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Doctors as border police: what happened to ‘first, do no harm’?

Doctors as border police: what happened to ‘first, do no harm’?

Not a doctor's domain. EQRoy/Shutterstock

Building trust and acting in the patient’s best interests are guiding principles of medical practice. This is especially true when caring for vulnerable and marginalised people, such as undocumented migrants. They often delay going to the doctor and find it hard to discuss their problems, personal history and social situation. But some countries, including the UK and US, are now actively undermining the doctor-patient relationship.

Two case studies published together in the NEJM – one from the UK, the other from the US – show how state pressure for medical involvement with anti-immigration policies hinders the duties of healthcare professionals. The case studies (composites to protect patients’ identities) describe how doctors and nurses found themselves caught up in national strategies to target and deport undocumented migrants.

Two patients put at risk of deportation

In London, Ms Z, a victim of trafficking and sexual exploitation, arrived in an emergency department suffering from anxiety and post-traumatic stress. The attending doctor told Ms Z how to register with a local GP where she could continue to get free care. As she was leaving the hospital, she was arrested and taken to a detention centre.

The doctor found out later that Nurse M, who had admitted Ms Z, called the police believing that because she could not produce identity documents she was “illegal” and therefore not entitled to care. The nurse’s action was a direct response to recent training she’d attended about the new NHS Visitor and Migrant Cost Recovery Programme that restricts free access to hospital care for migrants who are said to be attracted to the UK because of its health and welfare system.

Meanwhile, in Baltimore, US, Gloria, an undocumented migrant from Mexico, brought her disabled son, D, to a community paediatrician. According to the law, Gloria’s son is an American citizen because he was born in the US. The paediatrician knew that Gloria was anxious about government plans to increase deportations. Gloria described a recent attempted raid on her home by Immigration and Customs Enforcement (ICE) agents.

The doctor, worried about the health effects of parental deportation on D’s health provided Gloria with information about her legal rights. Another doctor, however, reported the paediatrician to the hospital’s legal office who reprimanded her for providing such information to an illegal immigrant believing this advice fell outside the duties of a doctor.

Public attitudes shaping healthcare policy

In both these cases, a healthcare professional acting in a patient’s best interest was undermined by a colleague effectively acting on behalf of the border and immigration authorities. What should clinicians do when state priorities and policies conflict with patient needs?

In response to public concern about migration and pressure from the political right, governments on both sides of the Atlantic have introduced strategies that restrict migrants’ access to welfare and increase deportations.

In the UK, Theresa May reduced access to healthcare by introducing charges for hospital care for the first time since the NHS was formed in 1947. The NHS is no longer universal (free for everyone). Hospitals have managers patrolling wards searching for people to charge and accountants to collect debts (much like in US hospitals). Doctors are expected to police access to care. The NHS has also shared patients’ addresses from their electronic GP records with the Home Office so they could be found and deported.

Theresa May’s government created a hostile environment.

Healthcare in the US is not universal. The Affordable Care Act (2010) extended coverage to the uninsured but excluded undocumented immigrants. Family separation as a result of an escalation in deportations, as in the above case, is a key tactic of US anti-immigrant policy, further increasing concerns for migrant-patient welfare.

Speaking out

Healthcare professionals are resisting the idea that some migrants are unworthy of healthcare. In the UK, doctors have advocated for their excluded patients, and lobbied (alongside NGOs) to end data-sharing with the Home Office. The British Medical Association, representing 155,000 doctors, voted on June 25, 2019, for the migrant charge to be scrapped because people have died and because it undermines the NHS.

In the US, physician organisations, such as the American Association of Pediatrics, have spoken out, supporting migrant patients and legislation that would protect hospitals from ICE activities. When faced with a choice, trust and the patient’s interests come first.

The Conversation

a.berlin@qmul.ac.uk is a Member of Medact, a volunteer for the Foundation for Family Medicine in Palestine and previously volunteered for the Helen Bamber Foundation.

Victoria Koski-Karell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.


Betting on speculative geoengineering may risk an escalating ‘climate debt crisis’

Betting on speculative geoengineering may risk an escalating ‘climate debt crisis’

Vladi333 / shutterstock

The opening of the Oscar-winning film The Big Short, a comedy-drama on the global financial crisis of 2007-2008, begins with a famous quote: “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

This phrase captures one of the main reasons why the US housing bubble popped in 2008, triggering the worst economic recession since the 1930s. The movie portrays an eccentric hedge fund manager discussing the idea of betting against subprime mortgage bonds. The investment bankers, at first, reply politely: “Those bonds only fail if millions of Americans don’t pay mortgages. That’s never happened in history.”

But it happened. And as a consequence, many people worldwide have suffered severely, and the enduring effects still haunt us, politically and economically, even a decade later.

In a new paper published in Climate Policy, we argue that a similar tragic “debt crisis” could unfold for climate change. The “debt” would be measured in excess carbon emissions, which will keep accumulating until we reach net-zero. In this scenario, the bankers are those who assume that the debt will be paid back by removing carbon from the atmosphere.

But such a bet will be necessary if we recklessly embark on the strategy of reducing emissions slowly and removing carbon later, while in the meantime using speculative technology to block out heat from the sun. Among climate scientists and policy analysts, this is the so-called temperature “overshoot and peak-shaving” scenario.

‘Overshoot and peak-shaving’

In December 2015, the world adopted the Paris Agreement and pledged to limit global temperature rise well below 2℃ – if not 1.5℃ – above pre-industrial levels. Despite that, global CO₂ emissions continue to rise.

The slow and uneven pace of global emissions reductions is increasing the likelihood of “overshoot” scenarios, in which warming will temporarily exceed 1.5 or 2°C, but will later fall to the target temperature through the large-scale deployment of negative emissions technologies. These remove CO₂ from the atmosphere by, for example, planting trees or scrubbing it through chemical filters and burying it deep underground.

But the world would still need to adapt to the impacts of increased warming during the overshooting period. Because of this concern, the idea of so-called “peak-shaving” has also emerged among some scientists who want to avoid such an overshoot by temporarily using solar geoengineering.

Solar geoengineering means dimming sunlight itself. In theory, the Earth could be cooled very quickly by, for example, spraying sulphate aerosols in the upper atmosphere.

Small particles in the upper atmosphere could reflect a few percent of incoming solar radiation.
Hughhunt, CC BY-SA

The concept of an “overshoot and peak-shaving” scenario is therefore based on the temporary use of solar geoengineering, combined with large-scale deployment of negative emissions technologies.

In this scenario, the two technologies are in a mutually dependent relationship – solar geoengineering is used to keep the temperature down for the time being, while negative emissions technologies are used to reduce atmospheric CO₂ to the point where solar geoengineering is no longer needed.

Emissions debt and temperature debt

But this assumed reciprocity may not work as intended. Here, the notion of debt is useful. As the sociologist Lisa Adkins suggests, the logic of debt rests on a promise to pay (back) in the future. In this sense, both overshooting and peak-shaving can be seen as acts of “borrowing” or “creating debt”.

Overshooting avoids reducing carbon emissions today by effectively borrowing emissions from the future (creating “emissions debt”), with a promise to pay back that debt later through negative emissions technologies.

Peak-shaving is borrowing global temperature (creating “temperature debt”) through the temporary use of solar geoengineering to cancel excess warming until the point when no further borrowing, of either sort, is needed.

In such an outcome the world will take on a double debt: “emissions debt” and “temperature debt”.

Emissions debt results from the near-term excess of CO₂ emissions in the overshoot compared to the non-overshoot scenario, while temperature debt results from the temporary masking of warming committed by excess emissions above the target temperature.
Asayama & Hulme

The analogy with housing loans

The fact of being indebted may not sound so bad. (Almost everyone has a debt of some kind in their everyday life, right?) But the key question is: can we duly pay off this “climate debt”? How credible is the promise?

Here, the analogy with housing loans is most useful for properly rating the riskiness of such debt repayment.

Given that overshoot allows slow rates of emissions reductions by “promising” that delays can be compensated later through carbon removal, this looks a bit like borrowing an adjustable-rate subprime mortgage loan. Peak-shaving, on the other hand, is more like borrowing additional loans for “home improvement”, which maintains house values – (keeps global temperature constant during the overshooting period).

Since most negative emissions technologies are still speculative or under development, overshoot should be rated like a subprime loan with a high risk of default. Just as American homeowners weren’t able to keep paying their mortgages after all, so negative emissions technologies may never be an effective enough way to take carbon out of the atmosphere.

This doesn’t sound like a secure, feasible investment. The failure to keep the overshoot promise of later repayment would lead to endless peak-shaving. Solar geoengineering would become an ongoing necessity – an unpayable massive “climate debt” accumulating year-by-year.

Framing matters — let’s not blind ourselves

Concerns over crossing so-called “tipping points” – paving the way toward a “hothouse Earth” – may push some people towards accepting overshooting and peak-shaving. But because this is a speculative scenario, it matters how we frame it.

Some scientists say that solar geoengineering is like a drug to lower high-blood pressure – an overdose is harmful, but a “well-chosen” and limited dose can lower your risks, helping you have a healthier life.

They suggest that solar geoengineering is not a substitute for cutting emissions but a supplement for containing global temperature increases. But this works only if negative emissions technologies are rolled out very swiftly on a massive scale.

Read more:
Blocking out the sun won’t fix climate change – but it could buy us time

The housing loans analogy sheds light on an important assumption that is implicitly built into such a scenario, namely that overshooting is simply like borrowing money (for example, a mortgage) and that people pay back mortgages. This was also the unquestioned assumption in the run up to the US housing market crisis and it created the systemic failure to notice the growing risk of the bubble bursting.

We shouldn’t fool ourselves into believing that a similar “debt crisis” will not happen for managing the risk of climate change. Beware the dubious promises of “overshoot and peak-shaving” technologies – they may well turn out to be risky subprime loans.

Click here to subscribe to our climate action newsletter. Climate change is inevitable. Our response to it isn’t.

The Conversation

Shinichiro Asayama receives funding from the Japan Society for the Promotion of Science, Grants-in-Aid for JSPS Research
Fellow (17J02207).

Mike Hulme does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

source: The Conversation: Environment

Apollo 11 made us believe we could do anything – the truth is it could hasten our downfall

Apollo 11 made us believe we could do anything – the truth is it could hasten our downfall

Earthrise seen from the moon by Apollo 8. NASA

The Apollo project gave us the astonishing spectacle of a blue marble rising over the sterile surface of the moon. Of course, the moon was already known to be uninhabitable. But being shown something in high-resolution colour photography makes a stronger impression than being told it by the experts. Our planet appeared in the photos as a small, vulnerable object amid surroundings utterly inimical to life. They showed, in a way that no scientific report could, the importance of keeping the Earth habitable, boosting the environmental movement.

But the moon landings affected many people in precisely the opposite way. No other public project has been such a spectacular success. The aim was so simple and concrete that everyone could immediately grasp it. Kennedy’s commitment to “landing a man on the moon and returning him safely to the Earth” was made before the US had even put a man into orbit. Yet it was achieved just eight years later – barely half the time it takes nowadays to build a new railway across London. “Top that,” the Americans can easily say. Fifty years on, no one has.

The trouble with spectacular successes is that they breed complacency. The moon landings reinforced the belief that technology will always be able to solve our problems. Everyone knows the saying, “If we can put a man on the moon, surely we can…” All we need is the will to do it. And a lot of money, of course. But not as much as you might think: the entire Apollo programme, over 12 years, cost about £120 billion in today’s money. That’s how much the US spends on its military in 11 weeks (and Britain in three years). If technology can do that, what can it not do?

This faith in technology has given us a false sense of security. Every day we hear urgent warnings about antibiotic resistance, soil depletion, deforestation, loss of biodiversity and of course climate change. These imminent catastrophes are the result of our own behaviour. The obvious solution is to change that behaviour: to stop abusing antibiotics, destroying tropical forests, burning fossil fuels, and so on. Yet we don’t.

Part of the reason we don’t is the expectation that technology will save us. If we can put a man on the moon, surely we can develop new antibiotics, replenish the soil and restore the tropical forests. We can stop climate change by building machines to remove greenhouse gases from the atmosphere. (And anyway, we can build walls to keep out the rising seas.) All we need is better politicians.

This sense of security is unwarranted. Technology cannot do everything. Once an ecosystem has been completely destroyed or a species has gone extinct, nothing can bring it back. No new Apollo programme will ever enable us to raise the dead after they have turned to dust. Some things are simply impossible – not for lack of money or technical know-how, but because of the laws of nature.

Political obstacles

And just as our sense of security overestimates the power of technology, it underestimates the political obstacles. It’s not just that large public science projects are out of fashion. The moon landings had the advantage of drawing on national pride: they served to demonstrate the superiority of the US over other countries – the Soviet Union in particular.

President John F. Kennedy sends his historic message to put a man on the moon in May 25, 1961. NASA

Combating antibiotic resistance, deforestation, and climate change, by contrast, requires all countries to work together. And these projects are unlike the moon landings in being essentially altruistic: one country’s expenditure benefits all inhabitants of the planet equally, whether or not they have contributed themselves. The selfish can get a free ride.

A further obstacle is that solving problems we have created for ourselves is not the sort of thing that easily inspires greatness. No one likes cleaning up after the party. It was easy to excite people about the first moon landing because it was such a great spectacle. We could watch it on TV in real time, from blast-off to splashdown. Like a good mini-series, it lasted just eight days. Averting catastrophe is not like that – especially when the problem cannot be shown in a simple stunning image.

Saving the planet doesn’t make compelling TV. There is no dramatic start or end point. And if the mission succeeds, the result will be only more of the same: the absence of catastrophe. What could be more boring? In democratic societies at least, addressing global problems will always be a hard sell. That’s why Kennedy’s contemporary heirs have done so little.

The success of the moon landings is no reason to expect technology to save us from ourselves. I fear it will make catastrophe more likely. Technology can help, but we need to know its limits. We’d be better off forgetting about rocketry and remembering the image of our planet as a tiny oasis in an inhospitable universe.

The Conversation

Eric Olson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Source: The Conversation: Technology http://theconversation.com/apollo-11-made-us-believe-we-could-do-anything-the-truth-is-it-could-hasten-our-downfall-120249

Barbudans are resisting ‘disaster capitalism’, two years after Hurricane Irma

Barbudans are resisting ‘disaster capitalism’, two years after Hurricane Irma

"The recovery? Look around. It been nearly two years … and I want people to know things are still bad here" – Barbuda resident Fifi. Tamzin Forster, Author provided

It’s been nearly two years since Hurricane Irma devastated the tiny Caribbean island of Barbuda. Gusts of 150mph or more damaged or destroyed almost every structure on the island, and its 1,600 residents were evacuated. Around 1,300 people soon returned, but since then, most have lived without routine public services or safe housing, and they face increasing pressure from the government to migrate off the island so it can be redeveloped for mass tourism.

Antigua and Barbuda are a twin island state. Barbuda, the smaller and less built up of the two, has until now escaped overdevelopment and has been largely left to its natural state of mangroves and scrub brush. Its residents make a living from sustainable fishing and the export of lobster, along with low-key tourism.

Since emancipation from slavery in 1834, Barbudans have governed their land in common, without private ownership. Residents and their descendants can confirm their claim for parcels of land with the democratically elected, 11-member Barbuda council.

Irma was one of the strongest Atlantic hurricanes on record, and it passed directly over Barbuda.
Tamzin Forster, Author provided

Following Hurricane Irma in 2017, the prime minister of Antigua and Barbuda – Gaston Browne – has sought to revoke this centuries-old system of communal land rights, stating that freehold tenure will allow Barbudans to secure bank loans to rebuild their houses.

Earlier in 2019, the photographer Tamzin Forster and I travelled to Barbuda to see what this meant in practice. We spoke to many local residents in order to understand how the island is – or isn’t – recovering, and what their visions were for the future of Barbuda.

À lire aussi :
‘Land grab’ on hurricane-hit Barbuda could leave the island almost entirely owned by banks

“After Irma the Antiguan side of government has been calling us all sorts of names, like inhabitants and squatters. But this is our land and we have lived here all our lives,” said Barbudan resident and resident DJ, Ordrick.

Ordrick, aka Jicky, set up a radio station in his home.
Tamzin Forster, Author provided

Browne’s rhetoric that Barbudans are “squatting” on the land has been met with collective resistance from locals who argue that the Antiguan side of government wants to establish freehold tenure to free up the island for purchase by international interests to establish private resorts for mass tourism, as in Antigua. Locals, including secretary of the island’s council, Paul Nedd, have argued that Barbudans legally own land communally.

‘Our citizens are going through a psychological trauma since Hurricane Irma. They appear normal walking by … but when they go back to their homes, they are back to that trauma’ – Paul Nedd.
Tamzin Forster, Author provided

The situation in Barbuda has been described as an example of “disaster capitalism”. As Naomi Klein argued in The Shock Doctrine, disaster capitalism describes how wealthy elites exploit crises, such as major natural disasters, to reap profits and deepen inequality, while affected populations are still in shock.

Barbudans are highly suspicious of the Antiguan government’s intentions. As only one out of 17 parliamentary members represent Barbuda, political power is concentrated in Antigua. This adds to the often tense relationship between the two islands since unification in 1981, following independence from the British.

As local resident Byron told us: “I don’t think the government is doing the best for the people. They are doing what is best for Antigua – to profit from our land. They just want a quick fix for development.”

‘We don’t need these huge hotels and international airports’ – Byron Askie.
Tamzin Forster, Author provided

Yet residents have stoically remained on the island despite difficult living conditions and a cripplingly slow disaster recovery process. There is only one bank and one post office on the island, and neither are fully functioning. The bank in Barbuda remains derelict with an ATM that only dispenses EC$100 (US$37) at a time, if it works at all. This prompted 30 Barbudans to travel to Antigua to protest about the time it is taking the Antigua Commercial Bank to return banking services. Visitors cannot access money for tours and accommodation, which is stifling the local economy.

‘If I want my post or to draw money out of the bank so I can buy materials to rebuild my house, I have to spend US$90 to go to Antigua and back’ – Romeo (right).
Tamzin Forster, Author provided

Most Barbudans we spoke to were opposed to mass development for tourism, epitomised by controversial plans – backed by Browne and Hollywood star Robert De Niro – to build a large luxury resort called Paradise Found. George Jeffreys, a 72-year-old who has been living in a tent ever since Irma, said that plans for mass tourism threaten Barbudan culture: “The Antigua side of government is against our lifestyle. We as Barbudans don’t want automatic development – we want control. It has to be developed according to our own population’s needs.”

George Jeffreys: wants control – not development.
Tamzin Forster, Author provided

Disasters are often viewed as an opportunity for societies to build back better. However, Barbudans have alternative visions of what better means for the island. “Mass development means you need more employees than the Barbudans on the island, which undermines the whole Barbuda concept of lifestyle,” resident Joycelin told us. “What needs to happen is small, effective hotels. Small effective restaurants and shops that can accommodate our community.”

Joyce: ‘We need to be able to vote on what is allowed to be built here after Irma.’
Tamzin Forster, Author provided

Ida has lived on Barbuda for more than 70 years. “We ain’t against the hotels,” she said, “but we need new industries where people can learn skills instead of us always being the cleaners in the hotels”. Others we spoke to wanted to amend regulations to allow Barbuda’s seaport to directly trade with other islands. Currently, imports and exports must go via Antigua, which means that profits from trade tariffs go directly to Antigua.

Ida (left): ‘It’s always been bad between Barbuda and Antigua, but this government is the worst.’
Tamzin Forster, Author provided

Recovery is progressing painfully slowly on Barbuda, and the Antiguan side of government continues to mount pressure for people to leave the island. For now Barbudans are continuing to fiercely defend their system of communal land rights.

The Conversation

Gemma Sou receives funding from royal geographical society

source: The Conversation: Environment

The internet is surprisingly fragile, crashes thousands of times a year, and no one is making it stronger

The internet is surprisingly fragile, crashes thousands of times a year, and no one is making it stronger

Roman Samborskyi/Shutterstock

How could a small internet service provider (ISP) in Pennsylvania cause millions of websites worldwide to go offline? That’s what happened on June 24, 2019 when users across the world were left unable to access a large fraction of the web. The root cause was an outage suffered by Cloudflare, one of the internet’s leading content hosts on which the affected websites relied.

Cloudflare traced the problem to a regional ISP in Pennsylvania that accidentally advertised to the rest of the internet that the best available routes to Cloudflare were through their small network. This caused a massive volume of global traffic to the ISP, which overwhelmed their limited capacity and so halted Cloudfare’s access to the rest of the internet. As Cloudflare remarked, it was the internet equivalent of routing an entire freeway through a neighbourhood street.

This incident has highlighted the shocking vulnerability of the internet. In 2017 alone there were about 14,000 of these kinds of incidents. Given it is mission-critical for much of the world’s economic and social life, shouldn’t the net be designed to withstand not just minor hiccups but also major catastrophes, and to prevent small problems turning into much bigger ones? Governing bodies such as the EU Agency for Network and Information Security (ENISA) have long warned of the risk of such cascading incidents in causing systemic internet failure. Yet the internet remains worryingly fragile.

Like a road network, the internet has its own highways and intersections that consist of cables and routers. The navigation system that manages the flow of data around the network is called the Border Gateway Protocol (BGP). When you visited this website, BGP determined the path through which the site’s data would be transmitted to your device.

The problem is that BGP was designed only to be a temporary fix, a “good enough” solution when the internet was rapidly growing in the late 1980s. It then proved good enough to help the net sustain its explosive expansion and quickly became part of every backbone router that manages the flow of data down the internet’s principal pathways. But it wasn’t built with security in mind, and mechanisms to ensure that the paths BGP sends data down are valid have never been added. As a result, routing errors go undetected until they cause congestion and outages.

Even worse, anyone who can access a backbone router (and doing so is trivial for someone with the right knowledge and budget) can construct bogus routes to hijack legitimate data traffic, disrupt services and eavesdrop on communications. This means the modern internet operates using an insecure protocol that is exploited on a daily basis to compromise communications from governments, financial institutions, weapon manufacturers and cryptocurrencies, often as part of politically-motivated cyber-warfare.

These issues have been known about at least since 1998, when a group of hackers demonstrated to the US Congress how easy it was to compromise internet communications. Yet, little has changed. Deploying the necessary cryptographic solutions turned out to be as hard as changing the engines of an airplane in mid-flight.

Many paths to choose from. Greg Mahlknecht/Openstreetmap, CC BY-SA

In an actual aviation issue, such as the recent issues with Boeing’s 737 MAX aircraft, regulators have the authority to ground an entire fleet until it is fixed. But the internet has no centralised authority. Different parts of the infrastructure are owned and operated by different entities, including corporations, governments and universities.

The tussle between theses different players, which often have competing interests, means they don’t have incentives to make their own part of the internet more secure. An organisation would have to bear the significant deployment costs and operational risks that come with a switch to a new technology, but it wouldn’t reap any benefits unless a critical mass of other networks did the same.

The most pragmatic solution would be to develop security protocols that don’t need global coordination. But attempts to do this have also been impeded by the decentralised ownership of the internet. Operators have limited knowledge of what happens beyond their networks because of companies’ desires to keep their business operations secret.

As a result, today nobody has a complete view of our society’s most critical communications infrastructure. This hinders efforts to model the internet’s behaviour under stress, making it harder to design and evaluate trustworthy solutions.

Improving security

The direct implications of this bleak situation on national security have led government agencies to intensify their activities to protect their critical internet infrastructure. For example, the UK National Cyber Security Centre (NCSC) recently launched the Active Cyber Defence (ACD) program, which puts the security of internet routing among its top priorities.

As part of this program, my own research involves mapping the internet at an unprecedented level of detail. The aim is to illuminate hidden locations where the infrastructure is particularly susceptible to attack and responsible for cascading failures.

At the same time, new initiatives are attempting to make security a more routine consideration for people who work for organisations controlling internet infrastructure.

As we become more economically dependent on the internet, the cost of outages will grow further. And the advent of cryptocurrencies, whose transactions are fundamentally vulnerable to BGP hijacking attacks, could finally make resolving this problem a priority for internet infrastructure businesses.

It’s no exaggeration to say that the internet is currently a cyber Wild West. But after two decades of ineffectual efforts, there’s a chance the outlaw days may slowly be nearing to an end.

The Conversation

Vasileios Giotsas receives funding from HM Government. He is affiliated with the Association for Computing Machinery (ACM)

Source: The Conversation: Technology http://theconversation.com/the-internet-is-surprisingly-fragile-crashes-thousands-of-times-a-year-and-no-one-is-making-it-stronger-120364

ADHD: how race for the Moon revealed America’s first hyperactive children

ADHD: how race for the Moon revealed America’s first hyperactive children

America's space race with Russia revealed an education system that was not up to the task, with many children diagnosed with ADHD. Shutterstock

As the world commemorates the 50th anniversary of the first moon landing, we can appreciate the numerous technological advances that have emerged through space exploration, ranging from artificial limbs and water purification systems, to satellite TV and freeze-dried food. But the race for space that was contested between the US and the Soviet Union also resulted in profound social changes, including the discovery of a new childhood psychiatric disorder: Attention Deficit Hyperactivity Disorder (ADHD).

On October 4, 1957, the Russians successfully launched two Sputnik satellites into orbit, beating America into space. For Americans who believed that they were the predominant scientific and technological power during the early years of the Cold War, Sputnik came as a profound shock. Politicians, military leaders, scientists and educators immediately began asking why the US had fallen behind the Soviets and soon found their culprit: the American education system.


Join us as we delve into the last 50 years of space exploration and the 50 years to come. From Neil Armstrong’s historic first step onto the lunar surface to present-day plans to use the moon as a launchpad to Mars, hear from academic experts who’ve dedicated their lives to studying the wonders of space.

Since the 1920s, the prevailing ideology in American education had been progressive education, a philosophy pioneered by educational reformer John Dewey. Progressive education was a child-centred approach through which children learned by doing and by discovery in flexible, active educational spaces where they worked at their own pace.

Rather than learning from a textbook, children might learn about botany by growing a vegetable garden. By selling their wares to the local community, they would engage in writing and art by creating advertising for their produce, and arithmetic and economics in setting prices and calculating profits.

Changing the system

Although progressive education was compelling in theory, it was difficult to implement in practice. It was quickly identified by critics as one of the key explanations for US failings in the space race. Sputnik demonstrated to critics that American children should no longer be allowed to learn at their own pace and in their own way. The pressure to train new scientists, engineers and astronauts demanded that the country’s education system upped its game and cracked down on those not capable of making the grade.

A comprehensive response came in 1958, with the passage of the National Defense Education Act (NDEA), which emphasised a return to subject-centred, teacher-centred learning in rigid, fixed learning environments, where students were expected to match the pace set by the curriculum.

Specifically, NDEA provided US$1 billion to achieve three aims:

1. Renewed focus on core subjects, including science, maths, English and foreign languages;

2. Drastic reduction in the number of students dropping out of school for low-skilled jobs;

3. Raising of educational achievement for children from all social and ethnic backgrounds from the slums to the suburbs.

Thousands of guidance counsellors were hired (ideally at a ratio of one to every 250-300 pupils) to help schools achieve these goals. These counsellors were expected to:

… be on the lookout for the bright boy or girl whose high ability has been demonstrated through … aptitude tests … but whose achievement, as measured by grades … has been low.

But what was underlying such underachievement before this point? It soon became apparent that underachievers exhibited certain characteristics which were seen to undermine their academic progress: hyperactive, impulsive, inattentive behaviour along with occasional defiance and aggression. In other words, all the hallmarks of ADHD.

Discovering ADHD

Helping to transform what was an educational problem into a medical one was a new psychiatric condition identified in 1957: hyperkinetic impulse disorder. Prior to the emergence of this term – which is virtually synonymous with ADHD – children had to demonstrate extremely pronounced hyperactive, impulsive and often violent behaviour for their behaviours to be considered pathological.

In many cases, brain damage or allergies were identified as the root causes for such symptoms. The definition of hyperkinetic impulse disorder drastically lowered this threshold, creating a disorder that could be found in most classrooms .

Guidance counsellors emerged as the lynchpin between the educational sphere, where such behaviours were identified, and the medical sphere, where they were diagnosed and treated. Although psychiatrists debated the best way to treat such children, stimulant drugs, such as methylphenidate (commonly known as Ritalin which was made available for use in children in 1962), quickly became the preferred option.

By the late 1960s, what we now call ADHD was the most common childhood psychiatric disorder and Ritalin had become a bestseller for its initial manufacturer, Ciba, which engaged in a vigorous marketing campaign to promote its use.

Although Ritalin was acknowledged to be an effective treatment for many, though not all, hyperactive children, it was almost immediately controversial due to its side effects and its chemical similarity to banned stimulants. Many also thought it was wrong to give children a drug to treat a contested disorder; debates about Ritalin and other ADHD medication have not faded away.

Along with the space race, a long list of other factors contributed to heightened academic expectations of children and in increased hyperactive, impulsive and inattentive behaviour in children more generally.

ADHD diagnosis in children remains controversial.

On the one hand, for example, the GI Bill provided millions of American servicemen with funding to engage in higher education, creating an expectation that their children would follow suit. Equally, the massive bulge of the 75m baby boomers born after World War II exerted huge pressures on an education system already buckling under the strain of the Great Depression and the war itself.

On the other hand, a raft of post-war developments – chemicals in the food supply, lead in the atmosphere, reduced tolerance for corporal punishment, less physical activity and time spent outdoors – arguably made children more likely to be hyperactive, impulsive and inattentive.

A decade later, on July 20, 1969, the US had won the space race. But this achievement had unexpected consequences. Regardless of whether one supports ADHD as a valid diagnosis or not, a wide range of factors – not least those bound up in the race to the moon – led to its discovery in American children.

The Conversation

Matthew Smith receives funding from the Wellcome Trust.


Helping smokers quit: financial incentives work

Helping smokers quit: financial incentives work

Bokeh Blur Background/Shutterstock

Smoking kills one in two regular smokers, but quitting at any point in life leads to big improvements in health, increased life expectancy and savings in healthcare costs. That’s why we need a range of ways to help people quit – and new evidence shows that paying people to quit is one way to boost quit rates.

Our recently updated Cochrane review looked at the evidence from 33 trials and found strong evidence that incentive programmes help people to quit smoking, increasing quit rates at six months or longer by about 50%. In these programmes, smokers who could prove they’d quit smoking were rewarded financially. Some have expressed concern that smokers would return to smoking once the financial rewards ended, but the studies showed that people stayed smoke free, even after the rewards finished.

Financial incentives can come in all shapes and sizes. In our review, they ranged from vouchers for goods or services, to actual money. We didn’t find any evidence that success varied based on the amount of the reward, but more studies are needed to investigate this. Some studies paid people money, others were deposit programmes where people deposited their own money at the start and then had the chance to earn it back by staying smoke free.

There was no evidence that the success rates were different when it was a deposit programme. It might be harder to attract smokers to take part in a deposit programme, but they might be more attractive for programme providers worried about the cost or potential backlash of paying smokers to quit.

Immediate reward

There are compelling reasons why paying people to quit might help them. Financial incentives can reward the desired behaviour of being smoke free. Paying people may also offer the benefit of an immediate positive outcome of stopping smoking, providing instant gratification, as many find it difficult to think about the longer-term health benefits of stopping smoking.

That’s why it’s encouraging that more and more programmes do this – including programmes that help pregnant women stop smoking and programmes for people with a history of substance misuse.

Providing incentives as a way to help people quit, however, presents different challenges to offering support through, say, quitlines or counselling. Though quit rates among these different approaches appear broadly similar, some people worry that non-smokers will enrol on the financial-reward programmes just to get paid.

But most programmes test the levels of smoking-related chemicals in participants’ blood, breath or urine before allowing them on the programme, so this is unlikely to happen. Also, there’s no evidence of this kind of deception regularly occurring.

Most programmes test levels of smoking-related chemicals.

In other cases, there are concerns about how certain programmes reward quitting. For example, the tobacco firm Philip Morris recently launched an insurance company that includes financial benefits for smokers who quit. The amount of the benefit depends on how they quit and whether they use other Philip Morris products to do so.

Some people object, in principle, to paying people to quit as it may be seen as unfair that non-smokers receive nothing in comparison. After all, people who’ve never smoked aren’t eligible for such programmes. This is an important point to address because public acceptance of public health interventions is key to their success.

Of course, on some level, these programmes are rewarding smokers, but it is difficult to conceive that anyone would start smoking just to enter such a programme. The vast majority of smokers start young, influenced by billions spent on advertising directly targeting them. In this scenario, smoking is not a free choice; it’s a behaviour constrained by social influence that can become an addiction.

Most smokers want to quit. They know smoking is bad for their health; they know it is costing them and society dearly, but cigarettes have been designed to make quitting really difficult. As a society, if there’s anything we can do to make this easier, shouldn’t we?

The Conversation

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.


Breastfeeding support cuts are leaving unpaid volunteers to fill the role of public health

Breastfeeding support cuts are leaving unpaid volunteers to fill the role of public health

Anton Korobkov/Shutterstock

Support plays a vital role in enabling women to breastfeed for longer. It helps solve many different challenges, stops physical and emotional pain, and helps women feel accepted as part of a community. Yet across the UK, many breastfeeding support services have been cut. Austerity is usually cited, with policymakers failing to see that such support could save the NHS many millions, even billions, further down the line.

So who picks up the slack? Volunteers. Charities. Women who have breastfed their own babies (often through difficulties) who can’t bear to see women sold a dream of “breast is best” then failed with an absence of actual support. Imagine that for any other area of health – sorry your hip is broken, can’t help with any medical treatment, but if you pop along to the association for broken hips, they’ll help you.

Breastfeeding might be “natural” but just like many physical skills, it can take time to learn. In previous generations, when breastfeeding rates were much higher, we would have learnt about breastfeeding as we grew up. We would have seen it happening more often in our families and communities, directly and indirectly learning how it worked. There would have been little need for promotion of breastfeeding or organised support because the community would have picked up and supported any issues.

Fast forward to today and we just don’t see breastfeeding in the same way in our day to day lives – unsurprising given less than half of babies are receiving any breastmilk at all by six weeks, and only half of women who breastfeed ever do so in public.

In one study in Scotland, less than half of pregnant women reported having seen someone breastfed in the last 12 months. More astonishing than that, a study of teenagers in Ireland found only half had ever seen a baby breastfed in their lives.

In the absence of this everyday learning, coupled with cuts to formal support, women are turning to a different type of community in the form of online support groups and social media pages. Typically run on a voluntary basis, these groups are designed to help women with breastfeeding challenges and provide a circle of support particularly for those in “real life” communities where breastfeeding rates are very low.

When mothers are struggling, the internet can be a vital lifeline.

Our new research shows just what a lifeline these online groups can be. In a series of interviews with mothers who had recently turned to online breastfeeding support, the findings highlighted just what a service gap these groups were plugging for new mothers.

When the local group closes down, and a mother can’t reach her overstretched health visitor fast enough to solve the pain she is experiencing, these groups are her answer. And given the global nature of some pages, and the regularity of babies waking at night, someone, somewhere, is always there, bleary-eyed or otherwise.

Online groups also provide a layer of support that face-to-face provision cannot bring. They don’t require you to be out of the door at a certain time, or even dressed. They don’t even require you to make actual conversation. You can listen to others’ stories when anything more than clicking “like” feels too much. This means that these groups play a vital role in supporting mothers who may be struggling with new motherhood, with local online groups helping mothers feel confident in building up to attending their face-to-face version (if they still exist).

The women we spoke to attributed the support they received in these groups to enabling them to continue breastfeeding. Which means that these groups are essentially propping up services that should be centrally funded. After all, although women value breastfeeding, by doing so they are benefiting the government by reducing the need for GP appointments, hospital treatment and days off work. So why, in an era where so much we do is now online, can the work of these groups not be recognised, valued and supported through funding?

The lack of funding can mean that some experience a dark side to online support. Groups that are led by those who are not trained to support breastfeeding, or do not have qualifications to manage complications, may be giving inconsistent, misleading or downright dangerous advice. The internet allows anyone to set themselves up as an expert, with no requirement that the advice that they give is accurate.

A lack of moderation by someone trained to do so can also mean that some online groups may do more harm that good. Women in our study reported online fights breaking out, polarised debates, and judgements being made (particularly against women who had decided for whatever reason that they needed to introduce formula milk).

Some level of regulation is needed to ensure women get the best possible information and support, yet many that do have these structures in place are still relying on volunteers, placing significant demands on their time and even well-being.

When breastfeeding mothers need help, women and communities will come to support them. But this major public health responsibility should not be laid in the lap of unpaid volunteers.

The Conversation

Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd – 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.

With many thanks to Sian Regan who led the research as part of her MSc in Child Public Health at Swansea University.


Space radiation: the Apollo crews were extremely lucky – future astronauts may not be

Space radiation: the Apollo crews were extremely lucky – future astronauts may not be

Apollo Lunar Rover – Apollo 15. Irwin with the LRV on the Moon

As the 50th anniversary of humankind’s first moon landing approaches, the conspiracy theories that claim the Apollo missions were a hoax refuse to die. One perennial anomaly pointed to by moon landing deniers is that the Apollo astronauts could never have survived their passage of two belts of intense radiation partly surrounding the Earth at heights of several thousand kilometres.

Although some fairly straightforward physics can dispense with the idea of a barrier of deadly radiation imprisoning us on our planet, like all good conspiracy theories it is built on a kernel of truth. There is potentially harmful radiation in space. So how did the astronauts survive it?

The term “radiation” is used to describe energy that is emitted in the form of electromagnetic waves and/or particles. Humans can perceive some forms of electromagnetic radiation: visible light can be seen and infrared radiation (heat) can be felt.

Meanwhile, other varieties of radiation such as radio waves, X-rays and gamma rays are not visible and require special equipment to be observed. Worryingly, when high energy (ionising) radiation encounters matter, it can cause changes at the atomic level, including in our bodies.

To the moon and beyond is a new podcast series from The Conversation marking the 50th anniversary of the moon landings. Listen and subscribe here.

There are a several sources of ionising radiation in space. The sun continuously pours out electromagnetic radiation across all wavelengths – especially as visible, infrared and ultraviolet radiation. Occasionally, enormous explosions on the solar surface known as solar flares release massive amounts of X-rays and gamma rays into space, as well as energetic electrons and protons (which make up the atomic nucleus along with neutrons). These events can pose a hazard to astronauts and their equipment even at distances as far from the sun as Earth, the moon and Mars.

Potentially dangerous radiation in space also originates from outside our solar system. Galactic cosmic rays are high energy, electrically charged atomic fragments that travel at nearly the speed of light and arrive from all directions in space.

On Earth, we are protected from most of this ionising radiation. The Earth’s strong magnetic field forms the magnetosphere, a protective bubble that diverts most dangerous radiation away, while the Earth’s thick atmosphere absorbs the rest.

Van Allen belts. NASA

But above the atmosphere, the magnetosphere traps energetic subatomic particles in two radiation regions. These “Van Allen belts” comprise an inner and outer torus of electrically charged particles.

Lucky escape

So how did NASA solve the problem of crossing the Van Allen belts? The short answer is they didn’t. To get to the moon, a spacecraft needs to be travelling quickly to climb far enough away from the Earth such that it can be captured by the moon’s gravity. The trans-lunar orbit that the Apollo spacecraft followed from the Earth to the moon took them through the inner and outer belts in just a few hours.

Although the aluminium skin of the Apollo spacecraft needed to be thin to be lightweight, it would have offered some protection. Models of the radiation belts developed in the run-up to the Apollo flights indicated that the passage through the radiation belts would not pose a significant threat to astronaut health. And, sure enough, documents from the period show that monitoring badges worn by the crews and analysed after the missions indicated that the astronauts typically received doses roughly less than that received during a standard CT scan of your chest.

But that is not the end of the story. To get to the moon and safely back home, the Apollo astronauts not only had to cross the Van Allen belts, but also the quarter of a million miles between the Earth and the moon – a flight that typically took around three days each way.

They also needed to operate safely while in orbit around the moon and on the lunar surface. During the Apollo missions, the spacecraft were outside the Earth’s protective magnetosphere for most of their flight. As such, they and their crews were vulnerable to unpredictable solar flares and events and the steady flux of galactic cosmic rays.

The crewed Apollo flights actually coincided with the height of a solar cycle, the periodic waxing and waning of activity that occurs every 11 years. Given that solar flares and solar energetic particle events are more common during times of heightened solar activity, this might seem like a cavalier approach to astronaut safety.

There is no doubt that the political imperative in the 1960s to put US astronauts on the moon “in this decade” was the primary driving factor in the mission timing, but there are counterintuitive benefits to spaceflight during solar activity maxima. The increased strength of the sun’s magnetic field that permeates the solar system acts like an umbrella – shielding the Earth, moon and planets from galactic cosmic rays and therefore lessening the impact on astronaut radiation doses.

Join us as we delve into the last 50 years of space exploration and the 50 years to come. From Neil Armstrong’s historic first step onto the lunar surface to present-day plans to use the moon as a launchpad to Mars, hear from academic experts who’ve dedicated their lives to studying the wonders of space.

History tells us that the gamble of flying during the years of high solar activity during the Apollo era paid off. None of the Apollo flights were blasted by powerful solar flares or engulfed by clouds of solar energetic particles. But there could have been a different outcome.

On August 4, 1972 – mid-way between the safe return to Earth of the Apollo 16 crew and the launch of Apollo 17 – a solar energetic particle event was detected. Had this struck a crew en route to the moon, or working on the lunar surface, it is likely that the astronauts would have needed to make an emergency return to Earth for prompt and potentially life-saving medical treatment, all while suffering from acute radiation sickness.

Even now, forecasting “space weather” is a challenge. Astronauts working on board the International Space Station in low Earth orbit benefit from much of the protection offered by the Earth’s magnetosphere, but they can also take shelter in the best shielded areas of the station if required.

But for crews on future lunar missions, or beyond the moon to Mars, dealing with the space radiation risk remains a key challenge. When your flight lasts months rather than days, the odds of dodging space radiation bullets are simply not as favourable.

The Conversation

Jim Wild receives research funding from UK Research and Innovation, specifically the Natural Science Research Council and the Science and Technology Facilities Council.

Source: The Conversation: Technology http://theconversation.com/space-radiation-the-apollo-crews-were-extremely-lucky-future-astronauts-may-not-be-120339

To the moon and beyond 3: The new space race and what winning it looks like

To the moon and beyond 3: The new space race and what winning it looks like

From Algeria to Vietnam, there are 72 countries with some sort of space programme. And the new space race involves a number of private companies too, that are becoming increasingly crucial to national missions.

In the third episode of To the moon and beyond, we find out who some of the key players are in this new space race, what they are competing for and what winning looks like.

Space exploration has long been driven by competition. As we heard in the first episode of this podcast series, the success of NASA’s Apollo missions to the moon was driven by the Cold War between the US and the Soviet Union. After the US had won this space race, they soon stopped sending manned missions to the moon because of the cost and the risks involved.

But, for all the similarities with 50 years ago, John Horack, who holds the Neil Armstrong chair in aerospace policy at Ohio State University in the US, says today is very different.

There are still significant national prestige and pride factors associated with spaceflight. But there are many many things going on in space that have absolutely nothing to do with national prestige. They’re about economics. They’re about philanthropic activities, they’re about testing new business models. So it’s less of a race and more of an explosion.

Join us as we delve into the last 50 years of space exploration and the 50 years to come. From Neil Armstrong’s historic first step onto the lunar surface to present-day plans to use the moon as a launchpad to Mars, hear from academic experts who’ve dedicated their lives to studying the wonders of space.

Still, only three countries have successfully sent astronauts into space: Russia, the US and China. And one of the most exciting developments in space exploration, which took place earlier this year, was China’s successful Chang’e 4 mission. In January 2019, Chang’e 4 made a soft landing on the mysterious far side of the moon – the first time this has been done.

Yang Gao, professor of space autonomous systems at the University of Surrey, tells us why this was a remarkable feat of engineering. She also explains some of China’s plans to conduct scientific research on this south side of the moon – where there is evidence of an abundance of hydrogen and water ice.

These are really very exciting for us because those resources can potentially provide in the future the life support for human habitation or long-term existence on the moon, instead of us transporting those resources from Earth.

China’s success seems to have put rocket boosters under the US government’s space plans. Donald Trump’s administration has talked a lot about increasing NASA’s budget in order to send a manned mission to the moon in the next five years, looking to use it as a base for exploring Mars and beyond.

As well as new countries getting involved in space, the explosion of space activity that’s taken place in recent years has come from a number of commercial players entering the fray. The world’s first space tourist was an American billionaire called Dennis Tito who paid US$20m for an eight-day trip to the International Space Station in 2001. But the space tourism industry is still struggling to get off the ground. We talk to Louis Brennan, a business professor at Trinity College Dublin who researches space businesses, about whether the industry will ever take off.

If you imagine civil aviation and the way civil aviation evolved from being one which very few people partook in to one in which it became an activity engaged in by the masses. If space were to evolve in a similar way, space travel, then one could envisage these companies becoming quite profitable.

Read more: How Luxembourg is positioning itself to be the centre of space business

It’s not just tourism, though. There are myriad opportunities to make money through space now. Brennan talks us through the business models of Elon Musk’s SpaceX and Blue Origin, which was founded by Amazon’s Jeff Bezos. Both are successfully reducing the costs of space travel by developing reusable rockets. And riding on their coat tails are a number of other new and innovative companies.

So for all the talk of a new space race, today’s competition doesn’t to be a zero sum game where some groups win and others lose. From scientific projects to business endeavours, we find out how different countries and businesses are collaborating to push the boundaries of human discovery.

To the moon and beyond is a global collaboration between different editions of The Conversation around the world, hosted by Miriam Frankel and Martin Archer. You can listen via The Conversation, or subscribe wherever you get your podcasts by hitting the “Listen and Subscribe” button at the top of this page.


To the moon and beyond is produced by Gemma Ware and Annabel Bligh. Additional reporting by Johnathan Gang. Sound editing by Siva Thangarajah. Thank you to City, University of London’s Department of Journalism for letting us use their studios.

Picture source: SpaceX Falcon rocket, SpaceX on Unsplash

Music via Free Music Archive:

Even when we fall and Western Shores by Philipp Weigl. An Oddly Formal Dance and Bedroll by Blue Dot Sessions. Canada, by Pictures of the Floating World, and Awake by Scott Holmes.

And As time passes marimba via Zapslat.

Archive footage:

Dennis Tito making history, BBC World Service, Fifth meeting of the National Space Council, NASA, President Trump announces plan to send NASA back to the moon, PBS Newshour, Dark side of the moon: China’s Chang’e 4 probe makes historic landing, by Guardian News, Chinese Chang’e-4 lunar probe makes first landing on far side of the moon, CGTN, The International Space Station: The next hot tourist destination, Al Jazeera, The New Space Race,Google Lunar XPRIZE, Israel’s Beresheet Spacecraft to Enter Moon’s Orbit, i24NEWS English. Apollo 11 and 17 audio from NASA.

The Conversation

Martin Archer receives funding from the Science and Technology Facilities Council.

Miriam Frankel works for The Conversation.

Source: The Conversation: Technology http://theconversation.com/to-the-moon-and-beyond-3-the-new-space-race-and-what-winning-it-looks-like-120372