The Sudden Cardiac Arrest Problem

Reading Time: 8 minutes

Heart Attack VS Cardiac Arrest

With the occurrences of the recent “high profile” sudden cardiac arrest in the news, it made me think “what exactly is really going on?”

I stated “high profile” because if it wasn’t for a celebrity, or known sports figure, no one would have ever known about the other over 300,000 others that have suffered a sudden cardiac arrest or similar heart related issue per year.

So what exactly is sudden cardiac arrest and what makes it so different from a heart attack or a stroke.

According to the Mayo Clinic, a sudden cardiac arrest is the abrupt loss of heart function, breathing and consciousness. The condition usually results from a problem with your heart’s electrical system, which disrupts your heart’s pumping action and stops blood flow to your body.

Sudden cardiac arrest isn’t the same as a heart attack, when blood flow to a part of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.

If not treated immediately, sudden cardiac arrest can lead to death. Survival is possible with fast, appropriate medical care. Cardiopulmonary resuscitation (CPR), using a defibrillator — or even just giving compressions to the chest — can improve the chances of survival until emergency workers arrive.

The signs of sudden cardiac arrest are immediate and drastic and include:

  • Sudden collapse
  • No pulse
  • No breathing
  • Loss of consciousness

Sometimes other signs and symptoms occur before sudden cardiac arrest. These might include:

    • Chest discomfort
    • Shortness of breath
    • Weakness
    • Fast-beating, fluttering or pounding heart (palpitations)

The usual cause of sudden cardiac arrest is an abnormal heart rhythm (arrhythmia), which happens when your heart’s electrical system isn’t working correctly.

The heart’s electrical system controls the rate and rhythm of your heartbeat. If something goes wrong, your heart can beat too fast, too slowly or irregularly (arrhythmia). Often these arrhythmia’s are brief and harmless, but some types can lead to sudden cardiac arrest.

The most common heart rhythm at the time of cardiac arrest is an arrhythmia in a lower chamber of your heart (ventricle). Rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood (ventricle fibrillation).

The American Heart Association has released Heart and Stroke Statistics – 2022 Update. According to the report, cardiac arrest remains a public health crisis. There are more than 356,000 out-of-hospital cardiac arrests (OHCA) annually in the U.S., nearly 90% of them fatal. The incidence of EMS-assessed non-traumatic OHCA in people of any age is estimated to be 356,461, or nearly 1,000 people each day. Survival to hospital discharge after EMS-treated cardiac arrest languishes at about 10%.

There are several ongoing challenges to understanding the epidemiology of cardiac arrest in the U.S. Despite being a leading cause of death there are currently no nationwide standards for surveillance to monitor the incidence and outcomes of cardiac arrest. Thus, registries and clinical trials are used to provide best estimates. These sources include the Resuscitation Outcomes Consortium (ROC), 2005-2015, and the ongoing Cardiac Arrest Registry to Enhance Survival (CARES).
OHCA incidence: Adults

The incidence of EMS-assessed OHCA in 2015 was 347,322 based on extrapolation of ROC data.
Based on CARES data, in 2020 the location of OHCA in adults was most often a home or residence (73.9%), followed by public settings (15.1%), and nursing homes (10.9%).
OHCA was witnessed by a layperson in 37.1% of cases or by a 911-responder in 12.8% of cases. For 50.1% of cases, collapse was not witnessed.

OHCA incidence: Children

Based on ROC data, the incidence of EMS-assessed OHCA in children in 2015 was 7,037.[1]
Based on CARES data, in 2020, the location of OHCA in children was most often home (87.5%), followed by a public place (12.2%).

Sports-related SCA/SCD

Sports-related SCA accounted for 39% of SCAs among those ­<18 years of age, 13% for those 19-25 years of age, and 7% for those 25-34 in a prospective registry of 3,775 SCAs in Portland, OR between 2002-2015.
The incidence of SCD from Lexis Nexis and public media reports during youth sport participation, estimated by the Sport and Fitness Industry Association from 2007-2015, was 1.83 deaths per 10-million athlete years.
Pre-participation screening of 5,169 middle and high school students (mean age 13 years) from 2010-2017 revealed high-risk cardiovascular conditions in 1.47%.

COVID effects

The COVID pandemic had multiple effects on the incidence of OHCA.

In New York City, the incidence of OHCA attended by EMS (March 1-April 25, 2020) increased 3-fold, compared with the same period a year earlier.
Data from the CARES registry showed increased delays to initiation of CPR for OHCA and reduced survival after OHCA coinciding with timing of the pandemic. There was a reduction in the frequency of shockable rhythms, OHCA in public locations, and bystander AED use. Despite this, there was no significant alteration in frequency of bystander CPR.

Awareness and treatment

The prevalance of reported CPR training was 18% and having CPR training at some point was 65% in a survey of 9,022 people in the U.S. in 2015. The prevalence of CPR training was lower in Hispanic/Latino people, older people, people with less formal education, and lower-income groups.
Laypeople initiated CPR in 40.8% of OCHAs (CARES 2020 data). States with higher bystander CPR rates include Alaska (72%), California (41.8%), Hawaii (45.2%), Mississippi (42.4%), Montana (49.6%), Nebraska (49.1%), North Carolina (42.9%), Oregon (56%), Vermont (53.8%), and Washington (56.3%).
Laypeople were less likely to initiate CPR for people with OHCA in low-income Black neighborhoods or in predominately Hispanic neighborhoods than in high-income White neighborhoods.
Laypeople used AEDs in 5.8% of OHCAs and provided a shock in 1.3% of OHCAs (CARES 2011-2020 data).
Laypeople used AEDs in 9% of OCHA cases in 2020. States with higher rates of bystander AED use include Alaska (9.7%), Minnesota (9.4%), Nebraska (16.3%), North Carolina (9.5%), Oregon (13.5%), Pennsylvania (10.3%), Utah (9.5%), and Washington (10.9%).

OHCA outcomes: Adults

Survival to hospital discharge after EMS-treated OHCA was 9% and survival to hospital discharge with good functional status was 7%, based on 124,088 cases (CARES 2020). Note: the AHA previously reported that unadjusted survival to hospital discharge after EMS-treated OHCA increased from 10.2% in 2006 to 12.4% in 2015 in the ROC epistry.
Survival to hospital discharge after EMS-treated OHCA was higher in the Midwest and South, relative to the Northeast.
Survival and neurologic recovery after OHCA are worse in White Hispanic, Black, and Asian patients, compared with White patients. Disparities were explained only in part by delays in onset of medical care, suggesting there may be other underlying vulnerabilities.

OHCA outcomes: Children

Survival to hospital discharge after EMS-treated nontraumatic OHCA in 2015 was 13.2% for children in the ROC epistry.
Survival to hospital discharge was 6.5% for 1,366 children < 1 year of age, 14.4% for 880 children 1-12 years of age, and 21.2% for 736 children 13-18 years of age (CARES 2020).

OHCA outcomes: Sports-related SCA-SCD

In a population-based registry of all paramedic responses for SCA from 2009-2014, 43.8% of athletes with SCA during competitive sports survived to hospital discharge.

Complications

Survivors of cardiac arrest experience multiple medical problems including impaired consciousness and cognitive deficits.
Functional impairments are associated with reduced function, reduced quality of life, and shortened life span.
Functional recovery continues over at least the first 12 months after OHCA in children and over 6 to 12 months after OHCA in adults.
Serial testing in a cohort of 141 people who survived hospitalization after SCA revealed severe cognitive deficits (13%), anxiety and depression (15%), post traumatic stress symptoms (28%), and severe fatigue (52%). Subjective symptoms declined over time after SCA, although 10-22% had cognitive impairments at 12 months, with executive functioning being most affected. Of 141 individuals who survived hospitalization after SCA, 72% returned to work after 12 months.
Of 287 people who survived hospitalization after OHCA, 47% had reduced participation in pre-OHCA activities and 27% of those who were working before OHCA were on sick leave at 6 months.
Among 195 caregivers of cardiac arrest survivors, 25% experienced anxiety and 14% experienced depression at 12 months.

 

The Chinese Room Argument

Reading Time: 15 minutes

Chinese Room Argument

In two previous articles: A robot wrote this entire article. Are you scared yet? and The Machine I’ve written about Artificial Intelligence not being all that is it cracked up to be. This third article is what I’ve been squawking about since the beginning. The so-called “Artificial Intelligence” that is being shoved down the throats of everyone on the planet is not what it seems in the light of day.

The argument and thought experiment now generally known as the Chinese Room Argument was first published in a 1980 article by American philosopher John Searle. It has become one of the best known arguments in recent philosophy. Searle imagines himself alone in a room following a computer program for responding to Chinese characters slipped under the door. Searle understands nothing of Chinese, and yet, by following the program for manipulating symbols and numerals just as a computer does, he sends appropriate strings of Chinese characters back out under the door, and this leads those outside to mistakenly suppose there is a Chinese speaker in the room.

The narrow conclusion of the argument is that programming a digital computer may make it appear to understand language but could not produce real understanding. Hence the Turing Test is inadequate. Searle argues that the thought experiment underscores the fact that computers merely use syntactic rules to manipulate symbol strings, but have no understanding of meaning or semantics. The broader conclusion of the argument is that the theory that human minds are computer like computational or information processing systems is refuted. Instead minds must result from biological processes; computers can at best simulate these biological processes. Thus the argument has large implications for semantics, philosophy of language and mind, theories of consciousness, computer science and cognitive science generally. As a result, there have been many critical replies to the argument.

Work in Artificial Intelligence has produced computer programs that can beat the world chess champion, control autonomous vehicles, complete our email sentences, and defeat the best human players on the television quiz show Jeopardy. AI has also produced programs with which one can converse in natural language, including customer service virtual agents, and Amazon’s Alexa and Apple’s Siri. Our experience shows that playing chess or Jeopardy, and carrying on a conversation, are activities that require understanding and intelligence. Does computer prowess at conversation and challenging games then show that computers can understand language and be intelligent? Will further development result in digital computers that fully match or even exceed human intelligence? Alan Turing (1950), one of the pioneer theoreticians of computing, believed the answer to these questions was “yes.” Turing proposed what is now known as “The Turing Test.” If a computer can pass for human in online chat, we should grant that it is intelligent. By the late 1970’s some AI researchers claimed that computers already understood at least some natural language. In 1980 Universty of California, Berkeley philosopher John Searle introduced a short and widely discussed argument intended to show conclusively that it is impossible for digital computers to understand language or think.

Searle argues that a good way to test a theory of mind, say a theory that holds that understanding can be created by doing this or that, is to imagine what it would be like to actually do what the theory says will create understanding. Searle (1999) summarized his Chinese Room Argument.

Imagine a native English speaker who knows no Chinese locked in a room full of boxes of Chinese symbols. Together with a book of instructions for manipulating the symbols. Imagine that people outside the room send in other Chinese symbols which, unknown to the person in the room, are questions in Chinese. And imagine that by following the instructions in the book, the man in the room is able to pass out Chinese symbols which are correct answers to the questions. The book enables the person in the room to pass the Turing Test for understanding Chinese but he does not understand a word of Chinese.

Searle goes on to say, “The point of the argument is this: if the man in the room does not understand Chinese on the basis of implementing the appropriate book for understanding Chinese then neither does any other digital computer solely on that basis because no computer, has anything the man does not have.”

Searle demonstrated years ago with the so-called Chinese Room Argument that the implementation of the computer program is not by itself sufficient for consciousness or intentional. Computation is defined purely formally or syntactically, whereas minds have actual mental or semantic contents, and we cannot get from syntactical to the semantic just by having the syntactical operations and nothing else. To put this point slightly more technically, the notion “same implemented program” defines an equivalence class that is specified independently of any specific physical realization. But such a specification necessarily leaves out the biologically specific powers of the brain to cause cognitive processes. A system, me, for example, would not acquire an understanding of Chinese just by going through the steps of a computer program that simulated the behavior of a Chinese speaker.

“Intentionality” is a technical term for a feature of mental and certain other things, namely being about something. Thus a desire for a piece of chocolate and thoughts about real Manhattan or fictional Harry Potter all display intentionality.

Searle’s shift from machine understanding to consciousness and intentionality is not directly supported by the original 1980 argument. However the re-description of the conclusion indicates the close connection between understanding and consciousness in Searle’s later accounts of meaning and intentionality. Those who don’t accept Searle’s linking account might hold that running a program can create understanding without necessarily creating consciousness, and conversely a fancy robot might have dog level consciousness, desires, and beliefs, without necessarily understanding natural language.

In moving to discussion of intentionality, Searle seeks to develop the broader implications of his argument. It aims to refute the functionalist approach to understanding minds, that is, the approach that holds that mental states are defined by their causal roles, not by the neurons/ transistors that plays those roles. The argument counts especially against the form of functionalism known as the Computational Theory of Mind that treats minds as information processing systems. As a result of its scope, as well as Searle’s clear and forceful writing style, the Chinese Room argument has probably been the most widely discussed philosophical argument in cognitive science to appear since the Turing Test. By 1991, computer scientist Pat Hayes had defined Cognitive Science as the ongoing research project of refuting Searle’s argument. Cognitive psychologist Steven Pinker (1997) pointed out that by the mid-1990’s well over 100 articles had been published on Searle’s thought experiment, and that discussion of it was so pervasive on the Internet that Pinker found it a compelling reason to remove his name from all Internet discussion lists.

This interest has not subsided, and the range of connections with the argument has broadened, including papers making connections between the argument and topics ranging from embodied cognition to theater talk, psychotherapy to postmodern views of truth and, as well as discussions of group or collective minds and discussions of the role of intuitions in philosophy.

Searle’s argument has four important antecedents. The first of these is an argument set out by the philosopher and mathematician Gottfried Leibniz (1646–1716). This argument, often known as “Leibniz’ Mill”, appears as section 17 of Leibniz’ Monadology. Like Searle’s argument, Leibniz’ argument takes the form of a thought experiment. Leibniz asks us to imagine a physical system, a machine, that behaves in such a way that it supposedly thinks and has experiences.

Moreover, it must be confessed that perception and that which depends upon it are inexplicable on mechanical grounds, that is to say, by means of figures and motions. And supposing there were a machine, so constructed as to think, feel, and have perception, it might be conceived as increased in size, while keeping the same proportions, so that one might go into it as into a mill. That being so, we should, on examining its interior, find only parts which work one upon another, and never anything by which to explain a perception. Thus it is in a simple substance, and not in a compound or in a machine, that perception must be sought for.

A second antecedent to the Chinese Room argument is the idea of a paper machine, a computer implemented by a human. This idea is found in the work of Alan Turing, for example in “Intelligent Machinery” (1948). Turing writes there that he wrote a program for a “paper machine” to play chess. A paper machine is a kind of program, a series of simple steps like a computer program, but written in natural language, and implemented by a human. The human operator of the paper chess-playing machine need not know how to play chess. All the operator does is follow the instructions for generating moves on the chess board. In fact, the operator need not even know that he or she is involved in playing chess, the input and output strings, such as “N–QB7” need mean nothing to the operator of the paper machine.

As part of the WWII project to decipher German military encryption, Turing had written English language programs for human “computers,” as these specialized workers were then known, and these human computers did not need to know what the programs that they implemented were doing.

One reason the idea of a human-plus-paper machine is important is that it already raises questions about and understanding similar to those in the Chinese Room Arugement. Suppose I am alone in a closed room and follow an instruction book for manipulating strings of symbols. I thereby implement a paper machine that generates symbol strings such as “N-KB3” that I write on pieces of paper and slip under the door to someone outside the room. Suppose further that prior to going into the room I don’t know how to play chess, or even that there is such a game. However, unbeknownst to me, in the room I am running Turing’s chess program and the symbol strings I generate are chess notation and are taken as chess moves by those outside the room. They reply by sliding the symbols for their own moves back under the door into the room. If all you see is the resulting sequence of moves displayed on a chess board outside the room, you might think that someone in the room knows how to play chess very well. Do I now know how to play chess? Or is it a system that is playing chess? If I memorize the program and do the symbol manipulations inside my head, do I then know how to play chess, albeit with an odd phenomenology? Does someone’s conscious states matter for whether or not they know how to play chess? If a digital computer implements the same program, does the computer then play chess, or merely simulate this?

A third antecedent of Searle’s argument was the work of Searle’s colleague at Berkeley, Hubert Dreyfus. Dreyfus was an early critic of the optimistic claims made by AI researchers. In 1965, when Dreyfus was at MIT, he published a circa hundred page report titled “Alchemy and Artificial Intelligence.” Dreyfus argued that key features of human mental life could not be captured by formal rules for manipulating symbols. Dreyfus moved to Berkeley in 1968 and in 1972 published his extended critique, “What Computers Can’t Do.” Dreyfus’ primary research interests were in Continental philosophy, with its focus on consciousness, intentionality, and the role of intuition and the in-articulated background in shaping our understandings. Dreyfus identified several problematic assumptions in AI, including the view that brains are like digital computers, and, again, the assumption that understanding can be codified as explicit rules.

However by the late 1970s, as computers became faster and less expensive, some in the burgeoning AI community started to claim that their programs could understand English sentences, using a database of background information. The work of one of these, Yale researcher Roger Schank (Schank & Abelson 1977) came to Searle’s attention. Schank developed a technique called “conceptual representation” that used “scripts” to represent conceptual relations (related to Conceptual Role Semantics). Searle’s argument was originally presented as a response to the claim that AI programs such as Schank’s literally understand the sentences that they respond to.

A fourth antecedent to the Chinese Room argument are thought experiments involving myriad humans acting as a computer. In 1961 Anatoly Mickevich published “The Game,” a story in which a stadium full of 1,400 math students are arranged to function as a digital computer. For 4 hours each repeatedly does a bit of calculation on binary numbers received from someone near them, then passes the binary result onto someone nearby. They learn the next day that they collectively translated a sentence from Portuguese into their native Russian. Mickevich’s protagonist concludes “We’ve proven that even the most perfect simulation of machine thinking is not the thinking process itself.” Apparently independently, a similar consideration emerged in early discussion of functionalist theories of minds and cognition, functionalists hold that mental states are defined by the causal role they play in a system. Just as a door stop is defined by what it does, not by what it is made out of. Critics of functionalism were quick to turn its proclaimed virtue of multiple readability against it. While functionalism was consistent with a materialist or biological understanding of mental states, it did not identify types of mental states, such as experiencing pain, or wondering about the feeling of love. With particular types of neurophysiology’s states, as “type-type identity theory” did. In contrast with type-type identity theory, functionalism allowed sentient beings with different physiology to have the same types of mental states as humans, pains, for example. But it was pointed out that if extraterrestrial aliens, with some other complex system in place of brains, could realize the functional properties that constituted mental states, then, presumably so could systems even less like human brains. The computational form of functionalism, which holds that the defining role of each mental state is its role in information processing or computation, is particularly vulnerable to this maneuver, since a wide variety of systems with simple components are computationally equivalent. Critics asked if it was really plausible that these inorganic systems could have mental states or feel pain.

Let a functionalist theory of pain be instantiated by a system the sub-assemblies of which are not such things as C-fibers and reticular systems but telephone lines and offices staffed by people. Perhaps it is a giant robot controlled by an army of human beings that inhabit it. When the theory’s functionally characterized conditions for pain are now met we must say, if the theory is true, that the robot is in pain. That is, real pain, as real as our own, would exist in virtue of the perhaps disinterested and businesslike activities of these bureaucratic teams, executing their proper functions.

As you can see, a robot is not capable of feeling.

The Foundations

Reading Time: 9 minutes

The Foundations

The causes and effects of organizational corruption have been widely examined in literature, including malfeasance that is specific to nonprofits organizations. This post draws a distinction between outright illegal and soft corruption, the latter referring to the continued and deliberate misuse of donated funds to benefit officers of the nonprofit, with little – in some instances less than 5% – going to the nonprofit’s supposed cause.

Ultimately it has been shown that either the existence of an independent voting board or the conduct of an independent audit are the most important means of preventing soft corruption; far more important than state or federally mandated reporting requirements.

Thankfully, the vast majority of charities and nonprofits do a lot of good and they are largely unknown, never making it to the top of Google search. There are a lot of charities out there. According to the National Center for Charitable Statistics, there are upwards of 1.5 million nonprofits in the U.S. alone. Most of these are tiny, a fundraising organization for one Marine who has lost his legs, for instance, or an organization established by a wealthy family to provide scholarships to local youth. While news of scams will occasionally rise from these obscure ranks, most quietly go about doing good in their communities.

Here are five of the ugliest scandals involving charities.

1) The Clinton Foundation

Due to Hillary Clinton’s White House bid, her bitter back-and-forth with Donald Trump’s campaign, and her penchant for stirring up distrust toward herself, it was inevitable that Clinton’s nonprofit would be dragged under the microscope.

On the books, according to its financials on nonprofit watchdog site Charity Navigator, the Clinton Foundation is clean as a whistle. They brought in a ton of money in 2014, over $319 million, via donations, fundraisers, and grants. Nearly 87% of that went to the programs and services the charity offers. But it’s not the financials that have attracted the suspicion and scorn of the American public.

Earlier this year, it was revealed by the Daily Beast that, during Clinton’s tenure as Secretary of State, a suspicious number of donors to a State Department fund to restore parts of the White House also donated to the Clinton Foundation. But no wrongdoing could be connected to the findings.

Then in late summer 2016, as Clinton’s State Department emails began to come to light, it was revealed that an inordinate number of foundation donors were granted special access to Clinton, President Obama, and other important leaders via the State Department. Grumblings began to surface of Clinton using the foundation as a front for a pay-to-play scheme, where she sold access to movers and shakers in return for lucrative donations.

As the presidential race reached its climax, more revelations came to life, uncovering numerous instances where the Clinton’s received hefty sums of money from foreign leaders. In 2010, the foundation accepted $500,000 from the Algerian government, but they never disclosed the donation to State Department as they should have. Clinton had also received a $12-million donation from the King of Morocco, which was also not reported. Most recently, it’s been revealed that Clinton received a $1-million gift — a birthday gift to Bill Clinton — from the government of Qatar.

Helped along by other email revelations, all of this has cascaded into a likely indictment against Clinton and the foundation, and right on the doorstep of the 2016 election. It might be enough to end her White House bid.

2) 3. Wounded Warrior Project

In terms of charities for veterans, few have become as well known as the Wounded Warrior Project, which focused on helping wounded and disabled vets recover, mentally, physically, and financially. It was a worthy cause, to be sure. Sadly, this charity’s marketing got ahead of their actual charitable activities.

In February, the charity’s leaders were shown to be blowing shocking amounts of money on hobbies and parties. Employees flew in business class, stayed in $500-a-night hotels, and threw expensive parties. Their executive director was reported to rappel down buildings and ride a Segway to events. Events that cost as much as $3 million apiece. One employee called it, “extremely extravagant. Dinners and alcohol. Just total excess.”

CBS News reported: “Compared to other veterans’ organizations, Wounded Warrior is giving less to the people it serves. Disabled American Veterans Charitable Service Trust spends 96 percent of its budget on vets. Fisher House devotes 91 percent. But, the Wounded Warrior Project spends only 60 percent on vets.”

The silver lining here is that, since the expose and a Senate investigation , the Wounded Warrior Project has ousted its former leadership and is now focusing its efforts on financial responsibility and better serving veterans.

3) Moore Charitable Foundation

Not all charity scandals are the result of internal greed or irresponsibility. Like any other business or individual, they can, in an effort to get more for their buck, be duped into scams. That’s what happened to the Moore Charitable Foundation, which funds social welfare and environmental causes.

Wall Street hustler Andrew W.W. Caspersen was found to have scammed the Moore Charitable Foundation out of $25 million as part of a fraudulent investment scheme. Perhaps most shocking was how little due diligence the charity put into the investment before giving Caspersen the money. Luckily, when Caspersen came asking for another $20 million, the charity wised up and decided to do their homework before handing anymore over.

Unfortunately, fraud is not uncommon for charities, but the size of this scam was large enough to put it in the headlines.

4) Sugar Research Foundation

You ever wonder how one commercial can promote the health benefits of a product, only to be followed by another that says the opposite? This year, an old scandal finally saw the light of day that illustrates the forces that cause consumers to receive mixed messages about the food they eat.

A research paper was published in the scientific journal JAMA Internal Medicine that revealed a 1967 study on sugar as a fraud. According to the paper’s author, the Sugar Research Foundation paid a trio of Harvard scientists $50,000 to debunk claims that sugar was causing a host of health problems in the American public, including heart disease.

Sadly, the scientists went ahead with the deception, writing up a paper and having it published in the prestigious New England Journal of Medicine. As a result, consumers and health professionals remained uninformed and confused about the true dangers of sugar for decades.

The biggest twist of all of this is that one of the scientists, Dr. Mark Hegsted, went on to become the head of nutrition at the Department of Agriculture and one of the creators of the federal government’s first dietary guidelines in 1977.

Unfortunately, this illustrates how so-called charities are often used by businesses and powerful individuals to achieve decidedly un-charitable ends.

5) Leonardo DiCaprio Foundation

Leonardo DiCaprio. If you’ve followed the star’s career, you know that he has had an interest in climate change issues since Al Gore was a presidential candidate. So it makes sense that he’s set up a charity to bring attention and funding to environmental issues. According to its site, his foundation is “dedicated to the long-term health and well-being of all Earth’s inhabitants.”

In July, the U.S. Justice Department filed a complaint alleging that DiCaprio’s charity was part of the mounting three-billion Malaysian embezzlement scandal that was still fresh in the headlines. Because the foundation was set up as a donor-advised fund, it didn’t have to disclose its financials or much of anything about their internal workings to anyone.

The foundation claimed to have only six staff members, none paid, none of whom could be located or communicated with for questioning, but they regularly raised eye-popping figures at their lavish, star-studded events.

One gala was reported to have raked in $25 million, another $6 million in ticket revenue alone. At the time of the complaint, DiCaprio claimed to have raised $45 million total. But where exactly that money is coming from and where it’s going, no one knows. And DiCaprio’s not saying.

What is known is that DiCaprio is a friend of Jho Low, a central figure in the Malaysian money scheme, and that the two have a habit of taking lavish trips together. The Justice Department complaint alleges that the money to produce DiCaprio’s Wolf of Wall Street was actually siphoned from the Malaysian scheme. Low is even thanked in the film’s closing credits.