Rise of the Robot Barons

The robots are coming, ready to remake our world according to the specifications of a cabal of millennial asswipes and megalomaniacal billionaires. These are the people who are destined to become our feudal overlords in the Age of Robotics. The question is: is there any way to stop them?

There are a few ways to approach the problem of a robot economy. One is to reject increased automation of labor as generally undesirable, because people need jobs and robots are tricky devils. The 19th century had an unsuccessful but memorable tradition of anti-machine fervor, from the Luddite machine-breaking riots of the 1810s, to this magnificently sinister pronouncement by Samuel Butler in 1863:

“Our opinion is that war to the death should be instantly proclaimed against [machines]. Every machine of every sort should be destroyed by the well-wisher of his species. Let there be no exceptions made, no quarter shown; let us at once go back to the primeval condition of the race. If it be urged that this is impossible under the present condition of human affairs, this at once proves that the mischief is already done, that our servitude has commenced in good earnest, that we have raised a race of beings whom it is beyond our power to destroy, and that we are not only enslaved but are absolutely acquiescent in our bondage.”

Some people, of course, might regard this whole “war to the death against anything more complicated than an abacus” proposal as extreme. But full-on Unabomber-style technophobia aside, there’s an argument to be made that limits on automation ought to be established by regulation, in order to allow human beings to continue to work. This is not only because U.S. society, as currently constituted, makes livelihood contingent on employment, but also because work—so the argument goes—is generally a good thing for human beings. In his 2015 encyclical Laudato Si’, for example, Pope Francis wrote that we shouldn’t endeavor to have “technological progress increasingly replace human work,” as this outcome would, in his view, “be detrimental to humanity. Work is a necessity, part of the meaning of life on this earth, a path to growth, human development and personal fulfillment.” This line of thought is also fairly common within labor movements, because it holds that all occupations are equal in dignity, that a construction worker is no less deserving of respect, and entitled to a decent living, than a software engineer. Even if you could automate all labor, you wouldn’t want to, because human identity and psychological well-being are inextricably bound up in the work we do, and mechanization deprives people of the ability to contribute to their communities. The important thing is simply to make sure that workers are properly paid and protected. (...)

As we think about what increased automation ought to look like, in an ideal world where the economy serves human needs, we should first disabuse ourselves of the idea that efficiency is an appropriate metric for assessing the value of an automated system. Sure, efficiency can be a good thing—no sane person wants an inefficient ambulance, for example—but it isn’t a good in itself. (After all, an efficient self-disembowling machine doesn’t thereby become a “good” self-disembowling machine.) In innumerable contexts, inefficient systems and unpredictable forces give our lives character, variety, and suspense. The ten-minute delay on your morning train, properly considered, is a surprise gift from the universe, being an irreproachable excuse to read an extra chapter of a new novel. Standing in line at the pharmacy is an opportunity to have a short conversation with a stranger, who may be going through a hard time, or who may have something interesting to tell you. The unqualified worship of efficiency is a pernicious kind of idolatry. Often, the real problem isn’t that our world isn’t efficient enough, but rather that we lack patience, humility, curiosity, and compassion: these are not failings in our external environments, but in ourselves.

Additionally, we can be sure that, left to themselves, Market Forces will prioritize efficiencies that generate profit over efficiencies that really generate maximum good to humans. We currently see, for instance, a constant proliferation of labor-saving devices and services that are mostly purchased by fairly well-off people. This isn’t to say that these products are always completely worthless—to the extent that a Roomba reduces an overworked single parent’s unpaid labor around the home, for example, that might be quite a good thing—but in other respects, these minute improvements in efficiency (or perceived efficiency) generate diminished returns for the well-being of the human population, and usually only a very small percentage of it, to boot. The amount of energy that’s put into building apps and appliances to replace existing things that already work reasonably well is surely a huge waste of ingenuity, in a world filled with pressing social problems that need many more hands on deck.

Thinking about which kinds of jobs and systems really ought to be automated, however, can require complicated and nuanced assessments. Two possible baseline standards, for example, would be that robots should only do jobs at which they are equally good or better than humans, and/or that robots should only do jobs that are difficult, dangerous, or unfulfilling for humans. In some cases, these standards would be fairly straightforward to apply. A robot will likely never be able to write a novel to the same standard as a human writer, for example, so it doesn’t make sense to try to replace novelists with louchely-attired cyborgs. On the other hand, robots could quite conceivably be designed to bake cakes, compose generic pop songs, and create inscrutable canvases for major contemporary art museums—but to the extent that humans enjoy being bakers, pop stars, and con artists, we shouldn’t automate those jobs, either.

For certain professions, however, estimating the relative advantages of human labor versus robot labor is rather difficult by either of these metrics. For example, some commentators have predicted we’ll see a marked increase in robot “caregivers” for the elderly. In many ways, this would be a wonderful development. For elders who have health and mobility impairments, but are otherwise mentally acute, having robots that can help you out of bed, steady you in the shower, and chauffeur you to your destinations might mean several more decades of independent living. Robots could make it much easier for people to care for their aging loved ones in their own homes, rather than putting them in some kind of facility. And within institutional settings like nursing homes, hospitals, and hospices, it would be an excellent thing to have robots that can do hygienic tasks, like cleaning bedpans, or physically dangerous ones, like lifting heavy patients (nurses have a very high rate of back injury).

At the same time, the idea of fully automated elder care has troubling implications. There’s no denying that caring for declining elders can be difficult and often unpleasant work; anybody who has spent time in medical facilities knows that nursing staffs are overworked, and that individual nurses can be incompetent and profoundly unsympathetic. One might well argue that a caregiver robot, while not perfect, is still better than an exhausted or outright hostile human caregiver; and thus, that the pros of substituting robots for humans across a wide array of caregiving tasks outweigh the cons. However, as a society that already marginalizes and warehouses the elderly—especially the elderly poor—we ought to feel queasy about consigning them to an existence where the little human interaction that remains to them is increasingly replaced by purpose-built machines. Aging can be a time of terrible loneliness and isolation: imagine the misery of a life where no fellow-human ever again touches you with affection, or even basic friendliness. The problem is not just that caring for elders is often difficult, but that the humans who currently do it are undervalued and underpaid, despite the fact that they bear the immense burden of buttressing our shaky social conscience. It would be a lot easier to manufacture caregiver robots than to improve working conditions for human caregivers, but a robot can’t possibly substitute for a nurse who is actually kind, empathetic, and good at their job.

These sorts of concerns are common to most of the “caring” and educational professions, which are usually labor-intensive, time-consuming, poorly compensated, and insufficiently respected. Automating these jobs is an easy shortcut to meaningfully improving them. For example, people like Netflix CEO Reed Hastings think that “education software” is a reasonable alternative to a human-run classroom, despite the fact that the only real purpose of primary education, when it comes down to it, is to teach children about social interaction. (Do you remember anything substantive that you learned in school before, say, age 15? I sure don’t.) And what job is more difficult than parenting? If a robot caregiver is cheaper than a nanny and more reliable than a babysitter, we’d be foolish to suppose that indifferent, career-focused, or otherwise overtasked parents won’t readily choose to have robots mind their children for long periods of time. Automation may well be more cost-effective and easier to implement than better conditions for working parents, or government payouts that would allow people to be full-time parents to their small children, or healthier social attitudes generally about work-family balance. But with teaching and parenting, as with nursing, it’s intuitively obvious that software and robots are in no sense truly equivalent to humans. Rather than automating these jobs, we should be thinking about how to materially improve conditions for people who work in them, with the aim of making their work easier where possible, and rewarding them appropriately for the aspects of their work that are irremediably difficult. Supplementing some aspects of human labor with automated labor can be part of this endeavor, but it can’t be the whole solution.

Additionally, without better labor standards for human workers, determining which kinds of jobs humans actually don’t want to do becomes rather tricky. Some jobs are perhaps miserable by their very nature, but others are miserable because the people who currently perform them lack benefits and protections. We may all have assumptions and biases here that are not necessarily instructive. We might often, like Oscar Wilde, think primarily of manual labor when we’re imagining which jobs should be automated. Very likely there are some forms of manual labor so monotonous, painful, or unpleasant that nobody on earth would voluntarily choose to do them—we can certainly think of a few jobs, like mining, that are categorically and unconscionably dangerous for human workers. But it is also an undeniable fact that many people genuinely like physical labor. It’s even possible that many more people like physical labor than are fully aware of it, due to the class-related prejudices associated with manual work—why on earth else do so many people who work white-collar jobs derive their entire sense of self-worth from running marathons or lifting weights or riding stationary bicycles in sweaty, rubber-scented rooms? Why do so many retirees take up gardening? Why do some lunatics regularly clean their houses as a form of relaxation? Clearly, physical labor can be very satisfying under the right circumstances. The point is, there are some jobs we might intuitively think are morally imperative to automate, because in their current forms, they are undeniably awful. But if we had more humane labor laws, and altered our societal expectations about the appropriate relationship between work and leisure, they might be jobs people actually liked.

by Brianna Rennix, Current Affairs |  Read more:

Image: Pranas Naujokaitis

The Legion Lonely

On Thursday, July 13, 1995, a concentration of high pressure in the upper atmosphere above Midwest Chicago forced massive amounts of hot air to the ground, causing temperatures as high as 41°C (106°F). In a Midwestern city not built for tropical heat, roads buckled, cars broke down in the street, and schools closed their doors. On Friday, three Con Ed power transformers failed, leaving 49,000 people without electricity. In high-rise apartments with no air conditioning, temperatures hit 49°C (120°F) even with the windows open. The heat continued into Saturday. The human body can only take about 48 hours of uninterrupted heat like this before its defenses begin to shut down, and emergency rooms were so crowded they had to turn away heatstroke victims. Sunday was no better, and as the death toll rose—of dehydration, heat exhaustion, and renal failure—the morgues hit capacity, too, and bodies were stored in refrigerated meat-packing trucks. In all, 739 people died as a result of the heat wave.

In its aftermath, an inquiry found, unsurprisingly, that the majority of those who died were poor, old, and lived alone. More surprising was the gender imbalance: significantly more men died than women. This was especially strange considering that in Chicago in July of 1995, there were more old women who lived alone than old men.

What made these men more vulnerable than the women? It wasn’t physical circumstances. Both groups lived mostly in “single room occupancy” buildings, or SROs—apartments of one room in what used to be called flophouses. It was social circumstances. The phrase “No known relatives” appears repeatedly in police reports of the dead men’s homes. Letters of regret were found on floors and in backs of drawers: “I would like to see you if that’s possible, when you come to the city”; “It seems to me that our family should have gotten along.” The single rooms of the deceased are described as “roach infested” and “a complete mess,” indicating few or no visitors. The women, according to Eric Klinenberg, who wrote a book on the heat wave, had people who checked up on them and so kept them alive; the men did not. “When you have time please come visit me soon at my place,” read another letter, unsent.

What conditions lead to this kind of isolation? Why men?

Artie, 63, who lives in Beards Fork, West Virginia, population 200, has never married. He grew up in Beards Fork, but spent most of his life elsewhere. He moved back when he was 47 to take care of his sick mother, who died earlier this year. Now, after putting his own life on hold for sixteen years, he finds himself single, semi-retired, and without a close friend. “Life goes by really fast,” he said. Since his mom died, he’s found himself thinking, “Where in the hell did it go?”

This is the kind of thing he used to talk about with his mother. Now that she’s gone, he doesn’t really open up to anyone. He has no close friends in the area, and he’s “felt a lot of depression over the past few years.”

Artie’s not an antisocial guy or a homebody. His career brought him into contact with hundreds of interesting people over the years; he lived in California for a decade, and before that he had a nine-year relationship. But back in his hometown, all the connections he made seem to have melted away. “I don’t really have any close friends, other than my family,” he said, “which is something different.” (A 2005 Australian study agreed: while close friendships increase your longevity by up to 22 percent, family relationships make no difference.)

Artie has a group of friends he met in his thirties and forties with whom he’s still in touch, mainly on Facebook, but those relationships are “not quite the same as the friendships I had when I was younger. Less deep. Less vulnerable. And I’m not even sure I want to [open up].” He’s somewhat close with a few of his former coworkers, but though they confide in him, he doesn’t feel like he can confide in them. “They’re younger,” he said. “They don’t understand my problems.” Despite being semi-retired, he still goes into the office every day and stays late, after everyone’s gone. “I’m reluctant to go home,” he said. “Nobody’s there.”

In many ways, Artie seems in danger of going down the path of those Chicago SRO-dwellers. But there’s an important difference between those men and Artie: what the former had in common was their social isolation—having few or no social connections. Artie’s problem, on the other hand, is one of loneliness—the feeling of being isolated, regardless of your social connectedness, usually due to having few or no confidants.

Is this my future?

At first glance it seems unlikely. I’m 34. I have what seems to me a pretty active social life. I’m integrated into my community and I go to arts events regularly. I’ve lived here in Toronto off and on since I was 18. I went to university here. I helped found an arts venue here. I know hundreds of people here, if not thousands. I have multiple jobs—college instructor, freelance writer, tutor. I have friends. Whatever path led to these lonely destinations, I want to believe, is not the path I’m on. When I die, my floor will be tidy, and my letters sent.

And yet, there’s something about their stories that seems eerily familiar. Slowly but surely, I feel my social world slipping away from me. All three of my jobs combined require me to be around other humans a total of about eight hours out of a week’s 168. The other 160, I’m mostly at home. It’s not unusual for me to go several days in a row with no social contact of any kind, and the longer I go without it, the scarier it feels. I become shy, paranoid that no one would want to hang out with me. Social slights metastasize in my brain. I start to avoid social functions, convinced I’ll walk into a wall of mysterious eye contact. I live close to many friends, but I hide from them when I see them in the street. I don’t think of myself as antisocial—I love people, love being around them, and have had so many good friendships—but it often feels like an uphill battle, and mystifyingly complex, to not slip back endlessly into this pit of despair.

The thing is, I wasn’t always like this. How did I get here?

by Stephen Thomas, Hazlitt |  Read more:

Image: Postcard image via Flickr user Rob

The Opioid Crisis: Treating Root Causes of Addiction

AARON MATÉ: Thank you for joining us. Let’s start first with what this crisis is. The figures on overdose deaths in the US are something like 140 every single day, two-thirds from opioids. Describe for us what kind of crisis we’re dealing with here.

GABOR MATÉ: As the President’s Commission said, every three weeks in the US you have the equivalence of a 9/11, so that every year, currently, you have 14, 15 9/11s happening. In that sense, it’s reasonable to speak about it as an emergency. Another sense, of course, it’s been going on for a long, long, long time, it’s just that the numbers have increased in the recent years.

AARON MATÉ: The numbers and also in terms of who the victims are, right, demographically?

GABOR MATÉ: Yes. It’s now been found that the life expectancy of the white, working, and middle class is decreasing because of alcoholism and drug overdoses. It’s a question of who it’s hitting. It was always certain sections of the population, but now it’s hitting the mainstream.

AARON MATÉ: The implication there is that that’s the reason why it’s perhaps getting so much more attention and resources now?

GABOR MATÉ: Well, there was an article in New York Times earlier this year which said exactly that, that because it’s now hitting the white middle class, people are really starting to wonder what it’s all about, and what else can you do beside the usual ineffective responses. It’s interesting enough that, in the 2016 election, Trump got some of the biggest support in areas that are hardest hit by alcoholism and the opioid crisis and suicides.

AARON MATÉ: Why do you think that is?

GABOR MATÉ: That speaks to the very heart of addiction and what drug use is all about. It’s all about an attempt to escape from desperation. Those areas are the areas of the country with the greatest desperation. Those are the ones that most were susceptible to Trump’s message.

AARON MATÉ: Okay, let’s talk about that. You talk about addiction being an attempt to escape desperation. You’ve worked with addicts over many years. You were a physician at the Portland Hotel Society, which is a residential and hospice service for residents of Vancouver’s downtown east side, an area with a huge drug problem. Talk more about that, addiction being rooted in an attempt to escape adverse conditions.

GABOR MATÉ: If you look at the opioids, what are they? The opioids have been used in medicine for thousands of years. Used for what? Used for pain relief. They’re the most powerful pain relievers that we have. They don’t only soothe physical pain, they also soothe emotional pain. It turns out that the same area of the brain that experiences suffering from physical pain also experiences suffering from emotional pain. In other words, the primary question in any addiction, but especially in opioid addiction, is not why the addiction, but why the pain?

We have to look at what is the pain that people are trying to escape from. For that, there are two major causes. One cause is childhood trauma. We talk about how childhood trauma actually affects the brain in such a way as to make it more susceptible to addictions later on. Childhood trauma is one source of deep pain and all the addicts I worked with have been traumatized significantly so. That’s what the large scale studies in the US shows about it, the more trauma in childhood, exponentially the greater the risk of addiction. Childhood trauma is a huge problem in our society and in American society.

The other question is, what’s going on right now? That’s stress. What we also know is that stress makes the brain more susceptible to addiction and stress also makes people more desires of escape from the stress. If you look at what’s happening socially, economically, politically, culturally, is increasing insecurity, increasing stress, increasing uncertainty, increasing difficulty for people. Therefore, people will turn to short-term measures to escape those difficulties, or at least the awareness of them, by escaping into addictions, including drug use. What we’re looking at is, A, childhood trauma, and B, severe social stress. It’s not surprising that the areas where Trump got the greatest support are areas of great social stress. (...)

AARON MATÉ: Quite likely, they’re using drugs to deal or cope with those mental health issues?

GABOR MATÉ: Very often drugs are, apart from the general escape that provide from stress and emotional pain and distress, they’re also specifically self-medications for diagnosable mental conditions such as post traumatic stress, such as depression, such as anxiety, such as attention deficit hyperactive disorder, such as bipolar illness, such as social phobia and so on. Again, these conditions and their basis in trauma all have to be addressed if we’re to help addicts, addicted people really overcome their problem.

AARON MATÉ: Okay, so a final question, and it’s also about psychology, I’m curious your thoughts on what is the psychology of those who stigmatize addicts, who have a hard time seeing them as people in need, people with pain, more seeing them from a criminal perspective? What, in your view, is going on there?

GABOR MATÉ: (...) If you look at American society or Western society in general, it’s a highly addictive culture. People have all kinds of addictions. There’s not really a deep difference between drug addictions, and sex addiction, and gambling addiction, and shopping addiction, and eating additions, in terms of their causes, in terms of their brain circuits, and in terms of negative impact.

AARON MATÉ: Well, but listen, a lot of people would push back on that and say, “You can’t compare the impact of heroin use to the impact of gambling or sex or whatever else.”

GABOR MATÉ: Well, first of all, we can make a more direct comparison if we look at cigarettes use or alcohol use. You can make a direct comparison between cigarette use and alcohol use and, on the one hand, in heroin use and the other. You know what the comparison says? The comparison says that heroin use is far safer. In other words, if you take a thousand people who smoke or drink heavily or who inject heroin, as long as they don’t overdose, 30 years from now, there’ll be a lot more disease, a lot more death in the alcohol and cigarette groups than in the heroin group.

by Jerri-Lynn Scofield, Naked Capitalism | Read more:
Image: Tek Image/Science Photo Library/Getty

[ed. Finally, someone gets it right. It's an epidemic of despair, stress, trauma, social isolation and economic instability. Unless we deal with the factors causing those conditions, this epidemic can't help but continue. See also: Why social capital could be the key to solving America’s overdose epidemic]

Guy Bourdin
via:

Bob Marley

Is LIBOR, Benchmark for Trillions of Dollars in Transactions, a Lie?

It was easy to miss, with the impending end of civilization burning up the headlines, but a beyond-belief financial story recently crept into public view.

A Bloomberg headline on the story was a notable achievement in the history of understatement. It read:

LIBOR'S UNCERTAIN FUTURE TRIGGERS $350 TRILLION SUCCESSION HEADACHE

The casual news reader will see the term "LIBOR" and assume this is just a postgame wrapup to the LIBOR scandal of a few years back, in which may of the world's biggest banks were caught manipulating interest rates.

It isn't. This is a new story, featuring twin bombshells from a leading British regulator – one about our past, the other our future. To wit:

1. Going back twenty years or more, the framework for hundreds of trillions of dollars worth of financial transactions has been fictional.
2. We are zooming toward a legal and economic clusterfuck of galactic proportions – the "uncertain future" Bloomberg humorously referenced.

LIBOR stands for the London Interbank Offered Rate. It measures the rate at which banks lend to each other. If you have any kind of consumer loan, it's a fair bet that it's based on LIBOR.

A 2009 study by the Cleveland Fed found that 60 percent of all mortgages in the U.S. were based on LIBOR. Buried somewhere in your home, you probably have a piece of paper that outlines the terms of your credit card, student loan, or auto loan, and if you peek in the fine print, you have a good chance of seeing that the rate you pay every month is based on LIBOR.

Years ago, we found out that the world's biggest banks were manipulating LIBOR. That sucked.

Now, the news is worse: LIBOR is made up.

Actually it's worse even than that. LIBOR is probably both manipulated and made up. The basis for a substantial portion of the world's borrowing is a bent fairy tale.

The admission comes by way of Andrew Bailey, head of Britain's Financial Conduct Authority. He said recently (emphasis mine): "The absence of active underlying markets raises a serious question about the sustainability of the LIBOR benchmarks. If an active market does not exist, how can even the best run benchmark measure it?"

As a few Wall Street analysts have quietly noted in the weeks since those comments, an "absence of underlying markets" is a fancy way of saying that LIBOR has not been based on real trading activity, which is a fancy way of saying that LIBOR is bullshit.

LIBOR is generally understood as a measure of market confidence. If LIBOR rates are high, it means bankers are nervous about the future and charging a lot to lend. If rates are low, worries are fewer and borrowing is cheaper.

It therefore makes sense in theory to use LIBOR as a benchmark for borrowing rates on car loans or mortgages or even credit cards. But that's only true if LIBOR is actually measuring something.

Here's how it's supposed to work. Every morning at 11 a.m. London time, twenty of the world's biggest banks tell a committee in London how much they estimate they'd have to pay to borrow cash unsecured from other banks.

The committee takes all 20 submissions, throws out the highest and lowest four numbers, and then averages out the remaining 12 to create LIBOR rates.

Theoretically, a fine system. Measuring how scared banks are to lend to each other should be a good way to gauge market stability. Except for one thing: banks haven't been lending to each other for decades.

Up through the Eighties and early Nineties, as global banks grew bigger and had greater demand for dollars, trading between banks was heavy. That robust interbank lending market was why LIBOR became such a popular benchmark in the first place.

But beginning in the mid-nineties, banks began to discover that other markets provided easier and cheaper sources of funding, like the commercial paper or treasury repurchase markets. Trading between banks fell off.

Ironically, as trading between banks declined, the use of LIBOR as a benchmark for mortgages, credit cards, swaps, etc. skyrocketed. So as LIBOR reflected reality less and less, it became more and more ubiquitous, burying itself, tick-like, into the core of the financial system.

The flaw in the system is that banks don't have to report to the LIBOR committee what they actually paid to borrow from each other. Instead, they only have to report what they estimate they'd have to pay.

The LIBOR scandal of a few years ago came about when it was discovered that the banks were intentionally lying about these estimates. In some cases, they were doing it with the assent of regulators.

In the most infamous instance, the Bank of England appeared to encourage Barclays to lower its LIBOR submissions, as a way to quell panic after the 2008 crash.

It later came out that banks had not only lied about their numbers during the crisis to make the financial system look safer, but had been doing it generally just to rip people off, pushing the number to and fro to help their other bets pay off.

Written exchanges between bank employees revealed hilariously monstrous activity, with traders promising champagne and sushi and even sex to LIBOR submitters if they fudged numbers.

"It's just amazing how LIBOR fixing can make you that much money!" one trader gushed. In writing.

Again, this was bad. But it paled in comparison to the fact that the numbers these nitwits were manipulating were fake to begin with. The banks were supposed to be estimating how much it would cost them to borrow cash. But they weren't borrowing cash from anyone.

For decades now, the world's biggest banks have been dutifully reporting a whole range of numbers every morning at 11 a.m. London time – the six-month Swiss franc rate, the three-month yen, the one-month dollar, etc. And none of it seems to have been real.

These numbers, even when sociopathic lunatics weren't fixing them, were arbitrary calculations based on previous, similarly arbitrary calculations – a rolling fantasy that has been gathering speed for decades.

When regulators dug into the LIBOR scandal of a few years ago, they realized that any interbank lending rate that depended upon the voluntary reports of rapacious/amoral banks was inherently problematic.

But these new revelations tell us forcing honesty won't work, either. There could be a team of regulators sitting in the laps of every LIBOR submitter in every bank, and it wouldn't help, because there is no way to honestly describe a nonexistent market.

by Matt Taibbi, Rolling Stone |  Read more:

Image: Oli Scarff/Getty

Halalu

[ed. Sorry, I've been busy. See also: Born to Run and Secret Runs Of Halalu And Oama.]

How Technology is Changing the World of Tattoos

No longer considered a social or professional taboo, tattoos have by and large become a mainstream concept that is now considered commonplace both publicly and in the workplace. The U.S. Food and Drug Administration currently estimates that 45 million Americans sport a tattoo, with more women than men wearing ink in their skin. Much of this sea change in the perception of tattoos is attributed to the improvement and evolution in technology for applying tattoos safely with fewer health risks, less pain, and greater permanence.

The United States currently has over 8,000 registered tattoo parlors that generate an average of $3.4-billion in revenue due to popular demand. It is this booming business that is driving innovations in technology far beyond the arena of body art and individual rebellion against societal norms. Researchers in the medical, technology, and consumer electronics industries are all currently researching numerous potential advancements that tattoos could bring to their respective disciplines.

Scientists at The Massachusetts Institute of Technology, University of California San Diego, and the Advanced Institute of Science and Technology, Korea (KAIST) are all studying numerous applications for tattoos that function as anything from medical monitors to smartphone interfaces. New tech startups are being founded and funded every year that are dedicated to changing the way tattoos are applied and the functions they can serve beyond creating works of art and personal statements in the dermis of their bearers. (...)

Bio-Monitor Tattoos

Nano-tech engineers at UC San Diego are in the process of testing temporary tattoos that can both extract and measure blood-glucose levels from the fluid found between skin cells. It is the first device of its kind that can provide a non-invasive method for glucose testing in those who suffer from Type 1 and Type 2 diabetes. This temporary tattoo also demonstrates the potential for other uses for a biomonitoring implant in measuring other metabolites within the body, or as means of regulating dosage of medicine directly into the skin.

MIT has also been hard at work in the biomonitor tattoo field, presenting current research on their Dermal Abyss project. Instead of a temporary tattoo applied to the surface of the skin, these tattoos use specialized biosensor ink rather than traditional ink. Partnering with Harvard Medical School, the Dermal Abyss team developed three types of biosensor inks that can measure shifts in the interstitial fluid of the skin, altering their color according to the current level of glucose, sodium, or pH in a human body. This project is part of an ongoing series of projects being developed for future tech implants that have been dubbed “beauty technology”. Other innovations under development include smart fake-eyelashes, conductive makeup, and RFID-enabled nail polish. The purpose of such research is to find more ways to integrate technology into appealing and functional applications for men and women.

Duoskin Tattoos

This tech is a joint venture at MIT funded by Microsoft to develop an individual fabrication process for creating individually customized functional devices that can be adhered directly to the skin. Using gold-leaf ( a cheap, skin friendly, and robust conductive material), artists and technology developers have created touch sensor inputs, data output displays, and even wireless communication when interfaced with mobile devices such as a tablet or smartphone.

Designs tested so far have included controls for smartphones worn on the skin, new message and other information displays, data vaults, and even rudimentary microphones. The purpose of the DuoSkin initiative is to eliminate the idea of on-skin tech implants being some sort of unfathomable technology with no easily adapted, user-friendly applications.

Sub-Dermal Temporary Tattoos

Developed by a small company called Ephemeral, this new tech in tattooing is intended to reach any individual who is uncertain about the idea of permanently inking their body. Rather than using a hi-tech machinery, this innovation is thanks to specially formulated inks that are designed to fade from the skin after a year or so, with an option to use a specialized device to fade them out even faster.

Founder and CEO Seung Shin originally developed the concept as a result of a personal experience he had as a college student when he got a tattoo on his arm. His family’s reaction was extremely negative, and he actually ended up getting the tattoo removed eventually. However, he found the entire process of laser tattoo removal to be quite painful, and it left unsightly scarring. After graduating from New York University in 2015 with a Bachelor of Science degree in chemical and biomolecular engineering, Shin decided to put his education and experience to work developing a better temporary tattoo ink.

The secret is in the molecular structure of the ink, which Shin describes as a transparent sphere of biomaterial that is filled with smaller dye molecules. The bonds of these ink molecules naturally decay over time, but can also be broken up more rapidly using a device they have developed as a part of the process. They are currently seeking investors, and expect to have their temporary tattoo ink to market by 2018.

Biotech Tattoos

New Deal Design is a tech firm that spearheaded much of the wearable fitness tech we see today, such as FitBit. Their current innovation, Project Underskin, is to create a smart digital biotech tattoo that acts as an credentials implant for opening doors in secure locations or accessing user profiles and secure files on a computer or network. These tattoos would also have biosensor functions for personal health monitoring similar to current wearables, and would even allow contact transfer of information by touching specialized sensor interfaces. This technology is still in the very early stages of technology, but their current president states that once the flexibility issue has been resolved, products that integrate these technologies for sub-dermal implants and tattoos could be available as soon as the next ten years.

Soundwave Tattoos

This fascinating technology was designed by California-based artist Nate Siggard, who worked with a team of experts in various fields to create his unique and personalized augmented reality tattoos. Using an app called SkinMotion, users upload a recorded audio message in a clip to an online server. They then have their personalized soundwave tattooed on their skin by a certified Skin Motion artist. The resulting tattoo can be scanned with the app and the audio clip replayed. Other Skin Motion users can scan your tattoos and hear your audio clips, making your tattoos a visual and auditory statement. Popular choices for a Soundwave Tattoo include recordings of a loved ones voice or a favorite song.

by Rick Kolek, ART |  Read more:

Image: ART

Why We Fell for Clean Eating

In the spring of 2014, Jordan Younger noticed that her hair was falling out in clumps. “Not cool” was her reaction. At the time, Younger, 23, believed herself to be eating the healthiest of all possible diets. She was a “gluten-free, sugar-free, oil-free, grain-free, legume-free, plant-based raw vegan”. As The Blonde Vegan, Younger was a “wellness” blogger in New York City, one of thousands on Instagram (where she had 70,000 followers) rallying under the hashtag #eatclean. Although she had no qualifications as a nutritionist, Younger had sold more than 40,000 copies of her own $25, five-day “cleanse” programme – a formula for an all-raw, plant-based diet majoring on green juice.

But the “clean” diet that Younger was selling as the route to health was making its creator sick. Far from being super-healthy, she was suffering from a serious eating disorder: orthorexia, an obsession with consuming only foods that are pure and perfect. Younger’s raw vegan diet had caused her periods to stop and given her skin an orange tinge from all the sweet potato and carrots she consumed (the only carbohydrates she permitted herself). Eventually, she sought psychological help, and began to slowly widen the repertoire of foods she would allow herself to eat, starting with fish. She recognised that the problem was not her veganism, per se, but the particularly rigid and restrictive diet regime she had imposed on herself.

As Younger slowly recovered from her eating disorder, she faced a new dilemma. “What would people think”, she agonised, “if they knew the Blonde Vegan was eating fish?” She levelled with her followers in a blogpost entitled Why I’m Transitioning Away from Veganism. Within hours of announcing her new diet, Younger was receiving irate messages from vegans demanding money back from the cleanse programmes and T-shirts they had bought from her site (featuring slogans such as “OH KALE YES”).

She lost followers “by the thousands” and received a daily raft of angry messages, including death threats. Some responded to her confession that she was suffering from an eating disorder by accusing her of being a “fat piece of lard” who didn’t have the discipline to be truly “clean”.

For as long as people have eaten food, there have been diets and quack cures. But previously, these existed, like conspiracy theories, on the fringes of food culture. “Clean eating” was different, because it established itself as a challenge to mainstream ways of eating, and its wild popularity over the past five years has enabled it to move far beyond the fringes. Powered by social media, it has been more absolutist in its claims and more popular in its reach than any previous school of modern nutrition advice.

At its simplest, clean eating is about ingesting nothing but “whole” or “unprocessed” foods (whatever is meant by these deeply ambiguous terms). Some versions of clean eating have been vegan, while others espouse various meats (preferably wild) and something mysteriously called “bone broth” (stock, to you and me). At first, clean eating sounded modest and even homespun: rather than counting calories, you would eat as many nutritious home-cooked substances as possible.

But it quickly became clear that “clean eating” was more than a diet; it was a belief system, which propagated the idea that the way most people eat is not simply fattening, but impure. Seemingly out of nowhere, a whole universe of coconut oil, dubious promises and spiralised courgettes has emerged. Back in the distant mists of 2009, James Duigan, owner of The Bodyism gym in London and sometime personal trainer to the model Elle MacPherson, published his first Clean and Lean book. As an early adopter of #eatclean, Duigan notes that he “battled” with his publisher “to include ingredients like kale and quinoa, because no one had ever heard of them”. Now quinoa is in every supermarket and kale has become as normal as lettuce. “I long for the days when clean eating meant not getting too much down your front,” the novelist Susie Boyt joked recently.

Almost as soon as it became ubiquitous, clean eating sparked a backlash. By 2015, Nigella Lawson was speaking for many when she expressed “disgust” at clean eating as a judgmental form of body fascism. “Food is not dirty”, Lawson wrote. Clean eating has been attacked by critics such as the baker and cookbook author Ruby Tandoh (who wrote a much-shared article on the subject in Vice magazine in May 2016) for being an incitement to eating disorders.

Others have pointed out that, as a method of healthy eating, it’s founded on bad science. In June, the American Heart Association suggested that the coconut oil beloved as a panacea by clean eaters actually had “no known offsetting favourable effects”, and that consuming it could result in higher LDL cholesterol. A few weeks later, Anthony Warner – a food consultant with a background in science who blogs as The Angry Chef – published a book-length assault on the science of clean eating, calling it a world of “quinoa bowls” and “nutribollocks” fuelled by the modern information age.

When Dr Giles Yeo, a geneticist at the University of Cambridge, presented an episode of the BBC’s Horizon this year that examined the scientific evidence for different schools of clean eating, he found everything from innocuous recipes to serious malpractice.

He reported on the “alkaline diet” of Dr Robert O Young, who peddled the idea that disease is caused by eating “acidic” foods. After being diagnosed with terminal cancer in her 20s, Naima Houder-Mohammed, an officer in the British army, paid Young more than $77,000 for treatment (including meals of avocado, which Young calls “God’s butter”) at his “pH miracle” ranch in the US in 2012. She died later that year. Separately, Young was jailed in June this year after being convicted of charges including practising medicine without a licence. While he may represent an extreme case, it is clear that many wellness gurus, as Yeo’s programme concluded, tell a “troubling narrative” founded on falsehoods.

As the negative press for clean eating has intensified over the past year, many of the early goddesses of #eatclean have tried to rebrand – declaring they no longer use the word “clean” to describe the recipes that have sold them millions of books. Ella Mills – AKA Deliciously Ella, the food writer and entrepreneur whose coconut-and-oat energy balls sell for £1.79 apiece in British supermarkets – said on Yeo’s Horizon programme that she felt that the word “clean” as applied to eating originally meant nothing but natural, real, unprocessed food. “Now, it means diet, it means fad,” she complained.

But however much the concept of clean eating has been logically refuted and publicly reviled, the thing itself shows few signs of dying. Step into the cookbook section of any book shop and you will see how many recipe writers continue to promise us inner purity and outer beauty. Even if you have never knowingly tried to “eat clean”, it’s impossible to avoid the trend altogether, because it changed the foods available to all of us, and the way they are spoken of.

Avocados now outsell oranges in the UK. Susi Richards, head of product development at Sainsbury’s supermarkets, told me earlier this year that she had been taken aback by the pace at which demand for products fitting with the clean eating lifestyle have grown in the UK. Families who would once have eaten potato waffles are now experimenting with lower carb butternut “squaffles” (slices of butternut squash cut to resemble a waffle). Nutribullets – a brand of compact blenders designed for making supposedly radiance-bestowing juices and smoothies – are now mentioned in some circles as casually as wooden spoons.

Why has clean eating proved so difficult to kill off? Hadley Freeman, in this paper, identified clean eating as part of a post-truth culture, whose adherents are impervious, or even hostile, to facts and experts. But to understand how clean eating took hold with such tenacity, it’s necessary first to consider just what a terrifying thing food has become for millions of people in the modern world. The interesting question is not whether clean eating is nonsense, but why so many intelligent people decided to put their faith in it.

by Bee Wilson, The Guardian |  Read more:

Image: Yahoo
[ed. On a related note, the Honolulu Star Advertiser recently reported that "roughly half of the state population has diabetes or pre-diabetes (Diabetes Growing in Isles - hard pay wall, 8/5/17). Must be all those mac salad and sodas.]

Total Eclipse

To put ourselves in the path of the total eclipse, that day we had driven five hours inland from the Washington coast, where we lived. When we tried to cross the Cascades range, an avalanche had blocked the pass.

A slope’s worth of snow blocked the road; traffic backed up. Had the avalanche buried any cars that morning? We could not learn. This highway was the only winter road over the mountains. We waited as highway crews bulldozed a passage through the avalanche. With two-by-fours and walls of plywood, they erected a one-way, roofed tunnel through the avalanche. We drove through the avalanche tunnel, crossed the pass, and descended several thousand feet into central Washington and the broad Yakima valley, about which we knew only that it was orchard country. As we lost altitude, the snows disappeared; our ears popped; the trees changed, and in the trees were strange birds. I watched the landscape innocently, like a fool, like a diver in the rapture of the deep who plays on the bottom while his air runs out. (...)

It was dawn when we found a highway out of town and drove into the unfamiliar countryside. By the growing light we could see a band of cirrostratus clouds in the sky. Later the rising sun would clear these clouds before the eclipse began. We drove at random until we came to a range of unfenced hills. We pulled off the highway, bundled up, and climbed one of these hills.

The hill was 500 feet high. Long winter-killed grass covered it, as high as our knees. We climbed and rested, sweating in the cold; we passed clumps of bundled people on the hillside who were setting up telescopes and fiddling with cameras. The top of the hill stuck up in the middle of the sky. We tightened our scarves and looked around.

East of us rose another hill like ours. Between the hills, far below, 13 was the highway which threaded south into the valley. This was the Yakima valley; I had never seen it before. It is justly famous for its beauty, like every planted valley. It extended south into the horizon, a distant dream of a valley, a Shangri-la. All its hundreds of low, golden slopes bore orchards. Among the orchards were towns, and roads, and plowed and fallow fields. Through the valley wandered a thin, shining river; from the river extended fine, frozen irrigation ditches. Distance blurred and blued the sight, so that the whole valley looked like a thickness or sediment at the bottom of the sky. Directly behind us was more sky, and empty lowlands blued by distance, and Mount Adams. Mount Adams was an enormous, snow-covered volcanic cone rising flat, like so much scenery.

Now the sun was up. We could not see it; but the sky behind the band of clouds was yellow, and, far down the valley, some hillside orchards had lighted up. More people were parking near the highway and climbing the hills. It was the West. All of us rugged individualists were wearing knit caps and blue nylon parkas. People were climbing the nearby hills and setting up shop in clumps among the dead grasses. It looked as though we had all gathered on hilltops to pray for the world on its last day. It looked as though we had all crawled out of spaceships and were preparing to assault the valley below. It looked as though we were scattered on hilltops at dawn to sacrifice virgins, make rain, set stone stelae in a ring. There was no place out of the wind. The straw grasses banged our legs.

Up in the sky where we stood the air was lusterless yellow. To the west the sky was blue. Now the sun cleared the clouds. We cast rough shadows on the blowing grass; freezing, we waved our arms. Near the sun, the sky was bright and colorless. There was nothing to see.

It began with no ado. It was odd that such a well advertised public event should have no starting gun, no overture, no introductory speaker. I should have known right then that I was out of my depth. Without pause or preamble, silent as orbits, a piece of the sun went away. We looked at it through welders’ goggles. A piece of the sun was missing; in its place we saw empty sky.

I had seen a partial eclipse in 1970. A partial eclipse is very interesting. It bears almost no relation to a total eclipse. Seeing a partial eclipse bears the same relation to seeing a total eclipse as kissing a man does to marrying him, or as flying in an airplane does to falling out of an airplane. Although the one experience precedes the other, it in no way prepares you for it. During a partial eclipse the sky does not darken—not even when 94 percent of the sun is hidden. Nor does the sun, seen colorless through protective devices, seem terribly strange. We have all seen a sliver of light in the sky; we have all seen the crescent moon by day. However, during a partial eclipse the air does indeed get cold, precisely as if someone were standing between you and the fire. And blackbirds do fly back to their roosts. I had seen a partial eclipse before, and here was another.

What you see in an eclipse is entirely different from what you know. It is especially different for those of us whose grasp of astronomy is so frail that, given a flashlight, a grapefruit, two oranges, and 15 years, we still could not figure out which way to set the clocks for daylight saving time. Usually it is a bit of a trick to keep your knowledge from blinding you. But during an eclipse it is easy. What you see is much more convincing than any wild-eyed theory you may know.

You may read that the moon has something to do with eclipses. I have never seen the moon yet. You do not see the moon. So near the sun, it is as completely invisible as the stars are by day. What you see before your eyes is the sun going through phases. It gets narrower and narrower, as the waning moon does, and, like the ordinary moon, it travels alone in the simple sky. The sky is of course background. It does not appear to eat the sun; it is far behind the sun. The sun simply shaves away; gradually, you see less sun and more sky.

The sky’s blue was deepening, but there was no darkness. The sun was a wide crescent, like a segment of tangerine. The wind freshened and blew steadily over the hill. The eastern hill across the highway grew dusky and sharp. The towns and orchards in the valley to the south were dissolving into the blue light. Only the thin river held a trickle of sun.

Now the sky to the west deepened to indigo, a color never seen. A dark sky usually loses color. This was a saturated, deep indigo, up in the air. Stuck up into that unworldly sky was the cone of Mount Adams, and the alpenglow was upon it. The alpenglow is that red light of sunset which holds out on snowy mountaintops long after the valleys and tablelands are dimmed. “Look at Mount Adams,” I said, and that was the last sane moment I remember.

by Annie Dillard, The Atlantic |  Read more:

Image: Jon Olav Nesvold / Stringer / Getty

You Can Now Get High Just Drinking Water

Here's a prediction: In 20 years, most of the people consuming weed will be doing so without touching anything that looks remotely like cannabis. People will be taking little pills filled with microdoses of THC, nursing homes will be full of people rubbing pot lotions on their arthritic hands, restaurants will be serving desserts infused with weed alongside a cognac digestif, and it will be harder and harder to find someone who wants to split a bowl with you.

After all, pot smokers are still a minority of the country. Most people are turned off by the idea of inhaling smoke or vapor into their lungs. But if the legal weed industry is able to convince weed-shy folks to try pot without the smoke, it will considerably increase the market's size.

Enter PEARL2O, a brand-new product in Washington's legal market that might be the furthest thing from pot that can still get you high.

It's a mineral water that doesn't smell or taste like pot in any way. You can do almost anything to PEARL2O, and it will still get you high. The water can be frozen into ice cubes, it can be blended into a smoothie, and it can even be boiled while retaining the active THC and CBD, which is how I ended up getting high off instant ramen.

It was easy, really. I just snagged a bottle of PEARL2O infused with 50 milligrams of THC and 50 milligrams of CBD ($30 suggested retail price according to LemonHaze.com) and poured about six ounces into a saucepan. The bottle said that would be 20 milligrams of both THC and CBD, which in edible form usually gets me medium high.

The mineral water, which has a milky white color, started to boil—I mixed in my trusted packet of ramen seasoning and then plopped in the square of noodles. The broth tasted like normal beef ramen but with a bit of a chalky aftertaste, though I couldn't taste anything remotely like cannabis in it. (...)

Most edibles are based on a fat solvent, because THC is highly soluble in fat, but there didn't appear to be any oils in the mineral water. The makers of PEARL2O didn't want to disclose the specifics of how the mineral water was made, so I reached out to Shanel Lindsay, a cannabis entrepreneur and lawyer in Massachusetts who, in addition to helping write the initiative that legalized pot in that state, has more than a decade of industrial experience with pot edibles.

Lindsay told me that PEARL2O was probably made with a machine that uses ultrasound waves to combine a distilled cannabis concentrate with water. This same process is already being used by a number of other companies to make weed waters in other states, although most of those waters have CBD but not THC in them.

"The ultrasonic emulsification actually breaks down the molecule so it becomes very tiny—with ultrasonic, you are really changing the chemical structure of that material," Lindsay said.

by Lester Black, The Stranger |  Read more:

Image: Pearl2O

Tegan and Sara

The Myth of Drug Expiration Dates

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted. We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

What if the system is destroying drugs that are technically “expired” but could still be safely used?

In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

“Refining our prescription drug dating process could save billions,” he says.

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.

by Marshall Allen, ProPublica |  Read more:

Image: Sandy Huffaker

Should I Help My Patients Die?

I was leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”

I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.

That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.

I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.

California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.

But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.

That aside, the idea of hastening death is uncomfortable for many doctors. In its original version, the Hippocratic oath states, “I will not administer poison to anyone when asked to do so, nor suggest such a course.” The American Medical Association, the nation’s largest association of doctors, has been formally opposed to the practice for 23 years. Its ethical and judicial council has recently begun to study the issue further.

At a dinner shortly after the law went into effect, I polled 10 palliative care colleagues on their impressions of it. There was a chorus of groans. Like me, they were being asked about it with increasing frequency, yet hadn’t found an answer that felt right. It wasn’t necessarily that we disapproved, but we didn’t want to automatically become the go-to people on this very complex issue, either.

This first patient of mine was not a simple case. When I walked into his room, he glared at me. “Are you here to help me with this aid-in-dying thing?” he asked. He was in his early 60s, thin and tired, but in no obvious distress. From my read of his chart, he met all criteria to qualify. Terminal illness, decision-making capacity, ability to self-administer the medications. And he had made the requisite first request for the drugs two weeks earlier, as procedure dictates.

When I asked why he wanted to end his life early, he shrugged. “I’m just sick of living.” I asked about any symptoms that might lie behind his request: unrelenting pain, nausea, shortness of breath. He denied them all. In palliative care, we are taught that suffering can take many forms besides the physical. I probed further and the floodgates opened.

He felt abandoned by his sister. She cared only about his Social Security payments, he said, and had gone AWOL now that the checks were being mailed to her house. Their love-hate relationship spanned decades, and they were now on the outs. His despair had given way to rage.

“Let’s just end this,” he said. “I’m fed up with my lousy life.” He really didn’t care, he added, that his sister opposed his decision.

His request appeared to stem from a deep family wound, not his terminal illness. I felt he wanted to punish his sister, and he had found a way to do it.

At our second meeting, with more trust established, he issued a sob, almost a keening. He felt terrified and powerless, he said. He didn’t want to live this way anymore.

I understood. I could imagine my own distress in his condition — being shuttled like a bag of bones between the nursing home and the hospital. It was his legal right to request this intervention from me. But given how uncomfortable I was feeling, was it my right to say no?

In the end, he gave me an out. He agreed to a trial of antidepressants. “I’ll give you four weeks,” he said. He would follow up with his primary care doctor. I couldn’t help feeling relieved.

The patient died in a nursing home, of natural causes, three months later. And I haven’t had another request since. But the case left me worried. What if he had insisted on going through with it?

I’ll admit it: I want this option available to me and my family. I have seen much suffering around death. In my experience, most of the pain can be managed by expert care teams focusing on symptom management and family support. But not all. My mother is profoundly claustrophobic. I can imagine her terror if she were to develop Lou Gehrig’s disease, which progressively immobilizes patients while their cognitive faculties remain largely intact. For my mother, this would be a fate worse than death.

But still. I didn’t feel comfortable with the idea of helping to shorten the life of a patient because of depression and resentment. In truth, I’m not sure I am comfortable with helping to intentionally hasten anyone’s death for any reason. Does that make me a hypocrite?

I realized it was past time to sort out my thinking and turned to the de facto specialist in our area on this issue for counsel. Dr. Lonny Shavelson, an emergency medicine and primary care physician in Northern California, has been grappling with the subject for many years.

Given his interest in the topic, Dr. Shavelson felt a personal obligation to ensure that this new practice would be carried out responsibly after the law was passed. He founded Bay Area End of Life Options, a consulting group that educates physicians, advocates on patients’ behalf and prescribes the lethal concoction for some patients who meet the criteria for participation.

He has devised a process for his patients that not only adheres to the letter of the law, but goes far beyond it. His patient intake procedures are time-consuming and include a thorough history and physical, extensive home visits, a review of medical records and discussions with the patients’ doctors. He assesses the medical illness, the patient’s mental and emotional state and family dynamics.

He does not offer the medications to most of the patients who request them, sometimes because he deems them more than six months away from death or because he is worried that they have been coerced or because he believes that severe depression is interfering with their judgment. Since starting his practice, he has been approached by 398 patients. He has accepted 79 of those into his program and overseen ingestion and death for 48.

Dr. Shavelson’s careful observations have made him something of a bedside pharmacologist. In his experience, both the medications used and their dosages should be tailored to individual patients. While all patients enter a coma within minutes of ingesting the lethal cocktail, some deaths take longer, which can be distressing for the family and everyone else involved. One of his patients, a serious athlete, experienced a protracted death that Dr. Shavelson attributes to the patient’s high cardiac function. After that experience, Dr. Shavelson began to obtain an athletic history on every patient, and to add stronger medications if indicated.

In another patient, a mesh stent had been deployed to keep his intestines from collapsing. This stent prevented absorption in key areas, slowing the effect of the drugs and prolonging his death. Dr. Shavelson now routinely asks about such stents, something that a doctor less experienced in this process might miss.

Dr. Shavelson strives to mitigate all symptoms and suffering before agreeing to assist any patient in dying. He recounted many cases where patients no longer requested the medications once their quality of life improved. He counts these cases among his greatest successes. This demonstrates that his commitment is to the patient, not the principle.

When I asked Dr. Shavelson how he might have proceeded with my patient, he said he would have tried everything to relieve his distress without using the lethal medication. But if in the end the patient still wanted to proceed, he would have obliged, presuming his depression was not so severe as to impair his judgment. “I don’t have to agree with a patient’s reasoning or conclusions,” he said. “Those are hers to make, just as much as turning down chemotherapy or opting not to be intubated would be.”

by Jessica Nutik Zitter, NY Times | Read more:

Image: Chris Silas Neal

[ed. See also: Death as a social privilege?]

Free Alaskan Salmon: Just Bring a Net and Expect a Crowd

Wenceslous Fru, a physician assistant from Anchorage, stood on the sandy shore of the Kenai River and imagined the dinner he would put together once he felt the jostle of a salmon in his long-handled dip net. He would make it the way they do back home in Cameroon, splitting it down the belly and opening it like a book, rubbing it with ginger, garlic and spices, and then slipping it under the broiler.

Fishing nearby, Raviwan Dougherty, an Anchorage restaurant worker from Thailand, envisioned steaming hers and bathing it in fish sauce, lime juice and chiles.

Lyubov Miroshnick, who works in a dental office in Wasilla, planned to smoke her catch after a soak in her Ukrainian grandparents’ brine recipe.

“Mainly, we fish for the winter,” said Ms. Miroshnick, who had a dozen family members with her. “That’s how most people survive here. It’s the cheaper way.”

There is no more popular fishery in Alaska than the Kenai (KEEN-eye), a three-hour drive southwest of Anchorage, where millions of sockeye salmon ripple through the silty turquoise water each summer to spawn.

And there is most likely no more democratic fishing spot in America — a place where any Alaska resident, from an oil company executive to a carwash attendant, can fill a freezer with premium salmon for only the cost of gas and gear.

Most of the Kenai’s fish are caught by commercial boats and sold around the world. The rest go to sport fishermen, who catch them with a rod and reel, and, increasingly, a wildly diverse group of mostly urban dip-netters, who crowd the river’s mouth for three weeks in July, hoping to score a winter’s supply of wild salmon that most can’t afford to buy. In the roughly 20 years since the state started regulating dip-net fishing in the region, the number of permits it issues has doubled, to more than 30,000.

Now, when the dip-netters descend, the beach takes on the motley, slightly claustrophobic feel of a music festival. Whole families set up camp in the sand, hauling tents, chairs, dogs, children and nets by four-wheelers from the packed parking lot.

This year, a church group brought in a bouncy house and grilled hot dogs. A cart sold espresso. People on the beach spoke Hmong, Korean, Tagalog, Spanish and Thai. They played Christian rock, reggaeton and Pacific Island R&B.

July’s dip-net army lifts the economy in the town of Kenai, but it also clogs the highway and litters the beach with fish heads and guts that have to be raked to the water at night by special tractors. Hundreds of gulls cry overhead, diving to feast on entrails. On weekends, when crowding is at its worst, there are dust-ups over fishing territory, tangled gear, pilfered bags of ice and stolen coolers. Differences in culture, language and notions of personal space sometimes fuel the conflicts.

“It used to be 200 people — now it’s 5,000” on a given day, said Scott Turney, an Anchorage telecommunications engineer who has been fishing on the beach for more than 30 years. “There never used to be any conflicts, but the newcomers don’t have the same courtesy. As soon as you drag a fish out, one or two people will come take your place.”

Even with the crowds, he said, landing a big haul of fish is worth the hassle: “l still love it. I’ll never stop.”

To fish, most people stand elbow to elbow along the shoreline, wearing waders, chest-high in the cold river. Each holds a long steel pole with a five-foot-wide net basket on the end. When a fish hits the net, the fisher drags it onto the beach and bonks it on the head with a short bat. Some people also fish by boat to avoid the crowd, holding their nets overboard as they drift with the current.

Occasionally, a commercial boat putters by. There’s always a little tension.

Commercial fishermen catch salmon by stretching large nets in the inlet near the mouth of the river. When things are slow, dip-netters grumble that the larger boats take too many fish.

The commercial fishermen, on the other hand, must sometimes stop work for a few days at the direction of state biologists who monitor the number of fish in the river for conservation purposes. They don’t love watching the dip-netters filling their coolers.

“It’s always hard to not be catching fish,” said Hannah Heimbuch, who runs a 32-foot aluminum commercial boat, Salmon Slut, in the inlet. “I feel like our harvest is pretty responsible and pretty moderate.”

A single dip-netter is allowed to take home 25 sockeye, or red, salmon, and an additional 10 for each family member per season — limits enforced by state officers who patrol the beach.

The average dip-net fisher in the Cook Inlet — the 180-mile finger of ocean that runs along the Kenai Peninsula from Anchorage to the Gulf of Alaska — brings home 60 to 70 pounds of salmon each summer, said Ricky Gease, the executive director of the Kenai River Sportfishing Association. Even in Alaska, this is a bargain: Although wild salmon can sell for more than $25 a pound in the lower 48, here it will still cost $10 or more at the grocery.

An estimated 90,000 people, fishers and their families, share about 400,000 sockeye annually, Mr. Gease said, which breaks down to 2.4 million meals, the majority of fish coming from the Kenai. Food-bank workers in Anchorage say salmon has also become a supplemental source of protein for the city’s hungry.

“Outside the revenues generated from oil,” Mr. Gease said, “this is the largest single shared natural resource in Alaska for residents.”

by Julia O'Malley, NY Times |  Read more:

Image: Joshua Corbett

Annalynn Hammond, Back to the River
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No One Should Have Sole Authority to Launch a Nuclear Attack

In just five minutes an American president could put all of humanity in jeopardy. Most nuclear security experts believe that's how long it would take for as many as 400 land-based nuclear weapons in the U.S. arsenal to be loosed on enemy targets after an initial “go” order. Ten minutes later a battalion of underwater nukes could join them.

That unbridled power is a frightening prospect no matter who is president. Donald Trump, the current occupant of the Oval Office, highlights this point. He said he aspires to be “unpredictable” in how he might use nuclear weapons. There is no way to recall these missiles when they have launched, and there is no self-destruct switch. The act would likely set off a lethal cascade of retaliatory attacks, which is why strategists call this scenario mutually assured destruction.

With the exception of the president, every link in the U.S. nuclear decision chain has protections against poor judgments, deliberate misuse or accidental deployment. The “two-person rule,” in place since World War II, requires that the actual order to launch be sent to two separate people. Each one has to decode and authenticate the message before taking action. In addition, anyone with nuclear weapons duties, in any branch of service, must routinely pass a Pentagon-mandated evaluation called the Personnel Reliability Program—a battery of tests that assess several areas, including mental fitness, financial history, and physical and emotional well-being.

There is no comparable restraint on the president. He or she can decide to trigger a thermonuclear Armageddon without consulting anyone at all and never has to demonstrate mental fitness. This must change. We need to ensure at least some deliberation before the chief executive can act. And there are ways to do this without weakening our military responses or national security.

This is not just a reaction to current politics. Calls for a bulwark against unilateral action go back more than 30 years. During the Reagan administration, the late Jeremy Stone, then president of the Federation of American Scientists, proposed that the president should not be able to order a first nuclear strike without consulting with high-ranking members of Congress. Such a buffer would ensure that actions that could escalate into world-destroying counterattacks would not be taken lightly. Democratic legislators recently introduced a law that would require not just consultation but congressional support for a preemptive nuclear attack. Whether or not that seems like the best check on presidential nuclear power is a matter for Congress.

We already know that second-check plans would not compromise American safety. Security experts used to worry that a hair-trigger launch was needed to deter a first strike by an enemy: our instant reactions would ensure that our opponent would feel catastrophic consequences of aggression. In the modern world, that is no longer the case. The U.S. has enough nukes in enough locations—including, crucially, our roving, nuclear-armed submarines—that nuclear strategists now agree it would not be possible to take out all of the nation's weapons with a first strike. The Pentagon, in a 2012 security assessment, said the same thing. It noted that even in the unlikely event that Russia launched a preemptive attack on the U.S.—and had more nuclear capability than current international agreements allow for—it “would have little to no effect on the U.S. assured second-strike capabilities.” That conclusion suggests that we will have ample firepower even if two or more people discuss how to use it.

by The Editors, Scientific American |  Read more:

Image: Ross MacDonald