“Sugar is so harmful that it should be controlled and taxed in the same way as tobacco and alcohol,” according to health experts quoted in today’s Daily Express
.
The researchers say that sugar indirectly contributes to 35 million deaths a year worldwide.
The news is based on a comment article by US health scientists, who argue that there has been a massive rise in diseases such as heart disease, cancer and diabetes since we began eating more sugar contained in processed food. The researchers argue that many of the health effects of excess sugar consumption are similar to those of alcohol, and that sugar should, therefore, be controlled and taxed in a similar way. They advocate introducing a tax on processed foods with added sugar, limiting sales during school hours and placing age limits on purchase. Interestingly, the authors rate sugar as more dangerous to health than saturated fat and salt, which they call dietary “bogeymen”.
It is important to highlight that the researchers’ article is a comment piece and, therefore, primarily reflects their views and opinions, rather than presenting direct research on the issue. While it is certainly an interesting concept, there is still a lack of evidence supporting the effectiveness of such measures and, crucially, whether the public would actually accept them.
Where did the story come from?
The article was written by researchers from the University of California. There is no information about any external funding. It was published in the comment section of the
peer-reviewed scientific journal Nature
.
The article was covered fairly by the papers, many of which included comments from UK experts including the UK Food and Drink Federation, which represents food manufacturers. The BBC also quoted an expert from the British Heart Foundation, who reportedly said that taxing salt and fat alongside sugar should also be considered.
What kind of article was this?
This was a comment piece in which experts discuss the global burden of general chronic disease related to sugar consumption and the need to regulate certain dietary items. In particular, the authors draw parallels between the health effects of sugar and the use of alcohol and tobacco, arguing that sugar should be regulated in a similar manner.
It is important to highlight that this was a comment piece only and, as such, it primarily reflects the views and opinions of the authors. A formal
systematic review of the literature does not appear to have been conducted and, as such, it is not certain whether all relevant evidence and resources related to sugar consumption and its health effects will have been consulted.
Also, the short piece looks at the issue from a global perspective and, therefore, is not a direct commentary on sugar consumption in the UK. In fact, a map showing average added sugar consumption per day across different nations shows that people in the UK consume a relatively low amount of sugar, at least compared with the rest of the world. Much of the article’s content may be focused on policies suited to the US, which has by far the greatest per-head sugar consumption, at more than 600 calories worth of sugar per day.
What does the article say?
The article points out that, for the first time in human history, non-communicable diseases such as
heart disease,
cancer and
diabetes, pose a greater health burden worldwide than infectious disease. While alcohol, tobacco and diet are all targeted as risk factors for these diseases by policymakers, only the first two – alcohol and cigarettes – are regulated by governments to protect public health. (Although, as the report points out, Denmark taxes food high in saturated fats and is now considering taxing added sugar.) The authors argue that fat and salt have become the current “dietary bogeymen” in the US and Europe, but that most doctors no longer believe that fat is the “primary culprit” of such disease. Doctors are apparently calling for attention to be turned towards the dangers of excess sugar consumption.
The authors estimate that over the past 50 years sugar consumption has tripled worldwide, mainly as a result of it being added to cheap processed foods. While excess sugar is thought to be a key cause of the obesity epidemic, they argue that obesity itself is not the root cause of disease but that its presence is a marker for metabolic damage. This, they say, could explain why 40% of those with metabolic syndrome (a collection of the key metabolic changes that lead to heart disease and diabetes) are not obese.
Why do they think sugar is dangerous?
The authors say that although sugar is described as “empty calories”, a growing body of evidence suggests that fructose (one component of table sugar) can trigger processes that lead to liver toxicity and a host of other chronic diseases. “A little is not a problem but a lot kills – slowly,” they say.
The authors argue that sugar meets all the four criteria used by health policy makers to justify the regulation of alcohol. These are:
- Unavoidability. While sugar was only available as fruit and honey at certain times of the year to our ancestors, it is now present in nearly all processed foods. In some parts of the world people are consuming more than 500 calories worth of sugar per day.
- Toxicity. There is growing evidence that excess sugar has an effect on human health beyond simply adding calories and can cause many of the same problems as alcohol, including high blood pressure, high blood fats, insulin resistance and diabetes.
- Potential for abuse. The authors argue that, like tobacco and alcohol, sugar acts on the brain to encourage dependence. Specifically, it interferes with the workings of a hormone called ghrelin (which signals hunger to the brain) and it also affects the action of other important compounds.
- Negative impact on society. The economic and human costs of these diseases place excess consumption of sugar in the same category as smoking and drinking.
What do they think should be done?
While the authors accept that sugar is “natural” and a “pleasure”, they argue that, like alcohol, too much of a good thing is toxic. Strategies to reduce consumption of alcohol and tobacco show that government controls, such as taxation and imposing age limits, work better than educating people. They make several proposals for controlling sugar, including:
- taxing any processed foods with added sugar, including drinks
- reducing the hours during which retailers can sell food containing added sugar
- tightening the licensing requirements on vending machines and snack bars selling sugary products
- controlling the numbers of fast food outlets and convenience stores
- limiting sales during school hours or imposing an age limit for drinks with added sugar
Finally, they argue that regulating sugar will not be easy, but it can be done with enough pressure for change, citing bans on smoking in public places as an example of what can be achieved.
What does this mean for me?
This article will be of interest to food scientists, health policy makers and the public alike, but the use of strategies to restrict the consumption of added sugar is complicated and, indeed, controversial. The implications of such moves would need to be considered in both medical and societal terms. They would need both medical evidence to support their effectiveness and assurance that the public would accept drastic changes, such as age limits on buying sweets. For example, in recent years, Denmark has imposed taxes on fatty foods, a move that has divided opinions greatly.
It is generally accepted that added sugar or excessive sugar consumption is bad for health and dietitians advise restricting sugar intake to the occasional “treat”. However, to what extent sugar is directly to blame for the rise in chronic disease and how much is due to other dietary components, such as saturated fat and salt, is open to debate. The current article does not appear to be a formal systematic review of the literature, and it is not certain whether all relevant evidence and resources related to sugar consumption and its health effects have been consulted. As such, it should be considered primarily to reflect the views and opinions of the authors.
In the UK at present, policymakers generally favour encouraging healthier eating through education and the provision of healthier options. This is carried out through public health campaigns such as
5 A DAY or by introducing new food ranges to schools. Whether this approach alone is adequate and whether healthier eating patterns should be encouraged by government regulation, is a crucial area of debate.
Links To The Headlines
Sugar 'is toxic and must be regulated just like cigarettes', claim scientists. Daily Mail, February 2 2012
Sugar tax needed, say US experts. BBC News, February 2 2012
Tax harmful sugar. Daily Express, February 2 2012
Links To Science
Lustig RH, Schmidt LA, Brindis LD.
Public health: The toxic truth about sugar. Nature, February 2 2012
“Heartburn pills taken by thousands of women ‘raise risk of hip fractures by up to 50 per cent’,” the Daily Mail reported today. The headline is based on a large new study of drugs called proton pump inhibitors (PPIs), which are commonly used to treat heartburn, acid reflux and ulcers.
The study found that post-menopausal women who regularly took PPIs for at least two years were 35% more likely to suffer hip fracture than non-users, a figure that increases to 50% for women who were current or former smokers. However, although this increase in risk is large, the overall risk of fractures remains small.
This was a large, well conducted study that suggests that long-term use of PPIs is associated with a small increase in risk of hip fracture, although the researchers point out that the risk seems to be confined to women with a history of smoking. Unlike previous research, this study took careful account of other factors that might affect risk such as body weight and calcium intake.
Women who are concerned about their use of PPIs are advised to consult their GP.
Where did the story come from?
The study was carried out by researchers from Massachusetts General Hospital, Boston University and Harvard Medical School and was funded by the US National Institutes of Health. The study was published in the
peer-reviewed British Medical Journal.
Although the Mail’s headline is technically correct, it gives the impression that these drugs carry a very large increase in the risk of hip fracture. In fact, the study found that, in absolute terms, the increase in risk for regular users was small. Researchers found that among the women in the study who regularly used PPIs, about 2 in every 1,000 fractured a hip each year. In non-users, this figure was about 1.5 in every 1,000. This is a increase of about 5 fractures a year in every 10,000 women taking PPIs.
The Mail did point out this “absolute difference” towards the end of its story. Both the Mail and the BBC included comments from independent experts.
What kind of research was this?
The researchers point out that PPIs are among the most commonly used drugs worldwide. In the US they are available over the counter, but in the UK are available only on prescription. They are used for symptoms of heartburn,
gastro-oesophageal reflux disease (GORD) and
stomach ulcers. PPIs are thought to work by reducing acid production in the stomach. Concern has grown over a potential association between long-term use of these drugs and bone fractures, although the researchers say that previous studies have had conflicting results and many did not take other factors (called
confounders) that might affect the risk of fracture into account.
In their
cohort study of nearly 80,000 post-menopausal women, the researchers set out to examine the association between long-term use of PPIs and the risk of hip fracture. Unlike a
randomised controlled trial, a cohort study cannot prove cause and effect. However, cohort studies enable researchers to follow large groups of people for long periods and they are useful for looking at potential long-term risks and benefits of treatments. The study was
prospective, which means it followed participants in time, rather than collecting information retrospectively. This makes it more reliable.
What did the research involve?
This study took its data from a large ongoing US study called the Nurses Health Study, which began in 1976 and which sent health questionnaires every two years to 121,700 female nurses aged 30-55.
From 1982 participants were asked to report all previous hip fractures and in each biennial questionnaire, women were asked if they had sustained a hip fracture over the previous two years. Those who reported a hip fracture were sent a follow-up questionnaire asking for more details. Fractures from bad accidents, such as falling down a flight of stairs, were excluded from the study. A review of medical records for 30 of the women validated all self-reported fractures.
From 2000 to 2006 the women were asked if they had regularly used a PPI in the previous two years. In earlier questionnaires (1994, 1996, 1998 and 2000), the women were also asked if they had regularly used other drugs for acid reflux, called H2 blockers.
The biennial questionnaires also included questions on other factors including menopausal status, body weight, leisure activities, smoking and alcohol use, use of hormone replacement therapy (HRT) and other medicines. Researchers used a validated food frequency questionnaire to calculate the women’s total intake of calcium and vitamin D.
They then analysed the data for any association between regular use of PPIs and hip fracture, adjusting their findings for key confounders such as body weight, physical activity, smoking, and alcohol and calcium intake. They also took into account whether the reasons for using a PPI might have affected the results.
Finally, they carried out a systematic review combining their results with 10 previous studies on the risk of hip fracture and the long-term use of PPIs.
What were the basic results?
The researchers documented 893 hip fractures during the period of the study. They also found that, in 2000, 6.7% of women regularly used a PPI – a figure that had risen to 18.9% by 2008.
- Amongst women who had regularly taken a PPI at any time, there were 2.02 hip fractures per 1,000 person years, compared with 1.51 fractures per 1,000 person years among non-users.
- Women who regularly used PPIs for at least two years had a 35% higher risk of hip fracture than non-users (age adjusted hazard ratio (HR) 1.35; 95%
confidence interval (CI) 1.13 to 1.62), with longer use associated with increasing risk. Adjustment for risk factors, including body mass index, physical activity and intake of calcium did not alter this association (HR 1.36; CI 1.13 to 1.63).
The increased risk did not change when researchers also took into account the reasons for PPI use:
- Current and former smokers who regularly used PPIs were 51% more likely to have a hip fracture than non-users (HR 1.51; (CI) 1.20 to 1.91).
- Among women who never smoked there was no association between PPI use and hip fracture (HR 1.06; (CI) 0.77 to 1.46).
- In a meta-analysis of these results with 10 previous studies, the risk of hip fracture in users of PPI was higher compared with non-users of PPIs (pooled odds ratio 1.30; CI 1.25 to 1.36).
The researchers also found that two years after women stopped taking PPIs, their risk of hip fracture returned to a similar level to that in women who had never taken them. Also, women taking H2 blockers had a “modest” increased risk of hip fracture but the risk was higher in women who took PPIs.
How did the researchers interpret the results?
The researchers conclude that their results provide “compelling evidence” of a risk between PPI use and hip fracture. They say the findings suggest that the need for long-term, continuous use of PPIs should be carefully evaluated, particularly among people who have smoked or are still smokers.
They suggest that PPIs may increase the risk of fracture by impairing the absorption of calcium, although in this study the risk of fracture was not affected by dietary calcium intake. The finding that the risk was confined to women with a history of smoking (an established risk factor for fracture) indicates that smoking and PPIs may act together (have a “synergistic effect”) on fracture risk.
Conclusion
This large study had several strengths. Unlike some previous studies, it collected information on and took into account other key risk factors for fracture, including body weight, smoking, alcohol use and physical activity. It also looked at the women’s use of PPIs every two years (rather than just asking them once) and took into account variations in use during this time in their analysis.
However, as the authors note, it also had some limitations:
- It did not ask about the brands of PPI used, nor the doses of PPI the women took, both of which could affect risk of fracture.
- The information about hip fracture was self-reported and not confirmed by medical records (although a smaller study has found self-reporting of hip fracture to be reliable).
- Also, the study did not record the women’s bone mineral density (BMD). Low BMD is an important risk factor for fracture and adding a measure of this could have strengthened the study.
Finally, because this was a cohort study, other factors both measured and unmeasured may have affected the results, even though researchers took many of these into account in their analysis. Socio-economic status and education, for example, were not established. Because this was a study of registered nurses, the applicability of the results to other socio-economic groups might be limited.
This study found that the long-term, regular use of these drugs is associated with a small increased risk in hip fracture among older women, a risk that seems to be confined to past or current smokers. Women who regularly take PPIs and who are concerned about these findings are advised to talk to their GP. Whether any change in use of this commonly prescribed drug is needed requires further study.
Links To The Headlines
Indigestion drugs taken by millions linked to hip fractures. The Daily Telegraph, February 1 2012
Heartburn pills taken by thousands of women 'raise risk of hip fractures by up to 50 per cent'. Daily Mail, February 1 2012
Ulcer drugs 'link to fractures'. BBC News, February 1 2012
Links To Science
Khalili H, Huang ES, Jacobson BC, et al.
Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. British Medical Journal. Published online January 31 2012
YESTERDAY the Associated Press reported that the Susan G. Komen Race for the Cure—America's most prominent breast-cancer charity—
is stopping its grants to Planned Parenthood, America's leading reproductive health-care provider:
Planned Parenthood says the move results from Komen bowing to pressure from anti-abortion activists. Komen says the key reason is that Planned Parenthood is under investigation in Congress—a probe launched by a conservative Republican who was urged to act by anti-abortion groups.
Susan G. Komen provides grants dedicated to breast-cancer screening; Planned Parenthood says that of the 4m breast-cancer screenings it has conducted over the past five years, 170,000 have been paid for by the grants in question. On the left, the news has been greeted as a betrayal (see, for example,
here,
here,
here,
here,
here, and from Planned Parenthood itself,
here). On the right, it has been heralded (examples
here,
here,
here, and
here). What's interesting about the reactions is that neither side is giving any credence to Susan G. Komen's apparently anodyne explanation that it's a matter of policy to suspend funding for any organisation under congressional investigation. For progressives and feminists, the news is evidence that Susan G. Komen's commitment to women's health can be abrogated by political pressure from the pro-life right. For the pro-life right, in turn, the news is evidence that Susan G. Komen has taken a bold stance against the abortionists at Planned Parenthood.
It's a cynical thing to say, but I suspect this might cost Susan G. Komen more than it does Planned Parenthood. The former has long been criticised for sugar-coating or even commercialising breast cancer. See Barbara Ehrenreich's 2001 essay "Welcome to Cancerland" for
an elegant indictment:
What has grown up around breast cancer in just the last fifteen years more nearly resembles a cult—or, given that it numbers more than two million women, their families, and friends—perhaps we should say a full-fledged religion. The products—teddy bears, pink-ribbon brooches, and so forth—serve as amulets and talismans, comforting the sufferer and providing visible evidence of faith. The personal narratives serve as testimonials and follow the same general arc as the confessional autobiographies required of seventeenth-century Puritans: first there is a crisis, often involving a sudden apprehension of mortality (the diagnosis or, in the old Puritan case, a stem word from on high); then comes a prolonged ordeal (the treatment or, in the religious case, internal struggle with the Devil); and finally, the blessed certainty of salvation, or its breast-cancer equivalent, survivorhood.
Planned Parenthood, by contrast, serves several million people a year; mostly women, but also men. The bulk of its activities are focused on contraception, STI screening, and cancer screening, and it places a particular emphasis on providing reproductive health care to people who otherwise wouldn't have access. They also provide abortions, which are controversial, obviously, but legal, obviously. And insofar as access to contraception and other family-planning services reduces the demand for abortion, Planned Parenthood also prevents abortion. In my view, it is an important part of civil society. Even from a pro-life position, I would think it qualifies: being pro-life is a coherent moral position, and not one that necessarily implies a lack of concern for women's health. So I really don't understand why Planned Parenthood gets so much grief from the right. Or perhaps it's more accurate to say that I understand what the complaints are, but I'm not really convinced. Last year, for example, Kathryn Jean Lopez published an admiring interview with Abby Johnson, a Planned Parenthood clinic director turned pro-life activist. Among other things, Ms Johnson said that Planned Parenthood
should be defunded:
Planned Parenthood is an organization that does not provide quality health care. Our tax money should go to organizations that provide comprehensive care to women, men, and children. There are better uses of our money. Planned Parenthood provides shabby, limited health care. Why would we want women to get
some
health care when they can go to a different clinic, other than Planned Parenthood, and receive
total
health care?
That makes some sense—Planned Parenthood doesn't focus on comprehensive health care—but what clinics is she talking about? The emergency room? Crisis pregnancy centres? No organisation is beyond inquiry, of course, and if people want to have a debate about whether the government should help fund Planned Parenthood, that's fair;
according to its most recent annual report, nearly half of its 2009-2010 revenue, or roughly $487m, came from government grants (federal, state or local). With that said, in the absence of a better safety net, it's a little bit churlish to be so reactionary about the organisations that are slogging away in this space. As for the Susan G. Komen grants, they added up to
about $680,000 last year. I wouldn't be surprised if Planned Parenthood raises more than that from private donations in the wake of this announcement.
(Photo credit: AFP)
“Malaria deaths twice as high as was thought,” The Independent has reported today. Many newspapers have covered research that found that malaria claimed 1.2 million lives worldwide in 2010. The Guardian also reveals that the study “demolishes conventional thinking” that almost all malaria deaths are in babies and small children under the age of five.
Malaria-related deaths in the UK were not examined in this study. Malaria is not generally present in the UK, but this preventable disease is commonly contracted by unprepared travellers visiting tropical and subtropical regions. In recent years, newspapers have reported several cases of high-profile people who have caught malaria, including pop star Cheryl Cole and Premiership footballer, Didier Drogba.
The headlines are based on a disease-modelling study that examined a large database, alongside a systematic review of other studies, to identify deaths due to malaria across 105 countries over the past 30 years. The research found that malaria in 2010 was the cause of death for 1.2 million individuals, including 714,000 deaths in children younger than five years and 524,000 in individuals aged five years or older. The results tend to show an increase in mortality from 1980 to peak levels in 2004, but since then a clear decline.
The researchers say that the recent decrease in malaria mortality in Africa in particular is due to an increase in measures to control the disease, which has been supported by international help. They say that support from international donors needs to increase if malaria is to be eradicated.
However, the primary aim of this study was to predict trends over time in malaria mortality, not to try to find causes for malaria mortality or to examine the effectiveness of different solutions to the problem.
Where did the story come from?
The study was carried out by researchers from the University of Washington, Seattle, and the University of Queensland in Australia, and was funded by The Bill & Melinda Gates Foundation.
It was published in the
peer-reviewed medical journal The Lancet. The papers accurately reflected the findings of the research.
What kind of research was this?
This was a modelling study that involved collecting all available data on malaria mortality between 1980 and 2010. During the past 10 years, efforts to tackle malaria have increased. This study aimed to accurately assess the trends in malaria mortality in order to check the progress of these efforts, and to identify areas that need future attention. To do this, the researchers developed a range of models to estimate mortality by age, sex, country and year.
What did the research involve?
As part of the Global Burden of Disease 2010 Study, all available data for mortality by cause from 1980 to 2010 are being systematically collated, and the researchers used this along with the Malaria Atlas Project (MAP). The MAP monitored the levels of transmission of Plasmodium falciparum (the parasite that causes the most severe form of malaria) in different countries.
The researchers describe how they used a large database to identify systematically all data for deaths identified as due to malaria. The researchers restricted their analyses to 105 countries that had information on malaria transmission during the 30-year period of interest. For countries that had eliminated malaria during this period, they identified the year of elimination and estimated the number of malaria deaths for the period when transmission was still occurring.
The researchers supplemented the information identified with a search of the global literature to identify published and unpublished ‘verbal autopsy’ studies. These record the probable cause of death based on the deceased's symptoms and likely medical diagnosis. The verbal autopsy method tends to be used in countries that lack a formal and reliable system for registering deaths. These were population-based studies that covered a period of at least one year and provided the number of deaths by cause according to verbal autopsy. The verbal autopsy method tends to be used in countries that lack a formal and reliable system for registering deaths.
In order to develop their models they divided the world into three groups:
- countries from sub-Saharan Africa and Yemen (45 countries)
- countries outside of sub-Saharan Africa (45 countries)
- countries with only Plasmodium vivax malaria (15 countries)
Malaria deaths in countries that only have Plasmodium vivax malaria are lower than others, so for these countries the researchers simply modelled malaria death rate by age. For the other 90 countries the researchers tested different predictive models, including:
- looking separately by sex
- looking separately by age group (less than five years and five years and older)
- looking at the transmission intensity of Plasmodium falciparum malaria, which is a key predictor of the number of malaria deaths
What were the basic results?
The study provides extensive mortality data by country. Overall, the researchers observe a fluctuation in the number of malaria deaths worldwide over the 30-year period:
- 995,000 deaths in 1980 (
95% confidence interval CI 711,000 to 1,412,000)
- a peak level of 1,817,000 deaths in 2004 (95% CI 1,430,000 to 2,366,000)
- a decrease to 1,238,000 deaths in 2010 (95% CI 929,000 to 1,685,000)
In Africa there were:
- 493,000 deaths in 1980 (95% CI 290,000 to 747,000)
- an increase to 1,613,000 in 2004 (95% CI 1,243 000 to 2,145,000)
- about a 30% decrease to 1,133,000 in 2010 (95% CI 848,000 to 1,591,000)
Outside of Africa, malaria deaths have steadily decreased:
- 502,000 in 1980 (95% CI 322,000 to 833,000)
- down to 104,000 in 2010 (95% CI 45,000 to 191,000)
The researchers estimated that there have been more deaths in people aged five years or older than previous studies have estimated. In 2010 there were 435,000 deaths in over-fives in Africa (95% CI 307,000 to 658,000) and 89,000 deaths in over-fives outside of Africa (33,000–177,000). The comparative 2010 figures for under-fives are 699,000 deaths (95% CI 415,000 to 1,112,000) in Africa and 15,000 deaths (95% CI 4,300 to 31,000) outside of Africa.
Deaths in both under- and over-fives have been decreasing over the past five years. However, the trend of deaths for countries within Africa is different to that for those of countries outside of Africa: in Africa deaths have declined in both the under- and over-fives in the past five years, though deaths in the under-fives still remain clearly higher than those in the over-fives; outside of Africa deaths in both age groups have also steadily declined, though here the mortality rate in the over-fives is higher than those below this age.
How did the researchers interpret the results?
The researchers conclude that their findings show that the global malaria mortality burden is larger than previously estimated, especially in adults. They say that the recent decrease in malaria mortality in Africa is due to more measures being taken to control the disease, which has been supported by international help. However, they say that support from international donors needs to increase if malaria is to be eradicated.
Conclusion
This study has looked at a lot of data and used systematic methods to examine trends in malaria mortality over the past 30 years. It shows that malaria in 2010 was the cause of death for 1.2 million individuals, including 714,000 deaths in children younger than five years and 524,000 in individuals aged five years or older. The results tend to show an increase in mortality from 1980 to peak levels in 2004, but since then a clear decline.
The researchers say that the recent decrease in malaria mortality in Africa in particular is due to malaria control activities being increased, supported by international help. They say that support from international donors needs to increase further if malaria is to be eradicated.
However, the primary aim of this study was to predict trends over time in malaria mortality, not to try to find causes for malaria mortality or to examine the effectiveness of different solutions to the problem.
Links To The Headlines
Malaria is twice as deadly as first thought after disease claims 1.2million lives in a year. Daily Mail, February 2 2012
Malaria death toll far higher than previously thought. The Daily Telegraph, February 2 2012
Malaria kills 1.2m worldwide - double the level feared. Metro, February 2 2012
Malaria kills twice as many people as previously thought, research finds. The Guardian, February 2 2012
Malaria deaths twice as high as was thought. The Independent, February 2 2012
Links To Science
Murray CJL, Rosenfeld LC, Lim SS, et al.
Global malaria mortality between 1980 and 2010: a systematic analysis. Lancet 2012; 379: 413–31
Editorial: New estimates of malaria deaths: concern and opportunity. The Lancet, 2012:379;385
We catch up with campaigners working hard to keep their local services going
With National Libraries Day taking place on Saturday 4 February, we invited readers to tell us in their own words, how their campaigns to save their local library have progressed in the 12 months since
Save Our Libraries Day, 2011. Several have managed to stay open, but others are still battling. We had many contributions, thank you to everyone who emailed us.
Mar Dixon, started
#savelibraries Twitter hashtag
This time last year, I was in my local
Bridgnorth Library in Shropshire supporting Save Our Libraries Day. While Shropshire wasn't under threat, I was making a point – if we don't continue to use it, it would be under threat next year. This year, I'll be doing the same.
In January 2011, I went
world trending with #savelibraries where I asked people to answer: "Libraries are important because _______."
The response was overwhelming. Many replies had nothing to do with books, but more to do with the library's importance in the community. The single mums who enjoyed the weekly toddler group, or the OAPs enjoying learning IT.
This year, I'm still fighting for libraries. On 13 March I will be lobbying parliament as part of a coalition to have the ministers take responsibility for their duty to assist local authorities in honouring the Library Act of 1964.
Many people ask why I bother when my local library is healthy and vibrant. Isn't that the point? I want to use Shropshire as a model that others should and could use to have a healthy balance of volunteers (along with Friends of Bridgnorth Library) working WITH the libraries, not replacing. This allows us to provide more for our community, creating a library that is central to our community.
Joanna Flint, Cockerton Library
I got a horrible sinking feeling last year when I first heard that our local library was proposed to close the following year due to budget cuts. It was wrong. Cockerton library is one of only two libraries in Darlington, County Durham so we don't have much access to library services as it is. While collecting signatures for our petition outside the library on cold bright January days, I can see who uses it: Everyone, there is no one type of user. Closing libraries affects everyone in society.
The wide community it serves have now formed
Friends of Cockerton Library to save our library. Cockerton East & West have the lowest access to internet services in our town, therefore we need the library not just for books, DVDs and CDs but also for internet access.
In times of hardship we need it more than ever. Our small library is popular, attracts nearly 1,000 users per week and costs just over ?100k a year to run. A small price for the hub of our community.
Our campaign is gathering momentum. Local businesses and schools have joined us and we have huge community support. The proposal to close the library
failed to get backing from scrutiny resources in a council meeting last week, a step in the right direction.
Natalie de Gruchy, Isle of Wight
Natalie contacted us last year to tell us about her Save Our Libraries Day.
Despite best efforts across the Isle of Wight, the Save Our Libraries Day was not as successful in swaying decision-making on the council as campaigners would have hoped. After contesting strongly and even taking the council to court over their decision, plans went ahead and all but two libraries on the IOW are set to close in April this year, leaving
Lord Louis and
Ryde libraries remaining. Until then, five libraries here are being run by community groups comprising of volunteers, leaving six still governed by the council. They have introduced "self service" machines that perform most library duties, and have radically cut down on staff. My job was terminated shortly after Save Our Libraries Day in April 2011. However, money is still being spent on the service, the standard of new books ordered and renovation work being done on the existing libraries is high. The fate of the buildings after closure, however, still appears uncertain.
Emily Malleson, Stony Stratford Library
I am a friend of
Stony Stratford Library. In January 2011, we asked the community to borrow every book (16,000) in our library in protest of its proposed closure. We received worldwide press coverage including the
New Yorker, Sunday Times, Private Eye and
BBC World Service, we recorded interviews for Newsnight (that were never shown) and two children from our local school went to interview author Philip Pullman at his home, and culture minister Ed Vaizey in London for BBC Newsround. We also were
interviewed in the Guardian and took part in the live blog as part of the Read-In day.
Well what can I say, it worked!! The council agreed to fund the library for another year while a proper review was carried out. This is still ongoing but the council has assured us that they will fully fund the library for the next few years. After that they cannot make any promises. We keep the campaign going so that we are always at the ready for any future threat.
Erica Coulehan, Sonning Common
Friends of Sonning Common Library helped to save our local village library from closure after a huge outcry across the county. The council then changed its proposal to a three-tier system, with the top tier keeping all staff and funding, the second tier losing one-third staff funding,
and the bottom tier (that's us!) losing 50% funding. That's an improvement from the original plans, and their second offer which was to lose two-thirds funding, but we're still very disappointed.
Oxfordshire County Council's consultation criteria were biased towards urban areas, looking at how many people lived, worked, shopped, commuted in a half-mile radius of the library, which naturally favoured them over the rural libraries that will now suffer the most cuts.
Our library is housed in the old primary school hall. The school pays the utility bills so it doesn't even cost them that much, and is used by four primary schools in the area. We don't feel they have taken these important considerations into account.
We're also angry that the council automatically assumed that the Friends Groups should recruit, manage and organise volunteers to replace the lost staff. No consultation with us. That's a very big job which we don't feel we're able to undertake: the library could need 20 to 40 volunteers. If we don't supply volunteers, we don't yet know how the council will react.
Our village has a large elderly population, who are already heavily involved in voluntary work across the village - we're not short of the "Big Society" believers – but many don't want to take on a role they feel has been forced on them because of cuts with a heavy rural bias.
Margaret Bailey, Cricklewood and Kensal Rise
We are into the second year of our campaign to keep
Kensal Rise library open.
As we wait to find out whether or not we will be granted permission to appeal to the supreme court we continue to offer our community a library service from the pop-up library outside our closed library building. Volunteers run this service seven days a week from donations of more than 3,000 books.
On Friday 3 February we will mark National Libraries Day with a fundraiser selling signed prints that have been designed and donated to us by artist Jamie Reid and on the day itself we will have a children's event at the pop up library where we will ask local children to once again cover Kensal Rise Library with their artwork, expressing more eloquently than the adults in the campaign their feelings about the loss of the library.
Our campaign remains strong. At times the level of support and goodwill, locally and beyond, is overwhelming. We are committed to saving our library and we are becoming used to the hard work of campaigning, but this community is unified in its desire to make sure we do not lose our library. It's not over yet.
Juno Baker, Upper Norwood
Our library, the
Upper Norwood Joint Library (UNJL) is threatened with closure, not because it's too expensive, it's cheaper than most libraries, but because the two councils who fund it have fallen out after 112 years.
It's complicated. Lambeth and Croydon had an agreement whereby each would have at least two councillors on the management board. Then in the 2010 election, Croydon's local Tory councillors lost their seats. Presumably because they didn't want to appoint Labour councillors, Tory-led Croydon Council appointed two councillors from the opposite end of the borough. With the best will in the world, they were never going to represent local interests that well, and they haven't.
So Lambeth objected and didn't turn up to an AGM which, Croydon said, was breaching the terms of the contract. According to Croydon, this means it doesn't have to stump up for its half anymore, which leaves the library with a shortfall of ?200,000 from end of March. Also, by laying the blame with Lambeth, Croydon has absolved itself from giving the library 12 months' notice to find alternative funding.
But we have our suspicions Croydon was planning to close the library all along;
a leaked letter, allegedly from Croydon's chief exec to his counterpart in Lambeth, requests half the costs of valuing the library's assets. And Croydon has given Lambeth three options:
• buy Croydon's half-share of assets and take responsibility for the library
• lease Croydon's half-share in the premises and take responsibility for the library
• agree to the library being sold with the profit being equally divided between the two boroughs.
Thea Sherer, Friends of York Gardens Library
York Gardens Library and Community Centre, on a deprived estate in Wandsworth very close to the scene of riots in August, was threatened with closure due to council cuts. A concerted community campaign led to a rethink. A deal was done to allow the library to remain open, primarily as a children's library with shorter opening hours, using volunteers to assist a reduced number of librarians. Volunteers are supporting a homework club and running GCSE tutoring for local teenagers as well as other activities, and giving general help in the library. A local school is using rooms in the building during the week (providing income) and a charitable foundation is running children's activities. The library has been labelled by Wandsworth Council as a "Big Society" library because of the community involvement. We are discovering that there are many challenges to this model of operating – for example, defining the boundaries between council and community responsibilities, volunteers feeling strong-armed into helping out but struggling with long-term commitment,
reduced adult provision threatening some community engagement etc. The council is also seeking to outsource the entire library service – including this library – adding further uncertainty. However the biggest challenge is that the community group has been tasked with raising around ?70,000 per year, by hiring out community rooms in the building and fundraising, to cover the shortfall in council funding. It remains to be seen whether this will be achievable, and what will happen if it is not, but we are all pleased that the library's doors are still open.
Lynne Coppendale, Doncaster
Save Doncaster Libraries has worked tirelessly throughout 2011 trying to stop the short-sighted destruction of the public library service by Mayor Peter Davies and his cabinet. Protests, petitions, two call-ins of the plans by supportive councillors to the Overview and Scrutiny committee, a new (yet still flawed) consultation process in recognition of the initial inadequate attempt, and much publicity. The mayor and cabinet have not moved, despite being given an alternative budget AND having a nil cost independent consultation report of library improvements from before the whole decimation process began. We are now consulting regarding potential legal action and hoping against hope that the 12 libraries being thrown over to the community with the threat of volunteer-or-lose-it, will survive long enough for the future council members to realise their costly error and resume running this vital social and educational service.
Sadly, it is too late for the libraries of Denaby and Carcroft, which were closed very quietly just before Christmas, and whose residents in the deprived ex-mining communities now have to rely on a sparse mobile service.
Demelza Jones, Friends of Gloucestershire Libraries
In November 2011 Gloucestershire library users
won a high court judicial review against Gloucestershire County Council's (GCC's) plans to close 10 static libraries and all mobile libraries, and reduce opening hours and services at many more, with Judge McKenna quashing the council's plans entirely. The court case followed GCC's adoption of these plans despite widespread opposition (16,000-signature petition and overwhelmingly negative consultation feedback) and repeated warnings of potential illegality by retired senior library service staff and opposition councillors.
In January 2012, GCC announced its redrawn plans for the service. Although as a direct result of our campaign and the court challenge, three libraries originally slated for closure will now retain a statutory service (Hesters Way in Cheltenham, and Matson and Tuffley in Gloucester), seven libraries will still be closed (including the library with the highest usage figures per head of population in the county! -
Minchinhampton) and the future of the mobile service remains uncertain.
GCC has just embarked on a new consultation process, including a survey which has been described as "needlessly complex". We are continuing our campaign, and continue to lobby for intervention from Ed Vaizey and Jeremy Hunt (who are responsible for superintending library services nationwide) to avoid yet more needless waste of public money and irreparable damage to our library service. After the success of last year's Save Our Libraries Day events where "Flying Authors" visited every library in Gloucestershire, library users have again organised author visits and activities in many local libraries on Saturday. However, they have been told that the events will not be allowed to go ahead if they are "linked to any campaign".
Alan Gibbons, author
I started the campaign in 2009 after speaking at a meeting in Doncaster where major cuts were mooted. Three years on, campaigners have put libraries at the centre of debate about the defence of public services. On Saturday, National Libraries Day takes place and events will be happening all over the UK. I put forward the idea months ago and the programme of events reflecting the importance of school and public libraries in the cultural life of the country will be the culmination of a lot of hard work by many organisations and individuals. I am also involved in planning for a national lobby of parliament on 13 March.
In spite of all our efforts we are still fighting an uphill battle. Libraries are closing. Opening hours are being cut. Book funds are being slashed. Librarians are being made redundant. In my home city of Liverpool over a third of library posts are under threat. The "hollowing out" of the library service is catastrophic at a time when illiteracy costs the country ?81bn a year and one child in three does not own a single book. We need the culture secretary to take his responsibilities seriously and ensure that library users have a comprehensive and efficient service in the coming years. Of course libraries could be improved but we will not have the libraries of tomorrow if we allow the libraries of today to close.
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A supporter of Republican presidential hopeful and former U.S. Sen. Rick Santorum wears a pin with a photo of Bella Santorum, Rick's daughter, which reads 'Go Dad! Love, Bella.' Photo by Andrew Burton/Getty Images.
When Victoria Miller heard the news that presidential hopeful Rick Santorum had
temporarily stepped off the campaign trail to sit by his daughter's hospital bed, Miller's thoughts traveled back to Germany.
It was there -- after being Medevaced from a U.S. military base in Bahrain -- that she gave birth. And it was there that she first heard a diagnosis that would upend her world and eventually afflict the Santorum family: Trisomy 18, sometimes known as Edwards Syndrome. Miller's son had it, and it was almost certain he wouldn't live long.
The devastating genetic disorder is brought on by an extra chromosome -- three copies of No. 18 rather than just two. For reasons that are still unknown, that extra chromosome means that nearly half of those born with Trisomy 18 die within three months -- and 90 percent are gone before their first birthday. Isabella, who is 3, is in the small minority. Miller's son Isaac died after just 11 days.
That's why the nation took note when Rick Santorum rushed his daughter to a Virginia hospital last weekend. The double pneumonia could have been fatal on its own, but the underlying Trisomy 18 -- which keeps her respiratory system fragile -- made the situation far more grim.
Nearly a week later, "Bella" has once again defied the odds. But as she struggles toward recovery, her family's openness about their battle with the condition has prompted a national question: What is it?
Below, Dr. Melanie A. Manning answers just that. She's one of the medical geneticists at Lucile Packard Children's Hospital at Stanford. You can also
read more about Miller's story and the Trisomy 18 Foundation she created in the aftermath of Isaac's death and watch another very personal account of a third family's struggle with the syndrome here:
In layman's terms, what is Trisomy 18?
Dr. Melanie A. Manning: Trisomy 18 is a genetic condition in which an individual has one extra chromosome more than the typical 46 we have in our cells. That extra chromosome is No. 18. Chromosomes 1 through 22 are the same in boys and girls, and we have two copies of each. The last pair determines our sex.
What causes the extra chromosome?
Manning: We don't understand all the mechanisms, but the extra chromosome can be in a sperm cell or an egg cell. When those eggs or sperm are being formed and the chromosomes are being divided, they can't contain 46 chromosomes each -- that would be too many for the final genetic code. So each egg has 23 and each sperm has 23. But sometimes the division of chromosomes doesn't happen as expected and you get an extra one. In that case, when the egg meets the sperm, you get a total of 47 chromosomes.
And why is that a problem?
Manning: Our chromosomes contain the genes that are the individual units of inheritance or the determiners of all of the features that make us human beings. If additional information is there that shouldn't be, it can cause organ system development to be altered. There are really only three common Trisomies: 13, 18, and 21. Those children tend to survive after birth because the developmental differences in the brain might not be as severe. You can have Trisomies of all of the other chromosomes, but that extra information is just too much and makes the development of the fetus not viable. We don't understand all of it but that extra information is just something that's not tolerated.
Do we know what causes the irregular chromosome division?
Manning: Maternal age is associated with an increased likelihood of not having everything go quite right. But it can also happen in sperm, and that's been shown to not necessarily be associated with paternal age. For that matter, it's not always associated with maternal age. There are plenty of children born with Trisomy 13 or 18 to parents who are only 18 or 21 years old. So there must be something we don't understand yet.
What are the symptoms of Trisomy 18?
Manning: Often the babies are small at birth, they're underweight and their length is shorter than what's typical for their gestational age. There can also be differences in their facial appearance -- they often have very petite features. Their respiratory system is often weak, so things like pneumonia can be a common problem. One of the most characteristic features is they have an unusual overlapping of their fingers. Their hands can be clenched but their second and fifth fingers overlap the two middle ones. And finally, for whatever reason, the connections from the brain that tell the body to keep breathing are altered. So that's one of the reasons children with Trisomy 18 often expire -- they just stop breathing.
How common is this condition?
Manning: Some estimates say it's as common as 1 in 3,000 for live births, others say it's closer to 1 in 10,000. It's not as common as Trisomy 21 -- or Down Syndrome -- but it's still one of the more common that we would see that are live born. On the other hand, Trisomy 13 is even less common than Trisomy 18, and the birth defects are even more severe -- you see heart defects, severe abdominal wall defects, and clefting in the mid-portion of the face, which can be an indication of severe brain abnormalities.
It's possible to test the child for these conditions before birth, correct?
Manning: Yes, there are some different signs that might indicate abnormality. For Trisomy 18, an ultrasound might pick up that the baby keeps his or her hands clenched, or that there's a heart defect, or they're smaller than they should be. Noticing these clues can indicate that there might be a chromosome abnormality, and testing would be able to check which chromosome has been affected.
And finally, how long do children with Trisomy 18 usually live?
Manning: The vast majority of these conceptions are miscarried. More than half of those born alive will probably not survive past one month of age and 90 percent will not survive past one year. As with any child, it really depends on the severity of their birth defects and the general health of the child. Because those birth defects are so severe for children with Trisomy 18 -- even in the best-case scenario -- there can be some long-term survival but we would expect their development to be greatly affected despite their overall good-health.
Pointing out the similarities (and differences) between slavery and the use of fossil fuels can help us engage with climate change in a new way
In 2005, while teaching history at a French university, I was struck by the general disbelief among students that rational and sensitive human beings could ever hold others in bondage. Slavery was so obviously evil that slave-holders could only have been barbarians. My students could not entertain the idea that some slave-owners could have been genuinely blind to the harm they were doing.
At the same time, I was reading a book on climate change which noted how today's machinery – almost exclusively powered by fossil fuels like coal and oil – does the same work that used to be done by slaves and servants. "Energy slaves" now do our laundry, cook our food, transport us, entertain us, and do most of the hard work needed for our survival.
Intriguing similarities between slavery and our current dependence on fossil-fuel-powered machines struck me: both perform roughly the same functions in society (doing the hard and dirty work that no one wants to do), both were considered for a long time to be acceptable by the majority and both came to be increasingly challenged as the harm they caused became more visible.
The history of slavery and its abolition shows how blurred the frontier between what is considered good and evil can be, and how quickly it can shift. We have a mental image of slave-owners as cruel, sadistic, inhuman brutes, and forget too easily the ordinariness of slave ownership throughout the world. To many, slavery seemed normal and indispensable. In the US, George Washington and Thomas Jefferson owned slaves. Lifestyles and healthy incomes were predicated upon it, just as we today depend on oil. Similarly, many slave-owners lived with the impression that they were decent people.
Obviously, there are differences between the use of slaves and of fossil fuels. Fundamentally, slavery is a crime against humanity. Fossil fuel use is not a moral evil, but burning coal or oil contributes to global warming, already causing widespread harm: it now directly or indirectly kills 150,000 people per year according to
a 2004 World Health Organisation study. States and energy companies' lust for oil also leads to wars and the toppling of democratically elected governments. Our addiction to fossil fuel is increasingly destructive.
Unlike the harm caused by slavery, the harm in the use of fossil fuels is of course indirect, long range, even unintended. It seems at first glance to be a fundamentally different kind of harm, and the unintended consequences of ongoing use of fossil fuels have only recently become understood. Initially, their use was seen as positive and progressive. But now that we know the consequences, and continue, globally, to increase emission levels, how can we still consider these consequences "unintended"?
Consumers of goods made by slaves or absentee plantation owners who lived in Britain in the 18th century also benefited from the slave system without maintaining direct connections to it. Those beneficiaries can certainly be said to have committed a morally comparable sort of human transgression to that of people who benefit from fossil fuels today.
Why is all of this relevant for climate change policy? Our contemporary economies have become extremely dependent on fossil fuels, just as slave societies were dependent on their slaves – indeed far more than the latter ever were. As one scholar remarked: "That US Congressmen tend to rationalise fossil fuel use despite climate risks to future generations just as southern congressmen rationalised slavery despite ideals of equality is perhaps unsurprising."
It should thus come as no surprise that there is so much resistance to climate science. Our societies, like slave-owning societies, have a vested interest in ignoring the scientific consensus. Pointing out the similarities between slavery and the use of fossil fuels can help us engage with the issue in a new way, and convince us to act, as no one envisages comfortably being compared with a slave-owner.
Furthermore, because of the striking similarities between the use of slaves and of fossil fuels, policymakers can find inspiration from the campaigns to abolish slavery and use them to tackle global warming. For example, the history of the abolition of slavery, in the UK at least, suggests that an incremental approach and the development of compromises worked better at moving the cause forward than hardline stances.
The evidence also implies that slavery came to be challenged and finally abolished when people became aware of an alternative. This alternative – steam power – was of course a great moral improvement until we came to know the consequences of fossil fuel consumption. This, in turn, suggests that we will restrain our use of fossil fuels if we can favour a new energy transition and find clean sources of energy – and that we should concentrate our efforts on developing "green" technologies at the same time as reducing our consumption of fossil fuels.
If we do not change, the human family will pay heavily for the consequences of our reckless activity. Moreover, future generations will look back at us and wonder how our civilisation could have been so backward and have lived in such appalling moral blindness. Will the next generation have any awareness that industrialised societies had mitigating circumstances? Probably not. They are more likely to curse us for the irreparable damage we have done to the planet. Surely, they will say, we were a barbarian people.
• Jean-Francois Mouhot is a visiting researcher at Georgetown University. He is the author of Past Connections and Present Similarities in Slave Ownership and Fossil Fuel Usage,
published in the journal Climatic Change, and the book
Des Esclaves Energetiques: Reflexions sur le Changement Climatique.
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I think I feel more pregnant this week. It's amazing the impact that something the size of a grape can have on a woman's body & life.
My not-morning-sickness has kicked itself up a notch. For the most part, I feel fine until early afternoon and then start to get really nauseated. This feeling often continues through dinner, making trying to find something I can eat a real chore. With my last
pregnancy
, I had nausea pretty much all day but it was less severe than what I find myself facing this time. And then there are the random scents that set off the nausea (and occasional vomiting) at other times. That's always a (not) fun surprise because I often can't predict which smells will be a problem.
I'm still tired, though I'm less tired than I was with my last pregnancy. Some days I can actually manage without a nap. (During my previous pregnancy, I could not make it through a day without a 2 hour nap in the afternoon.) This time though, I realize that when I start to get tired, I also get more anxious and my nausea will increase. I've had more anxiety with this pregnancy than I would have expected. I tend to be a worrier in general and have dealt with some anxiety in the past. However, since I conceived I've been far more anxious about this pregnancy. I often find myself thinking that there is something wrong with me and the thoughts are more common when I'm tired. Studies indicate that anxiety can be a common thing for pregnant women. Pregnancy and/or parenting have a big effect and bring added stress to women's lives and the hormonal and physical changes can alter things too. This is something I'll be talking to my care provider about during my next appointment. I'm also considering prenatal massage, as I have read that it has been shown to be helpful in reducing anxiety. (As a note, for anyone considering massage during pregnancy, it is important to see bodywork practitioners who are trained and certified to work with women during pregnancy.)
Like many women who have some kind of ongoing health issue, I've found that pregnancy aggravates things that are already underlying. In my case, the result is fairly mild. I have eczema (a skin condition where I get dry, itchy patches). I've had it since I was very young and, in my case, it tends to be aggravated by major hormonal changes (
puberty
was a nightmare). It generally has a minimal impact on me now unless something else triggers an outbreak. However, pregnancy for me seems to be a key activator. I have to moisturize myself constantly in an attempt to prevent any problematic areas (which would then require treatment with prescription medications to control them).
Beyond that, it is still not obvious that I am pregnant unless I've told you. My clothes might be fitting a smidgen tighter, but I don't "look pregnant." With my first pregnancy, I wore all of my regular clothes until I was probably 3-4 months along. At that point, my pants were becoming uncomfortable (even though I still didn't look very pregnant at that point) and so I switched to a maternity pant. Anecdotally, I've heard from many other women that the change to maternity pants happens sooner in subsequent pregnancies that it does in the first. I'm not sure if this is due to abdominal muscles that are familiar with the stretching necessary for a pregnancy or if you just realize how darn comfortable those elastic waist pants are and want to start wearing them sooner. (Yes, I realize that pants with an elastic waist are not fashionable in general, but they might some of the most comfortable things in the world. Besides, they make plenty of fashionable maternity pants and skirts these days where you would not even realize they have elastic unless you saw it or somebody told you.) I don't know how long I'll stay in my regular pants, but they fit for now.
My
partner
and I told our families about our upcoming addition this week. Outside of our family and a few friends, nobody knows (except for all of you, of course). It's not obvious just from looking at me and I haven't felt the need to out myself to the world just yet. It is a personal decision about when to share the news with the world. Many women choose to wait until after they've reached 12 weeks (when the likelihood of
miscarriage
decreases). Others may wish to share the news right away. I'm not sure when I'll start telling people, but eventually it will feel right and I'll let the cat out of the bag!
What’s the News: If you’ve ever been told been that a massage is good for “releasing toxins”—or to sound more scientific, “lactic acid”—from your muscles, then you’ve been told wrong. Turns out muscle cells do like a good massage, but it has nothing to do with lactic acid.
In the first study on the cellular effects of massage post-exercise, researchers found that massage bolsters chemical signals reducing inflammation and promoting repair of muscle cells.
How the Heck:
tears your muscle fibers; that’s why an intense workout can leave you sore for days. (Don’t worry—it’s normal and it generally heals fine.) The researchers wanted to study how massage affects this muscle damage, so they made 11 healthy young men cycle to the point of exhaustion. Then, finally, relief! Sort of. One leg on each man was randomly chosen for a 10-minute massage. Unfortunately more pain was then in store for these volunteers. A tissue sample was taken from the
quadriceps muscle (often known simply as “quad”) of each leg 10 minutes and 2.5 hours after the massage. Researchers looked at the level of different
mRNA, or messenger RNA, transcripts in these tissue samples. mRNA carries the ...
In response to a growing realisation that neo-liberal capitalism is morally and literally bankrupt, Britain’s political leadership have provided three visions of ethical capitalism for us to aspire to. So, is there such a thing as ethical capitalism? And why is this question being asked now?
What is Ethical?
First, we must decide how we approach this question: from a binary or a spectrum view of ethics. In binary views of ethics, to use a metaphor, you are either pregnant or not. You can’t be half pregnant. Therefore, the question has a yes or no answer. However, using a spectrum view, there is a sliding scale ranging from the most heinous unethical extreme at one end, to the apex of moral good standing at the other. In short, binary ethics asks ‘if’ something is ethical, spectrum ethics ‘how’ ethical it is.
It is interesting that this question – 'is there such a thing as ethical capitalism?' – is asked in binary terms, yet often answered in spectrum. Notice the question is not ‘what is the most ethical economic system?’ or ‘which economic model promotes the most ethical economy?’
Furthermore, the very question itself acts as a ring fence around the resulting debate, concentrating the imagination within the boundaries of just this one system – capitalism. The reason it is answered in spectrum might well be that the unethical behaviour associated with capitalism is so overwhelming and unignorable, that even the most ardent defence relies on relativity arguments – ‘given human nature’, ‘compared with communism’, ‘would you rather live here or North Korea?’.
Therefore I consider the question itself to be unethical. It is either insincere or ignorant. Insincere, in that it has been posed in response to plans for ‘ethical’ capitalism by
Nick Clegg,
David Cameron and
Ed Miliband, with knotted brows and solemn voices, as if it were consistent with the conversation happening outside of the rarefied air of
Whitehall. It is not. The conversation outside is around what an ethical society would look like, and what structures, economic included, would need to exist to support that.
If, however, the question is not insincere then it must be asked in ignorance of the myriad alternative economic models available and the broader social, economic, ecological and political questions being asked by individuals and movements, such as
Occupy,
UK Uncut and
Climate Camp.
However, if people have themselves in knots over ethics, this is small beer compared to the state of our understanding of capitalism.
What is Capitalism?
Our understanding of
capitalism is incredibly limited. Despite this being the prevailing world economic system, it is not taught until University in the United Kingdom. This means the vast majority of the population have never even had a structured, informed conversation around the mechanics and iterations of capitalism, let alone whether it is ethical or not. People, on the whole, don’t know what it is, what it does, what it means, where it came from or what it replaced.
As a snapshot, capitalism is a socio-economic ideology, a theory and the current global economic paradigm. It originated in the West, gained a foothold in the 1700s and 1800s and ultimately replaced
feudalism. It has gone through various incarnations, or developments, from Mercantilism, Industrialism, Keynesianism, and the latest, Neo-Liberalism. It exists in established democracies and totalitarian dictatorships.
Yet I have had conversations on the topic of a world without capitalism with intelligent people who, without irony, have stated that capitalism has always existed and will always exist because people will always want to exchange things with each other. To be clear, you can have an economy without it being capitalist. You can have trade of ideas, labour, skills and products without capitalism. Capitalism is not synonymous with any of these things.
I mention this not to belittle, but to demonstrate how successfully and misleadingly capitalism has been branded as natural, inevitable, permanent and, arguably the most intriguing, ‘post-ideological’. It is none of these things. But consider for a moment: if most people believe it is, then does it matter whether it is ethical at all? If something is natural, inevitable, permanent and not based in ideology, isn’t even entering a conversation about the ethics of it somewhat irrelevant outside of the curiosities of academia?
This is precisely how this conversation becomes pointless, for most, fast. This is where the conversation slides into a rational black hole, we hang our heads and bemoan the cursed world and go back to watching the telly. This is how quickly and easily a question seemingly challenging of capitalism, leads inexorably to a conclusion in favour of the defence of the status quo. The question itself acts as a kind of cerebral sat-nav guiding anyone who answers it without first analysing it, straight to the pre-set destination: turn right at the false dilemma, left at the pop psychology and come to a stop at the dead end.
This is why I have taken the time to set the question in some context before even attempting to address the material content of it.
A Matter of Context and Perspective
These matters of context and perspective are sadly missed in the current and painstakingly narrow debate conducted at sound bite level across the rolling news channels today. A large part of the thinking taking place at venues such as
The Bank of Ideas, a building repossessed by
Occupy London for the purpose of a Free University Campaign, is around placing questions of ethical economics in context and shifting perspectives from ‘western’ based to a more holistic view.
Be it economic stability, education, health, famine, poverty, security, the global commons, climate change, civil liberties, human rights, technological and scientific progress – any mode of economy needs to be consistent with social goals related to these elements. Why? Because if it is inconsistent, then you place individuals and organisations in a position of conflicting social and economic priorities. Either they honour the social goals, the economic goals, or they search for some compromise – and there is often not a compromise to be found as the goals are diametrically opposed.
For example, technological and scientific progress rely on the broadest population of educated, innovative, critical thinkers with access to means of contributing ideas, skills and capabilities to achieve breakthrough results. Yet in order to safeguard the profit from any venture, it makes economic sense to have the smallest group of people involved as possible, operate secretively, and use patents and licenses to prevent others from ‘stealing your idea’ and making the profit from it that you yourself seek. In order to progress more quickly, one would need to over-ride or compromise this economic imperative. There has been fascinating work recently covered in
TED talks on this matter and I’ll use one example: cancer research.
Jay Bradner, a researcher at Harvard University, and his lab discovered a molecule JQ1 which they thought might explain how cancer cells know they are cancer cells – and wanted to explore if this finding could be used to outfox cancer. He expounds on the success of the decision of his microbiology lab to refuse to patent JQ1, and instead to publish their findings, post them out to 40 other labs, and open source the development of their work. Please watch the short video below.
The work is truly inspiring. This case demonstrates two things. Firstly, that scientific progress does not rely on competition, but collaboration. Secondly, people are driven as much by purpose and passion, as they are by financial gain, or put another way – actual success and economic success not synonymous.
Even in this case, participation is still limited by the need to make money from it at all, and no doubt Jay Bradner and his team made less money than they ultimately could have if they had chosen to stay in the secretive, closed, patent model. This is important as it is exactly what has the majority of people remain in the model which Bradner and his team have demonstrated is a de facto slow lane for research and development.
Supporters of capitalism might ask ‘why should people not benefit financially from their skills and capabilities?’, yet it could equally be asked of capitalism, ‘why would you penalise people for collaboration?’, or ‘why would you incentivise behaviour which holds us back?’
Do we want, as a society, to make people choose between personal wealth and making the best decisions on critical matters like curing cancer?
Far from progress being caused by capitalism, in many areas progress has been made in spite of capitalism. Considering the incredible pace of scientific and technological advancements with these limits in place, the mind boggles at what would happen to human progress if the collective mental and physical power of the three billion people currently starving in the world, were available.
This is why context is so important when addressing the matter of ethical economy, and one way in which capitalism places ethical dilemmas into just one area of our lives.
Moving on to perspective, this is vital in addressing questions of ethics, particularly in the case of capitalism. One of the hardest argued cases for capitalism is the aforementioned progress. Capitalism, it is said, propels people to work hard, in order to succeed financially, and therefore wider society benefits from the increased productivity of the population. It is also leads inexorably to individual liberty, freedom and democracy.
Now, superficially, taking a ‘Western’ view of this, the post industrial revolution period of history has seen extraordinary leaps of progress in science, technology, human rights and democratic participation. So for many people, compared to feudalism, capitalism is an improvement. People cite democracy, universal healthcare, education and the welfare state as representative of this progress. Let us assume for the moment that they are.
If you were born into another family, country or region of the world – you would have seen quite the opposite. From
Foreign Direct Investment, to
The Debt Trap, to
coups of democratic leaders in order to install dictators who would ultimately generate a profit for western corporations, to
Structural Adjustment Programmes used by the
IMF on African and Latin American countries shifting production to foreign trade rather than domestic need, to the morally defunct trade in weapons, to a toothless
UN general assembly and a pointless US dominated UN Security council. All of these policies, decisions and institutions, created in order to perpetuate and stimulate ‘progress’ on one side of the world, at the direct and indirect expense of survival, let alone progress, on the other. This argument is not refuted by
realists of politics, economics or international relations – it is defended and justified. It is only
neo-liberals and neo-liberalist ‘idealism’, that seeks to wash its hands of any responsibility for generating this mass dispossession, suffering and death – whilst claiming to be the only show in town in terms of dealing with it. It could be argued that rather than replacing feudalism, capitalism merely globalised it.
It is unconscionable, to the
Citizens of the World perspective exemplified by the global Occupy movement, that this progress continue to be made at the cost of, and with little or no benefit to, the majority of people on the planet. On the whole, set in context, they find it difficult to see how on earth, given the competitive nature of it, a capitalist economic model is the choice model for the globalised civil society emerging in the 21st Century.
The Least Unethical Thing?
For those people who see the ethos of capitalism itself as unethical, when people ask ‘is there an ethical or more ethical form of capitalism’ the initial response is a palm to the forehead.
Nick Clegg, Deputy Prime Minister of the UK government and leader of the Liberal Democrat party, is currently trumpeting the idea of what he calls a
John Lewis economy. It is not clear that it means anything at all. John Lewis is a department store; it operates within a capitalist economy. Aspiring to a John Lewis economy is like aspiring to Scout Club Christianity, or Air Cadets Security. John Lewis is a company, the world isn’t. A wistful, ‘oh wouldn’t it be nice if all our companies acted like John Lewis?’ does not translate into a just and ethical economic model – what of currency control, trade agreements, migration – what would John Lewis do?
Furthermore, even if we take the statement at face value, assuming it to mean a more equitable, responsible, fair capitalism, the concept is still problematic if capitalism itself is considered unethical. In this light, talking about John Lewis Capitalism, is comparable to talking about
Theresienstadt Nazism or expounding the virtues of
‘separate but equal’ over slavery. They may well be moving in the direction of ethical on a spectrum scale, but what is the point of making such an unethical thing, slightly less unethical? Surely, one could conclude, our collective time and energy would be far better spent in the act of creating an ethical scenario, than seeking – cynically or otherwise – to dampen the worst impacts of an unethical one.
For Whom the Bell Tolls
As before, in the dying days of feudalism, human society is once more at the point where its economic model no longer fits the ethical or social ambitions of the majority of its constituents. There is friction, fracture and frustration. Discontent hangs in the air, as does the unspoken terror that is (in stage whisper) ‘change’.
So, is there such a thing as ethical capitalism? I believe not. More importantly, despite the failure of political and other institutions to do so, broader social movements are resetting the horse before the cart by asking first – what kind of society do we want? We can then move into ‘what kind of economy will best deliver on those ambitions?’, ‘what economic model serves that society best?’
The people today refusing to entertain even the conversation, or imagining of a post-capitalist economy, are no different to the feudal barons and peasants who could not foresee or were hostile to the dynamic newcomer capitalism in centuries past. For them, humanity has reached the apex of its ability to generate economic and political ideas.
To hold a view of humankind as static, or finite in our ability to innovate and create is, in my opinion, to fundamentally close one’s mind to the facts, as demonstrated by human history. It has been said before, that the economy is a great servant but a terrible master. This is demonstrated perfectly by a glance at the current state of our world. It seems we have forgotten that we, human beings, invented this economy. If it has ceased to serve us then our best efforts should - and in the tent cities, repossessed public buildings and occupied homes across the world
are -
being made to design another.
A day will come when whatever new model replaces capitalism also ages, withers and no longer fits our future society’s ambitions, and the process of socio-economic evolution will continue. This is the reality of human existence, and in my view, the wonder of it. Let us take this opportunity to be not the desperate hangers-on to a dying, unjust regime, but the instigators of evolution and the architects of our social and economic destiny.
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Created: 2/1/2012 11:01:00 AM
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