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John Bogle: The “Train Wreck” Awaiting American Retirement

In terms of the evolution of America’s retirement health, we’ve moved from defined benefit programs, pensions, to defined contribution. … Describe what’s happening to our retirement health as these [different] instruments are introduced and the rush of people into mutual funds. …

… In my new book, which is called The Clash of the Cultures, I have a chapter on future retirement planning, and it says our retirement system is … headed for a train wreck unless we do something about it.

I start off, simply put, with Social Security, which has to be changed in gradual, small ways to become solvent again. … Then you go to corporate defined benefit plans. They are assuming — and state and local government defined benefit plans even worse — they are all assuming that the market return in their portfolio will be 8 percent a year.

There is no way under the sun that they’re going to earn 8 percent. It’s just impossible. No matter what they do, they’re stuck in a bind given the kind of markets we expect in stocks and bonds. … The best they can really hope for is a 5 percent return unless some wonderful, attractive scenario for the future unfolds, which is really unimaginable. If anything, it’s going to be worse.

So if you think about them compounding their returns at 4 percent instead of the 8 percent that they build into the plan, they’re going to have to start putting a lot of money into those plans. They’re going to be bankrupt.

Those plans have been dying out for a long time.

… They’re dropping out. They’re changing to defined contribution plans, the corporations are. But if you have a bad year, you don’t make any contributions for your employees, the management says, “Can’t afford it this year,” well, that’s the year they should afford it. So the defined contribution system is deeply flawed.

And what it really is — when you look at IRA and 401(k), and particularly 401(k) thrift plans — they are thrift plans. They are not retirement plans. They were never designed to be retirement plans, but we’re using them to build a retirement plan now, and it simply is not going to work. …

The 401(k) arrived. What prompted its creation?

… Some very smart people found a sort of loophole in the law, not a bad loophole, where you could have companies put their money in and employees put their money in together, and you could get clearance to make sure that didn’t have any taxes on it. That’s the 401(k) plan in essence.

But you can get out of it when you want. You can say you have an emergency when you want. And here’s the worst of it: You can pick any fund that you want. …

If you want to gamble with your retirement money, all I can say is be my guest, but be aware of the mathematical reality. The chances you will do better playing that game are infinitely small. If I want to put a number on it, let me just say [off the] top of the head that maybe you have 0.1 of 1 percent chance of beating the market over time.

Now, think about this for a minute. You’re 25 years old, and you’re going to invest for the next 50 years, so you’re going to buy an index fund and hold it all that time. You never have to worry about the manager. There aren’t new brooms that come in and sweep clean.

Now you buy an actually managed fund. First of all, half of the actively managed mutual funds that are out there today aren’t going to be around 10 years from now. There’s going to be a 50 percent failure rate. We’ve had that in the past, in the last 20 years. …

So how can you be a long-term investor if the fund you own doesn’t last for the long term? And then there’s something else. Even if you’re lucky enough to be in that half of funds that does survive, they’re going to have a new manager every five years. That’s how long a portfolio manager lasts in this business.

So if you have, say, four mutual funds, you’re going to have four managers every five years, and if you take that to 50 years, you’re going to have 40 managers. Think about the possibility of 40 mutual fund managers with those high fees coming anywhere near the return of an unmanaged low-expense index fund. It just isn’t there. Mathematically can’t be there.

The marketing tells you otherwise. And the industry has created legends, such as Peter Lynch at Fidelity Magellan Fund, who outperform the broad market, outperform your index fund, year after year after year. So in the interest of giving people choices, the industry puts forward funds like Magellan and gives you an opportunity to beat the market. Isn’t that a good thing?

Well, if only the past were prologue it would be a great thing. But look, the Magellan Funds are a great example. … The pressure from employers to bring in outside funds, to have “open architecture” for their investors, was so powerful that we allowed them to add Magellan Fund.

Bad judgment. Magellan Fund reached its peak over the market in 1992. It had $105 billion of assets in 1992. It has been pretty much an abject failure, worse than mediocre, in the 20 years that followed. Way below par. And the fund now has assets of $10 billion. That’s $95 billion smaller, 92 percent smaller than it was in 1992. Everybody’s getting out of Magellan now. …

by PBS, Frontline |  Read more:

Image: uncredited

Georges Braque, The Pantry. 1920
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The 'Napster Moment' for 3-D Food Printing

The revolution in 3D printing is seeing enthusiasts sharing designs for everything from chairs to guns to faces. With small steps, it's even making its way into the world of food.

That might seem the most natural of all, on the face of it. Food is a social thing, from the sharing of recipes to the sharing of a meal. But it's a different kind of sharing to that we associate with other arts. Sharing a recipe isn't an economic issue for the food industry like sharing a song is to the music industry -- but what if you could print off not just a hamburger, but a Big Mac? For a look at how this future might turn out, let's look at the Coca-Cola recipe. (...)

The spread of Open Cola is interesting, given this framework of secrecy. The terms of the Open Cola GNU license are such that anyone can take the recipe and adapt it, as long as they put their own version online for others to also take advantage of. Take Open Soda in the US, which produces a range of different colas and sodas both for fun and for selling at large events. Its latest recipe, as of April 2009, has some significant differences with Open Cola, but it's still a cola. It's still an attempt at cloning something famous. (...)

Imagine yourself in twenty years sitting down in your kitchen and wanting a glass of cola and a hamburger. You could download Coca-Cola's classic recipe to go with a McDonald's Big Mac, but you could also download that extra-caffeinated cola someone's hacked onto the server along with a Big Mac with a particularly smoky ketchup in place of the banal, "official" version. Or you could knock something new up yourself, a drink that's sugar- and caffeine-free and with an extra shot of vitamin B and a burger bun that's gluten-free.

Open Cola can be see a first, extremely crude example of this change, in this case. Once the infrastructure for 3D printing is in place -- the cultural expectation of being able to get home, slot a cartridge into the machine, and print out anything you want -- then the food industry is going to struggle to keep its secrets safe. In large part, the mystique around the brand is what protects Coca-Cola -- in For God, Country & Coca-Cola, Pendergrast is told by a Coke spokesperson that he could safely print the real recipe if he had it and go into competition with Coke, but there's no way an upstart would be able to match the real thing for price, distribution, marketing, history, and all the other things that maintain Coke's position around the world.

But if it did want to sue someone who overcame these hurdles -- as the decentralised 3D printing might well facilitate -- then that's made trickier for the copyright/patent holder with the legal grey area recipes lie within. A list of ingredients isn't something that can be copyrighted, but their preparation in a certain way can be -- that's how you can copyright a Jaffa Cake, but not the ingredients within in. Coca-Cola currently relies on established legal precedent, such as that in the Coco v Clark case of 1969 that established an employee leaking a trade secret was in breach of a confidentiality contract, and could be sued.

Kurman and Lipson have collaborated on Fabricated: the new world of 3D printing, a book exploring the social issues that will come from the spread of 3D printing. Lipson said: "The moment somebody is making money off the recipes, that's when you'll see digital rights management around it. But it's very social, there's a big social component through sharing these things, and therefore it will propagate and follow the same path [as music]."

by Ian Steadman, Wired UK |  Read more:

Image: Shutterstock

Game Theory in Teaching

[ed. Alternatively titled 'Why I Let My Students Cheat on Their Exam' although, technically, they weren't really cheating...]

On test day for my Behavioral Ecology class at UCLA, I walked into the classroom bearing an impossibly difficult exam. Rather than being neatly arranged in alternate rows with pen or pencil in hand, my students sat in one tight group, with notes and books and laptops open and available. They were poised to share each other’s thoughts and to copy the best answers. As I distributed the tests, the students began to talk and write. All of this would normally be called cheating. But it was completely OK by me.

Who in their right mind would condone and encourage cheating among UCLA juniors and seniors? Perhaps someone with the idea that concepts in animal behavior can be taught by making their students live those concepts. (...)

Much of evolution and natural selection can be summarized in three short words: “Life is games.” In any game, the object is to win—be that defined as leaving the most genes in the next generation, getting the best grade on a midterm, or successfully inculcating critical thinking into your students. An entire field of study, Game Theory, is devoted to mathematically describing the games that nature plays. Games can determine why ant colonies do what they do, how viruses evolve to exploit hosts, or how human societies organize and function.

So last quarter I had an intriguing thought while preparing my Game Theory lectures. Tests are really just measures of how the Education Game is proceeding. Professors test to measure their success at teaching, and students take tests in order to get a good grade. Might these goals be maximized simultaneously? What if I let the students write their own rules for the test-taking game? Allow them to do everything we would normally call cheating?

A week before the test, I told my class that the Game Theory exam would be insanely hard—far harder than any that had established my rep as a hard prof. But as recompense, for this one time only, students could cheat. They could bring and use anything or anyone they liked, including animal behavior experts. (Richard Dawkins in town? Bring him!) They could surf the Web. They could talk to each other or call friends who’d taken the course before. They could offer me bribes. (I wouldn’t take them, but neither would I report it to the dean.) Only violations of state or federal criminal law such as kidnapping my dog, blackmail, or threats of violence were out of bounds.

Gasps filled the room. The students sputtered. They fretted. This must be a joke. I couldn’t possibly mean it. What, they asked, is the catch?

“None,” I replied. “You are UCLA students. The brightest of the bright. Let’s see what you can accomplish when you have no restrictions and the only thing that matters is getting the best answer possible.”

by Peter Nonacs/ Zócalo Public Square | Read more:
Image: mrfishersclass

A Messenger for the Internet of Things

[ed. For more information on the IoT see: this, this and this.]

The vision of the Internet of Things is inspiring, if much-hyped. Billions of digital devices, from smartphones to sensors in homes, cars and machines of all kinds, will communicate with each other to automate tasks and make life better.

But some daunting obstacles litter the road to this mechanized nirvana. A crucial challenge is figuring out how all the smartish gadgets will talk to each other. A group of technology companies — including Cisco Systems, I.B.M., Red Hat and Tibco — thinks a technology with a mouthful of a name is the answer. On Thursday, they are officially introducing the Message Queuing Telemetry Transport protocol as an open standard through an international standards organization, Oasis.

MQTT, the less-than-catchy abbreviation for the software, is not really a lingua franca for machine-to-machine communication, but a messenger and carrier for data exchange. MQTT’s advocates compare its potential role in the Internet of Things to that played by the Hypertext Transfer Protocol, or HTTP, on the Web. HTTP is the foundation of data communication on the Web.

MQTT’s origins go back nearly two decades. Its co-inventor, Andy Stanford-Clark, who holds the title of distinguished engineer at I.B.M., has long been a passionate home-automation tinkerer. His laboratory has been his house, a 16th-century stone cottage with a thatched roof on the Isle of Wight, in the English Channel. His electronic gadgets range from temperature and energy monitors to an automated mousetrap. His TedX talk explains the back story.

by Steve Lohr, NY Times |  Read more:

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Ellen Von Unwerth
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20 Pounds? Not Too Bad, for an Extinct Fish

For most fishermen a 20-pound trout is a trophy, but for Paiute tribe members and fish biologists here the one Matt Ceccarelli caught was a victory.

That Lahontan cutthroat trout he caught last year, a remnant of a strain that is possibly the largest native trout in North America, is the first confirmed catch of a fish that was once believed to have gone extinct. The fish has been the focus of an intense and improbable federal and tribal effort to restore it to its home waters.

“I was in awe,” said Mr. Ceccarelli, 32, an engineer from Sparks, Nev., of the speckled trout with hues of olive and rose.

Early settlers told stories of Pyramid Lake Lahontan cutthroats that weighed more than 60 pounds, though the official world record was a 41-pounder caught by a Paiute man in 1925. The explorer who discovered this electric-blue oasis in 1844, John Fremont, called them “salmon trout.” Mark Twain raved about their flavor. Clark Gable, the actor, chased them. President Bill Clinton and tribe members called for their restoration. (...)

In the late 19th and early 20th centuries, fishermen netted scores of Lahontan cutthroats to feed miners and loggers gnawing at the Sierra Nevada Mountains. But the Truckee River, where the fish spawned, was dammed, and its level dropped as water was taken for irrigation. It was also polluted with chemicals and sawdust. And Lake Tahoe was stocked with a nonnative char called lake trout, which gobble baby cutthroat. By the mid-1940s, all the native trout in Pyramid Lake and Lake Tahoe were dead and the strain was declared extinct. (...)

In the late 1970s, a fish biologist identified what he thought were surviving specimens of the vanished Pyramid Lake strain of Lahontan cutthroat in a small creek near a 10,000-foot mountain on the border of Nevada and Utah called Pilot Peak. A Utah man used buckets to stock the rugged stream with trout in the early 1900s, but made no record, federal biologists say. Geneticists recently compared cutthroats from the Pilot Peak stream with mounts of giant Pyramid Lake trout and discovered an exact DNA match.

“They are the originals,” said Corene Jones, 39, the broodstock coordinator for the Lahontan National Fish Hatchery in Gardnerville, Nev.

In 1995, United States Fish and Wildlife Service biologists harvested cutthroat eggs from Pilot Peak and brought them to the Gardnerville hatchery, just a few years before a devastating wildfire scorched the mountain and killed off the creek. In 2006 federal officials, in cooperation with the tribe, began stocking Pyramid Lake with what many now call Pilot Peak cutthroats. They waited to see how the fish might readapt to its ancestral home.

The answer came from ecstatic anglers. Late last year, a Reno man caught and released a 24-pounder. David Hamel, 27, of Reno, just did the same with a pair of 20-pound cutthroats.

“Biggest fish of my life,” he said. “Amazing.”

by Nate Schweber, NY Times |  Read more:

Image: Winslow Homer: Two Trout (1891) via:

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How Not to Die

Unwanted treatment is American medicine’s dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.

In 2009, my father was suffering from an advanced and untreatable neurological condition that would soon kill him. (I wrote about his decline in an article for this magazine in April 2010.) Eating, drinking, and walking were all difficult and dangerous for him. He ate, drank, and walked anyway, because doing his best to lead a normal life sustained his morale and slowed his decline. “Use it or lose it,” he often said. His strategy broke down calamitously when he agreed to be hospitalized for an MRI test. I can only liken his experience to an alien abduction. He was bundled into a bed, tied to tubes, and banned from walking without help or taking anything by mouth. No one asked him about what he wanted. After a few days, and a test that turned up nothing, he left the hospital no longer able to walk. Some weeks later, he managed to get back on his feet; unfortunately, by then he was only a few weeks from death. The episode had only one positive result. Disgusted and angry after his discharge from the hospital, my father turned to me and said, “I am never going back there.” (He never did.)

What should have taken place was what is known in the medical profession as The Conversation. The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired. Alas, evidence shows that The Conversation happens much less regularly than it should, and that, when it does happen, information is typically presented in a brisk, jargony way that patients and families don’t really understand. Many doctors don’t make time for The Conversation, or aren’t good at conducting it (they’re not trained or rewarded for doing so), or worry their patients can’t handle it.

This is a problem, because the assumption that doctors know what their patients want turns out to be wrong: when doctors try to predict the goals and preferences of their patients, they are “highly inaccurate,” according to one summary of the research, published by Benjamin Moulton and Jaime S. King in The Journal of Law, Medicine & Ethics. Patients are “routinely asked to make decisions about treatment choices in the face of what can only be described as avoidable ignorance,” Moulton and King write. “In the absence of complete information, individuals frequently opt for procedures they would not otherwise choose.” (...)

Angelo Volandes was born in 1971, in Brooklyn, to Greek immigrants. His father owned a diner. He and his older sister were the first in their family to go to college—Harvard, in his case. In Cambridge, he got a part-time job cooking for an elderly, childless couple, who became second parents to him. He watched as the wife got mortally sick, he listened to her labored breathing, he talked with her and her husband about pain, death, the end of life. Those conversations led him to courses in medical ethics, which he told me he found abstract and out of touch with “the clinical reality of being short of breath; of fear; of anxiety and suffering; of medications and interventions.” He decided to go to medical school, not just to cure people but “to learn how people suffer and what the implications of dying and suffering and understanding that experience are like.” Halfway through med school at Yale, on the recommendation of a doctor he met one day at the gym, he took a year off to study documentary filmmaking, another of his interests. At the time, it seemed a digression.

On the very first night of his postgraduate medical internship, when he was working the graveyard shift at a hospital in Philadelphia, he found himself examining a woman dying of cancer. She was a bright woman, a retired English professor, but she seemed bewildered when he asked whether she wanted cardiopulmonary resuscitation if her heart stopped beating. So, on an impulse, he invited her to visit the intensive-care unit. By coincidence, she witnessed a “code blue,” an emergency administration of CPR. “When we got back to the room,” Volandes remembered, “she said, ‘I understood what you told me. I am a professor of English—I understood the words. I just didn’t know what you meant. It’s not what I had imagined. It’s not what I saw on TV.’ ” She decided to go home on hospice. Volandes realized that he could make a stronger, clearer impression on patients by showing them treatments than by trying to describe them.

He spent the next few years punching all the tickets he could: mastering the technical arts of doctoring, credentialing himself in medical ethics, learning statistical techniques to perform peer-reviewed clinical trials, joining the Harvard faculty and the clinical and research staff of Massachusetts General Hospital. He held on to his passion, though. During a fellowship at Harvard in 2004, he visited Dr. Muriel Gillick, a Harvard Medical School professor and an authority on late-life care. Volandes “was very distressed by what he saw clinically being done to people with advanced dementia,” Gillick recalls. “He was interested in writing an article about how treatment of patients with advanced dementia was a form of abuse.” Gillick talked him down. Some of what’s done is wrong, she agreed, but raging against it would not help. The following year, with her support, Volandes began his video project.

The first film he made featured a patient with advanced dementia. It showed her inability to converse, move about, or feed herself. When Volandes finished the film, he ran a randomized clinical trial with a group of nine other doctors. All of their patients listened to a verbal description of advanced dementia, and some of them also watched the video. All were then asked whether they preferred life-prolonging care (which does everything possible to keep patients alive), limited care (an intermediate option), or comfort care (which aims to maximize comfort and relieve pain). The results were striking: patients who had seen the video were significantly more likely to choose comfort care than those who hadn’t seen it (86 percent versus 64 percent). Volandes published that study in 2009, following it a year later with an even more striking trial, this one showing a video to patients dying of cancer. Of those who saw it, more than 90 percent chose comfort care—versus 22 percent of those who received only verbal descriptions. The implications, to Volandes, were clear: “Videos communicate better than just a stand-alone conversation. And when people get good communication and understand what’s involved, many, if not most, tend not to want a lot of the aggressive stuff that they’re getting.”

by Jonathan Rauch, The Atlantic |  Read more:

Image: Eric Ogden

Facebook Home Propaganda Makes Selfishness Contagious

The new ads for Facebook Home are propaganda clips. Transforming vice into virtue, they’re social engineering spectacles that use aesthetic tricks to disguise the profound ethical issues at stake. This isn’t an academic concern: Zuckerberg’s vision (as portrayed by the ads) is being widely embraced — if the very recent milestone of half a million installations is anything to go by.

Critics have already commented on how the ads exploit our weakness for escapist fantasy so we can feel good about avoiding conversation and losing touch with our physical surroundings. And they’ve called out Zuckerberg’s hypocrisy: “Isn’t the whole point of Facebook supposed to be that it’s a place to keep up with, you know, family members? So much for all that high-minded talk about connecting people.”
Think off-camera and outside the egocentric perspective framed by the ads.

However, the dismissive reviews miss an even deeper and more consequential point about the messages conveyed by the ads: that to be cool, worthy of admiration and emulation, we need to be egocentric. We need to care more about our own happiness than our responsibilities towards others.

Let’s examine the most egregious Facebook ad of them all: “Dinner” (in the video above). On the surface, it portrays an intergenerational family meal where a young woman escapes from the dreariness of her older relative’s boring cat talk by surreptitiously turning away from the feast and instead feasting her eyes on Facebook Home. With a digital nod to the analog “Calgon, Take Me Away” commercials, the young woman is automatically, frictionlessly transported to a better place: full of enchanting rock music, ballerinas, and snowball fights.

But let’s break Zuckerberg’s spell and shift our focus away from Selfish Girl. Think off-camera and outside the egocentric perspective framed by the ad. Reflect instead on the people surrounding her.

Ignored Aunt will soon question why she’s bothering to put in effort with her distant younger niece. Eventually, she’ll adapt to the Facebook Home-idealized situation and stop caring. In a scene that Facebook won’t run, Selfish Girl will come to Ignored Aunt for something and be ignored herself: Selfishness is contagious, after all. Once it spreads to a future scene where everyone behaves like Selfish Girl, with their eyes glued to their own Home screens, the Facebook ads portend the death of family gatherings.

More specifically, they depict the end of connecting through effort. Because unlike the entertaining and lively Chatheads the ad recommend we put on our personalized network interfaces and Home screens, we don’t get to choose floating family members. It’s a dystopian situation when everyone matches our interests and we don’t feel obliged to try to connect with those folks: people with whom it’s initially difficult to find common ground.

So why doesn’t the “Dinner” ad depress us? Well that’s where the clever propaganda comes in — the ads give Selfish Girl special license: Everyone else behaves responsibly except for her. Moreover, her irresponsible behavior doesn’t affect what others do. (...)

So what, big deal, some argue about these ads. Unfortunately, the message of technological efficiency and frictionless sharing is increasingly being depicted as an appropriate social ethic beyond Silicon Valley.

by Evan Selinger, Wired |  Read more:
Video: theofficialfacebook

Downtown LA
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Jon Spencer Blues Explosion

Nestow Sakaczbia. Men stumble on stones, not mountains.
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The Big One?

We are at a mysterious fork in the road. One path leads to years, perhaps decades, of spread of a new type of influenza, occasionally making people sick and killing about 18 percent of them. It's not a pleasant route, strewn as it is with uncertainties, but no terror seems to lurk on its horizon. The other path, however, wrenches the gut with fear, as it brings worldwide transmission of a dangerous new form of flu that could spread unchecked throughout humanity, testing global solidarity, vaccine production, hospital systems and humanity's most basic family and community instincts.

There may be some minor footpaths along the way, heading to other alternatives, but they can't be discerned at this moment. At this writing, 108 cases of H7N9 flu, as the new virus has been dubbed, have been confirmed, and one asymptomatic carrier of the virus has been identified. Twenty-two of the cases have proven fatal, and nine people have been cured of the new flu. The remainder are still hospitalized, many in severe condition suffering multiple organ failures. As the flu czar of the World Health Organization (WHO), Dr. Keiji Fukuda, tersely put it to reporters last week, "Anything can happen. We just don't know."

On this tenth anniversary of China's April 2003 admission that the SARS virus had spread across that country -- under cloak of official secrecy, spawning a pandemic of a previously unknown, often lethal disease -- Beijing finds itself once again in a terrible position via-a-vis the microbial and geopolitical worlds. In both the SARS and current H7N9 influenza cases, China watched the microbe's historic path unfold during a period of enormous political change. And the politics got in the way of appropriate threat assessment. (...)

I covered the SARS epidemic in Hong Kong and throughout mainland China, and there are more than a few aspects of the current H7N9 situation that provoke feelings of déjà vu. As was the case in 2003, Beijing now has new leaders, President Xi Jinping and Premier Li Keqiang, who assumed office on March 14, 2013. As was the case with SARS in 2003, information regarding the new H7N9 flu did not start to flow publicly until after safe installation of the new leadership. And during the months between the Communist Party's closed meetings that selected Xi and Li and March 14th, the country was rocked by scandals, including murder and billions of dollars' worth of financial shenanigans, pitting one Communist Party faction against another. Both the SARS and H7N9 outbreaks unfolded in atmospheres of political intrigue and secrecy.

Today, with the future path of the new influenza still uncertain, Beijing faces conundrums similar to those it confronted after publicly admitting to SARS. May Day, one of China's biggest travel holidays, is approaching. Travel restrictions might be warranted to prevent nationwide spread if the virus is now thought to be geographically confined, and if further evidence shows that people can act as carriers and transmitters of H7N9. But the economic and geopolitical consequences of clamping down on social mobility are profound, particularly now that China's economic growth is slowing.

In 2003, Beijing warned the public to limit travel, but did not actually barricade the capital and set up health checkpoints in all of the nation's train, bus, shipping, and air travel stations until it was too late. I watched tens of thousands of fearful migrant workers and students -- impelled by rumors of forced quarantines targeting those without permanent Beijing residency papers -- flee the capital by trains over the days between the April 20 admission and May Day holiday, taking the SARS virus to every region of the country. Having lost control of geographic spread, China had no choice but to assume the entire country was infected, and create an extraordinarily expensive, nationwide response. I witnessed construction of Xiaotangshan SARS Hospital, a 1,500-bed quarantine facility erected in only eight days, complete with isolation rooms, dedicated sewer and water filtration systems, negative air pressure flow, and state-of-the-art nursing stations. That astounding feat was repeated all over the country, with quarantine hospitals built in five to 10 days in every region. As I traveled around China by car, I was stopped roughly every 50 miles by police and subjected to thermometer checks. Any individual anywhere in the country that evidenced a fever was immediately placed in one of the newly erected quarantine facilities, and would remain there indefinitely -- no visitors allowed. In Beijing, such fever stations were ubiquitous: Anybody with an abnormal temperature was immediately packed off to a military-run quarantine site or Ditan Hospital for Infectious Diseases, where even the doctors and nurses were on lockdown, forbidden to see their families for weeks. Knowing that the virus was spreading inside of hospitals, terrified physicians and nurses jumped out of windows and patients hid in their homes until May 15, when the central government declared it a high crime, punishable even by death, to hide or spread SARS cases.

That is how by July 5, 2003, China stopped SARS -- with a nationwide find-the-fever campaign that could not possibly be executed in a country that places civil liberties above the rights of the state. I have often thought about the fever stations I encountered in the mountains of Shanxi, where coal truck drivers were compelled to submit to fever checks while people in bio-containment space suits sprayed antimicrobials all over their vehicles' cabs. I've tried to imagine such fever stations positioned along America's superhighways: Visions of angry drivers pulling shotguns on public health nurses and highway patrol officers always dance thru my head. Few countries could today manage a nationwide fever/quarantine campaign akin to China's SARS effort.

Indeed, I'm not sure the China of 2013 could pull off the feat it executed in 2003. Thanks to Weibo, China's equivalent of Twitter, and dozens of other Internet-posting possibilities, very little about this flu outbreak has remained secret for long. Any perceived violation of patients' rights or individual dignity is getting a virtual shout-out. And though President Xi and top health officials have already noted that travel over May Day might be unwise, and Hong Kong has signaled anxiety about the pending tsunami of mainland visitors, possibly bringing H7N9 their way, it seems unimaginable that today's government could close the perimeter of any major city, let alone Shanghai, the epicenter of H7N9, with population of some 23 million people.

by Laurie Garrett, Foreign Policy |  Read more:

Image: STR/AFP/Getty Images

Fabio Hurtado, The Letter
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Manolo Millares (Spanish, 1926–1972), Untitled, 1961
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Microbes: The Trillions of Creatures Governing Your Health

Of all the cases Barbara Warner has faced as a pediatrician specializing in newborns, the one that sticks hardest in her mind involved a couple who had been trying for years to have children. Finally, in 1997, the woman was pregnant. She was in her mid-40s. “This was her last chance,” says Warner. Then, too soon, she gave birth to twins. The first child died at two weeks of respiratory failure, at the time the most common killer of preterm babies.

A week later—it happened to be Thanksgiving Day—Warner folded down the blanket on the surviving twin, and even now she draws in her breath at the memory. The baby’s belly was reddened, shining and so swollen “you could have bounced a nickel off it.”

It was necrotizing enterocolitis, or NEC, little known outside neonatal intensive care units, but dreaded there as a sudden, fast-moving bacterial inflammation of the gut. On the operating table, a surgeon opened the baby boy’s abdomen and immediately closed it again. The intestinal tract from stomach to rectum was already dead. Warner, in tears, returned the child to die in the arms of his shattered parents.

“It’s 15 years later, and there’s nothing new,” Warner says bleakly as she moves among her tiny patients, each one covered in tubes and bathed in soft violet light, in a clear plastic incubator. NEC is still one of the leading killers of preterm babies. But that may soon change, thanks to a startling new way of looking at who we are and how we live.

Over the past few years, advances in genetic technology have opened a window into the amazingly populous and powerful world of microbial life in and around the human body—the normal community of bacteria, fungi and viruses that makes up what scientists call the microbiome. It’s Big Science, involving vast international research partnerships, leading edge DNA sequencing technology and datasets on a scale to make supercomputers cringe. It also promises the biggest turnaround in medical thinking in 150 years, replacing the single-minded focus on microbes as the enemy with a broader view that they are also our essential allies.

The subject matter is both humble and intimate. In Warner’s neonatal care unit at St. Louis Children’s Hospital, researchers studying NEC have analyzed every diaper of almost every very low-weight baby delivered there over the past three years. They don’t expect to find a single pathogen, some killer virus or bacteria, the way medical discovery typically happened in the past. Instead, says Phillip Tarr, a Washington University pediatric gastroenterologist who collaborates with Warner, they want to understand the back-and-forth among hundreds of microbial types in the newborn’s gut—to recognize when things go out of balance. Their goal is to identify the precise changes that put a baby on track to developing NEC and, for the first time, give neonatal care units crucial advance warning.

A separate research group demonstrated early this year that secretions from certain beneficial microbes seem to relieve the deadly inflammation characteristic of NEC. So doctors may soon see into life-or-death processes that until now have been hidden, and take action to address them.

The new insights into NEC suggest why the microbiome suddenly seems so important to almost everything in the medical and biological worlds, even our understanding of what it means to be human. We tend to think that we are exclusively a product of our own cells, upwards of ten trillion of them. But the microbes we harbor add another 100 trillion cells into the mix. The creature we admire in the mirror every morning is thus about 10 percent human by cell count. By weight, the picture looks prettier (for once): Altogether an average adult’s commensal microbes weigh about three pounds, roughly as much as the human brain. And while our 21,000 or so human genes help make us who we are, our resident microbes possess another eight million or so genes, many of which collaborate behind the scenes handling food, tinkering with the immune system, turning human genes on and off, and otherwise helping us function. John Donne said “no man is an island,” and Jefferson Airplane said “He’s a peninsula,” but it now looks like he’s actually a metropolis.

by Richard Conniff, Smithsonian |  Read more:

Image: Stephanie Dalton Cowan