The refrigerator revolution.

How a simple, new technology threw the best-laid plans of the chemical and refrigerator industries into disarray - and provided a new perspective on how future environmental agreements can be reached.

In recent years, a series of massive business mergers has mesmerized the industrial world: publishing empires merging into entertainment empires; cigarette companies swallowing major food companies; giant banks pooling assets with other giant banks. The executives who have negotiated the deals - men like Sumner Redstone of the communications giant Viacom, and Michael Eisner of Disney - have been regarded by an awed business media as the very highest achievers of the new global economy.

In the early 1990s, when many of these deals were in the making, a German environmentalist, Wolfgang Lohbeck, put together a very different sort of deal. Unlike Redstone or Eisner, Lohbeck was not an executive in a major corporation and did not have the power to move giant amounts of capital. He had worked for a while as an architect for the German ministry of buildings, but had become disillusioned with the bureaucratic life, and in his late thirties he had quit the government to join Greenpeace. As an environmentalist, he had little standing among the movers and shakers of industry.

The deal Lohbeck made, compared to the mega-mergers being breathlessly chronicled in the Wall Street Journal or Economist, may have seemed too small to mention - yet may prove, in time, to have had far greater consequences for the world. The first impacts were felt in two multi-billion-dollar manufacturing industries - the global refrigerator business and the chemical industry that supplies it. In both, major changes had been expected as a result of the global mandate to phase out the use of ozone-depleting substances - particularly the chlorofluorocarbons, or "CFCs" used as coolants in refrigerators and air conditioners. But the changes Lohbeck triggered were not the ones the executives of those companies had expected.

In some respects, Lohbeck's story is a cautionary tale: it offers important insights into what can go wrong as the world struggles to set in motion the technological transformations that will be required to put the world on a sustainable course. It also offers new hope for international efforts both to stem the depletion of the Earth's ozone layer and to slow the onset of global warming.

The Context

The immediate setting for Lohbeck's deal was the small town of Marienbad in eastern Germany, just after reunification in the early 1990s. One of the town's main industries was a company called DKK Scharfenstein (or DKK), which had once been the largest manufacturer of refrigerators in East Germany. After the Berlin Wall was torn down, the company was thrown into competition with the more modernized manufacturers of western Germany, which were rapidly preparing for the new, more "ozone-friendly" substitutes for CFCs, called HCFCs (hydrochlorofluorocarbons) and HFCs (hydrofluorocarbons). Within months, DKK - run-down and hopelessly obsolescent - was struggling to stay afloat. It was on the verge of going under, when Lohbeck approached it with his proposal: that instead of trying to compete in the making of new, HCFC and HFC-based refrigerators, it make a bold leap into the future by designing a completely ozone-benign refrigerator, of a kind no company in the world was yet making. Such idealistic proposals, of course, are commonplace now. What made this one different was that within three years, it would compel major manufacturers all over the world to change their plans.

The broader setting for Lohbeck's deal was the growing urgency of the need to mend the ozone layer in the stratosphere, which protects the earth and its inhabitants from damaging ultraviolet radiation. In the 1970s, scientists had begun to theorize that widely used chlorine-containing industrial substances - including the CFCs - might be causing chemical reactions in the stratosphere that were ravaging the ozone shield. As excessive levels of ultraviolet radiation reached Earth, they warned, the consequences could include rises in the incidence of skin cancer, diminished crop yields, and extensive damage to marine life. But it was not until May 1985, when the British Antarctic Survey reported the discovery of an enormous "ozone hole" over Antarctica, that the issue was widely perceived as a crisis.

Just over two years later, in September 1987, the historic Montreal Protocol on Substances that Deplete the Ozone Layer was signed, initially by 26 countries. In its most important outcome, industrial nations agreed to cut production of CFCs in half by 1999. The agreement was subsequently strengthened three times, requiring that the production of CFCs in industrial countries be phased out altogether by 1996, and restricting the use of several other ozone-depleting chemicals. It gave developing countries a 10-year grace period. By 1996, the accord had been ratified by more than 150 nations.

The Race for Substitutes

In the early days of the ozone negotiations, the handful of large chemical companies that produced CFCs, including DuPont, AtoChem, and ICI, had resisted any moves for binding actions. However, as demands for action grew more forceful the companies began gradually to change course. Believing that regulation was inevitable, and sniffing profits from substitute chemicals, the industry - first in the United States but ultimately in other countries as well - decided to support the accord.

The chemical industry decided to stake its bets on the HFCs (used as coolants) and HCFCs (used to make insulating foam). DuPont, for one, invested half a billion dollars in these new chemicals, expecting that the payback period would likely be 10 years or more. To some extent, governments encouraged such investments, knowing that the availability of substitutes was a necessary precondition for phasing out CFCs. Yet these substitute chemicals had some important liabilities of their own. The HCFCs, while less damaging than what they replaced, are still ozone-depleting. And both HCFCs and HFCs are greenhouse gases, meaning that they contribute to yet another pressing global threat - that of climate change. For this reason, both types of chemicals were generally viewed as interim rather than permanent solutions to the problem, which could buy time for the development of fully benign replacements.

In 1990, treaty members gathered in London with an eye toward strengthening the accord in the face of evidence that depletion was proceeding far more rapidly than had originally been predicted. One of the questions on 'the agenda was what to do about HCFCs. Recalls U.S. chief negotiator Richard Eliot Benedick, "The central issue was to set a phase-out date for HCFCs that was not too early to discourage development of these substitutes, but not too late to increase unacceptably the risk to the ozone layer."

At the time, delegates decided to officially stipulate that HCFCs were "transitional substances" - meaning that their days were numbered. Two years later, in Copenhagen, parties to the treaty decided to require HCFC use to be phased out in industrial countries by 2030. Finally, in December 1995 in Vienna, world leaders moved up the deadline for phasing out HCFCs in industrial countries to 2020, though with a 10 year "service tail" during which old refrigeration or air-conditioning equipment could be serviced with HCFCs. Developing countries were to phase out HCFCs by 2040.

Meanwhile, however, the other substitutes - the HFCs - were left off the evolving negotiating agenda altogether, because from the viewpoint of the ozone negotiators, what mattered about HFCs was that they are ozone-benign.' The fact that they are also an extremely potent greenhouse gas was something for others to deal with; in the segmented world of international environmental diplomacy, it was an issue for the global warming talks, which did not get underway until late 1988. Yet, when the Convention on Climate Change was finally completed in 1992, it contained only a weak pledge to stabilize greenhouse gas emissions, and no concrete commitment to do so.

As negotiations have proceeded over the last few years, aimed at toughening this accord, the primary focus has remained on carbon dioxide, the most voluminous greenhouse gas. The quantities of HFCs being produced are indeed minuscule compared to the quantifies of [CO.sub.2]. But what may have been taken too lightly is that, molecule for molecule, both HCFCs and HFCs are significantly more potent in their warming effect. Over a 20-year span, for example, a molecule of HFC-134a, a substitute coolant now being produced for refrigerator compressors, will produced 3,400 times as much global warming effect as a molecule of carbon dioxide; over 100 years, it will have 1,300 times the effect.

Over the course of time, then, the Montreal "success" may have the perverse effect of mitigating the ozone problem at the expense of having exacerbated the global warming problem. According to projections by the Intergovernmental Panel on Climate Change (IPCC), HFC emissions are expected to reach 148,000 tons per year by 2000 - approaching the global warming impact of all the coal, oil, and natural gas burned in the United Kingdom. By 2050, the IPCC estimates that HFC emissions will reach 1.5 million tons per year roughly equivalent in global warming impact to the fossil fuel-based [CO.sub.2] emissions of the U.K. plus Germany, Italy, and France.

Enter Rosin and Preisendanz

Around the time that Dupont and others were moving quickly into HFCs and HCFCs, two German scientists, Harry Rosin and Hans Preisendanz, were doing some CFC-substitute experiments of their own. Rosin was teaching medical microbiology and infectious disease at the University of Dusseldorf and directing the Institute of Hygiene in Dortmund, Germany. In his spare time, along with his colleague Preisendanz, he had developed a refrigeration system that used no chlorine gases at all. Instead, it relied on a mixture of two familiar old hydrocarbons (HCs), propane and butane. Propane was among the chemicals that had been used in refrigerators in the 1920s, although not in the same mixture with butane that Rosin and Preisendanz created. What the German doctors had made was an effective refrigerant that could be used in a quantity that was not large enough to be a fire hazard. The safety issue was crucial; before the invention of the miraculous, non-flammable, non-toxic CFCs around 1930, refrigerants had posed a real health risk.

On environmental grounds, the system developed by Rosin and Preisendanz offered important advantages over refrigerators cooled and insulated with HCFCs and HFCs. It contributed nothing to ozone depletion, and only minimally to global warming. And the new system had yet another important advantage: it was unpatentable. "It cannot be patented because all we have done is find the right mix of two existing common gases," Rosin told a reporter for the British newspaper The Guardian. "The technology is totally free and can be used by the whole world, whether rich or poor, for a whole range of uses. The irony is that the chemical industry also searched for a substitute for CFCs, but only in one direction - to find substances they could patent."

The irony was heightened when the two doctors were told by municipal authorities that their institute was supposed to be working on public health, not inventing a new refrigerator, and that further work on their project would be forbidden. Indeed, the connection between medical work and refrigerators may not have seemed immediately obvious. But to Rosin, it was a passion. "I am a professor of hygiene," he explained, "and the task of hygiene is to avoid external risks for our health. All risks to nature are risks to mankind also. Therefore, a medical doctor who has to protect human health has to be concerned about the ozone hole and has to avoid those substances that make the ozone hole greater. So, it is my profession to do such things, even if it is a little bit extraordinary that a medical doctor make refrigerators!"

The Dortmund authorities did not see things so broadly, however, and the refrigerator project was on the verge of being shut down (after Dr. Rosin had spent $53,000 of his own money on it), when it came to the attention of Wolfgang Lohbeck.

Lohbeck, who by then was directing Greenpeace Germany's atmosphere campaign, had seen a photo of Dr. Preisendanz in a now-defunct magazine called Quick, accompanied by a small article "about this strange doctor in Dortmund who cooled his laboratory fridge with propane." He had seen the article in late 1990 or early 1991, and forgotten about it until about a year later, when a journalist called to ask his opinion on the use of hydrocarbons as CFC substitutes. Lohbeck, who knew little about the technology, learned from the journalist that propane was going to be used in a large industrial cooling installation being constructed for Schering, a major pharmaceutical company.

At that moment Lohbeck realized that the Quick article hadn't necessarily been about a crackpot scientist. After ending his phone conversation with the journalist, he looked up the phone number of Preisendanz and made an appointment to meet him. The meeting took place in late 1991, and Lohbeck came away from it highly impressed.

That meeting was to prove fateful, because at the time, Lohbeck was a prominent skeptic in the public debate about whether HFCs should be adopted as the replacement for CFCs. Shortly before the meeting with Preisendanz, at a conference on CFC alternatives, a representative of DuPont had asked Lohbeck why Greenpeace hadn't endorsed HFC-134a - a form of HFC which Dupont had just made a large investment in producing. Lohbeck had responded that he was open to the idea, but not yet convinced. The DuPont rep then proposed a symposium on HFC-134a and invited Lohbeck, along with about 30 others from the chemical industry and the German ministry of the environment. Wary of being "the only guy against this big armada of HFC-134a promoters," Lohbeck brought Dr. Preisendanz along as a scientific expert. To his amazement, the assembled experts were unable to answer the questions of Preisendanz, who argued that HFC-134a was not only environmentally but technically inferior to a hydrocarbon alternative.

Success in Europe

At this point, convinced that HFCs were a mistake, Lohbeck began urging major refrigerator manufacturers to consider "leapfrogging" directly from CFCs to the kind of hydrocarbon technology Preisendanz and Rosin had developed. He traveled around Germany, proposing the idea to Bosch, Siemens, and at least five other major producers. All turned him down. It was only then that Lohbeck approached the failing east-sector company, DKK Scharfenstein.

His first impression was not encouraging. "The factory really was in a very bad state - very old machinery, very dirty, very polluted. Normally it would not have been a very good partner. If you looked behind the production buildings, you could see every sort of environmental problem." Moreover, the DKK engineers themselves were doubtful. But Lohbeck met with them "seven or eight times," and in the end, they had little alternative. In June 1992, Greenpeace and DKK reached an agreement: Greenpeace would give the company 27,000 Deutschmarks to build 10 refrigerators by the fall of that year. A few days later, Lohbeck read in the newspaper that a German government office, the Treuhand, which had been set up to manage (and selectively privatize) former East German state-owned enterprises, was planning to liquidate DKK.

Greenpeace quickly called a press conference to protest the liquidation and explain to the public the company's planned "Greenfreeze" technology. Just before the conference was to take place, Treuhand faxed DKK a message ordering it to cancel the press conference. The company's executive director, saying he felt responsible for DKK's 5,000 workers, disobeyed the order. The director of Treuhend arrived by helicopter to abort the conference personally. But Greenpeace, which has a formidable record in publicizing environmental causes, showed the reporters the faxed order from Treuhand not to speak to the press, and from that point there was no stopping the press.

Immediately after the news of the Greenfreeze deal broke, the major refrigerator makers mounted an anti-hydrocarbon campaign. They argued that the Greenfreeze refrigerator used more energy than did its conventional counterparts, and that hydrocarbon refrigerators were likely to burn or explode. Siemens, Bosch, Liebherr, and other appliance manufacturers sent letters to retailers warning, as Lohbeck recalls, "Don't sell these propane fridges, they will explode, they will put your little shop at risk, and the consumers do not want them!" Both arguments proved to be spurious, but were effective in blocking sales nonetheless.

Rejected by the retailers, Greenpeace responded by launching its own marketing campaign touting the DKK refrigerators' environmental benefits and their safety. By then, the German product-safety agency had tested them and declared them safe. Within a few months, the Greenfreeze campaign obtained 70,000 orders, mostly from individual consumers. And within a few months after that, the same companies that had been warning of fires and explosions all began designing HC refrigerators of their own. By 1996, 90 percent of the refrigerators used in Germany were HC-based, and the Greenfreeze technology had spread around the globe to countries as far-flung as Spain, Italy, Sweden, China, and Australia.

Foot-dragging in North America 

It is curious, then, that in the United States, which produces more than 8 million refrigerators each year, no domestic hydrocarbon refrigerators have been either sold or made as of late 1996.

The U.S. refrigerator manufacturers offer two principal explanations. First, unlike their European counterparts, the U.S. makers are still spooked by the safety issue - in part because the problem of product liability, looms larger in U.S. law. Second, U.S. manufacturers argue that from the standpoint of global warming, their HCFC/HFC refrigerators are competitive with, if not better than, the European hydrocarbon models.

On the safety issue, HC proponents note that half a decade after hydrocarbon refrigerators were introduced commercially in other countries, they don't know of a single case in which one has caught fire. (During that half-decade, there have been thousands of fires in cars, which carry far larger fuel loads; yet millions of parents put their babies in scats within a few inches of the fuel tank, with no thought that there's any serious risk involved.) To put the risk in perspective, Rosin and Preisendanz point out that the amount of fuel used in a modern HC refrigerator is about equivalent to the amount in two and one-half cigarette lighters.

U.S. manufacturers reply that refrigerators sold in the United States are considerably larger than those typically used in Europe, which means more coolant would be needed. This makes the flammability risk somewhat greater. In addition, according to Vince Anderson, former director of environmental programs at Whirlpool, the electrical "frost-free" mechanism common in U.S. refrigerators poses a safety risk. If this component were to fail in combination with hydrocarbons leaking, a fire could ensue. Anderson explains that the European hydrocarbon frost-free refrigerators are safe, but they use a mechanism that's not found at all in the United States, and is more expensive.

Beyond this, American law seems to be unique in its obeisance to even the smallest possibility of injury, and manufacturers often feel inordinately handcuffed by the threat of lawsuits resulting in huge punitive awards granted by juries who are swayed by the perception that big corporations have deep pockets. If a McDonalds customer who was scalded by coffee that was too hot could be awarded $1 million, what might GE have to pay if a refrigerator door blew off and struck a housewife in the face?

The question of energy efficiency is more complex. Though Greenfreeze refrigerators sold in Europe are more efficient than competing models there, in the United States, considerable effort has gone into designing super-efficient refrigerators - and the winning models at this point use HCFCs and HFCs. For instance, one of the models now being criticized by some activists was originally developed under the "Golden Carrot" Super Efficient Refrigerator Program, an energy efficiency program supported by environmentalists and organized by the U.S. Environmental Protection Agency in the early 1990s. Through this program, a group of 24 electric utilities pooled $30 million as a prize to the first manufacturer to make a CFC-free refrigerator that was also extremely energy-efficient and affordable. Whirlpool won that prize, and bragging rights to the most environmentally friendly refrigerator in the United States, with a refrigerator that used HFCs and HCFCs. After such an effort, it is understandable that the U.S. manufacturers would be reluctant now to abandon that course.

Whether the impact of refrigerators on global warming is reduced more by eliminating direct leaks of HFCs or by reducing the use of power from fossil fuel-burning plants through improvements in the appliance's efficiency, as Whirlpool did, is a quantitative question which continues to be debated - as does the relative cost of the two strategies. Over the long run, it may be a moot point: experience in Europe suggests that it should be possible to attain high levels of efficiency with hydrocarbon refrigerators if the same kind of attention is given to it as was given to the Golden Carrot competition.

When it comes to the danger of a thinning ozone layer, however, the coolants used by refrigerators - and potentially by air conditioners as well - are at the heart of the problem. In fact, it is this last point, about air conditioning, that is the chemical industry's greatest worry. Technically, there may be little barrier to leapfrogging to the safe haven of HC technology for domestic refrigerants, since some 5 million such refrigerators are already in use worldwide. But it is not the idea of lost refrigerant profits alone that scares the chemical companies, so much as the thought that once refrigerators convert to HC, it will only be a matter of time before air conditioners convert as well - a kind of domino theory of technological substitution. And when it comes to market share, the quantities of coolant used in home refrigerators is quite small compared to the quantity used in air conditioning.

Leapfrogging Opportunities in the Developing World

While the industrialized countries ponder a possible second generation of CFC-substitutes, many developing countries are still relying mainly on the old ozone-hostile CFCs. Under the Montreal protocol, developing countries were granted an extra 10 years to phase out CFCs, partially on the grounds that shifting immediately from CFCs would cause too great a blow to their economies. In retrospect, however, that delay had another, less anticipated benefit. Because these countries didn't have to rush to replace CFCs, they were not heavily invested in chemical replacements when the opportunity to invest in HC technology came along. Ironically, as a result of having taken a slower and more circumspect approach to the future, these "less developed" countries' manufacturers found themselves with an opportunity to leapfrog ahead of the industrialized countries when the right moment comes.

That moment may be now. Proponents of hydrocarbon-based technology argue that Green-freeze is particularly well-suited for developing countries, as the simple technology is more compatible with humid tropical climates and requires only minor changes to the old refrigerator production equipment. Because hydrocarbons are not patented, refrigerators using them can be manufactured locally, reducing the need either to import substitute chemicals from abroad or to purchase expensive licenses from the handful of large chemical corporations that currently hold the rights to HCFCs and HFCs.

Moreover, in countries like India and China, where consumer markets are expanding exponentially, it makes more sense to convert to the technologies of tomorrow today, if possible, than to have to invest twice in a single generation - first in the transitional technologies, and then (for much larger populations, and at higher future costs) for the benign replacements that will ultimately be required - perhaps as a result of restrictions on HFCs under the climate change convention.

Inspired by the Greenfreeze success in Europe, many developing countries are gearing up to go the hydrocarbon route. For instance, eight of China's 12 refrigerator manufacturers, representing 60 percent of the fast-growing Chinese market, are adopting HC technology for the foam insulation, and companies serving 30 percent of the market will be using HCs for both the foaming agent and the coolant. In India, two companies, Godrej-GE and Voltas Ltd., are embarked on a pilot project aimed at converting their operations to hydrocarbon foam insulation, with the help of the Swiss-German ECOFRIG project.

One of the factors delaying the transition in the developing world has been a reluctance to fund hydrocarbon technology on the part of the World Bank - the main implementing agency for the "multilateral fund" set up under the Montreal Protocol to help finance ozone-friendly investments in the developing world. Yet in the face of heavy pressure from Greenpeace and others, the Bank now appears to be abandoning its earlier reluctance to back the new technology. Significantly, it recently agreed to help finance the construction of hydrocarbon capacity by Koh-i-noor, an Argentinean refrigerator manufacturer.

Global Cooling 

If the Montreal Accord marked a revolution in global decisionmaking, then the advent of the Greenfreeze refrigerator technology was a revolution within a revolution. A decade after the historic decision in Montreal to phase down use of a dangerous chemical, the unexpected aftermath - a spreading rejection of the expected replacement in favor of a still better one - has important implications for the future.

For the regeneration of the ozone layer, Wolfgang Lohbeck's deal may prove to have marked a critical challenge to the prevailing wisdom. The question of when - or to what extent - hydrocarbon cooling technology and other non-chemical alternatives to CFCs will prevail worldwide, and in air conditioning as well as in refrigerators, has not yet been resolved. It is clear, however, that demand for HCFCs and HFCs is far less than the chemical companies had expected, owing to the dramatic success of Greenfreeze and other such efforts.

Meanwhile, as companies with broader interests than the chemical companies - such as those that produce Greenfreeze - start to flex their muscles in international negotiating arenas, the political landscape is gradually shifting. No doubt influenced by their new-found success with the new refrigerators, European countries have moved solidly ahead of the United States on their timetable for phasing out HCFCs. In 1994, the European Union agreed to eliminate HCFCs by 2015, 15 years before required under the treaty. Disappointed that the agreement on HCFCs reached last December in Vienna was not stronger, 24 countries announced their intent to proceed unilaterally with stricter controls.

Meanwhile, the question of how HFCs will be dealt with under the climate change convention looms on the horizon. Governments are working toward a December 1997 deadline for reaching agreement on a protocol to the treaty that is expected to include clear and binding reduction goals for greenhouse gases. Though HFCs have not received focused attention so far in these talks, a number of countries are nonetheless taking preliminary steps toward their control. In January of this year, for instance, the U.K. government announced a program of voluntary agreements with industry aimed at minimizing HFC use. And the U.S. Climate Change Action Plan calls for the Environmental Protection Agency to take a number of steps to reduce the use of HFCs wherever possible - which the agency has begun to do.

Beyond its direct implications for the ozone layer, the Greenfreeze story offers important lessons for how future agreements will be made to phase out damaging technologies on other fronts. For future decisions on technological successions, two kinds of information will demand far greater consideration than they initially received in Montreal: the opinions of independent scientists who do not have large financial interests in a particular technological succession (the future counterparts of Drs. Rosin and Preisendanz, who questioned the HCFC/HFC technology from the start); and the broad environmental consequences of the choice in question (the future counterparts of the greenhouse-warming potential of HFCs).

In addition, the Greenfreeze story makes clear that there is more to the question of how best to involve industry in international environmental negotiations than first meets the eye. The chemical industry has been widely praised for participating so extensively in the ozone talks. Though its input was without doubt essential to the process, the Greenfreeze story underscores the fact that there may not be just one "industry position" to take into account, but many. No doubt worried about the potential for HFC use to be restricted under the climate treaty, the chemical business - along with many other industries - has begun to make its presence felt in the climate change negotiations. Fortunately, two different business groups have staked out positions in favor of a strong climate accord. The Business Council for a Sustainable Energy Future represents the renewable energy, energy efficiency, cogeneration, and natural gas businesses, and these industries seem to have calculated that a strong climate change treaty would help their bottom lines. The insurance industry, too, has become a convert to the cause. At the most recent international negotiations on climate, insurers called for early and substantial reductions in greenhouse gas emissions. Worried that extreme weather disturbances linked with climate change will add up to steeply rising claims, they are likely to support the growing demand for measures to reduce greenhouse gases - including the production of refrigerators that are HFC-free.

The saga of Lohbeck's deal seems an improbable tale, but an instructive one. It's a compelling reminder that in an age of sophisticated technologies that have produced unacceptable dangers along with their touted benefits, simple alternatives can sometimes work remarkably well. Moreover, those solutions do not always come from the most high-profile dealmakers and industrial insiders. Perhaps more to the point, on an increasingly crowded and stressed planet that everyone shares, no-one is an outsider - as Lohbeck demonstrated.

Finally, there is the lesson that when large changes are imposed on existing markets - as has happened with the Montreal Accord and will happen again with other agreements that must soon come to terms with the planer's limits - the results can be as unpredictable as the course of a hurricane. The technology Lohbeck launched took two industries by storm, and since then has gained a large momentum of its own. Lohbeck, for his part, has moved on to other challenges. Now 52 years old, and still restless, he has turned his attention to the problem of cars.

Ed Ayres is editor of World Watch. Hilary French is a senior researcher at the Worldwatch Institute. Anjali Acharya, staff researcher, and Molly O'Meara, research intern, also contributed to this article.