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JUDY WOODRUFF: Speaking of the pope, he is due to head to the Greek island of Lesbos tomorrow to see for himself the extent of the refugee crisis.

He plans to visit a detention camp where some of the migrants are being held, pending possible deportation. That’s according to terms of a deal signed last month between the European Union and Turkey.

So, just how important is this visit?

Special correspondent Malcolm Brabant reports from Lesbos.

MALCOLM BRABANT: Another day of uncertainty begins on an island that once offered hope to hundreds of thousands seeking security, protection or prosperity.

But the estimated 4,000 migrants currently stranded on Lesbos worry that their foothold in Europe is more tenuous than ever. This island is now a place of despair. Human rights groups regard it as an open prison for people desperate to avoid being sent back across the stretch of water that claimed so many lives.

George Kosmopoulos of Amnesty International:

GEORGE KOSMOPOULOS, Director, Amnesty International Greece: We hope that the visit of the pope will highlight both the solidarity, the great solidarity shown by the Greek people and people from all over the world to refugees in Lesbos, in Mytilini, but also will shed some light additionally to the problems, to the big problems with regards the implementation of the E.U.-Turkey deal, in the rushed attempt of Greece to proceed with a deal that is both dangerous and illegal, in our view.

MALCOLM BRABANT: In preparation for the pope’s visit, they were whitewashing the walls of the detention camp and covering up graffiti expressing support for the migrants.

Whenever dignitaries come to look at the refugee crisis for themselves, the Greek authorities do what they can to sanitize the situation. When actress and U.N. Refugee Agency special envoy Angelina Jolie visited, the razor wire for the detention center was conveniently taken down and put straight up as soon as she left.

In the run-up to the pope’s visit, all deportations to Turkey have stopped. But I’m told by sources at the E.U.’s border agency, Frontex, that they will resume early next week.

Human rights advocates are highly critical of conditions in this so-called hot spot, where asylum-seekers are supposed to be processed. The police weren’t keen on us getting too close.

MAN: It’s not allowed.

MALCOLM BRABANT: Why not?

MAN: Stop the shooting.

MALCOLM BRABANT: Why not?

MAN: Sir, it’s not allowed.

MALCOLM BRABANT: Why not?

MAN: Problem. Close. Close. Close.

MALCOLM BRABANT: OK. All right.

Eva Cosse of Human Rights Watch was also prevented from entering, but interviewed people through the fence.

Her organization and others believe the detentions are arbitrary and unjust.

EVA COSSE, Human Rights Watch: What’s wrong? First, there are large, large numbers of vulnerable groups being detained there.

We interviewed families with young children, people with disabilities, people with mental health problems, pregnant women who are really suffering inside there, because there are no services. Since the implementation of the E.U.-Turkey deal, NGOs withdrew from the detention facilities, in line with their policies not to work in closed facilities. So there is a big lack of services for those people.

MALCOLM BRABANT: An alarm goes off at the phone recharging center at another, more relaxed and better-equipped refugee camp. It’s the Muslim call to prayer.

Sitting nearby is Murteza Hasainzada, a tailor from Kabul. Having spent $10,000, he arrived in Lesbos after Europe made it clear through the deal with Turkey that it was no longer wide-open to all comers. He’s not too sure what the pope can do, but he will take any help that will stop him from being deported.

MURTEZA HASAINZADA, Refugee: I don’t want to go back. I say, until they open the borders, I am — stay here, and I don’t want to go back.

MALCOLM BRABANT: The same unwillingness to accept the new reality is evident in a conversation between a visiting Danish politician and a Palestinian asylum-seeker, Yousef Hammad, who fled Gaza after being jailed for six months by the radical Hamas government. He also arrived in Lesbos after Europe pulled down the shutters.

YOUSEF HAMMAD, Refugee: I don’t like to think about the situation about going back, maybe, like, stay here just good.

MALCOLM BRABANT: The Danish politician, former center-left Interior Minister Morten Ostergaard, is concerned that asylum-seekers’ rights under international law are possibly being breached, but doubts whether Pope Francis is the catalyst for change.

MORTEN OSTERGAARD, Leader, Radicale Party, Denmark: At least what I think that the pope can do is perhaps shed a bit of hope in the people who are desperate. But, politically, it’s up to people like me and the political leaders in the European Union to make a difference. We can’t let — leave that to the pope.

MALCOLM BRABANT: And this is Spyros Galinos, the mayor of Lesbos, who was instrumental in inviting the pope to draw attention to the plight of the refugees and the islanders’ burden.

MAYOR SPYROS GALINOS, Lesbos: It is a visit of enormous symbolic importance. And we hope that all governments will follow the pope’s lead and finally move in the right direction for all the peoples of Europe.

MALCOLM BRABANT: On a religious level, the pope’s visit is fraught with difficulties. The Catholic and Orthodox churches split cataclysmically 1,000 years ago, and are still unable to resolve differences.

There are some forces within orthodoxy that are seeking reconciliation, but leading theologian Panayotis Tsagaris is skeptical.

PANAYOTIS TSAGARIS, General Secretary, Panhellenic Union of Theologians (through interpreter): We consider that the pope’s visit is little more than a public relations exercise which will not provide any real solution to the refugee problem facing not only my island and country, but also extending to Europe.

MALCOLM BRABANT: The fraught history between the two churches has even led some ultra-conservative religious leaders to call the papal mission a stab in the back. One archbishop expressed concern that hiding among the migrants are Islamic extremists on a mission to undermine Europe and its traditions.

But on the waterfront in Greece’s main port, Piraeus, their Orthodox Church is demonstrating its willingness to reach across the religious divide. Every day, the church’s charity, Apostoli, distributes 1,000 meals to asylum-seekers living rough on the harbor.

Spokeswoman Despina Katsivelaki rejects the Islamophobic wing of orthodoxy.

DESPINA KATSIVELAKI, International Orthodox Christian Charities (through interpreter): We help human beings, regardless of their race, religion, color, nationality. That’s what we do. That’s our role and aim, and that’s what we try to succeed in doing.

MALCOLM BRABANT: Although the islanders are desperate for the human tide to diminish, there’s profound empathy for people escaping conflict and trying to improve themselves, because Greeks have a similar history.

Father Athanasios Giousmas is the chief priest at the Exquisite Church in Mytilini, Lesbos’ main town.

FATHER ATHANASIOS GIOUSMAS (through interpreter): This is why we have such mixed feelings within ourselves, not only pain for these refugees, but also agony about what is likely to happen generally, and in this country, together with disgust — and forgive me for saying so — but disgust, not only for the world leaders, but also those here in Greece.

MALCOLM BRABANT: Despite misgivings about the E.U.-Turkey accord, it seems to be working as its deal-makers intended. The numbers of arrivals are substantially down.

Spanish lifeguards have returned from patrols empty-handed for nearly two weeks. The Turks are either upholding their end of the bargain, or the boats are being intercepted by the E.U. border agency.

The big question is, will the despair on Lesbos filter back down the migrant trail and deter the throng, or will they find new routes to reach their goal?

For the “PBS NewsHour,” I’m Malcolm Brabant in Lesbos.

JUDY WOODRUFF: And there will be more on the pope’s visit to Lesbos on “PBS NewsHour Weekend,” right here on most of these PBS stations.

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JUDY WOODRUFF: Today, Republican presidential front-runner Donald Trump continued to attack his own party’s process for choosing a presidential nominee, a system he says is rigged.

For more on that, the chairman of the Republican National Committee, Reince Priebus, joins me now.

And, Reince Priebus, we welcome you to the program.

What do you say? Donald Trump has been saying this for days. I heard him say it again in Syracuse, New York, just a few hours ago. What do you say? I mean, this is a very serious charge he’s making, that the process is crooked.

REINCE PRIEBUS, Chairman, Republican National Committee: Well, I don’t know how serious the charge is.

And I’m not sure how much is rhetoric, and — but the truth is, is that the process is the same process it’s been for decades. But the reality is, no one actually cared about how delegates were allocated. Each state has the opportunity to choose the method by which they allocate delegates to the national convention.

Some states have primaries. Some states have caucuses, and some states have actual conventions where delegates are voted on. These are things that have been set in place since October of 2015. All the candidates have been briefed. They have all been aware of the rules. They’re out there for the whole world to see.

There is nothing mysterious about it. And, by the way, no one complained either before Colorado, before the result. It was only after the results did we get a single complaint about the process.

JUDY WOODRUFF: Right.

Well, let me read — you’re familiar with this, but let me read you what Donald Trump said about Colorado. He said: “When I joined the campaign in June,” he said, “they had a system. He said, “After they saw I was going to win in Colorado, they changed the system.” And he said the people in Colorado didn’t know that their votes were going to be taken away from them.

REINCE PRIEBUS: Well, and that statement has been debunked by many people.

Colorado had a convention the last time. Colorado used to have what we call beauty contests. In other words, there weren’t elections. It was a straw poll that didn’t award any delegates to anyone, and so it had no value, no use of a straw poll, so they dumped the straw poll.

And they went to the straight-up convention. So — and, By the way, 60,000 people competed in Colorado in the precinct level contest. Then those people moved to a county contest. Then those people moved to a congressional district contest. And then they moved to a state convention contest, where all the candidates participated.

They had surrogates speaking. No one along the way said, hey, I don’t really like the way this is going. I don’t really like this kind of system.

JUDY WOODRUFF: But it is…

REINCE PRIEBUS: And now, all of a sudden…

JUDY WOODRUFF: I was just going to say, but it is the case, if you look at state after state after state, the process is different in virtually every one of the 50 states. It’s not a simple thing.

You have to be some kind of an expert to understand all this. Is it really democratic anymore? And I mean with a small D.

REINCE PRIEBUS: Of course it is.

It’s the same method that we have been using, and the Democrats use the same delegate method. We’re not a public entity. We’re an organization that is made up of members across this country and state parties. State parties have a right to determine how each of their delegates get to go to the national convention.

You know, 150 years ago, delegates ran in the states, and they just went to the convention and they voted, and they set rules and they vote for officers. It’s a real convention. It’s not a four-day party. It’s just that no one ever watches what happens during the day at these conventions, when rules are voted on and there is actual business that goes on.

It’s no different than when the Boy Scouts have a convention…

JUDY WOODRUFF: But when…

REINCE PRIEBUS: … or when the Kiwanis have an election. They get together, and they vote on officers and they have an election.

JUDY WOODRUFF: But when — I think what Mr. Trump is — and others have made this point — that when the person who gets the most votes in a primary or a caucus doesn’t end with the most delegates, or at least not a proportional percentage of those delegates, something smells.

REINCE PRIEBUS: Yes, but they do end up with the most delegates. They do.

In the case of Florida, Donald Trump won about — in the mid-50s percentage of the vote. He won 100 percent of the delegates. I didn’t hear a lot of complaining about that. The reality is, is that the bound delegates that are awarded to the candidates are absolutely bound to those candidates. They don’t lose that support.

They are bound to the candidate, no matter what. Even if they don’t like the candidate, they have to vote for that candidate. What the problem comes in that you’re hearing complaining about is the unbound delegates, who’s getting the unbound delegates. And that is a separate issue.

That is an issue of each campaign going into each of these states and competing for those unbound delegates. But they’re not losing anything, unbound delegates to the national convention, not one thing.

JUDY WOODRUFF: Well, I think not everybody understands the difference between bound and unbound.

But I do want to move on and ask you this. Donald Trump’s central argument seems to be that the American — I mean, is — that the American system is — political system, is rigged. He talks about, it’s the consultants, it’s the pollsters, it’s the party, what he calls the party bosses who are running things.

He says the politicians have grown rich and powerful; ordinary people are left behind.

Do you agree with his really central thesis here?

REINCE PRIEBUS: Well, sure, I think a lot of people agree with — I think all — I think the actual — all the candidates. I mean, I think those are themes that I think everyone can relate to. So I don’t quarrel with that.

But in regard to whether or not a national party has a right to set the rules as to how a nominee is chosen from a party is unquestionable. I mean, these candidates, what are they doing? They are competing to see which one of these people are going to be chosen by the voters and the delegates of our party.

One of them is going to be chosen. I’m not competing for one of them. They’re competing to join the Republican Party. They can compete to join whatever party they want to join, but if they want to join the Republican Party, then they have to play by the rules of the Republican Party, and I can’t imagine any controversy about that whatsoever.

JUDY WOODRUFF: So, just quickly, then, are you ruling out somebody being chosen, nominated at the convention who didn’t run in the primaries?

REINCE PRIEBUS: They would be chosen — if any — if a majority of the delegates at the convention choose a person to be the nominee of our party, they will be the nominee of our party.

Now, I find that to be highly, highly unlikely. I have said that many times. Certainly, Donald Trump and Ted Cruz have great advantages. But, ultimately, they have to or John Kasich or whoever has to be able to get the majority of delegates on the floor of the convention to be the nominee of our party.

And we will support that nominee at the Republican National Committee.

JUDY WOODRUFF: Reince Priebus, the chairman of the Republican National Committee, thank you very much.

REINCE PRIEBUS: You bet.

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JUDY WOODRUFF: Now: a high-profile showdown between a tech giant and the U.S. government over accessing private data.

This time, it’s Microsoft. Yesterday, the company filed a suit against the Department of Justice in federal court. Microsoft argues it’s unconstitutional for the government to ask for customers’ personal data or e-mails in most cases without the individuals’ knowledge. The company says it’s received more than 5,600 requests for such data from the government in the last year-and-a-half, often from the cloud or remote servers. And nearly half of those requests come with a ban from the government on alerting customers.

Brad Smith is the president of Microsoft. He joins me from company headquarters in Redmond, Washington.

And welcome to the program, Brad Smith.

I do want to point out we invited the Department of Justice to join the interview, but they declined.

So, let me begin by asking you, what is it that the federal government is doing that Microsoft doesn’t like?

BRAD SMITH, President, Microsoft: Well, what gives us concern is the fact we have received almost 2,600 — almost 2,600 of these so-called gag or secrecy orders over the last 18 months.

Over two-thirds of them have no end date at all. So it means that we are permanently prohibited from telling customers that the government has accessed, read and obtained copies of their e-mails. We feel that infringes on the constitutional rights of consumers and businesses to be secure from unreasonable government searches.

It infringes on our First Amendment right to speak, to share information with our customers.

JUDY WOODRUFF: Well, we know the Justice Department has not responded to the lawsuit. They have not said anything publicly, but we know that in the past they have said these are investigations that involve criminals, people who are breaking the law, that involve — that are perhaps involved in potential terrorist acts.

Why not work with the government when they’re trying to go after the bad guys?

BRAD SMITH: Well, this is an issue that we have discussed with various officials in government for some time.

And we readily recognize that there are many cases where there should be some kind of secrecy, that there is a real danger if information is disclosed. But we feel that these kinds of secrecy orders have been — become too routine. They’re being issued in cases that involve businesses, as well as consumers.

And it especially concerns us that there is no end date. Let’s face it. Forever is a long time. Even military secrets are declassified eventually. Why should we have a country where people will never learn that the government has accessed their e-mails?

JUDY WOODRUFF: Well, I was reading today that some investigators who have worked on, I guess, in this area have said that if you notify people who are being investigated, you run the risk that they are going to change their communication pattern, they’re going to tamper with evidence. They may even try to leave the country. What about that?

BRAD SMITH: Well, that really goes to the point that, yes, there are times when a nondisclosure order is a sensible thing to do.

But the law in this case does, in our view, not require the government to make the kind of compelling showing that it should, and, hence, the government is getting these kinds of orders in too many cases. And even in cases where this kind of secrecy is needed, eventually, the need for secrecy goes away.

And yet, even then, people will never learn that the government accessed their e-mail. And that, as much as anything, really runs, we think, right into the constitutional protections we all should enjoy.

JUDY WOODRUFF: Brad Smith, what do you say to those who look at this and say, well, this is just an effort to do what’s good for business, rather than what’s good for the American people, for the American government?

BRAD SMITH: Well, I think this is fundamentally about what is good for people and their rights. It is good for technology. It is good for businesses who are customers as well, whose e-mails are being read.

But, most importantly, I think it’s about one thing. It’s about ensuring the kinds of values that we have had in this country under the Constitution for 230 years remain intact even as technology changes, and information that we have long stored on paper is now stored in the cloud instead.

JUDY WOODRUFF: Did you think about another course of action other than filing suit? Did you try to sit down with the government and talk to them about what they’re doing?

BRAD SMITH: We have had multiple conversations about these and similar issues. And this lawsuit doesn’t for an instant mean that those kinds of conversations should come to an end.

I definitely believe that, ultimately, across the technology sphere, it’s going to take a lot of good discussion to find new solutions. But we have found in recent cases that things were going the wrong way, not the right way, and there does come a point when you just have to put a stake in the ground and say that these constitutional rights matter, and we need the courts to intervene.

JUDY WOODRUFF: Is there a middle ground, though? Is there some — something, some level of information the government could share with you that would make you comfortable turning this individual’s e-mails over to them without notifying the individual?

BRAD SMITH: I think we always have to ask ourselves at the end of the day, is there some kind of middle ground that might emerge? And I think the answer is probably yes.

If we look at other statutes in other areas of federal law, there is typically a right for the government in the right circumstances to keep something secret for 30 days or 90 days, and, if the need continues, the government can go back, and it has to make its case before a magistrate yet again.

I think that if we could move this area of the law to be more like that kind of area, we’d find a middle ground emerge.

JUDY WOODRUFF: And just finally, there are some who are looking at this and saying, is this some kind of a turning point in this, I guess, larger tech industry — battle with the tech industry — battle with the government on the part of the tech industry over privacy, over the citizens’ privacy?

BRAD SMITH: Well, I think we’re living in a time where it feels like there is a turning point every other month.

When I step back from it all, I think what we’re seeing is this evolution of technology, people storing things digitally, storing them in data centers. And across the board, whether you’re in government or you’re in the tech sector, we’re all trying to find a path, so that the traditional values we have had in this country, the traditional rights we have enjoyed, will remain, so that information that’s stored in the cloud gets the same kind of protection as information stored on paper.

That, I think, is what we need to continue to seek.

JUDY WOODRUFF: Brad Smith, the president of Microsoft, we thank you for talking with us.

BRAD SMITH: Thank you.

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JUDY WOODRUFF: Good evening. I’m Judy Woodruff.

On the “NewsHour” tonight: A Greek island that has welcomed thousands of migrants prepares to welcome the pope. But some question whether his trip will do any good.

PANAYOTIS TSAGARIS, General Secretary, Panhellenic Union of Theologians (through interpreter): We consider that the pope’s visit is little more than a public relations exercise, which will not provide any real solution to the refugee problem facing not only my island and country, but also extending to Europe.

JUDY WOODRUFF: And it’s Friday. Mark Shields and David Brooks are here to analyze last night’s fiery Democratic debate, as is the chairman of the Republican National Committee, Reince Priebus, to discuss the strains in the GOP.

Then: Violinist Rachel Barton Pine takes classical music to unexpected places and people.

RACHEL BARTON PINE, Violinist: If we only played for the converted, we would be not honoring our gifts to the fullest extent.

JUDY WOODRUFF: All that and more on tonight’s “PBS NewsHour.”

(BREAK)

JUDY WOODRUFF: In the day’s other news, President and Mrs. Obama released their federal tax return for this past year. They paid $81,000 in taxes on income of $436,000. The couple donated 15 percent of what they made to charity.

Lawmakers in Brazil began debate today on whether to impeach President Dilma Rousseff. She’s accused of corruption in a political drama that’s all but paralyzed the country. Impeachment proponents argued today that Rousseff’s political maneuvering has led to Brazil’s high inflation and currency devaluations.

MIGUEL REALE JUNIOR, Author of Impeachment Legislation (through interpreter): Which is the most serious crime, a crime where a president puts in her pocket a sum of money, on that president which, due to the hunger for power, in search of maintaining power, sees no limits in destroying the Brazilian economy?

JUDY WOODRUFF: The impeachment charges allege that Rousseff doctored her government’s financial accounting to win public support. But defenders, including former President Lula da Silva, insisted today she has done nothing wrong.

LUIZ INACIO LULA DA SILVA, Former President, Brazil (through interpreter): I am convinced that the impeachment will not be approved. To topple a government that was democratically elected without any proof of any fiscal crime is not going to fix anything. All it will do is make the crisis even worse. Nobody will be able to govern a country with 200 million people without being legitimized by the popular vote.

JUDY WOODRUFF: The house vote there is slated for Sunday. If it passes, the Brazilian senate would decide whether to hold a trial of Rousseff.

North Korea tried today to launch a mid-range missile, one with a capacity to reach U.S. bases in Japan and Guam, but it blew up. The Pentagon called it a catastrophic failure. The missile test came as the North celebrated the birthday of the late Kim Il-Sung, founder of the communist state. His grandson, Kim Jong-un, is the current leader of North Korea.

A powerful new earthquake has hit Southern Japan, on the heels of one that killed nine people Thursday night. There were no immediate reports of casualties this time. NHK television showed the moment the shaking began, early Saturday morning, and triggered a tsunami advisory. The alert was later lifted, but the quake did leave collapsed buildings and cracked roads.

One hundred and fifty countries geared up today for a final push to eliminate polio around the world. The effort begins Sunday, and the World Health Organization says it is possible to stop all transmission of the crippling disease within a year. To do that, the campaign will target the last few areas of risk.

MICHEL ZAFFRAN, Director of Polio Eradication, World Health Organization: The virus travels without any barrier, so if we do not eradicate the virus, if we don’t get rid of it, we will quite rapidly go back to the situation we had before we started the eradication program. And we could have hundreds of thousands of cases of the polio disease around the world.

JUDY WOODRUFF: There have been only 12 cases of polio reported worldwide this year, in Afghanistan and Pakistan. Islamist militants there have attacked immunization teams, accusing them of being Western spies.

Back in this country, the governor of Mississippi signed a law permitting guns in churches. A holstered gun sat on top of a Bible as Governor Phil Bryant held the signing ceremony. Designated church members may be trained to provide armed security for their congregations.

President Obama announced today that he will support giving cable TV customers more choices on cable boxes. As it is, most people lease the boxes from a cable company. The Federal Communications Commission wants to let them buy elsewhere and possibly get a better price. The president also today ordered up a report on increasing competition in the industry.

On Wall Street today, the Dow Jones industrial average lost about 29 points to close at 17897. The Nasdaq fell seven, and the S&P 500 slid two. For the week, all three indexes added nearly 2 percent.

And it is must-see TV in Norway for those seeking relief from fast-paced daily life. On May 20, public broadcaster NRK will televise the world’s strongest tidal current for 12 hours live and uninterrupted. It is a strait just north of the Arctic Circle where seawater flows at 25 miles an hour. Previous shows included footage of a train ride, a canal cruise and a knitting tutorial, and all were viewer hits.

Maybe we should try those in the United States.

Still to come on the “NewsHour”: Microsoft’s president explains why his company is suing the U.S. government; GOP Chair Reince Priebus on the rules for selecting a presidential nominee; Mark Shields and David Brooks take on the week’s news; a preview of the pope’s visit to a refuge camp in Greece — can he make a difference?; and how violinist Rachel Barton Pine became an evangelist for classical music.

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JUDY WOODRUFF: Next: music with a purpose, a story about a violinist charting her own musical path.

Jeffrey Brown tells us exactly how her music is hitting the spirit.

JEFFREY BROWN: It was an unlikely setting for a classical music performance: a homeless shelter, the Community for Creative Non-Violence, in the shadow of the nation’s capital, where concert violinist Rachel Barton Pine played a special engagement for the residents.

There was music from many eras and styles. Along the way, Pine offered bits of musical history.

RACHEL BARTON PINE, Violinist: So, Mozart was from Germany from the late 1700s.

JEFFREY BROWN: And told them a bit about herself.

RACHEL BARTON PINE: And we were often one missed payment away from losing the roof over our heads, which was the scariest thing of all when I was a little kid.

JEFFREY BROWN: Pine, in fact, knows something of the plight of her audience. Her father was mostly unemployed, and the family had to scrape by.

RACHEL BARTON PINE: So, We had these three sort of grocery crates rescued from the garbage and this one little electric heater. And I would rotate it every 10 minutes, so that, as part of me was warming up and thawing, another part would be starting to freeze.

But we had to do unusual things, like get my concert clothes from a thrift store and try to fix them up to be something presentable for stage.

JEFFREY BROWN: These days, Pine tours the world a good part of the year, traveling with her husband, Greg, who serves as her manager, and their 4-year-old daughter.

But she feels a pull to give back wherever she goes.

RACHEL BARTON PINE: Sometimes, I go to hospitals. I have even been to prisons, and just wherever music can uplift people’s spirits. That’s the meaning of being a musician.

JEFFREY BROWN: But you have a life on the road that is different, in the sort of traditional performing and then playing in places like this.

RACHEL BARTON PINE: Absolutely.

Well, yes, I think more and more artists, especially with the younger generation, are really understanding the value of community engagement. If we only played for the converted, we would be not honoring our gifts to the fullest extent.

JEFFREY BROWN: One spirit lifted today, Ray Simmons, who told us of falling on hard times and finding hope in Pine’s music and his own.

Do you have to hold onto something?

RAY SIMMONS, The Community for Creative Non-Violence: You have to hold onto something. You have to hold onto your sanity.

(LAUGHTER)

JEFFREY BROWN: Yes.

RAY SIMMONS: Yes.

JEFFREY BROWN: For you, it sounds like you hold onto your music too.

RAY SIMMONS: I hold onto my music quite often. That’s what gets me through, knowing that I’m going to — yes, I’m going to play my way out and sing my way out of this place, for sure, for sure.

JEFFREY BROWN: Pine started young. She gave her first recital at age 5, played with a professional orchestra at 7, and with one of the great ones, the Chicago Symphony, in a concert of young performers at age 10.

MAN: And now super-duper Rachel Barton makes her debut with the Chicago Symphony Orchestra.

(APPLAUSE)

JEFFREY BROWN: In recent years, she formed a foundation to help what she calls poor prodigies with things not covered by traditional scholarships: accompaniment fees, sheet music, transportation to competitions.

To date, she’s helped 70 young people. Another project, Global HeartStrings, supports aspiring musicians in developing countries such as Haiti.

RACHEL BARTON PINE: Music programs here in America, we kind of take for granted, like rosin to put on your bow hair, or, you know, a shoulder rest, so that your violin will sit on your body properly.

JEFFREY BROWN: At 21, on the brink of a major career, the doors of a Chicago commuter train closed on the straps of her violin case, trapping Pine. The train dragged her 200 feet, severing her left leg and mangling her right foot. Fifty surgeries later, she walks on a prosthetic leg.

RACHEL BARTON PINE: Really, of course, it was a case of corporate negligence, because there had been many, many prior instances before the day that I happened to get hurt.

And, thankfully, they have changed their safety procedures. Everybody has something they have to deal with, and this just happens to be mine.

JEFFREY BROWN: And the concert violinist is also a heavy metal lover and performer, a regular headbanger, here playing Metallica’s “One.”

RACHEL BARTON PINE: So, at first, it was like the mainstream bands, but then I started to get into the classic thrash groups like Anthrax, Megadeth, Slayer, early Metallica, Pantera (INAUDIBLE). Like, this music just grabbed me. It was so intense.

JEFFREY BROWN: But you were playing classical music, playing Bach during the day, and then at 10:00, you’re listening to…

RACHEL BARTON PINE: Anthrax.

JEFFREY BROWN: Anthrax.

RACHEL BARTON PINE: So, it sounds silly to say I relaxed to this like headbanging metal, but, yes, I could just turn off my brain and rock out.

I started playing these things on my instrument and realized, wait a sec, this is actually very sophisticated music.

JEFFREY BROWN: For us, she played Ozzy Osbourne’s “Crazy Train.”

Maybe, Pine says, she can help bridge these disparate musical worlds.

RACHEL BARTON PINE: One of my goals has to been to get fellow headbangers out to the symphony. There is nothing more intense than 100 people on stage playing the Tchaikovsky Violin Concerto. And, you know, it’s just an experience like none other.

JEFFREY BROWN: A hundred people on stage, or one at a homeless shelter, where Rachel Barton Pine gave residents a taste of her newly released album, her 30th, called “Testament: Bach’s Sonatas and Partitas for Solo Violin.”

In Washington, D.C., I’m Jeffrey Brown for the “PBS NewsHour.”

JUDY WOODRUFF: Heavy metal on the violin.

And you can watch all of Rachel Barton Pine’s version of “Crazy Train” on Art Beat. That’s online at PBS.org/NewsHour.

And for more online: Rembrandt retold. A video artist has tied the 17th century Dutch painter’s work to a modern story, one of cancer, tragedy and growing up in South Central Los Angeles. You can view the touching piece on our home page.

And more from our Race Matters series. Journalists share their experience reporting on race and policing. Watch highlights from a town hall hosted by special correspondent Charlayne Hunter-Gault.

All that and more is on our Web site, PBS.org/NewsHour.

The post From poverty to prodigy: star violinist turns to other musicians in need appeared first on PBS NewsHour.

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JUDY WOODRUFF: It is the final weekend before the all-important New York primary, and the presidential candidates, Democrats and Republicans alike, were on the go today.

Most traveled to towns and cities across the Empire State. One traveled half-a-world away.

John Yang has the story.

AUDIENCE: Bernie! Bernie! Bernie!

JOHN YANG: They cheered Bernie Sanders in Rome, but it was Italy, not New York. His visit to the Vatican came just hours after the most combative Democratic debate yet. It was held in Brooklyn.

SEN. BERNIE SANDERS (VT-I), Democratic Presidential Candidate: I am sure a lot of people are very surprised to learn that you supported raising the minimum wage to 15 bucks an hour.

(CHEERING AND APPLAUSE)

HILLARY CLINTON (D), Democratic Presidential Candidate: You know, wait a minute, wait a minute. Wait. Come on.

SEN. BERNIE SANDERS: That’s just not accurate.

HILLARY CLINTON: I have stood on the debate stage with Senator Sanders eight prior times.

(CROSSTALK)

HILLARY CLINTON: I have said the exact same thing If we can raise it to $15 in New York or Los Angeles or Seattle, let’s do it.

(CROSSTALK)

WOLF BLITZER, CNN: If you’re both screaming at each other, the viewers won’t be able to hear either of you.

JOHN YANG: The animosity between Sanders and Hillary Clinton was clear, as they clashed on the minimum wage and her relationship with Wall Street.

HILLARY CLINTON: I stood up against the behaviors of the banks when I was a senator. I called them out on their mortgage behavior.

SEN. BERNIE SANDERS: Secretary Clinton called them out. Oh, my goodness, they must have been really crushed by this.

(CHEERING AND APPLAUSE)

SEN. BERNIE SANDERS: And was that before or after you received huge sums of money by giving speaking engagements?

JOHN YANG: Clinton called that a phony attack and slammed Sanders for voting to shield gun makers from some lawsuits.

HILLARY CLINTON: We hear a lot from Senator Sanders about the greed and recklessness of Wall Street. And I agree. We have got to hold Wall Street accountable.

SEN. BERNIE SANDERS: Thank you

HILLARY RODHAM CLINTON: Well, what about the greed and recklessness of gun manufacturers and dealers in America?

(CHEERING AND APPLAUSE)

JOHN YANG: Today, though, the two candidates were 4,000 miles apart, Clinton visiting a senior center in Harlem.

HILLARY CLINTON: It looks like we’re in Las Vegas.

(LAUGHTER)

JOHN YANG: And Sanders at a Vatican conference, assailing what he called an economy operated for the top 1 percent.

SEN. BERNIE SANDERS: Pope Francis has called on the world to say — and I quote — and how profound, how important this is — “no to a financial system that rules rather than serves.”

JOHN YANG: Senator Sanders said his campaign detour was well worth it. The high-profile Vatican visit came just four days before the crucial New York primary, a high-stakes race for both parties.

Today, all three Republican hopefuls fanned out across the Empire State.

DONALD TRUMP (R), Republican Presidential Candidate: Good to be with you. Good to be with you.

JOHN YANG: In Plattsburgh, front-runner Donald Trump kept hammering away, hoping to hold what polls show is a double-digit lead.

DONALD TRUMP: I’m not one of these politicians that say, it doesn’t matter if you vote for me or my opponent. It’s so important for the American spirit for you to vote.

Well, let me just give you a little hint. If you want to vote for somebody else, don’t vote, OK?

JOHN YANG: In Binghamton, Ted Cruz knocked Trump for complaining about the delegate selection process.

SEN. TED CRUZ (R-TX), Republican Presidential Candidate: It is not surprising when a candidate loses 11 elections in a row, he’s unhappy about it. And so he complains. And that’s fine. Look, we’re focused on winning elections with the people.

JOHN YANG: John Kasich also campaigned in New York today, with events in Watertown and Utica.

For the “PBS NewsHour,” I’m John Yang.

JUDY WOODRUFF: Bernie Sanders also said at last night’s debate that he’s releasing his 2014 tax returns. Hillary Clinton says she’s released 30 years of returns, but she declined to issue transcripts of her paid speeches to banks unless other candidates do likewise.

The post Clinton, Sanders spar in debate; GOP argues over delegates appeared first on PBS NewsHour.

U.S. Democratic presidential canditate Bernie Sanders leaves with his wife from the ‘Centesimus Annus 25 Years Later Symposiumon’ at the Casina Pio IV April 15, 2016 in Vatican City, Vatican. Photo by Franco Origlia/Getty Images

ROME — U.S. presidential candidate Bernie Sanders told The Associated Press that he met briefly with Pope Francis at the papal residence Saturday and said it was a “real honor” to call on “one of the extraordinary figures” in the world.

Sanders, in Rome for a Vatican conference on economic inequality and climate change, said the meeting took place before the pope left for Greece, where Francis was highlighting the plight of refugees.

The Vermont senator, in a race with Hillary Clinton for the Democratic nomination for president, said he told the pope that he appreciated the message that Francis was sending the world about the need to inject morality and justice into the world economy. Sanders said that was a message he, too, has tried to convey.

“We had an opportunity to meet with him this morning,” Sanders said in an Associated Press interview. “It was a real honor for me, for my wife and I to spend some time with him. I think he is one of the extraordinary figures not only in the world today but in modern world history.”

Before returning to the United States and campaigning in New York, where voters get their say Tuesday in the next election contest, Sanders said he had the chance to tell the pope that “I was incredibly appreciative of the incredible role that he is playing in this planet in discussing issues about the need for an economy based on morality, not greed.”

Sanders and his wife, Jane, stayed overnight at the pope’s residence, the Domus Santa Marta hotel in the Vatican gardens, on the same floor as the pope. They were seen at the hotel reception, carrying their own bags.

Jeffrey Sachs, a Sanders foreign policy adviser, said there were no photographs taken of the meeting.

Supporters of U.S. Democratic presidential canditate Bernie Sanders hold signs outside the ‘Centesimus Annus 25 Years Later Symposiumon’ at the Casina Pio IV April 15, 2016 in Vatican City, Vatican. Photo by Franco Origlia/Getty Images

The Vatican is loath to get involved in electoral campaigns, and usually tries to avoid any perception of partisanship as far as the pope is concerned, although Francis in February rebuked Republican presidential candidate Donald Trump over Trump’s stand on immigration. Popes rarely travel to countries during the thick of political campaigns, knowing a papal photo opportunity with the sitting head of state can be exploited for political ends.

But Francis has been known to flout Vatican protocol, and the meeting with Sanders was evidence that his personal desires often trump Vatican diplomacy.

“His message is resonating with every religion on earth with people who have no religion and it is a message that says we have got to inject morality and justice into the global economy,” Sanders said.

Sanders said the meeting should not be viewed as the pope injecting himself into the campaign.

“The issues that I talked about yesterday at the conference, as you well know, are issues that I have been talking about not just throughout this campaign but throughout my political life,” Sanders said in the interview. “And I am just very much appreciated the fact that the pope in many ways has been raising these issues in a global way in the sense that I have been trying to raise them in the United States.”

Sachs said the candidate and his wife met the pope in the foyer of the domus, and that the meeting lasted about five minutes. Sanders later joined his family, including some of his grandchildren, for a walking tour of St. Peter’s Basilica, one of the holiest Catholic shrines.

The trip gave Sanders a moment on the world stage, putting him alongside priests, bishops, academics and two South American presidents at the Vatican conference.

Sanders has been at a disadvantage during his campaign against Clinton, President Barack Obama’s former secretary of state, on issues of foreign policy. But Sanders was peppered with questions from academics and ecclesiastics during Friday’s conference in a manner that might have been afforded a head of state.

The invitation to Sanders to address the Vatican session raised eyebrows when it was announced and touched off allegations that the senator lobbied for the invitation.

But the chancellor for the pontifical academy, Bishop Marcelo Sanchez Sorondo, said he invited Sanders because he was the only U.S. presidential candidate who showed deep interest in the teachings of Francis.

Once back home, Sanders was set to refocus on the pivotal presidential contest in New York, a state with a significant number of Catholic voters. Clinton holds a lead among the delegates who will determine the Democratic nominee, and Sanders is trying to string together a series of victories in upcoming contests to draw closer.

The post Sanders: It was a ‘real honor’ to meet briefly with Pope Francis appeared first on PBS NewsHour.

U.S. Republican presidential candidate Donald Trump speaks at a campaign rally in Hartford, Connecticut April 15, 2016. Photo by Brian Snyder/Reuters

WASHINGTON — To all the political junkies yearning for a contested Republican convention this summer: not so fast.

It’s still possible for Donald Trump to clinch the nomination by the end of the primaries on June 7. His path is narrow and perilous. But it’s plausible and starts with a big victory Tuesday in his home state New York primary.

Trump is the only candidate with a realistic chance of reaching the 1,237 delegates needed to clinch the nomination before the July convention in Cleveland. His rivals, Texas Sen. Ted Cruz and Ohio Gov. John Kasich, can only hope to stop him.

If Cruz and Kasich are successful, politicos across the country will have the summer of their dreams – a convention with an uncertain outcome. But Trump can put an end to those dreams, and he can do it without any of the 150 or so delegates who will go to the convention free to support the candidate of their choice.

What comes next isn’t a prediction, but rather, a way in which Trump could win the nomination outright on June 7.

To be sure, Trump will have to start doing a lot better than he has so far. He gets that chance starting Tuesday, beginning the day with 744 delegates.

NEW YORK

There are 95 delegates at stake in the Empire State, and it’s important for Trump to win a big majority of them. It won’t be easy.

There are 14 statewide delegates and three delegates in each congressional district.

If a candidate gets more than 50 percent of the statewide vote, he gets all 14 delegates. Otherwise, he has to share them with other candidates.

If a candidate gets more than 50 percent of the vote in a congressional district, he gets all three delegates. Otherwise, again, he has to share.

Trump leads statewide in the most recent preference polls, with right around 50 percent. New York is a large and diverse state, so he probably won’t win all the congressional districts.

Let’s say Trump does make it to 50 percent, but Kasich or Cruz wins five congressional districts; Trump will take 77 delegates on the night.

Trump’s running total: 821 delegates.

APRIL 26

Five states have primaries on April 26, with 172 delegates at stake: Pennsylvania, Connecticut, Delaware, Maryland and Rhode Island.

Pennsylvania could be trouble for Trump. The state has a unique system in which 54 delegates – three from each congressional district – are listed by name on the ballot, with no information for voters to know which candidate they support.

That means even if Trump wins Pennsylvania, he’s only guaranteed to claim 17 of the state’s 71 delegates.

Connecticut awards 13 delegates to the statewide winner and three to the winner of each congressional district, for a total of 28. The New York real estate mogul needs to win his neighboring state. If he does well, he could get 22 delegates.

Delaware’s 16 delegates are winner-take-all, increasing the importance of this small state. If Trump loses Delaware, he has to make it up elsewhere.

Maryland awards 14 delegates to the statewide winner and three to the winner of each congressional district, for a total of 38. Recent polls show Trump with a significant lead. If he does well, he could get 32 delegates.

Trump can afford to lose Rhode Island, which awards its 19 delegates proportionally.

In all, it’s a day on which we’ll say Trump claims 93 delegates.

Trump’s running total: 914.

MAY

Five states hold contests in May, with a total of 199 delegates at stake: Indiana, Nebraska, West Virginia, Oregon and Washington State.

Indiana’s May 3 primary is important for Trump. The state awards 30 delegates to the statewide winner and three delegates to the winner of each congressional district, for a total of 57. If Trump can win the state and a majority of the congressional districts, he could collect 45 delegates.

West Virginia is another unique state in which voters elect 31 delegates in the May 10 primary. In West Virginia, however, the delegates will be listed on the ballot along with the presidential candidate they support. If Trump does well here, he could pick up 20 or more delegates.

Nebraska’s 36 delegates are winner-take-all. But if Nebraska is like its neighbors Kansas and Iowa, two states Cruz won earlier in the race, Trump can’t count on these delegates.

Oregon and Washington state award delegates proportionally, so even the losers get some.

We’ll give Trump 70 delegates for the month.

Trump’s running total: 984.

JUNE 7

This could be Trump’s D-Day. Or his Waterloo.

Five states vote on June 7, with 303 delegates up for grabs. The biggest prize is California, along with New Jersey, South Dakota, Montana and New Mexico.

The only state Trump can afford to lose is New Mexico, which awards 24 delegates proportionally.

New Jersey, South Dakota and Montana are winner-take-all, with a total of 107 delegates.

California is more complicated, with 172 delegates at stake. The statewide winner gets only 13. The other 159 are awarded according to the results in individual congressional districts.

Each of the state’s 53 congressional districts has three delegates. You win the district, you get all three.

For Trump to clinch the nomination on June 7 – the last day of the primary season – he has to win a big majority of California’s congressional districts. If he wins 39 districts, he gets 130 delegates.

On the last voting day of the primary campaign, we’ll say Trump wins 242 delegates.

Trump’s running total: 1,226 – or 11 delegates short of the magic number.

OH, WAIT!

Missouri has certified the results of its March 15 primary, with Trump beating Cruz by 1,965 votes. If the results survive a potential recount, Trump wins Missouri and another 12 delegates.

Trump’s total: 1,238.

Cue the balloons.

The post Here’s how Trump could clinch GOP nomination before the convention appeared first on PBS NewsHour.

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KARLA MURTHY: This house on the south side of Youngstown has been vacant for eight years. The city condemned it after a fire inside.  Now it’s being torn down. 

Robert Morris lives next door. He says he’s glad to see these abandoned homes in his neighborhood finally get demolished.

ROBERT MORRIS: This neighborhood right here, this used to be high class over here. I mean this whole south corridor was all, it was nice. It was really nice.

KARLA MURTHY: These demolitions are part of a citywide plan to eliminate blight and rebuild. Since the 1950s, Youngstown’s population has declined by 60 percent, from about 168-thousand to 65-thousand and is still shrinking. Thousands of empty homes have been left behind, crippling the housing market, and eroding the social fabric of this once mighty industrial base.

When the steel mills closed in the 1970s, Youngstown lost 40-thousand good paying jobs. Today, almost 40 percent of residents live below the federal poverty line — earning less than 24-thousand a 300 dollars a year for a family of four.

HUNTER MORRISON: What’s a city to do as a city? Pick itself up, dust itself off and start all over again, move forward.

KARLA MURTHY: Hunter Morrison is an urban planner who has worked on rebuilding Youngstown since 2002.  He says the plan started with a simple premise: accept that the city was smaller.  

HUNTER MORRISON: In America, the entire business of planning and development is based on the phenomena of growth. But what happens when communities one after another see themselves shrinking?

KARLA MURTHY: Over the last 14 years, this new smaller mindset has been the guiding vision for the city, which took stock of its assets, like Youngstown State University, with 14,000 students. The city and the university developed blighted land to connect the campus to downtown – which now has new housing and more places to go out.

HUNTER MORRISON: Today, if you talk to a student, they go down to the restaurants. Some of them live downtown who never would have lived there before.

KARLA MURTHY: But beyond downtown, the city didn’t have the resources to fix its broken neighborhoods. Fewer residents means less tax revenue. So in 2009, the city created a new nonprofit, the Youngstown neighborhood development corporation, or Y.N.D.C., in partnership with the Raymond John Wean Foundation.

IAN BENISTON: You could walk to my house if you want to keep going…”

KARLA MURTHY: Ian Beniston is the executive director.  He grew up in Youngstown. His father worked at a steel mill until it closed in 1980.  

IAN BENISTON: We don’t go around here talking about utopian visions. We’re dealing with the real basics here.  We’ve just got to get neighborhoods cleaned up.

KARLA MURTHY: The Y.N.D.C. has an annual budget of  3 million dollars.  The group surveyed every neighborhood in the city to figure out where it could make the biggest difference and create more stability.

IAN BENISTON: Our focus, as an organization, is on those neighborhoods in the middle. So, neighborhoods that have many signs of distress, but they’re not to a point where we have 70 or 80 percent vacancy. So that even in the future, we do at least have these pockets, if nothing else, of healthy neighborhoods.

KARLA MURTHY: One of the first neighborhoods the Y.N.D.C. targeted is called “Idora,” where a quarter of the houses were vacant….Like this one currently being renovated by the Y.N.D.C. Tiffany Sokol has been overseeing this project.

TIFFANY SOKOL: We’ve been able to acquire a lot of properties at zero cost either through bank donations or private personal donations…

KARLA MURTHY: Many homes the Y.N.D.C. acquires are foreclosed properties and are renovated with the help of “Americorps” volunteers.

TIFFANY SOKOL: There’s an abundance of vacant homes but unfortunately the quality is very low. So part of what we’re doing here is trying to raise the standard and raise the quality of homes available.

KARLA MURTHY: A couple blocks away is a house the Y.N.D.C. just finished.

TIFFANY SOKOL: This one was built in the 70s, so it’s really out of character for the neighborhood.

VO: It’s listed for sale for 40 thousand dollars…Above Youngstown’s median home price of 31-thousand, but affordable in this market.

KARLA MURTHY: Have you had any problems getting people to buy the homes that you’ve renovated?

TIFFANY SOKOL: No, most of our homes generally we end up pre-selling before we are even done with the rehabilitation.

KARLA MURTHY: Y.N.D.C. helps potential buyers who have low-to-moderate incomes through housing counseling and mortgage financing.

In the past six years in Idora, 137 abandoned homes have been demolished, 35 homes have been renovated and sold and 88 occupied homes have been repaired.  

IAN BENISTON: This was a house we fixed too…

KARLA MURTHY: Today, the occupancy rate of this stripped down, rebuilt neighborhood is 93 percent.

IAN BENISTON: Wait till you see it. It’s pretty awesome…

KARLA MURTHY: Beniston showed me one more feature he’s using as a selling point for Idora: this natural waterfall right in the middle of city.

IAN BENISTON: We had nine vacant homes right by this, yeah, but not anymore.

KARLA MURTHY: Brownlee Woods is another neighborhood where the Y.N.D.C. works.  Nancy Martin and her husband Russell have lived here since 1982, and over the years watched people leave as their neighborhood declined.

NANCY MARTIN: We can do one of two things — you can either sit here on the porch and complain, or you get up and do something.

These are the benches we just put in…

KARLA MURTHY: She’s president of her neighborhood association and meets regularly with the Y.N.D.C., which also helps residents develop their own neighborhood action plans…

NANCY MARTIN: They bring a list of all the houses that we’re working on, and we go through each one.

KARLA MURTHY: One house that was falling apart was owned by an out of town businessman.  Ian Beniston stepped in.

NANCY MARTIN: And he told him, “Are you going to do anything with this property? Cuz if you’re not, we’re taking it…

KARLA MURTHY: The community is taking over that house,  and the Y.N.D.C. brought  more than a dozen other houses up to code in Brownlee Woods.

IAN BENISTON: We are making progress.  I mean, we know that in terms of owner occupancy, vacancy data. However there are still large swaths of the city, the most distressed swaths, where people are still leaving.

KARLA MURTHY: In those areas of Youngstown with heavy vacancy, the focus is on simply eradicating blight with board-ups, demolitions, and cutting the grass.  

Robert Morris is happy to see his neighborhood getting cleaned up, but he’s skeptical things will really improve.

KARLA MURTHY: Do you think this area will ever become what it once was?

ROBERT MORRIS: No. No, I doubt it. No, it’s over. No jobs. Nobody got jobs. Everybody’s out there trying to hustle to make their buck. You know, that’s—it is what it is.

DAWN GRIFFIN: I’m going to give myself maybe another year or two here…

KARLA MURTHY: Dawn Griffin says she’s had a hard time finding a job in Youngstown, and thinks about leaving.  Unemployment in Youngstown is eight-and-half percent, three-and-half percent above than the national average. Griffin, a single mother of three, remembers a better time.

DAWN GRIFFIN: I thought we were rich, you know?  [laughs]  And we were pretty well off, you know? But what is here?

KARLA MURTHY: She also feels like the city isn’t doing enough, especially in low-income neighborhoods like hers, on the east side of Youngstown.

DAWN GRIFFIN:One of my questions was, ‘okay, you’re removing the blight, okay, but what’s going to be there? And it’s nothing but a slab on concrete there. No one wants to invest in that. You can’t do it a little bit, you’ve got to go all the way.

KARLA MURTHY: I asked Beniston about their critique.

KARLA MURTHY: Boarding up homes, grass cutting. How’s it really going to make a big difference?

IAN BENISTON: That will improve the quality of life for the people that are living there now, but by no means am I trying to say that in the most distressed of places just cutting grass and boarding up the houses is sufficient. I’m saying it’s the reality of a lack of resources. I think one of the things we need more of here without a doubt is just jobs.  That’s the reality of it, that’s why people leave. So until we can get to a point where we’re attracting, developing, creating, even here locally, more jobs.  We’re going to be struggling to get to where we need to be.

KARLA MURTHY: Part of Youngstown’s plan to create more jobs is to change its image as a city dominated by steel. Sharon Woodberry, Youngstown’s director of economic development and community planning, is trying to lure technology entrepreneurs

SHARON WOODBERRY: We’re still primarily manufacturing-focused but there are other industries that are emerging.

KARLA MURTHY: She points to “America Makes,” a national institute for 3D printing and  also the Youngstown business incubator which has created almost 400 jobs at tech start-ups in Youngstown since 2011.

KARLA MURTHY: But unemployment is still high here, right?

SHARON WOODBERRY: It is. It was a decline over decades. It’s a rebuilding that’s going to take some significant time.

HUNTER MORRISON: There are a lot of obstacles in older industrial communities.

KARLA MURTHY: Urban planner Hunter Morrison says progress may seem slow, but not when you understand what’s happened across this region.

HUNTER MORRISON: These communities are very much like New Orleans. New Orleans lost half its population over a weekend. Flint, Cleveland, Youngstown, Detroit lost it over a generation. It’s a major trauma to a community. It takes a long time to get over it.

KARLA MURTHY: How do you stay hopeful, is it a false sense of hope?

IAN BENISTON: For me it’s not a false of hope, because I have a pretty good memory and I know, for example, what this neighborhood looked like. I’ve also seen streets change, where, you know, dozens of houses have been removed, others have come back to life. I feel good about the progress that we’ve made.  Am I satisfied with it?  Certainly not.

Chasing the Dream: Poverty and Opportunity in America is a multi-platform public media initiative that provides a deeper understanding of the impact of poverty on American society. Major funding for this initiative is provided by The JPB Foundation. Additional funding is provided by Ford Foundation.

The post How Rust Belt city Youngstown plans to overcome decades of decline appeared first on PBS NewsHour.

A group of Syrian refugees wait to board a plane with Pope Francis at the airport of Mytilene, in the Greek island of Lesbos, April 16, 2016. Photo by Filippo Monteforte/Reuters

Pope Francis ended an emotional and symbolic trip to the Greek island of Lesbos on Saturday by taking three refugee families back with him to the Vatican in Rome.

He said the decision to bring the 12 Syrian refugees to Italy was a humanitarian gesture, not a political act.

The families, whose houses had been bombed, had arrived in Greece before an agreement made in March to to deport asylum-seekers who reach European shores. The 12 refugees will be cared for the by the Holy See.

The pope’s visit to the island was a plea for morality and sympathy, a “gesture of welcome,” according to a statement released by the Vatican.

The six adults and six children chosen through negotiations between Greek and Italian authorities are among hundreds of thousands of migrants seeking refuge in Europe.

“Migrants, rather than simply being a statistic, are first of all persons who have faces, names and individual stories,” he said in a speech during a ceremony at the port of Lesbos. “Europe is the homeland of human rights.”

Pope Francis greets migrants and refugees at Moria refugee camp near the port of Mytilene, on the Greek island of Lesbos, April 16, 2016. Photo by Filippo Monteforte/Reuters

Many people wept at his feet at the Moria refugee detention center where he and two Orthodox leaders greeted more than 200 individually while some in the crowd chanted “Freedom! Freedom!” according to the Associated Press.

“The world will be judged by the way it has treated you. And we will all be accountable for the way we respond to the crisis and conflict in the regions that you come from,” the pope said.

Francis is the son of Italian immigrants and was born in Argentina.

The Vatican said the pope also met with the Prime Minister Alexis Tsipras of Greece during his visit to talk about the migration crisis and the need to protect people who risk their lives crossing the Aegean and Mediterranean Seas.

“The Pope has appreciated the humane stance of the Greek people, who despite harsh economic strains have shown solidarity and commitment to universal values,” the statement said.

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U.S. Secretary of Defense Ash Carter and Chairman of the Joint Chiefs of Staff Gen. Joseph Dunford speak to press in Washington March 25, 2016. Carter said Saturday he will talk with his commanders in the coming days to identify additional ways the U.S. can fight ISIS. Photo by Department of Defense/Navy Petty Officer 1st Class Tim D. Godbee/Handout via Reuters

AL-DHAFRA AIR BASE, United Arab Emirates — U.S. Defense Secretary Ash Carter said he will talk with his commanders in the coming days to identify additional ways the U.S. can intensify the fight against Islamic State militants in Iraq and Syria, including more airstrikes, cyberattacks and American troops on the ground.

He said the United States wants to do more in the fight and is “only limited by our own ingenuity” and ideas. Carter expressed confidence that the White House will approve recommendations, saying nothing he has asked President Barack Obama for yet in the conflicts has been turned down.

Carter spoke to reporters at Al-Dhafra Air Base near Abu Dhabi, an important launching point for military operations against the Islamic State group in the region.

His visit comes as the U.S. is considering moves to boost the number of American troops in Iraq, as well as other steps to help the Iraqis take on IS.

Carter suggested the U.S. may consider shifting the nature of its military campaign against the extremists, adding there could be more rapid targeting of the enemy as intelligence on the ground improves.

“As we’ve learned more and are more on top of the enemy, you can do more dynamic targeting,” Carter said.

Late last month, U.S. Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, told reporters that he and Carter believe there will be an increase in U.S. forces in Iraq in the coming weeks. Any final decision would be worked out with the Iraqi government and require Obama’s approval.

It’s unclear whether the increase would force the White House to formally approve a higher cap on troop levels in Iraq, now set at 3,780.

The Pentagon says there are close to 3,400 U.S. troops there now. According to U.S. officials, however, there are actually as many as 5,000 American forces in the country, but some do not count against the cap because they are in Iraq on temporary duty.

Dunford and Carter have said that accelerating the fight against IS could mean using Apache helicopters for combat missions, deploying more U.S. special operations forces or using American military advisers in Iraqi units closer to the front lines.

The U.S. also is likely to provide additional artillery fire and targeting help for Iraqi forces advancing on Mosul. Those American forces, however, would remain well behind the front lines.

Carter has said that Obama and other U.S. leaders will encourage other Gulf nations to contribute economically to the effort to rebuild Iraq once IS is defeated.

Obama and other U.S. officials are expected to attend the U.S.-Gulf Cooperation Council leaders’ summit next week in Saudi Arabia. The six member countries are Saudi Arabia, Kuwait, the UAE, Qatar, Bahrain and Oman.

Carter said Saturday that the U.S. hopes that the Gulf nations will support Iraq politically as it tries to establish a more successful multisectarian government.

During his visit to the air base, Carter spoke with troops, including those who have been flying and supporting the airstrikes over Iraq and Syria.

Two large Global Hawk surveillance aircraft, an F-22 Raptor fighter jet and and F-15E strike fighter were arrayed in the hangar where Carter spoke.

U.S. Air Force Col. Johnny Barnes, the vice commander of the 380th Air Expeditionary Wing told reporters that Russian fighters in Syria haven’t impeded U.S. airstrikes. But he acknowledged that there were moments in northwest Syria when the Russian jets were an “inconvenience.”

Now that some have left the country, he said it’s been “less inconvenient.”

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CHEYENNE, Wyo. — Donald Trump’s presidential campaign has all but thrown in the towel in Wyoming ahead of Saturday’s Republican convention.

A senior Trump adviser, Alan Cobb, says the billionaire businessman’s campaign made a conscious decision not to commit resources to Wyoming.

Trump picked only up a single delegate in last month’s Wyoming county conventions while rival Ted Cruz scored nine. There are 14 more delegates at stake at this weekend’s state convention.

In a telephone interview Friday with The Associated Press, Cobb said he expects Cruz to sweep what remains of the 29 delegates up for grabs in the Wyoming convention. He says the process is favorable toward party-insider folks like Cruz.

Cruz’s campaign has been working for months lining up support among the Wyoming’s GOP insiders.

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JEFF GREENFIELD: Donald Trump will probably come to the Cleveland convention with a couple hundred more delegates than anyone other candidate and a couple million more votes. So even if he’s short of a delegate majority, it’s only fair that he should become the Republican nominee, right?

DONALD TRUMP: In all fairness we’re way ahead in delegates. I’m not supposed to have less delegates than a guy I beat. It doesn’t work that way.

JEFF GREENFIELD: Not so fast. A lot more Republican voters chose someone other than Trump. “Anyone But Trump” won a majority of votes in the first 8 Republican contests. If Trump doesn’t achieve a delegate majority on the convention’s first ballot, Republican Party rules say most of his delegates will be unbound — free to do whatever they want.

REINCE PRIEBUS: If Trump can pick up enough unbound delegates to commit to him then on the first vote he’d get 1237 he’d be the nominee. If he doesn’t then he would be short and then you go to ballot number two under the rules you to call the roll again and you would keep calling the roll until somebody gets to the majority of delegates.

JEFF GREENFIELD: The convention could nominate someone who didn’t even run this year. Is that fair?

The answer is: there isn’t any one answer about the right way to decide who wins an election. In different places, very different rules apply…and in fact, without some distinctly unfair rules, we wouldn’t have a country at all.

For instance, beyond the presidential race, in almost every state, you can be elected Governor or Senator by getting more votes than the next candidate…even if a majority of voters were against you.  In 2014, four senators and ten governors won that way – with pluralities.

Two states, Georgia and Louisiana, require a “runoff” if no one wins a majority in a statewide race. So, in the 2014 race for Senator in Louisiana, incumbent Democrat Mary Landrieu narrowly edged Republican Bill Cassidy in November, but didn’t get a majority. In the runoff that followed, Cassidy beat Landrieu decisively.

California now has its own kind of runoff for all statewide and Congressional races. Every candidate regardless of party runs on the same ballot. Then the top two finishers face off in November.  It doesn’t matter if both are Republicans or Democrats or Independents. Proponents say this encourages candidates to appeal to the center of the political spectrum. Opponents say the system deprives voters of a clear contrast in November, when it really counts.

Or consider how we choose a President. As everyone learned in 2000, you can lose the White House even if you get more popular votes than your opponent; because it’s the electoral votes of the states that matter. Every state is winner-take-all except Maine and Nebraska.

In 2012, Barack Obama won Florida by less than one percent of the vote, but he got all 29 electoral votes. Mitt Romney won North Carolina by barely two percent, but got all 15 electoral votes.

Is this fair? Or should electoral votes be awarded proportionally? Or winner-take-all by Congressional district?  Should we even have an Electoral College anymore? After all, starting each state with two electoral votes based on their U.S. Senate seats gives the small states more clout than their population would mandate. In fact, isn’t it unfair that Wyoming has the same power in the Senate as California, which has sixty times the population?

The answer is: credit—or blame—the Founding Fathers. When they gathered in Philadelphia to write the Constitution in 1787, a central issue was the fear of small states that they would be dominated by the big states. Not only did they insist on equal representation in the Senate, but they made it the only part of the Constitution that can’t be amended. It’s right there in Article V.  Without this obviously “undemocratic” rule, we wouldn’t have a country.

So is there a hard and fast rule that will tell you what’s fair? Actually, in practice there is. For almost every one of us, whatever process most helps the candidate we want to win is obviously, clearly, the fairest of them all.

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An eight-month-old baby is carried away by rescue workers after being rescued from her collapsed home caused by an earthquake in Mashiki town, Kumamoto prefecture, southern Japan, in this photo taken by Mainichi Shimbun April 15, 2016 early morning. Daisuke Wada/Mainichi Shimbun via Reuters

The second deadly earthquake to strike southern Japan this week killed dozens of people in the early morning hours Saturday as emergency workers flocked to scenes of destruction across the Kumamoto Prefecture.

At least 41 people were killed and more than 1,500 injured following a 7.3-magnitude tremor outside the city of Kumamoto, trapping residents nearby under collapsed buildings and causing widespread power outages and water shortages for at least 200,000 people, officials said.

Japanese troops hurried to the region to assist in the recovery operation.

Video from the scene showed residents pulled from beneath shattered concrete and mounds of smoking debris as hundreds more huddled in shelters, bracing for possible aftershocks.

Rescue workers conduct a search and rescue operation to a collapsed house at a landslide site caused by earthquakes in Minamiaso town, Kumamoto prefecture, southern Japan, in this photo taken by Kyodo April 16, 2016. Kyodo/Reuters

On Thursday night, nine people died when a 6.5-magnitude quake struck the same region.

“It is unusual but not unprecedented for a larger and more damaging earthquake to follow what was taken to be ‘the main event,'” David Rothery, a professor of planetary geosciences at The Open University in Britain, told the Associated Press.

One Tokai University student who had sought refuge in the school’s gymnasium described the moment when the quake hit to local media.

“I felt strong shaking at first, then I was thrown about like I was in a washing machine,” the student said. “All the lights went out and I heard a loud noise. A lot of gas is leaking and while there hasn’t been a fire, that remains a concern.”

Japan’s Chief Cabinet Secretary Yoshihide Suga said nearly 100,000 people had been evacuated from their homes after roughly 200 buildings had been decimated during Saturday’s quake.

Officials also warned of possible mudslides with forecasters predicting heavy rains this weekend.

“The wind is expected to pick up and rain will likely get heavier,” Prime Minister Shinzo Abe said. “Rescue operations at night will be extremely difficult. It’s a race against time.”

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Chain link fence and concertina wire surrounds a deserted guard tower within Joint Task Force Guantanamo’s Camp Delta at the U.S. Naval Base in Guantanamo Bay, Cuba March 21, 2016. Photo by Lucas Jackson/Reuters

The Pentagon has sent nine men to Saudi Arabia from the U.S. military prison at Guantanamo Bay, Cuba, seeing through negotiations that began during the administration of President George W. Bush.

In a statement, the Department of Defense confirmed the transfer of Ahmed Umar Abdullah Al-Hikimi, Abdul Rahman Mohammed Saleh Nasir, Ali Yahya Mahdi Al-Raimi, Tariq Ali Abdullah Ahmed Ba Odah, Muhammed Abdullah Muhammed Al-Hamiri, Ahmed Yaslam Said Kuman, Abd al Rahman Al-Qyati, Mansour Muhammed Ali Al-Qatta, and Mashur Abdullah Muqbil Ahmed Al-Sabri.

All are from Yemen, but due to unrest and al-Qaida activity there, the detainees were sent to Saudi Arabia, where they also have family ties.

One of the men released, 36-year-old Ba Odah, had protested his detention without charges for 14 years by staging a long-term hunger strike.

Ba Odah’s weight dropped from 160 to 74 pounds during the strike, and the military force fed him to keep him alive.

Of Odah’s release, Center for Constitutional Rights Attorney Omar Farah said in a statement to PBS NewsHour:

The government played Russian roulette with Mr. Ba Odah’s life for more than a year. It stood by as he wasted away on hunger strike to 74 pounds, intervening only to force liquid supplements through his nose, block his appeal for humanitarian relief in federal court, and sabotage a deal that would have secured his freedom and access to emergency medical care months ago. That he survived is not so much a cause for celebration as it is a reckoning that ought to remind the White House of the cost of elevating politics over the life and liberty of a human being. Mr. Ba Odah’s transfer today ends one of the most appalling chapters in Guantánamo’s sordid history. Now that Mr. Ba Odah is finally free, we are hopeful that the Kingdom of Saudi Arabia will provide him the sophisticated medical care he desperately needs.

80 prisoners remain at the controversial facility, which President Barack Obama has vowed to close.

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A girl receives polio vaccination drops during a house-to-house vaccination campaign in Yemen’s capital Sanaa, April 12, 2016. Photo by Khaled Abdullah/Reuters

This weekend marks the start of a global effort that health officials are hoping will be the final push to eradicate polio.

The process involves 150 countries that have to switch vaccines, which is complicated and expensive.

Doctor Steve Cohi from the Centers for Disease Control and Prevention joined NewsHour’s Alison Stewart to discuss.

“We’re on the verge of completely finishing the job of eradicating polio,” he said.

The countries are expected to switch from the trivalent vaccine, first developed in 1961, to the bivalent one, which contains only the type 1 and 3 polio viruses, over the next two weeks.

The campaign is led by the World Health Organization along with the CDC, UNICEF, the Bill and Melinda Gates Foundation and Rotary International.

Attempts for polio eradication began in 1988, when there were 355,000 cases per year in 125 countries. The disease has since been reduced by more than 99 percent and new cases are only found in two countries, Pakistan and Afghanistan.

If this final push is successful, it will be the second disease to be eradicated since smallpox was quashed in 1980, according to Reuters.

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Carl Cullenberg of Falmouth drops his son’s tax return into the mailbox on April 15, 2016 at the Forest Ave. Post Office as the deadline for filing rapidly approaches. Gordon Chibroski/Portland Press Herald via Getty Images

WASHINGTON — Millions of taxpayers face a midnight deadline Monday to file their tax returns, while millions of others will ask for more time —a six-month extension. There was a three-day delay beyond the traditional April 15 deadline Friday was a legal holiday in the District of Columbia.

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Republican presidential candidates Donald Trump speaks during a campaign event at the Nicholas J. Pirro Convention Center in Syracuse, NY on April 16. Photo by Jabin Botsford/The Washington Post via Getty Images

DES MOINES, Iowa — Donald Trump’s relentless assault on the rules that govern how Republicans choose their nominee is coming far too late to change what even what defenders acknowledge is a complicated selection system.

He seems to know it, too.

Instead, his railing against a “rigged” process appears aimed at amplifying his central message to an angry electorate: America is a mess, and only Trump can clean it up.

“Politicians furiously defended the system,” Trump wrote Friday in The Wall Street Journal. He equated the party’s nomination procedures with the “unfair trade, immigration and economic policies that have also been rigged against Americans.”

He added, “Let me ask America a question: How has the ‘system’ been working out for you and your family?”

Underlying the constant criticism, Trump’s goal is to rally supporters and pile up primary season victories that would bring him the 1,237 delegates needed to win the nomination outright before the summer convention. But it’s a tactic that Republicans say carries real risks for the billionaire businessman.

Should Trump fall short of that clinching number going into the Cleveland convention in July, they said, his rantings against the party are likely to annoy the delegates who would then decide the nominee.

“He is trying to pit voters against the very people who make the decision of whether he gets the nomination,” said Matt Borges, chairman of the Republican Party in Ohio. “If he does not arrive in Cleveland with 1,237 pledged delegates, then there is no way he gets the nomination.”

Trump’s tirades have aired the backroom tension with the party. But GOP officials are pushing against the front-runner accusations of unfairness.

Republican National Committee Chairman Reince Preibus took to Trump’s favorite medium, Twitter, to to make the point that the nomination process has been known to all for more than a year.

“It’s the responsibility of the campaigns to understand it,” Priebus wrote. “Complaints now? Give us all a break.”

Priebus told NBC’s “Meet the Press” on Sunday that he will not allow Trump to bully him, and noted that a majority – not a plurality – rules in most aspects of governance. “The rules are set. … I’m not going to allow anyone to rewrite rules for the party.”

On Friday, the party’s chief strategist, Sean Spicer, laid out the rules for elected delegates in each of the remaining states that will hold primary contests.

Spicer noted those rules were shared with all the campaigns last year, adding that “each process is easy to understand for those willing to learn it.”

At the same time, however, party insiders who make the rules appear keenly aware of the emotions that Trump is stirring.

At a rally this past week in New York, Trump said RNC members “should be ashamed of themselves for allowing this crap.”

Several of those involved in the rule-making process told The Associated Press that they believe there’s a consensus inside the party against considering changes before the convention.

“We want to avoid even the appearance that somehow, the RNC is trying to meddle or manipulate the convention process,” said Florida GOP committeeman Peter Feaman.

That isn’t likely to do much to placate Trump. He says the process should favor the candidate who wins the most votes during the primary campaign.

Trump has received about 8.2 million votes to date, about 2 million more than his closest competitor, Texas Sen. Ted Cruz. “I think the vote is the thing that you count,” Trump said.

Cruz is outmaneuvering Trump in lining up support among the individuals who will attend the Cleveland convention as delegates. That’s a separate process, in which party activists seek the positions primarily through local, district and state party conventions.

If Trump can’t clinch by the time the last group of primaries on June 7, then those delegates will largely be free after the first ballot at the convention to vote for the candidate of their choice.

“To be fair, it’s complicated for everyone,” said Ron Kaufman, a longtime member of the RNC’s standing rules committee. “And I understand why someone who’s never done it before, and hasn’t taken time to learn it, gets frustrated.”

But that frustration isn’t winning Trump any friends among the party officials who will have sway at a multi-ballot convention.

Several noted the irony of Trump’s focus on the fairness of the rules. Some states allowed him to win all of their pledged delegates even when he captured less than a majority of the vote.

Morton Blackwell, an RNC rules committee member from Virginia, said Trump is guilty of “selective moral indignation.”

Henry Barbour, also rules committee member, put it more simply: Trump’s attack on the party and the delegate selection process is bad politics.

“If you want to ask a girl to the prom, you don’t tell her how ugly she is the week before,” Barbour said.

This report was written by Thomas Beaumont and Steve Peoples of the Associated Press. AP writers Alan Fram in Washington and Bill Barrow in Atlanta contributed.

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BY: CHRISTOPHER BOOKER AND SASKIA DE MELKER

Read the full transcript of this segment below:

JOSEPH ZEBLEY: Along in here, Any pain?

LYNN LEVINE: No, but I did take my medicine this morning.

CHRISTOPHER BOOKER: Lynn Levine is one of tens of millions of Americans diagnosed with chronic pain. After numerous surgeries for a range of health problems, Levine has taken opioid painkillers for the last seven years.

LYNN LEVINE: One medicine, morphine, in the morning. And I take an oxycodone at around noon or 1 o’clock. And then I take a morphine late in the evening. They’re long acting.

CHRISTOPHER BOOKER: Where would you be, do you think, without the opioids?

LYNN LEVINE: I think I would be laying in a bed most of the time.

CHRISTOPHER BOOKER: Levine’s doctor, Joseph Zebley, has been treating patients with cancer and chronic pain since the 1980’s. He and Levine recognize the risk of addiction in taking these potent drugs.

CHRISTOPHER BOOKER: You have a very healthy fear of just how this opioid intake can get out of hand.

LYNN LEVINE: It can.

CHRISTOPHER BOOKER: Why?

LYNN LEVINE: It can, because I know it can, because I’ve known lots of people who take it unnecessarily and take it for the high they supposedly get off of it.  And I don’t want to be in that position.

CHRISTOPHER BOOKER: As the number of U-S prescriptions for opioids doubled over a 15 year period from 105 million in 1998 to 207 million in 2013, the number of fatal overdoses from the drugs soared almost fivefold, from four thousand deaths a year in 1999 to nearly nineteen thousand in 2014. That includes people who illicitly used prescription opioids and those who overdosed on pills prescribed for them.

As recently as the early 1990’s, doctors were criticized for not prescribing enough painkillers, according to David Thomas, a doctor who works for the National Institute of Drug Abuse, known as NIDA.

DAVID THOMAS: Back then, there was a thing called opioid-phobia. A lot of healthcare professionals did not want to prescribe opiates at all, because they thought you give the slightest amount, you turn your patients into addicts. And so even people with stage four cancer weren’t being given opiates, they were left to suffer.

CHRISTOPHER BOOKER: Dr. Zebley says prescribing opioids wasn’t a treatment option he even considered for chronic pain when he graduated from the University of Maryland School of Medicine 40 years ago.

JOSEPH ZEBLEY: Back then, if we wrote for even Tylenol with codeine you would have a precept, or someone, looking over your shoulder and wondering why you were using a narcotic.

DAVID THOMAS: I think there was a number of well meaning health care providers that said, ‘This is wrong. We have to take care of people in pain. And we have the means, we have opiates.’ Instead of just using them to some degree to help people, they were starting to be used just as a replacement for comprehensive pain treatment.

JOSEPH ZEBLEY: And then there was an entire movement and I have colleagues who were in pain medicine who were involved in this movement, who said that we had an unrecognized epidemic of pain in America.

CHRISTOPHER BOOKER: As the approach to treating pain evolved, pharmaceutical companies touted studies saying painkillers carried little risk of addiction.

JOSEPH ZEBLEY: I think I, like many others, were fooled into at least partially believing that and starting to write prescriptions more liberally.

CHRISTOPHER BOOKER: How much responsibility do the doctors have in our opioid epidemic?

JOSEPH ZEBLEY: I think we all share some responsibility. But I would put a lot more and this may be controversial, on the pharmaceutical industry. I won’t name the names of certain companies but they were in my office 15, 20 years ago promoting long-acting narcotics with articles in their defense saying that these were less addicting.

CHRISTOPHER BOOKER: In the late 1990’s, Purdue Pharma, the maker of Oxycontin, which earned billions of dollars in revenue for the company, promoted the painkiller as having a low risk for addiction. But in 2007 the company admitted those claims were fraudulent and paid 600 million dollars in fines.

Since 2010, Purdue says, it has “reformulated Oxycontin with abuse-deterrent properties.” And it now refers physicians to new guidelines for opioid-prescribing from the Centers for Disease Control.

When releasing the guidelines in March, director Tom Frieden of the CDC stated: “The science of opioids for chronic pain is clear: for the vast majority of patients, the known, serious, and too-often-fatal risks far outweigh the unproven and transient benefits.”

LYNN LEVINE: I wouldn’t be able to stop ’em right away. That’s for sure.  Because I’m physically addicted, not, you know, not addicted where I take more than the dose that they order. But I’m physically dependent on them. And that would mean a lot to me if they were to just, you know, stop the doses all of the sudden.

JOSEPH ZEBLEY: There’s a certain amount of anger on the part of physicians who feel trapped. We have a large cohort now of patients who are taking these medications long term and on the other hand we’re being told, ‘Well, you guys are at fault because you’re writing all these opioids.’  Well, what are we to do?

CHRISTOPHER BOOKER: One answer to that question has been for medical schools to reexamine how their students are taught to treat pain.

A 2011 study found that during four years of training, a typical U-S medical student spends only nine hours learning about pain.

DAVID THOMAS: That’s, like, one long day at work. The amount of opioids that we’re prescribing is way too much and the amount of education that the average prescriber gets is way too little and that’s a prescription for disaster.

ANTJE BARREVELD: The challenge is there’s only so much time in the day and medical students have to learn about lots of things.

ANTJE BARREVELD: You doing OK?

CHRISTOPHER BOOKER: Dr. Antje Barreveld is a pain specialist and assistant professor at Tufts University School of Medicine outside Boston. Barreveld says that Tufts currently has no formalized program on pain. Right now she teaches roughly fifty students a year about pain for one hour.

ANTJE BARREVELD: She told the nurse that she ran out of oxycodone.

ANTJE BARREVELD: I think that a lot of the students still feel that managing pain is very mysterious. They still just don’t have a real handle on the basics of it.

CHRISTOPHER BOOKER: So Barreveld has developed a new pain education class as part of a program by NIDA and the National Institutes of Health. They’re making 50 to 100 interactive pain patient case studies accessible online, so other medical schools can use them too.

This case study shows a re-enactment of Barreveld assessing a patient with a history of chronic pain and substance abuse.

The students then meet with her to think creatively about treatment options, including physical and behavioral therapies as well as opioids, if appropriate, at low doses, and with caution.

ANTJE BARREVELD: Can you get “hooked” on buprenorphine? Absolutely. It’s an opioid.

CHRISTOPHER BOOKER: Tufts third year medical student Olivia Pezulo took Barreveld’s class and says it was the most comprehensive pain training she’s had.

OLIVIA PEZULO: You have a lot of exposure to patients and pain, but you don’t get the exposure to the treatment side of it.

CHRISTOPHER BOOKER: So then what was different here?

OLIVIA PEZULO: First of all just addressing this is problem, this is real. And then coming up with multiple options and some are options I’ve never seen before and not really heard of before.

ANTJE BARREVELD: We get to have perspectives from different disciplines. A nurse treats pain very differently from a doctor or a dentist or a pharmacist. But we all together can come up with some excellent strategies that complement each other.

ANTJE BARREVELD: It’s real. Your pain is real. But you’ve made so much progress. This is why I have tissue boxes here.

ANTJE BARREVELD: Pain isn’t necessarily that simple. And there aren’t easy answers to treating it. And it often takes a special kind of person to take the time to really listen to the patient. So modeling that for students, of course, is the ultimate goal.

CHRISTOPHER BOOKER: What more do you think medical schools should be doing?

ANTJE BARREVELD: So finally someone is recognizing that this is important. I’m hoping that it’s not just gonna be an opioid-centric education. I think this needs to be about human beings as a whole and the human that suffers.

CHRISTOPHER BOOKER: This holistic approach is something the University of Maryland School of Medicine is trying with its month long elective dedicated to alternatives to medication for treating pain. The techniques range from chiropractic methods to guided imagery techniques that incorporate meditation and even Tai Chi. Fourth year medical student Kevin O’Malley took the class.

KEVIN O’MALLEY: After taking this rotation, I feel much more comfortable and prepared for treating chronic pain in patients because I’ve been exposed to so many different therapies. I think it can be easy to think, “Well, you know, someone’s in pain, they experience it like anyone else does. And it’s more complicated than that.

CHRISTOPHER BOOKER: O’Malley plans to become a family doctor, just like Maryland Alumnus Joseph Zebley. Seasoned physicians like him are taking steps to update their training. Maryland is one of at least 20 states where doctors are required to take a class in pain management, opioid prescribing, or substance abuse in order to be relicensed.

SPEAKER: Don’t ever think you know your patient even if they show up once a week for something. You don’t.

JOSEPH ZEBLEY: I think it’s a reasonable first step. But it’s nowhere near sufficient to really have doctors slow down the use of opioids.

CHRISTOPHER BOOKER: At least 12 twelve states also require doctors to check databases listing who has been prescribed opioid painkillers before issuing the first opioid prescription to a patient. But none regularly check to see if prescribers are actually using the database.

JOSEPH ZEBLEY: Has anyone talked to you about weaning….

CHRISTOPHER BOOKER: Zebley still faces the challenge of managing opioid dependent patients like Lynn Levine. He says he’s vigilant in looking for signs of abuse and avoids prescribing opioids unless it’s absolutely necessary.

CHRISTOPHER BOOKER: How hard is it for you, in that position, and for doctors to change this, being like what I was taught was wrong?

JOSEPH ZEBLEY: Well, first you have to have some humility. That’s hard right there. And then one has to change. But we’ve changed how we use antibiotics.  We’ve changed what we do for high blood pressure. So if you have science that backs you up then you change. It may be difficult.

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