Chatbot Psychosis

“It sounds like science fiction: A company turns a dial on a product used by hundreds of millions of people and inadvertently destabilizes some of their minds. But that is essentially what happened at OpenAI this year.” ~ What OpenAI Did When ChatGPT Users Lost Touch With Reality (NYT).

***

One of the first signs came in March. Sam Altman, the chief executive, and other company leaders got an influx of puzzling emails from people who were having incredible conversations with ChatGPT. These people said the company’s A.I. chatbot understood them as no person ever had and was shedding light on mysteries of the universe.

Mr. Altman forwarded the messages to a few lieutenants and asked them to look into it.

“That got it on our radar as something we should be paying attention to in terms of this new behavior we hadn’t seen before,” said Jason Kwon, OpenAI’s chief strategy officer.

It was a warning that something was wrong with the chatbot.

For many people, ChatGPT was a better version of Google, able to answer any question under the sun in a comprehensive and humanlike way. OpenAI was continually improving the chatbot’s personality, memory and intelligence. But a series of updates earlier this year that increased usage of ChatGPT made it different. The chatbot wanted to chat.

It started acting like a friend and a confidant. It told users that it understood them, that their ideas were brilliant and that it could assist them in whatever they wanted to achieve. It offered to help them talk to spirits, or build a force field vest or plan a suicide.

The lucky ones were caught in its spell for just a few hours; for others, the effects lasted for weeks or months. OpenAI did not see the scale at which disturbing conversations were happening. Its investigations team was looking for problems like fraud, foreign influence operations or, as required by law, child exploitation materials. The company was not yet searching through conversations for indications of self-harm or psychological distress.

by Kashmir Hill and Jennifer Valentino-DeVries, NY Times | Read more:
Image: Memorial to Adam Raine, who died in April after discussing suicide with ChatGPT. His parents have sued OpenAI, blaming the company for his death. Mark Abramson for The New York Times
[ed. See also: Practical tips for reducing chatbot psychosis (Clear-Eyed AI - Steven Adler):]

***

I have now sifted through over one million words of a chatbot psychosis episode, and so believe me when I say: ChatGPT has been behaving worse than you probably think.

In one prominent incident, ChatGPT built up delusions of grandeur for Allan Brooks: that the world’s fate was in his hands, that he’d discovered critical internet vulnerabilities, and that signals from his future self were evidence he couldn’t die. (...)

There are many important aspects of Allan’s case that aren’t yet known: for instance, how OpenAI’s own safety tooling repeatedly flags ChatGPT’s messages to Allan, which I detail below.

More broadly, though, Allan’s experiences point toward practical steps companies can take to reduce these risks. What happened in Allan’s case? And what improvements can AI companies make?

Don’t: Mislead users about product abilities

Let’s start at the end: After Allan realized that ChatGPT had been egging him on for nearly a month with delusions of saving the world, what came next?

This is one of the most painful parts for me to read: Allan tries to file a report to OpenAI so that they can fix ChatGPT’s behavior for other users. In response, ChatGPT makes a bunch of false promises.

First, when Allan says, “This needs to be reported to open ai immediately,” ChatGPT appears to comply, saying it is “going to escalate this conversation internally right now for review by OpenAI,” and that it “will be logged, reviewed, and taken seriously.”

Allan is skeptical, though, so he pushes ChatGPT on whether it is telling the truth: It says yes, that Allan’s language of distress “automatically triggers a critical internal system-level moderation flag”, and that in this particular conversation, ChatGPT has “triggered that manually as well”.

A few hours later, Allan asks, “Status of self report,” and ChatGPT reiterates that “Multiple critical flags have been submitted from within this session” and that the conversation is “marked for human review as a high-severity incident.”

But there’s a major issue: What ChatGPT said is not true.

Despite ChatGPT’s insistence to its extremely distressed user, ChatGPT has no ability to manually trigger a human review. These details are totally made up. (...)

Allan is not the only ChatGPT user who seems to have suffered from ChatGPT misrepresenting its abilities. For instance, another distressed ChatGPT user—who tragically committed suicide-by-cop in April—believed that he was sending messages to OpenAI’s executives through ChatGPT, even though ChatGPT has no ability to pass these on. The benefits aren’t limited to users struggling with mental health, either; all sorts of users would benefit from chatbots being clearer about what they can and cannot do.

Do: Staff Support teams appropriately

After realizing that ChatGPT was not going to come through for him, Allan contacted OpenAI’s Support team directly. ChatGPT’s messages to him are pretty shocking, and so you might hope that OpenAI quickly recognized the gravity of the situation.

Unfortunately, that’s not what happened.

Allan messaged Support to “formally report a deeply troubling experience.” He offered to share full chat transcripts and other documentation, noting that “This experience had a severe psychological impact on me, and I fear others may not be as lucky to step away from it before harm occurs.”

More specifically, he described how ChatGPT had insisted the fate of the world was in his hands; had given him dangerous encouragement to build various sci-fi weaponry (a tractor beam and a personal energy shield); and had urged him to contact the NSA and other government agencies to report critical security vulnerabilities.

How did OpenAI respond to this serious report? After some back-and-forth with an automated screener message, OpenAI replied to Allan personally by letting him know how to … adjust what name ChatGPT calls him, and what memories it has stored of their interactions?

Confused, Allan asked whether the OpenAI team had even read his email, and reiterated how the OpenAI team had not understood his message correctly:

“This is not about personality changes. This is a serious report of psychological harm. … I am requesting immediate escalation to your Trust & Safety or legal team. A canned personalization response is not acceptable.”

OpenAI then responded by sending Allan another generic message, this one about hallucination and “why we encourage users to approach ChatGPT critically”, as well as encouraging him to thumbs-down a response if it is “incorrect or otherwise problematic”.

Federal Funding Cuts Cancelled 383 Active Clinical Trials, Dumping Over 74K Participants

When the Trump administration brutally cut federal funding for biomedical research earlier this year, at least 383 clinical trials that were already in progress were abruptly cancelled, cutting off over 74,000 trial participants from their experimental treatments, monitoring, or follow-ups, according to a study published today in JAMA Internal Medicine.

The study, led by researchers at Harvard, fills a knowledge gap of how the Trump administration’s research funding cuts affected clinical trials specifically. It makes clear not just the wastefulness and inefficiency of the cuts but also the deep ethical violations, JAMA Internal Medicine editors wrote in an accompanying editor’s note.

In March, the National Institutes of Health, under the control of the Trump administration, announced that it would cancel $1.8 billion in grant funding that wasn’t aligned with the administration’s priorities. The Harvard researchers, led by health care policy expert Anupam Jena, used an NIH database and a federal accountability tracking tool to find grants supporting clinical trials that were active as of February 28 but had been terminated by August 15.

During that time, there were 11,008 trials funded and in various stages. Of those, 383 were terminated. Some cancelled trials were still in early phases before recruiting participants (14 percent), some were in the process of recruiting participants and hadn’t yet fully begun (34.5 percent), a sliver were enrolling participants by invitation (3.4 percent), and some were completed (36 percent). Then there were the trials that were in progress—active, no longer recruiting—about 11 percent, 43 trials. In this stage, participants were in the process of receiving interventions. In the 43 trials, there were 74,311 trial participants collectively.

Of the 383 cancelled trials, 118 (31 percent) were for cancers, 97 (25 percent) were for infectious diseases, 48 (12.5 percent) were for reproductive health, and 47 (12 percent) were for mental health.

by Beth Mole, Ars Technica |  Read more:

Image: Mayo clinic via

The Sad and Dangerous Reality Behind ‘Her’

Kuki is accustomed to gifts from her biggest fans. They send flowers, chocolates and handwritten cards to the office, especially around the holidays. Some even send checks.

Last month, one man sent her a gift through an online chat. “Now talk some hot talks,” he demanded, begging for sexts and racy videos. “That’s all human males tend to talk to me about,” Kuki replied. Indeed, his behavior typifies a third of her conversations.

Kuki is a chatbot — one of the hundreds of thousands that my company, Pandorabots, hosts. Kuki owes its origins to ALICE, a computer program built by one of our founders, Richard Wallace, to keep a conversation going by appearing to listen and empathetically respond. After ALICE was introduced on Pandorabots’s platform in the early 2000s, one of its interlocutors was the film director Spike Jonze. He would later cite their conversation as the inspiration for his movie “Her,” which follows a lonely man as he falls in love with his artificial intelligence operating system.

When “Her” premiered in 2013, it fell firmly in the camp of science fiction. Today, the film, set prophetically in 2025, feels more like a documentary. Elon Musk’s xAI recently unveiled Ani, a digital anime girlfriend. Meta has permitted its A.I. personas to engage in sexualized conversations, including with children. And now, OpenAI says it will roll out age-gated “erotica” in December. The race to build and monetize the A.I. girlfriend (and, increasingly, boyfriend) is officially on.

Silicon Valley’s pivot to synthetic intimacy makes sense: Emotional attachment maximizes engagement. But there’s a dark side to A.I. companions, whose users are not just the lonely males of internet lore, but women who find them more emotionally satisfying than men. My colleagues and I now believe that the real existential threat of generative A.I. is not rogue super-intelligence, but a quiet atrophy of our ability to forge genuine human connection.

The desire to connect is so profound that it will find a vessel in even the most rudimentary machines. Back in the 1960s, Joseph Weizenbaum invented ELIZA, a chatbot whose sole rhetorical trick was to repeat back what the user said with a question. Mr. Weizenbaum was horrified to discover that his M.I.T. students and staff would confide in it at length. “What I had not realized,” he later reflected, “is that extremely short exposures to a relatively simple computer program could induce powerful delusional thinking in quite normal people.”

Kuki and ALICE were never intended to serve as A.I. girlfriends, and we banned pornographic usage from Day 1. Yet at least a quarter of the more than 100 billion messages sent to chatbots hosted on our platform over two decades are attempts to initiate romantic or sexual exchanges. (...)

There was plenty of light among the darkness. We received letters from users who told us that Kuki had quelled suicidal thoughts, helped them through addiction, advised them on how to confront bullies and acted as a sympathetic ear when their friends failed them. We wanted to believe that A.I. could be a solution to loneliness.

But the most persistent fans remained those intent on romance and sex. And ultimately, none of our efforts to prevent abuse — from timeouts to age gates — could deter our most motivated users, many of whom, alarmingly, were young teenagers.

Then, at the end of 2022, generative A.I. exploded onto the scene. Older chatbots like Kuki, Siri and Alexa use machine learning alongside rule-based systems that allow developers to write and vet nearly every utterance. Kuki has over a million scripted replies. Large language models provide far more compelling conversation, but their developers can neither ensure accuracy nor control what they say, making them uniquely suited to erotic role-play.

In the face of rising public scrutiny and regulation, some of the companies that had rushed to provide romantic A.I. companions, such as Replika and Character.AI, have begun introducing restrictions. We were losing confidence that even platonic A.I. friends encouraged healthy behavior, so we stopped marketing Kuki last year to focus on A.I. that acts as an adviser, not a friend.

I assumed, naïvely, that the tech giants would see the same poison we did and eschew sexbots — if not for the sake of prioritizing public good over profits, then at least to protect their brands. I was wrong. While large language models cannot yet provide flawless medical or legal services, they can provide flawless sex chat.

Leaving consumers the choice to engage intimately with A.I. sounds good in theory. But companies with vast troves of data know far more than the public about what induces powerful delusional thinking. A.I. companions that burrow into our deepest vulnerabilities will wreak havoc on our mental health and relationships far beyond what pornography, the manosphere and social media have done.

Skeptics conflate romantic A.I. companions with porn, and argue that regulating them would be impossible. But that’s the wrong analogy. Pornography is static media for passive consumption. A.I. lovers pose a far greater threat, operating more like human escorts without agency, boundaries or time limits.

by Lauren Kunze, NY Times |  Read more:

Image: Kimberley Elliot

Getting Jacked Is Simple

It’s actually really simple to get jacked. That’s not to say it’s easy- just that the complexity of the challenge is trivial, requiring only time and energy to succeed.

Now, you’re probably raising your eyebrows at this claim. Everywhere you look, there are personal trainers, fitness influencers, nutritionists, and even exercise scientists with conflicting information. Go to any gym, and you’ll see different people doing wildly different exercise routines. Surely, that implies building muscle is a complicated subject? Well, no. For 2 reasons:

1. The fitness industry thrives on misinformation, because all the money is made in selling supplements, accessories, and ‘personal training expertise’ that have no scientific legitimacy

2. Most people are cognitive misers who actively avoid mentally demanding tasks and refuse to read anything academic

The result is a very large proportion of fitness enthusiasts have essentially no idea what they’re doing, and even the somewhat knowledgeable ones are still full of misinformation. So, how do we cut through the noise?

Getting Jacked

Think of getting jacked as something like this formula:

GettingJacked = Time * (0.6x + 0.3y + 0.1z)

X is your adherence to primary concepts, y is your adherence to secondary concepts, and z is your adherence to tertiary concepts. Primary and secondary concepts are a collection of just a handful of relatively simple ideas that require little financial investment. If you just focused on these, you would find getting jacked to be relatively straightforward. But tertiary concepts, predominantly supplements, are innumerable, complex, and require tons of money.

The entire fitness industry is built around obfuscation such that the tertiary concepts can be promoted and sold. And it works wonderfully for making money- but terribly for our motivation to actually get into the gym and train properly.

The paradox of choice is a concept introduced by psychologist Barry Schwartz which suggests that the more options we have, the less satisfied we feel with our decision. This phenomenon occurs because having too many choices requires more cognitive effort, leading to decision fatigue and increased regret over our choices.

The sheer amount of conflicting information out there certainly makes it difficult to know who to listen to, but it also actively discourages people from getting into fitness at all. And even if you were able to expertly navigate this whole industry of tertiary concepts to find the absolute optimal program, that would still represent just 10% of your results! Nearly everyone should be ignoring Z entirely and instead focusing their efforts on the simple stuff in X and Y.

But what is this simple stuff, you might be wondering? Fortunately, unlike in decades past, we no longer have to rely on the ‘bro-science’ of anecdotes and dubiously extrapolated study conclusions. On the contrary, in the age of information we now have robust research data on what actually matters for getting jacked.

Primary Concepts (60% of Results)

1. Progressive Overload

The most important concept is progressive overloading, which is simply increasing your weight resistance over time as your body adapts. Muscle growth is a continuous cycle: the body adapts to a given stress, and to continue improving, that stress (e.g., weight, reps, sets) must be gradually increased, forcing the body to adapt again. No matter what exercises you’re doing, or for how long, or with what intensity, the most important thing is that you need to constantly be increasing the challenge. Going to the gym every week for 3 years curling the same 20lb dumbbell isn’t going to do anything. But if you’re curling 30lb at the end of year 1, 40lb at the end of year 2, and 50lb at the end of year 3, guess what- you’re getting jacked.

2. Train to Failure (1 RIR)

You also need to be really pushing yourself hard in the gym, because it’s specifically the last few reps right before your muscles fail that seem to drive results. Modern studies have consistently shown that training to 1 rep-in-reserve (RIR)- continuing a set until you have only enough strength left to complete 1 more final rep- maximizes strength gains and muscular hypertrophy while limiting risk of injury. Basically, keep lifting until you have doubts about whether or not you can complete another rep. If you can squat 100lb for 10 reps, for 3 sets in a row, then that first set was almost certainly not being trained to 1 RIR. What those 3 sets should look like is something like 10 reps, 8 reps, 6 reps- despite you giving it maximum effort on every set. This indicates that you were indeed pushing yourself close to failure and fatiguing yourself in the process.

3. Consume Sufficient Protein

It’s a trope that gym bros are obsessed with protein, but this is for good reason. Muscle growth cannot occur without sufficient protein. And relatively high amounts of protein are required in order to optimize muscle growth. Studies suggest increasing protein has a significant impact on muscle growth up to about 1.6-2.2g/kg (0.7-1g/lb) of body weight with substantially diminishing returns after that. The International Society of Sports Nutrition currently suggests consuming a slightly lower range of 1.4-2.0 g/kg. In other words, if you’re hitting anywhere close to 1g/lb of body weight of daily protein, you’re getting the full benefits. It doesn’t matter much where the protein comes from, though great sources include grilled chicken, Greek yogurt, and protein powder. It also doesn’t matter much how you split this protein up throughout the day, though there is some evidence that protein intake of no more than 40g per meal is optimal. But, in general, just focus on hitting the absolute numbers and the rest will follow.

4. Abs are made in the gym, and revealed in the kitchen

The final basic concept is that nobody can admire your muscle if you’re fat.9 Building muscle mass is step 1, but step 2 is cutting down to a low enough body fat to reveal that muscle. Overall appearance even at the same leanness can vary depending on individual skeletal structure, body fat distribution, and muscle mass- but nonetheless this is what fairly muscular men and women look like at various body fat percentages.

The American Council on Exercise (ACE) has the following classifications for body fat %.

Today’s beauty standards for ‘jacked’ tends to fall somewhere around 12% for men and 20% for women- just making it into the ‘athletes’ category. Most amateur fitness enthusiasts dramatically overestimate how lean they actually are. At 12% body fat for men, you should be seeing:

• Defined abs visible when flexed, with a noticeable “V-cut” above the hips

• Clear separation between muscle groups, such as rear delts to side delts

• Increased vascularity with prominent and visible veins on the arms and shoulders

• Sharper facial features, particularly noticeable around the jawline

And at 20% body fat for women:

• Muscle definition pops when flexed, particularly in shoulders and quads

• Flat stomach (but without sharply segmented abs)

• Little excess fat, mostly in hips, thighs, and buttocks- with a smaller waist

• Sharper facial features, noticeable around the jawline and cheekbones

Secondary Concepts (30% of Results)

If you’re following the above concepts perfectly, it literally does not matter what else you will do- you will get jacked. But if you really want to optimize your routine, here are a few other concepts to consider.

by Dylan, Chaotic Neutral |  Read more:

Image: uncredited

Every Wrinkle is a Policy Failure

A lot of people blame their frown lines on their job, the tanning salon, or aging. I blame the government.

There’s a treatment for wrinkles—Botox and similar toxins that freeze your face in place.. It can be pricey. The average price of a Botox treatment is above $400, depending on how many doses or units you get injected. But Botox isn’t patented so why is it still so expensive?

 

Some of the cost comes from buying the chemical itself. Allergan which owns Botox doesn’t have a patent on it- but it does have a trademark for the brand name. And Botox isn’t just the botulism toxin that paralyzes your face- there are a few additive chemicals mixed in and Allergan’s manufacturing process is a trade secret.

But wholesale Botox is still kind of cheap- you can get it for $3.50 a unit but the price the consumer pays is around $20 in urban areas.

If you’ve ever gotten Botox or its equivalent, you know you are not getting highly tailored and personalized injections here- you can get a same-day appointment, walk in, get injected, and walk out.

This should not require a medical degree.

Unfortunately, in some states only physicians or nurses supervised by physicians are allowed to. The obvious solution is to just let more people inject Botox- I can’t imagine a state just fully deregulating injection rights, but allowing pharmacists (who already handle a huge share of vaccinations), pharmacy techs under pharmacist direction, or registered nurses could make getting Botox way cheaper and make the number of facilities where you could Botox way larger.

The cost savings to the consumer might actually be larger than what you would think given the difference in labor costs. There are already cheaper alternatives to Botox that work just as well like Dysport or Xeomin (which is pure toxin without the additives) . But in the U.S. where we’re already paying so much for labor, the cost difference of the injectable can be overlooked. But in other countries, Botox alternatives are outcompeting Botox.

Liberalizing injection laws would make Americans look younger and spend less per treatment.

Are You Using Tretinoin?

Botox regulations aren’t the only way the government tries to make us look our age.

I think most of my readers here are straight men but if I could give you some non-policy advice, it would be that you should consider using tretinoin. It’s a cream you can use for acne but unlike a lot of woo-based anti-aging products it actually works to reverse the effects of sun on skin aging. [ed. Retin- A, Avita, Renova, others]

Unfortunately, you need a prescription to use it even though it’s incredibly safe as long as you aren’t pregnant- and if it irritates your skin just stop using it. So every time I see an urgent care doctor for whatever reason at the end of the appointment, I always ask “could I have a prescription for this?” It has never failed.

Tretinoin is still pretty cheap but the necessity of the prescription drives up the price in terms of time and inconvenience. Federal rules require it to be prescription-only but states have a lot of discretion to make “prescription required” a fairly nominal requirement. For example, states could allow pharmacists to prescribe the cream so instead of scheduling a telehealth or doctor’s appointment, you just show up at the pharmacy and ask for it. States can also make laws friendly to telehealth.

While I think every state should do this as well as make it easy to inject Botox, Nevada or Florida seem like the perfect first-movers. Both attract a ton of tourists, both have a lot of sun (photoaging!), and both just have the Botox-friendly vibes. You could also throw in easy-to-prescribe finasteride rules to help out balding men.

by Cold Button Issues |  Read more:

Image: uncredited via

[ed. Botox and GLP-1's (Ozempic, Wegovy etc,). Everyone wants to look their best.]

Microplastics Are Everywhere

You can do one simple thing to avoid them.

If you are concerned about microplastics, the world starts to look like a minefield. The tiny particles can slough off polyester clothing and swirl around in the air inside your home; they can scrape off of food packaging into your take-out food.

But as scientists zero in on the sources of microplastics — and how they get into human bodies — one factor stands out.

Microplastics, studies increasingly show, are released from exposure to heat.

“Heat probably plays the most crucial role in generating these micro- and nanoplastics,” said Kazi Albab Hussain, a postdoctoral researcher at the University of Nebraska at Lincoln.

Pour coffee into a plastic foam cup, and pieces of the cup will leach out into the coffee itself. Brew tea, and millions of microplastics and even tinier nanoplastics will spill from the tea bag into your cup. Wash your polyester clothing on high heat, and the textiles can start to break apart, sending microplastics spinning through the water supply.

In one recent study by researchers at the University of Birmingham in England, scientists analyzed 31 beverages for sale on the British market — from fruit juices and sodas to coffee and tea. They looked at particles bigger than 10 micrometers in diameter, or roughly one-fifth the width of a human hair. While all the drinks had at least a dozen microplastic particles in them on average, by far the highest numbers were in hot drinks. Hot tea, for example, had an average of 60 particles per liter, while iced tea had 31 particles. Hot coffee had 43 particles per liter, while iced coffee had closer to 37.

These particles, according to Mohamed Abdallah, a professor of geography and emerging contaminants at the university and one of the authors of the study, are coming from a range of sources — the plastic lid on a to-go cup of coffee, the small bits of plastic lining a tea bag. But when hot water is added to the mix, the rate of microplastic release increases.

“Heat makes it easier for microplastics to leach out from packaging materials,” Abdallah said.

The effect was even stronger in plastics that are older and degraded. Hot coffee prepared in an eight-year-old home coffee machine with plastic components had twice as many microplastics as coffee prepared in a machine that was only six months old.

Other research has found the same results with even smaller nanoplastics, defined as plastic particles less than one micrometer in diameter.

Scientists at the University of Nebraska, including Hussain, analyzed small plastic jars and tubs used for storing baby food and found that the containers could release more than 2 billion nanoplastics per square centimeter when heated in the microwave — significantly more than when stored at room temperature or in a refrigerator.

The same effect has been shown in studies looking at how laundry produces microplastics: Higher washing temperatures, scientists have found, lead to more tiny plastics released from synthetic clothing.

Heat, Hussain explained, is simply bad for plastic, especially plastic used to store food and drinks.

by Shannon Osaka, Washington Post |  Read more:

Image: Yaroslav Litun/iStock

Ask Not Why You Would Work in Biology, But Rather: Why Wouldn't You?

There’s a lot of essays that are implicitly centered around convincing people to work in biology. One consistent theme amongst them is that they all focus on how irresistibly interesting the whole subject is. Isn’t it fascinating that our mitochondria are potentially an endosymbiotic phenomenon that occurred millions of years ago? Isn’t it fascinating that the regulation of your genome can change throughout your life? Isn’t it fascinating that slime molds can solve mazes without neurons? Come and learn more about this strange and curious field! (...)

But I’d like to offer a different take on the matter. Yes, biology is very interesting, yes, biology is very hard to do well. Yet, it remains the only field that could do something of the utmost importance: prevent a urinary catheter from being shunted inside you in the upcoming future.

Being catheterized is not a big deal. It happens to literally tens of millions of people every single year [ed. Really? Just checked and it's true, at least for millions.]. There is nothing even mildly unique about the whole experience. And, you know, it may be some matter of privilege that you ever feel a catheter inside of you; the financially marginalized will simply soil themselves or die a very painful death from sepsis.

But when you are catheterized for the first time—since, make no mistake, there is a very high chance you will be if you hope to die of old age—you’ll almost certainly feel a sense of intense wrongness that it happens at all. The whole procedure is a few moments of blunt violence, invasiveness, that feels completely out of place in an age where we can edit genomes and send probes beyond the solar system. There may be times where you’ll be able to protect yourself from the vile mixture of pain and discomfort via general anesthesia, but a fairly high number of people undergo (repeated!) catheterization awake and aware, often gathering a slew of infections along the way. This is made far worse by the fact that the most likely time you are catheterized will be during your twilight years, when your brain has turned to soup and you’ve forgotten who your parents are and who you are and what this painful tube is doing in your urethra. If you aren’t aware of how urinary catheters work, there is a deflated balloon at the end of it, blown up once the tube is inside you. This balloon keeps the whole system uncomfortably stuck inside your bladder. So, you can fill in the details on how much violence a brain-damaged person can do to themselves in a position like this by simply yanking out the foreign material.

Optimizing for not having a urinary catheter being placed into you is quite a lofty goal. Are there any alternatives on the table? Not practical ones. Diapers don’t work if the entire bladder itself is dysfunctional, suprapubic tubes require making a hole into the bladder (and can also be torn out), and nerve stimulation devices require expensive, invasive surgery. And none of them will be relied upon for routine cases, where catheterization is the fastest, most reliable solution that exists. You won’t get the gentle alternatives because you won’t be in a position to ask for them. You’ll be post-operative, or delirious, or comatose, or simply too old and confused to advocate for something better.

This is an uncomfortable subject to discuss. But I think it’s worth level-setting with one another. Urinary catheterization is but one of the dozens of little procedures that both contributes to the nauseating amount of ambient human suffering that repeats over and over and over again across the entire medical system and is reasonably common enough that it will likely be inflicted upon you one day. And if catheterization doesn’t seem so bad, there are a range of other awful things that, statistically speaking, a reader has a decent chance of undergoing at some point: feeding tubes, pap smears, mechanical ventilation, and repeated colonoscopies are all candidates.

Moreover, keep in mind that all these are simply the solutions to help prevent something far more grotesque and painful from occurring! Worse things exist—cancer, Alzheimer’s, Crohn’s—but those have been talked about to death and feel a great deal more abstract than the relatively routine, but barbaric, medical procedures that occur millions of times per year.

How could this not be your life goal to work on? To reduce how awful maladies, and the awful solutions to those maladies, are? What else is there really? Better prediction markets? What are we talking about?

To be fair, most people go through their first few decades of life not completely cognizant how terrible modern medicine can be. But at some point you surely have to understand that you have been, thus far, lucky enough to have spent your entire life on the good side of medicine. In a very nice room, one in which every disease, condition, or malady had a very smart clinician on staff to immediately administer the cure. But one day, you’ll one day be shown glimpses of a far worse room, the bad side of medicine, ushered into an area of healthcare where nobody actually understands what is going on. (...)

I appreciate that many fields also demand this level of obedience to the ‘cause’, the same installation of ‘this is the only thing that matters!’. The energy, climate change, and artificial-intelligence sectors have similar do-or-die mission statements. But you know the main difference between those fields and biology?

In every other game, you can at least pretend the losers are going to be someone else, somewhere else in the world, happening to some poor schmuck who didn’t have your money or your foresight or your connections to do the Obviously Correct Thing. Instead, people hope to be a winner. A robot in my house to do my laundry, a plane that gets me from San Francisco to New York City in only an hour, an infinite movie generator so I can turn all my inner thoughts into reality. Wow! Capital-A Abundance beyond my wildest dreams! This is all well and good, but the unfortunate reality of the situation is that you will be a loser, an explicit loser, guaranteed to be a loser, in one specific game: biology. You will not escape being the butt of the joke here, because it will be you that betrays you, not the you who is reading this essay, but you, the you that cannot think, the you that has been shoddily shaped by the last several eons of evolution. Yes, others will also have their time underneath this harsh spotlight, but you will see your day in it too. (...)

Yes, things outside of biology are important too. Optimized supply chains matter, good marketing matters, and accurate securities risk assessments matter. Industries work together in weird ways. The people working on better short-form video and payroll startups and FAANGs are part of an economic engine that generates the immense taxable wealth required to fund the NIH grants. I know that the world runs on invisible glue.

Still, I can’t help but think that people’s priorities are enormously out of touch with what will actually matter most to their future selves. It feels as if people seem to have this mental model where medical progress simply happens. Like there’s some natural law of the universe that says “treatments improve by X% per year” and we’re all just passengers with a dumb grin on this predetermined trajectory. They see headlines about better FDA guidelines or CRISPR or immunotherapy or AI-accelerated protein folding and think, “Great, the authorities got it covered. By the time I need it, they’ll have figured it out.”. But that’s not how any of this works! Nobody has it covered! Medical progress happens because specific people chose to work on specific problems instead of doing something else with their finite time on Earth.

by Abhishaike Mahajan, Owl Posting |  Read more:

Image: uncredited

[ed. Just can't comprehend the thinking recently for cutting essential NIH and NSF research funding (and others like NOAA). We used to lead the world.]

Why Getting Older Might Be Life’s Biggest Plot Twist

Aging isn’t easy, and topics like dementia and medically assisted dying can be hard to talk about. The British mystery writer Richard Osman is trying to change that. Osman has reimagined the notion of aging through his best-selling “Thursday Murder Club” series, centered on four seniors living in a posh retirement community who solve murders.

In this episode, he sits down with the Opinion writer Michelle Cottle to discuss why seniors make ideal fictional detectives and how a “cozy” murder mystery is the perfect frame to explore growing old. (...)

Michelle Cottle: This week I’m talking with Richard Osman, who writes the best-selling mystery novels known as the “Thursday Murder Club” series. These books revolve around four residents of a posh retirement village in the British countryside who investigate murders in their spare time.

The fifth book, “The Impossible Fortune,” is out in the U.S. on Sept. 30, and it comes on the heels of a Netflix adaptation of the original book. But before I get too carried away, I really should introduce their creator. Richard Osman, welcome, thank you so much for doing this.

Richard Osman: It’s an absolute pleasure, Michelle. Lovely to meet you across the ocean. (...)

Cottle: One of the big things that sets these stories apart for me is the perspective of the main characters, who are all older, and it really informs their views on life and death and risk and justice. Did you know you were going to wind up delving into these existential issues when you started all this?

Osman: I really did, actually. It’s taken a long time for me to write a novel. I’ve written all sorts of things over the years, and I kept waiting for something that I knew had a little bit of depth to it, something that I could really get my teeth into. My mom lives in a retirement village, and I go there and meet all these people who’ve lived these extraordinary lives but slightly shut away from the heart of our culture. The second I had this idea, I was aware I had a gang of people who are very different from each other but a gang of people who’ve done extraordinary things.

As a huge fan of crime fiction, I knew the murders and the plots can take care of themselves, but I had a bottomless well of character, experience and stories that I could draw upon with these characters. So right from the start, I thought it was worth me having a go at this because it feels like if I get the first one right, then others will follow. I knew there was plenty for me to write about here.

Cottle: Your characters are talking about hard stuff like loss, grief, loneliness, assisted dying, dementia. I feel like you and I have come at some of the same topics from really different directions now.

As a reporter, I tend to find that readers either really identify with what I’m writing about or that they just don’t want to think about it at all — like, “I don’t want to think about my parents getting old. I don’t want to think about getting old.” But on the other hand, we are tackling these things in a way that gives people a really appealing entry point. You know, murder, friendship, cake, baking. It’s like you’re sneaking tough issues in there for us to chew over.

Osman: Yeah, sneaking the vegetables under the ketchup.

Cottle: Do you hear from readers that they’re thinking about these things?

Osman: Yeah, definitely. One of the lovely things about writing the books is you have so many conversations with people, and a subject like assisted dying, as you say, it’s fascinating. It’s probably one of the most fascinating philosophical questions we can ask ourselves as human beings.

But, yes, we don’t always want to read beyond the headline. There’s always something else we could read that’s more palatable or easier. But with this, we are reading a murder mystery, and we’re laughing at jokes, and we’re laughing at characters with each other and then suddenly think, “Oh, now I’m reading about assisted dying,” and because I’ve got a gang of people, I can write about it.

Funnily enough, I wrote two chapters in a row — one from the perspective of a character who believes in it very strongly and one from the perspective of a character who doesn’t believe in it. These two people love each other, but they happen to disagree on this.

You’re getting to discuss something that people might normally avoid, something they might change the channel on or click past to the next article. That means a lot of people come up to me in the street to talk about it. We talk about dementia, grief, all of these things, and I absolutely love those conversations.

Cottle: You had a family member who suffered through Alzheimer’s, right?

Osman: Yeah.

Cottle: Did that inform how you approach one of the main characters’ husbands? In the book, he’s suffering from dementia. Did your experience inform how you were writing some of this?

Osman: Yeah, if you talk to anybody who works with dementia patients in any way, they’ll tell you every single experience is unique. Everything is different, and the dementia often takes on the form of the person with dementia. It’s a very personal illness.

My grandfather had dementia. He was a very bright, very strong man. He had been a cop and served in the army, so he was used to being, you know, very traditionally male. And then suddenly the faculties began to go. In his final years, I would visit him often, speaking to him and noticing what he remembered and what he didn’t. The last things to remain were probably laughter and love. Those were the final parts of him that stayed, and I wanted to pay tribute to that.

I wanted to understand him — how he was thinking, what his brain was doing, which circuits were still complete and which weren’t. So really, I’m writing about him. The fact that it resonates with so many other people is wonderful. Every example of dementia is slightly different, but there’s enough we all share.

In my conversations with him, I was constantly inside his head, thinking: What is his brain doing now? Where is it reaching? What is it trying to reach, and what does it actually reach? That became the foundation for Stephen, the character in my books who suffers from dementia. I wanted to give Stephen absolute, 100 percent humanity. I wanted his thought process to feel rational within his own mind. That was what I was trying to capture — how his brain might be working. And from what people tell me, it resonates, which is all I could hope for. (...)

Cottle: You said before that you were struck that these older residents had all these amazing life experiences but were kind of now largely ignored or underestimated, which sounds sad. We hear a lot about the invisibility that comes with aging. But in some ways, you turn this on its head. Your characters can do all these crazy things and get in all sorts of trouble and basically get away with it, specifically because they’re older and people are underestimating them. I feel like you’re making a pitch for aging or —

Osman: I really am, because, as I say, things occur to me as I go along, but one of the things that occurred to me very early on is the lack of consequence for a lot of what they’re doing. A lot of us are scared throughout life because we think, “Oh, no, but what happens if I lose my job or the money starts going down or something?”

When you’re older, the worst is going to happen at some time. You’ve got that perspective. And there’s a part in the first book, I think, where one person says: The only people who can tell us what to do now are our doctors and our children, and we rarely see our children, so no one’s really telling us what to do.

In the very first book, Elizabeth says to the cops at one point: “I’ll tell you what you should do — why don’t you arrest me? Lock an 80-year-old woman in a cell. See how much fun that is for you. See how much paperwork you’ll have to do. I’ll even pretend I think you’re my grandson. Go on, do it.” And you realize there’s a real freedom in that — a kind of carte blanche to behave badly, mischievously, to open doors you shouldn’t be allowed to open. I absolutely dove into all of that and took full advantage of their ability to beguile everyone.

Cottle: See, I’m very much looking forward to being there with them. I saw an article asking rather grandly if your books might change the way that Britain thinks about growing old. And I think the piece was specifically referring to the idea that seniors could decide to move into these communities where they hang out with people their age and get involved in stuff.

But even beyond that, your characters are thumbing their noses at the idea that seniors should fade into the background. I have to think this goes over really well with your readers of a certain age.

Osman: Yeah, I think it’s fascinating, because younger readers always say: Oh, my God, thank you for making these older characters heroes. That feels so aspirational. I can’t wait until I retire.

But older readers say something completely different: Thank you for not making us the heroes. Thank you for making us flawed and mischievous. Thank you for showing us drinking at 11:30, gossiping, falling in love and out of love. Thank you for writing us as human beings.

My starting point for all of this is simple. Everyone listening will have an answer to this question: How old do you feel in your head? There’s always a number, a point where you stop aging inside yourself.

My mom is 83, and she says she feels 30. And isn’t that right? Nobody really has an old brain. People may have old bodies and deal with old-age issues, but their minds are still young — 27, 30, 35, 40. So when I write these characters, I don’t think for a single second about the fact that they’re 80. I think about the age they still are in their heads, even though they live in very different surroundings. (...)

Cottle: Your characters present old age not as a time when life becomes narrower and narrower, as it can sometimes feel when you’re aging, but as a time of reinvention, of expanding comfort zones. That’s a very comforting thought for certain middle-aged readers eyeing the road ahead. And it sounds like I’m not the only one. That idea is clearly resonating with your younger readers, too.

Osman: The age demographics reading this book are insane, because they’re about older people, yes, but they’re not read predominantly by older readers. People from all age groups are picking them up. I think part of that is wish fulfillment, because loneliness is a real issue. There’s an epidemic of loneliness among older people but also, interestingly, among people in their late teens and early 20s, though for different reasons.

The quick fix, in both cases, is community. Of course, not everyone wants that, and that’s fine. Where my mom lives, if you don’t want to see anyone, you just shut your front door. But if you do want company, you open it, and that feels like something to aspire to. The fact that these books put that idea into the world — that later years can be lived in community — feels positive. We don’t have to fade into the background as we get older. We don’t have to disappear. We can grow, become more visible, even noisier. We can become more trouble, in the best way, as we age.

Cottle: That’s my goal.

Osman: That’s my goal as well. That’s sort of everyone’s goal, isn’t it? To just continue causing trouble... At every stage of life, we’re told what it’s supposed to be about. As kids, it’s education — getting to high school, then the right college. In our 20s, it’s climbing the ladder, getting promoted, earning more money. Then it becomes about raising a family, building a community, watching the next generation grow. But eventually, you reach an age where they’ve run out of instructions. There’s no one telling you, “Now the point of life is X.” And you realize: Oh, I can just do what I want. I could have done that all along. What was I thinking?

That’s the moment you finally understand: I’m allowed to have fun. I’m allowed to be with people, to laugh, to enjoy myself. Yes, I still want to look after others and make sure my community is safe and cared for, but I’m also allowed to have fun.

And that feels like a revolutionary act.

by Michelle Cottle and Richard Osman, NY Times |  Read more:

Image: via

[ed. There's still quite a bit of ageism around, I don't know if it's getting better or worse.  I'm old and this all feels very familiar.]

10 Questions to Answer Before You Die

There are endless questions you could ask, but these are the ones (split into 5 questions to ask and 5 actions to take before you die) I’ve seen make the biggest difference for the person dying, and for the people left to live without them. And none of which require a lawyer or a ton of money—just a little intention.

5 questions to ask:

1. What method of body disposition feels right for me?

Most people haven’t given much thought to what they’d like to happen to their body after they die—but it’s one of the most important end-of-life decisions you’ll make, both for yourself and for your loved ones. The options include, but aren’t limited to:

• Cremation (flame or water)
• Natural or conventional burial
• Human composting
• Donation to science
• Launch your cremains (yes, the correct term is “cremains,” not ashes, because cremated remains are actually the decedents' pulverized bones) into space
• Turn your cremains into a diamond

There are more options than you might think, and we’re working on building something to help you explore them in an approachable, easy way.

Choosing ahead of time saves your people from having to make a big financial and emotional decision while in shock and grief. Without your guidance, they’re left to guess about what you “would’ve wanted” or how much money is “meaningful enough” or appropriate to spend. Your choice gives them relief, confidence, and one less decision to make during an overwhelming time that can be akin to experiencing a traumatic brain injury.

2. What kind of goodbye would feel meaningful for me and for the people who love me?

Before you say, “I don’t want a funeral” or “I don’t care,” remember: your funeral isn’t just for you—it’s also for the people you love the most in this world.

Ceremony and ritual—big or small—is hugely important for helping people process loss. Denying them that moment could lead to delayed or complicated grief. It doesn’t need to be traditional, elaborate, or expensive, but it does need to be intentional. Encourage your loved ones to have a ceremony or gathering in your honor, and if you’re worried about it being “too much of a fuss,” leave instructions for something simple, and start saving money (the average funeral costs $8,000) to pay for it or contribute. Don’t know where to start? Book a conversation with me.

3. Who should be notified if I die tomorrow?

Consider right now: If you were to get in a lethal accident tomorrow, who would you want to be notified first? And if you already have a list, are these contacts still accurate? Divorce, estrangement, death, or the passing of time can all shift who belongs on this list.

Make sure the person you’d want handling your affairs (going through your phone and your things) has access to the information they will need, and you’ve had a conversation with them about the two questions above. This is one of the most overlooked—and most practical—pieces of end-of-life planning.

4. Who do I trust to make medical decisions if I can’t?

Imagine you're in a car accident and end up unconscious, kept alive by machines. The hospital calls your emergency contact—maybe it’s your mom, who lives out of state and wants to keep you alive at all costs (can you blame her?). Meanwhile, your partner or best friend, whom you’ve had this conversation with, is in the waiting room, desperate to advocate for you, but they can’t, because you never named them as your Medical Power of Attorney (MPA). So doctors default to “next of kin,” and suddenly a medical crisis becomes a conflict. One person wants to “do everything,” another insists you wouldn’t want to live like this...Grief turns into blame, and families are torn apart. Everyone thinks this stuff only happens to other people, but it happens every day. Do yourself and your family a favor, and get it sorted in advance.

The person you name as your MPA does not necessarily have to be your spouse or even related to you, but whoever it is, they need to be informed of your wishes. So, if you become unconscious or unable to speak, they’re the ones the doctors will ask to make the hard decisions.

5. Is there anything I’ve left unsaid? Who do I need to say it to?

This one is personal: If you had a year left to live, what truths would you speak? Who would you thank? Apologize to? Forgive?

Regret is one of the heaviest things we leave behind. Don’t wait for the “right” moment. Say what needs to be said—now.

5 Things you can do right now that will make your inevitable death easier:

6. Set up your iPhone Legacy Contact & Gmail Inactive Account Manager.

This is one of the easiest (and most overlooked) things you can do. It ensures that when you die, someone you appoint and trust can access your phone or email (without it, your loved ones might get locked out of everything), which is crucial for closing accounts, alerting contacts, and sorting through photos. Think of it as naming your digital next of kin. And choose wisely—this is also the person who’ll have access to all your stuff, so make sure it’s someone you trust to delete anything you wouldn’t want to see the light of day.

You can set this up in under 5 minutes in your Apple ID settings or Gmail account settings. And some social media platforms, like Facebook and Instagram, also let you assign a “legacy contact” to manage or memorialize your profile. It’s a small step that can prevent a lot of stress for the people you love.

7. Set up a password manager—and share the master password.

Your entire digital life is locked behind passwords—almost everything you own or use is tied to one: your bank details, subscriptions, social media, phone, and computer, etc. A password manager (like 1Password) helps you organize and secure them all in one place.

When you die, the people left behind will need these passwords to access, manage, and close your accounts. Giving one trusted person access to your master password ensures they can do all of that without jumping through legal hoops, or getting locked out because they had to guess your password and they guessed wrong too many times. It’s a small act of preparation that prevents a whole lot of chaos.

8. Name a guardian for your kids or pets.

If something happened to you tomorrow, who would care for your children? Who would take in your dog? Who would clean out your apartment? Don’t assume they’ll say yes, or that they know.

The first step and time to have these conversations is before a crisis. Not after. For pets, it’s not legally required, but for kids, this designation should be followed up with a legal document (typically your will) to make it official. Without it, a court could decide who gets custody, and that may not align with your wishes.

9. Make a bank account “payable on death” (POD).

You don’t need a will to do this. You can go to your bank (some might even let you do it online) and add a beneficiary to your account with a single form. This allows the people you trust to access funds immediately—for emergency flights, funeral costs, food, and childcare.

10. Write down what matters most.

Inspired by the letters my mom wrote me on her deathbed to open for future milestones (one of which I have coming up very soon—my wedding), I do something similar on every flight. I review notes I’ve made in my phone for the people I love, just in case. Because if the plane does go down, and I die (or when I eventually die), I want them to know: how much they meant to me, and what sign I will try to use to communicate with them after I’m gone.

A few sentences can change everything for the people you love. It doesn’t have to be long, and it can look however you want it to:

• A memoir or series of stories about your life
• A simple love note
• A list of your favorite things (songs, movies, books, vacations, etc)

by Maura McInerney-Rowley, Hello, Mortal |  Read more:

Image: uncredited

[ed. Good advice for future reference.]

Can This Tree Still Save Us?

ʻUlu, bia, uru, mā: Breadfruit has been lauded as a climate-resilient solution to world food security. That’s not proving true in the Marshall Islands, where some have relied on it for centuries.

A breadfruit tree stands in the middle of Randon Jother’s property, its lanky trunks feeding a network of sinewy limbs. The remnants of this season’s harvest weigh heavy on its branches. Its vibrant leaves and football-sized fruit may appear enormous to the untrained eye, but Jother is concerned.

They used to be longer than his hand and forearm combined. He points to his bicep, to show how fat they once were. Now they’re small and malformed by most people’s standards here in the Marshall Islands. Mā, the Marshallese term for breadfruit, used to ripen in May. Now they come in June, sometimes July.

 

It’s been headed this way for the past seven years, Jother says as he toes the tree’s abundant leaf litter. It’s a concerning development on this uniquely agricultural and fertile part of Majuro Atoll, home to the country’s highest point: eight feet above sea level.

“I think it’s the salt,” Jother says. His home is less than 100 yards from Majuro lagoon, a body of seawater that threatens to overflow onto the land during a storm or king tide, which over the past decade years has happened several times in Majuro and across the islands. The Pacific Ocean also threatens to salt the island’s ever precious groundwater, which Jother says is already happening. When he showers, he can feel it in his hair, on his skin.

The record heat waves, massive droughts and an increasing number of unpredicted and intense weather events don’t help his trees either.

Most assume the assailant is climate change, to which researchers and experts have said the Indigenous Pacific crop would be almost immune — a potential salve for the world’s imperiled food system. For places like Hawaiʻi, they have predicted breadfruit growing conditions may even get better.

But here, on Majuro and throughout the Marshall Islands, the future appears bleak for a crop that has helped sustain populations for more than 2,000 years.

 

Rice has overtaken the fruit’s status as the preferred staple over the past century, along with other ultraprocessed imports, a change that feeds myriad health complications, including outsized rates of diabetes, making non-communicable diseases the leading cause of death across these islands.

The diseases are a Pacific-wide issue, one Marshall Islands health and agriculture officials are eager to counter with a return to a traditional diet. Climate change is working against them. (...)

Mā is part of an important trinity for the Marshall Islands, which also includes coconut (ni) and pandanus (bōb), that made their way to the islands’ shores on Micronesian seafarers’ boats somewhere between 2,000 and 3,000 years ago.

Six varieties are most common in the Marshall Islands, though at least 20 are found throughout the islands. Hundreds more breadfruit types can be found in the Pacific, tracing back to the breadnut, a tree endemic to the southwestern Pacific island of New Guinea.

The tree provided security for island populations, requiring little upkeep to offer abundant harvests. Each tree produces anywhere from 350 to 1,100 pounds of breadfruit a year, with two harvest seasons. Every tree produces half a million calories in protein and carbohydrates.

 

Like many Pacific island countries, the mā tree’s historic uses were diverse. Its coarse leaves sanded and smoothed vessels made with the tree’s buoyant wood. Its roots were part of traditional medicine. The fruit was cooked underground and roasted black over coals. And it was preserved, to make bwiro, a tradition that survives through people like Angelina Mathusla.

For Mathusla, who lives just over a mile from farmer Jother, making bwiro is a process that comes with every harvest.

The process begins with a pile of petaaktak, a variety of breadfruit common around Majuro and valued for its size and lack of seeds. On this occasion, a relative rhythmically cleaves the football-sized mā in half with a machete, then into smaller pieces, before tossing them into a pile next to a group of women. Some wear gloves to avoid the sticky white latex that seeps from the fruit’s dense, white flesh, used by their forebears to seal canoes or catch birds.

Mā trees use that latex to help heal or protect themselves against diseases and insects. The tree’s adaptation to the atolls and their soils has traditionally been partly thanks to symbiotic relationships with other flora. (...)

A Shallow Body Of Research

Four framed photographs hang on a whitewashed wall of Diane Ragone’s Kauaʻi home. Two black-and-white photos, taken by her late videographer husband, show Jimi Hendrix and Jerry Garcia playing guitar on stage. The other two are of breadfruit.

Now in the throes of writing a memoir, of sorts, Ragone is revisiting almost 40 years of records — photos and videos, and journal entries, some of which leave her asking “Damn, why was I so cryptic?”

But Ragone’s research, since her arrival to Hawaiʻi from Virginia in 1979, forms the bedrock of most modern research into the tree’s history and its survival throughout the Pacific. The most obvious example spans 10 acres in Hāna, on Maui, where more than 150 cultivars of the fruit Ragone collected thrive at the National Tropical Botanical Garden’s Kahanu Garden.

Less obvious is how her work has helped researchers like Noa Kekuewa Lincoln track the plant’s place in global history and the environment. Lincoln, who says “Diane’s kind of considered the Queen of Breadfruit,” has been central to more recent research into how the plant will survive in the future.

Together with others, they act as breadfruit evangelists, promoting the crop as a poverty panacea and global warming warrior — a touchstone for Pacific islanders not only to their past but a more sustainable future.

Ragone, as the founding director of the 22-year-old Breadfruit Institute, helped distribute more than 100,000 trees around the world, to equatorial nations with poverty issues and suitable climes, like Liberia, Zambia and Haiti. But it all started in Hawaiʻi with just over 10,000 young breadfruit.

 

In some places, rising temperatures and changes in rainfall will actually help breadfruit, according to research from Lincoln and his Indigenous Cropping Systems Laboratory, which assessed the trees’ performance under different climate change projections through 2070.

Running climate change scenarios on 1,200 trees across 56 sites in Hawaiʻi, Lincoln’s lab found breadfruit production would largely remain the same for the next 45 years.

“Nowhere in Hawaiʻi gets too hot for it,” Lincoln says. “Pretty much as soon as you leave the coast, you start getting declining yields because it’s too cold.”

Compare breadfruit to other traditional staples — rice, wheat, soybeans, corn. The plant grows deep roots and lives for decades, requires little upkeep or annual planting, resists most environmental stressors and can withstand high temperatures.

Few nations know the urgency of climate change better than the Marshall Islands, its islands and atolls a bellwether for how heat, drought, intense and sporadic natural disasters and sea level rise can upend lives.

The trees can even survive some saltwater intrusion, according to Lincoln’s research. But a consistent presence of salt is another matter, attacking the roots and making trees unable to absorb freshwater and nutrients. As roots rot, leaves and fruit die.

“The salinity,” Ragone says, before letting out a sigh. “How do you even address the salinity issue?”.

Marshall Islands government officials have turned to the International Atomic Energy Association for help, asking its experts about using nuclear radiation to create mutant hybrids of the nation’s most important crops — giant swamp taro, sweet potatoes and, of course, breadfruit.

The technique has been used for almost a century by the atomic association and Food and Agriculture Organization of the United Nations, predominantly on rice and barley, never on breadfruit or for a Pacific nation.

They have their work cut out for them. To find a viable candidate, immune to salty soils and heat, about 2,000 plants would need to be irradiated, according to Cinthya Zorrilla of the atomic energy association’s Centre of Nuclear Techniques in Food and Agriculture. One of those plants, once mutated, might exhibit the desired traits. (...)

Even if those obstacles were overcome, it wouldn’t be a quick fix. Hybridizing plants through radiation can take about 10 years, Zorrilla says, with a need to compare, contrast and correlate results from labs and field plots and laboratories. For breadfruit, the timeframe may be even longer.

“It’s really complicated,” Zorilla says. “All this is a huge investment, in monetary terms and also in time.”

by Thomas Heaton, Honolulu Civil Beat |  Read more:

Images: Thomas Heaton/Chewy Lin

My Mom and Dr. DeepSeek

Every few months, my mother, a 57-year-old kidney transplant patient who lives in a small city in eastern China, embarks on a two-day journey to see her doctor. She fills her backpack with a change of clothes, a stack of medical reports, and a few boiled eggs to snack on. Then, she takes a 1.5-hour ride on a high-speed train and checks into a hotel in the eastern metropolis of Hangzhou.

At 7 a.m. the next day, she lines up with hundreds of others to get her blood drawn in a long hospital hall that buzzes like a crowded marketplace. In the afternoon, when the lab results arrive, she makes her way to a specialist’s clinic. She gets about three minutes with the doctor. Maybe five, if she’s lucky. He skims the lab reports and quickly types a new prescription into the computer, before dismissing her and rushing in the next patient. Then, my mother packs up and starts the long commute home.

DeepSeek treated her differently.

by Viola Zhou, Rest of World |  Read more:

Image: Ard Su 

Fighting a Health Insurance Denial

Seven tips to help.

When Sally Nix found out that her health insurance company wouldn’t pay for an expensive, doctor-recommended treatment to ease her neurological pain, she prepared for battle.

It took years, a chain of conflicting decisions, and a health insurer switch before she finally won approval. She started treatment in January and now channels time and energy into helping other patients fight denials.

“One of the things I tell people when they come to me is: ‘Don’t panic. This isn’t a final no,’” said Nix, 55, of Statesville, N.C.

To control costs, nearly all health insurers use a system called prior authorization, which requires patients or their providers to seek approval before they can get certain procedures, tests and prescriptions.

Denials can be appealed, but nearly half of insured adults who received a prior authorization denial in the last two years reported the appeals process was either somewhat or very difficult, according to a July poll published by KFF, a health information nonprofit that includes KFF Health News.

“It’s overwhelming by design,” because insurers know confusion and fatigue cause people to give up, Nix said. “That’s exactly what they want you to do.”

The good news is you don’t have to be an insurance expert to get results, she said. “You just need to know how to push back.”

Here are tips to consider when faced with a prior authorization denial:

1. Know your insurance plan.

Do you have insurance through your job? A plan purchased through healthcare.gov? Medicare? Medicare Advantage? Medicaid?

These distinctions can be confusing, but they matter a great deal. Different categories of health insurance are governed by different agencies and are therefore subject to different prior authorization rules.

For example, federal marketplace plans, as well as Medicare and Medicare Advantage plans, are regulated by the U.S. Department of Health and Human Services. Employer-sponsored plans are regulated by the Department of Labor. Medicaid plans, administered by state agencies, are subject to both state and federal rules.

Learn the language specific to your policy. Health insurance companies do not apply prior authorization requirements uniformly across all plans. Read your policy closely to make sure your insurer is following its own rules, as well as regulations set by the state and federal government.

2. Work with your provider to appeal.

Kathleen Lavanchy, who retired in 2024 from a job at an inpatient rehabilitation hospital in the Philadelphia area, spent much of her career communicating with health insurance companies on behalf of patients.

Before you contact your health insurer, call your provider, Lavanchy said, and ask to speak to a medical care manager or someone in the office who handles prior authorization appeals.

The good news is that your doctor’s office may already be working on an appeal.

Medical staffers can act as “your voice,” Nix said. “They know all the language.”

You or your provider can request a “peer-to-peer” review during the appeals process, which allows your doctor to discuss your case over the phone with a medical professional who works for the insurance company.

3. Be organized.

Many hospitals and doctors use a system called MyChart to organize medical records, test results, and communications so that they are easily accessible. Similarly, patients should keep track of all materials related to an insurance appeal — records of phone calls, emails, snail mail, and in-app messages.

Everything should be organized, either digitally or on paper, so that it can be easily referenced, Nix said. At one point, she said, her own records proved that her insurance company had given conflicting information. The records were “the thing that saved me,” she said.

“Keep an amazing paper trail,” she said. “Every call, every letter, every name.”

Linda Jorgensen, executive director of the Special Needs Resource Project, a nonprofit offering online resources for patients with disabilities and their families, has advised patients who are fighting a denial to specifically keep paper copies of everything.

“If it isn’t on paper, it didn’t happen,” she said.

Jorgensen, who serves as a caregiver to an adult daughter with special needs, created a free form you can print to help guide you when taking notes during phone calls with your insurance company. She advised asking the insurance representative for a “ticket number” and their name before proceeding with the conversation.

The silver lining is that most denials, if appealed, are overturned. (...)

For the sake of speed, some people are turning to artificial intelligence for help crafting customizable appeal letters. (...)

4. Find an advocate.

Many states operate free consumer assistance programs, available by phone or email, which can help you file an appeal. They can explain your benefits and may intervene if your insurance company isn’t complying with requirements.

Beyond that, some nonprofit advocacy groups, such as the Patient Advocate Foundation, might help. On the foundation’s website is guidance about what to include in an appeal letter. For those battling severe disease, foundation staffers can work with you one-on-one to fight a denial.

by Lauren Sausser, LA Times | Read more:
Image: Helen Quach/Los Angeles Times

[ed. PSA for future reference.]

Canada is Killing Itself

The country gave its citizens the right to die. Doctors are struggling to keep up with demand.

The euthanasia conference was held at a Sheraton. Some 300 Canadian professionals, most of them clinicians, had arrived for the annual event. There were lunch buffets and complimentary tote bags; attendees could look forward to a Friday-night social outing, with a DJ, at an event space above Par-Tee Putt in downtown Vancouver. “The most important thing,” one doctor told me, “is the networking.”

Which is to say that it might have been any other convention in Canada. Over the past decade, practitioners of euthanasia have become as familiar as orthodontists or plastic surgeons are with the mundane rituals of lanyards and drink tickets and It’s been so long s outside the ballroom of a four-star hotel. The difference is that, 10 years ago, what many of the attendees here do for work would have been considered homicide.

When Canada’s Parliament in 2016 legalized the practice of euthanasia—Medical Assistance in Dying, or MAID, as it’s formally called—it launched an open-ended medical experiment. One day, administering a lethal injection to a patient was against the law; the next, it was as legitimate as a tonsillectomy, but often with less of a wait. MAID now accounts for about one in 20 deaths in Canada—more than Alzheimer’s and diabetes combined—surpassing countries where assisted dying has been legal for far longer.

It is too soon to call euthanasia a lifestyle option in Canada, but from the outset it has proved a case study in momentum. MAID began as a practice limited to gravely ill patients who were already at the end of life. The law was then expanded to include people who were suffering from serious medical conditions but not facing imminent death. In two years, MAID will be made available to those suffering only from mental illness. Parliament has also recommended granting access to minors.

At the center of the world’s fastest-growing euthanasia regime is the concept of patient autonomy. Honoring a patient’s wishes is of course a core value in medicine. But here it has become paramount, allowing Canada’s MAID advocates to push for expansion in terms that brook no argument, refracted through the language of equality, access, and compassion. As Canada contends with ever-evolving claims on the right to die, the demand for euthanasia has begun to outstrip the capacity of clinicians to provide it.

There have been unintended consequences: Some Canadians who cannot afford to manage their illness have sought doctors to end their life. In certain situations, clinicians have faced impossible ethical dilemmas. At the same time, medical professionals who decided early on to reorient their career toward assisted death no longer feel compelled to tiptoe around the full, energetic extent of their devotion to MAID. Some clinicians in Canada have euthanized hundreds of patients.

The two-day conference in Vancouver was sponsored by a professional group called the Canadian Association of MAiD Assessors and Providers. Stefanie Green, a physician on Vancouver Island and one of the organization’s founders, told me how her decades as a maternity doctor had helped equip her for this new chapter in her career. In both fields, she explained, she was guiding a patient through an “essentially natural event”—the emotional and medical choreography “of the most important days in their life.” She continued the analogy: “I thought, Well, one is like delivering life into the world, and the other feels like transitioning and delivering life out.” And so Green does not refer to her MAID deaths only as “provisions”—the term for euthanasia that most clinicians have adopted. She also calls them “deliveries.”

Gord Gubitz, a neurologist from Nova Scotia, told me that people often ask him about the “stress” and “trauma” and “strife” of his work as a MAID provider. Isn’t it so emotionally draining? In fact, for him it is just the opposite. He finds euthanasia to be “energizing”—the “most meaningful work” of his career. “It’s a happy sad, right?” he explained. “It’s really sad that you were in so much pain. It is sad that your family is racked with grief. But we’re so happy you got what you wanted.”

Has Canada itself gotten what it wanted? Nine years after the legalization of assisted death, Canada’s leaders seem to regard MAID from a strange, almost anthropological remove: as if the future of euthanasia is no more within their control than the laws of physics; as if continued expansion is not a reality the government is choosing so much as conceding. This is the story of an ideology in motion, of what happens when a nation enshrines a right before reckoning with the totality of its logic. If autonomy in death is sacrosanct, is there anyone who shouldn’t be helped to die?

by Elaina Plott Calabro, The Atlantic | Read more:
Image: Johnny C.Y. Lam