Online Trackers Follow Our Digital Shadow By 'Fingerprinting' Browsers, Devices

New technology helps trackers to follow consumers’ digital imprints — including across devices — through browser settings, battery levels and other details. Mark Airs/Getty Images/Ikon Images hide caption

toggle caption Mark Airs/Getty Images/Ikon Images

As we surf from website to website, we are being tracked — that’s not news. What is news, revealed in a recent paper by researchers at Princeton University, is that the tracking is no longer just about the “cookies” that record our tastes. The researchers surveyed a million websites and found that state-of-the-art tracking is a lot more sophisticated, allowing websites to track the fingerprints left by our devices.

Princeton’s Arvind Narayanan and Steven Englehardt studied how all the things we do not see as users are valuable to someone on our digital trail, as our presence may be authenticated and tracked through such minutia as personalized browser settings or even our laptops’ battery levels.

Fingerprinting “allows a tracker to put an identifier on your entire history of online activity,” Narayanan, assistant professor of computer science, tells NPR’s Robert Siegel. “They’ve been collecting those histories, that’s not new — that’s a given. But what the technological sophistication is for, is for linking all of your online breadcrumbs together, even if you’re not necessarily putting your real name or email address into all your online interactions.”

Interview Highlights

On how fingerprinting techniques work

It turns out that websites as well as the hidden so-called third parties that track us online can ask your browser for the entire list of fonts or extensions that you’ve ever installed. And that list could be different from almost anybody else on planet Earth. And so that might present a nearly unique or completely unique fingerprint of your device that can help a website or a third-party tracker recognize you when you come back. …

These fingerprinting techniques are not directly getting at what sort of person you are; they’re merely trying to develop some sort of recognizable pseudo identity of you. … If you have this pseudo identity based on the fingerprint of your device, then what the website is going to be able to do is piece together all of the online breadcrumbs that you’ve left in different places and compile that into a profile, into a dossier of you. And using that, they can apply algorithms and infer your interests and preferences and so on.

On how fingerprinting can follow you across devices

This is best seen if you think about you as a traveler with two different devices, let’s say your laptop and your mobile phone. What some website or tracker is going to observe is that there are two different devices over and over again connecting from the same networks, from the same set of IP addresses. … Over time, that allows this online tracker to put together a profile of the behavior of those two devices and infer statistically, with a very high degree of confidence, that this pattern of coincidences could not have happened by chance — it must be because these two devices belong to the same individuals. …

For the most part, these are very new and interesting technologies, but also creepy from a privacy perspective and more-or-less unregulated.

On the uses of online tracking

The most obvious consequences are certainly going to be online ads that you see and targeted offers that you get. Occasionally, we know that websites have been experimenting with price discrimination based on your online activities and trying to infer if you’re a more affluent or less affluent type of consumer online. That’s not so widespread yet but there are a few studies that have revealed that it does happen from time to time. …

Increasingly, people are discovering new uses for all of this online tracking information. For example, there are concerns that political campaigns might be using this data to specifically individually target political messages to us. To the point where someone else might be getting a slightly different messages that is tuned to their tastes or political proclivities or whatever. This has implications for democracy and we need to have the societal conversation about this.

On ways to combat tracking technologies

There are many extensions that you can install in your browser that are going to block all of these online tracking technologies. One of them is Ghostery that we studied in our paper. There are a variety of others. The Electronic Frontier Foundation has released one called Privacy Badger. And these are tools — some of which I use myself and my colleagues employ — that are going to cut down on tracking. Although they come with some trade-offs. Occasionally one of the websites you’re visiting might break, might not work exactly as you wanted it to. …

These measures are a sort of Band-Aids. We do need systemic solutions, but that conversation is not happening yet.

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Accused Washington State Mall Gunman Confesses To Killing 5 People

Investigators at the apartment complex tied to Arcan Cetin, the man suspected of shooting five people at a mall in Washington state. Martha Bellisle/AP hide caption

toggle caption Martha Bellisle/AP

The man suspected of shooting five people in the cosmetics department of a Macy’s department story in Burlington, Wash., has confessed to the crimes, reports the Associated Press citing court documents released by the Skagit County Superior Court.

An undated Department of Licensing photo posted on Twitter Saturday by the Washington State Patrol shows Arcan Cetin, 20. Washington State Patrol via AP hide caption

toggle caption Washington State Patrol via AP

According to the documents, 20-year-old Arcan Cetin told detectives who interviewed him that “he did bring the rifle into Macy’s and shot all 5 victims,” reports the wire service. Cetin has been charged with five counts of first-degree murder, NPR’s Martin Kaste reports, and the documents charging him do not give a possible motive for the crime.

Kaste reports Cetin had previously been charged with assault. Washington state’s online superior court records show at least seven cases filed against Cetin between October 2013 and June 2015. The Seattle Times reported court records include three domestic-violence charges against Cetin in two different counties, and that the victim in those cases was his stepfather.

The Times reports:

“It’s clear from the court docket that Cetin was struggling with emotional or mental health issues, and that the court, prosecutors office and defense team were trying to get him help.

“Island County District Court records show that Cetin was told by a judge on Dec. 29 that he was not to possess a firearm.

“However, Cetin’s stepfather urged the judge not to impose a no-contact order, saying his stepson was ‘going through a hard time’ and that he couldn’t help him with the order in place.”

Martin Kaste reports the weapon Cetin used in Friday’s shootings was a Ruger rifle, described by police as a hunting-style weapon, and that was also equipped with a 25-round magazine that allows for rapid, repeat firing.

As the Two Way reported, Cetin was arrested on Saturday evening, about 24 hours after the shooting. Amber Cathey, a former high school classmate and neighbor in the apartment complex where Cetin lived in the town of Oak Harbor told the AP she found him “creepy, rude and obnoxious.” She told the wire service she complained to apartment management about Cetin, and blocked him on Snapchat after he sent her a photo of his crotch.

When Cetin appeared in court Monday, he told the judge calmly that understood the charges against him, each of which carries a minimum penalty of 20 years in prison, according to the Washington Post.

The courtroom was packed, the Post reported, and Cetin’s mother appeared “visibly distraught” as she watched her son.

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Walking Fends Off Disability, And It's Not Too Late To Start

Senior man walking Zing Images/Getty Images hide caption

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People who have reached their later years may think it’s primarily a time to relax, not to increase their physical activity. Not so. Previous research has suggested that exercise can improve memory and reverse muscle loss in older adults, among other benefits. And a study out Monday finds that a regular program of physical activity reduces the time spent with mobility-limiting disability.

Researchers took more than 1,600 sedentary people between 70 and 89 years old who had some functional limitations, but who could walk about a quarter of a mile in 15 minutes or less, unassisted by another person or a walker. (Canes were OK.)

Half of the participants got a health education program involving regular in-person sessions and some stretching exercises, while the other group was told to aim for 150 minutes of aerobic activity as well as strength, flexibility and balance training both at the study’s facilities and at home. “Walking was the cornerstone of the program,” says Thomas Gill, a professor of geriatrics at the Yale School of Medicine and an author of the study, which appears in Annals of Internal Medicine.

The study followed participants for about 2.7 years, and found that the physical activity program cut the amount of time that people spent with a “major mobility disability” — defined as being unable to walk a quarter mile — by 25 percent compared to the education program. Previous findings from the same study showed that the exercise program lowered the risk of becoming disabled in the first place; this one showed that it sped recovery from an episode of disability and lowered the risk of subsequent episodes.

“They’ve done a really nice job of showing the incredible power of physical activity,” says Bradley Cardinal, a professor of kinesiology at Oregon State University who wasn’t involved with the study. “It’s the secret ingredient to successful aging in terms of quality of life.” An editorial accompanying the study, by the University of California, San Francisco’s Patricia Katz and the University of South Carolina’s Russell Pate, also noted that people who engage in physical activity have a lower risk for heart disease, diabetes, certain cancers, depression, cognitive impairment and functional decline.

The exercise program pretty closely followed the government’s recommendations for all adults, including older ones: 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week, plus two strength sessions that hit all the major muscle groups.

But most Americans don’t get that much exercise, and that becomes increasingly true as people age. According to statistics from the Centers for Disease Control and Prevention, just 28 percent of those 75 and up meet the recommendation for aerobic activity, and only 8 percent also did the suggested amount of strength training.

Cardinal says older adults need to realize that exercise can greatly improve their quality of life by maximizing function as long as possible. But he says that many believe that older age is for relaxing and that physical activity is somehow dangerous or unnatural. That belief “is pervasive among older adults,” he says, even though for many of them, meeting the minimum requirements “is doable.”

Semantics can help. “We try to frame this as more physical activity than exercise,” says Gill. “We talk with older folks and many say, ‘I can’t exercise, but maybe I can become more physically active.’ ” Study participants were advised to “start low and go slow,” and some were even able to get rid of their canes after six months of exercise, which Gill says they found particularly rewarding.

Physicians can also help. “Prescribing exercise may be just as important as prescribing medications — perhaps even more important in some cases,” the editorial said. The authors called on medical schools to “start preparing students to prescribe exercise as effectively as they prescribe statins, and for health systems to support physicians in addressing inactivity just as they provide support in addressing other health risks.” (The American College of Sports Medicine has an “Exercise is Medicine” initiative to help physicians integrate exercise recommendations into their treatment plans.)

There are also some basic behavioral strategies for getting yourself to get moving, no matter your age, including giving yourself an incentive to change and engineering your environment to encourage the activity.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson

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World Cafe Next: Brent Cobb

Brent Cobb’s major-label debut, Shine On Rainy Day, comes out Oct. 7. Courtesy of the artist hide caption

toggle caption Courtesy of the artist

  • “Solving Problems”

  • “Diggin’ Holes”

Brent Cobb is from rural Georgia, but he’s been paying the bills as a songwriter in Nashville for the last 10 years. These days, he’s an overnight sensation with a major-label debut produced by his cousin Dave Cobb. The simply produced, largely acoustic Shine On Rainy Day is reminiscent of Kris Kristofferson‘s debut for its importance, of Billy Joe Shaver for its down-home intelligence and even of James Taylor for its deceptively lazy delivery.

Hear two songs in this segment, and look for Ann Powers’ Nashville Sessions interview with Cobb to hear live versions of more songs from Shine On Rainy Day.

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NASA Spots What May Be Plumes Of Water On Jupiter's Moon Europa

Europa is believed to have a vast subterranean, saltwater ocean that contains twice as much water as Earth’s oceans. NASA/JPL-Caltech/SETI Institute hide caption

toggle caption NASA/JPL-Caltech/SETI Institute

Scientists have seen what might be plumes of water vapor erupting out of the icy surface of Jupiter’s moon Europa, suggesting that its subsurface ocean could be probed without having to drill through miles of ice.

That’s according to new findings from images captured by NASA’s Hubble Space Telescope that were released Monday and that will be published this week in The Astrophysical Journal.

Europa is one of the most intriguing places in the solar system because it’s thought to have a vast subterranean ocean with twice as much water as Earth’s oceans. This saltwater ocean is a tempting target for astrobiologists who want to find places beyond Earth that could support life.

The trouble with exploring this ocean is that the water is hidden beneath an icy crust that’s miles thick. But if plumes are indeed erupting from Europa, a spacecraft could potentially fly through them and analyze their chemistry — much like NASA’s Cassini probe did recently when it sped close to Enceladus, a moon of Saturn that has small geysers.

Scientists used Hubble to watch Europa’s silhouette as the moon moved across Jupiter’s bright background. They looked, in ultraviolet light, for signs of plumes coming from the moon’s surface. They did this 10 separate times over a period of 15 months, and saw what could be plumes on three occasions.

Scientists scrutinized Europa’s silhouette as the moon passed in front Jupiter and saw what could be plumes of water vapor erupting from Europa’s surface. A. Field (STScI) hide caption

toggle caption A. Field (STScI)

“There are intriguing features apparently emerging from Europa,” says William Sparks, an astronomer with the Space Telescope Science Institute in Baltimore, though he cautioned that researchers are really working at the limits of Hubble’s capabilities. “The possible plumes are mostly clustered around the southern edge, although there is also one candidate at a more equatorial location.”

NASA says the plumes are estimated to rise up about 125 miles, and presumably material then rains back down onto Europa’s surface.

Using Hubble in a different way, scientists previously saw hints that salty water occasionally travels up to the moon’s surface. In 2012, the telescope detected evidence of water vapor above Europa’s south polar region, suggesting the existence of plumes that shoot out into space.

“These are different approaches, but they complement one another and they seem to both be independent evidence of plume activity on Europa,” says Jennifer Wiseman, senior Hubble project scientist at NASA’s Goddard Space Flight Center in Greenbelt, Md.

“On Earth, life is found wherever there is energy, water, and nutrients. So we have a special interest in any place that might possess those characteristics. And Europa might be such a place,” says Paul Hertz, Astrophysics Division director at NASA headquarters in Washington, D.C.

The agency’s Juno spacecraft is currently in orbit around Jupiter, but it isn’t slated to take any observations of Europa. However, Congress has ordered NASA to launch a mission to Europa no later than 2022, leading some people to joke that it’s the only mission that would be illegal for NASA not to fly.

“One of the biggest unknowns we have with these putative plumes is understanding their timing,” says Curt Niebur, who is the Europa mission program scientist at NASA headquarters. He says the more observations scientists can get, “the better we can use that to construct a schedule for when we search for these plumes at close range from the Europa flyby mission.”

Besides the NASA mission, the European Space Agency is planning a mission called JUICE, short for Jupiter Icy Moons Explorer, that will observe Europa and two other Jovian moons.

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Republicans Say Obama Administration Is Giving Away The Internet

A screen at a 2012 press conference shows a rolling feed of new Web address endings, for which ICANN had received applications.

Andrew Cowie/AFP/GettyImages

Republican lawmakers are accusing the Obama administration of allowing countries like Russia, China and Iran to take control over the Internet. Their beef with the administration focuses on a relatively obscure nonprofit overseen by the U.S. government that is scheduled to become fully independent Saturday.

The organization is called the Internet Corporation for Assigned Names and Numbers, or ICANN for short. Its history traces back to a graduate student at UCLA named Jon Postel.

He started keeping track of the unique numbers assigned to particular computers using the Internet, during its early days. Jonathan Zittrain, an Internet law professor at Harvard, says Postel kept a clipboard to make sure no user had the same number — sort of like a phone book.

“It was just sort of an honor system that would stop Caltech from coming in, or Bulgaria, from saying, ‘You know what, we’re going to start using those numbers,’ ” Zittrain says. “It’s just something that would be a way of coordinating as people came online and needed to use numbers and, later, names.”

Today that function is done by ICANN, a nonprofit based in Los Angeles with a budget of more than $130 million and more than 350 employees. It keeps track of millions of websites all over the globe.

Since its founding in 1998, ICANN has been overseen by the U.S. Commerce Department. But the government contract ends on Sept. 30 and the Obama administration plans to let ICANN become fully independent.

Republican Sen. Ted Cruz of Texas has waged a campaign against the transition that includes ominous sounding videos, in which he says that the phase-out of U.S. oversight will open the door to authoritarian governments taking control of the Internet.

“Russia, and China, and Iran don’t have a First Amendment,” Cruz says in one of the videos. “They don’t protect free speech, and they actively censor the Internet. ICANN could do the same thing, putting foreign countries in charge of what you can say online, prohibiting speech that they disagree with.”

Though ICANN oversees a fairly geeky administrative function, it does have an advisory panel that includes representatives of governments from all over the world. And there have been some dust-ups over the granting of new domain names, which has made some critics worry that ICANN is already being used to clamp down on speech.

Gay rights advocates have been trying to get approval for a .gay domain so that gay people all over the world can easily find resources. ICANN has been evaluating the requests for years, says Berin Szoka, president of the TechFreedom think tank that has opposed the transition. He says it’s not clear what’s really going on.

“It’s always going to be a little bit hazy. It’s going to be hard to actually know who’s really driving what,” Szoka says. “So here, for example, I guarantee you there are governments that have been exercising whatever influence they can to stop the creation of .gay.”

Advocates for ICANN’s independence say that there are a lot of safeguards in place to limit any government intrusion. The organization’s global board is made up of business, nonprofit and academic leaders. The rules make it hard for governments to exert that much influence.

And, Harvard’s Zittrain says, governments that want to censor the Internet already do so in much more effective ways: “There are so many other paths that the Russians or the Chinese could take and have taken to make sure that their citizens or even people around the world can’t see stuff that they don’t want them to see.”

He points out that despite Cruz calling the transition “a radical proposal,” the U.S. government has been planning to fully privatize ICANN for years — going back to the Clinton administration, continuing with George W. Bush and now Obama.

The plan’s supporters argue that not completing the phase-out could undermine U.S. credibility. “There are people who will argue that if we don’t give it up that we have bad motives,” Michael Chertoff, former Homeland Security secretary under George W. Bush and Obama, told the AP.

Zittrain thinks Republicans are politicizing this to attack the president. “It’s a little strange to see people who have been vocal about getting the government out of content-based decisions insisting that the government remain in the position of wielding a veto over some aspect of the flow of bits online,” he says.

Cruz had pushed to include a provision to preserve U.S. oversight of ICANN into the Senate’s spending bill, but the legislation’s most recent version didn’t include it. He is now urging House Republicans to take up the cause.

And though Cruz and Donald Trump have their differences, last week the Republican nominee came out in support of Cruz’s efforts to stop the transition.

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How Arnold Palmer Hit A Hole In One With His Signature Drink

A fresh Arnold Palmer, waiting to quench someone’s thirst. Chapendra/Flickr hide caption

toggle caption Chapendra/Flickr

As we mourn the golf great Arnold Palmer, we acknowledge another contribution he made to our culture: the tasty and refreshing iced tea and lemonade beverage that carries his name.

Over his long career, Palmer won seven majors, 62 PGA Tour events, the Masters, the U.S. Open, and the British Open. However, it was his working-class background — Palmer’s dad was a greenskeeper and golf pro — as well as his humble spirit that helped the now-iconic sports figure grow famous. So the non-alcoholic concoction that Palmer stirred up fit with his plainspoken persona.

But how did Palmer come up with the eponymous refreshment? In a 2013 episode of ESPN’s 30 for 30, the sports hero explained how it just poured out of him one afternoon in his Pennsylvania kitchen. As he recalled, he asked his wife to make a big pitcher of iced tea and put a little lemonade in it.

“We mixed it up and I got the solution about where I wanted it and I put the lemonade in it, and I had it for lunch,” Palmer said.

From then on, the golfer took a thermos of the drink with him when he teed up on the links.


Still, it wasn’t until the 1960s that the drink became known as the “Arnold Palmer.” As the golfing champion recounted in a 2012 interview with CNBC, one time he was at a restaurant and ordered a glass of iced tea and a glass of lemonade, and mixed them up.

“A lady in the restaurant heard me do that and ordered a tea, and she says, ‘I want a Palmer.’ She called it by name, and I said, ‘Boy, maybe I should do that,’ ” he said.

In the early 2000s, Palmer went into business with the Arizona Beverage Company, marketing the drink with his name and labeling it “Half & Half.”

But even with that label there is no consensus on the recipe, as some insist it’s actually two-thirds tea to one-third lemonade.

While Palmer declined to reveal the precise amounts of tea and lemonade he prefers in some interviews, he did make it clear in that CNBC interview that tea should be the star of the drink.

“Iced tea has the dominant side, that dominates the drink,” Palmer said. “And if it doesn’t, it isn’t really right.”

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Young Syrian With A Dream Risks His Life To Film New Netflix Doc

Khaleed Khateeb, 21, was the videographer for the Netflix documentary The White Helmets. “This photo was after double tap of aircraft in 27-7-2014,” he says, referring to an air strike followed by another attack. “I don’t know how I survived.” Fadi al Halabi/Courtesy of Khaleed Khateeb hide caption

toggle caption Fadi al Halabi/Courtesy of Khaleed Khateeb

Khaleed Khateeb dreamed of being a photojournalist when he was in high school. As he watched Syria crumble into chaos around him, he wanted to share his country’s story with the world.

“And now,” he says, “I have finally got my dream.” Khateeb is a 21-year-old volunteer for the Syrian Civil Defense forces, rescuing those caught in the crossfire of the civil war.

And over the past year, he’s had a second job: filming his fellow volunteers’ heroic efforts for the Netflix documentary The White Helmets, a 41-minute film released this month.


Khateeb worked with U.K.-based filmmaker Orlando von Eisiedel, director of the Oscar-nominated 2014 film Virunga, about the gorillas who live in that national park.

Von Einsiedel says he first found out about the Civil Defense forces — informally known as the White Helmets — when “some friends showed me and [producer Joanna Natasegara] this grainy YouTube footage of this tiny baby being pulled out from the rubble after a bombing.”

“We were even more moved when we found out who the rescuers were,” von Einsiedel says — regular citizens. They’re former blacksmiths and accountants, gym teachers and students — like Khateeb.

In the five years since the civil war between President Bashar Assad’s government and rebel groups began, more than 250,000 Syrians have died in the conflict. But thanks to the White Helmets, over 60,000 lives have been saved.

The story, von Einsiedel says, was “one that reignited my faith in humanity.”

So von Einsiedel reached out to the nonprofit Mayday Rescue, which provides the White Helmets with equipment and guidance, to ask if he could join a group of volunteers in Turkey. They had come up from Aleppo for a boot camp in search-and-rescue techniques.

The director wasn’t sure how to get footage from Syria’s front lines. “The risks to journalists in Syria at the moment are so high that for us to go there would have been frankly just reckless,” von Einsiedel says.

A White Helmets volunteer in Aleppo carries an injured child after an airstrike. Beha el Halebi/Anadolu Agency/Getty Images hide caption

toggle caption Beha el Halebi/Anadolu Agency/Getty Images

That’s when the filmmakers found out about Khateeb, who had been informally filming rescue missions and posting them on YouTube since he joined the White Helmets back in 2013.

“When the Assad regime lost many areas inside Syria, I saw many photographers and reporters come in Syria, doing very important work, documenting,” Khateeb says. “And I thought I wanted to be just like them.”

Von Einsiedel asked Khateeb to come meet him and the rest of the film crew at the training in Turkey and commissioned him to be a videographer. “We helped hone his documentary filming skills,” von Einsiedel says. Khateeb went back to Aleppo with better camera equipment.

Khateeb’s footage offers a look into daily life for the White Helmets as they rush toward bomb blasts and dig through rubble, searching for life among a mess of dismembered bodies.

He also captures the quieter moments in between rescue missions. One volunteer collapses in tears when he learns that his brother has been killed in a bombing, and another folds over with relief when he learns that his son has been spared.

Khateeb himself has experienced considerable loss while working with the White Helmets.

“The most difficult thing for us is losing another volunteer,” he says. “In 2014, we lost three volunteers in one day. We were going to a rescue operation. When we arrived to the massacre, the aircraft targeted the same place again.”

Medical workers — as well as first responders, including the White Helmets — are especially at risk of being targeted by Assad’s military, according to international aid groups. Over 130 White Helmets have died on duty since the group started in 2013.

Khateeb says he plans to stay in Aleppo as the White Helmets’ official chronicler, even though he understands the grave risks. Though he’d rather that his parents, who fled to Turkey, not know just how dangerous his job is.

Recently, he texted them a nice picture of the swimming pool at the White Helmets headquarters.

“I told them, you know, ‘I’m bored and I’m just swimming,'” he says. “I sent them this because I want them to forget the bad images of Aleppo.”

And yet, he says, it’s important that the rest of the world see those images. “So maybe they will exercise pressure on their government to intervene,” he says. “Maybe then we can stop this genocide.”

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Philippine President Says He'll Open Trade Alliances With China, Russia

Philippine President Rodrigo Duterte speaks during a presidential awarding ceremony held at the Malacanang Palace in Manila, Philippines on Monday. George Calvelo/Anadolu Agency/Getty Images hide caption

toggle caption George Calvelo/Anadolu Agency/Getty Images

Philippine President Rodrigo Duterte said Monday that he’s interested in offering trade alliances and long-term land leases to China and Russia.

Duterte said he realized he’d be “crossing the Rubicon” with the U.S., his country’s close ally and former colonial ruler.

“I am not really going to break ties” with the U.S., Duterte said, but he indicated he’d be willing to forge closer economic relationships with the other side of “the ideological barrier.”

The Associated Press reports that Duterte would be offering countries in China and Russia the ability to lease land in the Philippines for more than a century.

Duterte told reporters that he would be traveling to China soon and would meet with President Xi Jinping. He also said he’d already opened up a conversation with Russian Prime Minister Dmitry Medvedev, speaking with him during a summit in Laos earlier this month, the AP reports:

” ‘I would need your help in everything — trade, commerce — and I will open up,’ [Duterte] said he told Mevedev.

“Asked by a reporter what he meant by crossing the Rubicon, he said it was ‘a point of no return.’ He said the problem was that the Philippines’ mutual defense treaty with the U.S. does not guarantee that Washington will come to the Philippines’ defense if it is attacked because the U.S. president would need the approval of Congress.

“U.S. Embassy officials were not available for comment Monday night.”

The U.S. and its former colony have a long and complicated relationship. The U.S. recognized the Philippines’ independence and established diplomatic ties in 1946, and both nations signed a mutual defense treaty in 1951. The U.S. has traditionally been the Philippines’ largest foreign investor.

For decades, the U.S. maintained large military bases there, but amid growing anti-American sentiment, the Philippines voted to push the U.S. bases out in the early ’90s.

More recently, the U.S. military presence in the Philippines has grown again — although permanent bases have not returned — as some Filipino leaders have grown increasingly wary about the conflict over the South China Sea.

But since Duterte took office this summer, he’s called for the withdrawal of U.S. military advisers and said the Philippines will no longer conduct joint patrols with the U.S. Navy.

He’s also insulted President Obama and the U.S. ambassador in Manila.

Duterte has prompted international criticism for pursuing a harsh crackdown on the drug trade in the Philippines, one that has left thousands of people dead. Some of Duterte’s headline-grabbing insults have been defiant reactions to criticism — real or hypothetical — over an initiative that many say violates human rights.

But as Michael Sullivan recently reported for NPR, the president and his bloody war on drugs remain popular within the Philippines.

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Medications Can Help People Stop Abusing Alcohol, But Many Don't Know

Public health officials want doctors to consider treating alcohol abuse with medications that have a track record of success. Hero Images/Getty Images hide caption

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Two often-overlooked medications might help millions of Americans who abuse alcohol quit drinking or cut back.

Public health officials, building on a push to treat people who abuse opioids with medications, want physicians to consider using medications to treat alcohol addiction. The drugs can be used in addition to or sometimes in place of peer-support programs, they say.

“We want people to understand we think AA is wonderful, but there are other options,” says George Koob, director of the National Institute of Alcohol Abuse and Alcoholism, a part of the federal National Institutes of Health.

It is still rare for a person struggling with alcohol to hear that medication therapy exists. This partly reflects the tradition of treating addiction through 12-step programs. It’s also a byproduct of limited promotion by the drugs’ manufacturers and confusion among doctors about how to use them.

A key study funded by the federal government reported last year that only 20 percent people who abuse alcohol will ever receive any form of treatment, which ranges from a seeing a counselor or doctor to entering a specialized treatment program.

The same is true for opioid addiction — about 80 percent of people dependent on opioids will never receive treatment.

The NIAAA, in an effort to give patients and doctors more choices, has launched programs to develop medications and support drug trials. NIAAA and the Substance Abuse and Mental Health Services Administration also asked a panel of outside experts to report on drug options.

“Current evidence shows that medications are underused in the treatment of alcohol-use disorder, including alcohol abuse and dependence,” the panel reported last summer. It noted that although public health officials and the American Medical Association say alcohol dependence is a medical problem, there continues to be “considerable resistance” among doctors to this approach.

Naltrexone and acamprosate are the two drugs on the market for patients with alcohol cravings. “They’re very safe medications,” said Koob. “And they’ve shown efficacy.”

One of the drugs, naltrexone, is also used to treat opioid abuse.

For one North Carolina woman eager to get sober, naltrexone provided that help. Dede, who wishes to remain anonymous, says she went to hundreds of AA meetings. She spent time in two different rehabilitation facilities, one of which cost her $30,000 out of pocket. But she still struggled.

“The self-loathing was the worst thing about it,” she says. “I hated myself as an alcoholic, but I could not stop.”

Eight years ago, during a meeting for people who had drinking problems with counselors at the University of North Carolina, Chapel Hill, she first heard about Dr. James Garbutt, a psychiatrist who uses naltrexone to treat patients with alcohol-use disorders. She tried to get an appointment to see him, but was told it would take weeks to fit her in. She wouldn’t wait that long. Instead, she showed up in the doctor’s waiting room and stayed until he was able to see her.

“I begged. I really begged to get to see him,” she says.

With the help of naltrexone and one-on-one counseling, Dede says she has consumed no more than two sips of wine since that visit.

A third drug is also available, but it does not work against alcohol cravings. Disulfiram, also known by the brand name Antabuse, makes people violently ill when they consume alcohol. It has been found to be less effective in helping stem alcohol abuse than the other two drugs.

Naltrexone comes in both an oral and injectable form and has few side effects. It was approved for use in alcohol addiction in 1994. Acamprosate was approved in 2004 to treat only alcohol problems. It comes as a tablet.

When naltrexone came on the market, many misunderstood how and for whom the drug worked. Naltrexone’s makers stopped marketing the drug in 1997. Acamprosate was plagued by many of the same marketing problems. Misunderstanding still persists today.

Naltrexone’s history of opioid treatment also hurt its image. The drug blocks the effects of opioid receptors in the brain, so opioid users who take it without first having completely detoxed experience agonizing withdrawal.

But naltrexone doesn’t have the same effect on patients with alcohol-use disorders. A patient who drinks while taking the drug will still experience the effects of alcohol that impair coordination and judgment, but not get the opioid-induced reward to reinforce the behavior. That makes the idea of drinking less appealing.

Garbutt, who was on the expert panel last year, encourages complete abstinence for his patients, but also supports patients who would rather set a goal of harm reduction.

“If we can reduce your intake 80 percent and reduce your heavy drinking days a lot, that’s also very positive,” he says. “Some people just aren’t ready. The idea of sobriety is just too big of a concept for them to wrap their head around.”

In fact, explains Garbutt, while naltrexone does help patients remain abstinent, “the effect of reducing heavy drinking is the most prominent effect of naltrexone.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Emily Yasinski is on Twitter: @EmmaYas24

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