Frank Butler

BBC Click's Marc Cieslak puts VR gaming to the test

by Charles Ornstein

This article has been corrected.

Fraud and abuse continue to dog Medicare's popular prescription drug program despite a bevy of initiatives launched to prevent them, according to two new reports by the inspector general of Health and Human Services.

The release follows the arrests of 44 pharmacy owners, doctors and others, who last week were accused of bilking the program, known as Part D.

The reports issued Tuesday provide more insight into the extent of the fraud, as well as steps federal regulators should take to stop it. The first, which covers data from last year, found:

• More than 1,400 pharmacies had questionable billing practices last year in the drug program. Some billed for extremely high numbers of prescriptions per patient and others billed for a high proportion of narcotic controlled substances. Collectively, they billed Part D $2.3 billion in 2014.
• Prescriptions for commonly abused opioids continue to rise, despite warnings about inappropriate use. Between 2006 and 2014, Medicare's spending on them grew to $3.9 billion from $1.5 billion, a 156 percent increase. By comparison, spending for all drugs in the program, including expensive specialty medications, grew by 136 percent during the same period. More than 40 percent of Medicare beneficiaries in Alabama, Tennessee, Oklahoma and Alaska filled at least one prescription for a narcotic in 2014, compared to 32 percent for the nation as a whole.
• New York and Los Angeles remain hotbeds for questionable prescribing, with far higher use of expensive drugs associated with fraud than other parts of the country. The New York metropolitan area, for instance, accounted for half of all prescriptions for the expensive topical ointment Solaraze last year, a disproportional rate. The drug is used for lesions formed as a result of overexposure to the sun. New York and Los Angeles also stood out for prescribing of two omega-3 fatty acids, used to help reduce very high triglyceride levels. The two regions accounted for nearly half of all prescriptions for Vascepa and about a third of those for Lovaza.

The inspector general's findings come two years after ProPublica reported on how weak oversight by the Centers for Medicare and Medicaid Services (CMS) allowed abusive prescribing and outright fraud to proliferate in Part D. Medicare promised a more aggressive approach to analyzing its own data.

People can use Prescriber Checkup, a tool created by ProPublica, to look up doctors and see how their prescribing patterns compare to peers in the same specialty and state.

Medicare Part D provides drug coverage for 39 million seniors and disabled people, at a cost of $121 billion in 2014. It is the fastest-growing component of the Medicare program. Part D is administered by health insurers under contract with the federal government, but CMS is responsible for overseeing it.

For years, the inspector general, an internal watchdog that evaluates HHS programs and investigates wrongdoing, has dinged Medicare for its failure to keep a close enough eye on doctors, pharmacies, beneficiaries and even its fraud contractors. That's beginning to change, officials say.

"CMS has made progress on a number of recommendations we've made, as well as on the initiatives that they've had," said Jodi Nudelman, regional inspector general for evaluation and inspections in the New York office. "They're starting to use data to drive their strategies."

At the same time, she said, "There are still concerns. More needs to be done. We can't stop here."

A second report from the inspector general says that Medicare needs to adopt a number of reforms that it has so far resisted. They include:

• Requiring health plans to report all potential fraud and abuse to CMS and its fraud monitoring contractors. Right now, the agency encourages plans to voluntarily report suspicions of fraud but it doesn't mandate it. Last year, the inspector general found that less than half of Part D insurers voluntarily reported data on potential fraud and abuse.

• Expanding reviews for questionable drug prescribing beyond controlled substances to other commonly abused drugs, including antipsychotic medications, respiratory drugs and those for HIV.

• Restricting patients suspected of doctor shopping—visiting multiple doctors in search of controlled substance prescriptions—to a limited number of doctors and pharmacies. CMS said it doesn't have legal authority to do this, but the inspector general said it should seek the authority, which is commonly used by private insurance companies and state Medicaid programs for the poor.

During last week's Medicare fraud takedown, 243 people total were charged, including 46 doctors, nurses and other licensed health professionals. Some 44 of the people arrested were charged with fraud related to Part D.

In Miami, for example, a number of pharmacy owners were charged with health care fraud and conspiracy to commit fraud. In one case, the government charged several people with paying Medicare beneficiaries for their personal identification numbers, which they used to file fraudulent claims for drugs that were never dispensed. They worked with a clinic owner, who forged and altered prescriptions and sold them to the pharmacies. This scheme alone defrauded Medicare of $21.2 million, the government alleged.

Last year, CMS announced that it was granting itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways. The agency also said it would compel health providers to enroll in Medicare to order medications for patients covered by Part D. Currently, that isn't required.

The changes were supposed to take effect on June 1, but have since been delayed twice, most recently until January 1.

CMS spokesman Aaron Albright said in a written statement that Medicare “works diligently with our law enforcement partners to prevent fraud in the first place and to recover payments for wasteful, abusive or fraudulent services.” In addition to requiring 400,000 prescribers to enroll in Medicare by next year to retain the ability to prescribe in Part D, Albright said, officials are helping health plans decrease overutilization of dangerous drugs and taking action against providers and pharmacies with potentially fraudulent billing practices.

In April, CMS launched a Web-based tool to allow CMS, law enforcement, and health plans to share information and coordinate actions against pharmacies deemed high risk. CMS also said it is monitoring potentially fraudulent activity in geographic hot spots like the ones identified by the inspector general.

Correction, June 23, 2015: This article originally stated that 243 people were arrested during Medicare's fraud takedown. Two hundred forty-three people were charged. Not everyone charged was arrested.

Former GOP presidential candidate Mitt Romney says take it down. Present GOP presidential candidate Jeb Bush says take it down. South Carolina Governor Nikki Haley will say a qualified take it down. The “it” is the Confederate Flag. They now...

by Nicole Collins Bronzan

When retired New York Post editor Vincent Musetto died this month, the Internet fondly revisited his famous 1983 headline on a story about a grisly New York City crime: HEADLESS BODY IN TOPLESS BAR. The New York Times obituary for Musetto even evoked his turn of phrase with its headline: “Vincent Musetto, 74, Dies; Wrote ‘Headless’ Headline of Ageless Fame.”

The writer of that headline, Kyle Massey -- often called The Times’ reigning headline guru -- joins ProPublica Assistant Managing Editor Eric Umansky in this week’s podcast on what makes a good headline -- in The Times and elsewhere.

As assistant news editor, Massey focuses on the articles destined for the paper’s front page and, in particular, headlines. He even writes a weekly in-house critique of headlines for the staff.

Oh, and The Times headline on the 1983 killing? “Owner of a Bar Shot to Death; Suspect Is Held.”

Highlights from this episode:

• The ways online news has changed headline writing. (11:57)
• How headlines are written and approved at The Times. “The essence is the key, and the tone is the key.” Massey says, noting the “restrained tone,” that is The Times’ hallmark. “It’s not ‘bloodbath,’ and ‘thugs,’ ” he says. (2:16)
• The Times’ well-documented “fondness, or maybe even overuse” of headlines beginning with a prepositional phrase, which spawned the #nytbooks hashtag on Twitter in 2012. (4:50)
• Massey’s background, from his start as a sportswriter at the Log Cabin Democrat in Conway, Arkansas. (6:58)
• Tips for writing clear, engaging headlines: “You have to write the headline on the story that’s there,” Massey says. “You can’t, sort of, write the headline on the story you wish were there.” (15:47)

Hear their conversation on iTunes, SoundCloud and Stitcher, and subscribe to ProPublica’s podcasts to hear conversations like these each week.

Pictures of the high coiffure on the Ivorian catwalks

by Terry Parris Jr.

Some of the best #MuckReads we read this week. Want to receive these by email?  Sign up to get this briefing delivered to your inbox every weekend.

Political profiteers push Ohio's pot vote (The Center for Public Integrity)

A political firm could earn $5.6M to push pot legalization measure in Ohio — an idea they created. http://t.co/pBnoz5Gv7X #muckreads

— Kytja Weir (@kytja) June 18, 2015

"'The honest and most easy response is: I am going to profit from this,' the initiative's creator told the Center for Public Integrity. 'If people are upset about me making money, I don't know what to say other than that that's part of the American process.' ... The measure would root the 10 marijuana growth sites to particular land parcels, which happen to be controlled by the mysterious companies funding the initiative."

In an unmarked grave, a baby's untold story (BuzzFeed News)

She died 8 days after officials placed her in giant for-profit foster care co. Then they kept it secret. http://t.co/aPexLrcuWc #MuckReads

— Amanda Zamora (@amzam) June 18, 2015

"BuzzFeed News obtained from other sources many of the documents (Department of Children and Families) tried to keep secret. But the name of the little baby who had died remained unknown. She was anonymous. Then, this March, the city clerk of Beverly, Massachusetts, found a death certificate of an infant who died on Jan. 21, 2012, aged 2 months and 5 days. There it was, under 'decedent name': Lily Marie Brown."

Locked away: Grady Memorial Hospital withheld rape evidence from police, despite victim requests (The Atlanta Journal-Constitution)

This is effing unbelievable. #muckreads https://t.co/uIP6aNiWTu

— Carrie Brown (@Brizzyc) June 16, 2015

"...victims at Grady may have undergone an invasive, grueling rape exam for nothing, advocates said, and dangerous criminal may have gone unpunished. Police could have been flagged to patterns of attacks. Entering DNA samples into a national database could have unmasked attackers who were strangers to their victims or prevented serial rapists from striking again."

In North Dakota's Bakken oil boom, there will be blood (Reveal News)

As death count mounts in Bakken oil fields, accountability for worker safety shifts b/t companies: http://t.co/41hubLEKZm #muckreads @reveal

— Christina Jewett (@JewettCIR) June 15, 2015

"...the boom also has been a serial killer. On average, someone dies about every six weeks from an accident in the Bakken – at least 74 since 2006, according to an analysis by Reveal, the first comprehensive accounting of such deaths using data obtained from Canadian and U.S. regulators."

A fragile peace: Part 1 and part 2 of a special report on Ciudad Juárez (El Daily Post)

For Mexico, the drop in violence in #Ju√°rez is a case study, but not a complete victory. http://t.co/YoKoEVPBdH

— El Daily Post (@ElDailyPost) June 11, 2015

"It has been three years since the violence abated and the murder rate dipped from 300 a month to 30. In March and April of 2015, the number of homicides in the city reached its lowest point since 2005. But crime experts say that could change because the judicial system hasn't come down hard enough on some of the criminals."

As VA cuts narcotic prescriptions, veterans with chronic pain cry foul (The Austin American-Statesman)

Tons of VMs this am from frustrated vets after story on VA patients getting their painkillers cut off: http://t.co/khsLwNUCD5 #muckreads

— Jeremy Schwartz (@JinATX) June 15, 2015

"'Why do they let us suffer without our pain medicine?' one veteran said. 'It feels like we are being punished for other people who abused drugs. But what about those of us who take the medications on a regular basis for chronic pain? The VA should just treat its patients humanely.'"

Social worker obtained state licenses despite criminal past (Milwaukee Journal Sentinel)

Convicted serial rapist, bank robber became licensed social worker in Wis., Mich. & Ind. http://t.co/HeiZR60Ngf @cspivak #muckreads

— John Diedrich (@john\_diedrich) June 14, 2015

"He raped several women while their husbands were at work. He robbed a Milwaukee bank and burglarized homes. And he kidnapped and raped a 14-year-old girl. Deisler was convicted and spent a decade behind bars. He got out and became a licensed social worker and therapist in Wisconsin and two other states, specializing in treating addicts and sex offenders."

How to be a back seat driver - even when you are not in the car

Earlier this month we published an investigation with NPR into the American Red Cross' failures in Haiti. We've gotten a lot of questions from readers (including on Reddit) wondering what to do next time a big disaster hits.

What should you do if you want to help? To whom should you send money?

There's no simple answer. And there is no one-stop shop that can answer those questions.

But if you're willing to put in a bit of time, you can be a more informed donor and increase the chances that your money will reach those in need.

Here are a few tips, based on conversations with experts and reporting in Haiti:

Research before you give.

Take the time to read up on your group — this can be as simple as a few Google searches and checking out information compiled by various charity watchdogs. Have there been any issues with management? Has the group performed well in the past? Has it had problems? The answers to these questions can inform your choices.

If you do give, you can demand meaningful transparency.

Nonprofit organizations are generally required to make only broad disclosures about their finances. (The American Red Cross' annual tax return, for example, doesn't reveal anything at all about its Haiti program.)

But as a donor, you can ask the organization you're giving to to make public, detailed disclosures about their spending.

As Haiti aid expert Jake Johnston pointed out in our Reddit AMA discussion, you can also ask elected officials to exercise their own oversight of charities that raise money after disasters.

Local groups or those that have deep local ties can be the best option

One issue that came up again and again in our Haiti reporting is that the American Red Cross did not have significant experience working in Haiti, hindering its efforts to operate in the country. We also heard about groups — some large, some small — that had been in the country for decades and employed Haitians in top positions. They tended to be more successful.

As  Francois Pierre-Louis, a political science professor and former community organizer in Haiti added on Reddit, donors can "work with local organizations that are connected with the population. Too often these groups are not even recognized."

So if you're considering giving to a group, it's worth doing a bit of research to see what kind of experience it has in the country in question.

There are options beyond traditional charities.

While the idea remains the subject of much debate, some in the aid world are now advocating simply giving money to those in need.

Think beyond the next disaster

Jonathan Katz, a reporter who wrote the book on the troubled post-earthquake relief efforts in Haiti, argues that it's the time between disasters when the most important work has to be done. From his book:

"Poverty and a lack of local institutions create the shoddy conditions that make disasters deadlier than they have to be...Supporting efforts to give aid directly to local governments, and the goal of building local institutions that operate independently of foreign control, will go exponentially further than cargo planes of tarps and bottled water. It's true that we don't always know what locals will do with that assistance, but that's the point. It's up to them."

by Julia Angwin

This is the latest in a series we've done about how to protect your privacy. This post is based on a tip sheet that I prepared for a panel discussion about how journalists can communicate securely with sources at the 2015 Investigative Reporters and Editors Conference.

It's easy to feel hopeless about privacy these days.

In the post-Snowden era, we have learned that nearly every form of communication-from emails, phone calls, to text messages – can leave a digital trace that can and likely will be analyzed by commercial data-gatherers and governments.

Here are some ways to keep those communications private. While these tips were designed for journalists and confidential sources, they're just as useful for protecting any private communications, such as a conversation between family members, or a confidential business dealing.

Some tactics are more difficult than others, but the good news is that not all of them require technical skills. The key is to figure out your communication strategy. First, decide if you are trying to hide WHO you are talking to (metadata) or WHAT you are talking about (content), or BOTH.

In each case, there are both high-tech and low-tech ways to evade surveillance.

If you are trying to mask WHO you are talking to, consider three tactics that I call ACE — which stands for "Add Noise, Cloak or Evade."

• Add noise means fuzzing the metadata by adding false connections or false content to the communications.

A high-tech way to add noise online is to use Tor Web browser which bounces your Internet traffic around to a bunch of locations so that the website you arrive at doesn't know where you are coming from.

You could also add noise in a low-tech way. If, for instance, you are a journalist calling a source in the mayor's office, you could also call everyone in the office, too. That protects the source from being the only one with a record of a call with you. (However, you should talk for a short time and set up another means of communications to avoid creating a data trail of a long conversation).

• Cloak means using alternate identities.

Another way to mask who you are talking to is to set up new accounts – whether it is email, instant messaging or a cellphone – using alternate identities.

For these disposable online accounts, it's best to use Tor when setting up a disposable email (instructions here) or instant messaging account (instructions here for Windows and Mac) so that your location is not revealed during the setup and use of the account.

For disposable cellphones, also known as burner phones, the best practice is to buy them in cash in a location not close to your usual work and home (because your location is a very distinctive giveaway). Give one to your correspondent and set up a time in which you will each go to a location that is not on your usual route in order to make the call.

• Evade means avoiding metadata collection.

This usually means meeting in person, and turning off your phones (or, even better, leaving your phone at home) so there is not a record of your phones being in the same place. The challenge is to avoid using digital forms of communication to arrange the in-person meeting.

If you are trying to mask WHAT you are talking about, I suggest three strategies that I call HEM — which stands for "Hide, Encrypt or Mask." 

• Hide means hiding the existence of the content, by placing it in a secret compartment either physically or digitally.

Hiding content can be as low-tech as hiding a USB stick in your pocket (as long as you are not going through a border or airline inspection).

Or it can be as high-tech as creating a hidden volume of encrypted content on your computer (a program called TrueCrypt offers this feature) that is not detectable to a person inspecting your computer.

• Encrypt means to make content unreadable to outsiders using cryptographic techniques.

Encryption scrambles your messages in ways that are extremely difficult for even the most powerful computers to break.

In the post-Snowden era, new encryption services seem to be sprouting every month. To sort out the best services, we ranked many of them last year in a joint project with the Electronic Frontier Foundation.

For encrypted communications to work, both parties must install the same software - whether it is the encrypted iPhone app Signal for text messages and voice, calls or the widely used GPG software for email encryption. (Instructions here for Mac and Windows users).

• Mask means disguising the content as an innocuous other type of content.

Known as steganography, this is the art of hiding a message in plain sight. For example, a teenager may post a song lyric to her Facebook page, which conveys a certain meaning to her friends, but is impenetrable to her parents.

For this to work, both parties must agree on the meaning of their messages in advance - whether it is using code words or physical symbols - such as the famous flower pot on the balcony that "Deep Throat" apparently moved when he wanted to signal a request for a meeting with journalist Bob Woodward.

by David Epstein

Over the past two weeks, ProPublica and the BBC have reported allegations from professional runners and their support staff that iconic coach Alberto Salazar — head of the Nike Oregon Project and coach of the 10K gold and silver medalists in the last Olympics — violated anti-doping and prescription drug regulations. Salazar has denied the allegations.

Elite distance runner Lauren Fleshman says that Salazar helped her get treatment for asthma, but she became squeamish when he suggested that she use medication in a different manner than the doctor instructed. Fleshman, 33, won five NCAA titles while at Stanford University, and won U.S. titles in the 5K in 2006 and 2010. She is a prominent figure in American running, not only by virtue of her on-track accomplishments, but also because she coaches, writes "The Fast Life" column for Runner's World, is active on social media, and co-founded two businesses related to training and health.

Fleshman was previously part of a Nike-sponsored team, but was never coached by Salazar. She spoke with ProPublica reporter David Epstein about her experience seeking medical help from Salazar.This conversation has been edited for length and clarity. (Listen to the full interview below or on Soundcloud.)

Alberto Salazar has never coached you, but you did go to him for some medical help. Can you tell us what it was?

In 2005, I started having worse symptoms of exercise-induced asthma. I had gone to an allergy and asthma doctor on my own, and I got tested after the season was over in 2004 and didn't fail the asthma test. The environmental triggers [like pollen] weren't there. [The doctor] was like, sorry, you don't have asthma, you can't get a prescription.

Alberto set up an appointment in Portland, during allergy season, with a doctor who had seen many other runners. He had a specific protocol ... you would go to the local track and run around the track, work yourself up to having an asthma attack and then run down the street, up 12 flights of stairs to the office and they would be waiting to test you. So that's what I did and I failed the test, and the doctor prescribed Advair for during the racing season when pollen counts were the highest, and albuterol, which is a rescue inhaler.

Alberto was actually really great; he was instrumental in helping me get the appointment, taking me to the appointment ... I was a Nike athlete; I wasn't his athlete, but I was a Nike athlete, and to him that was enough.

How was the appointment?

When I left is when I felt uncomfortable. The experience didn't leave me not liking Alberto; I actually really like Alberto. After I got the medication, he explained to me that this is going to be great for you, so many athletes once they got on this, did so much better than they'd ever done before. And he described the ways that could happen: there's a glucocorticosteroid in [Advair], and there's a possibility that some of that could get systemically into your body and give you an advantage, and you can legally take it because you have asthma ... He encouraged me to push to be on the highest dose of it year round, which was something different than what the doctor had said.

There was this whole other level it seemed of how to use the medication, and it made me feel uncomfortable because it was clear to me that, well maybe there is some kind of advantage to this and how do I feel about that now that I have this medication. Is it ok? I guess legally it's ok. Alberto is saying it's ok ... It took me a while to process that.

Alberto and the doctor had different ideas of how you should use the medication, right?

There were three dosage levels of Advair ... and the highest one is for extreme situations. So when I came to the doctor I was really flared up ... so he didn't think it was a bad idea to start with that to calm things down, then the idea was to change to something lower ... because there are side effects to those medications. But Alberto very clearly pointed out that he felt the glucocorticosteroid could have a positive effect, so why not take the highest dose. And he didn't really talk about side effects or anything. I looked that stuff up on my own later, because I got thrush, and it also gave me kind of bad breath, from the thrush ... That really took me by surprise, but he didn't really seem worried about any of that stuff.

And what about in terms of the times of the year that he wanted you to take it?

The doctor said to take it during pollen season, which overlaps with peak competition season, and then to either not take it the rest of the year or phase it down to the lowest dose.

And Alberto?

His recommendation was to take it year round.

And in terms of the method of administration, could you explain a little bit about Alberto's suggestion?

The doctor told me breathe it in my mouth, hold it for 10 seconds, and then breathe out normally. And Alberto said to breathe it in, hold it, and then breathe it out your nose slowly, because then you expose the glucocorticosteroid to the nasal passages as well. And the theory is if it's supposed to open up your passages, then it will open up your nasal passages too, and make sure that every single passage the air could come down is maximally opened.

Whose recommendations did you follow?

At first I followed Alberto's, and I was on [the highest dose] ... And then, this is going to sound so dumb, but I got this educational pamphlet in the mail from USADA [the U.S. Anti-Doping Agency], and it was talking about clean sport ... and you have to take this test that shows you have an understanding of the rules and the purpose of USADA and clean sport and all this stuff.

There was just something about it that made me feel very clearly that that approach to my inhaler was wrong, that the spirit of the sport did not support that. Turning illness into an advantage was not right. That you take a medication to fix the problem, not to fix the problem and then go above and beyond. I don't even know if the medication really does that ... The inkling I'd had in my stomach in that first conversation with Alberto just felt stronger. I wouldn't feel comfortable telling people, publicly sharing that I'm taking the highest dose of this, so maybe that's not right.

Fleshman said she began to feel bad about the situation.

There were other things that happened later that kind of reinforced that that asthma experience had started to take me down a path that I didn't want to go. That's the main thing that motivates me to tell this story at all ... the way my interactions with Alberto made me feel ... something changed in me where I started to feel like the TUE [therapeutic use exemption] system was something to work around, that it was ok to look for loopholes and this is just kind of the American way. Maybe we're not born in Africa and we don't get raised at 8,000 feet elevation, and have long stick legs and extremely light frames to fly around the track, but we're in the most medically advanced country ... So there was this part of me thinking maybe this is just the way, maybe there is a way through medicine and TUEs ... And it felt dangerous.

Fleshman said she later called Salazar for help with another training aid.

I called up Alberto when I heard people were turning their apartments into altitude apartments ... and he came down and set it up to have it installed in my apartment, and I was sleeping in an altitude apartment.

I was unable to handle the training load that I'd been able to handle without any problem for the past few years. I wasn't resting at night; I was restless ... because of the altitude ... And I'd heard some of his athletes had seen this doctor and they had suppressed thyroids, and I knew these athletes slept in altitude tents too. And I was like, oh man, well maybe that's the problem, maybe my thyroid is messed up and maybe — instead of looking at it like the altitude tent messed up my thyroid — maybe it's something about my thyroid is insufficient to handle this altitude tent. You can see there's a different in that mentality, right? I felt like somehow I deserve to have some superhuman thyroid that can handle anything. So I talked to my coach, Vin Lananna: I think my thyroid is suppressed. He said that could very well be it, you're not responding to the training anymore, you're tired all the time. And I was like people go to this doctor, Alberto knows about him and I'm thinking about reaching out. And this was the most embarrassing moment, but the really important turnaround for me: my coach looked at me and he goes: "Ya know, you could do that, and if you want to do that, it's your career, and I don't think there's necessarily anything illegal about it, but the reason why your thyroid is as messed up as it is because you're not resting enough, you're sleeping in an altitude tent, and you're training too hard. And you have to back off, you have to change those things, you have to take responsibility." And that made me so embarrassed that I was thinking the other way. I had almost been unconsciously scheming like, oh, cool, if my thyroid's suppressed I'll be able to get on thyroid medication, great, and that will have other advantages. It was like this idea of turning illness into advantage again, even if you are the one who causes your own illness.

Now, I definitely do think that's an ethical violation ... So I just hope more people talk about their experiences, because if we can talk about them, we can decide how we feel about them ... [Aside from drugs] there are also methods that are banned, and I would like to see those methods expanded to abuses of the TUE system, and to looking at illness as advantage. I think that would be a huge win for clean sport.

The discussion seems to be happening very openly in track right now, more than I've ever seen in any sport.

It makes me really proud to be a track and field athlete when I see athletes coming forward like that. And I really do believe the majority of track and field athletes are playing clean ... And so I guess, technically, maybe Alberto's stuff is clean with the exception of the testosterone, if that ends up being true. The things I really care about are more of these ethical questions of how TUEs are used. The reason why I think athletes are coming forward in this unprecedented way is because of how it makes you feel. When you decide to go that route, to take this aggressive medical approach, you feel gross about it ... I think a lot of these people will look back 10 years from now like, those things are not ok.

When you have a coach as powerful as Alberto Salazar, he's now attracting the country's best youth ... we're talking teenagers. And he's responsible for instilling in them what it means to be a professional athlete ... I am extremely uncomfortable thinking of him coaching a Mary Cain. I get uncomfortable around anyone in an Oregon Project uniform even if they're not doing anything wrong ... And I could've been coached by Alberto Salazar, the door was open. In the end I didn't go there because I knew I would have to police myself.

Fleshman said watching other athletes come forward inspired her.

I just can't not say something when people like Kara Goucher come out and puts her face to her words, and Steve Magness, and other people that have things to lose ... and [former Oregon Project runner Josh] Rohatinsky is the one that put me over the edge because I really respect that guy ... I don't think our sport is a lost cause, and I want to be part of the movement making it better.

Rohatinsky didn't have any particularly bad experiences, but felt there was a wall between what goes on with Galen Rupp and other people, and said he believed the "full extent" of all the allegations we reported, including faking symptoms to acquire a TUE, and Salazar testing testosterone on his son. What do you think?

I would say the same. The [Steve Magness account of] the book and the pills seems a little crazy to me ... but I don't see any reason to doubt Steve Magness at all. The other stuff, absolutely ... I think [Salazar] looks at the TUE system as the obstacle in the way, and it's not anything to be taken super seriously. It's the same thing with the handing out Celebrex or those other stories, those don't surprise me at all.