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More Important than Money: Sleep

The Problem with Your Clothes: Examining the Sustainability in Cotton Production Practices

Age-related Macular Degeneration (AMD)

Spring 2012 | National University of Singapore

ISSN 2164-4314

Geoengineering: Changing Worlds

Book 1.indb 1Book 1.indb 1 3/14/2012 10:06:54 PM3/14/2012 10:06:54 PM

THE TRIPLE HELIXA global forum for science in society

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TABLE OF CONTENTS

NUSUSUSSSUU

NN

Cover Article4 More Important than Money: Sleep Eric Bai, Brown

Local Articles7 Age-related Macular Degeneration (AMD) You Chuen Chin

9 Is the Red-Dead Conduit (RDC) the Solution to Reviving the Dead Sea? Jharyathri Thiagarajah

12 The Problem with Your Clothes: Examining the Sustainability of Priscilla Tong Rui Qi Cott on Production Practices

15 Geoengineering: Changing Worlds Shermaine Wong

International Features19 College Tuition: The Growing Ineffi ciency of the Market for Zach Branson, CMU Higher Education

22 Reading Reinvented: How Computers and the Internet are Infl uencing Latha Panchap, Cornell our Society

24 Acupuncture: A Needling Medical Mystery Talia Rett er, UChicago

27 The Death of the Physical? The Relevance of Primary Care and Jacob Ripp, Georgetown its ‘Archaic’ Exam

The Problem with Your ClothesSustainability of cotton practices12

Age-related Macular DegenerationIncreasing attention

GeoengineeringChanging worlds

157

Cover Design courtesy of Eric Bai ‘15 and Maja Czemier-Wolonciej ‘13 from Brown University.


2 THE TRIPLE HELIX Spring 2012 © 2012, The Triple Helix, Inc. All rights reserved.

INSIDE TTH

Message from the PresidentDear Advisors and Readers of The Triple Helix,

It is with great pleasure that my fellow members and I present to you another issue of The Triple Helix journal. I thank all contributors and team members for their passion in this endeavour.

To all advisors, I express my sincerest appreciation and gratitude for your continual support. I am confident that with the collective efforts of the current members, The Triple Helix will continue to serve the NUS community well.

As the team continues to grow, I urge readers to keep a lookout for upcoming activities.

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Best Regards,Mabel SeahPresident National University of SingaporeThe Triple Helix, Inc http://triplehelixblog.com/http://triplehelixnus.wordpress.com/

STAFF AT NUS

COO AsiaChin You Chuen

President Mabel Seah

Editor-in-ChiefMary-Ruth Low

Managing EditorRebecca Tan

Business Board DirectorMaximillian Chew

WritersYou Chuen ChinJharyathri ThiagarajahRui Qi TongShermaine Wong

Message from the Editors-in-ChiefDear Readers,

As you might have noticed, the National University of Singapore has in recent years pushed for a more holistic and multidisciplinary approach to learning and communication strategies across all areas of study. With the approaches towards academic approaches constantly changing, The Triple Helix journal seeks to provide a platform for students who have a desire to communicate their thoughts and views on matters regarding Science, Society and Law.

This Spring issue has our team excited after a hiatus last semester. While we recognize that communicating via writing in journals like The Triple Helix may not necessarily be the top priority for most students, we hope to garner more interest and inspire students to write and engage the wider audience, in turn gaining a broader perspective as well as an invaluable experience in seeing their hard labour bearing fruit.

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Sincerely,Mary-Ruth LowEditor-in-ChiefNational University of Singapore


3THE TRIPLE HELIX Spring 2012© 2012, The Triple Helix, Inc. All rights reserved.

INSIDE TTH

Message from the CEOIn October 2004, a Cornell University freshman had the idea of putting together a student organization that would look beyond the intellectual appeal of science and make critical connections between science and its relevance to other disciplines that shape our society. The Science in Society Review, the first product of The Triple Helix, was published in 2005, and the concept became so popular that over the next two years, the organization would expand to fifteen other US chapters and into three international regions.

We are constantly striving to be better. This was the year in which recent graduates played a more active role within the organization, thus building a foundation of collaboration and mentorship that we hope to maintain in the years to come. This was the year that we revamped our logo, created a new international website and standardized our international message. This was the year we instituted official social media outlets, shared our progress via monthly newsletters, reached out to local communities, and experienced ground-breaking attendance at both our annual conference and local science policy events. This was the year of new programs with the establishment of The Quanta (TTH@ASU), e-mentoring, podcasts, extra features, and alumni networks. And this year, we were proud to welcome UC Davis, Duke University, and the University of Oxford to our ever-growing list of TTH chapters.

In the last eight years, we’ve grown a tremendous amount. Yet what makes The Triple Helix so unique isn’t our Science in Society Review, our e-publishing division, our science policy podcasts, or even our extensive chapters, but our people. The Triple Helix would not be successful without the hard work, passion, and dedication of our writers, editors, leaders, and international team. So to everyone who has been involved in any capacity in this past year – from our international team, chapter leaders, editors, writers, and yes, our readers – thank you. Thank you for your time and effort. Without you, we would not have been able to come this far; and yet, still have the potential to accomplish so much more.

Cheers,Jennifer OngChief Executive Officer

Message from the EEiC and CPOSleep deprivation is no stranger to most college-age students. Pulling all-nighters to finish problem sets and papers seems worthwhile because we value our academic achievement over the seemingly trivial rest and relaxation of dream land. But in the Spring 2012 edition of the Science in Society Review, Eric Bai of Brown University, questions this assumption in our cover story “More Important than Money: Sleep”

Welcome to the biannual journal of The Triple Helix! Whether you are a loyal reader or you have just picked this up for the first time, inside you will find a unique forum for science, society, and law. We feature interdisciplinary articles that examine the nexus of science, society, and law to make sense of current events, global problems, and new discoveries and policies. All of our work is done by undergraduates. This publication cycle, writers and editors from ten chapter universities have contributed to this journal! Their tireless work has been complemented at the International level by the International Editorial Board, comprised of hardworking Senior Literary Editors.

Multiple teams located across the country have worked together to layout these journals. Much thanks to the senior production editors at Cornell, Berkeley, UChicago, and Georgetown, who have been leading these teams to complete the task of delivering the journal in print to your hands.

We hope you enjoy reading through this edition of the Science in Society Review. If you are intrigued by these articles, we hope you will engage with a dialogue with the writer by sending a Letter to the Editor or joining The Triple Helix.

Sincerely, Dhruba Banerjee and Darwin Chan Executive Editor-in-Chief and Chief Production Officer

Did you have strong opinions about any of the articles in this issue? Interested in giving feedback to the writers or editors? Engage in a dialogue through a letter to the editor. Email [email protected] for more information. Your letter may appear in the next issue of the Science in Society Review!



BROWN

More Important than Money: SleepEric Bai

Bleary-eyed vision and lack of concentration, the physical realities of sleep deprivation are unmistakable. With an estimated one third (50 to 70 million) of adults in the United States

reporting insufficient sleep and a purported $15 to $92 billion in annual economic losses as a result of sleep-induced negligence, inquiry into social assumptions regarding sleep becomes crucial [1]. While our time-honored notion of the man “early to bed and early to rise” as one who is “healthy, wealthy, and wise” remains firmly ingrained in our social consciousness, the traditional monophasic mode of sleep (sleeping at night) is an anachronism in a world where night no longer signals the end of the productive workday. Understanding the impact of valuing efficiency over health is possible only when we consider tailoring work to the worker rather than the worker to his work. The Development of Shift WorkThomas Edison’s commercialization of the light bulb in the late nineteenth century marks the substitution of human labor with machine labor, when work could continue unabated day or night [2]. Our modern day glorification of the sleepless, overambitious employee as the epitome of the efficiency continues this trend [3]. Corporate executives schedule late-night dinners and early-morning receptions in a bid to conduct as much business as possible in one day. Investment bankers wake up to the ringing of their alarm clocks at 2:30AM to track the opening of the DOW [3]. Still, others elsewhere work to fuel the lifeblood of a society built on the here and now. Packers, pilots, and truck drivers labor throughout the night to ensure timely delivery of packages. Airplane mechanics and highway repair crews work at night to avoid the bustle of daytime traffic. Doctors and nurses operate on-call to ensure the delivery of health care to those critically ill. As we grow to value Gross Domestic Product over Human Development Index, a combined measure of life expectancy, educational attainment, and income, we focus increasingly on perceived quantity of output over actual quality of work. We measure success by number of deals closed, number of packages delivered, number of miles travelled, number of patients seen—so much so that we forget to consider the productive possibilities of a work schedule tailored to respect our innate need for rest. The growing

mechanization of industry in the mid-twentieth century resulted in an “economic democracy planned by all members of the industrial organization,” but failed to consider the “’neurobiological cost’” of operating on borrowed time [4,5]. Working in lieu of sleep is not without its consequences.

What is Sleep and What is a Lack of It?Harvard Medical School Professor Charles Czeisler divides the need for sleep into four factors: (1) an innate drive for sleep, (2) total amount of sleep over the past several days, (3) perception of time of day, and (4) “sleep inertia,” the drowsiness experienced upon waking up [3]. Sleep is not only the product of interaction between these four factors, but also the result of variations within each factor: caffeine or exercise can temporarily reduce innate drive for sleep; sudden changes in work scheduling can unexpectedly lower total amount of sleep; an unusually dark work environment may skew perception of time of day [5]. Chronic sleep loss is difficult to treat because of the considerable variability of factors contributing to the diagnosis. Despite these difficulties, when we consider that

Reproduced from [13]


BROWN


one out of every three Americans experiences difficulty sleeping, this issue becomes impossible to ignore [2].

Although sleep deprivation is prevalent, current shift schedules only compound this problem through their dismissal of sleep as a requirement for productive work. Sleep-deprived workers are not only a workplace hazard, but also a burden on the healthcare system. Workers short of sleep cost employers on average 8.8 days of wasted wages a year due to sick leave and lower efficiency and accrue $14 billion in direct healthcare expenses [6]. With the prevalence of shift work today, these hidden costs represent a widely-distributed threat manifested in many forms. In hospitals, sleep-deprived healthcare professionals make 36% more life-threatening medical errors and five times as many serious diagnostic errors as their well-rested counterparts [6]. On roads, drowsy drivers account for 20% of all motor vehicle accidents and 8,000 deaths annually [3]. Preventable accidents stemming from a lack of sleep litter the annals of local and national media: the Exxon Valdez oil spill in Prince William Sound, the 1988 Aloha Airlines accident, or the Joubert tragedy in Beaumont, Texas [2,3]. Taken together, it is unsurprising that a nine-year longitudinal study commissioned by the National Commission on Sleep Disorders Research found a 70% higher mortality rate for those chronically deprived of sleep [2]. Though the cost of foregoing sleep is substantial, it is too often ignored.

A Different Mode of SleepOur symptomatic rather than holistic approach to illness seeks to conclusively address sleep loss with a pill. Despite the risk of addiction, Ambien remains the de facto standard for treatment of insomnia [3]. This methodology erroneously attempts to distill an intricate social phenomenon into a convenient, individually-packaged solution. It would be more productive to examine the viability of napping regimens and alternative modes of sleep distinct from the traditionally monophasic. Although monophasic sleep

enjoys a high degree of acceptance in our conventional mode of work, it is largely a social construct rather than a natural human tendency [7]. When deprived of external stimuli and sources of distraction, human subjects exhibit a napping schedule that closely approximates the four-hour polyphasic sleep cycles of newborn infants [7]. In societies with a more casual sociological order, or the less-structured lifestyle of the elderly, a biphasic pattern of sleep emerges [7]. In the course of physiological development, sleep begins as polyphasic, and, largely due to the constraints of school and work, gradually progresses towards the biphasic sleep of young children and eventually the monophasic sleep of adults [7].

Rethinking Shift Work DesignTo maximize productive gains, industry increasingly relies on twelve-hour rather than eight-hour shifts [10]. Under this system, employees work longer hours and have less time to rest, exacerbating existing sleep deficiencies. The solution may be surprisingly simple: permission to nap. For the 15% of U.S. and Canadian companies that permit napping, the incidence of accidents and lapses in judgment has decreased by 30% [7]. Otherwise, altering scheduling systems to minimize sleep cycle disruption can also reduce issues stemming from extension of shifts [8]. Novel work schematics have already been successfully tested in a wide variety of settings. The Italian Air Force adopted a part-monophasic, part-polyphasic sleep schedule alternating daily which resulted in minimal reduction of attentiveness and performance [9]. This case demonstrates the feasibility of rotating sleep patterns within a single shift. A later Finnish study concluded that allowing for a twelve-hour period for sleep after moderate sleep deprivation was an effective means of restoring alertness compared to only a short rest pause and light exercise [10]. This scenario adopts a more traditional alternation between periods of activity and rest to combat sleep deprivation. Selection of an appropriate shift schedule depends on the set of conditions at hand, but, regardless of type, schedules must recognize sleep deprivation as a critical barrier to efficient operation in order to maximize productivity and well-being.

Whether fixed or rotating, straight or oscillating, primary or staggered, implementing more desirable shift schedules preserves total amount of hours worked while dramatically increasing quality of time off [2]. At a Sandoz chemical plant, a new schedule deemed the “double long change” was so desirable that electricians and maintenance workers volunteered to rotate shifts round-the-clock. Total work time with this staggered shift remained constant, but work was scheduled more cohesively, allowing for greater predictability and improved overall well-being [9]. Similarly, shift workers at Portland General Electric’s Beacher, Oregon plant voluntarily gave up pay to switch to the same schedule as the nearby Boardman plant, which offered thirty-one weekends off and up to ten weeks of vacation per year [9]. Enhanced efficiency during working hours at the Boardman plant allowed for greater opportunity to rest and also reduced total commuting time all without impacting business operations [11]. These optimized shift assignments prevent the buildup of sleep debt [9], guaranteeing alertness and preventing impaired performance due to fatigue [12]. Work schedules with fewer consecutive shifts and more frequent days off do not compromise efficiency. They do, however, decrease cost of operations by reducing emphasis on premium pay as a

We measure success by number of deals closed,

number of packages delivered, number of

miles travelled, number of patients seen— so

much so that we forget to consider the productive possibilities of a work

schedule tailored to respect our innate need

for rest



BROWN

References1. Sivertsen B, Lallukka T, Salo P. The economic burden of insomnia at the workplace: An opportunity and time or intervention? SLEEP 2011;34(9):1151-1152.2. Oexman RD, Knotts TL, Koch JL. Working while the world sleeps: A consideration of sleep and shift work design. Employee Responsibilities and Rights Journal 2002;14(4):145-157.3. Fryer B. Sleep deficit: The performance killer. Harvard Business Review 2006;84(10):53-59.4. Weiss H. Human relations in industry. American J Economics & Sociology 1949;8(3):287-297.5. Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP 2003;2:117-126.6. The Center for Medicine in the Public Interest. Waking up to the insomnia crisis: How insomnia is costing America more than $42 billion a year and what we can do about it. [serial on the Internet]. 2009 [cited 2011 Oct 15]. Available from: http://www.cmpi.org/uploads/File/Insomnia-paper-5.15.09_final.pdf

7. Zulley J, Bailer J. Polyphasic sleep/wake patterns and their significance to vigilance. In: Nachreiner F, ed. Studies in industrial and organization psychology. Frankfurt: Verlag Peter Lang, 1988:167-80.8. Takahashi M. The role of prescribed napping in sleep medicine. Sleep Medicine Reviews 2003;7(3):227-235.9. Coleman RM. Cost effective shift schedules enhance utility operations. Power Engineering 1995;99(2):27==.10. Porcu S, Casagrande M, Ferrara M, Bellatreccia A. Sleep and alertness during alternating monophasic and polyphasic rest-activity cycles. International J Neuroscience 1998;95(1-2):43-50.11. Sallinen M, Holm A, Hiltunen JL, Hirvonen K, Harma M, Koskelo J et al. Recovery of cognitive performance from sleep debt: Do a short rest pause and a single recovery night help? Chronobiology International 2008;25(2-3):279-296.12. Baulk SD, Fletcher A, Kandelaars K, Dawson D, Roach Gd. A field study of sleep and fatigue in a regular rotating 12-h shift system. Applied Ergonomics 2009;40(4):694-698.13. http://health.mo.gov/living/families/wic/wicfamilies/education/img/babysleeping.jpg14. http://www.nlm.nih.gov/hmd/goya/images/sueno.jpg

means to attract an intrinsically motivated labor force [9].

Employers vs. Employees: A ConclusionWhen we consider the exhausted employee overseeing the safety gauges at a nuclear power plant or the overnight guard monitoring inmates in their cells, we must also take into account the demand for services generated by the growing importance of the night shift. While the economic importance of shift work renders it financially and productively indispensable, the enormous human cost of such work can be minimized by appropriate scheduling and collaboration between the worker and his organization, the manager and his company, and the doctor and his hospital [12]. While employers move to increase cohesiveness of off-time, employees must also learn to prioritize rest. In this sense, sleep deprivation is a personal, biological, cultural and economic phenomenon. While a personal

issue, inadequate sleep stems from biological and cultural factors and adversely affects performance at the workplace. Only when we begin to realize that the emergent effect of sleep on well-being is greater than number of hours a night can we achieve the “freedom in industry” touted by early industrialists in our modern-day post-industrial society [4].

Eric Bai is a freshman at Brown University considering a double concentration in Biochemistry and Sociology. As a sleep-deprived college student, he always thinks about how much sleep he got last night and how much more he could have gotten. While brainstorming for topics, Eric thought about what sleep was like for everyone else in the world, and subsequently the idea for this article was born. Eric can be contacted at [email protected].

Implementing more desirable shift schedules preserves total amount of hours worked while dramatically increasing

quality of time off



NUS


Age-related Macular Degeneration (AMD)You Chuen Chin

Although sight plays a crucial role in the negotiation between humans and the world, many take for granted this gift until it is taken away. Blindness, as it is widely

known, refers to the inability to see. The term “legal blindness” is less understood, and the definition differs between countries. In the U.S., a legally blind person is characterized by having a visual acuity of 20/200 or less in their better eye with cor-rective lenses, or a visual field of less than 20 degrees in their better eye [1]. One of the principal causes of legal blindness is age-related macular degeneration (AMD) [2]. AMD has gained increasing attention in recent years as it is the primary cause of severe and irreversible vision loss in developed and developing countries among people 55 years and older and is a major cause of severe loss of vision in people older than 65 years [3,4]. As the world is witnessing an aging population, it is speculated that a staggering three million individuals in the U.S. will be affected by AMD by 2020 [5]. The population of Asia is expected to be affected even more, as it is in a highly advanced stage of development. It has been estimated that 25% (1.5 billion) of Asian peoples will be at least 60 years old by 2050, and the current prevalence of early and late AMD at 6.8% and 4.6% respectively, is set to rise substantially [6].

Multiple studies across a number of countries have been done over the years to shed light on this disease. Thus far, two forms of AMD have been identified: geographic atrophic AMD and neovascular AMD. Geographic atro-phy AMD — also known as dry AMD - is characterized by the widespread loss of retinal pigment epithelium, which normally shields the retina from excess incoming light. Thus, the underlying choriocapillaries are exposed and degraded. Neovascular AMD—or wet AMD - occurs when newly formed blood vessels have leakages in the macular region of the retina [4,6]. The pathophysiology of wet AMD is that abnormal sprouting of blood vessels occurs in the macula (centre of retina) due to high levels of vascular endothelial growth factor (VEGF). The leaking blood and fluid from the vessels damages receptor cells of the macula region, causing vision loss. Wet AMD is more aggressive and results in a greater severity of visual acuity loss compared with dry AMD. In its early stages, AMD causes no symptoms; this means that since eyesight remains unaffected, the degeneration is allowed to progress menacingly. As AMD progresses, the victim may realize that his vision is gradually getting hazy, like a veil covering the eyes. He might also see a dark area in the center of his vision or notice that straight lines appear to curve [7].

While the prevalence and incidence of AMD has been rising over the years due to increased life expectancies in the

developed world, public awareness of the disease is still not widespread. In certain regions, such as Europe and North America, more than 30% of the population is aware of AMD. However, only 20-25% [8] of Australians have heard of the disease. In countries such as Germany, South Africa, France, and Switzerland, the figures drop to 10 - 20%. In Hong Kong, Spain, the Netherlands, Singapore, Italy, and Japan, more than 90% of the population is unaware that AMD exists [8,9].

The lack of awareness of AMD is particularly danger-ous given the insidious progression of the disease. Persons experiencing such symptoms should immediately consult an ophthalmologist who can provide professional advice. Since early stage AMD causes no symptoms, the American Academy of Ophthalmology recommends persons aged 60 to 65 to have annual eye examinations [7]. It is clear that a lack of aware-ness causes people to be unable to recognize the symptoms mentioned. Thus, it is extremely important to focus efforts on detecting AMD in its initial phase.

At present, the most commonly used diagnostic tool for detecting AMD is the digital fundus photography [10]. This technique takes pictures of the retina, allowing any abnormalities of the retina and macular region to be identified. To complement the digital fundus photography, an angiogram can be used to

visualize any abnormalities of the retinal blood vessels; this is particularly helpful in diagnosing wet AMD, which often causes neovascularization (the sprouting of new blood vessels) [10].

As a result of studies examining the pathophysiology of AMD, more treatments have been developed. First, the device known as implantable miniature telescope (IMT) can be used in people with severe vision loss after reaching end-stage AMD [11]. The IMT technique helps to amplify

the patient’s image while relatively decreasing the blind spot caused by AMD. Second, laser photocoagulation can be used to treat wet AMD. The laser light targets new blood vessels to obliterate them. However, this treatment is less prevalent now as it results in retinal fibrotic scars that add blind spots in the visual field [11].

Anti-vascular endothelial growth factor (anti-VEGF) drugs such as Bevacizumab (Avastin) and Ranibizumab (Lucentis) serve to block blood vessels from sprouting abnormally and thus improve vision [12]. The current debate on the use of anti-VEGF drugs has evolved from questions over whether the therapeutic benefits the drugs confer is worth the cost of the therapy; Bevacizumab costs $2000 per dose while Ranibi-zumab costs $50 per dose [13]. A study by the CATT Research Group found that Bevacizumab administered monthly was equivalent to Ranibizumab administered monthly with 8.0

Reproduced From [13]



NUS

and 8.5 letter gained (a measure of visual acuity) respectively [14]. Although one would be convinced by the cost effective-ness and efficacy of Ranibizumab, it has to be noted that the study conducted was insufficiently powered to identify dif-ferences in drug-related adverse events [7]. More studies are currently ongoing, and a full substitution of Ranibizumab for Bevacizumab will depend on the results from the second year of research by the CATT group and five other multicenter comparative clinical trials.

Despite the multiple studies conducted to shed light on AMD, the epidemiology of the disease remains unclear. Thus far, several risk factors have been identified and broadly grouped into modifiable and non-modifiable categories. Non-modifiable factors include increasing age and gender—men have been shown to be more susceptible to AMD than women [15,16]. Furthermore, studies have shown that people of African heritage are more protected against AMD compared with other ethnic groups [16,17]. Modifiable factors such as low socioeconomic status, low education level, smoking, or hav-ing diabetes mellitus, hypertension, high total blood cholesterol, or high body mass index (BMI), have also been shown to be positively correlated with AMD [18-23]. On the other hand, alcohol intake and high dietary intakes of betacarotene, vitamins C and E, and zinc were as-sociated with a substantially reduced risk of AMD in elderly persons [23,24]. Although it is possible that these modifiable factors have genetic links, they are also largely based on en-vironmental factors and lifestyle choices that can be altered.

Given that risk factors have been identified, people who are at a greater risk of developing AMD should be identified early on to prevent the onset of the disease. It is important

that people recognize that good dietary habits can be acquired over time, and that these can reduce their risk of developing AMD. The government can also work on this area by educating citizens about AMD. Some countries, such as Singapore, have implemented an AMD awareness week; during this week, the government conducts public forums on AMD in various languages and offers eye screenings for age-related eye diseases and patient support group meetings. Studies are currently underway to validate the impact of such events.

In conclusion, the prevalence of AMD has been predicted to rise rapidly in the near future as the global population ages, and measures need to be undertaken to circumvent this problem. The current level of awareness of AMD among the

general public is low and must be raised in order to reduce the incidence of AMD. Also, persons with risk fac-tors should be identified given that early AMD can be easily identified and treated. An informed public is more likely to seek medical advice earlier before visual loss becomes irrevers-ible, and to comply with the recom-mended therapy. Proactive checkups are particularly important because,

despite multiple studies, the epidemiology of AMD remains unclear. Thus, it is essential for more meta-analysis studies to be performed to unravel more about AMD. Such studies have the potential to provide policy makers with more robust estimates of AMD prevalence and incidence, allowing them to accurately predict the impact of AMD on the population and to determine the true benefits gained from pharmacological treatments.

You Chuen is a student from the Yong Loo Lin School of Medicine, NUS. He has an interest in ophthalmology.

[T]hree million individuals in the United States will be affected by

AMD by 2020

Reproduced From [14].

References1. Health.com [homepage on the Internet]. Caroline S. Rhoads, Christopher J. Rudnisky. [updated 2009 April 7.]. Available from: http://www.health.com/health/library/mdp/0,,stl17646,00.html2. Spanish Eyes Epidemiological (SEE) Study Group. Prevalence of age-related macular degeneration in Spain. BR J Ophthalmol. 2011;95:931-936.3. Klein R, et al. The prevalence of age-related macular degeneration in the US population. Arch Ophthalmol. 2011;129:75-80.4. Congdon N, et al. Eye Disease Prevalence Research Group: Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122:477-485.5. Eye Diseases Prevalence Research Group. Prevalence of age- related macular degeneration in the United States. Arch Ophthalmol. 2004;122:564–5726. Kawasaki R, et al. The prevalence of age-related macular degeneration in Asians: a systematic review and meta-analysis. Ophthalmology. 2010;117:921-927.7. ehealthMD [homepage on the Internet]. Guy Slowik. [updated 2011 June 28]. Available from: http://ehealthmd.com/library/maculardegeneration/MDG_symptoms.html8. AMD Alliance International. Awareness of Age-Related Macular Degeneration and Associated Risk Factors: AMD Global Report 2005. Toronto: AMD Alliance International, 2005.9. Srinivasan Sanjay, et al. Survey on the knowledge of age-related macular degeneration and its risk factors among Singapore residents. Clinical and Experimental Ophthalmology. 2009;37:795–80010. Massachusetts Eye and Ear [homepage on the Internet]. Ivana Kim. [updated 2009 September 12]. Available from: http://www.masseyeandear.org/specialties/ophthalmology/retina/diagnosis/11. All about vision [homepage on the Internet]. Marilyn Haddrill, Charles Slonim. [updated 2011 November]. Available from: http://www.allaboutvision.com/conditions/amd-treatments.htm12. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related

macular degeneration. N Engl J Med. 2006;355:1419-143113. Philip J. Rosenfield. Bevacizumab versus Ranizumab for AMD. N Engl J Med. 2011;364:1966-196714. The CATT Research Group. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364:1897-190815. Ryo Kawasaki, et al. Prevalence of Age-Related Macular Degeneration in a Malay Population. The Singapore Malay Study. Ophthalmology. 2008;115:1735–174116. Ronald Klein, et al. Prevalence of Age-Related Macular Degeneration in 4 Racial/Ethnic Groups in the Multi-ethnic Study of Atherosclerosis. Ophthalmology. 2006;113:373–38017. Ronald Klein, et al. Prevalence of Age-Related Macular Degeneration in 4 Racial/Ethnic Groups in the Multi-ethnic Study of Atherosclerosis. Ophthalmology. 2006;113:373–38018. James WP, Nelson M, Ralph A, et al. Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ. 1997;314:1545–9.19. P Cackett, et al. Education, socio-economic status and age-related macular degeneration in Asians: the Singapore Malay Eye Study. Br J Ophthalmol. 2008;92:1312–131520. Xu L, Li Y, Zheng Y, Jonas JB. Associated factors for age related maculopathy in the adult population in China: the Beijing Eye Study. Br J Ophthalmol. 2006;90:1087–90.21. U. Chakravarthy, et al. Cigarette Smoking and Age-Related Macular Degeneration in the EUREYE Study. Opthalmology. 2007;114:1157–116322. M Miyazaki, et al. Risk factors for age related maculopathy in a Japanese population: the Hisayama study. Br J Ophthalmol. 2003;87:469–47223. Amir L. Butt, et al. Prevalence and Risks Factors of Age-Related Macular Degeneration in Oklahoma Indians. The Vision Keepers Study. Ophthalmology. 2011;118:1380-1385.24. Redmer van Leeuwen, et al. Dietary Intake of Antioxidants and Risk of Age-Related Macular Degeneration. JAMA. 2005;294:3101-3107


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Is the Red-Dead Conduit the Solution to Reviving the Dead Sea?

Jharyathri Thiagarajah

At 420 meters below sea level, the Dead Sea is the lowest point on Earth and the world’s saltiest large water body [1]. The Dead Sea’s main tributary, the Jordan

River, once fed it with an estimated 1.3 billion cubic metres of freshwater; but this has been reduced to a mere 100 million cubic metres of agricultural run-off and sewage [2]. According to a research study carried out by Friends of the Earth-Middle East (FoEME), a regional non-governmental organization, the riparian nations Israel, Jordan, and Palestine have diverted an estimated 98% of Jordan River flow for domestic consumption and agricultural purposes [3]. As a result of this unsustainable consumption of the Jordan River, the Dead Sea’s surface water level has been declining at a perturbing rate of 0.7 meters per year [4]. The problems plaguing the environment as a result of the drop in the surface level of the Dead Sea, such as exposure of sinkholes, reduction of endemic biodiversity, and vitiation to unique ecosystems, are pressing [5]. In re-sponse, Israel, Jordan, and Palestine have proposed the construction of a costly but multi-beneficial 180-ki-lometer water conveyance conduit that would channel water from the Red Sea to the Dead Sea, called the Red-Dead Conduit (RDC) [6]. This project also includes the construction of a desalination plant that will help to solve the underlying problem of water scarcity in the densely popu-lated Middle East [7]. However, an engineering project of such colossal stature has irrevocable consequences on the environment that have not yet been fully analyzed. The potential environmental effects and potential benefits resulting from the construction of the conduit seem to be unbalanced, and this may in turn create a false sense of water security in the riparian nations. Considering this, it will be necessary to find other solutions to solve the core problem of the mismanagement of the River Jordan.

Environmental Impacts from the Construction of the RDC Given the magnitude of the potential environmental reverbera-tions due to the mixing of waters from the Red Sea and the Dead Sea, it is not surprising that environmentalists are against the construction of the RDC. The first issue that arises with the conduit is the surfeit growth of microorganisms in the Dead Sea. The Dead Sea is the habitat of the salt-tolerant unicellular green algae Dunaliella and the red algae Archaea of the family Halobacteriaceae [2]. Archaea subsists on Dunaliella, so that

if the rate of Dunaliella growth were to accelerate due to a decrease in salinity levels in the Dead Sea, Archaea growth would be stimulated and an algal bloom would be triggered. Algal blooms, also known as eutrophication, cause anoxic conditions in the sea that would affect the sustainability of benthic organisms [8]. It also accelerates the rate of sedimen-tation, affecting potable water supplies for the people. This process of eutrophication triggering sedimentation is likely to occur when there is an imbalance in salinity levels, which is what would occur when the relatively less salty Red Sea water enters the Dead Sea [9]. With the Middle Easterners depend-ing on the water from the Dead Sea for their daily needs, the possibility of water contamination due to sedimentation as a result of algal blooms, creates a false sense of water security.

The second complication that will result from an infu-sion of water from the Red Sea into the Dead Sea is the precipitation of gypsum crystals. Although the Dead Sea is supersaturated with gypsum, a type of calcium sulphate, slow reac-tion kinetics does not allow for its precipitation. However, if Red Sea water, which has ten times more sulphate, is released into the Dead Sea, the gypsum will precipitate into white crystals [10] during the long interim period when the water from the two seas fail to mix due to density differences. The consequences are uncertain, but Dr. Jonha Gavrieli, a professor of microbiology at Hebrew

University of Jerusalem, estimates that these white crystals may remain at the top of the water column. The presence of these crystals on the surface would cause light to scatter within the sea, in turn raising its temperature and accelerating evaporation. Ultimately, this further reduces the water level of the Dead Sea.

The effects that the conduit could have on the Red Sea are important as well. The conduit will pump 2 billion cubic metres annually from the Red Sea’s Gulf of Aqaba, and the World Bank Feasibility Report states that this would change currents and damage the Red Sea’s 110 species of reef-building corals. As a result, a significant portion of its endemic marine biodiversity is reduced [11]. Also, since construction processes can be prone to human error, leakage of the Red Sea water could contaminate ground water and pollute the potable hu-man water supply [12].

Biodiversity may not be spared either. Approximately 420 species of plants, 102 species of permanent and migratory birds,




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and 10 species of carnivore including the red fox, blandford fox, hyena, jackal, wild cat, caracal, badger, mongoose, wolf, and Arabian leopard [13] inhabit the regions bordering the Dead Sea. Thus, the physical presence of the conduit, which will run through the Arava Valley, may cause these animals to disappear [2] since their habitats would have to be cleared for the construction of the RDC.

Problems Arising from the Vulnerability to Earthquakes Scientists also raise the concern that since the route between the two seas passes along the earthquake-susceptible Syrian-African Rift [14], the RDC could be split in the event of an earthquake. The saline water would then flood groundwater reserves [15] of the Arava valley and render them permanently useless.

Proponents of the RDC may consider this potential risk of earthquake a non-issue if the RDC is punctiliously constructed to avoid the stimulation of an earthquake. For example, Dr. Jonha Gavrieli from Hebrew University of Jerusalem claims that earthquake dangers can be avoided if geologists carefully trace fault lines and engineers meticulously design the conduit. However, given that earthquakes can be highly unpredictable, the construction of the RDC at an area that is seismically active and vulnerable to earthquakes might be a very large risk to take. Therefore, even with established contingency plans, the unpredictability of earthquakes makes mitigating the risk of environmental damage even more difficult.

Despite the lack of full scientific certainty of the threats to the environment and the Middle Easterners, the extensiveness of the consequences should be noted. Threats to biodiversity and water salinity levels can-not be undone, and are, to say the least, irreversible. The aura of inevitability that surrounds these possible environmental risks makes them even more threatening than they already are. Therefore, all consequences resulting from the construction of the RDC should be carefully analyzed.

Political Motivation for the RDC projectHidden political agenda and vested interests of the ripar-ian nations may be why environmental consequences of the project are being overlooked. The World Bank guideline on environmental assessment states that the proposal for a project must include other possible solutions for solving the problem at hand. Opponents to the project, like the environmental organization Friends of the Earth-Middle East (FoEME), have protested that the World Bank-commissioned studies should incorporate a separate study on other possible solutions to save the Dead Sea. In addition, critics argue that Israel and Jordan are overstating the political symbolism of the project just to acquire the estimated international financing of $5 billion [16] for what is quintessentially a desalination and hydroelectricity

project through which all the riparian nations will stand to benefit. Proposed alternatives are studied by local politicians and not by objective international consultants, and therefore the conclusions that have been drawn may be biased. Politicians involved seem to be highly interested in potential solutions to energy and water scarcity issues that the project provides, thus putting political pressure on the World Bank to pass the proposal. Even the feasibility survey report to be completed by the World Bank is given a timeline of only two years [6], which is too short a duration to analyze the environmental repercussions in detail. Furthermore, the RDC has the potential to foster regional peace between the riparian nations [17] due to the involvement of otherwise rival political leaders. Besides, Shimon Peres, Israel’s then-deputy Prime Minister said that the development of the project is independent of the World Bank’s report [18], hence undermining the necessity for such a feasibility report in the first place. So, the push for construc-tion of the conduit system appears to be more politically and nationally motivated rather than stemming from a genuine interest in saving the Dead Sea.

Benefits of the RDC to the Middle EastWhile the RDC may not have many ardent fans from the envi-ronmentalist camp, the RDC is a logical panacea for meeting the water supply needs of the people in the parched Middle East. All three riparian nations suffer from water scarcity, elucidated by their per capita water supplies of less than 500 cubic metres of water per annum [6]. Thus, the populations in this region can extract the water pumped from the Red Sea

to the Dead Sea, which under-goes a desalination process on its way, for drinking water use. On top of this water balance that the Middle East could possibly enjoy, the RDC can lever transnational tourism, services, trade, and industry activities [19], thus improv-ing economic activity within the region as well. The aim for the RDC to be a multi-faceted solution that not only saves the Dead Sea but also provides a

fix to the water scarcity issues in the region is a desire that is justifiable. However, despite there being potential synergies that can be brought to fruition from constructing the RDC, it is difficult to dodge the argument that the RDC, with reference to its principal task of saving the Dead Sea, may not cure the root problem of unsustainable consumption of water from the Jordan River. Furthermore, the contamination of water supplies due to sedimentation and algal blooms as a result of constructing the RDC may weaken the proposal for its construction.

Turning to Better Solutions that Target the Core ProblemSince the price of the RDC is exorbitant, its construction could cause serious environmental problems, and the conduit itself

[P]ossible environmental degradation resulting from

the construction of the conduit may be worse than if we were to leave the Dead Sea

in its original conditions


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References1. World Wildlife Fund (WWF) Top 10: Scary Destinations-Dead Sea. [updated 2010; cited October 3 2011] Available from: http://wwf.panda.org/about_our_earth/teacher_resources/best_place_species/top_10_scary_destinations/dead_sea.cfm2. Glausiusz J. Environmental Science: New life for the Dead Sea? Nature. 2010; 1118-1120.3. Friends of the Earth Middle East (FoEME). Towards a Living Jordan River: An Environmental Flows Report on the Rehabilitation of the Lower Jordan River. 2010. 4. Shahrazad GA, Hartmann J, Jansen N, Kempe S. Water input requirements of the rapidly shrinking Dead Sea. Springer-Verlag. 2009. 5. Israel Ministry of Environment. Confronting The Dead Sea Dilemma- Israel Environment Bulletin. 2006.6. Bank Information Centre (BIC) Problem Project: Red Sea - Dead Sea Water Conduit Project. [updated 2011 June 27; cited 2011 26 September]. Available from: http://www.bicusa.org/en/Project.58.aspx7. Rosenburg D. Raising the Dead without a Red Sea-Dead Sea project? Hydro-economics and governance. 2011 8. Mason C. Biology of freshwater pollution. 4th ed. 20029. Oren, A., Gavrieli, J., Kohen, M., Lati, J., Aharoni, M., & Gavrieli, I. Saline Lakes Around the World: Unique Systems with Unique Values. 2009 10. Reznik I, Gavrieli I, Jiwchar G. Kinetics of gypsum nucleation and crystal growth from Dead Sea brine. 200911. William Alevizon P. Online Guide to Coral Reefs. [updated 2010; cited 2011 September 28] Available from: http://www.coral-reef-info.com/red-sea-coral-reefs.html12. Al-Hanbali A, Kondoh A. Groundwater vulnerability assessment and evaluation of human activity impact (HAI) within the Dead Sea groundwater basin, Jordan. 200813. Jordan Tourism Board (JTB). Jordan Tourism Board-Dead Sea-Eco & Nature. [updated 2010; cited 2011 September 28] Available from: http://visitjordan.com/default.aspx?tabid=14114. Milstein M. Daily News: National Geographic. [updated 2006 December 14;

cited 2011 September 27]. Available from: http://news.nationalgeographic.com/news/2006/12/061214-dead-sea.html 15. Lavie A. The Red-Dead Project: Potential for Regional Peace. The Mideast Peace Pulse, Israel Policy Forum. [updated 2009 June 29; cited 2011 September 28]. Available from: http://www.israelpolicyforum.org/blog/the-red-dead-project-potential-for-regional-peace 16. Sharp JM. The “Red-Dead” Canal: Israeli-Arab Efforts to Restore the Dead Sea. [updated 2008 May 13; cited 2011 October 2] . Available from: www.fas.org/sgp/crs/mideast/RS22876.pdf17. Eichner I, Yedioth Ahronoth. The Red-Dead Project: Potential for Regional Peace. The Mideast Peace Pulse, Israel Policy Forum. [updated 2009 June 29; cited 2011 September 27]. Available from: http://www.israelpolicyforum.org/blog/the-red-dead-project-potential-for-regional-peace 18. The Economist. Better red than dead? [updated 2007 March 15; cited 2011 September 28]. Available from: http://www.economist.com/node/886157119. Ministry of Foreign Affairs Israel. [updated 2002 August 10; cited 2011 September 28]. Available from: http://www.mfa.gov.il/MFA/MFAArchive/2000_2009/2002/8/Israel%20and%20Jordan%20Launch%20Global%20Campaign%20to%20Save%20t20. World Bank. Head in the sand over ‘Peace Conduit’ [Updated 2007 December 4; cited 2011 September 28]. Available from: http://www.brettonwoodsproject.org/art-55875021. Bromberg G. The Tree Hugger interview. [updated 2008 September 6; cited 2011 September 28]. Available from: http://www.treehugger.com/corporate-responsibility/the-th-interview-gidon-bromberg-friends-of-the-earth-middle-east-part-one.html22. Bromberg G., Khateb N, Mehyar M. Friends of the Earth Middle East and Water Resources Action Project Join Forces. [updated 2011; cited 2011 September 28]. Available from: http://www.wrapdc.org/updates.html23. Israel Environmental Bulletin. Confronting the Dead Sea Dilemma. [updated 2007 May; cited 2011 September 28]. Available from: http://www.docstoc.com/docs/91471358/israel-environment-bulletin24. http://eol.jsc.nasa.gov/EarthObservatory/Salt_Evaporation_Ponds_Dead_Sea.htm

may not cure the salient problem of human overconsumption of water from the River Jordan, more beneficial and cheaper alternatives must be genuinely considered. The primary alter-native is the rehabilitation of the Jordan River by introducing freshwater from various sources. Freshwater from the Sea of Galilee, dams on the Yarmouk River and other tributar-ies in the northern region [7] can be rerouted to the Jordan River. FoEME’s Environmental Flows Report [3], supported by the United States Agency for International Development (USAID), predicts that this solution would actually allow for substantial net environmental benefits. In addition, former Israeli Water Commissioner Dan Zaslavsky approximated that reconditioning of the Jordan River from water sources to the north of the river will cost $800 million dollars or less [20]. This is one-sixth of the cost of investing in the RDC project. The follow-up measures involve persuasion of the users of the Dead Sea and River Jordan. Evaporation ponds of The Dead Sea Works and the Arab Potash Company, which are private companies that extract minerals from the Dead Sea for com-mercial production, cause 30-40% of the sea level drop [2]. If these companies extract minerals by thrusting the Dead Sea water through high-pressure membranes instead [21], water evaporation can be reduced. However, these profit-maximizing entities may be unwilling to invest more finance and effort in such technology. Thus, corporate social responsibility with respect to the Dead Sea may necessitate government inter-vention. For example, governments of the riparian nations could collaborate and interact with these private companies by giving them tax incentives for engaging in new technology for mineral extraction. In addition, to encourage sustainable water usage, FoEME and Water Resources and Action Project (WRAP) have agreed on a Memorandum of Understanding [22], where the two organizations will join forces to encourage

sustainable water consumption practices. In this cooperation, environmentalists from riparian nations will target transbound-ary projects that champion proper usage of water, enabling all countries to use the water equitably. Since these follow-up actions deal with changing people’s mindsets and practices, the process to achieve the desired outcome may be arduous. However, since the main solution of rehabilitating the Jordan River with freshwater seems to be more guaranteed and cost-effective, the usage of other freshwater sources should be a prime candidate as an alternative solution to the RDC.

ConclusionThe issue of the plummeting water level of the Dead Sea requires an effective solution. However, contrivance of any remedial project to raise the Dead Sea level from 435-440 metres below sea level to the intended level, be it by the construction of the RDC or by the introduction of freshwater into the Jordan River, will be a protracted process [23]. Any of the proposed solutions will yield a desired outcome only in the long run, and therefore, environmental effects must hold weight in the debate over choosing the best solution. Furthermore, in this situation the less environmentally threatening option is cheaper, too. The repercussions the environment potentially faces with the construction of the RDC, albeit not scientifically certain, are large hurdles to clear. Hence, in obtaining the measure that better targets the core issue of the overconsumption of the Jordan River, the replenishment of the Jordan River with freshwater and supplemented with public education on sus-tainable water consumption might just edge the RDC by a whisker.

Jharyathri Thiagarajah is a first year Environmental Studies major from the National University of Singapore (NUS).



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The Problem with Your Clothes:Examining the Sustainability of Cotton

Production PracticesPriscilla Tong Rui Qi

AFlip the label of any shirt in your closet and chances are you will find cotton listed as a large percentage of the material used in its manufacture. Cotton is used

in more than half of the world’s fibers to make clothes and garments. Yet not enough attention is paid to the environmen-tal, social, and economic impacts of this extensively-grown crop. Cotton farming has been labeled as one of agriculture’s most environmentally destructive activities due to the massive amounts of pesticides and water it requires [1]. Cotton covers only two and half percent of the world’s cultivated land, yet uses up to a quarter of the world’s insecticides; this is more than any other single crop [2]. Against this backdrop, cotton farming is severely threatening the environment. The challenge for to-day’s consumerist world is to find environmentally sustainable ways to farm cotton.

Problems with High Water DemandAs cotton is a heavily cultivated crop that requires large amounts of water and insecticide, it is not difficult to see why it has been labeled “environmentally destructive.” The production of enough cotton for a simple shirt and a pair of jeans can use more than 20,000 liters of water, and 75% of global cotton harvest comes from irrigated land [3]. Such extensive irrigation inevitably leads to water-logging of soil and falling water tables. If left unchecked, this will ultimately deplete freshwater resources. Falling water tables in agricultural areas result in saltwater intrusion into freshwater sources and salinization of the soil, which causes many problems for wildlife. The effects of irriga-tion are most starkly illustrated by the depletion of the Aral Sea, an inland freshwater body located between Uzbekistan and Kazakhstan. Continual withdrawal of freshwater from the Aral Sea for the purpose of irrigating cotton fields led to a decrease in the surface water level. Shrinking of the sea, which now covers only 10% of its original area, has been described by the UN Secretary-General Ban Ki Moon as “one of the worst environmental disasters in the world” [4]. Freshwater influx from the Syr Darya River and Amu Darya River that feed the

sea declined as flows were diverted for irrigation, and salinity increased over large areas of the river basins. Consequently, 20 out of 24 native fish species disappeared [3]. As Uzbekistan remains the world’s second largest cotton exporter [5], Uzbek leaders are unwilling to give up their main irrigation source and the Amu Darya River is still being diverted [6]. Hence, the risk of continued shrinking of the sea and further loss of marine biodiversity remains.

In addition, dam construction to increase irrigation and land reclamation for cotton fields directly destroys freshwater habitats. Ecosystems downstream of dams are severely af-fected by the reduced and regulated flow of freshwater. In

Egypt, where cotton is of high eco-nomic importance [7], the Egyptian government pays great attention to the quality and quantity of the cot-ton crop. Located in a geographic region that receives little appreciable rainfall, Egypt’s cotton industry de-pends entirely on irrigation. Hence, the Aswan High dam was built be-tween 1960 and 1970 along the Nile River to boost agricultural produc-tion. Following the construction of the dam, the Nile river ecosystem has seen a drastic decrease in the diversity of fish populations due to the trapping of sediments behind the dam, which prevents the flow of nutrients downstream [8]. It is clear then, that the large requirements for water on cotton fields, imposed by irrigation and dam systems, has generated numerous environmental problems in countries dependent on

cotton production.

Problems with High Chemical DemandAdditionally, cotton production consumes large quantities of chemicals, which have serious environmental and health impacts. These chemicals are added to ensure high yields, ef-ficient mass production, and consistent quality. For example, bug repellents are used during seeding, herbicides and insec-ticides are used to protect the plants, and fertilizers are added to enhance growth. However, these chemicals are not absorbed by the plant but rather dissolve in runoff water and go on to



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contaminate rivers, wetlands, and groundwater. The toxic properties of these chemicals may then kill wildlife directly or accumulate to fatal levels in the ecosystem. This was the case in 1995, when Endosulfan was sprayed on cotton fields and contaminated runoff from these fields resulted in the death of more than 240,000 fish in Alabama [3]. Organisms that feed on the pests are also indirectly harmed in the process of pesticide application. In one case, laughing gulls in Texas were poisoned by a parathion application meant to eliminate bollworms on a cotton field a few miles away. The birds died after feeding on the poisoned insects from the cotton field [3]. Such heavy use of insecticides has also resulted in health concerns among growers and consumers. Direct exposure to the chemicals by farmers could potentially have long-term effects on the health of farmers. The cottonseed hull extracted from the cotton plant is a secondary crop that is used as a food commodity. It is estimated that 65% of cotton production ends up in our food chain, whether directly through food oil or indirectly through the milk and meat of animals. Traces of cotton pesticides have been reported in cow’s milk in Brazil, fueling concerns of safety to human health [2]. Also, groundwater runoff from cotton fields containing the chemicals could potentially contaminate drinking water sources.

Furthermore, it is not only the growing of cotton that negatively affects wildlife. During the processing stages of cotton manufacturing, which include cleaning, dyeing, and finishing, many hazardous chemicals are added; this results in large quantities of toxic wastewater. Some of these chemicals include silicone waxes, heavy metals, and softeners. When the contaminated effluent is disposed of into the environment, the chemicals present can deplete river water of oxygen and destroy aquatic ecosystems [2]. It has been estimated that over 8,000 chemicals are used in various stages of dyeing and bleaching alone [9].

Measures to Achieve Sustainable CottonIn an effort by the cotton industry to mitigate damage to hu-mans and the environment, there have been measures taken to grow ‘sustainable cotton.’ Yet the measures are still in their infancy and are themselves controversial. This is clearly ex-emplified by genetically modified (GM) cotton, which many claim could potentially solve the problem of heavy pesticide

application. Bt cotton, a type of GM cotton, was developed to reduce reliance on pesticides. In Bt cotton, a strain of Bacillus

thuringiensis is inserted into cotton so that the plant is able to produce a toxin that acts as a natural insecticide to kill pest larvae. Higher yields coupled with less pesticide use have been reported with the introduction of the GM crop (Fig. 1).

Fig 1. Change in pesticide use (kilograms of active ingredient per h]ectare) on Australian cotton crops. Significant reductions have been achieved on both conventional and INGARD® cottons over the last five years. Source: Cotton Consultants Association Market Audit Survey 2003.

However, Bt cotton has created a host of other environmental and ethical issues, and is itself unsustainable. Non-target pest populations are increasing, which leads to even greater use of pesticides. In addition, there have been reports that target pests are developing resistance to the toxin naturally produced in these transgenic crops, which suggests that the Bt strain is losing its effectiveness [10]. Bt cotton has also subjected farmers to manipulation by large multinational biotechnology com-panies, the most famous of which is Monsanto. Due to clever genetic seed segregation by Monsanto, farmers are unable to harvest seeds from crops already grown and have little choice but to buy new seeds every year [11]. They are charged high prices for the Bt cotton seeds, forced to purchase Monsanto pesticides, and at the same time experience a significant loss in income from failed Bt cotton crops. Over the past decade, 200,000 farmers in India have committed suicide after suf-fering huge losses and mounting debts from loans taken out to purchase the seeds. The cotton growing region in India is now described as the “suicide belt” [11]. As the genetically modified Bt trait is only available to farmers in hybrid seeds, the crop requires more water than traditional Indian seeds. Hence, Bt cotton has also failed to address the problem of heavy water usage [11]. A recent study by anthropologists from Washington University has revealed that GM crops are causing significant problems for sustainable farm management while offering little or no increase in yield [12].

Transgenic cotton appeared to be a ‘wonder crop’ when first introduced in 2002, yet the numerous negative effects of Bt cotton we see today forces us to question its viability as a replacement for conventional cotton. Yet there is hope for the industry. Organic cotton farming has been heralded as one of the most promising solutions to address the problems of

Cotton farming has been labelled as one of agriculture’s most

environmentally destructive activities



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References1. Sustainable Cotton Project. [updated 2011; cited 2011 September 19]. Available from: http://www.sustainablecotton.org2. Organic Trade Association. Cotton and the Environment [updated 2011 February; cited 2011 September 19]. Available from: htp://www.ota.com/organic/environment/cotton_environment.html3. Soth J, Grasser S. Background Paper: The Impact of Cotton on Freshwater Resources and Ecosystems. A Preliminary Synthesis. World Wildlife Fund; May 1999 [cited 2011 September 19]. Available from: www.assets.panda.org/downloads/impact_long.pdf4. Bernd. Global Adventures, LLC. Aral Sea a “shocking disaster”. [updated 2010 April 5; cited 2011 October 5]. Available from http://www.global-adventures.us/2010/04/05/aral-sea-shocking-disaster/5. Central Intelligence Agency US. [updated 2011 November 10; cited 2011 December 5]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/uz.html6. Bennett K. World Resources Institute. [updated 2008 May 23; cited 2011 December 5]. Available from: http://www.wri.org/stories/2008/05/disappearance-aral-sea7. Assem Abu Hatab. Northwest Agriculture and Forestry University, China, College of Economics and Management. Performance of Egyptian Cotton Exports in International Market. Agricultural Economics Research Review; July-December 2009. [cited 2011 December 5]. Available from: http://ageconsearch.umn.edu/bitstream/57401/2/6-DrHatab.pdf8. Sayed ES, Gert L, Van Dijken. Texas A&M University, Oceanography. The Southeastern Mediterranean ecosystem revisited: Thirty years after the construction of the Aswan High Dam. [updated 1995 July 4; cited 2011 December 5] Available

from: http://ocean.tamu.edu/Quarterdeck/QD3.1/Elsayed/elsayed.html9. Aura Herbal Textiles Ltd ES. Herbal Dyeing. [updated 2011; cited 2011 December 5]. Available from: http://www.auraherbalwear.com/herbal-dyeing.aspx10. Dinesh C. Sharma. Bt cotton has failed, admits Monsanto. GM Watch; 2010 March 6. [cited 2011 December 5]. Available from: http://www.gmwatch.org/latest-listing/i-news-items/12016-bt-cotton-has-failed-admits-monsanto11. Aaronson T. The suicide belt. [updated 2009 November 10; cited 2011 December 5]. Available from: http://www.gmfreecymru.org/documents/suicidebelt.html12. Benson J. GM cotton has not improved yields, but it has ruined sustainable agriculture. [updated 2011 February 9; cited 2011 October 3]. Available from: http://www.naturalnews.com/031266_GM_cotton_agriculture.html13. Menson S. Organic Cotton and Tencel. [updated 2010 February 12; cited 2011 December 5]. Available from: http://www.simplesteps.org/checkout-counters/choosing-between-organic-cotton-and-tencel14. Better Cotton Initiative. Better Cotton Fast Track Programme. [updated 2010 October 5; cited 2011 August 19]. Available from http://www.bettercotton.org/index/194/better_cotton_fast_track_programme.html15. Naturally Advanced Blog. Organic Vs GMO—There’s no comparison. [updated 2010 September 16; cited 2011 October 6]. Available from: http://naturallyadvanced.wordpress.com/2010/11/16/indias-white-gold/16. Everman V. How eco is organic cotton? The facts on 7 questions. Is organic cotton really worth the extra cost? [cited 2011 December 5]. Available from: http://life.gaiam.com/article/how-eco-organic-cotton-facts-7-questions17. http://eoimages.gsfc.nasa.gov/images/imagerecords/6000/6452/aral_tmo_2005098_lrg.jpg

conventional cotton as minimal, if any, pesticides are used, water use is lower, and impacts on the environment are con-siderably fewer than for GM cotton and conventional cotton. In organic farming, farmers switch from reliance on chemicals to more biologically sound practices, such as Integrated Pest Management and innovative weeding strategies [1]. Predator insects that prey on cotton insect pests, such as boll weevils, are cultivated. Farmers also plant trap crops, which lure in-sects away from the cotton. Also, organic farming methods use natural fertilizers, like compost and animal manure, that recycles nitrogen in the soil instead of introducing more. This reduces pollution, nitrogen dioxide emissions, and reliance on chemical fertilizers.

It is popularly thought that organic cotton requires more water than conventional cotton. Such misinformed views partly account for the reason why organic cotton currently represents less than one percent of global cotton production [2]. During the transitional phase from a conventional to organic cotton field, it is reported that organic cotton will require more water. However, recent evidence has shown that once fields completely make the switch to organic, the need for water is reduced and organic cotton could become a rain-fed crop. In fact, organic cotton grown in Brazil is almost entirely rain-fed [13]. With time, organic cotton could help reduce both water and chemical demands.

Even if cotton is grown sustainably through organic means, it may still be labeled unsustainable due to chemical addi-tions in the processing stages. To circumvent the problem of heavy chemical use during dyeing and bleaching, eco-brands have also developed the manufacture of un-dyed clothing or low-impact fiber-reactive dyes. Prominent companies such as Adidas, IKEA, H&M, Marks and Spencer, and Levi’s have also joined in a commitment towards buying cotton grown with less stress on the environment, through an effort called the Better Cotton Fast Track Program [14]. With these large textile companies supporting the organic cotton fiber market, the future looks promising. In fact, in 2010, organic cotton

fetched a higher premium than Bt cotton in the market and earned farmers in India more [15]. As retailers and manufac-turers emphasize sustainable cotton practices, consumers are encouraged to do the same. The higher cost of organic cotton, at almost 10 to 45 percent more than conventional cotton, is a significant deterrent to consumers when choosing their cotton. However, consumers need to be aware that the price includes the cost of “clean water, fresh air, and healthy farmers” [16].

Conclusion A reconsideration of the destructive practices of cotton farm-ing through heavy water and chemical use forces everyone in the cotton value chain to recognize the serious repercus-sions of traditional cotton farming. Its destructive practices and the measures taken to reduce negative impacts need to be re-examined. Current methods to achieve sustainability through GM cotton are themselves fraught with problems, while organic cotton farming remains limited in scope. Considering the widespread use and economic importance of cotton, it is difficult to recommend that more expensively produced organic cotton completely replace conventional cotton. There may not be a single alternative to conventional cotton. How-ever, with changes in cotton production, manufacturing and use practices, particularly by large companies, sustainable consumption of cotton could well be achievable. With each player in the supply chain taking active steps, there can be a healthy and profitable industry for everyone: growers, their communities, manufacturers, retailers, and users of all cotton products.

Priscilla Tong is a first-year student at the National University of Singapore majoring in Environmental Geography.


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Geoengineering: Changing WorldsShermaine Wong

Climate change has placed us in a quandary for the past fifty years, as we are both the perpetrators and victims of this crisis. Having recognized our relation-

ship with this crisis, there has been ongoing research into technologies that can rectify the crisis. Geoengineering has come into the spotlight as a technology that can, in a literal sense, change the world.

The term “geoengineering” expresses the array of technolo-gies that aim, through large-scale and deliberate modifications of the Earth’s energy balance, to reduce temperatures and counteract anthropogenic climate change [1]. For a technology or method to be classified under geoengineering, the magni-tude of its impact must be large and positive environmental change must come about as an objective, not as a side-effect [2]. This article focuses on two such technologies, namely strato-spheric aerosols and ocean fertilization. The former technol-ogy is categorized under solar radiation management (SRM) and entails firing sul-fur particles into the stratosphere in a bid to reduce tempera-tures. On the other hand, ocean fertil-ization comes under the ambit of carbon dioxide removal (CDR) and involves sequestering carbon dioxide into the deep seas to attenuate the greenhouse effect. It has been recognized that such technologies are still in their infancy and there are misgivings about both their direct and indirect impacts. There is a real possibility that unplanned or even dire consequences may arise from these technologies; these include the over-cooling of the Earth caused by the over-injection of aerosols, destruction of the ozone layer, changes in weather patterns, and ocean acidification. In addition, there are several social and ethical concerns, such as the possibility of negative spill-over effects onto parties that are not in favour of geoengineering, which then bring about a need to establish a mandate for parties to practice geoengineering research. Gray areas, such as the extent of intervention and ways of regulating this technol-ogy, coupled with scientific uncertainties have led to the ap-

plication of geoengineering methods solely in small-scale experiments. However, there may be worse repercussions in the future if nothing is done in the meantime to mitigate climate change, as there is a possibility that we will be un-able to extract ourselves from the climate change quagmire if nothing is done to engage geoengineering further. While implementation of geoengineering technologies should be put on hold till there is concrete evidence that its execution will not harm the environment, geoengineering research should not be postponed since it may prove itself to be the solution to climate change.

According to research findings by John Daniel of the National Oceanic and Atmospheric Administration’s (NOAA) Earth System Research Laboratory [3], an increase in strato-spheric aerosols since the late 1990s aided in the cooling of the

earth by about 0.07°C, causing global warming rates to be slower than projected rates. The 1991 Pinatubo volcano eruption reflected two percent of sunlight back into space by filling the skies with volcanic particles. This scatter-ing and reflecting of sunlight away from the Earth has resulted in a one degree Fahrenheit drop in temperatures, leading scientists to direct research to the mimicking of such a volcanic eruption. Intellectual Ventures (IV), a company that looks to spearhead new

inventions, has funded research investigating the so-called StratoShield technology. In essence, this technology involves firing sulfur dioxide particles, which will help to increase the albedo (ratio of light reflected by a surface) of the Earth, into the stratosphere. This will achieve a similar outcome as the Pinatubo eruption, with the cooling effect setting in instantaneously. Sulfur dioxide is a natural element of volcanic ash that constitutes the air we breathe in daily and has been observed to remain in the stratosphere for about two years before falling back to Earth [4]. This latter property is arguably an advantage of this particular technology, as sulfur dioxide is a fast mechanism with effects that are easily reversible. This offers room for mitigation if something were to go awry. In




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addition, stratospheric aerosols gravitate towards the poles [5]. This is further good news, as the polar regions have felt the effects of global warming more than other regions. Aero-sols introduced at the Arctic Circle are projected to cool the Arctic and have limited effect on the remainder of the Earth.

However the downside is that such methods have other less beneficial effects on the atmosphere and the ozone layer. Another group of researchers, using an Earth system model to explore the effects of injecting sulfur aerosols into the atmo-sphere [6], deduced that such a project would in fact decrease precipitation in the East and South-East Asian monsoon regions. This corroborates with Alan Robock’s computer simulations that indicate weakened Asian and African monsoons [7]. These weather alterations would be detrimental to the regional ecosys-tems and agricultural industries. Consequently, there is likely to be adverse environmental, social, and economic impacts caused by recurring droughts in the largely agrarian Asian nations [8]. More importantly, the emission of sulfur particles into the atmosphere will indirectly destroy the ozone layer through the release of chlorine, which is known to decompose ozone [9]. This will in turn exacerbate global warming. Robock has suggested that more diagnostics should be made to model how such aerosol molecules will interact with the ozone layer and the water cycle [7]. This view is shared by IV, and they recognize that it is necessary for more research to be done to establish the safety and persistence of aerosol particles. However, IV contends that geoengineering options are able to give us some leeway to transit to a clean energy system. This is because it is not likely for carbon dioxide emissions to fall drastically to the point where global warming will no longer be a threat. In a way, geoengineering measures are seen as a backup plan if the transition takes up more time than expected or unexpected climate changes occur. Thus, they have been giving financial support to research in this area with the understanding that there must be ongoing research for geoengineering technologies so that they can be readily implemented if the need arises [10].

The other category of geoengineering, carbon dioxide removal (CDR), focuses on the capture of atmospheric carbon dioxide [1]. A prominent example of this is ocean fertilization, which involves adding iron into oceans to stimulate phyto-plankton growth. Phytoplankton absorb half of the carbon dioxide in the Earth’s atmosphere through photosynthesis. The carbon dioxide absorbed during the growth of the phy-toplankton would be sequestered in the deep oceans when it dies. It has been estimated that the world’s oceans have, to date, sequestered one-third of all carbon dioxide that humans have emitted throughout the past two hundred years. At the same time, however, phytoplankton populations have been on the decline as a result of warmer temperatures and severely diminishing concentrations of iron entering oceans from the atmosphere. It is believed that iron is the limiting nutrient which will help to bring back phytoplankton populations and sequester two to three billion extra tonnes of carbon dioxide annually; this amount is approximately one-third to one-half of global industry and automobile emissions. An experiment done by researchers from the University of Southampton on

the Southern Ocean [11] revealed that iron successfully tripled the growth of phytoplankton. However, as with stratospheric aerosols, there is also scientific uncertainty and considerable side-effects surrounding ocean fertilization technology. The above outcome may seem like good news at first; however, enhancement of phytoplankton growth was in fact fifteen to fifty times [12] less than forecasted. Moreover, even if the growth of phytoplankton is sufficiently stimulated, there is the

problem of algal carbon being speedily transformed back into carbon dioxide [13] due to respiration from surface waters. This is because gaseous exchange between the oceans and atmosphere occurs readily and carbon dioxide will re-enter the atmosphere instead of being sequestered deep in the water columns. Furthermore, the marine ecosystem is at stake due to the changes in nutrient cycles and ocean acidification [14]. Phytoplankton make up the base of the marine food chain and its stimulated population growth is bound to have repercus-sions higher up the food chain, affecting the already fragile marine ecosystem. In addition, there have been protests from the Canadian action group on Erosion, Technology, and Con-centration (ETC) [11] against the Southern Ocean experiment, as the entire effects of such technologies are unknown and may be irremediable. Their stand lies with the moratorium issued by the United Nations Convention on Biological Diversity (CBD), which requests member parties to ensure that ocean fertilization activities are put on hold until there is sufficient scientific evidence to substantiate them [1].

As illustrated above, the effects of geoengineering are large-scale and trans-boundary. With the potential to cause major changes to the environment by affecting the Earth’s temperature, weather, and ecosystem balances, geoengineer-ing is an enormous power waiting to be harnessed. Moreover, geoengineering research requires funding and this is likely to be undergone by the more affluent Northern countries instead of their Southern counterparts which are consider-

However, there may be worse repercussions in the future if there is nothing done in the meantime to

mitigate climate change as there is a possibility that we cannot eradicate ourselves

from the climate change quagmire if nothing is done

to engage geoengineering further


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ably poorer but will be most affected by the effects of geo-engineering implementations. This is because seasons in the Southern Hemisphere are more extreme due to the tilting of the Earth’s axis. This highlights the fact that geoengineering projects inevitably involve many parties, due to the fact that

these technologies usually manipulate the shared skies and oceans. Thus, it is more equitable for geoengineering research to be accomplished in view of all the countries in the world. As such, it is necessary for multilateral cooperation, in the form of funding and research, to be forged. This is in line with the Royal Society report, “Geoengineering the Climate: Science, Governance and Uncertainty”, which recommends that governments fund a ten-year international geoengineering research program [15].

Currently, the majority of pioneering geoengineering research has been conducted by the United Kingdom (UK) and United States (US). Several institutions such as the Uni-versity of Leeds have expanded their horizons to include geo-engineering and have received funding from the UK’s research councils. In addition, UK gov-ernment departments have been keeping tabs on geoengineering developments. The situation is concomitant to that in the US, with the US National Science Foundation, the Department of Energy, and the Department of Agriculture having dabbled in minor research projects. Laud-ably, there exists collaboration between the UK House of Com-mons Committee on Science and Technology and its US Congres-sional counterpart in dealing with geoengineering regulation. There is also a three-year geoengineering research program sponsored by French, Norwegian, and German institutions [15]. Then again, the sum of $1.5 million pledged to

this program is a meagre one as compared to the $64 million that the US had assured in 2001 for a five-year program. It has come to light though, that only $950,000 was used for SRM research in 2009 and 2010 in the US. Moreover, there seems to be no funding for geoengineering research in the US’s 2012 budget. Comparably, the Environmental Protec-tion Agency (EPA) requires companies to expend billions of dollars to reduce carbon emissions [16]. The availability of such extensive funds for carbon emissions reduction suggests that there is a possibility of future funding for geoengineering research to come from this money pile. Thus, it is practical for geoengineering research to be carried out alongside methods of reducing carbon emissions in order to diminish uncertainties surrounding geoengineering. It has been said that an inter-national research program of about $100 million could aid research [17]; however, it is clear from the above-mentioned funding cuts that there is insufficient public funding.

Aside from the dearth of proper funding, it remains that there is a sore lack of multilateral collaborations between coun-tries of the Northern and Southern hemispheres. This is essential, as it aids not only in the pooling of expertise and resources, but also in assessing the wider and trans-boundary impacts of geoengineering. At the moment, the inklings of such collaboration can be found in the “Solar Radiation Management Governance Initiative” formed between The Academy of Sciences for the Developing World (TWAS), the UK Royal Society, and the Environmental Defense Fund (EDF) [15]. The primary objective of TWAS is to promote scientific competence and excellence for sustainable development in the global South [18], while the EDF looks to protect the environment through market-based initiatives [19]. Although these collaborative efforts are a good step towards narrowing the North-South divide, more should be done to include the indigenous and layman people on the ground instead of conducting discussions among those who

A portion of the money used to reduce carbon emissions could be put to better use

by funding geoengineering research which can present itself as a stop-gap solution

in time to come




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References1. Bracmort K, Lattanzio RK, Barbour EC. Geoengineering: Governance and Technology. Congressional Research Service. 2010.2. Watts RG. Innovative energy strategies for CO2 stabilization. United Kingdom: Cambridge University Press. 2002.3. Daniel JS, Solomon SIIIRR, Vernier JP, Dutton EG, Thomason LW. The Persistently Variable “Background” Stratospheric Aerosol Layer and Global Climate Change. Science. 2011; 866-870. 4. Caldeira K, Wood L. Global and Arctic climate engineering: numerical model studies. Phil. Trans. R. Soc. A. 2008 November 13; 366 (1882): [4039–4056]. Available from: http://rsta.royalsocietypublishing.org/content/366/1882/4039.full 5. Solomon S, Qin D, Manning M, Chen Z, Marquis M, Avery KB et al. Contribution of Working Group 1 to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Climate Change 2007: The Physical Science Basis. 2007. 6. Brovkin V, Petoukhov V, Claussen M, Bauer E, Archer D, & Jaeger C. Geoengineering climate by stratospheric sulfur injections: Earth system vulnerability to technological failure. Climatic Change. 2008 September 17 :[244-259]. 7. Fecht S. U.K. Researchers to Test “Artificial Volcano” for Geoengineering the Climate: Scientific American. 2011 September 14; [cited 2011 September 20] Available from: http://www.scientificamerican.com/article.cfm?id=uk-researchers-to-test-artificial-volcano-for-geoengineering-the-climate 8. Matern GG. Traditional Agriculture in Southeast Asia: A Human Ecology Perspective. Boulder, Colorado: Westview Press. 1986. Available from: http://www.gerrymarten.com/traditional-agriculture/tableofcontents.html 9. Berardelli P. Ozone: Friend or Foe? ScienceNOW. 2011 April 24; [cited 2011 September 20] Available from: http://news.sciencemag.org.libproxy1.nus.edu.sg/sciencenow/2008/04/24-01.html 10. Pablos. Intellectual Ventures Lab. StratoShield FAQ. [updated 2010 January 14; cited 2011 December 2]. Available from: http://intellectualventureslab.com/?p=474 11. Jha, A. Ocean iron plan approved as researchers show algae absorb CO2.

theguardian. 2009 January 28; [cited 2011 September 20] Available from: http://www.guardian.co.uk/environment/2009/jan/28/iron-carbon-oceans 12. Hobgood JS. Engineering Earth. Columbus: Springer Netherlands; 2011.13. The Royal Society. Geoengineering the climate. London: The Royal Society; 2009.14. Victor DG. Global Warming Gridlock. New York: Cambridge University Press; 2011.15. ETC Group. Governing Geoengineering or Geoengineering Governance? In: E. Group, Geopiracy: The Case Against Geoengineering. Ottawa; 2010. p. 34-40.16. Furchtgott-Roth D. ‘Geo-engineering’ may solve global warming problem. The Examiner. 2011 Dec 1; [cited 2011 December 2] Available from: http://washingtonexaminer.com/opinion/columnists/2011/12/geo-engineering-may-solve-global-warming-problem/1965806 17. Tollefson J. Nature News Blog: Panel recommends US geoengineering research program. nature.com. 2011 Oct 4; [cited 2011 October 24] Available from: http://blogs.nature.com/news/2011/10/panel_recommends_us_geoenginee.html 18.The Academy of Sciences for the Developing World. What’s TWAS. n.d. Available from: http://twas.ictp.it/about 19. Environmental Defense Fund. Our unique approach. n.d. Available from: http://www.edf.org 20. S Parthasarathy LR. Geoengineering the Arctic: Defining the Governance Dilemma. Michigan: Gerald R. Ford School of Public Policy. 2010.21. Kintisch E. The Politics of Climate Hacking. slate.com. 2009 April 29; [cited 2011 September 20] Available from: http://www.slate.com/id/2217230/pagenum/2 22. Caldeira K. Interviewed by: Biello D. 2010 April 6. What is Geoengineering and why is it considered a climate change solution? 23. The Economist. Geoengineering: Lift-off. The Economist; [updated 2010 November 4; cited 2011 September 19]. Available from: http://www.economist.com/node/17414216 24. http://aura.gsfc.nasa.gov/science/feature-102009j.html 25. http://newscenter.lbl.gov/news-releases/2009/05/06/ocean-carbon-iron/

are inclined towards the above approach of geoengineering governance. Moreover, countries in the Southern Hemisphere are poorer than those in the North and will not only have lesser financial capabilities, but may also have lesser political and scientific weights due to weaker educational and research capabilities for geoengineering. On the other hand, the brunt of geoengineering effects will be felt by the South due to the alignment of the Earth’s axis such that seasonal changes are more extreme in the Southern Hemisphere; this is of concern as these countries are largely agrarian economies and thus, are highly dependent on the weather for their sustenance. Even if there are collaborations between countries, it will be hard to reach common ground between all countries regard-ing geoengineering due to the presence of various councils representing different opinions. Besides, there is also a lack of a proper governing body, which is stunting the progress of geoengineering research and implementations. This is because the disputes regarding geoengineering execution have insofar been restricted to the scientific community when in fact a political arbitrator should be present to establish policies [20]. There is a need for an impartial authority to oversee and vet geoengineering technologies.

There is thus an exigency for a board [21] similar to the Intergovernmental Panel on Climate Change (IPCC) to be established. Such a board would be responsible for fixing the parameters for the execution of geoengineering experiments and implementations. It could also institute frameworks to govern geoengineering research and activities. With these in place, the proponents of geoengineering would be more re-sponsible to the public and the environment. In addition to a set of regulations, an Environmental Impact Assessment (EIA) can be made mandatory for proponents to consider the extent of trans-boundary impacts of geoengineering [1]. This again provides accountability to the various stakeholders involved in

geoengineering projects. More importantly, this board should allow for a bottom-up approach to be taken. An environment where feedback from laypeople can easily reach scientists and policymakers can be cultivated by setting up appropriate channels. For example, a council dealing specifically with such feedback schemes can be established to facilitate dialogue on geoengineering projects. Such a democratic arrangement will permit scientists and policymakers alike to gather feedback from local peoples so that they can properly weigh the benefits and risks of a particular technology and policy.

There is definite room for the continuation and financing of geoengineering research together with the establishment of the aforesaid board. It is natural that geoengineering tech-nology involves problems of costs, potential hazards, and measured efficacy [22], but these problems should not hinder the progress of geoengineering research and the mitigation of climate change. There are more studies and exploration being carried out in recent years, as indicated by the increase in the number published geoengineering papers [23]. With such increasing focus on geoengineering, there are bound to be new discoveries pertaining to the effects of geoengineer-ing on the environment. In that case, the yoke of scientific uncertainties will be lifted off the execution of geoengineering technologies and there will be greater scope for these climate change mitigation technologies to flourish in the future.

Shermaine Wong is a first year Environmental Studies major special-izing in Environmental Geography. She is interested in the ways human technology can complement the Earth’s natural processes and forces.


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National concern for college tuition costs has increased almost as rapidly as the costs themselves. It has become a rule-of-thumb that college tuition grows at least

twice as quickly as inflation [1], and as a result, many families are panicking about the affordability of a higher education. Some have argued that, over time, these rising tuition costs will push lower-income families out of the market for education to the point that eventually only upper-middle- and upper-class students will be able to afford a college education [2]. However, despite ris-ing tuition costs, col-lege attendance has consistently increased for decades [3]. Instead of not being able to af-ford a college educa-tion and thereby not attend college, many students have taken on loans in order to pay for their tuition costs. However, many stu-dents default on these loans, in turn causing severe economic ineffi-ciency [4]. This student debt crisis is only one of many market mal-functions that have occurred because of rising tuition costs. All of these market malfunctions make the issue of college tuition seem staggering at first glance, but with some basic analysis, several particular problems within the college market can be pinpointed, and thereby some specific solutions can be revealed.

There are many key differences between the market for higher education and most other economic markets, and these differences have led to soaring tuition costs. Possibly the big-gest difference between the college market and other economic markets is that competition in the former has pushed prices that consumers face upwards, whereas in most economic markets competition between firms lowers the price for the consumer. The reason for this is that many universities constantly increase spending in order to attract students. Universities, especially top institutions, always strive to present themselves as pos-

sessing the most up-to-date on-campus resources. Whenever a college obtains a new resource, many other colleges spend great amounts of money to bring the same resource to their college. This creates an arms race in school technology, where schools must match one another in terms of spending on new resources and technology [5]. Because colleges see a significant increase in student applications when they acquire new facili-ties and resources, they have every incentive to stay in this spending race. We can see this incentive in action by examining

how colleges spend their funds. In the past decade, private institutions increased spending on build-ing maintenance and student services by nearly twice as much as they increased spending on instruc-tion, research, insti-tutional support, and academic support [6]. The reason for this is that increased spending on physi-cal facilities and stu-dent benefits is much more noticeable to college-seeking families. This race for resources leads to

many new facilities that significantly increase colleges’ costs, and these costs are covered by raised tuition prices.

College spending has an even more direct impact on the demand to attend a certain school than just by improving on-campus resources. A university’s ranking in the U.S. News and World Report is “partially based on how much an institution spends educating each student,” meaning that universities tend to have a higher ranking when they report spending more per student. This gives colleges further incentives to increase spending, since having a higher ranking results in increased student applications, lower acceptance rates, and a reduced amount of financial aid required to enroll the class. In terms of national ranking, there is no reason for colleges to reduce spending per student and every reason to increase spending, even if this also means reduced efficiency.

College Tuition: The Growing Inefficiency of the Market for

Higher EducationZach Branson

Referenced from [14]



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Increased tuition prices are not only due to internal college incentives; there are also external factors that greatly affect the price of a higher education. Another reason why college tuition has increased in recent years is that the government has reduced subsidies to public institutions. While private universities have consistently increased spending in order to attract students, public and community colleges have actually decreased spending in order to make up for a loss in govern-ment subsidies. From 2002 to 2006, the amount of money public colleges received from taxpayers decreased by over $1,000 per student, which resulted in further increased tuition during

those years [7]. In many cases, public and community colleges have had to raise tuition and also decrease expenditure on classroom instruction in order to fill the fiscal hole created by decreased government subsidies. This means that not only has the price of a public education increased, but also that the overall quality of that education has arguably decreased.

As tuition for both private and public institutions has increased, the gap between public education and private educa-tion has widened, where private institutions’ new facilities raise tuition and public institutions are in need of facilities because of a lack of government funding. Some families are perpetually attracted to private institutions’ increasingly large spending on resources, while other families who opt for public education are paying more money for fewer resources. Though some have argued that higher college prices will push prospective students out of the market, it seems that the opposite is true: Attendance rates are increasing along with tuition. And since tuition is rising faster than inflation, how are families able to afford a higher education?

Though government subsidies have decreased in recent years, the government has been providing more and more loans to college students. Many government programs believed that this would be a more effective way to fund students’ higher education - because loans are given on an individual basis, it would be cheaper to fund each individual’s needs rather than subsidize tuition costs across whole schools. Additionally, the government would be able to collect interest on these student loans. However, many of these government-issued loans have proven to be inefficient due to a large number of students defaulting on their loans. In fact, almost 20% of students who accept loans eventually default; as a result, the government collects only about 50% of the original value of its total student loans. Student debt has become a pressing issue for the economy as the student loan system has become

more pervasive; in fact, total outstanding student loan debt amounted to over $850 billion last year, an amount even higher than credit card debt [8].

With the government only collecting half the original value of the loans it provides, it is clear that the current student loan system is highly inefficient. A very simple explanation for why more students have been taking out loans is that tuition costs have increased so dramatically that students cannot afford to do otherwise. However, there is a deeper explanation for this debt crisis.

It seems that many defaults on student loans are related to students’ turning away from public education. As stated earlier, public and community colleges have had to increase tuition and also lower expenditure on classroom resources since the government shifted from a subsidy-based student aid system to a loan-based system. This has led students to be more drawn to private institutions than public institutions in the past decade. Though private institutions are usually more expensive than public institutions, the government has made loans more accessible to students in recent years, so students have been able to take on large loans to pay for expensive private tuition costs. This is why we see an increased shift in enrollment in private colleges versus public colleges; in the past decade, the rate of enrollment into private institutions increased by an average of 4%, whereas the rate of enrollment into public institutions increased by an average of only 1.5% [9]. Some of these students never pay off these loans simply because the loans necessary to pay the private tuition costs are too large. Other students may also turn to for-profit schools as a cheaper option for education; however, students who attend for-profit schools are much more likely to default on loans. Though students who attend for-profit schools make up 26% of the borrower population, they also make up 43% of all defaulters [10]. This is largely due to the fact that for-profit institutions appear to not properly prepare students for em-ployment; recent studies have shown that students who attend for-profit institutions on average face higher unemployment rates and lower salaries than comparable students who attend other institutions [11]. As we can see, this student debt crisis is largely due to a movement from public institutions to private and for-profit institutions. The reason for this movement is rooted in the fact that the government is pushing a student loan-based system instead of a government subsidy-based system.

Because the government is not making a good return on student loans, it is clear that the problem of rising tuition is not only relevant to families and colleges, but also to the government. The government is still right to invest in higher education; adults who graduate from college earn about $19,000 more per year than adults without a college degree, and they also pay about $5,000 more per year in taxes [12]. This means that with more college graduates, the average national GDP and government tax revenues increase. The government should be and is interested in providing aid to students who seek a higher education; however, the way it is going about doing this is inefficient. One essential solution to this is for the government to switch back to a subsidy-based

...with some basic analysis, several particular problems

within the college market can be pinpointed, and thereby

some specific solutions can be revealed


CMU


References1. "FinAid | Saving for College | Tuition Inflation." FinAid! Financial Aid, College Scholarships and Student Loans. 2011. Web. 13 Oct. 2011. <http://www.finaid.org/savings/tuition-inflation.phtml>.2. Heller, Donald E. Introduction. The States and Public Higher Education Policy: Affordability, Access, and Accountability. Baltimore: Johns Hopkins UP, 2001. Print.3. "Fast Facts." National Center for Education Statistics (NCES) Home Page, a Part of the U.S. Department of Education. Web. 14 Oct. 2011.4. Salmi, Jamil. "Student Loans in an International Perspective." World Bank (2003). Print.5. Ehrenberg, Ronald. "Tuition Rising: Why Colleges Cost So Much." Print.6. Wellman, Jane V., and Louis Soares. The Delta Project on Postsecondary Education Costs, Productivity, and Accountability. Web.7. Clark, Kim. "The Surprising Causes of Those College Tuition Hikes." U.S. News

and World Report 15 Jan. 2009. Web.8. Tompor, Susan. "Student Loan Debt Exceeds Credit Card Debt in USA." USA Today 10 Sept. 2010. Web.9. School Enrollment: 1980 to 2020. U.S. Census Bureau. Web.10. Student Loan Default Rates Increase. Rep. U.S. Department of Education, 2010. Print.11. Deming, David J., Claudia Goldin, and Lawrence F. Katz. "THhe For-Profit Postsecondary School Sector: Nimble Critters or Agile Predators?" NBER Working Paper Series. Web. Dec. 2011.12. Education Pays. Rep. College Board, 2005. Print.13. Epple, Dennis, Richard Romano, Sinan Sarpça, and Holger Sieg. "Profiling in Bargaining Over College Tuition." The Economic Journal 116.515 (2006): F459-479. Print.14. http://topcollegesonline.org/student-debt/college-debt.jpeg

student aid instead of exercising a loan-based system.If the government returns subsidies to public institutions

to the levels they were ten years ago, students will be more at-tracted to go to public institutions either because public tuition will not increase as drastically or on-campus resources will improve. With this enrollment shift back to public universi-ties, private institutions may be more competitive with their tuition pricing in order to attract students. Some may argue that it is too expensive to increase these subsidies; however, it may be a cheaper strategy than providing student loans, since the government is currently only receiving 50% of the original value of student loans. If the government dedicates less money to loans and more money to subsidies, the student loans it does provide will be more efficient: Students will be less likely to default on loans because fewer will take out large loans to pay for private tuition costs or attend for-profit schools.

This shift back to subsidized-based student aid will have a large impact on the issue of rising tuition costs, but there are other solutions that are needed as well. College ratings, especially that of U.S. News and World Report, need to al-ter the criteria for high ratings. National ratings that use the amount spent per student as a determinant for a college’s rating only encourage colleges to increase their spending, thereby perpetuating the problem of rising tuition costs. The economic efficiency of a college’s tuition is a much better determinant for this; indeed, students want to get the most per dollar out of the tuition they are paying, so the top-rated schools should be institutions that produce the best results with the fewest funds.

Informing students about ways to reduce tuition can also be helpful. Again, the college market is different from most economic markets, and another difference is that colleges can greatly vary prices based on each consumer’s characteristics. More and more colleges are profiling students, meaning that they determine many students’ tuition costs based on certain characteristics of the students that they can observe [13]. Stu-

dents can attempt to lower tuition prices by either reporting the offer one college has made to another college they have applied to, or they can directly negotiate with the college about the tuition cost. When students receive financial offers from colleges, they can take note of which college gives the lowest offer, and then use this as a bargaining chip when negotiating the price of more expensive colleges. Many colleges are willing

to negotiate the price of tuition, but because many students do not actively participate in the negotiation process, tuition prices remain high. Students can easily participate in this process by contacting colleges and inquiring about the cost of tuition, while also using other colleges’ offers as a tool to lower the price of a higher education.

The cost of a higher education is a complex issue, and it has become more alarming in recent years. There are many solutions to the dilemma of rising tuition costs, such as having the government adopt a subsidized-based student aid system, regulating how colleges are publicly rated, and encouraging students to actively engage in the bargaining and negotiation process with colleges. These solutions would benefit fami-lies who are pressured by rising tuition costs, colleges that are struggling from a lack of government funding, and the government, which is now losing large sums of money in the student loan market.

Zach Branson is a sophomore at Carnegie Mellon University studying economics, mathematics, and creative writing. His primary academic interest is education – the economics of education, education policy, and the practice of actively instilling a satisfying, self-sustaining education in others.

These solutions would benefit families who are pressured by

rising tuition costs, colleges that are struggling from a lack of government funding, and

the government, which is now losing large sums of money in

the student loan market

National concern for college tuition costs has increased

almost as rapidly as the costs themselves



CORNELL

Reading Reinvented: How Computers and the Internet are

Influencing our SocietyLatha Panchap

AIn the mind of the average computer user, the internet has the answers to almost all of life’s questions. Be-tween the search engines and the millions of constantly

updated webpages, the internet gives users the ability to know everything that has happened, is happening, and might happen, all at their fingertips. This is the internet’s greatest gift: unlimited information. However, recent discov-eries about the internet’s effect on Americans’ reading skills show that such technology may have significant repercussions on society and today’s youth.

A 2010 study from the Pew Research Center shows that Americans spend an average of 60 hours a month on the Internet. American internet users spend 42% of this time viewing internet content, such as blogs and articles. [1] The growing concern among parents and teachers, however, is that this time spent surfing Fanfiction.net or Tumblr could be used to do something more intellectually stimulating. [2] A study released in 2004 by the National Endowment of the Arts (NEA) indicates that the decrease in the number of novels read by teenagers may be a crucial reason for the drop in standard-ized reading test scores. [3] Chairman of the NEA, Dan Gioia, believes that the Internet and its many distractions may be one of the main sources of this decline, signified by his statement “[The benefits of newer electronic media] provide no measurable substitute for the intellectual and personal development initiated and sustained by frequent read-ing.” [2]

Gioia’s claim brings up an interesting point: What exactly is the difference between read-ing in print and reading online? In their book The Myth of the Paperless Office, cognitive psychologist Dr. Abigail Sellen and researcher Richard Harper come to the conclusion that navigating a webpage requires more brain power than turn-ing the pages of a novel. Furthermore, the light-producing screens of computers force our eyes to constantly focus and refocus. [4] This difficulty alone causes users to read 25% slower on screen than on paper. [5] In addition, the many distractions of the internet cause readers to lose ‘flow’, a term used by psychology professor Dr. Mihaly Csikszentmihalyi

to describe “a deep but effortless involvement that removes from awareness the worries and frustrations of everyday life.” Paper novel enthusiasts can identify with this familiar feeling:

becoming immersed in a novel and losing all sense of time. This state of full absorption in reading is difficult to achieve with a computer. Instant messages, emails, music, and pop-up ads distract us and cause frequent breaks in our ‘flow’. [4]

Attention blindness is a crucial part of achieving ‘flow’. Cognitively, this can be explained through the actions of neurons. Neu-rons fire off in pathways to complete certain actions, such as reading. As these pathways are repeated more often, the neurons link together, and the actions are performed more efficiently.

Eventually, these actions become automatic reflexes that pass undetected under our radar of attention. This is known as attention blindness. Reading is an automatic reflex, mean-ing that our neurons are already wired together in efficient pathways to do this task. Because of this, we are subject to attention blindness while reading. Professor Cathy Davidson feels that people pay attention to actions, responses, and ideas for which their neurons have not formed pathways. Therefore, when pop-ups or instant messages appear on the screen, we

automatically pay more attention to these distractions than to the text. [6]

The internet’s negative ef-fects go much deeper than dis-tracting and taxing the user. In his article “Is Google Making Us Stupid?” Nicholas Carr voices the worry that many readers now have— that the internet is influencing the way we process

information. According to Carr, we no longer possess the focus and thought to deeply understand what we are reading, only the ability to skim and superficially grasp the meaning of the text. [7] Dr. Jakob Nielsen, who holds a degree in human-computer interactions, claims that humans’ method of reading has actually changed— our new reading pattern consists of web searches and scanning, paying attention to small paragraphs, bolded words, headings, and lists. [8] His eyetracking study, which observed the eye movements of 232 users, showed that people scan websites using a rough F-pattern, reading the first

Instant messages, emails, music, and pop-up ads distract

us and cause frequent breaks in our ‘flow’



CORNELL


two paragraphs and then scanning the left side of the page. [9] Nielson’s conclusion is that computer users have become ‘information foragers’. Like jungle animals scavenging for food, we’ve learned to scan websites for information, find what we need, and move on to the next website. [10] Search engines like Google and Bing have encouraged this process by organizing pertinent webpages into one list and giving snippets of text to summarize the contents of each site. Google’s desire to create “the perfect search engine” consequently takes all the work out of actively searching for information and discourages people from exhausting a single source before finding another.[7]

Proponents of this internet revolution argue that the benefits of the internet far outweigh the aforementioned repercus-sions. Experts in early childhood development claim that the interactive interface of the internet promotes the development of literacy and problem-solving skills, as well as the ability to synthesize information from multiple sources. [11] Educators supporting the use of the web as a reading medium believe that it can also provide many different perspectives and a wider, more comprehensive view of a subject. Computer-based read-ing’s strong influence on American children caused literacy experts to advocate the addition of a computer component to the Nation’s Report Card, an annual study conducted to measure the proficiency of the nation’s youth in a variety of subject areas. [2]

Mr. Jonathan Senchyne, a doctoral candidate in English at Cornell University, believes that the ability to instantly share and edit information is another huge advantage of internet reading (J. Senchyne, personal communication, October 27, 2011). The invention of blogs and other types of self-publish sites has granted everyone the ability to express their opinion to the world at large. Wikis, for example, have become a popular way for people to share the information that they have and

learn from what others have posted. Although this content may not always come from a reliable source, studies show that the collaboration of many individuals on one subject’s Wiki

page can lead to very accurate content. Wikipedia, for example, was found to have an error rate close to that of Encyclopedia Britannica, a highly-regarded scholarly encyclopedia. How-ever, Wikipedia differs from Encyclopedia Britannica in that if found, these errors can be fixed immediately by anybody with internet access. [12] Senchyne believes that this type of instant sharing and editing has allowed computer users, especially stu-dents and younger children, to become “social readers” who now read the article, then discuss it

in forums with one another.Access to unlimited information and multiple perspectives

makes the internet an invaluable source for young Americans in the process of developing synthesis and problem-solving skills. However, the internet’s many distractions and its com-plicated interface can cause us to lose focus on what we are reading. Over the years, our brains have learned to overcome these challenges by skimming articles for answers instead of gaining a deep understanding of the text. As the influence of the internet continues to grow, the differences between reading paper text and reading online will become more pronounced, as will the effects of web-based reading on the way we read, write, think, and communicate. During this revolution, we must stay aware of these differences and either learn to adapt our daily lives to this new system of thinking or find a way to control the degree to which the internet influences our daily lives.

Latha Panchap is currently a freshmen at Cornell University majoring in Biological Engineering and minoring in Business.

Google’s desire to create “the perfect search engine”

consequently takes all the work out of actively searching for information and discourages

people from exhausting a single source before finding

another

References1. Smith C. Internet Usage Statistics: How We Spend Our Time Online (INFOGRAPHIC). Huffington Post [Internet]. [homepage on the Internet]. 2010 Jun 22 [cited 2011 Oct 3]; Tech: [about 2 screens]. Available from: http://http://www.huffingtonpost.com/2010/06/22/internet-usage-statistics_n_620946.html2. Rich M. The Future of Reading - Literacy Debate - Online, R U Really Reading?. The New York Times [Internet]. 2008 Jul 27 [cited 2011 Oct 07]; Arts [about 10 screens]. Available from: http://www.nytimes.com/2008/07/27/books/27reading.html?pagewanted=all3. Rich M. Study Links Drop in Test Scores to a Decline in Time Spent Reading. The New York Times [Internet]. 2007 Nov 19 [cited 2011 Oct 02]; Arts [about 3 screens]. Available from: http://www.nytimes.com/2007/11/19/arts/19nea.html?adxnnl=1&ref=books&adxnnlx=1326294343-Nkr+Fh/sP757DBsEwL2+sQ4. Powers W. Hamlet’s Blackberry: Why Paper is Eternal. Joan Shorenstein Center on the Press, Politics and Public Policy Discussion Paper Series. Cambridge: Harvard College; 2007. p. 1-74.5. Nielsen J. Useit.com: Jakob Nielsen’s Website. [homepage on the Internet]. 1997 [cited 2011 Sep 30]. Why Users Scan Instead of Read; [2 screens] Available from: http://www.useit.com/alertbox/whyscanning.html6. Davidson C. Now You See It: How the Brain Science of Attention Will Transform the Way We Live, Work, and Learn. New York: Viking; 2011.7. Carr N. Is Google Making Us Stupid?. The Atlantic [Internet]. 2008 [cited 2011

Oct 02]; Magazine: [about 8 screens]. Available from: http://www.theatlantic.com/magazine/archive/2008/07/is-google-making-us-stupid/6868/ 8. Nielsen J. Useit.com: Jakob Nielsen’s Website. [homepage on the Internet]. 1997 [cited 2011 Sep 30]. How Users Read on the Web; [3 screens] Available from: http://www.useit.com/alertbox/9710a.html9. Nielsen J. Useit.com: Jakob Nielsen’s Website. [homepage on the Internet]. 2006 [cited 2011 Sep 30]. F-Shaped Pattern For Reading Web Content; [3 screens] Available from: http://www.useit.com/alertbox/reading_pattern.html10. Nielsen J. Useit.com: Jakob Nielsen’s Website. [homepage on the Internet]. 2003 [cited 2011 Sep 30]. Information Foraging: Why Google Makes People Leave Your Site Faster; [4 screens] Available from: http://www.useit.com/alertbox/20030630.html11. Johnson G. Internet Use and Cognitive Development: a Theoretical Framework. E-Learning Digital Media. 2006 [cited 2011 Oct 25] 3(4): [8 pages]. Available from: http://www.wwwords.co.uk/pdf/freetoview.asp?j=elea&vol=3&issue=4&year=2006&article=7_Johnson_ELEA_3_4_web12. Shu W, Chuang Y. The Behavior of Wiki Users. Soc Behav Personal [serial on the Internet]. 2011 [cited 2011 October 25]; 39(6): [14 pages] Available from: http://web.ebscohost.com/ehost/detail?sid=b1debc69-81bf-4fb4-a76a-01113140993%40sessionmgr110&vid=4&hid=112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=6271875313. http://tntel.tnsos.org/images/books-mouse.jpg



UCHICAGO

Acupuncture: A Needling Medical Mystery

Talia Retter

A gloved hand strikes a needle through the bared skin of the victim… patient. There is no crime, but it is an intriguing mystery, containing multiple culprits, chase

scenes, and the hope of capture and conviction. A medical mystery, in the form of a cure that is not yet understood, has countless lives at stake: by solving this case, we may make leaps in scientific knowledge and medical application. Acu-puncture is indeed a needling mystery: both the biological mechanisms of its effects and its relevant applications are still unclear to Western science. Yet, every good mystery has a twist. In the case of acupuncture, it is that the case has been buried for hundreds of years because of the difficulty of re-searching acupuncture according to the scientific method and the complexity of integrating Eastern and Western practices. Only in about the last two decades has research in acupuncture been seriously taken up by Western medicine (C. Yuan, 2012).

First, the case history: an examination of acupuncture. In its adoption into Western medicine, acupuncture involves the nearly painless insertion of thin needles into three to ten of the hundreds of acupoints, specific points on the body lying over arteries, nerves, or lymph passageways. Needles typically remain inserted for about ten to twenty minutes, and may cause “feelings of tingling, numbness, warmth, or ach-ing” [1]. While inserted, needles may remain motionless, be twirled, or be paired with electrical inputs. The FDA approved acupuncture needles for use by licensed practitioners in 1996, provided that needles are sterilized and labeled for single use only, and acupuncture may be covered by medical insurance; the advertised price range for a single acupuncture session is around $50-150, making it a relatively very inexpensive medical practice. There are few reasons to exclude anyone from receiving acupuncture, and side effects are uncommon, but may include minor bleeding in about 10% of patients and, extremely rarely, infection and injury to vital organs if needles are inserted too deeply [2].

The motive for researching acupuncture is quite apparent: acupuncture has been shown to have many potential health benefits. Acupuncture has proven most beneficial in three

cases: reducing pain, especially chronic pain from arthritis or joint pain, decreasing vomiting and nausea after surgery or chemotherapy, and alleviating depression during pregnancy. The list of less researched potential benefits of acupuncture is lengthy, but includes treatment for physiological disorders, e.g. high blood pressure, digestion, and facial aging, as well as more complex or psychological issues, e.g. asthma, anxiety, fatigue, and infertility.

Western science is investigating a lineup of nine main reasons for how acupuncture works: hormones/neurotransmit-ters, opioids, blood flow, bioelectricity, the pain gate, inhibi-tory controls, complex cortical processing, patient belief, and patient involvement. The first four suspects listed focus on the cellular and molecular level.

Hormones and neurotransmitters pose a possible ex-planation, because when an acupuncture needle is inserted, pressure increases in the skin, which may be picked up by sensory mechanoreceptors, which in turn signal to nerves, and thus transmit signals from the periphery to the brain. If the cranial vagus nerve, a prominent nerve extending into the

Reproduced from [9]

In the last two decades, the mystery of acupuncture has

pricked the interest of Western science…


UCHICAGO


brain, is activated, serotonin levels are increased, and cortisol levels are decreased, which is linked to increased pleasure and decreased stress [1].

Another theory targets endogenous opiods, a class of neurotransmitters including endorphins and enkephalins. The concentrations of opiods increase in the body following acupuncture, and these substances have analgesic, or painkill-ing, properties [1]. Alternatively, changes in blood flow may be responsible. An increase in blood flow stimulated by the needles may increase oxygen flow and amounts of immuno-logical cells at the needle sites [2]. Yet again, bioelectricity may be the primary reason, since acupuncture needles increase skin conductance, a measurable electrical voltage produced by the very small, endogenous flow of electricity in the skin, the increase of which may increase healing [3].

One of the two theories targeting sensory neurons is the “pain gate” theory, which asserts that nerve signals from acupuncture sent along myelin-ated axons may cause a sensory “gate” in the spinal cord, at a location called the substantia gelatinosa, to close, thus block-ing slow pain signals traveling along unmyelinated axons from passing up the spinal cord and being processed by the brain [3]. However, as suggested in the dif-fuse noxious inhibitory controls (DNIC) theory, acupuncture may activate neurons, which typically signal for pain, and although not perceived as pain by the patient, may have an effect to, as practi-tioner Alejandro Elorriaga asserts, “reboot the autonomic nervous system,” and eliminate lingering pain sensations [2].

The remaining theories of how acupuncture works concern the brain and psychology. Dr. Vitaly Napadow, an acupuncturist and Ph.D., comments that ‘’acupuncture affects many systems in the body, including parts of the brain that are involved with processing emotion and pain” [4]. Neuroimaging studies have shown that “acupuncture affects a network of systems in the brain, including decreasing activity in the limbic system, the emotional part of the brain” [2]. Furthermore, the placebo effect may be present, enabling the patients’ expectations to play a part in why acupuncture is so efficacious.

Alternatively, increased involvement of patients in their own healthcare may be the target of investigation: although acupuncture is often recommended to patients by their general practitioners, the choice to pursue it or not, and the exercise of going for the treatment, may make patients feel more in control of their health decisions and lives: “‘In general in integrative medicine, when patients are involved in their healing process, they have a tendency to do better,” reflects Angela Johnson, a practitioner at Rush Children’s Hospital [5]. The depth of the mystery is great, because any or all of these proposed

mechanisms may be working together to produce the medical benefits of acupuncture.

Despite this complexity, the current investigation is hot on acupuncture’s tracks. In the last two decades, the mystery of acupuncture has pricked the interest of Western science, with a leap from about 800 articles on acupuncture published in 1990 to over 2,500 articles in 2010 [6]. For an example of successful research in acupuncture, one study at the Martinos Center at the Massachusetts General Hospital in Boston concludes that patients with fibromyalgia, a chronic pain disorder, show increased endorphin levels from real and sham acupuncture, but only real acupuncture causes an increased number of pain-reducing neurotransmitter receptors, thus causing decreased pain over longer periods of time [2]. As concluded by the National Institutes of Health (NIH) Consensus in 1997, Western mechanisms that explain the beneficial effects of acupuncture are beginning to be discovered, a fact that is “encouraging

and may provide novel insights into neural, endocrine, and other physiological processes” [5]. The NIH thus suggests that further research in acupuncture would be advantageous and manifest in di-rect improvements in healthcare.

This mystery investigation of acupuncture may seem intrigu-ing and fast-paced, but in fact acupuncture has existed for over two thousand years in China [3]. Yet acupuncture gained inclusion in Western society just over two hundred years ago, from celebrity more than science. Acupuncture was brought to the United States in 1825 by Ben Franklin’s grand-son, and was popularized in the seventies by actor James Reston,

after President Nixon increased good relations between the United States and China through diplomatic travels [1]. But despite their long acquaintance, Western science and acupuncture have little understanding. Instead of being fully integrated into Western medicine, acupuncture is viewed as an alterna-tive, “evidence-based medicine,” validated primarily by the evidence of its beneficial practice instead of understanding of how it works, and it is classified as a traditional Chinese medicine, or a complimentary and alternative medicine.

So why has acupuncture historically not been researched more in Western science? Firstly, acupuncture has been difficult to research using the scientific method because researchers have had problems creating a good control group to which acupuncture can be compared. Control groups are essential in the scientific method because they allow experimental ma-nipulation that can eliminate confounding variables such as placebo effects from anticipated treatment. Unlike a drug study, when a placebo pill can be used, it is challenging to come up with a method for “fake acupuncture,” since the insertion of acupuncture needles is quite imaginably distinctive. Further-

As concluded by the NIH Consensus in 1997, Western mechanisms that explain the

effects of acupuncture are beginning to be discovered, a fact that is “encouraging and

may provide novel insights into neural, endocrine, and other physiological processes” [5]



UCHICAGO

more, the parameters required for valid sham acupuncture are undefined, since the mechanism for how acupuncture works is still unclear. Methods for sham acupuncture that have been implemented, with uncertain effectiveness, include less deep insertion of needles, insertion of needles not in acupoints, and fake electrical stimulation with un-inserted needles.

To avoid the problem of creating a suitable control, some researchers have compared acupuncture to validated medications. In one study at the Henry Ford Health System, conducted by Dr. Eleanor M. Walker, researchers compared acupuncture to a drug, Effexor, regarding treatment of hot flashes in cancer patients, and found acupuncture to be equally as effective and with fewer side effects. The benefits of acu-

puncture treatment are not merely temporary: “it lasts,” says Dr. Walker, “and the placebo effect doesn’t last once you stop a treatment’’ [7]. Other studies use animals as subjects, which are unlikely to have psychological expectations of benefiting from acupuncture. And as neuroimaging and microscopy progress, the structure and activity pathways of neurons in the periphery and brain become better understood, making acupuncture research increasingly accessible. The inability to have a consistent, valid control in the past has limited the validity and robustness of studies on acupuncture; however, this limitation has been alleviated in the last decade, produc-ing a great increase in the volume of acupuncture research.

The second main reason acupuncture has not been researched more in Western science is the challenge of in-corporating Eastern medicine with Western medicine. The Eastern scientific explanations of acupuncture are difficult to understand in Western terms. In traditional Chinese medicine, acupuncture is thought to be effective by correcting balances and flow of energy, known as qi, in the body. Qi flows through

12 meridians, six ying meridians and six yang meridians, each specifically named for its own organ or function. Acupoints lie on these qi meridians, so, when qi is blocked by physi-cal, mental, or emotional illness, the desired flow of qi may restored by inserting needles in acupoints [1]. The concept of qi is tied to early Chinese philosophy, and though paral-lel concepts exist in many other cultures, there is no parallel concept in Western science.

Furthermore, this foreignness leads to a bias of Western researchers and public. A Wall Street Journal article in 2002 claims that, “until recently, acupuncture was widely regarded as quackery in the U.S.” [8]. In another news article in 2010, an author calls qi “invisible” and “fanciful” [2]. Ironically, an acceptance and upholding of traditional explanations such as qi by many practitioners of acupuncture in the West may further the dismissal of acupuncture by some as an unscientific Eastern practice. Thus, acupuncture remains stigmatized in Western research.

Although the mechanism of acupuncture has not yet been captured, the practice of acupuncture can still be carried out with conviction in cases where there is supporting scientific evidence. Unfortunately, this is not reflected in the amount of acupuncture practiced in Western medicine: compared to an estimated 660,000 practicing physicians in the United States (according to the U.S. Census Bureau 2010 statistical abstract) today, there are about 18,000 acupuncturists practicing in the United States, of whom just 3,000 are physicians, although the rest have also completed at least masters-level coursework in acupuncture and passed a standard licensing exam [8]. In some ways, the practice of acupuncture is limited by the amount and quality of research: because scientists do not yet know how acupuncture works, they are not able to freely move from theory to practice by scientifically explaining in what cases acupuncture should be applied. Instead, effects of acupuncture must be determined for specific conditions, so that, for example, verifying benefits from acupuncture to relieve depression during pregnancy cannot be generalized to say that acupuncture may relieve all forms of depression.

Despite the difficulties in acupuncture research, the po-tential benefits merit its pursuit. Acupuncture is a treatment with much evidence for success, small cost, and few to no side effects. It has been practiced extensively and works with the body’s natural healing mechanisms to promote its effects. It is no longer a mystery why acupuncture research ought to become an important investigation in Western science: this part of the case is closed.

Talia Retter is in her fourth year at the University Chicago, majoring in Psychology and Biology with a Specialization in Neuroscience.

References1. Field, Tiffany. (2009). Complementary and alternative therapies research (pp. 43-53). Washington, D.C.: American Psychological Association, vii, 235.2. Beck, Melinda. (2010, March 24). Trying to decode an ancient therapy --- High-tech tools show how acupuncture works in treating arthritis, back pain and relieving other ills. Wall Street Journal, 27. 3. White, Peter. (2006). A background to acupuncture and its use in chronic painful musculoskeletal conditions. Perspectives in Public Health, 126(5), 219-227.4. Alderman, Lesley. (2010, May 8). A Chinese art, in the context of the west. New York Times.

5. Acupuncture. NIH Consensus Statement Online (1997, November 3-5). 15(5):1-34.6. Lui, S., Smith, E. J., & Terplan, M. (2010). Heterogeneity in search strategies among Cochrane acupuncture reviews: is there room for improvement? Acupuncture in Medicine, 28(3), 149-153. 7. Parker-Pope, Tara. (2010, August 24). Studying acupuncture, one needle prick at a time. New York Times, p. D5.8. Aches & Claims: Acupuncture: From Quackery to Mainstream. (2002, July 23). Wall Street Journal, p. D3. 9. http://nccam.nih.gov/sites/nccam.nih.gov/files/acupuncture1068hi.jpg

Western mechanisms that explain the effects of

acupuncture are beginning to be discovered, a fact that

is “encouraging and may provide novel insights into

neural, endocrine, and other physiological processes”


GEORGETOWN


The Death of the Physical? The Relevance of Primary Care and its ‘Archaic’

ExamJacob Ripp

D r. Eric Topol’s Technology, Innovation, and Design (TED) talk entitled, “The Wireless Future of Medi-cine”, discusses how we will soon use smartphones to

monitor our vital signs, diabetes, and even our REM cycles [1]. The goal, as Dr. Topol reiterates to his audience, is to keep more patients out of hospital beds. Yet, critics claim that this sort of medical technology further distances the doctor from the pa-tient and sacrifices the most holy of all exams: the physical. For example, WebMD, Healthline, and even hospital websites pride themselves on having “Better information [and] better health” than mainstream medicine [2]. Yet, this technology cannot feel the preliminary stages of an aortic aneurysm, hear a mitral valve prolapse, or recognize a melanoma from a seemingly benign mole.

On one side are the progressives, who argue that the demise of the physical exam is a natural consequence of evolution in medical technology. On the other side are the romantics, who cherish the sacred relationship between the doctor and patient. Perhaps both sides are a bit radical, and any reasonable doctor probably lies somewhere in the middle. There was surprisingly little research on this question until Dr. Brendan Reilly showed that a careful physical exam changed the patient’s diagnosis and treatment for the better in 26% of cases that were reviewed by his team [3]. This study, along with others, suggests that a thorough physical examination plays a critical role in making a diagnosis—one that cannot be replicated by even the most sophisticated medical device. The question is, then, which parts of physical diagnosis are worth saving and which parts should be disposed? And once this is solved, how can we incorporate this sort of change into medical education?

There is no doubting that technology has advanced medi-cine more than it has forwarded any other field, except the military. After CT scans, MRI machines, pacemakers, and hip or knee replacements emerged in the past fifty years, it is no surprise that the United States invested $140 billion dollars in medical research last year [4]. Yet, of all the technology that has been developed, perhaps none have changed healthcare as much as one recent invention—the Internet. Why? The Internet has equalized the control over diagnosing and treating

illness [5]. Traditionally, aside from personal anecdotes from family and friends, the doctor was the primary source for di-agnosing and treating illness. Now, ‘googling’ symptoms has

led patients to medical journals, clinical studies, physician evalu-ations, chat rooms, and, in many cases, horror stories.

Furthermore, under the banner of individualized medi-cine, which several hospitals pro-mote, the Internet has allowed self-diagnosis to replace the physician [7]. That is, instead of equalizing the control over the diagnosis and treatment between the physician and patient, the

Internet has shifted the control to the patient, in many cases. Sometimes, this has led patients to suggest a correct diagno-sis. However, for hypochondriacs, this has amplified their anxiety over their health issues and has led to an overwhelm-ing reliance and trust in the easily falsifiable Internet [5]. A study in the New England Journal of Medicine showed that Google found the right diagnosis for only 15 out of 26 cases (58 percent) [8]. Besides showing that Google flunked its ability to diagnose, the authors of the study also discovered that Google was more accurate for diseases that had unique symptoms and less accurate for “normal” symptoms [8]. At the fundamental level, patients have replaced the hands-on, low-tech physical exam with the high-tech, hands-off Google search. Yet, can we blame patients for killing the physical?

In 2004, the Accredatation Council of Graduate Medical Education (ACGME) mandated the eighty-hour workweek for residents [9]. Yet, the amount of work for residents has not decreased, only the amount of time to perform it. Thus, the work that is sacrificed by this mandate is the amount of time that residents spend with patients. For example, at the Yale School of Medicine, interns are not permitted to come to the hospital any earlier than one hour before work rounds [10]. This means that less time is spent with patients examining, feeling, hearing, and, ultimately, learning what ‘sick’ looks like. In addition, the amount of time that patients spend in the hospital has gone from ten days in 1980 to six in 2008 [11]. While this is a triumph for medicine in general, there is less opportunity to do bedside teaching for students, interns, and residents. Lastly, and perhaps the most telling statistic of all, only one in four medical schools offer structured teaching of

At the fundamental level, patients have replaced the

hands-on, low-tech physical exam with the high-tech, hands-

off Google search



GGEORGETTOWN

physical examination skills [12]. The usual response is that, in the “unwritten curriculum”, which says how medicine is actually practiced, the physical exam is a waste of time [10]. It makes sense, then, that patients will forgo the physical in favor of the Google search.

Moreover, misdiagnosis is the second leading cause of malpractice suits against hospitals [13]. Naturally, physicians will often skip the physical in favor of the ‘infallible’ CT scans, MRIs, and other expensive tests. In addition, Dr. Steven McGee’s studieshave shown that some well-known, frequently taught parts of the exam are worthless [14]. For example, listening to the lungs will rarely help a physician decide if a patient has pneumonia. From a physician’s point of view, the physical is a waste of time and, more importantly, just another way to get in legal trouble because of the increased risk of mishandling the pa-tient. Thus, can we blame physicians for killing the physical?

Yet, a closer look at the exam suggests that there are several symptoms and presentations that only the exam can reveal. Cardiac exams, for example, can identify problems in the valves almost as well as echocardiograms [12]. Further-more, Dr. Brendan Reilly’s study shows that the physical actually makes a difference in the diagnosis [3]. His team reviewed 100 cases look-ing for something that was found on the physical exam that changed the diagnosis and the treatment of the pa-tient. He found that, in 26 cases, the physical changed the diagnosis and treatment. In half of these cases, if the physical exam had not found the correct diagnosis, “rea-sonable testing” would not have found it either. Another statistic reveals equally im-pressive results. Seventy percent of breast cancers are detected by patients themselves, twenty percent are detected by a mam-mogram, and physicians detect five percent [15]. While this may seem marginal, given the unfortunately high number of breast cancers in the U.S., the physical exam essentially discovers up to ten thousand cancers every year.

Dr. Lisa Sanders suggests that medical education should work to reestablish our “fascination with the abnormal” that existed in our childhood [10]. For example, as children, people who appeared different than what we expected to see fascinated us. We had no problem asking someone if he or she were a man or a woman, how old he or she was, or what that red rash

on his or her thigh was. Naturally, says Sanders, our parents trained us to avoid such questions because they were offensive [10]. Thus, in order to resuscitate the physical exam from its struggling state, medical schools must teach their students to return to that childhood fascination with the abnormal. It is no coincidence that Dr. Sanders is the technical advisor to House, M.D.—the television show based on Sherlock Holmes, whose character in turn was based on Dr. Joseph Bell, whose fascination with the abnormal led to remarkable diagnoses in the late 19th century.

One positive development is the reinstitution of a clinical skills portion on the United States Medical Licensing Examination—theexam that doctors must take before they can practice medicine. Beginning in 1916, the exam required an evaluation of a patient, observed by a physician-grader [10]. However, this portion was dropped in 1964 because it was difficult to standardize such a setting. Interestingly, the clinical skills portion returned in 2005. Most likely, this happened because of poor physical exam skills of current physicians. Yet, on a deeper level, perhaps this change also reflects a concern about the rising cost of

healthcare. While innova-tions in medical technology have saved millions of lives, it is no secret that they have also dramatically increased costs [16]. A revival of the physical exam does not ig-nore such technology, but rather accompanies it in a cost-effective manner. This is because the physical exam differentiates those who need testing and those for whom testing is a waste of time and money.Thus, the value of the physical cannot be overlooked in modern medicine. The success of

the rapid evolution in technology, though saving countless lives, has raised healthcare expenditures as rapidly as the in-novations that have been created. The physical exam provides a cost-effective strategy that returns the doctor to his or her rightful place as the primary healer and teacher for patients.

Jacob Ripp is currently a junior studying Philosophy in the College of Arts and Sciences at Georgetown University.

Reproduced from [5]

References1. Eric Topol M.D., “lecture,” TEDMED 2009, performed by Dr. Eric Topol, Octo 12, 2011, Web, http://www.ted.com/talks/lang/eng/eric_topol_the_wireless_future_of_medicine.html.2. WebMD, “WebMD. Better Information. Better Health.” Accessed November 4, 2011. http://www.webmd.com/.

3. Brendan Reilly M.D., “Physical examination in the care of medical inpatients: an observational study,” The Lancet, 362, no. 9390 (2003): 1100-05. 4. 2010 U.S. Investment in Health Research.” Research America An Alliance for Discoveries in Health. : 1-4. 5. http://www.ncrr.nih.gov/clinical_research_resources/clinical_and_translational_science_awards/funded_institutions/images/USC_2010-2.jpg


ACKNOWLEDGMENTS

© 2012 The Triple Helix, Inc. All rights reserved. The Triple Helix at NUS is an independent chapter of The Triple Helix, Inc., an educational 501(c)3 non-profi t corporation. The Triple Helix at NUS is published once per semester and is available free of charge. Its sponsors, advisors, and NUS are not responsible for its contents. The views expressed in this journal are solely those of the respective authors.

The Triple Helix at NUS would sincerely like to thank the following groups and individuals for their generous

and continued support:

Associate Professor Chin Wee Siong and Ms Karen Wong from Science Dean’s Offi ce for their help and

support.

We also have much appreciation for Ms Susan Tan and other lecturers of SP1202 who channeled writers over.


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