[News & Analysis] Particle Physics: Europe Aims for a Cut-Rate Superlaser To Power Future Particle Accelerators

Science 16 August 2013:
Vol. 341 no. 6147 pp. 704-705
DOI: 10.1126/science.341.6147.704 Particle Physics Could the light at the end of high-energy physics' increasingly long tunnels be light? To keep making progress, physicists need to slam particles together at increasingly high energy. Many fear that the ever-more-powerful machines required will eventually become too expensive to build and run. In search of a way out, European researchers are investigating a radically new type of accelerator based on souped-up versions of devices already available: the fiber-optic lasers now used in telecommunications.

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Hopes And Fears For The Future Of The World, With Ted Koppel

The conflict in Syria rages on, the United States' relationship with Iran remains strained, and China is taking hold as an emerging superpower. As part of TOTN's "Looking Ahead" series, NPR commentator Ted Koppel looks to the future of international relations.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

NEAL CONAN, HOST:

This is TALK OF THE NATION. I'm Neal Conan, in Washington. As some of you may know, this program began in the crisis that led up to what we now call the first Gulf War, in 1991, as Daniel Schorr and I anchored live coverage of briefings from the White House and the Pentagon and congressional hearings.

I got called away to other duties, so Dan took over, and when events failed to start on time, he took phone calls. As this program wraps up today, our guest is another great broadcaster, best known for a program born in another crisis: the Iranian hostage crisis back in 1979. On "Nightline," Ted Koppel provided indelible and indispensible coverage of that and a thousand other stories.

It's been our privilege to include him as a commentator on this program over the past several years, and on our last day, we couldn't think of a better way to conclude the series of conversations we've called Looking Ahead than to call on Ted Koppel. And, of course, we want to hear from you, too.

What makes you believe the future will be better? What keeps you up at night? Our phone number: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. And Ted Koppel joins us today from member station WBEZ in Chicago. Ted, it's always a pleasure to have you on the program.

TED KOPPEL, BYLINE: Hello, Neal. I was just thinking, you know, maybe we need to explain the logic of having me on for this last program to all your many mourning fans out there. I think it's simply so that we can spend a few minutes taking a look around the world, so that by the end of the program, people will say it's terrible that Neal is going. It's terrible that TALK OF THE NATION is going, but there are even worse things going on out there in the rest of the world.

(LAUGHTER)

KOPPEL: I suspect we'll touch on a few of those.

CONAN: Well, I wanted to ask you, yes, to a lot of us, it looks like an incredibly dangerous world. The United States is economically weak. It's being challenged by China in one part of the world, and that, to some people, seems rather dangerous, as a new nationalistic power begins to flex its muscles in areas, well, where there aren't any rules. We look at the Middle East, and it seems like the cauldron in Syria is spilling over into other countries and could ignite a much broader war, that the conflict that a lot of people feared might happen with Iran over its nuclear program could erupt in, well, any of a half a dozen other ways.

And now we look at a situation where - I wanted to ask you: There was an extraordinary piece written in the New York Times a couple, three days ago, by Richard Haass at the Council on Foreign Relations, who we both know. And he said, in fact, what we - where we are is at a moment where the United States can breathe a little bit easier than it could in the past, that there are no existential threats, and we need to get our economic house in order and, well, just stay out of trouble in the rest of the world.

KOPPEL: Yeah, I think Richard's main point - and you're right. He is an old friend to both of us. But I think his main point was that perhaps this would be an opportune time for the United States to focus more on the internal problems that we have and the domestic issues that need to be resolved. I certainly agree with him on that. I'm not sure that I agree with the other point that you made that he puts forth in his op-ed piece, namely that the dangers out there are not as great as they were before.

I think, quite frankly, we are living in the most dangerous times that I have known in my adult lifetime.

CONAN: And Ted is not a young man anymore, so we're including the Cold War.

(LAUGHTER)

KOPPEL: No, you're exactly right. I mean, I was born in 1940. So that - yes, I wasn't terribly conscious of World War II, but by the time the Korean War came along, I was paying attention. And by the time Vietnam came along, I was there. So I am including those times.

I think we live - and I'm including the times of the Cold War. The Cold War was potentially, hugely dangerous. Obviously, the possibility of nuclear war between the Soviet Union and the United States dwarfs anything that we are confronting today, and mercifully, that threat seems to have eased somewhat.

But the fact of the matter was that the Soviet Union and the United States managed to maintain an uneasy sort of stability throughout the world, which even had an acronym, this notion of mutual assured destruction: We won't do it to you, because we know what you're going to be able to do to us after we've done it to you.

That doesn't exist anymore. We are not necessarily dealing with great nation-states anymore. They don't represent the big threat. The big threats now are the Hezbollahs and the al-Qaidas and the various groups around the world whose names we don't even know. But the individuals who, either through the use of explosives or perhaps chemical weapons or biological weapons or something that you and I have talked about before, cyber-warfare, are able to inflict enormous damage without our knowing where it's coming from.

CONAN: And the interesting part of it is that there are - we've been having a series of conversations with our correspondent in the Middle East, Deborah Amos, another old friend. And she has been talking about the ratcheting up of rhetoric in the conflict in Syria, and all of the nations around it, as Shiite groups and Sunni groups demonize each other in a way that has not been seen in our lifetimes. And that makes that conflict so much more dangerous as they find ways to, well, excuses to kill each other off.

KOPPEL: Well, and when you talk about the fact that there are well over a billion Muslims in the world, you realize - and, you know, that kind of warfare between the Sunni and the Shia, that can spread to parts of the world we haven't even included in our conversation about where danger lies: the Philippines, Indonesia, to me, still the most dangerous country in the world, Pakistan, which has over 100 nuclear warheads, maybe at this time, as many as 200 nuclear warheads. And the existential fear that has nagged everyone working for the U.S. administration - going all the way back now to 9/11 in 2001 and before - that one of these weapons, these weapons of mass destruction, will end up in the hands of a terrorist group that is capable of bringing it into the United States.

That is still what scares the hell out of everybody. And quite frankly, Neal, what worries me is not so much that danger alone, but the manner in which we, as a nation, have responded to it: two wars, neither of which has gone well for the United States. The war in Iraq did not turn out well. The war in Afghanistan is not turning out well.

And we have turned ourselves as a nation inside-out, both economically, and in terms of some of the systemic and organizational changes that have been made all in the name of national security. And, you know, we can get into any one of those aspects, obviously.

CONAN: Yet some would say, as difficult as that has been, as fundamentally altering of our society that has been in many ways, it has largely worked. There have been, yes, incidents, Fort Hood, yes, Boston. And as bad as those have been, they are not on the scale of 9/11, and the country is not in the same place as it was 11 years ago.

KOPPEL: No, you're exactly right, but that's not the greatest danger. The greatest danger is not what others do to us. The greatest danger is what we do to ourselves. And if you consider the number of lives that have been lost, the number of lives that have been damaged forever, the nature of this security behemoth that has been built up in the United States now - whether it's at the relatively trivial level of the folks in uniforms now that we see at the airports, to the notion of what's been done to encroach upon privacy in this country, the amount of money that has spent.

You know, we keep talking about, you know, the trillions that this, you know, that this nation owes. Well, two to 3 trillion has been spent on the wars in Iraq and Afghanistan, and I would argue that we're worse off in Iraq today than we were before the war. And we may be worse off in Afghanistan. That still remains to be seen.

And when I say we're worse off in Iraq, what I mean is that the balance in the Persian Gulf between Iran and Iraq was kept in a sort of uneasy equilibrium by Saddam Hussein, of all people. The fact that he is now gone has meant the world to the Iranians. Iran is now probably as influential, if not more influential, in Iraq than we are.

CONAN: Well, Ted, you've given us a lot of reasons to buy stock in Sominex. I do have to ask you, though: Are there things, as you look around the country, as you travel around, that give you hope?

(LAUGHTER)

KOPPEL: Neal, I hate to do it, but you've set me up for this. No. I guess that I'm more of a pessimist than an optimist, and I'm sure we'll get lots of good people calling in - I hope we do - who will explain to me how wrong I am and why I'm wrong. There's not a great deal that does give me optimism right now.

I am not hugely optimistic about the nature of communication in this country. I think we have trivialized communication to the point that everything now is reduced to snippets of thought. We respond in nanoseconds to one another. Reflection, thought are increasingly becoming a thing of the past. So no, I don't mean to be, you know, a total fool about this. I'm sure there are many wonderful things that are still going on.

And as an immigrant who came to this country at the age of 13 from England, I love the United States deeply. I wouldn't live anywhere else in the world, for anything. But that's precisely why I'm so pessimistic and why I'm so depressed by it.

CONAN: Because of the things we are willing to do to ourselves in fear?

KOPPEL: Well, it's not even so much what we're willing to do to ourselves. It's what we are doing to ourselves. I was talking - as you pointed out in the beginning, I'm out here at WBEZ in Chicago, and I was talking to a young producer, a reporter here who is working on a series that he hopes to do on people who are dying in the prison system here in Illinois.

And there have been 200 deaths, he was telling me, over the last couple of years. Some of them are as young as people in their 20s. Most of them are under the age of 53. And in large measure, this is happening because of the privatization of the health system in our prisons.

And we are privatizing ourselves into one disaster after another. We've privatized a lot of what our military is doing. We've privatized a lot of what our intelligence agencies are doing. We've privatized our very prison system in many parts of the country. We're privatizing the health system within those prisons. And it's not working well.

CONAN: What makes you believe the future will be better? What keeps you up at night? 800-989-8255 is our phone number. Email us: talk@npr.org. Ted Koppel will stay with us. More in a minute. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.

(SOUNDBITE OF MUSIC)

CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Over the years, Ted Koppel has joined us to talk about everything from an evolving China to the debate over torture, wars in Iraq and Afghanistan, turmoil in Syria, presidential power in this country, the changing new business. We've asked him back today one last time to help warp up our series of conversations called Looking Ahead.

We're taking the wide view this time. Call, tell us, what makes you believe the future will be better? What keeps you up at night? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. We'll go to Cher(ph), Cher with us on the line from San Antonio.

CHER: Yes, hi. Let me thank you before I start with my comment. I am very hopeful for my nephews. Thank you for your wonderful programming.

CONAN: Thank you.

CHER: I want to say that I am hopeful for my nephews. I'm not married. But the thing is that has kept me joyful or gives me joy in the future is even though we - when I first heard that they had cut out the two sections of the Civil Rights Act of '65, I had a sinking feeling in my stomach all day long and in part of the night. I still feel hopeful because my own family history, we have been here 18 generations.

We first, our Spanish side of the family came over in the 1500s, and we've survived the oppression from the, well, the U.S. invasion of Mexico. And we've seen where lands were taken away, where Texas rangers used to go to south Texas to - for Saturday night entertainment used to hang Mexicans and Niggers. And but even then my family, because they were very strong Catholic survivors, they believe in God's will and received strength from their faith.

I can point to my mom and dad, who sacrificed a lot to send myself and my siblings to private school. We never attended public schools. And it was because of the U.S. economic system. But now, the thing is now we have to go back and fight the civil rights struggle again, and...

CONAN: Cher, I'm sure you meant the Voting Rights Act is what the Supreme Court ruled on. And it was - wanted to bring Ted in, interesting to watch this week in the United States Supreme Court where so many, and we saw John Lewis and the pain on his face as he was responding to the Supreme Court decision and asking them to take a walk in his shoes to think that the voting rights that had been granted could not be taken away.

And then the next day to hear the Supreme Court revolutionize thinking on gay marriage.

I was about to say you - it's probably been one of the more historic weeks for the Supreme Court, certainly step back in terms of civil rights as far as the races are concerned but clearly a step forward in terms of rights for gay Americans. Curious that the same thing, that, you know, a step back and a step forward would happen with the same court in the same week, but it did.

Cher, thank you very much, and thank you for reminding us of the long and difficult period that your people have survived and the reasons that they are tough enough to look forward to the future.

CHER: Yes, we will, and God bless for whatever your endeavors. And do come back and let us know how and what you're doing. Thanks.

CONAN: All right, thanks very much, Cher.

CHER: God bless you.

CONAN: Thank you. Ted, I also wanted to ask you about the example of a man who lies dying in South Africa today.

KOPPEL: Nelson Mandela, yes.

CONAN: Indeed.

KOPPEL: An extraordinary man. It gives me a chance, Neal, to sort of play this game I sometimes play with friends and say, you know, if you go back to the 1930s and the 1940s, and if you take, without regard to good or bad, simply the word great and apply it to leaders, then you would, you know, clearly have Mao and Stalin and Hitler and Roosevelt and Churchill and de Gaulle.

I mean, the list goes on and on and on of great leaders. Now play the game today. If I were to say to you, Neal Conan, forget about Nelson Mandela for a moment because I think he's the exception to the rule, name two or three great leaders today.

CONAN: Joe Torre was a hell of a manager for the Yankees.

(LAUGHTER)

KOPPEL: Yes, he was. No, I don't mean to put you on the spot because I actually have a theory as to why that is. I think in some measure it's our fault. When I say our fault, I mean the media. The fact of the matter is that many Americans, most Americans, didn't even know that FDR was suffering from polio, that he was in a wheelchair, because the press in those days, the media were complicit in keeping that secret from the American public.

The world public didn't necessarily know very much about these leaders. They certainly didn't know in some of the more tyrannical societies how evil some of those people were. But the fact of the matter is we now know so much about our leaders, we know so much about everybody that it's very hard to maintain any kind of heroic stature.

And perhaps the thing that singles Nelson Mandela out is precisely the fact that he was isolated for almost 27 years of his life in prison. Now of course his greatest achievement was when he came out, was not only in not seeking revenge for what had happened under Apartheid, but far from that, seeking tolerance on both sides and trying to bring some kind of racial calm and political calm to South Africa, which for a while he and another heroic figure, de Klerk, succeeded in doing.

CONAN: Let's get another caller in on the conversation. Let's go to Maureen(ph), Maureen with us from St. Louis.

MAUREEN: Hi.

CONAN: Hi.

MAUREEN: Can I be cautiously optimistic?

CONAN: Sure.

KOPPEL: Oh, please.

MAUREEN: Of the future? My mind always goes back to an interview I saw Paul Tsongas do in 1993, and at the time he said if you're 30 years old today, you're not going to live the retirement that your parents are. And I always remember that. It stuck with me because I was 30 years old at the time. And now of course I realize he was exactly right.

You know, my husband and I might have to unfortunately, work until we can't stand anymore. And maybe we won't be able to help our kids too much with college or, you know, maybe a little bit with a house. So that's kind of my concern.

KOPPEL: Wait a second, is that the positive note you were going to inject into this...?

CONAN: I was just going to ask where's the optimistic part.

(LAUGHTER)

MAUREEN: Well, the optimistic part is I've got a job, and I have great insurance.

CONAN: Well, congratulations on the job, and we hope and look forward to your happy retirement, Maureen.

MAUREEN: Neal, thank you, and Neal, if I could just say one thing, at least once or twice a week, I must tell my husband that Neal Conan is brilliant.

(LAUGHTER)

CONAN: Well, it's interesting...

MAUREEN: I can't tell you how much we're going to miss you.

CONAN: Very few of the people who actually know me say that.

MAUREEN: Well, thank you so much and your staff for all you've done.

CONAN: Thank you so much, appreciate the phone call.

KOPPEL: Neal, if I were you, I'd put that on a loop and play it at home.

CONAN: I want to read some emails, this from Anna(ph): Honestly what keeps me most up at night is the future, and what keeps me up at night is climate change, not political conflicts but the pace at which humans are altering the planet and potential effects it will have for all of us.

This from Tina(ph): If we can get corporate money out of American politics, the future will be bright. If we can't, it will not. This from Casey(ph): Not being able to listen to my dad on the radio anymore. That's my daughter.

(LAUGHTER)

CONAN: Good run, she says. Thank you very much, Casey. What keeps me up at night are drone attacks around the world, spying here at home, as Ted Koppel said, it's a behemoth, one that's been built up behind a wall of aggressive secrecy by private contractors hidden even from our own Congress. This is not democratic. This is not safe. This is not sustainable. As for hope, my daughter, she is the reason I worry about the future and the reason I work to change it.

Work to change it, Ted, do you see any progress there?

KOPPEL: Well, there will be progress if indeed this next generation can tear itself away from the Facebook and the Twitter and the texting and start focusing on - and, you know, obviously I sound like an old curmudgeon, which increasingly I am becoming. I know there are many, many very bright young people out there. But I do worry about the nature of communication today.

It's not helpful. It's too fast. It's too abrupt. We need to reflect a little bit more, and, you know, with that, is the talent out there? You bet it is.

CONAN: Let's go next to Rafael(ph), Rafael with us from San Antonio.

RAFAEL: Hi Neal.

CONAN: Hi.

RAFAEL: I just want to say I've only found out about this show not too long ago, so I'm kind of sad that it's going to be taken away from me so fast. But on what your guest is saying about communication, about how it's too fast, that is actually what makes me optimistic. Because of the fact that it's so fast, we're able to spread idea more and more faster.

Social media, the Internet, all that, that makes me happy because they can't keep us in the dark.

We created our own media, which is person to person. Instead of having to go through a middle man, such as a news network or a corporate-sponsored news network, we were able to talk to each other with no filter, raw, right there, just - I mean, look at the Arab Spring. I mean, Facebook helped a little bit with that...

CONAN: And to emphasize Rafael's point, Ted, we look at what is happening in Turkey these past few weeks, where what was historically a society very able to suppress dissent has been unable to do so in part because it has been unable to control the news media because people can communicate on Twitter.

KOPPEL: In terms of social communication - and I draw a clear line of distinction between social communication and journalism. Journalism really does require certain disciplines. They have rusted, for the most part, these days. We're not seeing a great deal of it, particularly on radio and television these days, NPR mercifully being one of the exceptions. You still get great journalism on NPR.

Journalism requires a little bit more than simply people communicating with one another on Facebook or on Twitter. I agree that, in terms of the political impact, in terms of the social impact, it is huge. But if you look back on what the expectations and the hopes were for the Arab Spring when it first broke out in Tunisia and in Egypt, they have not been realized.

The - you know, the fact that certain tyrants have been overthrown is a first step, but it's not an end in itself. And if you look at the condition that Egypt is in today, I'm not sure that you can say that enormous progress has been made. I'm not sure that you can say that enormous progress, you know, is - we have no idea where things are going to go in Turkey.

I agree, you wouldn't have the demonstrations without the social media, but, you know, revolutions take a long time, and the results of revolution take sometimes decades and even generations to mature.

CONAN: And revolutions' history tells us, are not pretty.

KOPPEL: They never are. And the mere fact that people are able to, sort of, galvanize public meetings and engage in demonstrations that are very, very engaging to watch on television or to listen to on the radio, that doesn't mean, necessarily, that political progress has been made.

CONAN: Rafael, thanks for the point, and thanks very much for the call. And we're sorry we're not going to be around a little longer for you.

RAFAEL: You take care, man. You take care.

CONAN: So long. We're talking with Ted Koppel today as we conclude our series of conversations "Looking Ahead." You're listening to TALK OF THE NATION from NPR News.

This email from Ed(ph) in St. Louis: I'm a bit younger than you and Ted, born in 1964 - everyone is younger than me and Ted - and one of the things I'm hopeful about is how my generation is leaning in to the issues of our day. Many of us experience downsizing and other serious cultural disruptions that have caused us to take deeper stock in our lives. We're realizing we can no longer drift through life and have to work at things now unlike any period.

Ted, I hate to read things into an emailer's message, but it sounds like some of the focus that people developed during the Depression.

KOPPEL: I'm not quite sure I get the point, Neal. Help me out on this one. Where are we going here?

CONAN: Well, because times were so tough, people who were drifting through life before, now realize they have to buckle down and get to work.

KOPPEL: Well, I, you know, I don't think the problem today is an unwillingness of people to buckle down. I think the problem is the millions of unemployed who have given up hope, the millions of unemployed who are no longer even counted or listed because they've stopped looking for work.

You know, does massive unemployment focus the mind and get people to work harder? Yes. Of course it does. I don't doubt that for a minute, and in that sense, I guess I see the analogy you're making to the Depression.

But what came out of the Depression was a generation of people who desperately held on to any kind of good job they could get - the folks who, you know, who joined the Post Office, the folks who joined the Customs Service, the folks who went into the military back in the 1930s because a government job was the best thing you could hope for.

You know, that was one of the things that came out of the Depression. I'm not sure if we're quite there yet, or if - in fact, I doubt that we're going to be getting there. I don't think the nation is facing that kind of economic turmoil.

CONAN: Let's get Nettie(ph) on the line. Nettie is with us from Austin, Texas.

NETTIE: Hi. Thanks for taking me on the line. I'm really going to miss you, Neal.

CONAN: Thank you.

NETTIE: I grew up listening to you with my grandpa driving me around. So I really am going to miss the show. I'm very, very hopeful, only because I stood in the gallery two nights ago at the Senate hearing. And at 12:05, I looked around the gallery, and it was filled with both men and women, 50-50, out for their own, you know, their own perspective on the cause that was being discussed.

And so I'm incredibly hopeful that at 48, with a 17-year-old daughter, that men and women are united in a majority and that the majority is again becoming the people, not determined by our Democrats or our Republicans. And I think the greatest danger in the future is continuing to foster internal xenophobia within our country, so that we don't know our neighbors and we're afraid to go to our own community because of all the things that the media tells us to be afraid of. So...

CONAN: Nettie, of course, is referring to the event the other day at the state capital there in Austin where Democrats, led by state Senator Wendy Davis, filibustered the abortion bill and ran out the clock, and it was past midnight, and so the votes did not count. But, Nettie, I have to ask you. We know that Governor Perry has called another special session. That bill is going to pass.

NETTIE: Well, the bill is going to pass, but I believe it'll be in the courts after that. But the bigger thing to gain from what happened is that I think our state is going to go blue. And I think that in terms of even social media, having over 200,000 people watching the YouTube stream - YouTube stream at one in the morning is remarkable. And what it says is that people are engaged, and it's not about women's rights. It's not about men's rights. It's about humanity's rights.

And the press cannot be complicit and keep us from news anymore because of this tide of all the adoption of all these tools. So I'm very, very hopeful, no matter what you stand - where you stand on these issues, that we have new ways to communicate and that men and women are together showing up at this event.

CONAN: Nettie, thanks very much for call. We appreciate it.

NETTIE: Thank you.

CONAN: Here's an email that we have from Nancy. I'm a master's level social worker and do not earn enough to stave off student loan payments. It's troubling that we're encouraging our children to pursue college education, but we'll have to place an emphasis on the careers that will earn the most money and not on the careers that will help the most people.

Well, what encourages you about the future? What keeps you up at night? 800-989-8255. Email us: talk@npr.org. Stay with us. We're wrapping up our conversation "Looking Ahead" with commentator Ted Koppel. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

CONAN: Here on TALK OF THE NATION today, we're wrapping up our series of conversations "Looking Ahead." Commentator Ted Koppel is with us from member station WBEZ in Chicago. And, Ted, if the listeners will indulge a moment to talk about our own business, I have to say you've had two horses shout out from underneath you this week. "Rock Center" died earlier this week.

KOPPEL: Yes. Well, I was going to say, Neal, if anyone in the broadcasting business is listening to us right now, and I suspect some are, stay away from me.

(LAUGHTER)

KOPPEL: I have some kind of professional plague. Poor old "Rock Center" had the rug pulled out from under it, and I went to what they called a wrap party last night. A wrap party is where all the staff, many of them now without jobs, get together at the expense of NBC. And I have a couple of drinks and some canapes and start pumping each other about what jobs are available out there and now, today, with you. So I have, just as you correctly put it, had the "Rock Center" horse and now the TALK OF THE NATION shout out from under me.

But that gives me an opportunity to point to the good news for me. Unlike so many of your listeners, unlike the millions out there who are listening right now, Neal, I will not miss this program but simply for the reason that it was never heard in Washington in the first place. That's about the only good thing I have to say about not having been able to hear...

(LAUGHTER)

KOPPEL: ...TALK OF THE NATION all these years is that, you know, I never got used to listening to it in the afternoon. But I do appreciate talking to a fellow journalist who has principles, who has intelligence, who has experience and brings them all together with a great appreciation for the intelligence of his audience. You have always done that, and I am convinced that the opportunity will arise again for you do to it at some point in the future. Where? You haven't confided to me yet, but I'm sure it'll happen. Cream rises to the top.

CONAN: Ted, that's very kind of you to say, but that's a very small silver lining - tarnished silver lining. You've managed to identify that.

KOPPEL: Yes.

CONAN: I recently heard - Charlotte emails us - I recently heard Michael Moore say he was optimistic, which surprised me, considering the pessimistic topic of many of his documentaries. When questioned, he said it was because the young people today is a whole - are more accepting of each other - whether that is race, sexual orientation, religious belief - of differences in general. Upon reflection, I have to agree that for the most part, that's true. I think that's why the Republican Party is having such a hard time attracting younger people. When the old white guys that seemed to control a lot of the aspects of this country pass on, there's a good possibility it will look a good deal differently.

KOPPEL: I buy that. I think - I take that's absolutely true. In fact, my wife and I we're talking about it, just on the flight out here to Chicago. The level of tolerance that young people have for one another, for people of different backgrounds, different religions, race, sexual orientation, that truly is something in which, I think, we can all rejoice. So, yes, someone has identified something that I can look forward to with hope.

CONAN: Let's go to Summer - and if I can push the button correctly - there we go. Summer is on the line with us from Cascade, in Idaho.

SUMMER: Hi there.

CONAN: Hi.

SUMMER: I just want to make a comment. What really worries me as a young voter is partisanship in our government. I think that's it's extremely harmful. It causes people to blindly take sides, and it doesn't really allow them to form their own opinions, and it halts a lot of progress in our government. And that we also tend to abuse things that should be - we should approach with humanity. And we tend to take sides based on our own political views, like Trayvon Martin, for example. I mean, that's the case of a murder of a young boy, yet we turned it into a Republican and Democrat war.

CONAN: Culture wars and partisanship, Ted. We know, again, as students of history, that this country was bitterly divided at periods in the past. You think of 1800 or so. But it doesn't seem to me there's been anything quite like this in our lifetime.

KOPPEL: Well, and I think that we in the media bear a large responsibility for it, Neal. You know, the fact of the matter is that when you and I began in this business, we tended to focus more on what we thought the public needed to know. And I'm speaking more of commercial television and commercial radio than I am of NPR.

We focused on what the public needed to know, because we had a responsibility under the FCC regulations to operate under public interest, necessity and convenience, and we feared - or at least the owners of our networks and stations feared that if they didn't do that, if they didn't have a news division that counterbalanced all the money they were making from entertainment, that they might actually lose their licenses, or at least have them suspended.

That is no longer the case. And the fact of the matter is that the focus now is so much on having to divide the pie of listeners and viewers among - in the old days, it used to be ABC, NBC and CBS. Now, there are thousands of options out there. And that means that they have to focus more and more and more on giving the public what it wants rather than what it needs. And one of the things they found that the public wants is partisanship.

And so you have MSNBC on the left, and you have Fox on the right. And you have Jon Stewart on the left and you have Bill O'Reilly on the right, or you have Rush Limbaugh on the right. And the end result is, as your caller - or as your listener points out, the end result is that we are constantly at war with one another, looking for ways in which we can find fault with what we're doing rather than seeking some kind of compromise and progress. And that's a very, very dangerous trend.

CONAN: Summer, thanks very much for the phone call.

SUMMER: You're welcome. And thank you so much. I really love your show.

CONAN: Thank you. Oops, I hung up on her before she could finish saying nice things about me. Boy, there's somebody who needs another 35 years on radio. Here's an email from Analisha(ph) in St. Louis: There's a lot out there to keep me up at nights, certainly. I'm troubled by a whole slew of things: terrorism, our crumbling environment, the unethical garment industry, goings on in Syria, human inequality, the fact that the Internet and television is killing literature and human connection, drones, or the cancellation of TALK OF THE NATION. Even so, I know in my heart the future is bright.

We'll be OK because we've always been OK. Goodness prevails. It has to. Believing otherwise will only destroy us. Whenever I'm feeling too torn up about dismal current events, I reflect on a quote by Anne Frank: "Despite everything, I believe that people really are good at heart." If she believes it, there's no reason we shouldn't. And Ted, that is a reminder that as bleak as things might look now, in the past, they have looked bleaker.

KOPPEL: No one has ever said that you should do away with faith or hope. And I think that what that message conveys is a message both of faith and hope, and the last thing in the world I want to do is undermine confidence in either one of those.

CONAN: Let's go to John, and John is on the line with us from San Antonio.

JOHN: Yes. Neal, many years ago, you helped to turn me into an optimist when I was ranting and raving, and you turned me around. And your screeners suggested I tell you that one of the things that causes me to be an optimist about America is Thursday morning, starting in Louisiana after the young troops had left Thursday afternoon - well, Wednesday afternoon, San Antonio, Fort Sam.

I was taking these young guys who just graduated from AMEDD as medics to learn how to jump out of perfectly good airplanes at Fort Benning, Georgia. And the young people of America, like my six grandkids, four sons and one daughter caused me to have hope in the future, and you did, too, sir, for years. But I am inclined to agree a little bit with Ted. I remember Walt Kelly's comic strip of 40 years ago in which he said, we met the enemy. They is us.

KOPPEL: He is us, yep.

CONAN: Yep. "Pogo," of course.

JOHN: "Pogo," right.

CONAN: Do you still have your pew stamps, John?

JOHN: Yes, sir.

(LAUGHTER)

CONAN: Nobody...

JOHN: And, by the way, I'm Ted's age. My first historic memory was that Sunday when we were coming in from near the LBJ Ranch to San Antonio and my dad had the car radio on, and I heard that FDR had died at Warm Springs.

CONAN: My goodness. John, thank you very much for the call, and we appreciate the memories.

JOHN: And thank you. And, by the way, you're a little bit like the famous lion that C.S. Lewis wrote about in "The Lion, the Witch and the Wardrobe." You'll be back. You'll be back.

CONAN: Yeah. Things did not turn out well for him, right? There was this...

JOHN: Well, yes. But you won't be sacrificed. You'll be back, because I'm watching. And I know you can't keep a good guy like Neal Conan down. You'll be back.

CONAN: Thank you very much, John. And...

JOHN: Somewhere.

CONAN: ...we'll try to avoid the crucifixion if we can possibly can.

KOPPEL: I was going to say that it's a very nice analogy, because as I recall my C.S. Lewis, the lion was a God-figure, wasn't he?

CONAN: Right. He was a God - well, a Christ-figure, in any case.

KOPPEL: A Christ-figure, yes.

CONAN: Yes, indeed. This from Barb: As an immigrant, this country is full of people like me. We come because we believe in a better life. We know the future's bright. After 33 years, no regrets.

Michael in Anchorage emails: It is true America has problems, and it is trendy, ever since 9/11, to talk about how down America is. We're still the strongest economically and multi-culturally, and in terms of ideas and political ideals that we are gradually moving forward. Let's discuss America's strength.

Devlin in Ontario, California, excuse me, writes: People make me optimistic for the future. Though my volunteer work with African Well Fund, a nonprofit organization dedicated to the mission of funding the construction of clean water and sanitation projects in sub-Saharan Africa, I've been fortunate to work with people who saw a problem and are working to change that problem.

There are children as young as four volunteering for us who believe in doing right, who want to give water to people lacking clean water, feed people without food, house people without homes. For them, change is that simple and right. And they make me believe, too.

This from Scott in Oklahoma City: What scares me are the long-term consequences of the disappearing middle-class. I fear my children will see large-scale civil unrest from people who believe upward mobility no longer exists.

And many of these people have, well, just to avoid embarrassment, they have said nice things about the program. And I thank them all for that. Ted, you have, as well. I wanted to ask you, finally - we just have a couple of minutes left. As we move ahead, is there something that you are going to be working on next that we should be paying attention to?

(LAUGHTER)

KOPPEL: I don't know. I - actually, I am a great believer in the wonders of surprise. And it has always happened in my life - and I have no reason to believe that it won't happen again now - that something wonderful always crops up. People always have great ideas. Every once in a while, I even have a great idea. But you and I owe each other at least a cup of coffee and maybe lunch or dinner someplace and, you know, maybe we'll go out and start a network together.

CONAN: Hey. We could put on a show.

KOPPEL: We could put on a show. You write the music.

(LAUGHTER)

KOPPEL: I'll write the lyrics. Oh, well.

CONAN: Ted, thank you. It's been an honor. I referenced Daniel Schorr at the beginning of this broadcast. One of the great honors in my life is to work with people as brilliant as you and Dan.

KOPPEL: Well, you're very, very kind. And, Neal, I really mean it. Cream does rise to the top. Something will turn up. We will hear the voice of Neal Conan again, and it can't come too soon for me. And I know speak for millions of others.

CONAN: Ted Koppel joined us from our bureau in Chicago. WBEZ used to be our bureau in Chicago. Now, it's a member station in Chicago. Ted, thanks as always. You're listening to TALK OF THE NATION, from NPR News.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

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Surgeons Nuland And Gawande Look To The Future Of Medicine

As the Affordable Care Act rolls out and technology changes certain procedures, the role of doctors continues to shift. As part of TOTN's "Looking Ahead" series, Dr. Sherwin Nuland and Dr. Atul Gawande discuss the future of the practice and profession of medicine.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

NEAL CONAN, HOST:

This is TALK OF THE NATION. I'm Neal Conan in Washington. Of the many programs we've aired over the years on medicine, none has been more interesting than the series of conversations with Sherwin Nuland and Atul Gawande, both surgeons and teachers. Both have also gone public as writers on their profession both to inform the public about what they do and why and how it's changing and to speak with their colleagues about what works and what doesn't.

We're taking advantage of our series Looking Ahead to ask them back. We'd also like to hear from doctors in our audience today. What is changing? What works, and what doesn't? 800-989-825(ph). Email talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the program, Jason Osder on his documentary on a standoff that ended after the Philadelphia Police Department dropped a bomb that would eventually kill 11 men, women and children, "Let the Fire Burn." But first we're joined by Dr. Sherwin Nuland, professor of medicine at Yale School of Medicine, author most recently of "The Soul of Medicine: Tales from the Bedside." He joins us from studios at Yale. Welcome back.

SHERWIN NULAND: Well, it's a pleasure, Neal, thanks.

CONAN: And Dr. Atul Gawande, surgeon at Brigham and Women's Hospital, author of "A Surgeon's Notes on Performance," who is with us from studios at the hospital there in Boston. Good to have you back, as well.

ATUL GAWANDE: Thank you, Neal, thanks for having me on.

CONAN: And Dr. Nuland, let's start with you. I wonder, as you sit - at this - from this vantage point, what interests you the most about the profession?

NULAND: Oh my. It's fun. Can you imagine anything more rewarding than the opportunity to help people who are desperately in need because of sickness, to help their families for example, to see that something has changed because of a set of maneuvers or thoughts or whatever it may be that you yourself have carried out?

We're all looking for self-esteem, and perhaps I shouldn't admit this, but I don't know a group of people in general, men or women, who have more reason for self-esteem than those who have had the privilege of being able to help others, whether individually or in large groups.

CONAN: Dr. Gawande, let me ask you the same question.

GAWANDE: Well, it's interesting. You know I'm at that mid-stage in my career, and I feel like the work is the most meaningful that people can do. And we're also struggling, though, with what it means to be really good at this work in our profession. So our struggle is now over the fact that the complexity of the volume of knowledge we're dealing with, the skills we have to have, the number of specialists that we interact with have made it so we're transitioning from understanding how we have always thrived as cowboys, but now we're trying to become teams. We're trying to become parts of pit crews, and it chafes sometimes. That part of it is a struggle.

CONAN: I've learned that cowboys work together very well as a team. So it's a slander, sir.

(LAUGHTER)

CONAN: But anyway, the issue, as you look forward, though, to working in teams, Dr. Nuland, it was much easier when you started out to have command over large swaths of specialty.

NULAND: Well, that's true. For example my own training in surgery involved learning how to treat the heart, how to treat the lungs surgically, how to treat the contents of the abdomen and the contents of abdominal and chest wall. Well, we've become so super-specialized that we now have the intestinal tract divided into about three or four parts that different people - different people treat.

This is fascinating because at the same time as this is happening, and Atul was implying this, too, and you were, we are trying to learn how to work in teams in the sense that all members of the team may not carry that MD after their names because there are many diagnostic and therapeutic maneuvers that can be carried out just as well by people with perhaps a less rigorous kind of training.

And I'm thinking about physicians' assistants. I'm thinking about nurses who have had a special type of training so that we call them nurse practitioners. We are beginning to learn that the right way to give medical care is a team, but it's not a bunch of cowboys going out together all on the same kind of pinto pony. It's a team where the responsibilities are divided based largely on what each person can contribute with the leader, of course, of the team being the one most educated in physiology and pathology, and that will always be the doctor.

CONAN: And do you wonder if cowboys use surgical metaphors? I don't know. Anyway...

(LAUGHTER)

CONAN: Dr. Gawande, as you look at this, it is not only that these teams are expanding. The costs of using different kinds of people as costs become such a big focus of how we think about medicine now.

GAWANDE: Yeah, you know, the interesting thing is we're discovering in the last couple decades that there's a bell curve. There is a wide difference in the results that different places provide for the same operation or the same kind of diagnoses depending on where you go. There's also a big difference in the costs. And the curves don't match. The most expensive places are not the places that get the best results. Often they're among the least expensive.

And when we look at what the positive deviants do, they are often places that look more like systems of care, like teams that work together. Just a little story, my mother had knee surgery last year. It went beautifully well. She spent three days in the hospital. I sat with her. I'm kind of bored sitting around, so I just start counting the number of nametags that come in the room and make a decision for her care or touch her and are crucial to the success of her care.

And I counted 63 people. Those people can't be cowboys. If they don't work together, it's incredibly expensive, things go wrong. But when they work together, it's pretty amazing. And, you know, I'll take exception a little bit with what Dr. Nuland had to say. There were times when it was clear the best person wasn't necessarily the orthopedist in charge in order to get her the best care, make sure she was rehabilitating well, make sure she was getting out and strengthening. It is a passing range of responsibility and leadership, and I think that's where some of our pain at the change comes in.

NULAND: I think we're saying very much the same thing. This is in fact what we've come to, the realization that these kinds of teams do not require the head man to carry out every one of the therapeutic maneuvers that are involved in recovery that these can be very well done by other people. And its manpower, its cost, all sorts of considerations make this easily the better way to go.

CONAN: If that's one thing that is working, what isn't? What worries you, Dr. Nuland?

NULAND: Oh, what worries me, of course you can imagine what I'm going to say. It has to do with the increased technological emphasis in medicine with the increasing gap between the emotional and spiritual needs of the patient and what the world of medicine is able to provide. The more technological we are, and in fact the more scientific we are, the more we look for objective criteria.

Medicine, I believe, by its very nature is not objective, and it is not a science. It is an art that requires science in order to carry out its work most efficiently. One obviously has to know all the cutting-edge science. But at the same time, this seems to come - and it comes in education, too, of doctors - seems to come at the sacrifice of something that perhaps patients may need as much as they do the technology, namely that human touch that serves in many ways for a lot of people as a placebo, in fact, that helps them recover.

CONAN: Dr. Gawande, is that what concerns you the most?

GAWANDE: Yeah, it's interesting, you know, the question is why is it still so hard to provide humanity along the way. You know, conversation and in the course of how decisions are made, what people really are needing and wanting is - there's the combination of the decisions being made in a way that take into account what people's real priorities are and especially when they near the end of life.

There's also the conversations just to recognize that this person is suffering. And people often feel that their suffering is not even acknowledged. The most common complaint that I hear is that people just...

CONAN: I don't mean to interrupt - yes, I do - but the complaint we hear is doctors do not have the time as they're seeing one patient after another in rapid succession, to have those kinds of conversations to even use that healing touch.

GAWANDE: Yeah, so I think it's partly that each doctor or any clinician - nurses and everybody else - feel we just have a piece of care. We just do our little part, and that's all we do. There's no one who sees the whole. The most common complaint I hear from patients is that there doesn't seem to be anybody in charge.

And that problem is not one of time, it's one of someone feeling that that whole view is simply not part of their job. You can it's because they don't feel they're paid for it, but at a deeper level I don't think that all of us clinicians feel that we are responsible for being in charge and providing that need.

CONAN: Dr. Nuland, is that a responsibility someone should be assigned, or is that a responsibility someone should assume?

NULAND: Well, first let me say, Neal, that I'm not quite sure you're right about the question of how much time is available. I think most doctors who have practiced for a period of even several years know that there is five minutes that one spends with a patient and five minutes that one spends with a patient. Some patients just exude a kind of personal shepherding, I think, that makes those five minutes very valuable to the patient emotionally.

Some doctors come sliding in like, oh, Kramer on "Seinfeld," just (makes noise) right through the door, and they're working on their handheld computers, and they're getting lab tests and shouting orders to someone and they're out in the same five minutes. So I think a lot of this - although you're of course obviously partially correct, a lot of this has to do with the way physicians are trained with the kinds of role models that young people are seeing today that didn't exist in the careful clinical post-operative, let's say, visits of many years ago when there was less technology to use and much more hands-on and minds-on care.

CONAN: We need to hear from doctors. What's happening in your field? What's changing, what works, what doesn't? 800-989-8255. Email us, talk@npr.org. We'll return with more with Dr. Sherwin Nuland and Dr. Atul Gawande in just a moment. Stay with us. I'm Neal Conan. You're listening to TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan Dr. Sherwin Nuland and Dr. Atul Gawande are our guests today in our latest conversation Looking Ahead, this time at surgery in particular, medicine in general. They're both very well-known in their field, surgeons with decades of experience who also teach new classes of doctors how to practice medicine, how to care for patients.

They're also accomplished authors. Dr. Nuland has written a shelf's worth of books. His most recent, "The Soul of Medicine." He won the National Book Award for his best-seller "How We Die." Dr. Atul Gawande's most recent book is "The Checklist Manifesto: How to Get Things Right." He's also the author of "Better: A Surgeon's Notes on Performance," also a national best-seller.

So doctors, we want to hear from you today. What's changing in medicine? What works? What doesn't? 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. And we'll get to calls in just a minute, but I wanted to ask you both, why did you decide to devote such an important component of your time, a very precious commodity, to be a writer? Dr. Gawande?

GAWANDE: Boy, that's a hard one. I didn't expect to be in writing. I ended up writing midway through my surgical residency. And I found it was just because it was my way of thinking out loud about these puzzles, about how we get good at what we're doing, when I felt how I get good at what I'm doing, when I felt like the field was changing. I'm sort of obsessed with failure, and it was a great way to work through why failures happen even for myself.

CONAN: Dr. Nuland?

NULAND: Well, I think the chief appeal of writing to me is it's a way of trying to find out what I really think about things. I use my unconscious mind when I'm writing. I just let it flow. And astonishing things happen to my ability to understand thought processes and to synthesize all kinds of facts that don't seem to come together until I try to explain them to somebody else, on the end of my pencil.

And that's been the most gratifying part of it all, to do that and to realize that in a specialty like surgery, where you are taking care of one person at a time, and you've really, in your early origins, wanted to be a family physician, you have become family physician to the world now because you're able to explain to large numbers of people in a rather relaxed way what it is that sickness consists of, how the human body works, these kinds of things that are so difficult for us to bring to a large audience if we don't have the opportunity and the privilege to write.

CONAN: Well, let's get some of those callers in as I promised. Mike is on the line with us from San Francisco.

MIKE: Hi, good morning, I really enjoy your show.

CONAN: Thank you.

MIKE: I have a comment about the challenge of health care. I believe that the challenge, the biggest challenge is cost. And I think obviously it's multi-factorial. I'm a cardiologist, and my field is really driven by advances in the technology over the last few decades. And as a result, the cost has gone up, and I think as a response, the payers, namely the insurance companies and the government, have tried to contain costs by decreasing their reimbursement.

And subsequent to that, the physicians' response in trying to maintain their practice is to do more and more, and that has driven up the cost. And this has led to a vicious cycle so that the care actually may not be dramatically improved, although the cost has gone up, and the number of tests and treatments have gone up, as well.

CONAN: And I just wanted to follow up with you, Mike. There is an increased emphasis in the new legislation, the Affordable Care Act, on outcomes rather than on payment for procedures. And do you think that's the right way to go?

MIKE: I think that's a great step in the - in our models. But I think the biggest challenge still is because the majority of our country practices in a fee-for-service kind of model, that just really - the reality of it is that people have to make a living in a way to maintain the practices. But I think that's definitely a right model for the pay for performance.

CONAN: And Dr. Gawande, we've heard this not just from cardiologists but from psychologists and just about everybody else.

GAWANDE: Yeah, yeah, when we pay for widgets, we get widgets and not always a lot of sense of whether we're getting results. The last five years have been extraordinary. We have recognized that paying fee for service, fee for procedure, just leads to more procedures. And we are grappling for how to move to what some call fee for value or for paying for results. But we don't - we haven't known how.

We don't have the measures, we don't have the experience, and we are in the midst of this transition where many, many places are trying ways of doing it. Some of them are already producing some extraordinary improvements in results, which include higher quality and loser costs. But we're in this fertile phase of experimentation, and when there's a lot of change going on, it can lead to great distress but also great opportunity.

NULAND: Mike brings up a fascinating dilemma that medicine, the government, the public and insurance agencies face every day. Here we are in cardiology, and have the costs really gone up? If you take someone who has a coronary and can now within an hour, an hour and a half, have an arteriogram, coronary arteriogram, have a stent put in and doesn't need a very expensive coronary bypass, is that a savings?

Now, the other part of this issue is that cardiology - and infectious disease - are the only specialties in which real therapeutic advances and statistical advances in life-saving measures have occurred in the 20th century. So let's say the cost has gone up. In this particular situation, does that not become justified by the increased longevity that cardiac patients have?

The James Gandolfini situation, for example, was so common when I was an intern and a house officer. Middle-aged men who were obese, perhaps hypertensive, would have a sudden coronary, and there wasn't much we could do about it, and the death rate was enormous.

Well, right now with proper facilities, which we have in most American hospitals, people like that survive and survive for long periods of time. So what about the cost? In general, Mike, I agree completely with you. Cardiology is a mixed bag, and we've got to remember that this is one of the difficulties of solving the problem. What are we sacrificing when we cut costs?

CONAN: Mike?

MIKE: Yes.

CONAN: Did you want to follow up?

MIKE: Yeah, no, I think one of the thoughts I had was, you know, obviously politically, it's very difficult, but I believe that the only way to really contain costs and maintain quality is to try to have some kind of pre-payment model, nationalized health care. But obviously this is debated hotly, and it's very difficult. But I really think that is the way to go. You know, but it may not happen in this century.

CONAN: It may not happen in this century. You may be right about that.

(LAUGHTER)

CONAN: Mike, thanks very much for this call, appreciate it. Let's see if we can go next to - this is a call from Austin, Texas. It's Will.

WILL: Hi, thanks for having me on.

CONAN: Go ahead, please.

WILL: I'm a pre-medical student at the University of Texas and hoping - I'm applying to medical school this application cycle. It's an honor to talk to both of you guys. I've read all of Dr. Gawande's books. They've had a huge influence on me.

And I had a question, just what advice would you give to the sort of doctors of the future about what to expect and how to prepare for not only practicing the act of medicine but how to be involved in how medicine is practiced and the more overarching themes like you talk a lot about? So I just had a question for both physicians. Thanks.

CONAN: Go ahead, well Dr. Gawande, you got the royalty check already, so you start.

(LAUGHTER)

GAWANDE: Well, that was great. So besides making my day, let me try to answer the question. The - you know, maybe we can use Mike's example of coronary artery disease. Here we are in a country where 50 percent of coronary artery disease patients receive incomplete or inappropriate care. They don't get preventive remedies, they don't get the proper steps for blood pressure control, for dietary advice and many steps along the way, and that's just talking about the medical side.

Add in smoking and prevention, we have tremendous opportunity on that side. And there's a tremendous amount of inventiveness on the specialist side. How do we make it so that if you do have a coronary attack, we are more likely to be providing the right care in the right away and doing it in ways that don't bankrupt society.

We have only had a few years of innovators who are discovering how to produce far better results in our system for both prevention and treatment. When they're attacking the system in that way, it's mostly been leaders who know how to put the dots together, and they're getting some extraordinary results. I think that's the future for many young people in medicine; is understanding that innovation isn't just about producing a drug or a device or the - or another specialty. It's understand the innovations required to knit everybody together and make them successful. And I think that'll be the future.

WILL: Thank you, I appreciate it.

CONAN: Dr. Nuland, did you want to weigh in?

NULAND: Well, yes, I think so. I think if I were to advise Will, I would point out that most of the increase in life expectancy - which doctors love to take credit for in the 20th century, from age 49 to about age 77 - has not come from physicians. It has come from people in public health, of course aided and spurred on by physicians. The - as I say, infectious disease, yes, cardiology, yes. But we've made very small gains in cancer. We've made very small gains in the dementias and most of the other major disease.

Remember that public health has been the major issue throughout the 20th century. Immunizations, water purifications, good prenatal care, better housing, better diet. This is the primary reason why we have gone long as well as we have. So I think we've got to take some of the hubris out of ourselves as physicians, as organizations of physicians and remember that public health measures, preventive medicine will always be the key to better health.

This is seem - this seems to be much more well known in European countries than it is in our own, but we're beginning to go over the hedge, as it were, and see what's on the other side. I always think of good old Mayor Bloomberg who gets hit so hard, but his attacks on the probability of obesity in the population of New York City I think are very commendable.

CONAN: Well, Will, thanks very much for the phone call, and good luck with your studies.

WILL: Yeah. Thanks for having me on. I appreciate it.

CONAN: Here's an email we have from Donna in Tucson: What's changing in medicine is the rare female physician. I am a woman M.D. practicing 30-plus years in internal medicine who takes issue with his idea that he as the head of the team is always a doctor or that it is a man. Dr. Gawande's point was glossed over. It is not always the doctor who leads the care. And with greater than 50 percent of medical students now being women, it is not always a man.

And, Dr. Gawande, as I'm sure you look out over your classes, this is going to change more and more.

GAWANDE: Yeah. It's interesting. Surgery, which was sort of the last redoubt of not admitting females or attracting females to join our profession, has also crossed over to the point we now have - in my residency program, four to five out of our seven each year now are women.

And, you know, you see a dramatic change in two ways. One, is that as the restrictions on work hours have come in so that you can make it possible for people to have family life in their 30s as they're going through training, that's opened the door for more women who also want to start families.

And the second way is it's forced us, even in surgery, to become more family-friendly, and that's paid off for faculty like me who still has a young family and wants to make that part of what we do while still getting the work in very intense professions. And I think that's changing us for the better, not just because we have women coming on board but because we're forcing ourselves to be more family-friendly.

CONAN: Surgeons, professors of medicine and authors: Dr. Atul Gawande and Dr. Sherwin Nuland are with us. You're listening to TALK OF THE NATION from NPR News.

And let's see if we can go to Mark(ph), and Mark's with us from Knoxville.

MARK: Hello. How are you all doing?

CONAN: Good. Thanks.

MARK: Well, I was catching you driving back to town, and I just - I may have missed this earlier, but I was wondering if we can maybe open a little bit of discussion towards cost containment through decreased liability. I'm a physician, and I find myself as I'm getting more into evidence-based medicine - and that's what's being taught now - that maybe as a group, we can come together and, through legislation or whatever, we can have basic practice principles that if we do certain things that are accepted as evidence-based medicine, then we should be released from some of the liability if we miss something that's extremely rare or very unusual.

And I think your physicians on the panel are familiar with what I'm talking about, maybe over-testing or doing things that aren't necessarily evidence-based, more for liability reasons.

CONAN: Yeah. See why...

MARK: I was just curious what their comments were on that.

CONAN: (Unintelligible) reasons that, Dr. Gawande, you were talking about, your obsession with failure, and you've written about this.

GAWANDE: I have. I've become a supporter of no-fault liability. You know, the vaccine industry nearly got bankrupted by malpractice - well, product liability costs, and now 75 cents on every vaccine goes into a fund that then gets paid out to people when they're injured by vaccines, and it's allowed that world to thrive. And I think we could carry over some of those fundamental ideas.

What he's getting at is the notion that, you know, as we arrive at certain kinds of standards, people who follow them should be able to adhere to - be able to not be sued. But the core of failure of the malpractice system is only 1 percent of those who are actually harmed and injured by errors end up being able to be compensated in the system. Two-thirds of the money they get goes to lawyers in the court system, and it takes seven years or longer to see that.

I've paid well over a million, million-and-a-half dollars in premiums, and I know it could have gone to have helped patients who had serious complications with my care rather than where it's gone now. I think a no-fault system could have gotten there, but, you know, we're a long way. You said earlier a national system of health care is a century away. Well, this is even further away.

Neither the Democrats are interested in moving in this direction, and the conservatives have been interested mainly - the Republicans have mostly been interested in the - in capping the system rather than creating a no-fault system in itself, at least so far from the legislation we've seen.

CONAN: Dr. Nuland - and thanks very much for the call, Mark - this whole relationship with the legal system, with - and with the political system, that seems to me as a profound difference since you started.

NULAND: Oh. I have to point out to your listeners that I'm 82 years old and I've been at this for a very, very long time. And a generation of beyond, or I should say before Dr. Gawande, and he has had the good fortune to see attention, the searchlight of attention, turned on these dreadful problems of, for example, people not adhering to appropriate standards of care. Yes, we should base our decisions largely on evidence-based medicine. But all of us know that the evidence of today turns out to be totally erroneous tomorrow, and that medicine is essentially an uncertain profession.

CONAN: Thank you, both, as always, for your time today. We really appreciate it.

GAWANDE: We'll miss this show.

CONAN: I'll miss talking to you. Dr. Atul Gawande joined us from Boston and Sherwin Nuland joined us from New Haven; one teaches at Harvard, one teaches at Yale, you guess. Thank you very much for your time. When we come back...

NULAND: Thanks so much.

CONAN: ...let the fire burn. Filmmaker Jason Osder joins us to talk about his documentary. It's the TALK OF THE NATION from NPR News.

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NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

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Hyperloop: Hype or Future Transportation?

Elon Musk, founder of SpaceX and Tesla Motors, unveiled his designs for Hyperloop. The high-speed transit system could make the 400-mile trip from San Francisco and Los Angeles in 30 minutes. Tim De Chant, senior digital editor at NOVA, discusses the plans and whether the system could answer our transit problems.

Copyright © 2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

FLORA LICHTMAN, HOST:

You remember the Jetson family from Orbit City, right? Always flying off to school or the mall in their own pod. Well, this week, Elon Musk, another kind of space man, is trying to bring that pod travel down to earth. He unveiled designs for a high-speed transit system called hyper-loop. He says it would whisk you from San Francisco to Los Angeles in 30 minutes.

That means traveling at 700 miles per hour. So how does hyper-loop work and will it work. Our next guest is here to tell us just that. Tim de Chant is a senior digital editor at NOVA and he joins us from WGBH. Welcome to the show.

TIM DE CHANT: Thanks for having me.

LICHTMAN: Okay. So give us the real - this has been all the buzz this week. Give us the real deal. Could this work physically?

CHANT: Physically it does seem to be possible. There might be some changes that need to be made, but by and large, people think that theoretically that this actually could work.

LICHTMAN: Break it down. How would it work?

CHANT: Well, he envisions two tubes running down Interstate 5 in California and those tubes would be sucked clear of most of their air. They would be lowered to one-one thousandth of an atmosphere of pressure and that would reduce wind resistance in the tunnel for the capsules that would travel through. And these capsules would be made of, in theory, probably some lightweight material and along the bottom, they'd have some skis that would kind of work like the air hockey part that he mentioned.

So there would be a turbine compressor in the very front of these capsules that would feed the remaining oxygen in the tubes down through little holes in these skis, and that would create about half a millimeter to 1.3 millimeters of lift and that would keep the capsules gliding down these tubes. And as you said, over 700 miles an hour.

LICHTMAN: And so the pressure differential is actually the thing that's propelling them?

CHANT: No. That's what some people were speculating early on. But, in fact, what's driving them is a linear motor. So linear electric motors work similar to standard electric motors except kind of they're cut open and laid flat. So what they would be doing is he'd assemble, I think, two and a half miles of linear motors to get the cars up to speed.

And then, because of the low wind resistance in these tunnels, he's only need a booster linear motor about every 70 miles or so.

LICHTMAN: I gotcha. So the pressure, getting rid of the air gets rid of drag.

CHANT: Exactly.

LICHTMAN: But you still have to push some air out of the way, right? What about heat from that process?

CHANT: That's true, yeah. So one of the concerns is that these air cushions that they're running on are such high pressure in that there'd be so much friction there that you'd be generating a lot of heat. Now, Musk's solution is to use and advanced aerospace alloy called Inconel that they use in their SpaceX rockets. And he thinks this will deal with some of that heat.

But it remains to be seen if the heat transfer from these skis to the rest of the structure could be dealt with in such a way that would keep the cabin comfortable for passengers.

LICHTMAN: Yeah. I mean, speaking of that, I mean, 700 miles per hour seems pretty fast. Is he talking about having barf bags in the pods, too?

CHANT: No word on that yet, but I'm sure you'd need them. The force would be up to half a G, depending on the turn and the acceleration. So that's quite a bit.

LICHTMAN: I mean, I can't even envision what that's like. Are people's cheeks going to be flapping back?

CHANT: I don't think it would be quite that much. I saw somewhere that half a G is about going 0 to 60 between 6 and 7 seconds so that's a reasonably fast car, but it's certainly not among the fastest cars today.

LICHTMAN: And this is an old idea, actually. Is that right?

CHANT: It is. Yeah. The hyper-loop, from what I see of it, is kind of a hybrid of three different approaches to high speed transit. The first obvious one is high-speed rail, which he's kind of pitting hyper-loop against. The other one is what's called a vactrain. So again, this idea of an evacuated tube where you have low air pressure and that would facilitate cars zipping through.

And then, kind of a hybrid of two other ones. One's called a MagLev or the magnetic levitation trains and those are propelled by the linear motors that he's proposing in using in hyper-loop. And then also this air cushion idea where he's supporting the capsules on skis. That was actually first proposed by a French engineer back in the 1960s and the U.S. Department of Transportation experimented with these trains that were levitated on cushions of air and run down monorail type guide rails in the West, again, back in the 1960s and '70s.

LICHTMAN: But this would go, I mean, almost double the speed, right, of any of these?

CHANT: It would, yes. So right now, the current speed record for any kind of train is the Japanese MagLev and they've run that up to 311 miles an hour.

LICHTMAN: And this around 700.

CHANT: Yeah. He's actually saying that it could go up to 760 miles an hour, which one of the sources I spoke with was a little concerned about, because depending on the temperature of the air inside the tube, even though it's at very low pressure, the speed of sound is constant at different pressures. So depending on the temperature in that tube, 760 miles an hour may, in fact, exceed that and then you might be pushing kind of sonic waves in front or create a miniature sonic boom within the tunnel, which could probably wreak all sort of havoc.

LICHTMAN: Wow. What was this about passengers carrying water in the pods?

CHANT: So, yeah, I'm not sure if passengers would be carrying water, but I know the capsules would be, and he has an elaborate setup where he'd be using water to cool the skis and some of the other parts and then he would be storing the steam on the train or on the capsule and then they'd have swap that out when they got to the next station.

So there's certainly some complicated logistics involved in keeping this running.

LICHTMAN: Yeah, that's a lot of water, right, that would be...

CHANT: It is, yeah.

LICHTMAN: ...wash - for swapping.

CHANT: I don't remember off the top of my head how much there is, but it certainly would be a large amount that you would have to carry along, which, of course, would affect the efficiency of the system.

LICHTMAN: Elon Musk, I think, described this as a sort of cost effective solution. What are people saying about that?

CHANT: Pretty much universally people are saying that his estimates are very optimistic. He's saying about $6 billion he could get this thing built. But one of the biggest things that people have pointed out is that he only allocated $1 billion to acquiring land or leasing land for additional right of way for the tracks.

So even though I-5 is a very straight freeway, there are going to be points where it's going to turn or it enters a city and the turns are too sharp even at the lower 300 mile an hour speeds he's proposing running there. So you'd need to have much more gradual turns. And to do that, you're going to have to buy land from somebody. And given how expensive it was for the California high speed rail, to purchase bits of land for their first section, I can't imagine he's going to be able to get away with it for a billion dollars.

LICHTMAN: Well, let's go to the phones. Daniel in Ellensburg, Washington, welcome to Science Friday.

DANIEL: Yes, thank you. I see one major drawback to the situation is things can go wrong because, you know, nothing's perfect. So you have a tube that's basically has the vacuum in it and something goes wrong, breaks down or even an earthquake, you're going to have to drain the whole system and, you know, get the people out. You can stations, you know, so far apart, you're still going to have, you know, something's going to happen between.

LICHTMAN: Good point. What about that, Tim? How would you deal with maintenance?

CHANT: That's correct. It's one of the things that he kind of glossed over a little bit. You know, I think he said that, oh, don't worry, the trains really can't get stuck and if there is a loss of pressure within the cabin, that they'll have oxygen masks and they'd figure out some way to rescue them. But it's not really clear how a capsule that's stuck, say, would get rescued. Or if there was a rupture - one of the bigger concerns from someone I spoke with was that if there is in fact a rupture on the line, you're going to be moving from one one-thousandth of an atmosphere of pressure to one atmosphere of pressure. And that's a really, really big difference. And so something going 700 miles an hour traveling into that would essentially be like hitting a brick wall.

LICHTMAN: Oh, wow. I also read that the design only leaves a tiny, tiny amount of space between the skis and the tube wall, is that right?

CHANT: Yes.

LICHTMAN: Is that a problem?

CHANT: Again, one of my sources, Dean Peterson, who's worked on super-conducting magnets and Maglev trains at Los Alamos National Laboratory, when I spoke with him about this, that was one of the things he raised, is that the half a millimeter to 1.3 millimeters of lift that these air cushions would provide is a really tight tolerance. So you'd have to make sure that you're welds are incredibly precise and that your tubes are manufactured to a very exacting standard. If we want to...

LICHTMAN: Is there - go ahead.

CHANT: I was going to say, if we want to compare this to, say, what Maglev trains run at, generally they run between one centimeter and 10 centimeters of clearance from their track, which still sounds tight but it's obviously orders of magnitude more margin for error there.

LICHTMAN: Has this conversation prompted anyone to step in, and do you get the sense that this is going to happen or could happen?

CHANT: I get the sense that this very well could happen. A lot of people are very excited about this. And whether anyone actually steps up and does it, that's another matter. This is going to be very expensive to build, even on kind of a large scale prototype sort of situation. And so I think Elon Musk may find himself fulfilling his second partial promise in saying that, you know, maybe in five years he'll step in and build the full scale working prototype to show that it can be done.

LICHTMAN: You know what's amazed me about this news, is just how interested the public seems to be in it. It's really captured people's imaginations. I mean, it sounds really cool but I think people also have gotten onboard. Have you noticed that?

CHANT: Yes. I think it sparked a really interesting conversation. You know, a lot of times when you bring up high speed rail in this country, it kind of evokes a divisive mood in people. Some people are very much for it, others very much against it. And this, this is something that's kind of futuristicy(ph). And of course, Musk being a salesman knew that attaching a low price tag to it would help it get some traction in the media, I'm sure.

And I think that - I think that people are really intrigued by the idea. Again, it's kind of that Jetsons sort of feel that you had in the introduction. And I think that's right. It's the concept of sitting down in a tube and then getting essentially shot down that tube and being hundreds of miles away in a half an hour. It's got very much the feel of the future about it.

LICHTMAN: Yeah, it does. And he said it would be only for $20, right?

CHANT: He did, although if you look closely at his - at the proposal that he put forth, the $20 I believe only recoups the initial capital costs, so the $6 billion that he put out there. So of course if it goes over cost, you know, that projection's out the window. And the six billion is amortized over 20 years, so he's allowing himself two decades to get paid back for the $6 billion outlay. But what it doesn't include are things like maintenance or operational costs.

LICHTMAN: Well, that's where we have to leave it. Thank you so much for joining us today.

CHANT: Thanks for having me.

LICHTMAN: Tim De Chant is senior digital editor at NOVA.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

View the original article here