.

An unnamed Florida laboratory agreed to pay $50,000 to resolve violations that included failing to ensure accurate inventories of select agents and failing to notify the CDC and appropriate law enforcement agencies after discovering a missing select agent.

The inspector general's office, citing regulations stemming from the 2002 bioterrorism law, redacted the names of these labs, as well as all other labs receiving fines, in documents it provided to USA TODAY under the Freedom of Information Act. Other labs that have been fined over the years for select agent violations are located in Alabama, California, Missouri, South Dakota, Texas, Virginia and Wisconsin, records show.

As a way of providing some oversight, Congress requires a report each year on the number of thefts, losses and releases of bioterror pathogens at labs regulated by the Federal Select Agent Program.

Yet regulators provide scant details of their activities and the problems identified at labs. Usually just three pages long plus a cover page, the reports contain only aggregated counts of lab incidents by type, plus vague information on a few serious incidents.

The select agent program told Congress it had "imposed a $425,000 civil money penalty" on an unnamed lab where a serious biosafety lapse in 2008 had resulted in a cow in a nearby disease-free herd becoming infected with Brucella bacteria, which cause brucellosis.

Brucellosis is a contagious and economically significant agricultural disease — which causes cattle and other livestock to abort their fetuses, produce less milk, suffer weight loss, infertility and lameness. It has been the subject of eradication efforts for decades.

The $425,000 fine would have been one of the largest in the overall select agent program's history — if it had actually been imposed.

But it wasn't imposed, USA TODAY's investigation found, and the USDA never corrected the record with Congress.

USA TODAY was able to identify the Brucella research program at Louisiana State University's AgCenter in Baton Rouge as the likely recipient of the $425,000 fine by examining USDA animal health reports that tallied what states reported brucellosis cases in 2008. Louisiana, which had a case that year, had been declared brucellosis-free in 2000.

LSU officials spent months denying USA TODAY access to its records about the incident, citing among other things select agent regulations unrelated to the requested information. In statements and interviews, LSU downplayed its violations and provided information that was later contradicted by federal records.

"The incident was not found to be caused by a violation of federal regulations; no fines were imposed upon LSU, and the regulatory agencies had uncertainty as to whether the strain of bacteria in the affected cow was the same strain that was being used in the LSU research," LSU officials said in a November 2014 email to USA TODAY.

Yet, in December 2014, when USA TODAY received copies of the incident investigation reports from the USDA and Louisiana's state agriculture department, the documents showed no uncertainty.

USDA records show that investigators documented serious violations. In levying the $425,000 fine, regulators cited LSU for failing to have adequate biosafety measures, resulting in the release of the bacteria that caused the cow's infection. The USDA also cited LSU for violating regulations by sending Brucella-infected cattle that had been part of select agent vaccine experiments to an unregistered slaughter facility where their meat was sold for human consumption.

LSU's Phil Elzer, who at the time ran the Brucella studies and now is a university administrator, said in an interview the practice of sending research cattle to slaughter was declared in the lab's operating procedures that were reviewed and signed off on at each inspection by Federal Select Agent Program regulators. "To all of a sudden say we were doing it wrong was very surprising," Elzer said. LSU appealed, and the USDA eventually dropped the fine, he said.

In January 2010, records show, the USDA sent a letter to LSU saying the case was being closed but reiterating the issues with the infected cow and the use of the unauthorized slaughter plant.

USDA officials acknowledge that they never imposed the $425,000 fine and made a mistake touting it in their report to Congress.

"It should have stated that we were proposing a fine, instead of stating we issued a fine," said Freeda Isaac, USDA's director of Agriculture Select Agent Services, in an emailed statement. Isaac added that the USDA suspended a portion of LSU's select agent registration because of the Brucella incident and "that portion of the registration is still suspended," Isaac said last fall.

For those labs not in the select agent program — and even those that are — self-policing is the front line of biosafety. Biosafety committees at research institutions, often staffed by scientists' colleagues, assess the risks of proposed research and grant or deny approval for studies. Labs also have other safety staff who may do internal inspections and lab audits, plus additional committees overseeing the use of animals in research.

Yet some researchers appear ignorant of their institutions' biosafety rules. Others brazenly ignore repeated requests by biosafety staff to stop experiments and address issues.

Documents obtained by the USA TODAY Network include at least 50 incidents since 2012 in which researchers were conducting experiments with genetically manipulated organisms without proper approval from internal safety committees. In some cases, records show researchers flaunting their institutional rules.

• At the University of Tennessee Health Science Center in, biosafety staff concluded in a 2013 report that the root causes of a researcher failing to get her experiments approved included "general indifference of the investigator to institutional rules governing the need for biosafety compliance" as well as a "lack of oversight of research activities." The scientist, the investigation revealed, knowingly launched unapproved experiments — exposing mice to a genetically manipulated strain of Burkholderia thailandensis — in a quest to get a vaccine study manuscript published that reviewers said needed additional data. The research was halted after veterinarians found several cages containing dead and dying mice, yet none of the cages was labeled with the infectious agent and they were in an area not approved for experiments with a BSL-2 pathogen. The incident was "an extremely unusual event," said Sheila Champlin, an assistant vice chancellor at the center, noting corrective actions were taken before the scientist was allowed to resume research.

• At the University of Iowa, a biosafety officer in February 2014 discovered that a scientist had been conducting experiments with a genetically manipulated strain of the MERS virus since September 2013 without biosafety committee approval. The biosafety officer ordered the investigator to stop all experiments, and the scientist was put on probation and received increased safety monitoring. The work was being done in a BSL-3 lab at the time it was discovered, but started in a BSL-2 lab, the safety officer's investigation found. The university concluded that the scientist did not "effectively communicate" to his staff the importance of getting safety committee approval before starting the experiments with the virus, which can cause a deadly, contagious respiratory disease in people.

• At the University of California-Irvine, a researcher ignored repeated notices from biosafety staff during 2012 and 2013 that a research project's approval had expired, that it needed further revisions and that all work must cease — yet the scientist continued the experiments with a lentivirus, anyway, in the BSL-2 lab. As a result of the incident, the university now sends researchers four notices starting 90 days before approvals expire, said James Hicks, the university's associate vice chancellor of research. As the deadline nears, Hicks is copied on the notices so he can intervene if necessary. "We take a very strong view and a very correct view of the importance of following the regulations and the guidelines," he said in an interview.

• At the University of Nebraska, a biosafety officer in 2013 found that a researcher had continued growing plants as part of an experiment using a transgenic tobacco rattle virus vector — despite being told repeatedly over two months that additional approval was needed from the biosafety committee before research could begin. As a result of the incident, the university said it revised its biosafety guidelines to describe consequences of unapproved research and sent a letter to faculty. "This was an isolated instance that was fully and successfully resolved," the university said.

• At the University of Hawaii-Manoa, biosafety staff discovered a scientist was doing a type of cancer research in 2012 despite being denied biosafety committee approval and being repeatedly told not to do the experiments. Separately, at a March 2013 biosafety committee meeting at the university, members discussed the need for penalties when researchers fail to comply with biosafety rules, stating "there must be some consequence and corrective action other than an email" to the scientist, the minutes say.

Labs that receive funding from the National Institutes of Health and some other federal agencies are required to report incidents to the NIH involving certain types of genetically engineered organisms and recombinant DNA technology. From 2010 through 2014, the NIH received 644 reports of lab incidents during this kind of research.

Most of the reports the NIH receives are for what it says are non-serious incidents, such as small spills, splashes, cuts and equipment failures. Failure to obtain required biosafety committee approvals to do this type of research are among the more common types of non-compliance.

Although it is not a regulatory agency, the NIH said in a statement that agency staff have made site visits to 100 institutions in recent years in an effort to help improve biosafety committee resources and adherence to the NIH Guidelines for operating their labs.

"Most instances of non-compliance result from a lack of full understanding of the requirements of the NIH Guidelines, rather than willful disregard, and our emphasis has been on corrective actions through education, which institutions seem uniformly responsive to," the NIH said.

In September 2014, the NIH contacted the University of Louisville after a whistle-blower alleged the university had knowingly failed to report lab incidents as required, according to records obtained under the federal Freedom of Information Act. In response, the university told the NIH that it discovered three incidents that were not reported to the NIH but should have been, the records show.

The records indicate that University of Louisville biosafety officials were aware of some of the unreported incidents as much as six months before the NIH opened its inquiry. William Pierce Jr., the university's executive vice president for research and innovation, in a statement to USA TODAY, said "there was apparent confusion regarding the authority and responsibility for reporting violations to the NIH." Pierce said the university has hired an outside firm to oversee its biosafety committee and created training courses for scientists. "We feel confident the current system is working," he said.

The NIH closed its inquiry after the university answered the agency's questions, filed reports on the previously unreported incidents and agreed to take actions to ensure better reporting in the future.

"In investigating the incident, we did not find any evidence of willful non-compliance," the NIH said in response to USA TODAY's questions.

For some residents living near labs, the lack of transparency is frustrating — and worrisome. It's not enough to tell the public the labs have robust safety procedures. "What people are really interested in is how well it's working," said Beth Willis, the citizen lab safety representative near Fort Detrick. "The more people in the community feel that there's secrecy, the more they're distrustful, whether their distrust is warranted or not."