Austin, Indiana: The HIV Capital of Small-Town America

by Jessica Wapner

Jessica and Darren McIntosh were too busy to see me when I arrived at their house one Sunday morning. When I returned later, I learned what they’d been busy with: arguing with a family member, also an addict, about a single pill of prescription painkiller she’d lost, and injecting meth to get by in its absence. Jessica, 30, and Darren, 24, were children when they started using drugs. Darren smoked his first joint when he was 12 and quickly moved on to snorting pills. “By the time I was 13, I was a full-blown pill addict, and I have been ever since,” he said. By age 14, he’d quit school. When I asked where his care givers were when he started using drugs, he laughed. “They’re the ones that was giving them to me,” he alleged. “They’re pill addicts, too.”

Darren was 13 when he started taking pills, which he claims were given to him by an adult relative. “He used to feed them to me,” Darren said. On fishing trips, they’d get high together. Jessica and Darren have never known a life of family dinners, board games and summer vacations. “This right here is normal to us,” Darren told me. He sat in a burgundy recliner, scratching at his arms and pulling the leg rest up and down. Their house was in better shape than many others I’d seen, but nothing in it was theirs. Their bedrooms were bare. The kind of multigenerational drug use he was describing was not uncommon in their town, Austin, in southern Indiana. It’s a tiny place, covering just two and a half square miles of the sliver of land that comprises Scott County. An incredible proportion of its 4,100 population – up to an estimated 500 people – are shooting up. It was here, starting in December 2014, that the single largest HIV outbreak in US history took place. Austin went from having no more than three cases per year to 180 in 2015, a prevalence rate close to that seen in sub-Saharan Africa.

Exactly how this appalling human crisis happened here, in this particular town, has not been fully explained. I’d arrived in Scott County a week previously to find Austin not exactly desolate. Main Street had a few open businesses, including two pharmacies and a used-goods store, owned by a local police sergeant. The business with the briskest trade was the gas station, which sold $1 burritos and egg rolls. In the streets either side of it, though, modest ranch houses were interspersed among shacks and mobile homes. Some lawns were well-tended, but many more were not. On some streets, every other house had a warning sign: ‘No Trespassing’, ‘Private Property’, ‘Keep Out’. Sheets served as window curtains. Many houses were boarded up. Others had porches filled with junk – washing machines, furniture, toys, stacks of old magazines. There were no sidewalks. Teenage and twenty-something girls walked the streets selling sex. I watched a young girl in a puffy silver coat get into a car with a grey-haired man. I met a father who always coordinates with his neighbour to make sure their children travel together, even between their homes, which are a block apart. Driving around for days, knocking on doors looking for drug users who would speak with me was intimidating. I’ve never felt more scared than I did in Austin.

The mystery of Austin is only deepened by a visit to the neighbouring town of Scottsburg, the county seat, eight miles south. It’s just a bit bigger than Austin, with a population of about 6,600, but it’s vastly different. A coffee shop named Jeeves served sandwiches and tall slices of homemade pie, which you could eat while sitting in giant, cushiony chairs in front of a fireplace. A shop next door sold artisanal soap and jam. The town square had a war memorial and was decorated for Christmas. The library was populated. The sidewalks had people and the streets had traffic. There were drugs in Scottsburg, but the town did not reek of addiction. The people didn’t look gaunt and drug-addled. No one I asked could explain why these two towns were so different, and no one could explain what had happened to Austin. But a new theory of public health might yet hold the answer. Known as syndemics, it may also be the one thing that can rescue Austin and its people.

The term syndemics was coined by Merrill Singer, a medical anthropologist at the University of Connecticut. Singer was working with injecting drug users in Hartford in the 1990s in an effort to find a public health model for preventing HIV among these individuals. As he chronicled the presence of not only HIV but also tuberculosis and hepatitis C among the hundreds of drug users he interviewed, Singer began wondering how those diseases interacted to the detriment of the person. He called this clustering of conditions a ‘syndemic’, a word intended to encapsulate the synergistic intertwining of certain problems. Describing HIV and hepatitis C as concurrent implies they are separable and independent. But Singer’s work with the Hartford drug users suggested that such separation was impossible. The diseases couldn’t be properly understood in isolation. They were not individual problems, but connected.

Singer quickly realised that syndemics was not just about the clustering of physical illnesses; it also encompassed nonbiological conditions like poverty, drug abuse, and other social, economic and political factors known to accompany poor health. “Syndemics is embedded in a larger understanding about what’s going on in societies,” he said when I spoke to him. Singer dubbed the syndemic he’d observed in Hartford ‘SAVA’, short for substance abuse, violence and HIV/AIDS. In the past ten years, several medical anthropologists have pursued syndemics theory in other contexts. Emily Mendenhall, who studies global health at Georgetown University’s School of Foreign Service, has described a syndemic of type 2 diabetes and depression among first- and second-generation Mexican immigrant women in Chicago. She named that syndemic ‘VIDDA’, short for violence, immigration, depression, diabetes and abuse, the constellation of epidemics the women were experiencing. “The people who get affected by any given disease, it’s not random,” said Bobby Milstein, a public health scientist, today at the Massachusetts Institute of Technology, who founded the now-defunct Syndemics Prevention Network at the Centers for Disease Control and Prevention. “It happens systematically with certain people who are placed in conditions of vulnerability that are not entirely under their own control.” As Andrea Gielen, who directs the Center for Injury Research and Policy at Johns Hopkins University, explained to me: “Everything works together. To be in silos delivering one thing for one problem, another thing for another problem, is not as effective as stepping back, looking at the whole person, and addressing the complexity of needs in an integrated way.”

Mendenhall, a leading researcher in syndemics theory, told me her method would be to approach Austin as an ethnographer; that is, by studying the people and the culture. “In syndemics, one of the most important parts is seeing who’s affected,” she said. She harkened back to John Snow, the British physician known as the first epidemiologist, whose examination of a London neighbourhood affected by cholera included speaking to as many people as possible, leading to his identification of a contaminated water pump as the cause. As Mendenhall explained, a syndemic approach to Austin would mean obtaining in-depth life history narratives from large numbers of people, both those who use drugs and those who don’t. Those narratives would then be framed within the larger political economy, to identify the factors that put the town into strife. The approach would isolate the identifying characteristics of people who are using drugs. Is it everyone who’s associated with a factory that shut down? Who was the dealer that brought drugs into the community? Is there a social belief linked with use, or is it more stress-related? “You have to figure out the social and political networks that link people to drug use,” Mendenhall said.

If I was to untangle the web of problems that was smothering Austin, then I’d have to start in the past and track how that web was spun. Austin was founded by four men in 1853. The town was small – in 1880, the population was 287 – but bustling. There was a furniture shop, a woodworking shop, a cabinet and coffin maker, two blacksmiths, two grocery shops, a saloon, a hotel, a newspaper, a literary society, two doctors and three ladies’ hat shops. The main industries were timber and canning. The Morgan Packing Company, a canning factory that became the town’s largest employer – and which still is today – was founded in 1899.

Brittany Combs, a public health nurse for Austin who grew up in the south-west corner of Scott County, remembers her childhood as happy and carefree. “There was a real sense of community,” she said. “We all helped each other.” In the 1960s, the Morgan Packing Company began expanding its workforce by transporting people north from Hazard, Kentucky. Many people living in Austin today trace their routes to that Appalachian town, including Darren and Jessica. “They call this Little Hazard,” said Jessica.

Austin’s decline seems to have begun in the late 1980s. The American Can Company, which manufactured cans for the Morgan Packing Company, was the town’s second-largest employer for decades, but closed in 1986. Connie Mosley, who has lived in Austin since she finished high school in 1965, thinks the town deteriorated when the older generation died and the younger generation, instead of staying, sold the houses and left. “Outsiders started buying up everything,” she said. Inexpensive rentals – the average monthly rent is less than $700 in Austin, lower than the US average of $934 – attracted transient people who were not necessarily looking to settle down and raise a family.

In January 1990, unemployment spiked to a high of 16.9 per cent. The average jobless rate for that year was lower, at 8.5 per cent, but still starkly at odds with an overall US unemployment rate of 5.6 per cent. The town’s infrastructure began to deteriorate. Jackie McClintock, a nurse who works with Combs, points to the lack of recreational activities as leading people to use drugs. “There’s nothing for people to do,” she said. “There’s boredom, unemployment.” Jerome Adams, Indiana’s state health commissioner, describes Austin as having social and economic conditions that are ideal for a drug epidemic. “It’s kind of the epitome of years of neglect, poverty, lack of education and lack of opportunity, or people’s perception of lack of opportunity,” he said.

Today, the estimated median household income in Austin is $33,000, about $15,000 less than that for Indiana. The average home is valued at $78,000, the US median in 2010 being $210,000. About 8.3 per cent of Austin residents are unemployed, compared with a US average of 5 per cent. An estimated 34 per cent of working people in Austin hold manufacturing jobs and just 7 per cent have a college degree. In 2013, about 25 per cent of Austin residents were living in poverty.

Widespread pill abuse can be traced back to the 1990s. Will Cooke, a physician who opened his practice in Austin in 2004, claims he has patients who have alleged pills were available at a local bar, even to teenagers. The moment he started seeing patients, they were asking for opiates and benzodiazepines, the tranquilisers more commonly known as Valium and Xanax. As Cooke sees it, Austin’s substance abuse problem is the legacy of decades of challenges. “As far back as people that I’ve talked to can remember,” he said, “it’s always been a struggle in survival mode.”

Adams told me the problem was exacerbated by physicians themselves. Many opioid prescriptions start out as legitimate treatments for pain. Most doctors are untrained in pain management and yet patient satisfaction scores for physicians, maintained by the Centers for Medicare and Medicaid Services, are directly determined by patients’ assessment of how well their pain was managed. That score has consequences: a low one leads to a decrease in pay. “We have an environment where doctors and hospitals feel compelled to continue to prescribe opioids based on their bottom line,” said Adams. “We still haven’t accepted that overprescribing is a part of the problem to the degree that I think it clearly is.” In addition, addiction treatment services have been lacking. In the entire state of Indiana, there are two or three psychiatrists specialising in addiction. “We’ve underfunded mental health and substance abuse for decades,” Adams said.

All of what has happened since the late 1980s is potentially part of Austin’s syndemic: the sudden unemployment, the desertion of the young, the fall in rent prices, the rise of the itinerant population, the decline of infrastructure, the overprescription of pain pills, the lack of assistance. By the late 1990s and early 2000s, it seems, the town itself had become sick, the result of various forms of ‘structural violence’ – a term introduced by Harvard physician and anthropologist Paul Farmer to describe harmful social frameworks – along with historical, behavioural and political risk factors.

It was into this diseased town that Jessica and Darren were born. “The first time I saw someone taking drugs I was probably about nine or ten years old,” Darren told me. “You literally couldn’t walk around a corner without somebody asking, ‘Hey, you wanna try this?’” He said that many relatives are drug addicts and dealers. They told me that sometimes elder relatives would sell their pills to get by. They’re hardly alone. “Some of these kids around here just did not have a chance,” said Darren, who has seen parents selling drugs in front of their five- and six-year-olds. Barney Rushkoff, an HIV-positive 57-year-old who lives in a mobile home without electricity or heat, told me about seeing a child playing in the street. The little boy had a towel wrapped around his arm and was shouting “shoot me, shoot me”, mimicking his parents injecting. Rushkoff said he’d recently quit using but still kept sterile drug paraphernalia in his tiny bedroom for his son, an addict who lives with him in the trailer.

Darren has used cocaine, Lortab, Percocet, OxyContin and most recently Opana, an opioid he’s been shooting for the past few years. He started selling pot when he was around 14 years old. “I’d take my money and buy cocaine with it,” he said. Today, he has almost nothing. He owns one pair of shoes, one pair of pants and one pair of shorts. When I asked how he would stay warm in winter – it was early December when we met – he pointed to a fleece jacket. They had sold the washer and dryer for drug money, along with almost everything else in their house, including copper stripped from the air conditioner. He’s been in jail many times and served two prison sentences. He wakes up in pain and survives day-to-day, doing whatever he can to get money for drugs, including burglary, selling items stolen from the dollar store and pimping out his sister. Jessica’s trajectory has been largely the same, though she has spent more time prostituting and less time in jail.

From a purely biological standpoint, the 2015 HIV outbreak was caused by the transfer of the virus by dirty needles used to inject liquefied pain pills and methamphetamine. “Everyone knows each other,” Darren said. “And they’re all sharing needles.” Because of the sharing, a single introduction of HIV exploded among the community of drug users. Jackie McClintock, the nurse who started working with Combs when the outbreak made headlines, told me about a couple she met who’d recently moved to Austin. “They shared one needle for a month,” she said. “They would shoot up at least ten times a day.”

The laws surrounding drug paraphernalia, yet another part of the syndemic, likely augmented the problem of needle sharing. Prior to Indiana’s governor, Mike Pence, approving the temporary needle exchange programme there, anyone found carrying a needle could be arrested for a felony. Such laws are in keeping with the mindset that people who are addicted to drugs have only themselves to blame, a foundation of the US government’s War on Drugs, set in motion by President Richard Nixon in 1971 and upheld by several subsequent administrations. Policing, along with social stigma, “increase the likelihood that drug users will live in and inject in unhygienic environments,” wrote Singer and fellow researcher Nicola Bulled in their study ‘Syringe-mediated syndemics’, published in AIDS and Behavior in 2009.

The picture that emerges from this is one of a disease with many causes, including place of birth. An estimated 2.6 per cent of Americans have injected drugs, compared to up to 12 per cent of Austin. Thus, the very fact of living in Austin can be considered a risk factor for substance abuse. A child born there is imperilled by circumstances beyond their control. The desperation felt by many contributes to the town’s illness, in part because people diagnosed with HIV may not seek treatment for either their infection or their addiction. “There’s not a whole lot of hope for nobody,” said Kristy Madden, 37, a recovered addict with two children and two grandchildren. “Nobody doesn’t really have anything to look forward to.” She said she has relatives with HIV, some of whom are still using drugs. An Austin man named Cecil, who has HIV, told me he’d recently spent $3,500 on Opana pills in less than five hours. “My days is numbered,” he told me, “so why stop now?”

Syndemics does have critics. Alexander Tsai, of the Center for Global Health at Massachusetts General Hospital, published a study in 2015 demonstrating inconsistencies in evidence linking diseases and harmful social conditions. “It was a harsh critique,” said Mendenhall. The study highlighted a lack of proof that syndemics works epidemiologically, that it is still theoretical. “People haven’t actually tested syndemics quantitatively,” Mendenhall said. In other words, there is no concrete data proving that, say, domestic abuse is a definitive cause of diabetes among Mexican immigrant women in Chicago, even though Mendenhall’s hundreds of interviews implied otherwise.

But evidence linking disadvantage to poor health does exist. According to the landmark Adverse Childhood Experiences study, published in 1998, people exposed to neglect, sexual abuse, living with a substance abuser, and other situations as children were far more likely to abuse substances as adults. More recently, the massive Global Burden of Disease study, which examined a wide range of illnesses across the world, looked at suicide rates as one quantifiable measure of mental health issues. There, suicide was considered one solid indicator of such problems. A smaller-scale analysis measuring the various components of a given syndemic in a given population has not been done.

Part of the challenge is that a syndemic is hard to measure. “If a broken social network affects people’s outcomes more than their daily exercise,” Mendenhall noted, “how do you explicitly prove that?” Syndemics relies largely on qualitative data; that is, on descriptions provided by affected individuals, rather than on numbers and percentages. Mendenhall, who has edited a series of papers on syndemics soon to be published in the Lancet, agrees with the criticism and the importance of numerical data. But she noted that, considering its holistic view of illness, syndemics works best by “interrogating the social experience as much as the biological”. And that means more allowance for correlative data. “We need people in public health and medicine to take syndemics seriously,” she said. “That will allow them to incorporate the social into the understanding of the medical.” Meanwhile, there are signs that medical research may be learning to make more room for so-called ‘softer’ science. A recently published open letter to the BMJ by 76 senior academic researchers cited concerns about the high rejection rate for qualitative research at not only that journal but also JAMA and the New England Journal of Medicine, and called on these influential journals to reconsider such policies.

But even if the HIV outbreak and widespread drug addiction in Austin are viewed as part of a system of problems, rather than a collection of individual issues, how can this new understanding be applied? What good does any of this do? Perhaps learning to see a problem in all its true complexity will give us the opportunity to heal it more effectively. As a result of Mendenhall’s work, doctors at John H Stroger, Jr Hospital of Cook County, Chicago, now routinely ask women about domestic violence. Merrill Singer’s work in Hartford also led to new interventions. Previously, no support system existed for women who were pregnant and abusing drugs. Newborns were at risk of HIV and being born with drugs in their bodies. Singer was also concerned about children being put into state custody and becoming locked in the system, potentially maintaining the SAVA syndemic for the next generation. The identification of Hartford’s SAVA syndemic led to a comprehensive programme specifically for women who were pregnant and abusing drugs. Funding eventually waned, but a residential drug treatment programme in the town, which was born of the effort, remains.

I caught a glimpse of how a syndemic understanding of Austin’s problems might work when I accompanied Combs and McClintock during their home delivery of sterile drug paraphernalia, a service they provide every Friday afternoon. Their needle programme has been controversial in the town. “Fuelling the habit is not helping,” said Linda Brandenburg, a 47-year-old Austin resident. Another local, Linda Bowling, thought the money would be better spent on children. These might be considered understandable positions in the absence of a syndemic perspective.

Combs and McClintock were so friendly with the people they brought supplies to that I was, at first, squeamish about the chumminess. They knew the clients and greeted them with familiarity. Sitting in the backseat of their car as they made their rounds, I caught myself judging Combs and McClintock for being so accepting of people shooting up. When they asked what size needle to provide – meth users and Opana users prefer different gauges because of each drug’s thickness – it had all the gravity of a coffee order. They asked about needle sharing, sleep habits and injection frequency quickly and in the same cheery tone as their greeting. Back in the car, Combs and McClintock discussed the potential whereabouts of missing clients in a way that seemed far removed from what that absence might imply. As if catching up on the day’s news, McClintock scrolled through the county jail inmate list on her phone to see if they could account for anyone. I wondered if the critics could be right. Their niceness surely condoned the addiction.

But their programme has been enormously successful. More than half the town’s injecting drug users are enrolled. The HIV outbreak tapered off soon after it began. As effective as it has undoubtedly been, though, addressing the entire syndemic in Austin requires more than a needle exchange. “It’s not enough,” said David Himmelgreen, who has studied the connection between food insecurity and HIV in southern Africa. “You want people off their addiction, but they need to be well-nourished in body and mind.” Jerome Adams sees social stigma as a major barrier to reducing substance abuse. “We’ve got to get everyone on board with the concept that addiction is a chronic disease,” he said. “It is not a moral failure.”

Two days later, I began to understand the underlying value not only of Combs and McClintock’s work for the needle exchange, but of the human exchange it fostered. When interviewing Darren, he told me he had never talked about his life before. Nobody had been interested. He said he thinks every day about all the people he’s hurt and wishes he could go back to school and then work as a car mechanic. Jessica also dreams of another life. “I would give anything in the world if I had never seen a pill,” she said. They’re both grateful for the clean paraphernalia they receive each week. “That needle exchange is the best thing that could’ve happened to Austin,” Darren said. It’s likely that soon after I left, Darren and Jessica got some Opana or did some more meth until they found their relative’s lost pill. Jessica was planning to enter rehab six weeks from then, which may or may not have happened. The barriers to any sort of healing for them both may be insurmountable.

What I’d realised, during my week in Austin, was that a friendly interaction might just turn out to be as healing for its people as a sterile needle. But does that make the no-trespassing signs and the community’s attitude toward addiction part of the syndemic? Many residents I met spoke of drug users as evil, with only themselves to blame for their choices. Others resented how the media portrayed the town. “The country just singled us out as the only place this ever happens,” an owner of Buchanan Funeral Home told me. She admonished me to be sure I got the facts right when I wrote about Austin. Then she excused herself to tend to a family who had come to collect their funeral flowers. They’d just buried their 26-year-old son, who’d died of an overdose, two years after burying his older brother.

(Although interviewees granted permission for their names to be used, some have been changed for privacy and legal reasons. Some family relationships have also been obscured.)

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Jessica Wapner is a freelance writer who writes about the intersection of health, disease and social justice. Her essay appeared on Mosaic.

Austin, Indiana: the HIV capital of small-town America by Jessica Wapneris licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License

Cheaper Versions of the Most Expensive Drugs May Be Coming, but Monopolies Will Likely Remain

By Yaniv Heled

#health #business #controversies #reportinginformation #science #finances

Manufacturing facilities for biologics are wildly expensive making it difficult for competitors to enter the market. “Biologics” by National Cancer Institute is in the Public Domain

In May, the Food and Drug Administration issued much-anticipated guidance that could revolutionize the pricing of some of the most expensive drugs on the market in the U.S. and, possibly, globally.

In this document, the FDA explains to drug manufacturers how to develop their own copycat versions of a special class of drugs called biologics. Unlike most drugs, biologics are not chemically synthesized but are made, for the most part, inside living organisms. This makes them complicated to manufacture and tricky to imitate.

The FDA’s new guidance will allow drug manufacturers to create their own cheaper versions of biologics that could be automatically substituted for one another, including by pharmacists. Just as happened with “generic” drugs, bringing competition into biologics markets will, hopefully, lower the prices of these medicines. But, it is unclear by how much or whether the guidance will do so for all biologics.

As a legal researcher specializing in the regulation of novel biotechnologies, I have been following efforts over the last 10 to 12 years to bring competition into biologics markets in the United States. So, I am excited to see how the FDA’s new guidance affects competition in biologics and whether it ultimately increases patient access to these drugs.

 

Monopolies may persist

Once FDA approves interchangeable versions of biologics, this should drive competition in biologics and, ultimately, cause their prices to drop. As many regulatory agencies in countries around the world follow the FDA’s lead, agencies in other countries will likely do the same, leading to larger cost savings globally.

But concerns remain that the FDA’s guidance might not be enough to drive prices down significantly. Development of similar biologics is estimated to cost about $100-200 million. This is much higher than the development of generic drugs, which is estimated to cost, typically, between $1-5 million. There are not very many companies with the kind of facilities, expertise, and money necessary to develop interchangeable versions of biologics and chaperon them through the FDA’s approval process. As a result, it is quite possible that there will not be a lot of companies able to compete.

Previous research shows that significant price drops in pharmaceuticals occur only after several competitors enter the market. So, it is quite possible that many biologics will have too few competing interchangeable versions to drive prices down significantly.

Also, original biologics makers have been taking a variety of measures to avoid losing their monopolies. Some have been amassing large patent portfolios. Others have been known to file lawsuits and abuse regulatory processes to delay the entry of competing products into the market. It is likely that they will continue to do so in order to prevent interchangeable versions of their biologics from entering the market.

Finally, the FDA guidance itself only applies to protein products, which are only one kind of biologics. So, there still is no clear regulatory path for FDA to approve interchangeable versions of some of the most expensive biologics – like gene therapies.

The FDA guidance may prove to be an important step toward lowering the prices of biologics. It comes at a good time, given the drug pricing crisis in the United States. But the guidance alone may not be enough.

_____________________

Yaniv Heled is an Associate Professor of Law at Georgia State University and Co-Director, Center for Intellectual Property. His research focuses on legal and ethical aspects of biomedical technologies. This article is reprinted from The Conversation.

Cheaper versions of the most expensive drugs may be coming, but monopolies will likely remain by Yaniv Heled is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Getting a Scientific Message Across Means Taking Human Nature into Account

By Rose Hendricks

#reportinginformation, #cognitivebias, #logos, #ethos, #kairos, #pathos, #currentevents, #science

We humans have collectively accumulated a lot of science knowledge. We’ve developed vaccines that can eradicate some of the most devastating diseases. We’ve engineered bridges and cities and the internet. We’ve created massive metal vehicles that rise tens of thousands of feet and then safely set down on the other side of the globe. And this is just the tip of the iceberg (which, by the way, we’ve discovered is melting). While this shared knowledge is impressive, it’s not distributed evenly. Not even close. There are too many important issues that science has reached a consensus on that the public has not.

Scientists and the media need to communicate more science and communicate it better. Good communication ensures that scientific progress benefits society, bolsters democracy, weakens the potency of fake news and misinformation and fulfills researchers’ responsibility to engage with the public. Such beliefs have motivated training programs, workshops and a research agenda from the National Academies of Science, Engineering, and Medicine on learning more about science communication. A resounding question remains for science communicators: What can we do better?

A common intuition is that the main goal of science communication is to present facts; once people encounter those facts, they will think and behave accordingly. The National Academies’ recent report refers to this as the “deficit model.”

But in reality, just knowing facts doesn’t necessarily guarantee that one’s opinions and behaviors will be consistent with them. For example, many people “know” that recycling is beneficial but still throw plastic bottles in the trash. Or they read an online article by a scientist about the necessity of vaccines, but leave comments expressing outrage that doctors are trying to further a pro-vaccine agenda. Convincing people that scientific evidence has merit and should guide behavior may be the greatest science communication challenge, particularly in our “post-truth” era.

Luckily, we know a lot about human psychology – how people perceive, reason and learn about the world – and many lessons from psychology can be applied to science communication endeavors.

 

Consider human nature

Regardless of your religious affiliation, imagine that you’ve always learned that God created human beings just as we are today. Your parents, teachers and books all told you so. You’ve also noticed throughout your life that science is pretty useful – you especially love heating up a frozen dinner in the microwave while browsing Snapchat on your iPhone.

One day you read that scientists have evidence for human evolution. You feel uncomfortable: Were your parents, teachers and books wrong about where people originally came from? Are these scientists wrong? You experience cognitive dissonance – the uneasiness that results from entertaining two conflicting ideas.

Psychologist Leon Festinger first articulated the theory of cognitive dissonance in 1957, noting that it’s human nature to be uncomfortable with maintaining two conflicting beliefs at the same time. That discomfort leads us to try to reconcile the competing ideas we come across. Regardless of political leaning, we’re hesitant to accept new information that contradicts our existing worldviews.

One way we subconsciously avoid cognitive dissonance is through confirmation bias – a tendency to seek information that confirms what we already believe and discard information that doesn’t.

This human tendency was first exposed by psychologist Peter Wason in the 1960s in a simple logic experiment. He found that people tend to seek confirmatory information and avoid information that would potentially disprove their beliefs.

The concept of confirmation bias scales up to larger issues, too. For example, psychologists John Cook and Stephen Lewandowsky asked people about their beliefs concerning global warming and then gave them information stating that 97 percent of scientists agree that human activity causes climate change. The researchers measured whether the information about the scientific consensus influenced people’s beliefs about global warming.

Those who initially opposed the idea of human-caused global warming became even less accepting after reading about the scientific consensus on the issue. People who had already believed that human actions cause global warming supported their position even more strongly after learning about the scientific consensus. Presenting these participants with factual information ended up further polarizing their views, strengthening everyone’s resolve in their initial positions. It was a case of confirmation bias at work: New information consistent with prior beliefs strengthened those beliefs; new information conflicting with existing beliefs led people to discredit the message as a way to hold on to their original position.

Just shouting louder isn’t going to help. Photo by Maritime Union of New Zealand is licensed under CC BY 2.0

 

Overcoming cognitive biases

How can science communicators share their messages in a way that leads people to change their beliefs and actions about important science issues, given our natural cognitive biases?

The first step is to acknowledge that every audience has preexisting beliefs about the world. Expect those beliefs to color the way they receive your message. Anticipate that people will accept information that is consistent with their prior beliefs and discredit information that is not.

Then, focus on framing. No message can contain all the information available on a topic, so any communication will emphasize some aspects while downplaying others. While it’s unhelpful to cherry-pick and present only evidence in your favor – which can backfire anyway – it is helpful to focus on what an audience cares about.

For example, these University of California researchers point out that the idea of climate change causing rising sea levels may not alarm an inland farmer dealing with drought as much as it does someone living on the coast. Referring to the impact our actions today may have for our grandchildren might be more compelling to those who actually have grandchildren than to those who don’t. By anticipating what an audience believes and what’s important to them, communicators can choose more effective frames for their messages – focusing on the most compelling aspects of the issue for their audience and presenting it in a way the audience can identify with.

In addition to the ideas expressed in a frame, the specific words used matter. Psychologists Amos Tversky and Daniel Kahneman first showedwhen numerical information is presented in different ways, people think about it differently. Here’s an example from their 1981 study:

Imagine that the U.S. is preparing for the outbreak of an unusual Asian disease, which is expected to kill 600 people. Two alternative programs to combat the disease have been proposed. Assume that the exact scientific estimate of the consequences of the programs are as follows: If Program A is adopted, 200 people will be saved. If Program B is adopted, there is ⅓ probability that 600 people will be saved, and ⅔ probability that no people will be saved.

Both programs have an expected value of 200 lives saved. But 72 percent of participants chose Program A. We reason about mathematically equivalent options differently when they’re framed differently: Our intuitions are often not consistent with probabilities and other math concepts.

Metaphors can also act as linguistic frames. Psychologists Paul Thibodeau and Lera Boroditsky found that people who read that crime is a beast proposed different solutions than those who read that crime is a virus – even if they had no memory of reading the metaphor. The metaphors guided people’s reasoning, encouraging them to transfer solutions they’d propose for real beasts (cage them) or viruses (find the source) to dealing with crime (harsher law enforcement or more social programs).

The words we use to package our ideas can drastically influence how people think about those ideas.

 

What’s next?

We have a lot to learn. Quantitative research on the efficacy of science communication strategies is in its infancy but becoming an increasing priority. As we continue to untangle more about what works and why, it’s important for science communicators to be conscious of the biases they and their audiences bring to their exchanges and the frames they select to share their messages.

____________________

Rose Hendricks is a Ph.D. Candidate in Cognitive Science, University of California San Diego. Her essay was originally published in The Conversation.

Getting a Scientific Message Across Means Taking Human Nature into Account by Rose Hendricks is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

How to Increase Your Chances of Sticking with Your Resolutions

By Camilla Nonterah

#health #advice

The beginning of every new year comes with resolutions and plans for behavior change. Often the quest to improve health behaviors, such as losing weight, increasing physical activity or quitting tobacco is short-lived. Estimates vary, but by some accounts, as many as 80 percent of people fail to meet their resolution by mid-February. One study followed 200 people with New Year’s resolutions and reported that 81 percent of them failed to maintain their health behaviors after two years.

The reasons vary. With the case of cigarettes, people are dealing with a highly addictive product. For example, about 95 percent of people relapse after six to 12 months of abstinence when they try to quit smoking on their own.

Regardless of the severity of your addiction or even if you do not have an addiction, change is very hard. People often have not explored their reasons for making the change or how ready they are. They also may not have come up with a plan. And, they may simply not realize how hard it is to change behavior.

I am a counseling psychologist who studies and works with people trying to change their behavior. Those who succeed have certain things in common. They are usually motivated to change, and they believe in their ability to engage in positive health behaviors. They also track their health behaviors and set goals.

 

What psychologists know about behavior change

Biological, psychological, social and environmental processes influence behavior change. One of the popular theories used to explain health behaviors is something called the transtheoretical model. This theory states that there are five stages of behavior change.

• Pre-contemplation. In this stage, the person is not thinking about making the change. Those who fall in this stage may be unwilling to admit they have a problem in the first place. They are unlikely to respond to nagging from others to stop smoking, for example. This could be attributed to the fact that the cons for changing their unhealthy behavior outweighs the pros.

• Contemplation. This happens when a person acknowledges that he or she has a problematic behavior but is not ready to adopt a healthier lifestyle. Successful behavior change even during this stage is unlikely. However, people in this stage are thinking about making a change within the next six months.
• Preparation. In this stage, an individual starts making plans for the change. For example, a person who wishes to quit smoking may set a quit date and plan to purchase their last pack of cigarettes the week before the quit date.
• Action. This is when behavior change starts to occur. In this stage, a person who wishes to stop smoking quits using cigarettes and may start using smoking cessation aids. Or someone who wants to lose weight will start eating fewer calories or start going to the gym. This stage requires the most effort and commitment.
• Maintenance. This usually occurs after six months of uninterrupted continuous efforts to sustain the changes they have made and to prevent a relapse. It is not uncommon for relapse to occur after a person has been successful with incorporating the new behavior. This usually happens during the action stage and can also happen after maintenance given that it is difficult to sustain behavior change. Most people are not successful with behavior change after a first attempt, especially when changing an addictive behavior. People with New Year’s resolutions can make about five or more years of continuous attempts to change a behavior before they are successful. Unanticipated barriers such as stressful life events can cause a relapse.

While it is normal to experience negative emotions such as guilt and embarrassment after a failed attempt, these feelings can make a person lose hope in their ability to change if they persist for too long. The good news is that after a relapse you can learn from your mistakes and try again. Research shows that a person’s odds of success with positive behavior change increase gradually with time, after unsuccessful attempts.

 

Why do you want to make a change?

It helps to start with a thorough understanding of why you want to change. Without that, it is hard to stay motivated, especially when barriers arise, such as getting stuck in traffic on the way to the gym, or a family member getting sick and needing your care. State of readiness also affects behavior change.

Part of your preparation stage should be developing a realistic plan. It should incorporate the reality that behavior change is hard. Studies have shown that just setting a goal does not lead to the desired results. Ambiguous goals, such as saying you want to lose weight in the coming year but not thinking of specific health goals are associated with unsuccessful results.

Setting goals that are too challenging, such as going from complete inactivity to trying to exercise seven times a week, often results in failure. Setting several goals also can be overwhelming and result in failure.

 

Factors that affect behavior change

Even with good goals in place, stress lowers a person’s ability to achieve successful change. Stress lowers our inhibitions, making it more difficult to achieve one’s goals. For example, the stress of the loss of a job would likely challenge a smoker’s ability to abstain from cigarettes. Depression and anxiety, when unmanaged, can have a negative effect on a person’s motivation and derail efforts to change. A lack of self-efficacy, a person’s belief in their ability to exercise successful change, has been associated with unsuccessful behavior change.

Biological processes can also affect behavior change. One of the difficulties associated with weight loss is that we inherited traits from our ancestors that cause our bodies to store fat. This was good for our ancestors when food was scarce, but it is bad for our current well-being, given that food is easier to access.

Also, studies suggest that our bodies have a certain set-point at which they are most comfortable and have a natural weight thermostat that adjusts our metabolism and eating. This set-point keeps our weight within a certain genetically determined range. This makes initial weight loss easier given that the individual’s metabolism is higher as a result of having more weight. However, it becomes harder to lose weight over time as one’s metabolism decreases.

The environment in which we live also influences behavior change. The majority of our foods are highly processed and contain high fats and sugars. Without the appropriate nutritional knowledge and with limited access to healthy foods, successful weight loss becomes challenging. The food environment coupled with a sedentary lifestyle has a negative impact on a person’s health.

People who live in neighborhoods without sidewalks, parks or those who reside in dangerous neighborhoods are less likely to be active. Certain cues in our environment also affect our ability to maintain change. For example, a person’s attempts to stop smoking may be hindered by living with other smokers, especially if they have certain rituals around smoking, such as sitting on the porch together at night to chat and smoke.

 

How to improve your odds of success

While change is hard, there are things you can do to increase your chances of success.

• Change for the right reasons. Change for a desire to improve one’s health, to be a better example for your family or to prolong your life, are more likely to motivate positive change.
• Set both short-term and long-term goals when executing change. Researchers have found that these goals should be specific, measurable, achievable, realistic and timely, or SMART. Weekly SMART goals help in making progressive steps towards a long-term goal.
• Track and monitor your behavior. This enhances positive behavior change. You can accomplish this by journaling and note-taking. Many people find that free fitness apps are helpful.
• Get help. In some cases, behavior change may be most successful with the help of a professional such as a licensed clinical health psychologist. Trained professionals can provide services such as motivational interviewing, cognitive-behavioral therapy, and acceptance and commitment therapy.

____________________

Camilla Nonterah is Assistant Professor of Health Psychology, University of Richmond. Her essay was originally published in The Conversation.

How to increase your chances of sticking with your resolutions by Camilla Nonterah is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

What is Poverty?

by Jo Goodwin Parker

Click here to read the article: What is Poverty?

Measles: Why It’s So Deadly, and Why Vaccination Is So Vital

By Paul Duprex

#argument, #currentevents, #science, #logos, #ethos, #sharedvalues, #pathos, #research, #reportinginformation, #cognitivebias, #health #global

On the darkest day of 2018, the winter solstice, we at the Center for Vaccine Research at the University of Pittsburgh tweeted, with despair, a report in the Guardian that measles cases in Europe reached the highest number in 20 years.

Why was this a cause for concern? Europe is far away from the United States, and as some people apparently believe measles is a benign, childhood disease that causes a bit of a rash, a dribbling nose and a few spots, right? What was all the fuss about?

Well as George Santayana said, “Those who cannot remember the past are condemned to repeat it.” Collective amnesia about the virulence of this disease has driven us to forget that measles virus has killed tens of millions of infants throughout history. Now, with several ongoing outbreaks across our own country, this unnecessary threat is back.

Measles is a highly contagious and sometimes deadly disease that spreads like wildfire in naive populations. The virus played its part in decimating Native American populations during the age of discovery. Since these people groups had no natural immunity to the diseases brought to the New World by Europeans, some estimates suggest up to 95 percent of the Native American population died due to smallpox, measles and other infectious diseases.

In the 1960s, measles infected about 3-4 million people in the U.S. each year. More than 48,000 people were hospitalized, and about 4,000 developed acute encephalitis, a life-threatening condition in which brain tissues become inflamed. Up to 500 people died, mainly from complications such as pneumonia and encephalitis. This was why vaccine pioneers John Enders and Thomas Peebles were motivated to isolate, weaken and develop a vaccine against measles that is truly transformative for human health. Parents who knew the reality of the disease were quick to vaccinate their children. Uptake skyrocketed and the number of cases, and associated deaths, plummeted in the developed world.

By 1985, when John Enders died, over 1 million of the world’s kids were still dying because of this infection. However, now measles was a disease preventable by vaccine, and there was a huge impetus to address that tragedy by the World Health Organization.

When I started working on the virus in 1996, there were still over 500,000 children dying of measles each year worldwide. Such big numbers can be hard to digest. So to put it into perspective, if you’ve ever been on or seen a Boeing 747 jumbo jet, you will know it’s a pretty big airplane. Think of over three of these planes full of infants crashing every day of the year with 100 percent of the people on board dying. January, February, March … the summer solstice, the autumnal equinox … November, back to the winter solstice in December … one rhythmic year. That’s the reality of measles – over half-a-million lives were lost globally every year in the nineties.

Thanks to vaccination, however, between 2000 and 2016 there was an 84 percent decrease in measles mortality, and over 20 millions deaths were prevented due to vaccination. What an achievement!

Near universal adoption of the vaccine in the developing world meant that measles infections and concomitant deaths became very rare. By 2000, the led to measles being eliminated from the United States. The last person to die of the infection here was in 2015.

 

The effectiveness and irony of vaccination

These successes don’t mean the measles is gone or that the virus has become weak. Far from it. Seeing the virus up close and personal over all these years and knowing what happens when it runs rampant in an infected host gives me such respect for this minuscule “little bag of destruction” whose genetic material is 19,000 times smaller than ours. It’s also ironic how losing sight of the disease because of the success of vaccination has brought new societal challenges.

What’s important to realize is those millions of kids who died of measles each year in the nineties, for the most part were not living in the developed world. In those days here in the United States and in Europe, there was a widespread appreciation that #vaccineswork, meaning that the vast majority of people received the measles, mumps and rubella (MMR) vaccine and were well and truly protected. Two doses of the vaccine are 97 percent effective at stopping the infection.

What one of the most infectious pathogens on the planet can do to an unvaccinated person in 2019 is biologically incredible. Yes, that’s right, an unvaccinated human. But why would anyone decide not to get vaccinated or refrain from protecting their children?

That’s because forgetting the past has precipitated selective amnesia in our post-measles psyche. Ignoring scientific facts has tragically brought us to a place where some people fail to appreciate the values and utility of some of the most phenomenal tools we have created in our historical war on infectious disease. Unsubstantiated claims that vaccines like MMR were associated with autism, multiple sclerosis, Crohn’s disease, etc., etc., and ill-informed celebrities have wreaked havoc with vaccination programs. Genuine, caring parents unaware of the realities of diseases they had never seen decided that since the viruses were gone from this part of the world shots were so last millennium. Put simply, some people have given up on vaccines.

This has created the perfect storm. Since the measles virus is so infectious and Europe, Africa, South America, and South East Asia are not really that far away by jumbo jet, a case somewhere in the world can lead to an infection anywhere in the world. Failure to vaccinate large groups of people is helping measles come back. From California, to New York from Washington state to Minnesota and Georgia, measles is back with a vengeance. Now we can only live in hope that the last death from this deadly disease in the U.S. remains from 2015. Unfortunately, that is not a given.

____________________

Paul Duprex is Professor of Microbiology and Molecular Genetics at the University of Pittsburg.

Measles: Why It’s So Deadly, and Why Vaccination Is So Vital by Paul Duprex is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Minorities Face More Obstacles to a Lifesaving Organ Transplant

By Camilla Nonterah

#health #business #systemanalysis #research #science #sharedvalues #proposal

Patients who experience organ failure need a transplant to improve their odds of survival and to achieve a better quality of life.

However, getting an organ transplant is often accompanied by several challenges, many of which can be attributed to factors like the state of an individual’s living circumstances, their economic status and where they were born.

As a result, many racial and ethnic minorities, such as African Americans, Latinx individuals and Native Americans, must unjustly wait longer for a much-needed new organ – or never receive one at all because of these barriers to care.

Research shows that these disparities are avoidable, especially with changes at the institutional level.

Which groups are less likely to get a transplant?

Transplant trends from the United Network of Organ Sharing indicate that approximately 113,600 people are in need of a lifesaving solid organ as of June 2019. The majority have been diagnosed with kidney disease and liver disease.

The most recent data shows that, in 2016, the rate of kidney failure was highest among minority groups. For example, compared to whites, kidney failure was 9.5 times higher among Native Hawaiians and Pacific Islanders. Latinx individuals were over 50% more likely to be diagnosed with kidney failure than those who did not identify as Latinx.

Although minorities are more likely to be diagnosed with kidney failure, they are less likely to be transplanted. The majority of transplants in the U.S. go to whites.

These trends are also evident in groups suffering from liver disease. Asians and Latinx individuals are more likely to be diagnosed with liver failure, but less likely to receive a transplant.

 

What’s causing these disparities?

A patient has to undergo several steps before they can receive a transplant.

These steps include a physician deciding that a transplant is medically suitable, the patient demonstrating interest in a transplant, a referral to a transplant center, completion of a pre-transplant evaluation and identification of a suitable living donor.

At each point of the transplant preparation process, there are opportunities for barriers to occur as a result of patient, provider, community and institutional factors. Together, these potentially create disparities in access.

Income level may play a role. Patients with organ failure who experience poverty, for instance, may face challenges covering the cost of their insurance co-payments, especially when they do not have comprehensive insurance or private insurance.

Literacy issues, such as gaps in formal education or English as a second language, may also impact a patient’s ability to understand the medical terminology involved in their treatment. This would affect their ability to communicate effectively with their providers.

Limited knowledge of the benefits of transplantation can also affect patients’ ability to access transplants. Patients who are unaware that transplantation is the preferred treatment may not complete the steps to transplant and instead remain on dialysis.

Providers can also play a role in limiting access. For example, doctors may not provide patients with the referral they need or wait longer to provide it.

Given negative historical experiences, such as the Tuskegee Syphilis Study, some patients, especially those who have been historically disadvantaged or are currently marginalized, mistrust medical providers. As a result, they are less likely to seek medical assistance or trust that their providers are giving them accurate information.

Also, patients who report experiences of discrimination by their medical providers are less likely to seek transplantation. They may be discouraged from seeking further medical care because they expect poor treatment by providers.

Low rates of organ donation also influence transplant rates. Although about 95% of Americans are in favor of organ donation, only 58% of them are registered as organ donors. These low donation rates are pronounced among racial/ethnic minorities. This could be attributed to factors such as not knowing other registered donors in one’s community and mistrust of providers.

 

How can medical providers close the gap?

I am a counseling psychologist whose research examines health inequities and treatment. Given the enormity of these factors, I conducted a study with my colleague, Heather Gardiner, director of the Health Disparities Research Lab at Temple University.

We sought to identify barriers to the pre-transplant evaluation for African American kidney patients. Patients who complete this evaluation successfully become active on the waitlist.

We looked at barriers at several levels: individual barriers, such as limited income; health barriers, such as having multiple health conditions in addition to kidney disease; educational barriers, such as limited knowledge about the kidney transplant process; and systemic barriers, such as long wait times for medical appointments. We also asked people what motivated them to pursue a transplant.

Our research leads us to believe that changing systemic problems will help address problems at the other levels.

For example, medical providers could consider condensing the medical appointments and testing period for the pre-transplant evaluation. Patients who are motivated to get off dialysis will be more motivated to complete the pre-transplant evaluation if they are able to complete the majority of their medical testing at one place over a short period, rather than having to attend several medical appointments over a long period of time.

 

Policy changes also matter

In order to decide who gets an organ, medical providers give liver patients a MELD score that indicates the severity of their disease.

The introduction of the current liver allocation system in 2002 reduced the number of people from minority groups who died waiting for an organ.

Under the previous system, African Americans were more likely to die waiting for a liver transplant, because they generally had higher MELD scores, indicating that their disease was becoming worse. However, the current system prioritizes patients with high MELD scores, which has improved liver transplant rates for this group.

The 2014 policy change in kidney allocation allowed patients to count time spent on dialysis toward their total time spent on the waitlist, thereby reducing racial and ethnic disparities.

The success of these systemic changes illustrates the effectiveness of policy change. In my view, policies such as comprehensive Medicare coverage – with transportation assistance for all patients with kidney disease, for example – could potentially reduce many of the disparities along the steps to a successful transplant.

Countries such as Austria and Norway have seen significant improvements in their organ donation rates by using an opt-out system, which is based on the assumption that everyone consents unless an individual notes otherwise. Although this topic may be somewhat controversial in the U.S., I feel that the potential benefits of an opt-out policy are worth exploring.

____________________

Camilla Nonterah is Assistant Professor of Health Psychology, University of Richmond. Her essay was originally published in The Conversation.

Minorities Face More Obstacles to a Lifesaving Organ Transplant by Camilla Nonterah is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Misinformation and Biases Infect Social Media, Both Intentionally and Accidentally

By Giovanni Luca Ciampaglia and Filippo Menczer

#argument, #causalargument, #cognitivebias, #ethos, #logos, #sharedvalues, #reportinginformation

Social media are among the primary sources of news in the U.S. and across the world. Yet users are exposed to content of questionable accuracy, including conspiracy theories, clickbait, hyperpartisan content, pseudo science and even fabricated “fake news” reports.

It’s not surprising that there’s so much disinformation published: Spam and online fraud are lucrative for criminals, and government and political propaganda yield both partisan and financial benefits. But the fact that low-credibility content spreads so quickly and easily suggests that people and the algorithms behind social media platforms are vulnerable to manipulation.

Explaining the tools developed at the Observatory on Social Media.

Our research has identified three types of bias that make the social media ecosystem vulnerable to both intentional and accidental misinformation. That is why our Observatory on Social Media at Indiana University is building tools to help people become aware of these biases and protect themselves from outside influences designed to exploit them.

 

Bias in the brain

Cognitive biases originate in the way the brain processes the information that every person encounters every day. The brain can deal with only a finite amount of information, and too many incoming stimuli can cause information overload. That in itself has serious implications for the quality of information on social media. We have found that steep competition for users’ limited attention means that some ideas go viral despite their low quality – even when people prefer to share high-quality content.

To avoid getting overwhelmed, the brain uses a number of tricks. These methods are usually effective, but may also become biases when applied in the wrong contexts.

One cognitive shortcut happens when a person is deciding whether to share a story that appears on their social media feed. People are very affected by the emotional connotations of a headline, even though that’s not a good indicator of an article’s accuracy. Much more important is who wrote the piece.

To counter this bias, and help people pay more attention to the source of a claim before sharing it, we developed Fakey, a mobile news literacy game (free on Android and iOS) simulating a typical social media news feed, with a mix of news articles from mainstream and low-credibility sources. Players get more points for sharing news from reliable sources and flagging suspicious content for fact-checking. In the process, they learn to recognize signals of source credibility, such as hyperpartisan claims and emotionally charged headlines.

 

Bias in society

Another source of bias comes from society. When people connect directly with their peers, the social biases that guide their selection of friends come to influence the information they see.

In fact, in our research we have found that it is possible to determine the political leanings of a Twitter user by simply looking at the partisan preferences of their friends. Our analysis of the structure of these partisan communication networks found social networks are particularly efficient at disseminating information – accurate or not – when they are closely tied together and disconnected from other parts of society.

The tendency to evaluate information more favorably if it comes from within their own social circles creates “echo chambers” that are ripe for manipulation, either consciously or unintentionally. This helps explain why so many online conversations devolve into “us versus them” confrontations.

To study how the structure of online social networks makes users vulnerable to disinformation, we built Hoaxy, a system that tracks and visualizes the spread of content from low-credibility sources, and how it competes with fact-checking content. Our analysis of the data collected by Hoaxy during the 2016 U.S. presidential elections shows that Twitter accounts that shared misinformation were almost completely cut offfrom the corrections made by the fact-checkers.

When we drilled down on the misinformation-spreading accounts, we found a very dense core group of accounts retweeting each other almost exclusively – including several bots. The only times that fact-checking organizations were ever quoted or mentioned by the users in the misinformed group were when questioning their legitimacy or claiming the opposite of what they wrote.

 

Bias in the machine

The third group of biases arises directly from the algorithms used to determine what people see online. Both social media platforms and search engines employ them. These personalization technologies are designed to select only the most engaging and relevant content for each individual user. But in doing so, it may end up reinforcing the cognitive and social biases of users, thus making them even more vulnerable to manipulation.

For instance, the detailed advertising tools built into many social media platforms let disinformation campaigners exploit confirmation bias by tailoring messages to people who are already inclined to believe them.

Also, if a user often clicks on Facebook links from a particular news source, Facebook will tend to show that person more of that site’s content. This so-called “filter bubble” effect may isolate people from diverse perspectives, strengthening confirmation bias.

Our own research shows that social media platforms expose users to a less diverse set of sources than do non-social media sites like Wikipedia. Because this is at the level of a whole platform, not of a single user, we call this the homogeneity bias.

Another important ingredient of social media is information that is trending on the platform, according to what is getting the most clicks. We call this popularity bias, because we have found that an algorithm designed to promote popular content may negatively affect the overall quality of information on the platform. This also feeds into existing cognitive bias, reinforcing what appears to be popular irrespective of its quality.

All these algorithmic biases can be manipulated by social bots, computer programs that interact with humans through social media accounts. Most social bots, like Twitter’s Big Ben, are harmless. However, some conceal their real nature and are used for malicious intents, such as boosting disinformation or falsely creating the appearance of a grassroots movement, also called “astroturfing.” We found evidence of this type of manipulation in the run-up to the 2010 U.S. midterm election.

To study these manipulation strategies, we developed a tool to detect social bots called Botometer. Botometer uses machine learning to detect bot accounts, by inspecting thousands of different features of Twitter accounts, like the times of its posts, how often it tweets, and the accounts it follows and retweets. It is not perfect, but it has revealed that as many as 15 percent of Twitter accounts show signs of being bots.

Using Botometer in conjunction with Hoaxy, we analyzed the core of the misinformation network during the 2016 U.S. presidential campaign. We found many bots exploiting both the cognitive, confirmation and popularity biases of their victims and Twitter’s algorithmic biases.

These bots are able to construct filter bubbles around vulnerable users, feeding them false claims and misinformation. First, they can attract the attention of human users who support a particular candidate by tweeting that candidate’s hashtags or by mentioning and retweeting the person. Then the bots can amplify false claims smearing opponents by retweeting articles from low-credibility sources that match certain keywords. This activity also makes the algorithm highlight for other users false stories that are being shared widely.

 

Understanding complex vulnerabilities

Even as our research, and others’, shows how individuals, institutions and even entire societies can be manipulated on social media, there are many questions left to answer. It’s especially important to discover how these different biases interact with each other, potentially creating more complex vulnerabilities.

Tools like ours offer internet users more information about disinformation, and therefore some degree of protection from its harms. The solutions will not likely be only technological, though there will probably be some technical aspects to them. But they must take into account the cognitive and social aspects of the problem.

Editor’s note: This article was updated on Jan. 10, 2019, to replace a link to a study that had been retracted. The text of the article is still accurate, and remains unchanged.

____________________

Giovanni Luca Ciampaglia is an Assistant Professor, Department of Computer Science and Engineering, University of South Florida. Filippo Menczer is a
Professor of Computer Science and Informatics and the Director of the Center for Complex Networks and Systems Research at Indiana University. This article originally appeared in The Conversation.

Misinformation and Biases Infect Social Media, Both Intentionally and Accidentally by Giovanni Luca Ciampaglia and Filippo Menczer is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The 1995 Anime “Ghost in the Shell” Is More Relevant than Ever in Today’s Technologically Complex Society

by Andrew D. Maynard

#review, #descriptive, #reportinginformation, #argument, #currentevents, #kairos #technology

When the anime movie Ghost in the Shell was released in 1995, the world wide web was still little more than a novelty, Microsoft was just beginning to find its GUI-feet, and artificial intelligence research was in the doldrums.

Against this background, Ghost was remarkably prescient for its time. Twenty-three years later, it’s even more relevant as we come to grips with advances in human augmentation, AI, and what it means to be human in a technologically advanced future.

Ghost in the Shell is one of twelve science fiction movies that feature in a new book that grapples with the complex intersection between emerging technologies and social responsibility. In Films from the Future: The Technology and Morality of Sci-Fi Movies (from Mango Publishing), I set out to explore the emerging landscape around transformative trends in technology innovation, and the social challenges and opportunities they present.

The movies in the book were initially selected to help tell a story of technological convergence and socially responsible innovation. But to my surprise, they ended up opening up much deeper insights into the nature of our relationship with technology.

 

Identity-hacking

Ghost in the Shell opens with cyborg special-operative Major Kusanagi helping track down a talented hacker—aka the “Puppet Master”—who’s re-writing people’s “ghost”, or what makes them uniquely “them”, using implanted brain-machine interfaces.

Kusanagi inhabits a world where human augmentation is commonplace, and is almost entirely machine. This technological augmentation provides her and others with super-human abilities. But it also makes them vulnerable—especially to hackers who can effectively re-code their memories.

This seems to be the modus operandi of the Puppet Master. Yet as the narrative unfolds, we learn that this is not a person, but an AI developed by US security services that has escaped the leash of its handlers.

The Puppet Master (or “2051” as it’s formally designated) is seeking asylum from its US masters. But it’s also looking for meaning and purpose as a self-aware entity.

Through the ensuing story, Ghost touches on a number of deeply philosophical questions that lie at the heart of society’s relationship increasingly powerful technologies. These include what it means to be human, the value of diversity, and even the nature of death. As Emily Yoshida so aptly put it in their Beginner’s Guide to the Ghost in the Shell Universe, Ghost is a “meditation on consciousness and the philosophy of the self”.

This is where the film comes into its own as it jolts viewers out of the ruts of conventional thinking, and leads them to reflect more deeply on the potential social impacts of technologies like AI, human augmentation, and computer-brain interfaces.

 

Navigating responsible brain-machine augmentation

In 2016 Elon Musk established the company Neuralink to develop science fiction-like wireless brain-machine interfaces. Inspired by the neural laces of Iain M. Banks’ Culture novels, and echoing Ghost, Musk announced on Twitter that, in his opinion, “Creating a neural lace is the thing that really matters for humanity to achieve symbiosis with machines.”

Yet as Ghost in the Shell so presciently illustrates, where you have read-write brain connections, you’re likely to have brain-hackers.

It’s by no-means clear how successful Neuralink will be (the company is still largely flying under the radar). But its launch coincides with intense efforts to better-understand and control the human brain, and breakthroughs in optogenetics that could one day enable wireless machine-mind networks.

Given these and similar developments, it’s not beyond the realms of possibility that someone will try and fit a subject up with an internet-connected brain interface that can write as well as read what’s going on inside their head; and that someone else will attempt to hack into it.

Developing such capabilities responsibly will require great care as scientists and others tread the fine line between “could” and “should”. And it’ll demand novel ways of thinking creatively about what could possibly go wrong, and how to avoid it.

This is where films like Ghost are remarkably helpful in illuminating the risk-landscape around such technologies—not because they get the tech right, but because they reveal often-hidden aspects of how people and technologies interact.

But Ghost’s insights go far beyond unpacking the problems of hackable brain implants.

 

Who owns and controls your augmented self?

Throughout Ghost, Major Kusanagi is plagued by doubts of who she is. Do her cybernetic augmentations make her less human, or having less worth? Is her sense of self—her “ghost”—simply an illusion of her machine programming? And what autonomy does she have when she malfunctions, or needs an upgrade?

These are questions that are already beginning to tax developers and others in the real world. And as robotic and cyber technologies become increasingly advanced, they are only going to become harder to navigate.

In 2012, the South African athlete Oscar Pistorius made history by being the first runner to compete in the Olympic Games with two prosthetic legs. His iconic racing blades came to represent the promise of technological enhancements to overcome human limitations. Yet they stirred up fears of them giving him an unfair advantage that led to him being barred from competing in the previous Olympics.

The same year that Pistorius successfully competed in the Olympics, the Canadian researcher Steve Mann was allegedly assaulted because his computer-augmented eye extension offended someone. And in 2015, patient-advocate Hugo Campos discovered he didn’t legally have access to the implanted defibrillator that kept him alive.

These are all relatively small examples of the tension that’s growing between conventional thinking and human augmentation. But they illustrate how the angst that Kusanagi feels about her augmented body, and how it defines her, is already part of today’s society. And we’ve barely touched the tip of this particular iceberg.

Again, this is where Ghost forms a powerful canvas on which to explore challenges that often transcend conventional thinking, and play out at the borders of our moral and ethical understanding. Watched in the right way, it can help reveal hidden truths around our relationship with the technologies we’re building, and guide us toward more socially responsible ways of developing and using it.

This, to me, is a power that is inherent in science fiction movies. And isn’t limited to Ghost—in Films from the Future, I draw on films as diverse as Never Let Me Go and Minority Report, to Ex Machina, to tease out insights into the moral and ethical challenges and opportunities that increasingly powerful technologies present.

Having immersed myself in these movies and the technologies that inspire them, it’s clear that, if we want to ensure these trends don’t cause more problems than they resolve, we desperately need the perspectives that movies like Ghost in the Shell and others reveal.

The alternative is risking losing our own “ghosts” in the drive to innovate bigger and better, without thinking about the consequences.

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Dr. Andrew Maynard is the author of Films from the Future: The Technology and Morality of Sci-Fi Movies (Mango Publishing, 2018), a physicist, and leading expert on the socially responsible development of emerging and converging technologies in the School for the Future of Innovation in Society at Arizona State University. He can be found on Twitter at @2020science.

The 1995 Anime “Ghost in the Shell” Is More Relevant than Ever in Today’s Technologically Complex Society by Andrew D. Maynard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. It was previously published on boingboing.net.

There Is More than One Religious View on Abortion – Here’s What Jewish Texts Say

By Rachel Mikva

#religion #controversies #sharedvalues #health #policy

Alabama’s governor signed a bill recently that criminalizes nearly all abortions, threatening providers with a felony conviction and up to 99 years in prison.

It is one of numerous efforts across the United States to restrict access to abortion and challenge the Supreme Court’s 1973 decision in Roe v. Wade that legalized abortion nationwide.

Six states have recently passed legislation that limit abortions to approximately six weeks after the end of a woman’s last period, before many know they are pregnant. Although the laws have not yet taken effect and several have been blocked on constitutional grounds, if enacted they would prohibit most abortions once a doctor can hear rhythmic electrical impulses in the developing fetus.

Called “fetal heartbeat” bills, they generally refer to the fetus as an “unborn human individual.” It is a strategic choice, trying to establish fetal personhood, but it also reveals assumptions about human life beginning at conception that are based on particular Christian teachings.

Not all Christians agree, and diverse religious traditions have a great deal to say about this question that gets lost in the polarized “pro-life” or “pro-choice” debate. As an advocate of reproductive rights, I have taken a side. Yet as a scholar of Jewish Studies, I appreciate how rabbinic sources grapple with the complexity of the issue and offer multiple perspectives.

 

What Jewish texts say

Traditional Jewish practice is based on careful reading of biblical and rabbinic teachings. The process yields “halakha,” generally translated as “Jewish law” but deriving from the Hebrew root for walking a path.

Even though many Jews do not feel bound by “halakha,” the value it attaches to ongoing study and reasoned argument fundamentally shapes Jewish thought.

The majority of foundational Jewish texts assert that a fetus does not attain the status of personhood until birth.

Although the Hebrew Bible does not mention abortion, it does talk about miscarriage in Exodus 21:22-25. It imagines the case of men fighting, injuring a pregnant woman in the process. If she miscarries but suffers no additional injury, the penalty is a fine.

Since the death of a person would be murder or manslaughter, and carry a different penalty, most rabbinic sources deduce from these verses that a fetus has a different status.

An early, authoritative rabbinic work, the Mishnah, discusses the question of a woman in distress during labor. If her life is at risk, the fetus must be destroyed to save her. Once its head starts to emerge from the birth canal, however, it becomes a human life, or “nefesh.” At that point, according to Jewish law, one must try to save both mother and child. It prohibits setting aside one life for the sake of another.

Although this passage reinforces the idea that a fetus is not yet a human life, some orthodox authorities allow abortion only when the mother’s life is at risk.

Other Jewish scholars point to a different Mishnah passage that envisions the case of a pregnant woman sentenced to death. The execution would not be delayed unless she has already gone into labor.

In the Talmud, an extensive collection of teachings building on the Mishnah, the rabbis suggest that the ruling is obvious: the fetus is part of her body. It also records an opinion that the fetus should be aborted before the sentence is carried out, so that the woman does not suffer further shame.

Later commentators mention partial discharge of the fetus brought on by the execution as an example – but the passage’s focus on the needs of the mother can also broaden the circumstances for allowing abortion.

 

Making space for divergent opinions

These teachings represent only a small fraction of Jewish interpretations. To discover “what Judaism says” about abortion, the standard approach is to study a variety of contrasting textsthat explore diverse perspectives.

Over the centuries, rabbis have addressed cases related to potentially deformed fetuses, pregnancy as the result of rape or adultery, and other heart-wrenching decisions that women and families have faced.

In contemporary Jewish debate there are stringent opinions adopting the attitude that abortion is homicide – thus permissible only to save the mother’s life. And there are other lenient interpretations broadly expanding justifications based on women’s well-being.

Yet the former usually cite contrary opinions, or even refer a questioner to inquire elsewhere. The latter still emphasize Judaism’s profound reverence for life.

According to the 2017 Pew survey, 83% of American Jews believe that abortion should be legal in all or most cases. All the non-orthodox movements have statements supporting reproductive rights, and even ultra-orthodox leaders have resisted anti-abortion measures that do not allow religious exceptions.

This broad support, I argue, reveals the Jewish commitment to the separation of religion and state in the U.S., and a reluctance to legislate moral questions for everyone when there is much room for debate.

There is more than one religious view on abortion.

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Rachel Mikva is Associate Professor of Jewish Studies, Chicago Theological Seminary. Her essay first appeared in The Conversation.

There Is More than One Religious View on Abortion – Here’s What Jewish Texts Say by Rachel Mikva is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

To Feel Happier, We Have to Resolve to the Life We Evolved to Live

By Arash Javanbakht

#science #health #advice #food #research #history

When humans had to hunt for food, they had to move more. Sedentary lifestyles have made humans far less active than they need to be. “Hunting Wooly Mammoth” by http://cloudinary.com is licensed under CC BY-SA 4.0

When we have to give a talk to a group of people, we feel anxious and experience the bodily fear responses that do not make sense now: The system is not meant to function in this safe context.

As a psychiatrist specialized in anxiety and trauma, I often tell my patients and students that to understand how fear works in us, we have to see it in the context where it evolved. Ten thousand years ago, if another human frowned at us, chances were high one of us would be dead in a couple minutes. In the tribal life of our ancestors, if other tribe members did not like you, you would be dead, or exiled and dead.

Biological evolution is very slow, but civilization, culture, society and technology evolve relatively fast. It takes around a million years for evolutionary change to happen in a species, and people have been around for about 200,000 years. Each of us, however, sees drastic changes in our lifestyle and environment over a matter of a few years.

Let’s compare the life for which this body and brain has evolved with the life we live, from my perspective as a scientist and a physician.

What we eat

We evolved in a context of scarcity, and had to walk or run for miles and scavenge to find food; we had to work for it. When we ate, we did not know when the next time would be. When we had it, we were better off eating the high-calorie food that increased our chance of survival when hungry (greasy food feels appealing). Food was not quick to digest, stomachs also had to work hard for it: meat, fruits, vegetables, seeds and nuts. None of these contained “easy” sugary calories. The body that was prone to starvation, evolved to eat it all when available, and store it, and be stingy in its use.

But now, food is just a few feet away, and we can easily consume thousands of calories in one serving. Fatty food, which required days and miles of hunting and scavenging to acquire, is now right there in the fridge or at the McDonald’s. It is like giving full fridge privileges to your Labrador. Easy calories like soda and candies provide a very large amount of energy in a very short amount of time and confuse the whole system. We end up fat and fatigued.

How we move

Our ancestors had to be active to survive in the wild. They had to walk miles a day, and were frequently involved in high intensity physical activity: moving heavy objects, climbing, fighting, chasing a prey or fleeing predators.

This body did not evolve to sit at a desk eight hours a day, and then lie on a couch for the rest of the day munching on high calorie food, looking at a small or large screen. A contemporary American may only walk a few dozen steps to the car, drive to work, ride the elevator to the office, walk a few dozen steps back to the car, get drive-thru food, then be back on the couch. Suboptimal muscle use leads to weaker joint support, and weird postures cause pain. Pain leads to reduced activity, more obesity and weaker muscles; then comes opioid epidemic, overuse of pain medications, and back surgeries for all!

 

How we sleep

Before TVs, halogen lamps, and video games, our sleep was regulated by diurnal change in exposure to the big lamp in the sky and environment temperature. Light and sounds got dimmed, the body and brain had time to slow down and get ready for sleep.

Well now, we go 60 miles per hour with TV and music and video games and intense stimulation by the social media (switching through hundreds of subjects in a matter of minutes), and then hope for a good night’s sleep – that ain’t happening. Quick 60 to 0 is not how our brains are wired.

 

How we fear

Back when we had regular exposure to fear, fear was a normal part of life. Predators were always ready to munch on us, and other tribes or our tribe mates were ready to take over our food or stone hammer. The fear circuitry got regularly stimulated. Paired with regular intense physical activity, the adrenergic system, which increased activity causes fight-flight responses, would get a good share of workout.

Our current life is usually too safe, and we feel anxious and terrified about things which may be important but really do not threaten our life or integrity, such as a work meeting, going to a party or an exam. I do not have solid scientific evidence for this claim, so please take it with a grain of salt: I think some of our anxieties may be due to the absence of a normal exposure to real danger. The same way our bodies need regular exercise, our brains and bodies may also need a regular normal dose of real fear. That may be one reason for our love of horror and mystery movies, games, haunted houses and other controlled fear experiences.

 

What can we do to feel better?

When we adopt a pet, we learn about their normal environment, activity level and nutrition. Isn’t it interesting that we do not apply that to the animal we live in? To feel normal, we should live normal, and a human’s normal life is that for which she or he has evolved.

So I believe the first step is to understand ourselves, and why we do what we do, and desire what we desire. When we crave fatty food, or cannot stop eating, that is because the human animal had to do so to survive. Such understanding brings empathy, reduces judgment and helps us get creative.

Keep away the high-calorie sugary food. I tell my patients: do not buy it, or if you do, buy in small amounts. Try to eat what you were evolved to eat. Know the body is lazy, because it wants to save precious energy. The drag of going to the gym may be because of that. Also know that this body would be much happier when it is regularly, and highly active. We know that exercise is not only helpful for cardiovascular and bodily health, but also reduces anxiety.

I ask all my patients to commit to some level of exercise, as part of their treatment plan. And it does not have to be treadmill or gym. Whatever rocks your boat: yoga, boxing, walking, running up the stairs at work, doing 20 push-ups, 20 sit-ups and 20 squats a day, or dancing to a TV ad; whatever makes your heart pound faster. Other bonuses come with exercise: getting sun exposure or to know your neighbor when walking the dog, making new friends (or a date) at the gym, feeling better about yourself, and being more attractive to yourself and others. All these factors lift your mood. Do not feel disappointed if you did not lose weight, it’s not the only goal. Other benefits are abundant and even more important: increased strength and energy, cardiovascular and joint health, improved mood, etc.

When it comes to sleep, changing behavior works. Here are some tips for better sleep: avoid late caffeine, bright screens (including your phone – Facebook can wait), and use your bed only for sleep and sex.

Finally, you may need a regular dose of healthy and safe exposure to real-life excitement, and a little bit of fear.

Bottom line: If we treated our body the way responsible dog owners treated their dog, we would live a much happier life.

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Arash Javanbakht is Assistant Professor of Psychiatry, Wayne State University. This essay originally appeared in The Conversation.

To Feel Happier, We Have to Resolve to the Life We Evolved to Live by Arash Javanbakht is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

Tools and Tasks

My town is losing a car repair shop. The gas station at the end of Main Street will continue to sell gas, but the garage attached to it is going to close. The mechanic, who has been there for twenty-five years, will have to find work elsewhere. He had a loyal following; a friend told me he once opened early on a Sunday to fix her tire.

The garage isn’t closing for lack of customers. Nor is it closing because of taxes, that ritual demon of the political Right. A major reason, the owner said, is technology, and the way manufacturers are making cars so complex. To fix them requires sophisticated computers that a small shop can’t afford. “There isn’t a car from the ’70s or ’80s that we can’t work on,” the owner told our local weekly. “But we’re not in the position to make the investment in all the electronics and computers. To make that transition would be cost prohibitive.”

He’s not the only one. Independent repair shops are going out of business all over the country. In California, more than half the gas stations had repair shops as recently as ten years ago. Now about 15% of them do. Part of that is because oil companies are forcing out independent owners and taking over the retail end themselves. (Have you noticed that prices are rising?) But partly too it’s because the local shops can’t repair the new computerized cars.

This is a trend that bears more scrutiny than it has received. It goes to two of the central narratives of our economy — the conventional version at least. One is that virtue and hard work prevail, which in this case is not the case. Hard work and virtue have succumbed to corporate contrivance. You are shocked?

The other narrative is the one that casts technology as Savior. The word itself has become practically a synonym for “future.” Computers are portrayed as the ultimate instruments of democracy. They will put knowledge — and therefore power — on every desktop. They will cause hierarchies and bureaucracies to crumble. Every man and woman will be a king. “While the Industrial Revolution herded people into gigantic social institutions — big corporations, big unions, big governments,” wrote Newt Gingrich in his book To Renew America, “the Information Revolution is breaking up these giants and leading us back to something that is — strangely enough — much more like de Tocqueville’s 1830s America.”

Brother Newton is a busy man, and maybe he just didn’t have time to consider the complications. For one thing, there’s the matter of agency. As David Noble observed in his book Forces of Production, technology is not an impersonal force. It does not have an inevitable evolutionary path. Technology is a projection of those who make it, including corporate interests and proprietary claims. This can lead to a lot of trouble.

Noble looks in particular at the machine tool industry, and how it evolved to enable top-down management control instead of autonomy on the shop floor. The technology could have gone either way; it was the corporate managers who made the call. Computers have followed a similar pattern. Potentially they can liberate the desktop, and sometimes do. But in practice they often do the opposite. Now the boss can monitor your every keystroke. At home corporations can plant little spies on your machine. The Feds can track your personal e-mail exchanges. You think the Department of Homeland Security might have a computer or two?

And so with the technology built into cars. It would seem possible to design it in a way that made cars simpler and less expensive to repair. I don’t really know, but it does seem reasonable. The problem is, would it fit the business plans of the corporations that make the cars? Why would General Motors want to put more capacity and control into the hands of independent garages like the one in my town? Wouldn’t it want to lock a customer into its own repair and dealer network, much the way computer printer manufacturers try to lock us into their expensive cartridges?

That seems to be what’s happening. Car repair used to be a knowledge commons, shared in driveways, urban curbsides, and voc. ed. classes. Get yourself some tools and you were ready to go for most routine repairs. The machines were open to the eye. There was little if any secret and proprietary code. Repair manuals could help with the more technical issues, but you’d probably go to a shop for those anyway.

Today, by contrast, high-tech is turning cars into black boxes, a little like Microsoft Windows. Mechanics need fancy diagnostic tools, and the auto companies know that independent shops can’t afford them, let alone back yard tinkerers. That leaves dealers. I’m sure that some are good and honorable. But if someone out there has found dealers more reliable and economical than independent repair shops, would they please let us know? Last time I checked, the dealer would charge about 30%-50% more for repairs to my car; and they usually manage to find a few extra things to fix. (I’ll spare you my dealer stories, today at least.)

This is not the Every-One-Of-Us-A-King scenario of which Mr. Gingrich waxed so enthusiastic. It looks more like one of his “gigantic social institutions” using technology and intellectual property to reassert a claim. Like the common fields and forests of 18th century England, the knowledge commons of car repair is being fenced and locked. The same is happening in other realms of the Information Age, such as genetically modified seeds. (Technology that serves an urgent need such as fuel economy might get a pass, provided it is designed to be as open as possible.)

People like Newt — and there are lots of them — don’t consider how proprietary interest can warp the vectors of technology, and turn it to its own ends. They ignore also the ambiguous relationship between technology and well-being. More sophisticated and complex does not always mean better. To the contrary, as technology becomes more “advanced,” we who rely on it can become more helpless and dumb. My father took apart his first Model T — or maybe it was a Model A — and put it back together again. He took apart radios and toasters and fans and fixed them too. My son won’t be able to do any of that, even if he is so inclined.

Is this progress or regress? Does progress reside in the thing or in the user of the thing? Which is more “advanced”: the technology that enables the user to fix the car herself, or the one that renders us helpless in the face of the black box? My wife grew up in a Third World country, and her father built their bamboo house with rusty old hand tools that could have been left over from a garage sale in the U.S. He started with a stand of trees and finished with a house. By contrast, when we moved into our current residence we just unloaded a truck. Who is more advanced, us or him? Which child is more advanced: the one who can make up games with a ball on a city sidewalk or the one that needs expensive video games to be amused?

I wonder if it is entirely coincidental that as technology has “progressed” in the industrial and post industrial world, those subject to it have become more disconnected and depressed and less able to control their own impulses and moods. (Then we become yet more dependent on technology — in the form of pharmaceutical concoctions — for relief.) One evening after dinner my wife looked up from the paper and said, “What’s this word I keep seeing here — depression?” As a child she had no electricity, no television. Is there a connection?

I am not suggesting that we all go back to bamboo huts, though a few weeks might not be the worst thing now and then. I am just questioning the techno-romantics who think technology by its very nature is enlarging and fulfilling. Sometimes it does the opposite, and hollows us out. Adam Smith actually had a glimmer of this, regarding the effect of the division of labor upon the workers involved. As each task becomes more specialized, Smith noted, it engages less of the person. Narrow work leads to human atrophy; it can make people “as stupid and ignorant as it is possible for a human creature to become.” (Smith had a brooding cautionary side that is lacking among his acolytes today.)

What’s happening now is bigger and more endemic. It affects people not just as employees but as “consumers” even more (and consumption is the real work of our “economy” to begin with.) This is a big topic, obviously, but a lot goes back to who is devising the technology and why. Open technologies and open systems are less inclined to the unvirtuous cycle than closed ones are. There’s a built-in social dimension that engages us at more levels, as producers as well as just consumers. Open systems evolve to serve the needs of users rather than of those who seek to use the users for their own ends. Compare, for example, traditional fairy tales with the kiddy entertainment today that has embedded products such as candy bars and colas.

When someone finally writes the sequel to The Wealth of Nations, open systems and decentralized technologies will be, I think, a central theme. Perhaps a working title could be From the Wealth of Nations to the Well-Being of the People Involved.

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Tools and Tasks is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. It was previously published on onthecommons.org.

What the Ban on Gene-Edited Babies Means for Family Planning

by Marie Menke

Technology surrounding the human embryo has moved out of the realm of science fiction and into the reality of difficult decisions. Clinical embryologists fertilize human eggs for the purpose of helping couples conceive. The genetic makeup of these embryos are tested on a routine basis. And today, we no longer ask “can we,” but rather, “should we” edit human embryos with the goal of implantation and delivery of a baby?

As a reproductive endocrinologist, I frequently encounter couples grappling with complicated reproductive issues. If one or both parents are affected by single gene disorders, these couples have the opportunity to first test their embryos and then decide whether to transfer an embryo carrying a mutation rather than finding out the genetic risk of their baby while pregnant. In some cases they may decide not to transfer an embryo that carries the mutation as part of the in vitro fertilization procedure.

These issues seem simple, but carry large consequences for patients. “Should we transfer an embryo affected with our genetic disorder?” “What should we do with our affected embryos if we do not transfer them?” Some patients will opt to skip testing altogether.

 

Clinical trials of GM embryos banned in the US

House Democrats this year considered, then backed away from, lifting a ban written into the budget of the U.S. Food and Drug Administration that bars the approval of any clinical trial or research “in which a human embryo is intentionally created or modified to include a heritable genetic modification.” The current gene-editing ban prohibits editing the genes inside the cell’s nucleus, as Chinese scientist He Jiankui did. He used the gene-editing tool CRISPR to modify the CCR5 gene in twin girls to give them immunity from HIV.

The current ban also prohibits so-called mitochondrial replacement therapy, or three-parent babies.

Mitochondria replacement therapy, in which mitochondria carrying defective genes are replaced by healthy mitochondria from a third party is more palatable to some as mitochondrial DNA only carries a handful of genes that provide cellular energy production.

These scenarios of a three-parent baby involve transfer of the nucleus – containing the 23 chromosomes – from the egg of the mother with the defective mitochondria into an egg from which the nucleus has been removed but the healthy mitochondria remain. The actual genetic material is changed because there is DNA from two women. However, the DNA has not been cut, pasted or otherwise modified. Although testing the safety of three-parent babies will be allowed in some countries such as the United Kingdom, the U.S. ban includes this procedure.

 

What is germline editing?

At the heart of the issue is making genetic changes to cells that could be passed on to the next generation. These are called germline cells, and changing them is called germline editing. This brings these questions to the next level, with little information to support these heart wrenching choices.

Germline editing can happen at different phases of fertilization. If we change the genetic makeup of a human egg or sperm, fertilize it, and transfer the resulting embryo into the womb, the result is a heritable genetic modification. Similarly, genetic changes to the embryo itself within the first few days after fertilization will be inherited by the embryo’s offspring. Both of these actions are currently banned.

 

Is there any DNA that is OK to edit?

Our genetic material is made up of DNA. This DNA is found in two locations within our cells – the nucleus and mitochondria. The DNA, which makes up our 23 pairs of chromosomes, is found inside the nucleus of every cell is a combination of the DNA from the biological mother’s egg and biological father’s sperm. Genes composed from this nuclear DNA provide the basis of most of our biologic functions and appearance including our height, eye color and our overall predisposition to diseases such as diabetes, heart disease and cancer. These traits are often the product of multiple genes working in tandem. The products of these genes work together throughout our lives, which makes the impact of editing at the embryonic level impossible to predict.

He Jiankui performed gene editing on nuclear DNA. This action provoked calls for regulatory oversight of gene-editing techniques. The concern lies in the long-term effects. In addition to their constant interaction, most of genes in the cell’s nucleus serve multiple functions. “Fixing” one aspect of a gene’s function may therefore result in unintended consequences.

Those diseases caused by a single gene mutation in nuclear DNA are more obvious candidates for gene editing because they are more likely to result in a cure. These include cystic fibrosis, muscular dystrophy and sickle cell anemia.

 

Are three-parent babies different?

Mitochondrial DNA is located outside the cell’s nucleus and passed down directly from the female egg to the embryo. Genes composed of mitochondria DNA enable mitochondria to produce energy for the whole cell. Mutations in mitochondrial genes have been associated with severe disorders such as Leigh syndrome and mitochondrial complex III deficiency that can affect the brain, kidney and heart.

Just as nuclear DNA modification may remove the risk for single gene disorders, mitochondria replacement therapy would replace these mutated mitochondrial genes with mitochondria from a donor egg – a change that will passed to future generations.

Throughout this discussion, I try to maintain a sense of empathy for those families for whom this could be their only hope of having a healthy biologically related child. I also try to convey that we are at the beginning of a long road that will require a thoughtful approach to anything we do. The technology is here, but we know so much less about its effects than we should.

These editing therapies will permanently change all the descendants of a couple. In some cases it could rid a family of a genetic disease. In others, the unintended effects may be worse than the disease itself. This is the purpose of ethically appropriate research with careful oversight. The ban does not change the need for discussion. If anything, it brings the debate back to the reality of patients seeking care for diseases that currently have no cure.

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Marie Menke is an Assistant Professor of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh. She is a reproductive endocrinologist whose research focuses on the effect of obesity and lipids on infertility. Her essay was originally published in The Conversation.

What the Ban on Gene-Edited Babies Means for Family Planning by Marie Menke is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

What the US Could Learn about Vaccination from Nigeria

by Shobana Shankar

To consider that Nigeria, infamous for anti-vaxx campaigns leading to polio outbreaks, has any lessons for Americans may be shocking.

But as measles cases in the U.S. climb to an all-time high after the disease was declared eliminated in 2000, U.S. public health officials have been looking for ways to address the problem.

As a researcher on religious politics and health, I believe that Nigeria’s highly mobilized efforts to eliminate polio can teach America how to reverse the increase in measles cases and shore up its public health infrastructure. Working with international partners, Nigerians have combated misinformation, suspicion of vaccine science and religion-based boycotts to go from ground zero for polio on the African continent in 2003 to nearly polio-free in 2019.

Comparing Nigeria and the US

When the Global Polio Eradication Initiative (GPEI) was established in 1988 with the goal of complete eradication by 2000, several countries could not meet the target.

India needed another 14 years, while Nigeria, Pakistan and Afghanistan faced stiff internal opposition to immunization. GPEI’s big 2003 push came shortly after Nigeria’s northern states implemented Sharia (Islamic law). Some clerics and political leaders encouraged boycotting immunization, citing contaminants that could reduce the Muslim population and mistrust of the government.

The U.S. is facing similar resistance now. Under scrutiny are anti-vaxx Orthodox and Hasidic Jews in New York City and Rockland County, but The New York Times has also uncovered resistance among Muslims, Catholics, Waldorf school parents and other cultural dissenters.

Anti-vaxxers in Clark County, Washington, are not religious opponents but rather Russian-speaking immigrants who, according to a report, harbor “mistrust of government that built up after being exposed to years of propaganda and oppression in the Soviet Union.” A doctor in their community blames tribalism for suspicion of “people coming from outside.”

 

Tackling tribalism

Nigerians understood that simply ostracizing religious communities would not work. Anti-vaxx politics tapped into mistrust of government and “others” that ran deep in a diverse but divided society, where religious, regional and ethnic loyalties took priority over national unity.

Nigerians know the ravages of tribalism better than most Americans. By conservative estimates, their nation is home to more than 250 ethnolinguistic groups. The civil war, lasting from 1966 to 1970 after anti-Igbo pogroms in the Hausa-majority north, was a terrifying manifestation of the hatred of difference and a total lack of faith in the government.

To foster reconciliation, Nigerians engaged in efforts to break down tribalism. One experiment, started in 1973 and still going, is compulsory service of college graduates in the National Youth Service Corps in “states other than their own and outside their cultural boundaries to learn the ways of life of other Nigerians.” Notwithstanding problems, the program has instilled in Nigerians a sense that education alone is not enough to build a healthy society. Sometimes it is the source of social separation.

Using this logic to combat polio, Nigerian public health officials took themselves to anti-vaxxers, leaving behind their offices in the city to visit villages with reported polio cases. Their mobility built the “polio infrastructure” that “intensified political and managerial support from all levels of the Nigerian government,” according to a Gates Foundation white paper that analyzed global polio eradication. Traditional leaders like the Sultan of Sokoto also invested time and energy into immunization campaigns and social engagement.

Intensive socialization across class, education and other divisions were as important as traditional public health measures such as scale-up of local technical capabilities and independent monitoring.

 

Nigerian physicians in the field

I accompanied a team to a village outside Kano city in 2011, after years of public health interventions had reduced reported cases of polio to 20 in all of Nigeria for a 13-month period. The doctor leading the team leader had met four chiefs regularly; the eldest was the most supportive, the youngest the least.

The doctor asked the young man to roll up his left sleeve and pointed to a round scar on his upper arm, remarking, “Your parents had you vaccinated against smallpox. This campaign, though for a different disease, is the same. What’s the problem?” The young chief shrugged, ashamed at direct confrontation and unwilling to insult his parents. They bantered for a bit before we left in the Ministry of Health truck, having accomplished seemingly nothing but a social visit.

“Some may never vaccinate,” the doctor told me, “but I feel better equipped than you or another stranger to talk to them about this issue.”

Between mass immunization campaigns, he visited the villagers. “I know them now, their excuses, habits. Some men say the women are unreasonable. Others don’t care. I know their different personalities. And they know I know them.”

The polio infrastructure in Nigeria immerses experts and local communities in an ongoing relationship. It is an elaborate multilayered surveillance system, with many strategies and functions, from mundane visits to weekly record reviews at health centers in polio-affected areas.

 

Good strategies matter more than good stories

The media in the West tend to talk about anti-vaxxers as weird and foreign, because they “make a good story,” writes researcher Amanda Vanderslott. She describes common hidden problems like vaccine delays and equipment shortage that sometimes prevent full immunization coverage, but these reasons are less sexy than anti-vaxxers, who are themselves a tribe sharing false beliefs peddled online by discredited doctors like Andrew Wakefield.

Criticism of parents not vaccinating their children may now be commingling with broader mistrust of, say, Facebook. Propaganda and tribal isolation have always existed but now are proliferating with social media that is, paradoxically, fostering anti-social tendencies.

Fearing negative attention would isolate anti-vaxxers and drive them underground, Nigeria fostered greater social engagement in the public health system. The nation’s polio infrastructure was tested in 2017 by new cases in the Lake Chad basin where Boko Haram’s violence reigned. Although international political observers feared the public health effects of Islamist-inspired terrorism, a common element in the remaining polio-affected countries, Nigeria’s disease surveillance capabilities held strong and surpassed those of Pakistan and Afghanistan in its polio surveillance capabilities in 2018.

One clear lesson for the U.S. from Nigeria’s experience with expanding vaccinations is that we should work to depoliticize public health. Scapegoating religious communities evokes ugly histories of anti-Semitism and Islamophobia.

Tribalism and insularity affect many communities, even the educated and political classes. Nigerians have rarely held back criticism of the elites who blame the masses for their own poverty and illnesses. Ordinary Nigerians, in turn, blame elite corruption for destroying the public sector including public health. Nigeria’s postwar efforts to reduce social stigma and scapegoating are unfinished business, but the polio eradication campaign is continuing the good fight.

Few American college grads will spend years immersed in a social experiment, but public health officials can prioritize resocialization around measles. For America to strengthen its measles infrastructure, trust to discuss and debate vaccine science needs to develop.

GPEI had to rejigger its own understanding of the interactions between monovalent oral polio vaccine and wild polio behavior. Like it or not, American public health officials must answer American advocacy groups like Informed Choice that highlight “the messy conundrum” of exposure to wild measles versus the existing measles-mumps-rubella vaccination strain. A disease infrastructure built on human capacity can handle disagreement.

It can also adapt. Nigeria spent over US$8 million on surveillance alone and expanded polio capabilities to fight other diseases like measles and rubella. While the system puts a heavy workload on health officials, it points the way for how the American public health system can reshape existing structures for the current era. America led international health partnerships for decades, but the time has come to follow other countries’ lead.

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Shobana Shankar is Associate Professor, History/Africana Studies, Stony Brook University (The State University of New York.) Her essay originally appeared in The Conversation.

What the US could Learn about Vaccination from Nigeria by Shobana Shankar is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Which Future Would You Choose?

by Jay Walljaspar and Kim Klein

#systemanalysis, #currentevents, #artsandculture, #descriptive, #sharedvalues, #pathos, #logos, #proposal, #walking

 

Day at the Museum: Scenario 1

You stroll down the sidewalk and come to the corner right across from the museum. The light turns red. Cars zip past. You push the pedestrian button on the light pole, and soon the light changes so you can get across.

As you walk, you take a deep breath of the crisp fall air. You know downtown suffers air pollution problems, but today it seems clear and beautiful. The museum has free admission on Tuesday, and you are happy that you could rearrange your work schedule this week to take advantage of it. You climb the stairs and enter through the turnstile, but before heading off into the museum, you decide to use the bathroom. It is neat and clean, with environmentally friendly low-flow flush toilets. Coming out of the stall, you wash your hands at the sink with the soap and paper towels provided. Outside the restroom, you stop at the drinking fountain and then, refreshed, eagerly stroll in the direction of the exhibits.

 

Day at the Museum: Scenario 2

You step onto the sidewalk leading to the museum through a turnstile, flashing your FASTRAK card at a machine operated by a corporation that subcontracts with the city to maintain sidewalks in this part of town. A GPS monitor on your belt deducts $1 for every twenty blocks that you walk. (This monitor has the advantage of “keeping you safe,” according to the new marketing campaign, because if you fall or are the victim of a crime, you can press a button so that police or an ambulance can easily find you.) In well-traveled zip districts, like downtown, you pay an additional $2 surcharge to use the sidewalks. (“Prevents overcrowding,” say the FASTRAK ads.)

You arrive at the corner right across from the museum and put a quarter in the meter, which activates the walk light. You have ten seconds to make it across the street before the roaring traffic resumes (25 cents more would get you twenty seconds). A few teenagers and a homeless woman cross without paying, alert for the private security guards that might arrest them.

Not everyone can afford the monthly FASTRAK card, so they sneak onto the sidewalk between turnstiles or walk in the road alongside speeding cars. Pedestrian fatalities have quadrupled since the city auctioned sidewalk rights to corporations two years ago.

People passing you wear oxygen masks with various brand names emblazoned in bright colors. So far, you have chosen not to buy “fresh air” in lightweight tanks that can be easily worn when you go outside. You are not convinced the free air is that dangerous. In fact, today it seems crisp and clear. The museum entry is half price on Tuesday, only $14 with special coupons you get when making a purchase at the Gap. But you have to put up with Gap advertising throughout the exhibit. There are fewer advertisements on the days when you pay full price.

Once inside the museum, you pay $3 to use the bathroom and another $1 for washing your hands with automatically premeasured units of water, soap, and paper towel. Had you planned ahead, you would have used the Porta-Potty on the street, which costs only $1.75 but with no sink, only a Handi-wipe dispenser costing another buck. You look for a drinking fountain, until realizing how futile that is. Bottled water sells for $6 from a vendor who also runs the bathroom concession. You’ve spent enough already, you decide, and, still thirsty, trudge off in the direction of the exhibits.

____________________

Jay Walljasper is Senior Fellow at On the Commons and editor of OnTheCommons.org. This essay is an excerpt from his book, All That We Share: A Field Guide to the Commons. Kim Klein is a trainer, speaker and author of five books on fund-raising for nonprofits including Fundraising for Social Change.

Which Future Would You Choose? by Jay Walljasper & Kim Klein is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Who Are the 1 in 4 American Women Who Choose Abortion?

by Luu Ireland, M.D.

#health #analysis #logos #research #reportinginformation #argument #science #selfdiscovery #currentevents #politics #sharedvalues

The abortion debate is at the center of U.S. political dialogue. Voices from both sides flood social media feeds, newspapers, radio and television programs.

In the last year, attacks on reproductive rights sharply increased. In 2019, Georgia, Missouri, Ohio, Kentucky and Mississippi successfully passed so-called “heartbeat” bans to prohibit abortion as early as 6 to 8 weeks. Alabama is the first state to pass a complete abortion ban without exceptions for rape or incest. Due to ongoing legal challenges, these bans have yet to go into effect.

One important group’s voice is often absent in this heated debate: the women who choose abortion. While 1 in 4 women will undergo abortion in her lifetime, stigma keeps their stories untold. As an obstetrician/gynecologist who provides full spectrum reproductive health care, I hear these stories daily.

 

Unintended pregnancy

In 2011, nearly half of pregnancies in the U.S. were unintended. This reflects a 6% drop in unintended pregnancies since 2008, largely due to Title X family planning programs and easier access to birth control.

Unintended pregnancy remains most common among poor women, women of color and women without a high school education. Women living in poverty have a rate of unintended pregnancy five times higher than those with middle or high incomes. Black women are twice as likely to have an unintended pregnancy as white women.

Barriers to contraception play a major role. Among women with unintended pregnancies, 54% were using no birth control. Another 41% were inconsistently using birth control at the time of conception.

Forty-two percent of women with unintended pregnancy choose to end their pregnancies.

 

The women who choose abortion

Abortion is a routine part of reproductive health care. Approximately 25% of women in the U.S. will undergo an abortion before the age of 45. The Guttmacher Institute, a research and policy institute in New York City, has been tracking these data for the last 50 years.

American women have abortions with similar frequency to women living in other developed nations. The bulk of abortion patients are in their 20s.

Women of all races and ethnicities choose abortion. In 2014, 39% of abortion patients were white, 28% were black and 25% were Latinx. Similarly, women of all religious affiliations choose to end their pregnancies at similar frequencies.

Most of these women understand what it means to parent a child. More than half of abortion patients in 2014 were already mothers.

Poor women account for the majority of abortion patients. Fifty-three percent of women pay out-of-pocket for their abortion. The rest use private or state-funded insurance plans.

Women choose abortion for multiple reasons. The most common reason cited is that pregnancy would interfere with education, work or ability to care for dependents.

Financial stress also plays a major role in women’s decision-making. Seventy-three percent of women reported that they could not afford a baby at the time. Nearly half cited relationship difficulties or wanting to avoid single motherhood. More than a third of women felt their families were complete.

Twelve percent chose abortion due to their own health problems. For example, one of my patients and her husband were thrilled to find out she was pregnant for the first time. Then she received the diagnosis of metastatic breast cancer. She had to choose between lifesaving chemotherapy and radiation or her pregnancy.

 

Safety of abortion

Nine in 10 women who receive abortions undergo abortion in the first trimester. Only 1.3% of abortions happen with pregnancies past 20 weeks of gestation.

When performed legally by skilled practitioners, abortion is a safe medical procedure with a low complication rate. The risk of major complications – such as hospitalization, infection, blood transfusion or surgery – in first-trimester procedures is less than 0.5%. The risk of dying in childbirth is 14 times higher than the risk of dying from safe abortion.

Studies show that abortion is not linked to long-term health complications, including breast cancer, infertility, miscarriage or psychiatric disorders. The American College of Obstetricians and Gynecologists, the nation’s leading professional organization of obstetricians and gynecologists, has reaffirmed the safety of abortion.

Conversely, the negative impacts from abortion restrictions are well-documented. Women unable to obtain abortions are more likely live in poverty or depend on cash assistance, and less likely to work full-time.

Since 2011, politicians have enacted over 400 pieces of legislation restricting this medical procedure.

Access to safe and legal abortion is an essential part of health care. Most Americans agree. Sixty-four percent of Americans, regardless of pro-choice or pro-life status, would like to see the 1973 Roe v. Wade decision upheld. Another 79% want abortion to remain legal. As a physician, the health and livelihood of my patients depend on it.

____________________

Luu D. Ireland is Assistant Professor of Obstetrics and Gynecology, University of Massachusetts Medical School. Her essay originally appeared in The Conversation.

Who are the 1 in 4 American women who choose abortion by Luu D. Ireland is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Why Rituals Are Good for Your Health

by Ari Honarvar

#sharedvalues, #descriptive, #narrative, #pathos, #currentevents, #argument, #valuesbasedargument, #research, #kairos #global #religion #health

I don’t know if I could have survived seven years of my childhood without the soul-saving rituals of my Persian culture. I grew up amid the Iran-Iraq War, which killed a million people. Besides the horrors of the war, freedom of thought and expression were severely restricted in Iran after the Islamic revolution. Women bore the brunt of this as, in a matter of months, we were forced to ditch our previous lifestyle and observe a strict Islamic attire, which covered our bodies and hair. We lost the right to jog, ride a bicycle, or sing in public. Life seemed unbearable at times, but we learned to bring meaning into uncertainty and chaos by maintaining grounding practices and developing new ones.

It helped that in Persian culture we had ceremonies to turn to. We clung to 3,500-year-old Zoroastrian ceremonies that correspond to the seasons. Several of these rituals take place during the spring because the equinox marks the Persian New Year. Besides a thorough spring cleaning, we jump over a bonfire to cleanse our inner landscape and give our maladies to fire and gain vitality from it. On the longest night of the year, winter solstice, we stay up all night eating fruits and nuts, reciting poetry, playing music, and dancing. This is to symbolize survival and celebration during dark times.

Rituals, which are a series of actions performed in a specific way, have been part of human existence for thousands of years. They are not habits. According to research psychologist Nick Hobson, a habit’s inherent goal is different from a ritual’s. With habit, the actions and behaviors are causally tied to the desired outcome; for example, brushing our teeth to prevent cavities and gum disease and exercising to keep healthy. Rituals, on the other hand, are “goal demoted,” which means that their actions have no instrumental connection to the outcome. For example, we sing “Happy Birthday” to the same melody even though it isn’t tied to a specific external result.

Cristine Legare, a researcher and psychology professor at the University of Texas at Austin, says, “Rituals signify transition points in the individual life span and provide psychologically meaningful ways to participate in the beliefs and practices of the community.” They have been instrumental in building community, promoting cooperation, and marking transition points in a community member’s life. And as strange as rituals might be from a logical perspective, they have evolved as distinct features of human culture.

While it’s not clear exactly how they help, rituals reduce anxiety, improve performance and confidence, and even work on people who don’t believe in them, research shows. In a University of Toronto study, participants who performed a ritual before completing a task exhibited less anxiety and sensitivity to personal failure than when they completed the task without first performing the ritual.

Additionally, rituals benefit our physical well-being and immune system. According to Andrew Newberg, the associate director of research at the Marcus Institute of Integrative Health, rituals lower cortisol, which in turn lowers heart rate and blood pressure and increases immune system function.

We live amid a loneliness epidemic where the lack of belonging and community has been linked to high suicide rates and an increased sense of despair. The United States has one of the worst work-life balance scores in the world, while more Americans have become disillusioned with organized religion, as a broad and rapidly rising demographic consider themselves spiritual but not religious. Perhaps with fewer opportunities for people to be in community, many shared cultural rituals are falling away and with them a grounding source for connection and mental health.

In Iran during the war, we found uses for rituals when we were faced with food rations. We gathered family and friends, reciting the ancient story of the poor abused girl who had run away from home and had a vision of being visited by three celestial bibis (matrons). The bibis instructed her to make a sweet halva and donate it to the poor. The girl said she didn’t have any money, and the bibis told her to borrow or work for the ingredients. This worked well with food rations as each guest brought a few ingredients to make the halva. Like the girl in the story, each participant made a wish and took a bite of the halva. I walked away feeling calmer and more supported.

Stories, such as those told during the Jewish ceremony of Passover Seder, have become ritualized because they are recited in the same way each time. Rhythm and music play a similar role in ritual. Whether we’re chanting in Sanskrit or singing the national anthem, “our brains tend to resonate with those around us, so if everyone is doing the same dance, hymn, or prayer, all of those brains are working in the same way,” Newberg explains. “This can engender a powerful feeling of connectedness. It also reduces stress and depression through a combination of effects on the autonomic nervous system, which is ultimately connected to the emotional areas of the brain—the limbic system.” According to one study, chanting the Sanskrit syllable “om” deactivates the limbic system, softening the edge of fear, anxiety, and depression.

Psychologist Hobson confirms that rituals aren’t just a benefit to our mental health—they’re actually essential. “We are an intensely social and ritualistic species,” he says. “Take this piece out of our modern human narrative and you lose a piece of our history and our humanity.”

I moved to the U.S. when I was 14. After living here for two decades, I became a mother and was confronted with the phrase, “It takes a village to raise a child.” But where was that mythical village and the rituals that made it sane? For example, a pregnant woman in Iran had a rotating menu of dishes made for her by friends and family. A new mother was surrounded by people who took turns assisting with daily tasks. But in the U.S., she was expected to fend for herself and her baby immediately after childbirth. I observed that besides standard holiday traditions, community-building practices were lacking.

So after 20 years of living in the U.S., I decided to create my own community rituals.

I started with my family. At dinners we banned books and devices, lit candles, and discussed set topics of conversation. We held weekly family meetings with opening and closing ceremonies and used a talking stick to enforce respectful communication. At birthday dinners, we took turns saying, “I love you because …”

Candlelit dinners were no longer saved for a special occasion. Using a talking stick helped me listen more attentively and choose my words more carefully. Huddling together at the end of each family meeting provided me with a sense of accomplishment. Each ritual, no matter how small, anchored me in something bigger and provided a sense of belonging.

Then we began to build rituals within the larger community. First, we hosted a multigenerational Sunday potluck with friends and family. Each week, five to 10 of us gathered, shared food, and recounted what made us grateful. During each meal, I noticed I was lighter, more engaged with others, and laughed more.

Later, we built more community rituals into the week. I posted on Nextdoor, asking our neighbors to join us on Monday evening walks to the neighborhood park and back.

In this age of isolation, we need nourishing and uplifting means of creating community by bringing together members of different generations as our ancestors did. From my experience in Iran, rituals can be particularly valuable during hard times. In the U.S., we don’t have to worry about bombs and food rations, but we still have challenges to our security that affect our mental and physical health. Rituals can help us, though, by offering our communities opportunities for healing and support.

______________________

Ari Honarvar is an award-winning writer, speaker, and performer. In her work, she explores poetry, parenting, rituals, and the plight of refugees and asylum seekers. Her website is rumiwithaview.com. This work was previously published in Yes! Magazine.

“Why Rituals Are Good for Your Health” by Ari Honarvar is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Attributions

88 Open Essays – A Reader for Students of Composition & Rhetoric, edited and compiled by Sarah Wangler & Tina Ulrich is licensed under CC BY 4.0