Journal articles: 'United States. Federal Open Market Committee' – Grafiati (2024)

Abstract:

Drawing on an analysis of Federal Open Market Committee (FOMC) documents, this paper argues that political pressures on the Federal Reserve were an important contributor to the rise in inflation in the United States in the 1970s. Members of the FOMC understood that a serious attempt to tackle inflation would generate opposition from Congress and the executive branch. Political considerations contributed to delays in monetary tightening, insufficiently aggressive anti-inflation policies, and the premature abandonment of attempts at disinflation. Empirical analysis verifies that references to the political environment at FOMC meetings are correlated with the stance of monetary policy during this period. (JEL D72, E32, E52, E58, N12)

Abstract:

The emergence of Bitcoin in 2009 has received considerable attention surrounding the validity of cryptocurrencies as a viable and, in some jurisdictions, a legal currency alternative. Despite widespread concern that these cryptocurrencies are fostering the environment within which a substantial bubble can occur, it is important to analyze whether these new assets are behaving similarly to major international currencies. This paper investigates the effects of international monetary policy changes on bitcoin returns using a GARCH (1.1) estimation model. The results indicate that monetary policy decisions based on interest rates taken by the Federal Open Market Committee in the United States significantly impact upon bitcoin returns. After controlling for international effects, we find significant evidence of volatility effects driven by United States, European Union, United Kingdom and Japanese quantitative easing announcements. These results show that, despite its nature and ideals, bitcoin seems to be subject to the same economic factors as traditional fiat currencies, and is not entirely unaffected by government policies. This result has implications for investors using bitcoin as a hedging or diversification tool. In addition, we contribute to the existing debate regarding the classification of bitcoin as an asset class, by illustrating that bitcoin volatility exhibits various reactions that bear resemblance to both currency pairs and store-of-value assets.

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To control pharmaceutical spending and improve access, the United States could adopt strategies similar to those introduced in Germany by the 2011 German Pharmaceutical Market Reorganization Act. In Germany, manufacturers sell new drugs immediately upon receiving marketing approval. During the first year, the German Federal Joint Committee assesses new drugs to determine their added medical benefit. It assigns them a score indicating their added benefit. New drugs comparable to drugs in a reference price group are assigned to that group and receive the same reimbursem*nt, unless they are therapeutically superior. The National Association of Statutory Health Insurance Funds then negotiates with manufacturers the maximum reimbursem*nt starting the 13th month, consistent with the drug's added benefit assessment and price caps in other European countries. In the absence of agreement, an arbitration board sets the price. Manufacturers accept the price resolution or exit the market. Thereafter, prices generally are not increased, even for inflation. US public and private insurers control prices in diverse ways, but typically obtain discounts by designating certain drugs as preferred and by restricting patient access or charging high copayment for nonpreferred drugs. This article draws 10 lessons for drug pricing reform in US federal programs and private insurance.

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Several organizations in the United States have a major interest in creating, testing, and using methods of data presentation that respect privacy and assure confidentiality. The following are among those that do so, and provide up-to-date information on these topics for the benefit of others who conduct human research: (1) The Committee on Privacy and Confidentiality of the American Statistical Association; (2) an interagency committee of the federal government, the Federal Committee on Statistical Methodology, and its subcommittees, the Confidentiality and Data Access Committee and the Committee on Privacy; (3) the Inter-university Consortium for Political and Social Research (University of Michigan), whose core mission is to archive important social science data, provide open and equitable access to data, and promote the effective use of data; and (4) Carnegie Mellon University's Department of Statistics, which has created an open-access online journal, the Journal on Privacy and Confidentiality. These resources are described, and URLs are provided to give readers web access to these resources.

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The SARS-COVID-2019 pandemic of 2020 severely weakened the surgical innovation pipeline and ecosystem, primarily due to factors that include lack of a coordinated federal response, weakened health insurance coverage, a politicized approach to public health and safety, and disruption of the US economy. A successful bench to bedside innovation requires trust in the scientific research, open research and clinical facilities, and participation of patients in clinical studies. In addition, stay-at-home orders and the shutdown of elective medical and surgical care and research laboratories diminished opportunities for the informal interactions that are part of the new product development process. The pandemic and how it was managed prolonged the length of time for creation, adoption, and diffusion of new products and services into the market. Furthermore, the loss of hospital revenues from canceled elective care translates into a much smaller market for new technologies. Looking forward, critical success factors for innovation include federal policy that supports science and offers access and insurance coverage for health care, including addressing social determinants of health. Any further shutdowns of research and clinical care will hinder necessary collaborations between scientists, clinicians, and patients. Economic recovery is required to ensure federal and corporate funding for research and development. Trust in science must be restored to ensure support of necessary regulatory review processes and sufficient participation in clinical trials. Surgical discoveries have brought about lifesaving and life-extending cures, and the pipeline of these discoveries must continue without interruption.

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In this article, the author uses a survey of more that 90,000 members of the Federal Employees' Health Benefits Plan (FEHBP) to examine a population whose health care is provided by a regulated market unlike any other market in the United States. Within the FEHBP, the government defines the market and brings buyers and sellers together, guaranteeing each much more security than either is able to obtain in the open market. For the sellers, there is the promise of having a customer for at least a year. For the consumer, there is the promise of being treated like any other customer in spite of preexisting illness or other special health care needs. To assess the success of this plan, the author examines how the consumers perceive the quality of their plans and their overall level of satisfaction and then compares that information to perceived quality and satisfaction among consumers in the open market.

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Free trade is part of neo-liberal economics, which is centred on the free market principles of limited government regulation and private sector competition. Free trade focuses on the elimination of trade barriers and tariffs. In Canada, the movement toward free trade began in 1985 with the Royal Commission on the Economic Union and Development Prospects for Canada, which encouraged free trade between the United States and Canada, and concluded with the 1988 federal election that sealed Canada’s fate within economic union with the United States. This article will combine a Neo-Marxist and Political Process Theory framework to address how during the period from 1985 to 1988, Canadian social movements adopted innovative tactics and mobilized against free trade to gain greater influence over trade policy. Keywords: free trade; social movements; Canada; United States; Auto Pact; United Steel Workers; Canadian Auto Workers, National Action Committee on the Status of Women; Council of Canadians; Macdonald Commission

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The United States Federal Communications Commission delivered to Congress a national broadband plan in 2010. The purpose of this article is to analyze key economic arguments involving the development of the broadband plan addressing open network and competition issues, to make recommendations to the Commission in its formulation of federal policy as to positions that make the most economic sense, and to indicate recent economic and legal developments in broadband markets since publication of the broadband plan. One critical issue prior to the development of the broadband plan and subsequent to its publication is the competitiveness of the Internet Service Provider market. There is emerging evidence that, at least with respect to very high-speed broadband markets, a cable monopoly may be looming. The authors continue to predict with confidence that technological innovations are likely to make many opposing legal arguments obsolete in the near future.

Abstract:

Although the border between Canada and the United States for natural gas has been open for some time now, the free-market development of natural gas industries is changing from short-term deal-making to long-term industry placement. Here the Canada-United States Free Trade Agreement will take on a critical role in permitting decisions on elements of trade to be made more confidently. This article focuses on key U. S. federal regulatory principles and programs and how Congress's intention in the Natural Gas Act has been carried through so that the federal government will no longer occupy the field of gas regulation, but ensure that where the use of that commodity involves the interests of two or more states, the overall national public interest would be protected. Therefore, producing states would regulate the physical production of gas before it enters the stream of interstate commerce as well as control matters entirely intrastate in nature. The future of contract demand conversions and gas inventory charges will allow customers to purchase gas from a variety of competitive suppliers without suffering a loss of service reliability. In effect gas inventory charges represent the Federal Energy Regulatory Commission's attempt to prevent pipelines from finding them selves with massive take-or-pay liabilities. Through Order No. 436, the Commission has attempted to streamline the regulatory approval process for pipeline construction projects and in turn to foster market competition. The author argues that rate reform is making its way towards what he feels is its natural conclusion where contract, rather than regulation, will be the principal determinant of right and obligation between industry participants at the interstate level. The Federal Energy Regulatory Commission would become more of a referee than director for questions of anti-competitive behaviour in the use of interstate facilities.

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The Standard and Poor’s 500 Index (S&P500) is one of the commonly used indices on the New York Stock Exchange. The 500 publicly traded companies that make up the index are chosen by a committee to best reflect the overall market of the United States. The broader objective of this research is to estimate the dynamics of the financial market movement in the United States. It is achieved by developing a data-integrated tree-based simulation model to predict S&P500 open and close values for a week. Classification and Regression Trees (CART) - a data mining method - is utilized to extract patterns of the financial market dynamics based on a data set collected from May 1, 2008 to November 30, 2009. The data set included the daily movement of financial markets in seven countries in Asia and Europe in relation to the daily movement of the S&P500. CART also utilized data on the currency exchange rates to capture the financial dynamics between the US and other countries. The simulation model repeatedly samples from four trees developed by CART to know how the opening and closing values of the S&P500 move in tandem with the other markets.

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Federal and state governments in the United States use income and payroll taxes as their primary tools to collect revenue. Relative to the United States, governments in the rest of the world rely much more heavily on taxing consumption. Heavy American reliance on income rather than consumption taxation has not served the U.S. economy well. The inefficiency associated with taxing the return to capital means that the tax system reduces investment in the United States and distorts intertemporal consumption by Americans. While the economic logic of consumption taxation is compelling even for a closed economy, it is even more powerful for an open economy exposed to the world capital market. Consumption taxes in the form of excises can be designed to help protect the environment and control other externalities. Excise taxes can also serve the function of more closely aligning tax burdens with the benefits that taxpayers receive from certain government services. Understandable concerns arise about the distributional consequences of consumption taxation, but a system that relies heavily on consumption taxes, particularly if accompanied by an income tax, can be as progressive as any income tax the United States would realistically want to adopt.

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The cross-border nature of the spatial development of economically and socially significant regions identified in the geospace of the largest federal states of the modern world necessitates their study from the standpoint of the mesoeconomics of development as complex, open and dynamic systems in space-time. The object of this study is the cross-border regions of the United States with Mexico and Canada, which are distinguished by a characteristic set of specific properties of both system-structural and socio-economic nature. According to the systemic economic theory, the identified cross-border regions of the United States show the principle of duality of spatial development, and within the framework of evolutionary theory – ​a specific “socio-economic genotype” of the territory. Using elements of mesoeconomic modeling, the author identified and substantiated some trends in the spatial development of different groups of cross-border regions of the United States over a long time period of 1970–2020 and as a forecast until 2030. Based on a comparative analysis carried out on the results of modeling and testing, the author's hypothesis about a multidirectional change in the dynamics of indicators of socio-economic spatial development, which depends on the regional features of the spatiotemporal evolution of specific transboundary territories, is confirmed – ​as socio-economic systems of the mesolevel. The obtained results, revealing the spatial dependence of the data, indicate the growth of spatial relationships of both social and economic nature within the studied cross-border regions of the United States, which determine the spatiotemporal evolution of the latter in the geoeconomic and geocultural space of the United States and neighboring states. Based on the results of mesoeconomic modeling, the existence of an evolutionary-cyclical nature and duality of the studied mesosystems is empirically confirmed, having their own socio-economic genotype of territories, depending on the insurmountable specifics of spatial diversity and unevenness in the conditions of the market organization of American society. The main conclusion is that regional interest, which has dialectical unity and variability, manifested over time, causes different directions and levels of spatial development of specific regions of the United States as integral dynamic and open socio-economic systems of the mesoterritorial level, reflecting the gradual increase in economic regionalization. The approach used, taking into account the specifics of spatial development, is of interest for the study of similar subject issues in relation to large federal states that have a transboundary nature of genetically determined socio-economic interaction.

Abstract:

AbstractBackground and aimsAlthough large-scale population studies have linked the use of classic psychedelics (lysergic acid diethylamide, psilocybin, or mescaline) to reduced odds of physical health problems, mental health problems, and criminal behavior, the roughly 35 million adults in the United States who have used classic psychedelics are nonetheless stigmatized in the American job market. Various federal organizations in the United States automatically reject applicants on the sole basis of prior psychedelic use, thereby practicing an open form of legal discrimination against these applicants. The present study investigates whether this discrimination can be justified based on associations between lifetime classic psychedelic use and motivationally-based workplace absenteeism.MethodsUsing pooled cross-sectional data from the National Survey on Drug Use and Health (2013–2019) on 193,320 employed adults in the United States, this study tests whether lifetime classic psychedelic use predicts the number of workdays employees skipped in the last month (i.e., motivationally-based workplace absenteeism).ResultsAfter adjusting for sociodemographics, physical health indicators, and other substance use, no significant association between lifetime classic psychedelic use and motivationally-based workplace absenteeism is found.ConclusionThis study builds on classic psychedelic research that is just beginning to take work-specific outcomes into account and offers empirical justification for the elimination of arbitrary drug-based recruitment policies in the workplace.

Abstract:

TRB Special Report 267: Regulation of Weights, Lengths, and Widths of Commercial Motor Vehicles is critically evaluated. It is an important, congressionally mandated report that contains a series of conclusions and recommendations regarding truck size and weight (TS&W) regulations in the United States. The report concludes that increases in TS&W limits have great potential for increasing freight market efficiency but that safety and other effects are not well understood. To facilitate the liberalization of TS&W limits, the report recommends a revised regulatory regime that would involve federal supervision of state-set limits, with evaluation provided by an independent Commercial Traffic Effects Institute. This evaluation argues that the report focuses too narrowly on trucking efficiency and overlooks transportation efficiency. This narrow analytical perspective significantly limits its usefulness in establishing national transportation policy. Also, there is no analytical basis for the report's most important conclusions and recommendations, either in the report or in earlier TS&W studies evaluated by the Committee for the Study of the Regulation of Weights, Lengths, and Widths of Commercial Motor Vehicles.

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Article analyzes the changes in the space economy, as well as the U.S. federal policy for preserving American domination in this area. The evolution of the space economy in the United States is briefly considered, including formation of venture businesses since late 1990s (due to the computer and Internet revolution and development of space technologies). Of particular importance is a so-called Astropreneurship – growth of startups, developing space launch systems and spacecrafts. Amid technological factors, the main driver for the rise of Astropreneurship was a suboptimal technological and market strategy of Boeing and Lockheed Martin duopoly. It created conditions for disruptive innovation development in the industry and transition to a new, more open model of innovation processes there. Although in the 1980–1990’s federal government enacted a business-friendly regulations for the commercial space sector and set measures to support it through public procurement, a new situation in the markets and in sectoral innovation system has become a challenge for national policy, enforced by budget constraints and other factors. Catastrophe of the Columbia space shuttle in 2003, which raised the issue of maintaining independent U.S. access to the International Space Station and, in the future, to other orbital operations after shuttles’ phase-out, triggered changes in federal policies for the industry. As a result, since 2006 NASA (with some DoD support) initiated several programs to develop new space launch and delivery systems. These programs were based on the public-private partnerships with active involvement of small and medium innovative enterprises, primarily startups. The results turned out to be more significant than originally intended: formation of a new model of federal industrial and technological policy in the space sector, almost similar to the DARPA principles. The new policy assumes the role of NASA and, more broadly, the federal government as an equal (rather than a dominant) participant in space industry innovative processes and as a more active organizer of the industry`s innovation system (considering changes in its nature). Despite all activities are mission-oriented, more attention is paid to the development of complex partnerships, ecosystems, etc. – with an emphasis both on satisfaction of government needs and on ensuring market leadership of the U.S. companies. However, this new model faces sever al problems: ambiguity of federal expenditures on space- related research and development; need to restructure NASA science and technology organization; efficiency of federal efforts in support of new partners and processes – taking into account specifics of available policy instruments. The future of federal efforts will be determined by the solution of these problems and by the need to extend new model and practices to the key (in terms of market size and technology advances) segments of space economy – satellite manufacturing and the use of space data.

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Geographic Response Plans (GRPs) are location-specific plans developed to provide guidance for oil spill responses throughout the United States. Until recently, the majority of crude oil transportation in the United States has occurred via waterways on oil tankers and barges, therefore, most existing GRPs focus on the protection of sensitive biological resources and socio-economic features in near shore environments. The recent development of crude oil extraction from the Bakken formation has resulted in a significant increase in the volume of crude oil being transported via railroads and pipelines and has highlighted the need for inland response planning. Rail cars transporting the volatile and flammable Bakken crude oil now traverse more than 850 miles of New York State on two major Class 1 Railroads. In response, Executive Order 125 was issued by the governor directing state agencies to strengthen the state's preparedness for incidents involving crude oil transportation. New York State's (NYS) Department of Environmental Conservation (DEC), in collaboration with the Department of Homeland Security & Emergency Services and Department of Health, are leading a multi-stakeholder effort to develop Inland GRPs for the 21 NYS counties currently impacted by crude-by-rail transportation. County steering committees were established consisting primarily of local first response agencies, as well as their state and federal partners. Utilizing Sensitive Resource Maps developed by DEC, coupled with the local steering committee input, location-specific response plans were drafted, reviewed, and set as final working “evergreen” documents, which are open for update/refinement at any time in the future. The NYSDEC GRPs are similar to typical GRPs in that they are map-based, location-specific contingency plans that outline response strategies for the protection of sensitive resources. However, the NYSDEC GRPs differ from traditional GRPs in several ways. They extend contingency planning to cover spills on land, in addition to surface water-based spills. Due to the flammability of Bakken crude oil, much more emphasis is placed on the fire risks associated with a train derailment. This is done by mapping sensitive human receptors (e.g., schools, daycare centers, assisted living centers, etc.), critical infrastructure, and identifying fire (and vapor) suppression assets. The NYSDEC GRPs also place more emphasis on the initial response options available to local first responders, options that can be implemented before other response assets may arrive on-scene (State, Federal, and RP). This presentation will discuss the development, structure, proposed implementation, training and exercises associated with this ongoing program.

Abstract:

While the military and political accomplishments of World War I were clearly limited, the war, nonetheless, established a foundation for unparalleled economic growth in the United States during the 1920s. A significant consumer economy grew as many Americans worked fewer hours, earned higher salaries, invested in the stock market, and bought everything from washing machines to Model T Fords. This culture of consumerism in the 1920s changed the politics of American society and set the tone for American attitudes about economic political issues for decades to come. In the early 1920s, President Warren G. Harding's policies were generally conservative, especially regarding taxes, tariffs, immigration restriction, labor rights, and business regulation. Continuing Republican policies, President Calvin Coolidge included federal tax cuts and high tariffs. The expansive economy of the 1920s was fueled by the use of factory machine manufacturing and standardized mass production. The economic boom also resulted from the effects of World War I on technology, scientific management, the rapid increase in worker productivity, the psychology of mass consumption (with installment credit) behind the purchase of radios, motion picture tickets, electric appliances, and automobiles. Certainly, federal policies that supported big business with high tariffs, cutbacks in the authority of the Federal Trade Commission to regulate unfair trade practices, and the reduction of corporate and personal income taxes contributed to the boom as well. It was with this backdrop that Herbert Hoover and Al Smith squared off in the election of 1928. Hoover was born in Iowa and orphaned as a child. He began a career as a mining engineer soon after graduating from Stanford University in 1895. Within twenty years he had used his engineering knowledge and business skills to make a fortune as an independent mining consultant. In 1914, Hoover administered the American Relief Committee and during World War I he headed the Commission for Relief in Belgium and the U.S. Food Administration and was chairman of the Interallied Food Council. After the war he directed the American Relief Administration. Then Assistant Secretary of the Navy Franklin D. Roosevelt said of Hoover in 1920, "He is certainly a wonder and I wish we could make him President of the United States. There could be no better one." In 1919 Hoover founded the Hoover Institution on War, Revolution, and Peace at Stanford University. As Secretary of Commerce in the Harding and Coolidge administrations from 1921 to 1929, Hoover was widely celebrated for his leadership. The man who had fed Belgium, had run the U.S. Food Administration, revolutionized the Department of Commerce, and ministered to victims of the 1927 Mississippi flood appeared the ideal candidate in 1928. Hoover seemed more practical than Woodrow Wilson, glowed with respectability compared to the Harding administration, was easily more inspired than Coolidge, and was generally considered more "purely American" than his Democratic opponent, New York Governor Alfred E. Smith.

Abstract:

The article presents and analyzes the indicators of white cabbage production in Russia (by districts, subjects of the federation and categories of farms). The purpose of this study is to analyze the state of white cabbage production in the Russian Federation and in the world in terms of food security. Materials and methods. The information base of the research is information and scientific material, statistical data of the Food and Agriculture Organization of the United Nations (FAO), official periodicals of modern analytical centers. The study used general scientific methods of systematization, comparison and analysis of data. Study results. To increase the level of food security in Russia, it is necessary to ensure sustainable development of domestic production, physical and economic accessibility of high-quality food for the population. According to the new Food Security Doctrine, the strategic goal is to increase the export potential. The study revealed that about 70,150,406 tons of cabbage are produced. China is the largest cabbage producer in the world. In the Russian Federation, 14.3% of all cultivated areas of open ground crops are occupied for cabbage. The area under crop for cabbage in farms of all categories has decreased over the past six years. Many farmers and agricultural organizations refuse to grow cabbage due to its low profitability. The main cabbage production in 2022 is concentrated in the North Caucasus Federal District. In 2022, the volume of gross cabbage harvest amounted to 23,200.2 thousand tons. The current situation in the country makes it possible to implement import substitution of varieties and hybrids of white cabbage. Currently, the main task is to abandon the import of seeds of foreign breeding, and therefore it is important to focus on creating new hybrids that will be of high quality, good yield and shelf life, as well as resistance to diseases and pests. Conclusions. Today, the Russian Federation is under severe sanctions from the United States and European countries, so the issue of food security is acute. An important role in solving the problem of forming sufficient amounts of food resources belongs to the agro-industrial complex, which plays an important role in the country's economy. An important role belongs to the vegetable growing industry, which provides the population with a variety of vegetable products all year round. The country remains dependent on imported seeds, and for accelerated import substitution it is advisable to develop such forms of support as direct financing of seed production costs, provision of benefits, loans and guarantees. It is also necessary to develop a targeted state program for the transition of the industry to domestic seed material. According to analysts, Russia will be able to fully provide itself with seeds by 2025–2030.

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In October 2022, 4 new constituent entities were admitted to the Russian Federation: the Donetsk People’s Republic, the Luhansk People’s Republic, the Zaporozhye and Kherson regions, which put on the agenda the issue of integrating their banking business into the federal legal field. The study focuses on the following questions: how this process is going and what impact it makes on the national banking system as a whole. According to the results of the study, it is revealed that the legal regulation of the banking system of new constituent entities of the Russian Federation is undergoing a transitional period characterized by the effect of the norms adopted in these regions before they entered into the Russian Federation, as well as acts of emergency legislation. The author determines the factors influencing banking activity in the new constituent entities of the Russian Federation: the need for legal transformation, implementation of the special military operation, unfriendly actions on the part of the United States and foreign states and international organizations that have joined them. Extremely low availability of banking services in these constituent entitt*es of the Russian Federation makes it necessary to open branches and subsidiaries of Russian banks. To sum up, taking into account conclusions made about the nature of integration, the author proposes measures aimed at supporting the banking system not only in the new regions, but also in the Russian Federation as a whole: increasing limits on cash withdrawals; writing off loans the collateral for which was lost during hostilities for individuals and legal entities located in new regions; resumption of the work of exchange offices; acceleration of the process of introducing a non-bank payment service provider to the banking market; creation of a fund for settlement of losses in the banking sector; development of a mechanism for parliamentary control over acts of emergency regulation adopted by the Bank of Russia, the President of the Russian Federation and the Government of the Russian Federation.

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Lawns provide valuable ecological, economic and social services. Both the quantity and quality of the turfgrass affect the level of the services delivered. Unwanted weed infestations can degrade lawn quality and decrease the value of these services for lawn users and others. For example, Brosnan et al. reported that athletic fields with weed cover not only decreased aesthetic quality but also resulted in increased surface hardness and a concomitant increase in potential athlete injuries and soil erosion. Contemporary research pertaining to pest influences on lawn quality and management responses is sparse. We hope to begin filling that gap with findings from a recent study of U.S. lawn care operators about the challenges and opportunities omanaging Poa annua, an emergent threat to sustainable lawn management (USDA-NIFA Specialty Crops Research Initiative (SCRI) Grants Program (award #: 2018-51181-28436). Estimates for residential- and commercial-lawn cover in the United States (U.S.) range from 58,000 km2 to 120,000 km2 with total turfgrass cover (inclusive of golf courses, parks, schools, roadsides) estimated at 163,800 km2. The Federal Highway Administration (FHWA) estimated that there are 20,436 km2 of grassed rights of way (roadsides) in the U.S. The total U.S. urban area in 2010 was estimated at 802,053 km2. Together, we can estimate turf cover between 7 and 18% of U.S urban areas, including lawns as the primary turf surface along with parks, athletic fields, golf courses, and roadsides. The professional lawn care industry employed 295,000 workers and represented an $18.5 billion market value in 2002. Despite its size, the U.S. lawn care industry defies simple characterization in part due to its heterogeneity. Lawns may provide valuable ecosystem services, including wildlife habitat, water infiltration, and moderation of the urban heat-island effect as well as aesthetics and open space for recreation. Apart from offering economic and ecological services, lawns and their management can be an important component of community social character and culture. Effective weed management in lawns assures sustainable delivery of all of these services, such that lawns are uniform and free from potentially troublesome weed species, such as Poa annua which ranks as the #1 most troublesome weed in turfgrass systems.

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Abstract Introduction The commercial tobacco industry has long targeted Black communities by making menthol cigarettes not only appealing but affordable through marketing, advertising, and pricing strategies, particularly in the retail environment. Policies that focus on restricting the sale of menthol cigarettes have the potential to significantly reduce the death toll from smoking while also mitigating health inequities and advancing racial equity. However, limited qualitative research exists on the perceptions of menthol cigarette sales restrictions, including local policies, among Black adults who smoke menthol cigarettes. Aims and Methods In-depth semi-structured interviews were conducted between January and September 2021 with self-identified non-Hispanic Black adults who reported current menthol cigarette use (n = 26). Participants were asked open-ended questions about awareness and perceptions of the Los Angeles County law banning the retail sale of menthol cigarettes in unincorporated communities, including how it influences their smoking and purchasing behaviors. Results We used three thematic categories to structure the results: (1) Are People Aware of Local Menthol Cigarette Sales Restrictions? Levels of Awareness and Strategies to Increase Awareness, (2) Why Ban Menthol? Concerns About Equity and Fairness, and (3) Will Menthol Cigarette Bans Decrease Smoking? Mixed Perceptions About Potential Impact. Most participants (88.5%) had heard about the menthol ban in their communities. Participants described ambivalence towards the ban and identified several factors that hinder support, participation, and well-being, including uncertainty regarding the rationale for banning menthol cigarettes; perceptions that the ban specifically targets Black communities; and concerns regarding government overreach and constraining individual choice. Participants had differing views on whether the ban would likely help them and others who smoke menthol cigarettes reduce or quit smoking. Participants also described situations in which they would purchase menthol cigarettes in another state, country, online, or in the illicit market. Furthermore, participants often viewed the ban as perpetuating criminalization and over-policing of Black communities—arguments used by the commercial tobacco industry to oppose menthol bans. Conclusions Our community-based sample of Black adults who smoke menthol cigarettes face challenges and concerns about local menthol bans. Community-centered interventions, messages, and materials about racial equity in menthol bans, access to free cessation services, and countering commercial tobacco industry interference, in addition to measurable steps toward rectifying injustice from the commercial tobacco industry and repeated exemptions of menthol cigarettes from federal legislation through tangible reparations, would be helpful to this community. Implications We sought to add to the literature on flavored nicotine and commercial tobacco policies in the United States by centering the voices of Black adults who smoke menthol cigarettes regarding their awareness, perceptions, and opinions of local laws restricting menthol cigarette retail sales and how such polices influence their smoking and purchasing behaviors. Our findings suggest that Black adults who smoke menthol cigarettes are aware of local laws restricting menthol cigarette retail sales and are ambivalent about the rationale. Our findings have implications for the development and delivery of equity-focused strategies and resources to increase awareness of and rationale for the ban; counter commercial tobacco industry interference; and facilitate smoking cessation among Black adults who experience more combustible tobacco-related morbidity and mortality than their racial/ethnic counterparts. By understanding this relevance, we can also recognize how individual awareness and perceptions are moored within and contextualized by broader social structures and systemic inequities that warrant policy considerations.

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We live in a world of near continuous monitoring. In our automobiles we monitor the status of fuel, oil pressure, temperature, and seat belts through gauges, lights, and electronic voices. The consumption of electricity and fuel in our homes is monitored as is the chlorine in our drinking water and the alcohol in our beer. Manufacturers retain quality assurance inspectors and issue warrantees and guarantees to convince us that all is well. We monitor our schools and measure our own progress through grades and proficiency scores. It seemed appropriate, therefore, that the Illinois Natural History Survey should take a measure of the living natural resources of Illinois by bringing together a knowledgeable group of persons to summarize the state of the State. In order to share this information and to provide an opportunity for discussion, a symposium, "Our Living Heritage: The Biological Resources of Illinois," was sponsored by the Illinois Department of Energy and Natural Resources and organized by the Survey. The event, timed to coincide with Earth Day 1990 celebrations, was held on April 2.^ and 24 on the campus of the University of Illinois at Urbana-Champaign. It was attended by nearly 250 professional scientists from some 50 agencies and institutions along with a number of interested and dedicated citizens. To share the results of that symposium with an even larger audience, we have issued this publication of its proceedings. To address the salient features of the living resources of Illinois in an ordered fashion, the symposium was presented in five sessions: forests, prairies and barrens, wetlands, streams and caves, and agro-urban ecology. When we consider that only (.).59t of Illinois remains in undisturbed natural areas, that Illinois ranks 46th among states in publicly owned open space per person, that forest acreage has decreased by 73% in the past century and tallgrass prairie by over 99%, that 85% of our wetlands have been lost, that soil erosion proceeds at the rate of 200 million tons per year, and that approximately 30,000 tons of herbicide and 3,500 tons of insecticides are used annually on agricultural crops in Illinois, we can scarcely imagine the tone of the symposium to have been anything but pessimistic. In part, there was discouragement, but it was tempered by positive developments, including the designation of the Middle Fork of the Vermilion River as a National Wild and Scenic River, the acquisition of the Cache River Basin, the initiation of a study to identify high-quality Illinois streams based on biodiversity, and the ever quickening actions of the Nature Preserves Commission. Preservation/conservation has been in conflict with consumption/development since the days of Theodore Roosevelt. At times one side seems to prevail over the other, but the balance has been clearly on the side of consumption. Special interest groups have to a considerable extent managed to give the word environmentalist a pejorative cast and the word development a positive ring. During the past decade, the executive branch of the federal government has determinedly downplayed environmental concerns, and that stance has been translated into inertia in a number of federal agencies with responsibility for natural resources. The focus of the United States Environmental Protection Agency, for example, has until very recently ignored the living components of the environment. At the same time, public sensitivity to environmental concerns has dramatically increased, primarily through public service television and other media-generated presentations on tropical deforestation, extinction of species, depletion of the ozone layer, agro-chemical contamination of groundwater, and the effects of acid rain. Some of this concern is now being transformed into political action. Polls suggest that the public understanding of environmental matters is quite high, and some beheve that it exceeds the perceptions of elected officials. A Green Party has emerged in this country only very recently, but Greens are a part of both major political parties and the trend in federal legislation may soon begin to sway in favor of conservation/preservation and away from consumption/development. The National Institutes for the Environment may well become a reality within the next several years. Within this tentatively encouraging national picture, the symposium was timely indeed. One symposium event of special interest cannot be documented in these proceedings — the "citizens respond" program of Monday evening, April 23—and I would like to note it here. Michael Jeffords and Susan Post of the Survey opened that session with a mulitmedia presentation on the biodiversity of Illinois. Their slides of representative plants and animals and habitats of the natural divisions of Illinois brought home to us the beauty and fragility that can yet be discovered in the landscape of our state. A panel presentation by five environmental activists followed: Clark Bullard, Office of Energy Research at the University of Illinois at Urbana-Champaign; Max Hutchison, Natural Land Institute of The Nature Conservancy; Lawrence Page of the Illinois Natural History Survey; Donna Prevedell, farmwife and contributing editor to the Progressive Farmer, and Michael Reuter, Volunteer Stewardship Network of The Nature Conservancy. They spoke briefly but openly on preservation activities in which they had been closely involved. The discussion was then turned over to the audience, who asked questions and shared their experiences—successes and failures—with preservation efforts. I urge you to read on in order to understand the status of the biological resources of Illinois and to appreciate how much remains to be accomplished to secure their future—and ours. I would be remiss, however, if I did not conclude by acknowledging the committee of Survey staff who planned and conducted the symposium: Lawrence Page, Michael Jeffords, Joyce Hofmann, Susan Post, Louis Iverson, and Audrey Hodgins. Their efforts included developing the program, arranging for speakers and facilities, producing and mailing promotional materials, and welcomine the audience. Without their enthusiasm and hard work, the symposium v^ould not have materialized and our understanding of the biological resources of Illinois would be much diminished. Lorin I. Nevling. ChiefIllinois Natural History Suney

Abstract:

Financial information is one of the important information in decision making. However, many cases of fraud committed by management so that the information in the financial statements cannot be relied upon in decision making. Therefore, the auditor's job is to ensure that the company's financial statements are represented correctly (faithful representation) so that financial statement information becomes more quality and useful in making decisions. So this study aims to examine the effect of audit fee on audit quality. In addition, this study also examines important determinants of audit costs, namely company size, profitability, audit risk, complexity, and firm size. By using the purposive sampling method, samples of the financial and manufacturing industry in 2010-2017 used are 39 firms per year. This sample is used to examine the effect of audit fee on audit quality and the determinant of audit fee using simple linear regression analysis and multiple linear regression analysis. The result of this research shows that audit fees have a significant positive effect on audit quality. In addition, this study shows that firm size, complexity, and firm size are important determinants that determine audit fee. However, profitability and audit risk have not been proven to explain audit fees. Keywords: Audit Quality, Audit Fee, Firm Size, Profitability, Audit Risk, Complexity, Auditor Size Referencens: Al-Harshani, Meshari O. (2008), The pricing of audit services: Evidence from Kuwait. Managerial Auditing Journal, 23(7), 685–696. Al-Thuneibat, Ali. Abedalqader, Ream Tawfiq Ibrahim Al Issa, & Rana Ahmad Ata Baker, (2011), Do audit tenure and firm size contribute to audit quality? Empirical evidence from Jordan. Managerial Auditing Journal, 26(4), 317–334. Arens, Alvin A., Randal J. Elder,. Mark S. Beasley (2014), Auditing and Assurance Services: An Integrated Approach. United States: Pearson Education, Inc. Association of Certified Fraud Examiners (2018), Report to the Nations: 2018 Global Study on Occupational Fraud and Abuse, United States: ACFE. Bhandari, L. C. (1988), Debt/Equity Ratio and Expected Common Stock Returns : Empirical Evidence. The Journal of Finance, 43(2), 507–528. Bowerman, Bruce L., Richard T. O'Connell, Emily S. Murphree (2017), Business Statistics in Practice, Eighth Edition, New York: McGraw Hill Education. Brealey, Richard A., Myers, Stewart C. (2000), Principles of Corporate Finance, Boston: McGraw Hill Companies, Inc. Carey, P. J. (2008), The Benefits of Services Provided by External Accountants to Small and Medium Sized Enterprises. Carey, P., & Simnett, R. (2006), Audit partner tenure and audit quality. Accounting Review, 81(3), 653–676. Castro, Walther Bottaro de Lima, Ivam Ricardo Peleias, & Glauco Peres da Silva (2015), Determinants of Audit Fees: A Study in the Companies Listed on the BM&FBOVESPA, Brasil. Revista Contabilidade & Finanças, 26(69), 261–273. Chen, C. (2008), Audit Partner Tenure , Audit Firm Tenure , and Discretionary Accruals : Does Long Auditor Tenure Impair Earnings Quality ?, 25(2), 415–445. Cooper, D. R., & Schindler, P. S. (2014), Business Research Methods (Twelfth Edition). New York: McGraw-Hill/Irwin. DeAngelo, L. E. (1981), Auditor size and audit quality. Journal of Accounting and Economics, 3(3), 183–199. Dechow, Patricia. M., Richard. G. Sloan, & Amy P. Sweeney (1995), Detecting Earnings Management. The Accounting Review. DeFond, M., & Zhang, J. (2014), A review of archival auditing research. Journal of Accounting and Economics, 58(2–3), 275–326. Deis, Donald R., & Gary Giroux (1996), The effect of auditor changes on audit fees, audit hours, and audit quality. Journal of Accounting and Public Policy, 15(1), 55–76. Eilifsen, Aasmund, Jr William F Messier, Steven M Glover, Douglas F Prawitt (2014), Auditing & Assurance Services, Third Edition, London: McGraw-Hill. Ettredge, Michael., Elizabeth Emeigh Fuerherm, & Chan Li (2014), Fee pressure and audit quality. Accounting, Organizations and Society, 39(4), 247–263. Ferri, Michael G., & Wesley H. Jones (1979), Determinants of financial structure: a new methodological approach. The Journal of Finance, 34(3), 631–643. Francis, Jere. R. (2011), A Framework For Understanding And Researching Audit Quality. Auditing, 30(2), 125–152. Ghozali, H. Imam (2016), Aplikasi Analisis Multivariete dengan Program IBM SPSS 23, Edisi ke-8, Semarang: Badan Penerbit Universitas Diponegoro. Gitman, Lawrence J., Chad J. Zutter (2012), Principles Of Managerial Finance (Thirteenth). United States: Lawrence J. Gitman. Hoitash, Rani., Ariel Markelevich, & Charles A. Barragato (2007), Auditor fees and audit quality. Managerial Auditing Journal, 22(8), 761–786. Horngren, Charles T., L. Sundem, John A. Elliott (1999), Introduction to Financial Accounting, Seventh Edition, New Jersey: Prentice-Hall,Inc. Ikatan Akuntansi Indonesia (2017), Standar Akuntansi Keuangan (SAK), Jakarta: IAI International Accounting Standard Board (2018), The Conceptual Framework for Financial Reporting 2018. London : IASB. Jan, Chyan Long (2018), An effective financial statements fraud detection model for the sustainable development of financial markets: Evidence from Taiwan. Sustainability (Switzerland), 10(2). Jensen, Michael C., & William H. Meckling (1976), Theory Of The Firm : Managerial Behavior , Agency Costs And Ownership Structure, 3, 305–360. Joshi, P. L., & Hasan AL-bastaki (2000), Determinants of Audit Fees : Evidence from the Companies Listed in Bahrain, 138(November 1999), 129–138. Jubb. (1996), Audit fee determinants: The plural nature of risk. Managerial Auditing Journal, 11(3), 25–40. Kieso, Donald E., Jerry J. Weygandt, & Paul D. Kimmel (2013), Financial Accounting IFRS Edition. United States: John Wiley & Sons, Inc. Kieso, Donald E, Jerry J Weygandt, Terry D Warfield (2018), Intermediate Accounting: IFRS Edition Third Edition, United States: John Willey & Sons, Inc. Kikhia, Hassan Yahia (2014), Determinants of Audit Fees: Evidence from Jordan. Accounting and Finance Research, 4(1), 42–53. Knechel, Robert W., & Ann Vanstraelen (2007), The Relationship between Auditor Tenure and Audit Quality Implied by Going Concern Opinions. AUDITING: A Journal of Practice & Theory, 26(May), 113–131. Knechel, W. Robert, Gopal V. Krishnan, Mikhail Pevzner, Lori B Shefchik, & Uma K. Velury (2013), Audit quality: Insights from the academic literature. Auditing, 32(SUPPL.1), 385–421. Konrath, Larry F. (2002), Auditing A Risk Analysis Approach, Fifth Edition, South Western. Kusharyanti (2013), Analysis of the Factors Determining the Audit Fee. Journal of Economics, Business, and Accountancy | Ventura, 16(1), 147–160. Lennox, C. (1999), Are large auditors more accurate than small auditors? Accounting and Business Research, 29(3), 217–227. Lennox, C. S. (1999) Audit quality and auditor size: An evaluation of reputation and deep pockets hypotheses. Journal of Business Finance and Accounting, 26(7–8), 789–805. Liu, Siheng. (2017), An Empirical Study: Auditors’ Characteristics and Audit Fee. Open Journal of Accounting, 06(02), 52–70. Lobo, Gerald, & Yuping Zhao (2013), Relation between Audit Effort and Financial Report Misstatements: Evidence from Quarterly and Annual Restatements. Journal of International Accounting Research, 90(4), 1395–1435. Manry, David L, Theodore J. Mock, & Jerry L. Turner (2008), Does increased audit partner tenure reduce audit quality? Journal of Accounting, Auditing and Finance, 23(4), 553–572. Mohammed, Nishtiman Hashim, & Abdullah Saeed Barwari (2018), Determinants of Audit Fees : Evidence from UK Alternative Investment Market. Academic Journal of Nawroz University, 7(3), 34–47. Musah, A. (2017), Determinants of Audit fees in a Developing Economy: Evidence from Ghana. International Journal of Academic Research in Business and Social Sciences, 7(11). Newton, Nathan J., Dechun Wang, & Michael S. Wilkins (2013), Does a lack of choice lead to lower quality? evidence from auditor competition and client restatements. Auditing, 32(3), 31–67. Nikkinen, J., & Petri Sahlström (2004), Does Agency Theory Provide a General Framework for Audit Pricing ? International Journal of Auditing, 8, 253–262. Ohidoa, T., & Okun, O. O. (2018), Firms Attributes and Audit Fees in Nigeria Quoted Firms. International Journal of Academic Research in Business and Social Sciences, 8(3), 685–699. Pham, Ngoc Kim, Hung Nguyen Duong, Tin Pham Quang, & Nga Ho Thi Thuy (2017), Audit Firm Size, Audit Fee, Audit Reputation and Audit Quality: The Case of Listed Companies in Vietnam. Asian Journal of Finance & Accounting, 9(1), 429. Rahman, Dr Onaolapo Adekunle Abdul, Ajulo Olajide Benjamin, Onifade Hakeem Olayinka (2017), Effect of Audit Fees on Audit Quality: Evidence from Cement Manufacturing Companies in Nigeria. Effect of Audit Fees on Audit Quality: Evidence from Cement Manufacturing Companies in Nigeria., 5(1), 6–17. Rahmina, Listya Yuniastuti, & Sukrisno Agoes (2015), Influence of Auditor Independence, Audit Tenure, and Audit Fee on Audit Quality of Members of Capital Market Accountant Forum in Indonesia. Procedia - Social and Behavioral Sciences, 164(August), 324–331. Republik Indonesia (2008), Undang-Undang Republik Indonesia Nomor 20 tahun 2008 Tentang Usaha Mikro, Kecil, Dan Menengah. Sandra, & Patrick. (1996), The Deteminants of Audit Fees in HongKong: An Empirical Study. Asian Review of Accounting, 4(2), 32–50. Scott, William R (2015), Financial Accounting Theory, Seventh Edition, United States: Pearson Canada Inc. Shibano, T. (1990), Assessing Audit Risk from Errors and Irregularities. Journal of Accounting Research, 28(1990), 110. Sivathaasan, N., R. Tharanika, M. Sinthuja, V. Hanitha (2013), Factors determining Profitability: A Study of Selected Manufacturing Companies listed on Colombo Stock Exchange in Sri Lanka. European Journal of Business and Management, 5(27), 99-107–107. Subramanyam, K. R. (2014), Financial Statement Analysis, Eleventh Edition, New York: McGraw-Hill Education. Sun, Jerry, & Guoping Liu (2011), Client-specific litigation risk and audit quality differentiation. Managerial Auditing Journal, 26(4), 300–316. Tritschler, Jonas (2013), Audit Quality: Association Between Published Reporting Errors and Audit Firm Characteristics. Vu, Dinh Ha Thu Vu (2012), Determinants of audit fees for Swedish listed non-financial firms in NASDAQ OMX Stockholm. Whittington, Ray & Kurt Pany (2004), Principles of Auditing and Other Assurance Services, New York: McGraw-Hill/Irwin. Williams, David D. (1988), The Potential Determinants of Auditor Change. Journal of Business Finance & Accounting, 15(2), 243–261. Wooten, T. C. (2003), Research About Audit Quality. Wu, Shu-Hsing, Tsung-Che Wu, & Kun-Lin Yang (2017), Fair Value Information, Audit fees and Audit Committee in Taiwan. International Journal of Financial Research, 8(2), 124. Xu, Jiabing (2017), Analysis on the Relationship between Audit Fee Management and Audit Quality in China, 53(ICEM 2017), 530–533.

Abstract:

AbstractThe Federal Open Market Committee (FOMC) is a component of the Federal Reserve System responsible for overseeing open market operations. The FOMC meets roughly eight or more times per year to assess the economy of the United States. After each meeting, the FOMC releases a statement to the press outlining its assessment of the US economy and its monetary policy stance. The sentiment of these statements may have an influence on the US economy and financial markets. Using sentiment and correlational analyses, this research examines how the sentiment of these statements affects the US economy and financial markets by analyzing how FOMC statement sentiment is correlated with the Consumer Price Index (CPI), the National Financial Conditions Index (NFCI), and the Adjusted National Financial Conditions Index (ANFCI). We find evidence to suggest that there is a moderate negative correlation between an FOMC statement's sentiment and the US City Average CPI value associated with the month before and the month after the statement's release. We also find that there is no evidence to suggest there exists a correlation between an FOMC statement's sentiment and the NFCI value associated with the week before or the week after the statement's release. However, we do find evidence to suggest that there is a moderate negative correlation between an FOMC statement's sentiment and the ANFCI value associated with the week before and the week after the statement's release. We also found that out of the three models we tested (linear regression, vine copula regression, and Gaussian copula regression), the Gaussian copula regression model performs the best when forecasting the CPI and the ANFCI. Additionally, we find that when forecasting CPI values, the models that include FOMC statement sentiment are more accurate than the models that exclude FOMC statement sentiment.

Abstract:

With just 4.2 percent of the world’s population, the United States had, as of July 21, 2020, 26.0 percent of its confirmed Covid-19 cases and 23.1 percent of its deaths. The magnitude of the tragedy raises the critically important counterfactual question of how the United States as a nation would have fared had there been competent and committed political leadership in place when, during January 2020, intelligence indicating the severity of the unfolding pandemic became available. A partial answer to this question lies in identifying the organizational and technological capabilities to develop, produce, and deliver “countermeasures”—personal protective equipment (PPE), ventilators, diagnostic tests, therapies, and vaccines—that a prepared federal administration would have been able to mobilize to respond to the pandemic. Main repositories of the necessary capabilities are government agencies and business firms, with the development, production, and delivery of countermeasures heavily reliant on government-business collaborations (GBCs). We contend that the success of projects for pandemic preparedness and response depends on the strength of GBCs. In this essay, we focus on the particular case of ventilators for the Strategic National Stockpile (SNS). We trace the historical evolution within the federal government of the current system of pandemic preparedness for and response through the end of the Obama administration. We then analyze the particular GBCs to develop ventilators for the SNS initiated and implemented by the Biomedical Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS). BARDA initiated two successive GBCs, one beginning in 2010 and the second in 2014, with two different business firms, for the purpose of developing portable, easy-to-use, and affordable ventilators for the SNS. We show that the strength of these collaborations lay with the innovative ventilator manufacturers with which BARDA contracted. The weakness of these GBCs appeared when these innovative manufacturers fell under the control of business corporations committed to the ideology of “maximizing shareholder value” (MSV). In each case, the financialized business corporation undermined development and delivery of ventilators to the SNS. We then explain why, in general, we should expect that business firms driven by MSV will be unreliable partners in GBCs—at the expense of the nation’s preparedness for and response to an emergency such as the Covid-19 pandemic. This lack of reliability is rooted in the strategic orientation of corporations which have put stock-market valuation of the company ahead of its innovative performance in producing goods and services. The Covid-19 crisis has already revealed the extent to which, in the U.S. economy, the stock market functions not to support value creation but rather as the prime means of value extraction. The most overt form of value extraction is the corporate practice of open-market repurchases of the company’s own shares—aka stock buybacks—typically done in addition to copious distributions to shareholders in the form of cash dividends. In the decade 2010-2019, companies in the S&P 500 Index spent $5.3 trillion on buybacks, representing 54 percent of net income, in addition to $3.8 trillion (39 percent of net income) distributed to shareholders as dividends. In view of this “predatory value extraction,” we conclude this essay with the “$5.3 trillion” question for executives and directors of corporations who, in their embrace of MSV ideology, must bear significant responsibility for the failure of the United States to respond to not only the Covid-19 pandemic but also climate change and income inequity. The question: Why does the company that you head do stock buybacks? In particular, we direct this question to the executives and directors of three corporations that, as of the year 2020, are the biggest repurchasers of their own stock in history: Microsoft at number three, ExxonMobil at number two, and Apple at number one. We also pose this question to the senior executives and board members of any company engaged in the practice who, in August 2019, signed the Business Roundtable (BRT) Statement of the Purpose of a Corporation, which explicitly rejected the BRT’s 1997 pronouncement that “corporations exist principally to serve shareholders,” replacing it with a redefinition of “the purpose of the corporation to promote ‘an economy that serves all Americans’.”

Abstract:

With just 4.2 percent of the world’s population, the United States had, as of July 21, 2020, 26.0 percent of its confirmed Covid-19 cases and 23.1 percent of its deaths. The magnitude of the tragedy raises the critically important counterfactual question of how the United States as a nation would have fared had there been competent and committed political leadership in place when, during January 2020, intelligence indicating the severity of the unfolding pandemic became available. A partial answer to this question lies in identifying the organizational and technological capabilities to develop, produce, and deliver “countermeasures”—personal protective equipment (PPE), ventilators, diagnostic tests, therapies, and vaccines—that a prepared federal administration would have been able to mobilize to respond to the pandemic. Main repositories of the necessary capabilities are government agencies and business firms, with the development, production, and delivery of countermeasures heavily reliant on government-business collaborations (GBCs). We contend that the success of projects for pandemic preparedness and response depends on the strength of GBCs. In this essay, we focus on the particular case of ventilators for the Strategic National Stockpile (SNS). We trace the historical evolution within the federal government of the current system of pandemic preparedness for and response through the end of the Obama administration. We then analyze the particular GBCs to develop ventilators for the SNS initiated and implemented by the Biomedical Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS). BARDA initiated two successive GBCs, one beginning in 2010 and the second in 2014, with two different business firms, for the purpose of developing portable, easy-to-use, and affordable ventilators for the SNS. We show that the strength of these collaborations lay with the innovative ventilator manufacturers with which BARDA contracted. The weakness of these GBCs appeared when these innovative manufacturers fell under the control of business corporations committed to the ideology of “maximizing shareholder value” (MSV). In each case, the financialized business corporation undermined development and delivery of ventilators to the SNS. We then explain why, in general, we should expect that business firms driven by MSV will be unreliable partners in GBCs—at the expense of the nation’s preparedness for and response to an emergency such as the Covid-19 pandemic. This lack of reliability is rooted in the strategic orientation of corporations which have put stock-market valuation of the company ahead of its innovative performance in producing goods and services. The Covid-19 crisis has already revealed the extent to which, in the U.S. economy, the stock market functions not to support value creation but rather as the prime means of value extraction. The most overt form of value extraction is the corporate practice of open-market repurchases of the company’s own shares—aka stock buybacks—typically done in addition to copious distributions to shareholders in the form of cash dividends. In the decade 2010-2019, companies in the S&P 500 Index spent $5.3 trillion on buybacks, representing 54 percent of net income, in addition to $3.8 trillion (39 percent of net income) distributed to shareholders as dividends. In view of this “predatory value extraction,” we conclude this essay with the “$5.3 trillion” question for executives and directors of corporations who, in their embrace of MSV ideology, must bear significant responsibility for the failure of the United States to respond to not only the Covid-19 pandemic but also climate change and income inequity. The question: Why does the company that you head do stock buybacks? In particular, we direct this question to the executives and directors of three corporations that, as of the year 2020, are the biggest repurchasers of their own stock in history: Microsoft at number three, ExxonMobil at number two, and Apple at number one. We also pose this question to the senior executives and board members of any company engaged in the practice who, in August 2019, signed the Business Roundtable (BRT) Statement of the Purpose of a Corporation, which explicitly rejected the BRT’s 1997 pronouncement that “corporations exist principally to serve shareholders,” replacing it with a redefinition of “the purpose of the corporation to promote ‘an economy that serves all Americans’.”

Abstract:

The release of the UK Joint Information Systems Committee report Economic implications of alternative scholarly publishing models (Houghton and Oppenheim et al. 2009) generated considerable interest, particularly in the methods used to explore the benefits of open access publishing models, as well as their costs. During 2009, there were a number of follow-on studies. These included national studies in The Netherlands and Denmark, and a three-country comparison, which explored the impacts of alternative scholarly publishing models on one of the larger (United Kingdom), a mid-sized (Netherlands), and one of the smaller European countries (Denmark). This year there have been three further projects. The first focuses on Germany, and brings the German National Licensing Program (NLP) into the mix of alternative scholarly communication models. The second focuses on the United Kingdom, and uses the JISC EI-ASPM model to examine the cost impacts of alternative scholarly publishing models for a sample of UK universities. The third involved further application of some of the underlying methods to exploring the cost-benefit implications of the proposed US Federal Public Research Access Act (FRPAA). This presentation will examine what the methods developed, studies conducted and debate engendered tell us about the viability and sustainability of alternative publishing models, and their potential impacts on research, research infrastructure and the communication and application of publicly funded research findings.

Abstract:

This article examines the nationwide campaign by financial reformers in the 1910s to convince businesses across the United States to abandon established commercial credit practices and use trade acceptances—the quintessential “real bill”—in their stead. The creation of the Federal Reserve System (Fed) and the outbreak of World War I offered a powerful coalition of campaigners the opportunity to forcefully argue that by capitalizing open account credit, trade acceptances fostered good business practices and stabilized the banking and financial systems. These campaigners relied on trade associations to disseminate, and the federal government to legitimize, their message. While some firms obliged, many businesses and banks criticized the campaigners’ arguments, casting trade acceptances as a means of financial centralization and as being contrary to the American culture of credit. Trade acceptances did not supplant promissory notes or trade in the open market and were rarely used by banks to access Fed liquidity. Instead, their legacy lies in their adoption by finance companies in the hope of securing financing for the distribution and mass consumption of consumer durables.

Abstract:

Since the late 1980s, casino-style gaming has become an increasingly popular economic development strategy for federally-recognized tribes throughout the United States. What is the net effect of tribal gaming? According to economic theory, the opening of a casino could have negative economic ramifications that offset initial improvements in employment and wages. However, my research indicates that tribal gaming is responsible for sustained improvements in employment and wages on federal reservations. These labor market gains appear to be concentrated on Indigenous people living on the host reservations. I also find evidence of rising prices on reservations that open casinos, but the average price increase is smaller than the average wage increase, suggesting that tribal gaming generates net benefits locally.

Abstract:

Since the rise of Bitcoin in 2009 and recent interest in digital currency is on an ascending trend, the question is how far will it penetrate in financial system other industries? How stable is this currency? With recent comments from CEO of Tesla Elon Mask, we saw a crash of 14% in Bitcoin stock overnight trades of any other existing crypto currency stock in open market came to a halt. Thus, one should be concern about stability of digital currency, providing no centralized banking standing behind any of these digital crypto currencies like we see in traditional banking business where currencies are being backed up and insured by Federal governments like FDIC in United States. In this short review, we have brought a high level of information from the web at a very holistic level, yet in a layman language for those readers that want to have a quick understanding of Crypto Currencies or Digital Currencies that seem a hot topic of today’s market.

Abstract:

In the United States, state and federal reforms increasingly encourage the expansion of school choice policies. Debates about school choice contrast various concepts of freedom and equality with concerns about equity, justice, achievement, democratic accountability, profiting management organizations, and racial and class segregation. Arizona’s “market”-based school choice programs include over 600 charter schools, and the state’s open enrollment practices, public and private school tax credit allowances, and Empowerment Scholarships, (closely related to vouchers), flourish. This qualitative analysis explores one district-run public school and its surrounding community, and I discuss socio-political and cultural tensions related to school choice reforms that exist within the larger community. This community experienced school changes, including demographic shifts, lowered test scores, failed overrides, and the opening of high-profile charter school organizations near the school.

Abstract:

This abstract summarizes a study that investigates the impact of various policy changes made by central banks on the economies of India and the USA. The focus is on the Reserve Bank of India and the Federal Reserve System of the US. The primary objective is to analyze the relationships between different economic factors and the country's economic indicators, such as GDP, WPI, SLR, PPP, PCI, BOP, CRR, OMO, Repo, Reverse Repo, and interest rates. Data was collected from reliable sources, including the World Bank and RBI, covering a 12-year period from 2010 to 2021. The statistical analysis involved correlation and regression using SPSS software. In India, the study finds that Bank Lending Rate, Cash Reserve Ratio, Statutory Liquidity Ratio, Repo Rate, and Reverse Repo Rate exhibit negative correlations with GDP, PPP, WPI, PCI, and BOP. Conversely, Open Market Operations in India show positive correlations with these economic indicators. In the United States, Bank Lending Rate is positively correlated with GDP, PPP, WPI, and PCI, but negatively correlated with BOP. The Discount rate in the US shows negative correlations with GDP, PPP, WPI, and PCI but positive correlation with BOP. Open Market Operations in the US exhibit positive correlations with GDP, PPP, WPI, and PCI but negative correlation with BOP. Finally, the Reserve Ratio Requirement in the US is negatively correlated with GDP, PPP, WPI, and PCI but positively correlated with BOP. The study's findings offer valuable insights into the connections between monetary policy tools and economic indicators in both countries. These insights can aid policymakers and economists in understanding the effects of policy decisions on their respective economies.

Abstract:

The credit cycle theory states that credit build-ups and their subsequent crashes are the common cause of recessions. If true, this theory could be used to both predict and prevent future recessions. However, it is unclear if policymakers do in fact take the theory into account when crafting monetary policy. Using the U.S. Federal Reserve (the Fed) as a case study, this paper seeks to answer if policymakers consider the credit cycle theory when attempting to predict recessions and determine optimal monetary policy. This paper analyzes Federal Open Market Committee minutes from meetings prior to four previous recessions: the Savings and Loan Crisis, the Dot-Com Bubble, the Great Recession, and the Covid Recession. The results indicate that the Fed did not begin to consider the credit cycle theory when implementing monetary policy until after the Great Recession. Credit was not addressed prior to the Savings and Loan Crisis and was only substantially mentioned on the eve of the Dot-Com Bubble and the Great Recession. This indicates that instead of continually discussing credit, the Fed was only concerned with credit when it began to tighten. While it did mention credit build-up, especially before the Great Recession, the Fed did not adjust its monetary policy accordingly. Instead, it primarily adjusted policy to manage inflation. However, after the Great Recession, the Fed began adhering more closely to the credit cycle theory both in terms of what was discussed in each meeting, as it consistently discussed credit, and how it implemented monetary policy.

Abstract:

On the morning of Thursday, 4 May 2006, the United States House Permanent Select Committee on Intelligence held an open hearing entitled “Terrorist Use of the Internet.” The Intelligence committee meeting was scheduled to take place in Room 1302 of the Longworth Office Building, a Depression-era structure with a neoclassical façade. Because of a dysfunctional elevator, some of the congressional representatives were late to the meeting. During the testimony about the newest political applications for cutting-edge digital technology, the microphones periodically malfunctioned, and witnesses complained of “technical problems” several times. By the end of the day it seemed that what was to be remembered about the hearing was the shocking revelation that terrorists were using videogames to recruit young jihadists. The Associated Press wrote a short, restrained article about the hearing that only mentioned “computer games and recruitment videos” in passing. Eager to have their version of the news item picked up, Reuters made videogames the focus of their coverage with a headline that announced, “Islamists Using US Videogames in Youth Appeal.” Like a game of telephone, as the Reuters videogame story was quickly re-run by several Internet news services, each iteration of the title seemed less true to the exact language of the original. One Internet news service changed the headline to “Islamic militants recruit using U.S. video games.” Fox News re-titled the story again to emphasise that this alert about technological manipulation was coming from recognised specialists in the anti-terrorism surveillance field: “Experts: Islamic Militants Customizing Violent Video Games.” As the story circulated, the body of the article remained largely unchanged, in which the Reuters reporter described the digital materials from Islamic extremists that were shown at the congressional hearing. During the segment that apparently most captured the attention of the wire service reporters, eerie music played as an English-speaking narrator condemned the “infidel” and declared that he had “put a jihad” on them, as aerial shots moved over 3D computer-generated images of flaming oil facilities and mosques covered with geometric designs. Suddenly, this menacing voice-over was interrupted by an explosion, as a virtual rocket was launched into a simulated military helicopter. The Reuters reporter shared this dystopian vision from cyberspace with Western audiences by quoting directly from the chilling commentary and describing a dissonant montage of images and remixed sound. “I was just a boy when the infidels came to my village in Blackhawk helicopters,” a narrator’s voice said as the screen flashed between images of street-level gunfights, explosions and helicopter assaults. Then came a recording of President George W. Bush’s September 16, 2001, statement: “This crusade, this war on terrorism, is going to take a while.” It was edited to repeat the word “crusade,” which Muslims often define as an attack on Islam by Christianity. According to the news reports, the key piece of evidence before Congress seemed to be a film by “SonicJihad” of recorded videogame play, which – according to the experts – was widely distributed online. Much of the clip takes place from the point of view of a first-person shooter, seen as if through the eyes of an armed insurgent, but the viewer also periodically sees third-person action in which the player appears as a running figure wearing a red-and-white checked keffiyeh, who dashes toward the screen with a rocket launcher balanced on his shoulder. Significantly, another of the player’s hand-held weapons is a detonator that triggers remote blasts. As jaunty music plays, helicopters, tanks, and armoured vehicles burst into smoke and flame. Finally, at the triumphant ending of the video, a green and white flag bearing a crescent is hoisted aloft into the sky to signify victory by Islamic forces. To explain the existence of this digital alternative history in which jihadists could be conquerors, the Reuters story described the deviousness of the country’s terrorist opponents, who were now apparently modifying popular videogames through their wizardry and inserting anti-American, pro-insurgency content into U.S.-made consumer technology. One of the latest video games modified by militants is the popular “Battlefield 2” from leading video game publisher, Electronic Arts Inc of Redwood City, California. Jeff Brown, a spokesman for Electronic Arts, said enthusiasts often write software modifications, known as “mods,” to video games. “Millions of people create mods on games around the world,” he said. “We have absolutely no control over them. It’s like drawing a mustache on a picture.” Although the Electronic Arts executive dismissed the activities of modders as a “mustache on a picture” that could only be considered little more than childish vandalism of their off-the-shelf corporate product, others saw a more serious form of criminality at work. Testifying experts and the legislators listening on the committee used the video to call for greater Internet surveillance efforts and electronic counter-measures. Within twenty-four hours of the sensationalistic news breaking, however, a group of Battlefield 2 fans was crowing about the idiocy of reporters. The game play footage wasn’t from a high-tech modification of the software by Islamic extremists; it had been posted on a Planet Battlefield forum the previous December of 2005 by a game fan who had cut together regular game play with a Bush remix and a parody snippet of the soundtrack from the 2004 hit comedy film Team America. The voice describing the Black Hawk helicopters was the voice of Trey Parker of South Park cartoon fame, and – much to Parker’s amusem*nt – even the mention of “goats screaming” did not clue spectators in to the fact of a comic source. Ironically, the moment in the movie from which the sound clip is excerpted is one about intelligence gathering. As an agent of Team America, a fictional elite U.S. commando squad, the hero of the film’s all-puppet cast, Gary Johnston, is impersonating a jihadist radical inside a hostile Egyptian tavern that is modelled on the cantina scene from Star Wars. Additional laughs come from the fact that agent Johnston is accepted by the menacing terrorist cell as “Hakmed,” despite the fact that he utters a series of improbable clichés made up of incoherent stereotypes about life in the Middle East while dressed up in a disguise made up of shoe polish and a turban from a bathroom towel. The man behind the “SonicJihad” pseudonym turned out to be a twenty-five-year-old hospital administrator named Samir, and what reporters and representatives saw was nothing more exotic than game play from an add-on expansion pack of Battlefield 2, which – like other versions of the game – allows first-person shooter play from the position of the opponent as a standard feature. While SonicJihad initially joined his fellow gamers in ridiculing the mainstream media, he also expressed astonishment and outrage about a larger politics of reception. In one interview he argued that the media illiteracy of Reuters potentially enabled a whole series of category errors, in which harmless gamers could be demonised as terrorists. It wasn’t intended for the purpose what it was portrayed to be by the media. So no I don’t regret making a funny video . . . why should I? The only thing I regret is thinking that news from Reuters was objective and always right. The least they could do is some online research before publishing this. If they label me al-Qaeda just for making this silly video, that makes you think, what is this al-Qaeda? And is everything al-Qaeda? Although Sonic Jihad dismissed his own work as “silly” or “funny,” he expected considerably more from a credible news agency like Reuters: “objective” reporting, “online research,” and fact-checking before “publishing.” Within the week, almost all of the salient details in the Reuters story were revealed to be incorrect. SonicJihad’s film was not made by terrorists or for terrorists: it was not created by “Islamic militants” for “Muslim youths.” The videogame it depicted had not been modified by a “tech-savvy militant” with advanced programming skills. Of course, what is most extraordinary about this story isn’t just that Reuters merely got its facts wrong; it is that a self-identified “parody” video was shown to the august House Intelligence Committee by a team of well-paid “experts” from the Science Applications International Corporation (SAIC), a major contractor with the federal government, as key evidence of terrorist recruitment techniques and abuse of digital networks. Moreover, this story of media illiteracy unfolded in the context of a fundamental Constitutional debate about domestic surveillance via communications technology and the further regulation of digital content by lawmakers. Furthermore, the transcripts of the actual hearing showed that much more than simple gullibility or technological ignorance was in play. Based on their exchanges in the public record, elected representatives and government experts appear to be keenly aware that the digital discourses of an emerging information culture might be challenging their authority and that of the longstanding institutions of knowledge and power with which they are affiliated. These hearings can be seen as representative of a larger historical moment in which emphatic declarations about prohibiting specific practices in digital culture have come to occupy a prominent place at the podium, news desk, or official Web portal. This environment of cultural reaction can be used to explain why policy makers’ reaction to terrorists’ use of networked communication and digital media actually tells us more about our own American ideologies about technology and rhetoric in a contemporary information environment. When the experts come forward at the Sonic Jihad hearing to “walk us through the media and some of the products,” they present digital artefacts of an information economy that mirrors many of the features of our own consumption of objects of electronic discourse, which seem dangerously easy to copy and distribute and thus also create confusion about their intended meanings, audiences, and purposes. From this one hearing we can see how the reception of many new digital genres plays out in the public sphere of legislative discourse. Web pages, videogames, and Weblogs are mentioned specifically in the transcript. The main architecture of the witnesses’ presentation to the committee is organised according to the rhetorical conventions of a PowerPoint presentation. Moreover, the arguments made by expert witnesses about the relationship of orality to literacy or of public to private communications in new media are highly relevant to how we might understand other important digital genres, such as electronic mail or text messaging. The hearing also invites consideration of privacy, intellectual property, and digital “rights,” because moral values about freedom and ownership are alluded to by many of the elected representatives present, albeit often through the looking glass of user behaviours imagined as radically Other. For example, terrorists are described as “modders” and “hackers” who subvert those who properly create, own, legitimate, and regulate intellectual property. To explain embarrassing leaks of infinitely replicable digital files, witness Ron Roughead says, “We’re not even sure that they don’t even hack into the kinds of spaces that hold photographs in order to get pictures that our forces have taken.” Another witness, Undersecretary of Defense for Policy and International Affairs, Peter Rodman claims that “any video game that comes out, as soon as the code is released, they will modify it and change the game for their needs.” Thus, the implication of these witnesses’ testimony is that the release of code into the public domain can contribute to political subversion, much as covert intrusion into computer networks by stealthy hackers can. However, the witnesses from the Pentagon and from the government contractor SAIC often present a contradictory image of the supposed terrorists in the hearing transcripts. Sometimes the enemy is depicted as an organisation of technological masterminds, capable of manipulating the computer code of unwitting Americans and snatching their rightful intellectual property away; sometimes those from the opposing forces are depicted as pre-modern and even sub-literate political innocents. In contrast, the congressional representatives seem to focus on similarities when comparing the work of “terrorists” to the everyday digital practices of their constituents and even of themselves. According to the transcripts of this open hearing, legislators on both sides of the aisle express anxiety about domestic patterns of Internet reception. Even the legislators’ own Web pages are potentially disruptive electronic artefacts, particularly when the demands of digital labour interfere with their duties as lawmakers. Although the subject of the hearing is ostensibly terrorist Websites, Representative Anna Eshoo (D-California) bemoans the difficulty of maintaining her own official congressional site. As she observes, “So we are – as members, I think we’re very sensitive about what’s on our Website, and if I retained what I had on my Website three years ago, I’d be out of business. So we know that they have to be renewed. They go up, they go down, they’re rebuilt, they’re – you know, the message is targeted to the future.” In their questions, lawmakers identify Weblogs (blogs) as a particular area of concern as a destabilising alternative to authoritative print sources of information from established institutions. Representative Alcee Hastings (D-Florida) compares the polluting power of insurgent bloggers to that of influential online muckrakers from the American political Right. Hastings complains of “garbage on our regular mainstream news that comes from blog sites.” Representative Heather Wilson (R-New Mexico) attempts to project a media-savvy persona by bringing up the “phenomenon of blogging” in conjunction with her questions about jihadist Websites in which she notes how Internet traffic can be magnified by cooperative ventures among groups of ideologically like-minded content-providers: “These Websites, and particularly the most active ones, are they cross-linked? And do they have kind of hot links to your other favorite sites on them?” At one point Representative Wilson asks witness Rodman if he knows “of your 100 hottest sites where the Webmasters are educated? What nationality they are? Where they’re getting their money from?” In her questions, Wilson implicitly acknowledges that Web work reflects influences from pedagogical communities, economic networks of the exchange of capital, and even potentially the specific ideologies of nation-states. It is perhaps indicative of the government contractors’ anachronistic worldview that the witness is unable to answer Wilson’s question. He explains that his agency focuses on the physical location of the server or ISP rather than the social backgrounds of the individuals who might be manufacturing objectionable digital texts. The premise behind the contractors’ working method – surveilling the technical apparatus not the social network – may be related to other beliefs expressed by government witnesses, such as the supposition that jihadist Websites are collectively produced and spontaneously emerge from the indigenous, traditional, tribal culture, instead of assuming that Iraqi insurgents have analogous beliefs, practices, and technological awareness to those in first-world countries. The residual subtexts in the witnesses’ conjectures about competing cultures of orality and literacy may tell us something about a reactionary rhetoric around videogames and digital culture more generally. According to the experts before Congress, the Middle Eastern audience for these videogames and Websites is limited by its membership in a pre-literate society that is only capable of abortive cultural production without access to knowledge that is archived in printed codices. Sometimes the witnesses before Congress seem to be unintentionally channelling the ideas of the late literacy theorist Walter Ong about the “secondary orality” associated with talky electronic media such as television, radio, audio recording, or telephone communication. Later followers of Ong extend this concept of secondary orality to hypertext, hypermedia, e-mail, and blogs, because they similarly share features of both speech and written discourse. Although Ong’s disciples celebrate this vibrant reconnection to a mythic, communal past of what Kathleen Welch calls “electric rhetoric,” the defence industry consultants express their profound state of alarm at the potentially dangerous and subversive character of this hybrid form of communication. The concept of an “oral tradition” is first introduced by the expert witnesses in the context of modern marketing and product distribution: “The Internet is used for a variety of things – command and control,” one witness states. “One of the things that’s missed frequently is how and – how effective the adversary is at using the Internet to distribute product. They’re using that distribution network as a modern form of oral tradition, if you will.” Thus, although the Internet can be deployed for hierarchical “command and control” activities, it also functions as a highly efficient peer-to-peer distributed network for disseminating the commodity of information. Throughout the hearings, the witnesses imply that unregulated lateral communication among social actors who are not authorised to speak for nation-states or to produce legitimated expert discourses is potentially destabilising to political order. Witness Eric Michael describes the “oral tradition” and the conventions of communal life in the Middle East to emphasise the primacy of speech in the collective discursive practices of this alien population: “I’d like to point your attention to the media types and the fact that the oral tradition is listed as most important. The other media listed support that. And the significance of the oral tradition is more than just – it’s the medium by which, once it comes off the Internet, it is transferred.” The experts go on to claim that this “oral tradition” can contaminate other media because it functions as “rumor,” the traditional bane of the stately discourse of military leaders since the classical era. The oral tradition now also has an aspect of rumor. A[n] event takes place. There is an explosion in a city. Rumor is that the United States Air Force dropped a bomb and is doing indiscriminate killing. This ends up being discussed on the street. It ends up showing up in a Friday sermon in a mosque or in another religious institution. It then gets recycled into written materials. Media picks up the story and broadcasts it, at which point it’s now a fact. In this particular case that we were telling you about, it showed up on a network television, and their propaganda continues to go back to this false initial report on network television and continue to reiterate that it’s a fact, even though the United States government has proven that it was not a fact, even though the network has since recanted the broadcast. In this example, many-to-many discussion on the “street” is formalised into a one-to many “sermon” and then further stylised using technology in a one-to-many broadcast on “network television” in which “propaganda” that is “false” can no longer be disputed. This “oral tradition” is like digital media, because elements of discourse can be infinitely copied or “recycled,” and it is designed to “reiterate” content. In this hearing, the word “rhetoric” is associated with destructive counter-cultural forces by the witnesses who reiterate cultural truisms dating back to Plato and the Gorgias. For example, witness Eric Michael initially presents “rhetoric” as the use of culturally specific and hence untranslatable figures of speech, but he quickly moves to an outright castigation of the entire communicative mode. “Rhetoric,” he tells us, is designed to “distort the truth,” because it is a “selective” assembly or a “distortion.” Rhetoric is also at odds with reason, because it appeals to “emotion” and a romanticised Weltanschauung oriented around discourses of “struggle.” The film by SonicJihad is chosen as the final clip by the witnesses before Congress, because it allegedly combines many different types of emotional appeal, and thus it conveniently ties together all of the themes that the witnesses present to the legislators about unreliable oral or rhetorical sources in the Middle East: And there you see how all these products are linked together. And you can see where the games are set to psychologically condition you to go kill coalition forces. You can see how they use humor. You can see how the entire campaign is carefully crafted to first evoke an emotion and then to evoke a response and to direct that response in the direction that they want. Jihadist digital products, especially videogames, are effective means of manipulation, the witnesses argue, because they employ multiple channels of persuasion and carefully sequenced and integrated subliminal messages. To understand the larger cultural conversation of the hearing, it is important to keep in mind that the related argument that “games” can “psychologically condition” players to be predisposed to violence is one that was important in other congressional hearings of the period, as well one that played a role in bills and resolutions that were passed by the full body of the legislative branch. In the witness’s testimony an appeal to anti-game sympathies at home is combined with a critique of a closed anti-democratic system abroad in which the circuits of rhetorical production and their composite metonymic chains are described as those that command specific, unvarying, robotic responses. This sharp criticism of the artful use of a presentation style that is “crafted” is ironic, given that the witnesses’ “compilation” of jihadist digital material is staged in the form of a carefully structured PowerPoint presentation, one that is paced to a well-rehearsed rhythm of “slide, please” or “next slide” in the transcript. The transcript also reveals that the members of the House Intelligence Committee were not the original audience for the witnesses’ PowerPoint presentation. Rather, when it was first created by SAIC, this “expert” presentation was designed for training purposes for the troops on the ground, who would be facing the challenges of deployment in hostile terrain. According to the witnesses, having the slide show showcased before Congress was something of an afterthought. Nonetheless, Congressman Tiahrt (R-KN) is so impressed with the rhetorical mastery of the consultants that he tries to appropriate it. As Tiarht puts it, “I’d like to get a copy of that slide sometime.” From the hearing we also learn that the terrorists’ Websites are threatening precisely because they manifest a polymorphously perverse geometry of expansion. For example, one SAIC witness before the House Committee compares the replication and elaboration of digital material online to a “spiderweb.” Like Representative Eshoo’s site, he also notes that the terrorists’ sites go “up” and “down,” but the consultant is left to speculate about whether or not there is any “central coordination” to serve as an organising principle and to explain the persistence and consistency of messages despite the apparent lack of a single authorial ethos to offer a stable, humanised, point of reference. In the hearing, the oft-cited solution to the problem created by the hybridity and iterability of digital rhetoric appears to be “public diplomacy.” Both consultants and lawmakers seem to agree that the damaging messages of the insurgents must be countered with U.S. sanctioned information, and thus the phrase “public diplomacy” appears in the hearing seven times. However, witness Roughhead complains that the protean “oral tradition” and what Henry Jenkins has called the “transmedia” character of digital culture, which often crosses several platforms of traditional print, projection, or broadcast media, stymies their best rhetorical efforts: “I think the point that we’ve tried to make in the briefing is that wherever there’s Internet availability at all, they can then download these – these programs and put them onto compact discs, DVDs, or post them into posters, and provide them to a greater range of people in the oral tradition that they’ve grown up in. And so they only need a few Internet sites in order to distribute and disseminate the message.” Of course, to maintain their share of the government market, the Science Applications International Corporation also employs practices of publicity and promotion through the Internet and digital media. They use HTML Web pages for these purposes, as well as PowerPoint presentations and online video. The rhetoric of the Website of SAIC emphasises their motto “From Science to Solutions.” After a short Flash film about how SAIC scientists and engineers solve “complex technical problems,” the visitor is taken to the home page of the firm that re-emphasises their central message about expertise. The maps, uniforms, and specialised tools and equipment that are depicted in these opening Web pages reinforce an ethos of professional specialisation that is able to respond to multiple threats posed by the “global war on terror.” By 26 June 2006, the incident finally was being described as a “Pentagon Snafu” by ABC News. From the opening of reporter Jake Tapper’s investigative Webcast, established government institutions were put on the spot: “So, how much does the Pentagon know about videogames? Well, when it came to a recent appearance before Congress, apparently not enough.” Indeed, the very language about “experts” that was highlighted in the earlier coverage is repeated by Tapper in mockery, with the significant exception of “independent expert” Ian Bogost of the Georgia Institute of Technology. If the Pentagon and SAIC deride the legitimacy of rhetoric as a cultural practice, Bogost occupies himself with its defence. In his recent book Persuasive Games: The Expressive Power of Videogames, Bogost draws upon the authority of the “2,500 year history of rhetoric” to argue that videogames represent a significant development in that cultural narrative. Given that Bogost and his Watercooler Games Weblog co-editor Gonzalo Frasca were actively involved in the detective work that exposed the depth of professional incompetence involved in the government’s line-up of witnesses, it is appropriate that Bogost is given the final words in the ABC exposé. As Bogost says, “We should be deeply bothered by this. We should really be questioning the kind of advice that Congress is getting.” Bogost may be right that Congress received terrible counsel on that day, but a close reading of the transcript reveals that elected officials were much more than passive listeners: in fact they were lively participants in a cultural conversation about regulating digital media. After looking at the actual language of these exchanges, it seems that the persuasiveness of the misinformation from the Pentagon and SAIC had as much to do with lawmakers’ preconceived anxieties about practices of computer-mediated communication close to home as it did with the contradictory stereotypes that were presented to them about Internet practices abroad. In other words, lawmakers found themselves looking into a fun house mirror that distorted what should have been familiar artefacts of American popular culture because it was precisely what they wanted to see. References ABC News. “Terrorist Videogame?” Nightline Online. 21 June 2006. 22 June 2006 http://abcnews.go.com/Video/playerIndex?id=2105341>. Bogost, Ian. Persuasive Games: Videogames and Procedural Rhetoric. Cambridge, MA: MIT Press, 2007. Game Politics. “Was Congress Misled by ‘Terrorist’ Game Video? We Talk to Gamer Who Created the Footage.” 11 May 2006. http://gamepolitics.livejournal.com/285129.html#cutid1>. Jenkins, Henry. Convergence Culture: Where Old and New Media Collide. New York: New York UP, 2006. julieb. “David Morgan Is a Horrible Writer and Should Be Fired.” Online posting. 5 May 2006. Dvorak Uncensored Cage Match Forums. http://cagematch.dvorak.org/index.php/topic,130.0.html>. Mahmood. “Terrorists Don’t Recruit with Battlefield 2.” GGL Global Gaming. 16 May 2006 http://www.ggl.com/news.php?NewsId=3090>. Morgan, David. “Islamists Using U.S. Video Games in Youth Appeal.” Reuters online news service. 4 May 2006 http://today.reuters.com/news/ArticleNews.aspx?type=topNews &storyID=2006-05-04T215543Z_01_N04305973_RTRUKOC_0_US-SECURITY- VIDEOGAMES.xml&pageNumber=0&imageid=&cap=&sz=13&WTModLoc= NewsArt-C1-ArticlePage2>. Ong, Walter J. Orality and Literacy: The Technologizing of the Word. London/New York: Methuen, 1982. Parker, Trey. Online posting. 7 May 2006. 9 May 2006 http://www.treyparker.com>. Plato. “Gorgias.” Plato: Collected Dialogues. Princeton: Princeton UP, 1961. Shrader, Katherine. “Pentagon Surfing Thousands of Jihad Sites.” Associated Press 4 May 2006. SonicJihad. “SonicJihad: A Day in the Life of a Resistance Fighter.” Online posting. 26 Dec. 2005. Planet Battlefield Forums. 9 May 2006 http://www.forumplanet.com/planetbattlefield/topic.asp?fid=13670&tid=1806909&p=1>. Tapper, Jake, and Audery Taylor. “Terrorist Video Game or Pentagon Snafu?” ABC News Nightline 21 June 2006. 30 June 2006 http://abcnews.go.com/Nightline/Technology/story?id=2105128&page=1>. U.S. Congressional Record. Panel I of the Hearing of the House Select Intelligence Committee, Subject: “Terrorist Use of the Internet for Communications.” Federal News Service. 4 May 2006. Welch, Kathleen E. Electric Rhetoric: Classical Rhetoric, Oralism, and the New Literacy. Cambridge, MA: MIT Press, 1999. Citation reference for this article MLA Style Losh, Elizabeth. "Artificial Intelligence: Media Illiteracy and the SonicJihad Debacle in Congress." M/C Journal 10.5 (2007). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0710/08-losh.php>. APA Style Losh, E. (Oct. 2007) "Artificial Intelligence: Media Illiteracy and the SonicJihad Debacle in Congress," M/C Journal, 10(5). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0710/08-losh.php>.

Abstract:

We are entering a new energy era in the United States, one that isforcing—or will force—end-users to become much more energy-minded,efficient and more mindful of energy costs and uses. In other words, theywill need to become fairly sophisticated energy managers, or be willingto outsource their energy purchasing needs. There are a number of driv-ers to suggest that this scenario will, indeed, play out. Such drivers in-clude:• The Federal Energy Regulatory Commission (FERC) mega-Noticeof Proposed Rulemaking (NOPR RM01-12-000) issued in July, 2002states that the FERC is placing equal weight on all potential electrictransmission solutions, including distributed generation.• A formal or informal national energy policy that reflects the threatof energy shortfalls within two decades. This strategy will equallyfocus on conservation, efficiency improvements and alternativeenergy as well as domestic production;• Lack of investments in grid infrastructure (and subsequent eventssuch as the August blackout);• The popularity of existing demand response programs;• Volatile energy prices resulting in rising prices over time in someenergy markets; • Market rules that require much more sophistication in order tobenefit from deregulation, including nominations and compliancepenalties;• Automated meter reading (AMR) growth;• Rapid adoption of internet-connected devices;• Energy service companies’ continued growth; and,• An emerging liability issue.While the status of the FERC mega-NOPR is unclear, the demandresponse aspect will likely gain acceptance in other forums. Together,these drivers have the potential to help shape and deliver the long-awaited distributed generation (DG) market 1 . Of course, the current“hybrid” model of regulation—stuck somewhere between open andclosed markets—and other barriers (emissions, interconnect, etc.) willcontinue to be the determining factors in the short-term. But, the overalltrend suggests that DG will, indeed, finally emerge as a resource ac-cepted by all parties—regulators, utilities and end-users.Notice that the majority of drivers are demand side focused, andnot supply oriented!The strategy of the future is one of risk management. This is adramatically different business model from the one that is now in placebecause it could lead to fewer operating hours (peaking vs. base load),thus increasing paybacks. But, it could also lead to much wider accep-tance of DG as one more solution to manage customers’ energy bills. Theenabling technologies for this transformation include new generations ofcontrols and energy management systems that will seamlessly bring DGand load management together.Winning products will include low-cost, hassle-free, plug and playand clean DG/CHP; retrofit emissions controls; and sophisticated, reli-able, affordable controls.

Abstract:

Although I'm a rich white guy, I'm also a feminist anti-racism activist who fights for the rights of the poor and oppressed. (Carl Kenner)Systemic bias is a scourge to the pillar of neutrality. (Cerejota)Count me in. Let's leave the bias to the mainstream media. (Orcar967)Because this is so important. (CuttingEdge)These are a handful of comments posted by online editors who have banded together in a virtual coalition to combat Western bias on the world’s largest digital encyclopedia, Wikipedia. This collective action by Wikipedians both acknowledges the inherent inequalities of a user-controlled information project like Wikpedia and highlights the potential for progressive change within that same project. These community members are taking the responsibility of social change into their own hands (or more aptly, their own keyboards).In recent years much research has emerged on Wikipedia from varying fields, ranging from computer science, to business and information systems, to the social sciences. While critical at times of Wikipedia’s growth, governance, and influence, most of this work observes with optimism that barriers to improvement are not firmly structural, but rather they are socially constructed, leaving open the possibility of important and lasting change for the better.WikiProject: Countering Systemic Bias (WP:CSB) considers one such collective effort. Close to 350 editors have signed on to the project, which began in 2004 and itself emerged from a similar project named CROSSBOW, or the “Committee Regarding Overcoming Serious Systemic Bias on Wikipedia.” As a WikiProject, the term used for a loose group of editors who collaborate around a particular topic, these editors work within the Wikipedia site and collectively create a social network that is unified around one central aim—representing the un- and underrepresented—and yet they are bound by no particular unified set of interests. The first stage of a multi-method study, this paper looks at a snapshot of WP:CSB’s activity from both content analysis and social network perspectives to discover “who” geographically this coalition of the unrepresented is inserting into the digital annals of Wikipedia.Wikipedia and WikipediansDeveloped in 2001 by Internet entrepreneur Jimmy Wales and academic Larry Sanger, Wikipedia is an online collaborative encyclopedia hosting articles in nearly 250 languages (Cohen). The English-language Wikipedia contains over 3.2 million articles, each of which is created, edited, and updated solely by users (Wikipedia “Welcome”). At the time of this study, Alexa, a website tracking organisation, ranked Wikipedia as the 6th most accessed site on the Internet. Unlike the five sites ahead of it though—Google, Facebook, Yahoo, YouTube (owned by Google), and live.com (owned by Microsoft)—all of which are multibillion-dollar businesses that deal more with information aggregation than information production, Wikipedia is a non-profit that operates on less than $500,000 a year and staffs only a dozen paid employees (Lih). Wikipedia is financed and supported by the WikiMedia Foundation, a charitable umbrella organisation with an annual budget of $4.6 million, mainly funded by donations (Middleton).Wikipedia editors and contributors have the option of creating a user profile and participating via a username, or they may participate anonymously, with only an IP address representing their actions. Despite the option for total anonymity, many Wikipedians have chosen to visibly engage in this online community (Ayers, Matthews, and Yates; Bruns; Lih), and researchers across disciplines are studying the motivations of these new online collectives (Kane, Majchrzak, Johnson, and Chenisern; Oreg and Nov). The motivations of open source software contributors, such as UNIX programmers and programming groups, have been shown to be complex and tied to both extrinsic and intrinsic rewards, including online reputation, self-satisfaction and enjoyment, and obligation to a greater common good (Hertel, Niedner, and Herrmann; Osterloh and Rota). Investigation into why Wikipedians edit has indicated multiple motivations as well, with community engagement, task enjoyment, and information sharing among the most significant (Schroer and Hertel). Additionally, Wikipedians seem to be taking up the cause of generativity (a concern for the ongoing health and openness of the Internet’s infrastructures) that Jonathan Zittrain notably called for in The Future of the Internet and How to Stop It. Governance and ControlAlthough the technical infrastructure of Wikipedia is built to support and perhaps encourage an equal distribution of power on the site, Wikipedia is not a land of “anything goes.” The popular press has covered recent efforts by the site to reduce vandalism through a layer of editorial review (Cohen), a tightening of control cited as a possible reason for the recent dip in the number of active editors (Edwards). A number of regulations are already in place that prevent the open editing of certain articles and pages, such as the site’s disclaimers and pages that have suffered large amounts of vandalism. Editing wars can also cause temporary restrictions to editing, and Ayers, Matthews, and Yates point out that these wars can happen anywhere, even to Burt Reynold’s page.Academic studies have begun to explore the governance and control that has developed in the Wikipedia community, generally highlighting how order is maintained not through particular actors, but through established procedures and norms. Konieczny tested whether Wikipedia’s evolution can be defined by Michels’ Iron Law of Oligopoly, which predicts that the everyday operations of any organisation cannot be run by a mass of members, and ultimately control falls into the hands of the few. Through exploring a particular WikiProject on information validation, he concludes:There are few indicators of an oligarchy having power on Wikipedia, and few trends of a change in this situation. The high level of empowerment of individual Wikipedia editors with regard to policy making, the ease of communication, and the high dedication to ideals of contributors succeed in making Wikipedia an atypical organization, quite resilient to the Iron Law. (189)Butler, Joyce, and Pike support this assertion, though they emphasise that instead of oligarchy, control becomes encapsulated in a wide variety of structures, policies, and procedures that guide involvement with the site. A virtual “bureaucracy” emerges, but one that should not be viewed with the negative connotation often associated with the term.Other work considers control on Wikipedia through the framework of commons governance, where “peer production depends on individual action that is self-selected and decentralized rather than hierarchically assigned. Individuals make their own choices with regard to resources managed as a commons” (Viegas, Wattenberg and McKeon). The need for quality standards and quality control largely dictate this commons governance, though interviewing Wikipedians with various levels of responsibility revealed that policies and procedures are only as good as those who maintain them. Forte, Larco, and Bruckman argue “the Wikipedia community has remained healthy in large part due to the continued presence of ‘old-timers’ who carry a set of social norms and organizational ideals with them into every WikiProject, committee, and local process in which they take part” (71). Thus governance on Wikipedia is a strong representation of a democratic ideal, where actors and policies are closely tied in their evolution. Transparency, Content, and BiasThe issue of transparency has proved to be a double-edged sword for Wikipedia and Wikipedians. The goal of a collective body of knowledge created by all—the “expert” and the “amateur”—can only be upheld if equal access to page creation and development is allotted to everyone, including those who prefer anonymity. And yet this very option for anonymity, or even worse, false identities, has been a sore subject for some in the Wikipedia community as well as a source of concern for some scholars (Santana and Wood). The case of a 24-year old college dropout who represented himself as a multiple Ph.D.-holding theology scholar and edited over 16,000 articles brought these issues into the public spotlight in 2007 (Doran; Elsworth). Wikipedia itself has set up standards for content that include expectations of a neutral point of view, verifiability of information, and the publishing of no original research, but Santana and Wood argue that self-policing of these policies is not adequate:The principle of managerial discretion requires that every actor act from a sense of duty to exercise moral autonomy and choice in responsible ways. When Wikipedia’s editors and administrators remain anonymous, this criterion is simply not met. It is assumed that everyone is behaving responsibly within the Wikipedia system, but there are no monitoring or control mechanisms to make sure that this is so, and there is ample evidence that it is not so. (141) At the theoretical level, some downplay these concerns of transparency and autonomy as logistical issues in lieu of the potential for information systems to support rational discourse and emancipatory forms of communication (Hansen, Berente, and Lyytinen), but others worry that the questionable “realities” created on Wikipedia will become truths once circulated to all areas of the Web (Langlois and Elmer). With the number of articles on the English-language version of Wikipedia reaching well into the millions, the task of mapping and assessing content has become a tremendous endeavour, one mostly taken on by information systems experts. Kittur, Chi, and Suh have used Wikipedia’s existing hierarchical categorisation structure to map change in the site’s content over the past few years. Their work revealed that in early 2008 “Culture and the arts” was the most dominant category of content on Wikipedia, representing nearly 30% of total content. People (15%) and geographical locations (14%) represent the next largest categories, while the natural and physical sciences showed the greatest increase in volume between 2006 and 2008 (+213%D, with “Culture and the arts” close behind at +210%D). This data may indicate that contributing to Wikipedia, and thus spreading knowledge, is growing amongst the academic community while maintaining its importance to the greater popular culture-minded community. Further work by Kittur and Kraut has explored the collaborative process of content creation, finding that too many editors on a particular page can reduce the quality of content, even when a project is well coordinated.Bias in Wikipedia content is a generally acknowledged and somewhat conflicted subject (Giles; Johnson; McHenry). The Wikipedia community has created numerous articles and pages within the site to define and discuss the problem. Citing a survey conducted by the University of Würzburg, Germany, the “Wikipedia:Systemic bias” page describes the average Wikipedian as:MaleTechnically inclinedFormally educatedAn English speakerWhiteAged 15-49From a majority Christian countryFrom a developed nationFrom the Northern HemisphereLikely a white-collar worker or studentBias in content is thought to be perpetuated by this demographic of contributor, and the “founder effect,” a concept from genetics, linking the original contributors to this same demographic has been used to explain the origins of certain biases. Wikipedia’s “About” page discusses the issue as well, in the context of the open platform’s strengths and weaknesses:in practice editing will be performed by a certain demographic (younger rather than older, male rather than female, rich enough to afford a computer rather than poor, etc.) and may, therefore, show some bias. Some topics may not be covered well, while others may be covered in great depth. No educated arguments against this inherent bias have been advanced.Royal and Kapila’s study of Wikipedia content tested some of these assertions, finding identifiable bias in both their purposive and random sampling. They conclude that bias favoring larger countries is positively correlated with the size of the country’s Internet population, and corporations with larger revenues work in much the same way, garnering more coverage on the site. The researchers remind us that Wikipedia is “more a socially produced document than a value-free information source” (Royal & Kapila).WikiProject: Countering Systemic BiasAs a coalition of current Wikipedia editors, the WikiProject: Countering Systemic Bias (WP:CSB) attempts to counter trends in content production and points of view deemed harmful to the democratic ideals of a valueless, open online encyclopedia. WP:CBS’s mission is not one of policing the site, but rather deepening it:Generally, this project concentrates upon remedying omissions (entire topics, or particular sub-topics in extant articles) rather than on either (1) protesting inappropriate inclusions, or (2) trying to remedy issues of how material is presented. Thus, the first question is "What haven't we covered yet?", rather than "how should we change the existing coverage?" (Wikipedia, “Countering”)The project lays out a number of content areas lacking adequate representation, geographically highlighting the dearth in coverage of Africa, Latin America, Asia, and parts of Eastern Europe. WP:CSB also includes a “members” page that editors can sign to show their support, along with space to voice their opinions on the problem of bias on Wikipedia (the quotations at the beginning of this paper are taken from this “members” page). At the time of this study, 329 editors had self-selected and self-identified as members of WP:CSB, and this group constitutes the population sample for the current study. To explore the extent to which WP:CSB addressed these self-identified areas for improvement, each editor’s last 50 edits were coded for their primary geographical country of interest, as well as the conceptual category of the page itself (“P” for person/people, “L” for location, “I” for idea/concept, “T” for object/thing, or “NA” for indeterminate). For example, edits to the Wikipedia page for a single person like Tony Abbott (Australian federal opposition leader) were coded “Australia, P”, while an edit for a group of people like the Manchester United football team would be coded “England, P”. Coding was based on information obtained from the header paragraphs of each article’s Wikipedia page. After coding was completed, corresponding information on each country’s associated continent was added to the dataset, based on the United Nations Statistics Division listing.A total of 15,616 edits were coded for the study. Nearly 32% (n = 4962) of these edits were on articles for persons or people (see Table 1 for complete coding results). From within this sub-sample of edits, a majority of the people (68.67%) represented are associated with North America and Europe (Figure A). If we break these statistics down further, nearly half of WP:CSB’s edits concerning people were associated with the United States (36.11%) and England (10.16%), with India (3.65%) and Australia (3.35%) following at a distance. These figures make sense for the English-language Wikipedia; over 95% of the population in the three Westernised countries speak English, and while India is still often regarded as a developing nation, its colonial British roots and the emergence of a market economy with large, technology-driven cities are logical explanations for its representation here (and some estimates make India the largest English-speaking nation by population on the globe today).Table A Coding Results Total Edits 15616 (I) Ideas 2881 18.45% (L) Location 2240 14.34% NA 333 2.13% (T) Thing 5200 33.30% (P) People 4962 31.78% People by Continent Africa 315 6.35% Asia 827 16.67% Australia 175 3.53% Europe 1411 28.44% NA 110 2.22% North America 1996 40.23% South America 128 2.58% The areas of the globe of main concern to WP:CSB proved to be much less represented by the coalition itself. Asia, far and away the most populous continent with more than 60% of the globe’s people (GeoHive), was represented in only 16.67% of edits. Africa (6.35%) and South America (2.58%) were equally underrepresented compared to both their real-world populations (15% and 9% of the globe’s population respectively) and the aforementioned dominance of the advanced Westernised areas. However, while these percentages may seem low, in aggregate they do meet the quota set on the WP:CSB Project Page calling for one out of every twenty edits to be “a subject that is systematically biased against the pages of your natural interests.” By this standard, the coalition is indeed making headway in adding content that strategically counterbalances the natural biases of Wikipedia’s average editor.Figure ASocial network analysis allows us to visualise multifaceted data in order to identify relationships between actors and content (Vego-Redondo; Watts). Similar to Davis’s well-known sociological study of Southern American socialites in the 1930s (Scott), our Wikipedia coalition can be conceptualised as individual actors united by common interests, and a network of relations can be constructed with software such as UCINET. A mapping algorithm that considers both the relationship between all sets of actors and each actor to the overall collective structure produces an image of our network. This initial network is bimodal, as both our Wikipedia editors and their edits (again, coded for country of interest) are displayed as nodes (Figure B). Edge-lines between nodes represents a relationship, and here that relationship is the act of editing a Wikipedia article. We see from our network that the “U.S.” and “England” hold central positions in the network, with a mass of editors crowding around them. A perimeter of nations is then held in place by their ties to editors through the U.S. and England, with a second layer of editors and poorly represented nations (Gabon, Laos, Uzbekistan, etc.) around the boundaries of the network.Figure BWe are reminded from this visualisation both of the centrality of the two Western powers even among WP:CSB editoss, and of the peripheral nature of most other nations in the world. But we also learn which editors in the project are contributing most to underrepresented areas, and which are less “tied” to the Western core. Here we see “Wizzy” and “Warofdreams” among the second layer of editors who act as a bridge between the core and the periphery; these are editors with interests in both the Western and marginalised nations. Located along the outer edge, “Gallador” and “Gerrit” have no direct ties to the U.S. or England, concentrating all of their edits on less represented areas of the globe. Identifying editors at these key positions in the network will help with future research, informing interview questions that will investigate their interests further, but more significantly, probing motives for participation and action within the coalition.Additionally, we can break the network down further to discover editors who appear to have similar interests in underrepresented areas. Figure C strips down the network to only editors and edits dealing with Africa and South America, the least represented continents. From this we can easily find three types of editors again: those who have singular interests in particular nations (the outermost layer of editors), those who have interests in a particular region (the second layer moving inward), and those who have interests in both of these underrepresented regions (the center layer in the figure). This last group of editors may prove to be the most crucial to understand, as they are carrying the full load of WP:CSB’s mission.Figure CThe End of Geography, or the Reclamation?In The Internet Galaxy, Manuel Castells writes that “the Internet Age has been hailed as the end of geography,” a bold suggestion, but one that has gained traction over the last 15 years as the excitement for the possibilities offered by information communication technologies has often overshadowed structural barriers to participation like the Digital Divide (207). Castells goes on to amend the “end of geography” thesis by showing how global information flows and regional Internet access rates, while creating a new “map” of the world in many ways, is still closely tied to power structures in the analog world. The Internet Age: “redefines distance but does not cancel geography” (207). The work of WikiProject: Countering Systemic Bias emphasises the importance of place and representation in the information environment that continues to be constructed in the online world. This study looked at only a small portion of this coalition’s efforts (~16,000 edits)—a snapshot of their labor frozen in time—which itself is only a minute portion of the information being dispatched through Wikipedia on a daily basis (~125,000 edits). Further analysis of WP:CSB’s work over time, as well as qualitative research into the identities, interests and motivations of this collective, is needed to understand more fully how information bias is understood and challenged in the Internet galaxy. The data here indicates this is a fight worth fighting for at least a growing few.ReferencesAlexa. “Top Sites.” Alexa.com, n.d. 10 Mar. 2010 ‹http://www.alexa.com/topsites>. Ayers, Phoebe, Charles Matthews, and Ben Yates. How Wikipedia Works: And How You Can Be a Part of It. San Francisco, CA: No Starch, 2008.Bruns, Axel. Blogs, Wikipedia, Second Life, and Beyond: From Production to Produsage. New York: Peter Lang, 2008.Butler, Brian, Elisabeth Joyce, and Jacqueline Pike. Don’t Look Now, But We’ve Created a Bureaucracy: The Nature and Roles of Policies and Rules in Wikipedia. Paper presented at 2008 CHI Annual Conference, Florence.Castells, Manuel. The Internet Galaxy: Reflections on the Internet, Business, and Society. Oxford: Oxford UP, 2001.Cohen, Noam. “Wikipedia.” New York Times, n.d. 12 Mar. 2010 ‹http://www.nytimes.com/info/wikipedia/>. Doran, James. “Wikipedia Chief Promises Change after ‘Expert’ Exposed as Fraud.” The Times, 6 Mar. 2007 ‹http://technology.timesonline.co.uk/tol/news/tech_and_web/article1480012.ece>. Edwards, Lin. “Report Claims Wikipedia Losing Editors in Droves.” Physorg.com, 30 Nov 2009. 12 Feb. 2010 ‹http://www.physorg.com/news178787309.html>. Elsworth, Catherine. “Fake Wikipedia Prof Altered 20,000 Entries.” London Telegraph, 6 Mar. 2007 ‹http://www.telegraph.co.uk/news/1544737/Fake-Wikipedia-prof-altered-20000-entries.html>. Forte, Andrea, Vanessa Larco, and Amy Bruckman. “Decentralization in Wikipedia Governance.” Journal of Management Information Systems 26 (2009): 49-72.Giles, Jim. “Internet Encyclopedias Go Head to Head.” Nature 438 (2005): 900-901.Hansen, Sean, Nicholas Berente, and Kalle Lyytinen. “Wikipedia, Critical Social Theory, and the Possibility of Rational Discourse.” The Information Society 25 (2009): 38-59.Hertel, Guido, Sven Niedner, and Stefanie Herrmann. “Motivation of Software Developers in Open Source Projects: An Internet-Based Survey of Contributors to the Linex Kernel.” Research Policy 32 (2003): 1159-1177.Johnson, Bobbie. “Rightwing Website Challenges ‘Liberal Bias’ of Wikipedia.” The Guardian, 1 Mar. 2007. 8 Mar. 2010 ‹http://www.guardian.co.uk/technology/2007/mar/01/wikipedia.news>. Kane, Gerald C., Ann Majchrzak, Jeremaih Johnson, and Lily Chenisern. A Longitudinal Model of Perspective Making and Perspective Taking within Fluid Online Collectives. Paper presented at the 2009 International Conference on Information Systems, Phoenix, AZ, 2009.Kittur, Aniket, Ed H. Chi, and Bongwon Suh. What’s in Wikipedia? Mapping Topics and Conflict Using Socially Annotated Category Structure. Paper presented at the 2009 CHI Annual Conference, Boston, MA.———, and Robert E. Kraut. Harnessing the Wisdom of Crowds in Wikipedia: Quality through Collaboration. Paper presented at the 2008 Association for Computing Machinery’s Computer Supported Cooperative Work Annual Conference, San Diego, CA.Konieczny, Piotr. “Governance, Organization, and Democracy on the Internet: The Iron Law and the Evolution of Wikipedia.” Sociological Forum 24 (2009): 162-191.———. “Wikipedia: Community or Social Movement?” Interface: A Journal for and about Social Movements 1 (2009): 212-232.Langlois, Ganaele, and Greg Elmer. “Wikipedia Leeches? The Promotion of Traffic through a Collaborative Web Format.” New Media & Society 11 (2009): 773-794.Lih, Andrew. The Wikipedia Revolution. New York, NY: Hyperion, 2009.McHenry, Robert. “The Real Bias in Wikipedia: A Response to David Shariatmadari.” OpenDemocracy.com 2006. 8 Mar. 2010 ‹http://www.opendemocracy.net/media-edemocracy/wikipedia_bias_3621.jsp>. Middleton, Chris. “The World of Wikinomics.” Computer Weekly, 20 Jan. 2009: 22-26.Oreg, Shaul, and Oded Nov. “Exploring Motivations for Contributing to Open Source Initiatives: The Roles of Contribution, Context and Personal Values.” Computers in Human Behavior 24 (2008): 2055-2073.Osterloh, Margit and Sandra Rota. “Trust and Community in Open Source Software Production.” Analyse & Kritik 26 (2004): 279-301.Royal, Cindy, and Deepina Kapila. “What’s on Wikipedia, and What’s Not…?: Assessing Completeness of Information.” Social Science Computer Review 27 (2008): 138-148.Santana, Adele, and Donna J. Wood. “Transparency and Social Responsibility Issues for Wikipedia.” Ethics of Information Technology 11 (2009): 133-144.Schroer, Joachim, and Guido Hertel. “Voluntary Engagement in an Open Web-Based Encyclopedia: Wikipedians and Why They Do It.” Media Psychology 12 (2009): 96-120.Scott, John. Social Network Analysis. London: Sage, 1991.Vego-Redondo, Fernando. Complex Social Networks. Cambridge: Cambridge UP, 2007.Viegas, Fernanda B., Martin Wattenberg, and Matthew M. McKeon. “The Hidden Order of Wikipedia.” Online Communities and Social Computing (2007): 445-454.Watts, Duncan. Six Degrees: The Science of a Connected Age. New York, NY: W. W. Norton & Company, 2003Wikipedia. “About.” n.d. 8 Mar. 2010 ‹http://en.wikipedia.org/wiki/Wikipedia:About>. ———. “Welcome to Wikipedia.” n.d. 8 Mar. 2010 ‹http://en.wikipedia.org/wiki/Main_Page>.———. “Wikiproject:Countering Systemic Bias.” n.d. 12 Feb. 2010 ‹http://en.wikipedia.org/wiki/Wikipedia:WikiProject_Countering_systemic_bias#Members>. Zittrain, Jonathan. The Future of the Internet and How to Stop It. New Haven, CT: Yale UP, 2008.

Abstract:

Photo by Nathan Dumlao on Unsplash ABSTRACT The demographic of physicians in the United States has failed to include a proportionate population of Latinos in the United States. In what follows, I shall argue that the medical school admission process places an undue burden on low-income Latino applicants. Hence, the underrepresentation of Latinos in medical schools is an injustice. This injustice relates to the poor community health of the Latino community. Health disparities such as diabetes, HIV infection, and cancer mortality are higher amongst the Latino community. The current representation of Latino medical students is not representative of those in the United States. INTRODUCTION The demographic of physicians in the United States has failed to include a proportionate number of Latinos, meaning people of Latin American origin. Medical schools serve as the gatekeepers to the medical field, and they can alter the profession based on whom they admit. With over 60 million Latinos in the United States, people of Latin American origin comprise the largest minority group in the nation.[1] In 2020-2021, only 6.7 percent of total US medical school enrollees and only 4 percent of medical school leadership identified as Latino.[2] Latino physicians can connect to a historically marginalized community that faces barriers including language, customs, income, socioeconomic status, and health literacy. I argue that the medical school admissions process places an undue burden on low-income Latino applicants. This paper explores the underrepresentation of Latinos in medical schools as an injustice. A further injustice occurs as the barriers to medical education result in fewer Latino doctors to effectively deliver health care and preventive health advice to their communities in a culturally competent way. I. Latino Community Health Data The terms Latino and Hispanic have largely been considered interchangeable. US government departments, such as the US Census Bureau and the Centers for Disease Control and Prevention (CDC), define Hispanic people as those with originating familial ties to native Spanish-speaking countries, most of whom are from Latin America. The term Latino is more inclusive because it refers to all of those with strong originating ties to countries in Latin America, including those coming from countries such as Brazil and Belize who are not native Spanish speakers. Throughout this work, I refer to the term Latino because it is more inclusive, although the data retrieved from US government departments may refer to the population as Hispanic. “Low-income” refers to the qualifying economic criteria for the AAMC’s Fee Assistance Program Poverty Guidelines.[3] The AAMC Fee Assistance Program is designed to help individuals who do not have the financial means to pay the total costs of applying to medical school. For this paper, low-income refers to those who qualify for this program. The US government gathers data about Latino community health and its health risks. The Latino community has a higher poverty rate than the non-Hispanic white community.[4] Latino community health has long trailed that of white people collectively. For example, the Latino community experiences higher levels of preventable diseases, including hypertension, diabetes, and hepatitis, than the non-Hispanic white community does.[5] The CDC collects data about Latino community health and provides statistics to the public. Latinos in the United States trail only non-Hispanic blacks in prevalence of obesity. The Latino adult obesity rates are 45.7 percent for males and 43.7 percent for females.[6] Of the 1.2 million people infected with HIV in the United States, 294,200 are Latino.[7] The infection rate of chlamydia is 392.6 per 100,000 ― 1.9 times the rate in the non-Hispanic white population.[8] The tuberculosis incidence rate is eight times higher than that of non-Hispanic white people at 4.4 per 100,000.[9] Furthermore, Latinos have the third highest death rate for hepatitis C among all races and ethnic groups.[10] The prevalence of total diabetes, diagnosed and undiagnosed, among adults aged 18 and older also remains higher than that of non-Hispanic whites at 14.7 percent compared to 11.9 percent.[11] The high disease rate evidences the poor health of the community. Furthermore, 19 percent of Latinos in the United States remain uninsured.[12] Almost a quarter of the Latino population in the United States lives in poverty.[13] The high incidence of disease, lack of insurance, and high poverty rate create a frail health status for the Latino community in the United States. The medical conditions seen are largely preventable, and the incident rates can be lowered with greater investments in Latino community health. Considering the health disparities between Latino and non-Hispanic White people, there is an ethical imperative to provide better medical care and guidance to the Latino community. II. Ethical and Practical Importance of Increasing the Number of Latino Physicians Minorities respond more positively to patient-physician interactions and are more willing to undergo preventative healthcare when matched with a physician of their racial or ethnic background.[14] Latino medical doctors may lead to an improvement in overall community health through improved communication and trusting relationships. Patient-physician racial concordance leads to greater patient satisfaction with their physicians.[15] Identifying with the ethnicity of a physician may lead to greater confidence in the physician-patient relationship, resulting in more engagement on the patient’s behalf. A randomized study regarding African American men and the race of their attending physician found an increase in requests for preventative care when assigned to a black doctor.[16] Although the subjects were African American men, the study has implications applicable to other minority racial and ethnic groups. The application process is unjust for low-income Latinos. The low matriculation of Latinos in medical schools represents a missed opportunity to alleviate the poor community health of the Latino population in the United States. Medical school also would create an opportunity to address health issues that plague the Latino community. Becoming a physician allows low-income Latinos to climb the social ladder and enter the spaces in health care that have traditionally been closed off to them. Nonwhite physicians significantly serve underserved communities.[17] Increasing the number of Latino doctors can boost their presence, potentially improving care for underserved individuals. Teaching physicians cultural competence is not enough to address the health disparities the Latino community faces. Latino physicians are best equipped to understand the healthcare needs of low-income Latinos. I contend that reforming the application process represents the most straightforward method to augment the number of Latino physicians who wish to work in predominantly Latino or diverse communities, thereby improving healthcare for the Latino community. III. Cultural Tenets Affecting Healthcare Interactions “Poor cultural competence can lead to decreased patient satisfaction, which may cause the patient not to attend future appointments or seek further care.”[18] Latino community health is negatively affected when medical professionals misinterpret cultural beliefs. Cultural tenets like a reservation towards medication, a deep sense of respect for the physician, and an obligation to support the family financially and through advocacy affect how Latinos seek and use the healthcare system.[19] First, the Latino population's negative cultural beliefs about medication add a barrier to patient compliance. It is highlighted that fear of dependence upon medicine leads to trouble with medication regimens.[20] The fear stems from the negative perception of addiction in the Latino community. Taking as little medication as possible avoids the chance of addiction occurring, which is why many take the prescribed medicine only until they feel healthier, regardless of the prescribing regimen. Some would rather not take any medication because of the deep-rooted fear. Physicians must address this concern by communicating the importance of patient compliance to remedy the health issue. Explaining that proper use of the medication as prescribed will ensure the best route to alleviate the condition and minimize the occurrence of dependence. Extra time spent addressing concerns and checking for comprehension may combat the negative perception of medication. Second, the theme of respeto, or respect, seems completely harmless to most people. After all, how can being respectful lead to bad health? This occurs when respect is understood as paternalism. Some patients may relinquish their decision-making to the physician. The physician might not act with beneficence, in this instance, because of the cultural dissonance in the physician-patient relationship that may lead to medical misinterpretation. A well-meaning physician might not realize that the patient is unlikely to speak up about their goals of care and will follow the physician’s recommendations without challenging them. That proves costly because a key aspect of the medical usefulness of a patient’s family history is obtaining it through dialogue. The Latino patient may refrain from relaying health concerns because of the misconceived belief that it’s the doctor’s job to know what to ask. Asking the physician questions may be considered a sign of disrespect, even if it applies to signs, symptoms, feelings, or medical procedures the patient may not understand.[21] Respeto is dangerous because it restricts the patients from playing an active role in their health. Physicians cannot derive what medical information may be relevant to the patient without their cooperation. And physicians without adequate cultural competency may not know they need to ask more specific questions. Cultural competency may help, but a like-minded physician raised similarly would be a more natural fit. “A key component of physician-patient communication is the ability of patients to articulate concerns, reservations, and lack of understanding through questions.”[22] As a patient, engaging with a physician of one’s cultural background fortifies a strong physician-patient relationship. Latino physicians are in the position to explain to the patients that respeto is not lost during a physician-patient dialogue. In turn, the physician can express that out of their value of respeto, and the profession compels them to place the patient’s best interest above all. This entails physicians advocating on behalf of the patients to ask questions and check for comprehension, as is required to obtain informed consent. Latino physicians may not have a cultural barrier and may already organically understand this aspect of their patient’s traditional relationship with physicians. The common ground of respeto can be used to improve the health of the Latino community just as it can serve as a barrier for someone from a different background. Third, in some Latino cultures, there is an expectation to contribute to the family financially or in other ways and, above all, advocate on the family’s behalf. Familial obligations entail more than simply translating or accompanying family members to their appointments. They include actively advocating for just treatment in terms of services. Navigating institutions, such as hospitals, in a foreign landscape proves difficult for underrepresented minorities like Latinos who are new to the United States. These difficulties can sometimes lead to them being taken advantage of, as they might not fully understand their rights, the available resources, or the standard procedures within these institutions. The language barrier and unfamiliar institutional policies may misinterpret patients’ needs or requests. Furthermore, acting outside of said institution’s policy norms may be erroneously interpreted as actions of an uncooperative patient leading to negative interactions between the medical staff and the Latino patient. The expectation of familial contribution is later revisited as it serves as a constraint to the low-income Latino medical school applicant. Time is factored out to meet these expectations, and a moral dilemma to financially contribute to the family dynamic rather than delay the contribution to pursue medical school discourages Latinos from applying. IV. How the Medical School Admission Process is Creating an Undue Burden for Low-Income Latino Applicants Applying a bioethics framework to the application process highlights its flaws. Justice is a central bioethical tenet relevant to the analysis of the MD admissions process. The year-long medical school application process begins with the primary application. The student enters information about the courses taken, completes short answer questions and essays, and uploads information about recommenders. Secondary applications are awarded to some medical students depending on the institutions’ policies. Some schools ask all applicants for secondary applications, while others select which applicants to send secondary requests. Finally, interviews are conducted after a review of both primary and secondary applications. This is the last step before receiving an admissions decision. The medical school application process creates undue restrictions against underserved communities. It is understood that matriculating into medical school and becoming a doctor should be difficult. The responsibilities of a physician are immense, and the consequences of actions or inactions may put the patients’ lives in jeopardy. Medical schools should hold high standards because of the responsibility and expertise required to provide optimal healthcare. However, I argue that the application process places an undue burden on low-income Latino applicants that is not beneficial to optimal health care. The burden placed on low-income Latino applicants through the application process is excessive and not necessary to forge qualified medical students. The financial aspect of the medical school application has made the profession virtually inaccessible to the working class. The medical school application proves costly because of the various expenses, including primary applications, secondary applications, and interview logistics. There is financial aid for applications, but navigating some aid to undertake test prep, the Medical College Admission Test (MCAT), and the travel for interviews proves more difficult. Although not mandatory, prep courses give people a competitive edge.[23] The MCAT is one of the key elements of an application, and many medical schools will not consider applications that do not reach their score threshold. This practically makes the preparatory courses mandatory for a competitive score. The preparatory courses themselves cost in the thousands of dollars. There has been talk about adjusting the standardized test score requirements for applicants from medically underserved backgrounds. I believe the practice of holding strict cutoffs for MCAT scores is detrimental to low-income Latino applicants, especially considering the average MCAT scores for Latinos trail that of white people. The American Association of Medical Colleges’ recent data for the matriculating class of 2021 illustrates the wide gap in MCAT scores: Latino applicants average 500.2, and Latino matriculants average 506.6, compared to white applicants, who average 507.5 and white matriculants, who average 512.7.[24] This discrepancy suggests that considerations beyond scores do play some role in medical school matriculation. However, the MCAT scores remain a predominant factor, and there is room to value other factors more and limit the weight given to scores. The practice of screening out applicants based solely on MCAT scores impedes low-income Latino applicants from matriculating into medical school. Valuing the MCAT above all other admissions criteria limits the opportunities for those from underserved communities, who tend to score lower on the exam. One indicator of a potentially great physician may be overcoming obstacles or engaging in scientific or clinical experiences. There are aspects of the application where the applicant can expand on their experiences, and the personal statement allows them to showcase their passion for medicine. These should hold as much weight as the MCAT. The final indicator of a good candidate should not solely rest on standardized tests. There is a cost per medical school that is sent to the primary application. The average medical school matriculant applies to about 16 universities, which drives up the cost of sending the applications.[25] According to the American Association of Medical Colleges, the application fee for the first school is $170, and each additional school is an additional $42. Sending secondary applications after the initial application is an additional cost that ranges by university. The American Medical College Application Service (AMCAS), the primary application portal for Medical Doctorate schools in the United States and Canada, offers the Fee Assistance Program (FAP) to aid low-income medical school applicants. The program reduces the cost of the MCAT from $325 to $130, includes a complimentary Medical School Admission Requirements (MSAR) subscription, and fee waivers for one AMCAS application covering up to 20 schools.[26] The program is an important aid for low-income Latino students who would otherwise not be able to afford to send multiple applications. Although the aid is a great resource, there are other expenses of the application process that the program cannot cover. For a low-income applicant, the burden of the application cost is felt intensely. A study analyzing the American Medical College Application Service (AMCAS) data for applicants and matriculants from 2014 to 2019 revealed an association between income and acceptance into medical school. They state, “Combining all years, the likelihood of acceptance into an MD program increased stepwise by income. The adjusted rate of acceptance was 24.32 percent for applicants with income less than $50 000, 27.57 percent for $50 000 - $74 999, 29.90 percent for $75 000 - $124 999, 33.27 percent for $125 000 - $199 999, and 36.91 percent for $200,000 or greater.”[27] It becomes a discouraging factor when it is difficult to obtain the necessary funds. The interview process for medical schools may prove costly because of travel, lodging, and time. In-person interviews may require applicants to travel from their residence to other cities or states. The applicant must find their own transportation and housing during the interview process, ranging from a single day to multiple days. Being granted multiple interviews becomes bittersweet for low-income applicants because they are morally distraught, knowing the universities are interested yet understanding the high financial cost of the interviews. The expense of multiple interviews can impede an applicant from progressing in the application process. Medical schools do not typically cover travel expenses for the interview process. Only 4 percent of medical school faculty identify as Latino.[28] The medical school admission board members reviewing the application lack Latino representation.[29] Because of this, it is extremely difficult for a low-income Latino applicant to portray hardships that the board members would understand. Furthermore, the section to discuss any hardships only allows for 200 words. This limited space makes it extremely difficult to explain the nuances of navigating higher education as a low-income Latino. Explaining those difficulties is then restricted to the interview process. However, that comes late in the application process when most applicants have been filtered out of consideration. The lack of diversity among the board members, combined with the minimal space to explain hardships or burdens, impedes a connection to be formed between the Latino applicants and the board members. It is not equitable that this population cannot relate to their admissions reviewers because of cultural barriers. Gatekeeping clinical experience inadvertently favors higher socioeconomic status applicants. Most medical schools require physician shadowing or clinical work, which can be difficult to obtain with no personal connections to the field. Using clinical experience on the application is another way that Latinos are disadvantaged compared to people who have more professional connections or doctors in the family and social circles. The already competitive market for clinical care opportunities is reduced by nepotism, which does not work in favor of Latino applicants. Yet some programs are designed to help low-income students find opportunities, such as Johns Hopkins’ Careers in Science and Medicine Summer Internship Program, which provides clinical experience and health professions mentoring.[30] Without social and professional ties to health care professionals, they are forced to enter a competitive job and volunteer market in clinical care and apply to these tailored programs not offered at all academic institutions. While it is not unique to Latinos, the time commitment of the application process is especially harsh on low-income students because they have financial burdens that can determine their survival. Some students help their families pay for food, rent, and utilities, making devoting time to the application process more problematic. As noted earlier, Latino applicants may also have to set aside time to advocate for their families. Because the applicants tend to be more in tune with the dominant American culture, they are often assigned the family advocate role. They must actively advocate for their family members' well-being. The role of a family advocate, with both its financial and other supportive roles ascribed to low-income Latino applicants, is an added strain that complicates the medical school application. As a member of a historically marginalized community, one must be proactive to ensure that ethical treatment is received. Ordinary tasks such as attending a doctor's appointment or meeting with a bank account manager may require diligent oversight. Applicants must ensure the standard of service is applied uniformly to their family as it is to the rest of the population. This applies to business services and healthcare. It can be discouraging to approach a field that does not have many people from your background. The lack of representation emphasizes the applicant's isolation going through the process. There is not a large group of Latinos in medicine to look to for guidance.[31] The group cohesiveness that many communities experience through a rigorous process is not established among low-income Latino applicants. They may feel like outsiders to the profession. Encountering medical professionals of similar backgrounds gives people the confidence to pursue the medical profession. V. Medical School Admission Data This section will rely on the most recent MD medical school students, the 2020-2021 class. The data includes demographic information such as income and ethnicity. The statistics used in this section were retrieved from scholarly peer-reviewed articles and the Medical School Admission Requirement (MSAR) database. Both sources of data are discussed in more detail throughout the section. The data reveals that only 6.7 percent of medical students for the 2020-2021 school year identify as Latino.[32] The number of Latino students in medical school is not proportional to the Latino community in the United States. While Latinos comprise almost 20 percent of the US population (62.1 million), they comprise only 6.7 percent of the medical student population.[33] Below are three case studies of medical schools in cities with a high Latino population. VI. Medical School Application Process Case Studies a) New York University Grossman School of Medicine is situated in Manhattan, where a diverse population of Latinos reside. The population of the borough of Manhattan is approximately 1,629,153, with 26 percent of the population identifying as Latino.[34] As many medical schools do, Grossman School of Medicine advertises an MD Student Diversity Recruitment program. The program, entitled Prospective MD Student Liaison Program, is aimed such that “students from backgrounds that are underrepresented in medicine are welcomed and supported throughout their academic careers.”[35] The program intervenes with underrepresented students during the interview process of the medical school application. All students invited to interviews can participate in the Prospective MD Student Liaison Program. They just need to ask to be part of it. That entails being matched with a current medical student in either the Black and Latinx Student Association (BALSA) or LGBTQMed who will share their experiences navigating medical school. Apart from the liaison program, NYU participates in the Science Technology Entry Program (STEP), which provides academic guidance to middle and high school students who are underrepresented minorities.[36] With the set programs in place, one would expect to find a significantly larger proportion of Latino medical students in the university. The Medical School Admission Requirement (MSAR) database compiled extensive data about participants in the medical school; the data range from tuition to student body demographics. Of the admitted medical students in 2021, only 16 out of 108 identified as Latino, despite the much larger Latino population of New York.[37] Furthermore, only 4 percent of the admitted students classify themselves as being from a disadvantaged status.[38] The current efforts to increase medical school diversity are not producing adequate results at NYU. Although the Latino representation in this medical school may be higher than that in others, it does not reflect the number of Latinos in Manhattan. The Prospective MD Student Liaison Program intervenes at a late stage of the medical school application process. It would be more beneficial for a program to cover the entire application process. The lack of Latino medical students makes it difficult for prospective students to seek advice from Latino students. Introducing low-income Latino applicants to enrolled Latino medical students would serve as a guiding tool throughout the application process. An early introduction could encourage the applicants to apply and provide a resourceful ally in the application process when, in many circ*mstances, there would be none. Latino medical students can share their experiences of overcoming cultural and social barriers to enter medical school. b) The Latino population in Philadelphia is over 250,000, constituting about 15 percent of the 1.6 million inhabitants.[39] According to MSAR, the cohort of students starting at Drexel University College of Medicine, located in Philadelphia, in 2021 was only 7.6 percent Latino.[40] 18 percent of matriculated students identify as having disadvantaged status, while 21 percent identify as coming from a medically underserved community.[41] Drexel University College of Medicine claims that “Students who attend racially and ethnically diverse medical schools are better prepared to care for patients in a diverse society.”[42] They promote diversity with various student organizations within the college, including the following: Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), Drexel Black Doctors Network, LGBT Medical Student Group, and Drexel Mentoring and Pipeline Program (DMAPP). The Student Center for Diversity and Inclusion of the College of Medicine offers support groups for underrepresented medical students. The support offered at Drexel occurs at the point of matriculation, not for prospective students. The one program that does seem to be a guide for prospective students is the Drexel Pathway to Medical School program. Drexel Pathway to Medical School is a one-year master’s program with early assurance into the College of Medicine and may serve as a gateway for prospective Latino Students.[43] The graduate program is tailored for students who are considered medically underserved or socioeconomically disadvantaged and have done well in the traditional pre-medical school coursework. It is a competitive program that receives between 500 and 700 applicants for the 65 available seats. The assurance of entry into medical school makes the Drexel Pathway to Medical School a beneficial program in aiding Latino representation in medicine. Drexel sets forth minimum requirements for the program that show the school is willing to consider students without the elite scores and grades required of many schools. MCAT scores must be in the 25th percentile or higher, and the overall or science GPA must be at least 2.9.[44] The appealing factor of this program is its mission to attract medically underserved students. This is a tool to increase diversity in medical school. Prospective low-income Latino students can view this as a graduate program tailored to communities like theirs. However, this one-year program is not tuition-free. It may be tempting to assume that patients prefer doctors with exceptional academic records. There's an argument against admitting individuals with lower test scores into medical schools, rooted in the belief that this approach does not necessarily serve the best interests of health care. The argument asserts that the immense responsibility of practicing medicine should be entrusted to the most qualified candidates. Programs like the Drexel Pathway to Medical School are designed to address the lower academic achievements often seen in underrepresented communities. Their purpose is not to admit underqualified individuals into medical school but to bridge the educational gap, helping these individuals take the necessary steps to become qualified physicians. c) The University of California San Francisco School of Medicine reports that 23 percent of its first-year class identifies as Latino, while 34 percent consider themselves disadvantaged.[45] The Office of Diversity and Outreach is concerned with increasing the number of matriculants from underserved communities. UCSF has instilled moral commitments and conducts pipeline and outreach programs to increase the diversity of its medical school student body. The Differences Matter Initiative that the university has undertaken is a complex years-long restructuring of the medical school aimed at making the medical system equitable, diverse, and inclusive.[46] The five-phase commitment includes restructuring the leadership of the medical school, establishing anti-oppression and anti-racism competencies, and critically analyzing the role race, ethnicity, gender, and sexual orientation play in medicine. UCSF offers a post-baccalaureate program specifically tailored to disadvantaged and underserved students. The program’s curriculum includes MCAT preparation, skills workshops, science courses, and medical school application workshops.[47] The MCAT preparation and medical school application workshops serve as a great tool for prospective Latino applicants. UCSF seems to do better than most medical schools regarding Latino medical students. San Francisco has a population of 873,965, of which 15.2 percent are Latino.[48] The large population of Latino medical students indicates that the school’s efforts to increase diversity are working. The 23 percent Latino matriculating class of 2021 better represents the number of Latinos in the United States, which makes up about a fifth of the population. With this current data, it is important to closely dissect the efforts UCSF has taken to increase diversity in its medical school. Their Differences Matter initiative instills a commitment to diversifying their medical school. As mentioned, the school's leadership has been restructuring to include a diverse administrative body. This allows low-income Latino applicants to relate to the admissions committee reviewing their application. With a hopeful outlook, the high percentage of Latino applicants may reflect comprehension of the application process and the anticipated medical school atmosphere and rigor among Latino applicants and demonstrate that the admissions committee understands the applicants. However, there are still uncertainties about the demographics of the Latino student population in the medical school. Although it is a relatively high percentage, it is necessary to decipher which proportion of those students are low-income Latino Americans. UCSF School of Medicine can serve as a model to uplift the Latino community in a historically unattainable profession. VII. Proposed Reform for Current Medical School Application One reform would be toward the reviewing admissions committee, which has the power to change the class composition. By increasing the diversity of the admissions committee itself, schools can give minority applicants a greater opportunity to connect to someone with a similar background through their application. It would address low-income Latino applicants feeling they cannot “get personal” in their application. These actions are necessary because it is not just to have a representative administration for only a portion of the public. Of the three medical schools examined, the University of California San Francisco has the highest percentage of Latino applicants in their entering class. They express an initiative to increase diversity within their medical school leadership via the Differences Matter initiative. This active role in increasing diversity within the medical school leadership may play a role in UCSF’s high percentage of Latino matriculants. That serves as an important step in creating an equitable application process for Latino applicants. An important consideration is whether the medical school administration at UCSF mirrors the Latino population in the United States. The importance of whether the medical school administration at UCSF mirrors the Latino population in the United States lies in its potential to foster diversity, inclusivity, and cultural competence in medical education, as well as to positively impact the healthcare outcomes and experiences of the Latino community. A diverse administration can serve as role models for students and aspiring professionals from underrepresented backgrounds. It can inspire individuals who might otherwise feel excluded or underrepresented in their career pursuits, including aspiring Latino medical students. Furthermore, a diverse leadership can help develop curricula, policies, and practices that are culturally sensitive and relevant, which is essential for addressing health disparities and providing equitable healthcare. It is also important to have transparency so the public knows the number of low-income Latino individuals in medical school. The Latino statistics from the medical school generally include international students. That speaks to diversity but misses the important aspect of uplifting the low-income Latino population of the United States. Passing off wealthy international students from Latin America to claim a culturally diverse class is misleading as it does not reflect income diversity. Doing so gives the incorrect perception that the medical school is accurately representing the Latino population of the United States. There must be a change in how the application process introduces interviews. It needs to be introduced earlier so the admissions committee can form early, well-rounded inferences about an applicant. The interview allows for personal connections with committee members that otherwise would not be established through the primary application. The current framework has the interviews as one of the last aspects of the application process before admissions decisions are reached. At this point in the application process, many low-income Latinos may have been screened out. I understand this is not an easy feat to accomplish. This will lead to an increase in interviews to be managed by the admissions committee. The burden can be strategically minimized by first conducting video interviews with applicants the admission committee is interested in moving forward and those that they are unsure about because of a weakness in a certain area of the application. The video interview provides a more formal connection between the applicants and admission committee reviewers. It allows the applicant to provide a narrative through spoken words and can come off as a more intimate window into their characteristics. It would also allow for an opportunity to explain hardships and what is unique. From this larger pool of video-interviewed applicants, the admission committee can narrow down to traditional in-person interviews. A form of these video interviews may be already in place in some medical school application process. I believe making this practice widespread throughout medical schools will provide an opportunity to increase the diversity of medical school students. There must be an increase in the number of programs dedicated to serving as a gateway to clinical experience for low-income Latino applicants. These programs provide the necessary networking environment needed to get clinical experience. It is important to consider that networking with clinical professionals is an admissions factor that detrimentally affects the low-income Latino population. One of the organizations that aids underserved communities, not limited to Latinos, in clinical exposure is the Summer Clinical Oncology Research Experience (SCORE) program.[49] The SCORE program, conducted by Memorial Sloan Kettering Cancer Center, provides its participants with mentorship opportunities in medicine and science. In doing so, strong connections are made in clinical environments. Low-income Latinos seek these opportunities as they have limited exposure to such an environment. I argue that it is in the medical school’s best interest to develop programs of this nature to construct a more diverse applicant pool. These programs are in the best interest of medical schools because they are culturing a well-prepared applicant pool. It should not be left to the goodwill of a handful of organizations to cultivate clinically experienced individuals from minority communities. Medical schools have an ethical obligation to produce well-suited physicians from all backgrounds. Justice is not upheld when low-income Latinos are disproportionally represented in medical schools. Programs tailored for low-income Latinos supplement the networking this population lacks, which is fundamental to obtaining clinical experience. These programs help alleviate the burden of an applicant’s low socioeconomic status in attaining clinical exposure. VIII. Additional Considerations Affecting the Medical School Application Process and Latino Community Health A commitment to practicing medicine in low-income Latino communities can be established to improve Latino community health.[50] Programs, such as the National Health Service Corps, encourage clinicians to practice in underserved areas by forgiving academic loans for years of work.[51] Increasing the number of clinicians in underserved communities can lead to a positive correlation with better health. It would be ideal to have programs for low-income Latino medical students that incentivize practicing in areas with a high population of underserved Latinos. This would provide the Latino community with physicians of a similar cultural background to attend to them, creating a deeper physician-patient relationship that has been missing in this community. Outreach for prospective Latino applicants by Latino medical students and physicians could encourage an increased applicant turnout. This effort can guide low-income Latinos who do not see much representation in the medical field. It would serve as a motivating factor and an opportunity to network within the medical field. Since there are few Latino physicians and medical students, a large effort must be made to make their presence known. IX. Further Investigation Required It is important to investigate the causes of medical school rejections of low-income Latinos. Understanding this piece of information would provide insight into the specific difficulties this population has with the medical school application. From there, the requirements can be subjected to bioethical analysis to determine whether those unfulfilled requirements serve as undue restrictions. The aspect of legacy students, children of former alumni, proves to be a difficult subject to find data on and merits further research. Legacy students are often given preferred admission into universities.[52] It is necessary to understand how this affects the medical school admissions process and whether it comes at a cost to students that are not legacy. It does not seem like these preferences are something universities are willing to disclose. The aspect of legacy preferences in admissions decisions could be detrimental to low-income Latino applicants if their parents are not college-educated in the United States, which often is the case. It would be beneficial to note how many Latinos in medical school are low-income. The MSAR report denotes the number of Latino-identified students per medical school class at an institution and the number of students who identify as coming from low resources. They do not specify which of the Latino students come from low-income families. This information would be useful to decipher how many people from the low-income Latino community are matriculating into medical schools. CONCLUSION It is an injustice that low-income Latinos are grossly underrepresented in medical school. It would remain an injustice even if the health of the Latino community in the United States were good. The current operation of medical school admission is based on a guild-like mentality, which perpetuates through barriers to admissions. It remains an exclusive club with processes that favor the wealthy over those who cannot devote money and time to the prerequisites such as test preparation courses and clinical internships. This has come at the expense of the Latino community in the United States in the form of both fewer Latino doctors and fewer current medical students. It is reasonable to hope that addressing the injustice of the underrepresentation of low-income Latinos in the medical field would improve Latino community health. With such a large demographic, the lack of representation in the medical field is astonishing. The Latino population faces cultural barriers when seeking healthcare, and the best way to combat that is with a familiar face. An increase in Latino medical students would lead to more physicians that not only can culturally relate to the Latino community, but that are a part of it. This opens the door for a comprehensive understanding between the patient and physician. As described in my thesis, Latino physicians can bridge cultural gaps that have proven detrimental to that patient population. That may help patients make informed decisions, exercising their full autonomy. The lack of representation of low-income Latinos in medicine is a long-known issue. Here, I have connected how the physician-patient relationship can be positively improved with an increase in low-income Latino physicians through various reforms in the admissions process. My hope is to have analyzed the problem of under-representation in a way that points toward further research and thoughtful reforms that can truly contribute to the process of remedying this issue. - [1] Passel, J. S., Lopez, M. H., & Cohn, D. (2022, February 3). U.S. Hispanic population continued its geographic spread in the 2010s. Pew Research Center. https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ [2] Ramirez, A. G., Lepe, R., & Cigarroa, F. (2021). Uplifting the Latino Population From Obscurity to the Forefront of Health Care, Public Health Intervention, and Societal Presence. JAMA, 326(7), 597–598. https://doi.org/10.1001/jama.2021.11997 [3] Association of American Medical Colleges. (2023). Who is eligible to participate in the fee assistance program? https://students-residents.aamc.org/fee-assistance-program/who-eligble-participate-fee-assistance-mprogram [4] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [5] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm; Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf; Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [6] Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. (2020). Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db360.htm [7] Center for Disease Control and Prevention. (2021, October). Estimated HIV incidence and prevalence in the United States 2015–2019. https://www.cdc.gov/hiv/pdf/group/racialethnic/hispanic-latino/cdc-hiv-group-hispanic-latino-factsheet.pdf [8] Hispanics / Latinos | Health Disparities | CDC. (2020, September 14). Health Disparities in HIV, Viral Hepatitis, STDs, and TB. https://www.cdc.gov/nchhstp/healthdisparities/hispanics.html [9] CDC. (2020). [10] CDC. (2020). [11] Center for Disease Control and Prevention. (2019). National Diabetes Statistic Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [12] Office of the Assistant Secretary for Planning and Evaluation. (2021, October). Issue Brief No. HP-2021-2. Health Insurance Coverage and Access to Care Among Latinos: Recent Trends and Key Challenges. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/health-insurance-coverage-access-care-among-latinos [13] U.S. Department of Health and Human Services Office of Minority Health. (2021). Profile: Hispanic/Latino Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64 [14] Alsan, M., Garrick, O., & Graziani, G. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446 [15] Takesh*ta, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.24583 [16] Alsan, et. al. (2019). [17] Marrast, L., Zallman, L., Woolhandler, S., Bor, D. H., & McCormick, D. (2014). Minority physicians’ role in the care of underserved patients. JAMA Internal Medicine, 174(2), 289. https://doi.org/10.1001/jamainternmed.2013.12756 (“Nonwhite physicians cared for 53.5% of minority and 70.4% of non-English speaking patients.” Increasing the number of Latino doctors could lead to more nonwhite physicians to care for the underserved populations as they serve those populations at disproportionate rates. This may lead to better care for the patients.) [18] Cersosimo, E., & Musi, N. (2011). Improving Treatment in Hispanic/Latino Patients. The American Journal of Medicine, 124(10), S16–S21. https://doi.org/10.1016/j.amjmed.2011.07.019 [19] Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136(1), 14–23. https://doi.org/10.1016/s0022-3476(00)90043-x [20] Cersosimo & Musi. (2011). [21] Flores. (2000). [22] Torres, D. (2019). Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study. The Permanente Journal. https://doi.org/10.7812/tpp/18-258 [23] The Princeton Review. (n.d.). Score 513+ on the MCAT, Guaranteed! | The Princeton Review. [24] 2021 FACTS: Applicants and Matriculants Data. (2022). AAMC. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data [25] The Princeton Review. (n.d.). How Many Med Schools Should You Apply To? https://www.princetonreview.com/med-school-advice/how-many-med-schools-should-you-apply-to [26] Association of American Medical Colleges. (n.d.). Fee Assistance Program (FAP). AAMC. https://students-residents.aamc.org/fee-assistance-program/fee-assistance-program-fap [27] Nguyen, M., Desai, M. M., Fancher, T. L., Chaudhry, S. I., Mason, H. R. C., & Boatright, D. (2023). Temporal trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income, 2014-2019. JAMA. https://doi.org/10.1001/jama.2023.5654 [28] Ramirez, et al. (2021). [29] Ko, M. J., Henderson, M. C., Fancher, T. L., London, M., Simon, M., & Hardeman, R. R. (2023). US medical school admissions leaders’ experiences with barriers to and advancements in diversity, equity, and inclusion. JAMA Network Open, 6(2), e2254928. https://doi.org/10.1001/jamanetworkopen.2022.54928 [30] Johns Hopkins University School of Medicine. (n.d.). JHU CSM SIP. Johns Hopkins Initiative for Careers in Science and Medicine - the Summer Internship Program. https://csmsip.cellbio.jhmi.edu/ [31] Figure 18. Percentage of all active physicians by race/ethnicity, 2018 | AAMC. (2018). AAMC. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018 [32] Ramirez, et al. (2021). [33] Passel, et al. (2022). [34] Census Reporter. (n.d.). Census profile: Manhattan borough, New York County, NY. https://censusreporter.org/profiles/06000US3606144919-manhattan-borough-new-york-county-ny/ [35] MD Student Diversity Recruitment. (2022). NYU Langone Health. https://med.nyu.edu/our-community/why-nyu-grossman-school-medicine/diversity-inclusion/recruiting-diversity/md-student-diversity-recruitment [36] NYU. (n.d.). STEP Pre-College Program. New York University. https://www.nyu.edu/admissions/undergraduate-admissions/how-to-apply/all-freshmen-applicants/opportunity-programs/pre-college-programs.html [37] Association of American Medical Colleges. (2022). NYU Grossman School of Medicine. Medical School Admission Requirements (MSAR). https://mec.aamc.org/msar-ui/#/medSchoolDetails/152 [38] Association of American Medical Colleges. (2022). [39] U.S. Census Bureau. (2021). U.S. Census Bureau QuickFacts: Philadelphia County, Pennsylvania. Census Bureau QuickFacts. https://www.census.gov/quickfacts/philadelphiacountypennsylvania [40] Association of American Medical Colleges. (2022). Drexel University College of Medicine. Medical School Admission Requirements. https://mec.aamc.org/msar-ui/#/medSchoolDetails/833 [41] Association of American Medical Colleges. (2022). [42] Drexel University College of Medicine. (n.d.). Diversity, Equity & Inclusion For Students. https://drexel.edu/medicine/about/diversity/diversity-for-students/ [43] Drexel University College of Medicine. (n.d.-b). Drexel Pathway to Medical School. https://drexel.edu/medicine/academics/graduate-school/drexel-pathway-to-medical-school/ [44] Drexel University College of Medicine. 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Abstract:

Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk; Kimmelman, J., Hyun, I., Benvenisty, N. et al. Policy: Global standards for stem-cell research. Nature 533, 311–313 (2016). https://doi.org/10.1038/533311a [4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics. Oxford University Press. [8] Sherley v. Sebelius, 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf [9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text; Bush, G. W. (2006, July 19). Message to the House of Representatives. National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html [10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells [11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells. Social Research, 73(3), 819–834. http://www.jstor.org/stable/40971854 [12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics. 22. 10.1186/s12910-021-00678-4. [13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics, 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight, 49(4). [14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. 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Abstract:

The term “coffee palace” was primarily used in Australia to describe the temperance hotels that were built in the last decades of the 19th century, although there are references to the term also being used to a lesser extent in the United Kingdom (Denby 174). Built in response to the worldwide temperance movement, which reached its pinnacle in the 1880s in Australia, coffee palaces were hotels that did not serve alcohol. This was a unique time in Australia’s architectural development as the economic boom fuelled by the gold rush in the 1850s, and the demand for ostentatious display that gathered momentum during the following years, afforded the use of richly ornamental High Victorian architecture and resulted in very majestic structures; hence the term “palace” (Freeland 121). The often multi-storied coffee palaces were found in every capital city as well as regional areas such as Geelong and Broken Hill, and locales as remote as Maria Island on the east coast of Tasmania. Presented as upholding family values and discouraging drunkenness, the coffee palaces were most popular in seaside resorts such as Barwon Heads in Victoria, where they catered to families. Coffee palaces were also constructed on a grand scale to provide accommodation for international and interstate visitors attending the international exhibitions held in Sydney (1879) and Melbourne (1880 and 1888). While the temperance movement lasted well over 100 years, the life of coffee palaces was relatively short-lived. Nevertheless, coffee palaces were very much part of Australia’s cultural landscape. In this article, I examine the rise and demise of coffee palaces associated with the temperance movement and argue that coffee palaces established in the name of abstinence were modelled on the coffee houses that spread throughout Europe and North America in the 17th and 18th centuries during the Enlightenment—a time when the human mind could be said to have been liberated from inebriation and the dogmatic state of ignorance. The Temperance Movement At a time when newspapers are full of lurid stories about binge-drinking and the alleged ill-effects of the liberalisation of licensing laws, as well as concerns over the growing trend of marketing easy-to-drink products (such as the so-called “alcopops”) to teenagers, it is difficult to think of a period when the total suppression of the alcohol trade was seriously debated in Australia. The cause of temperance has almost completely vanished from view, yet for well over a century—from 1830 to the outbreak of the Second World War—the control or even total abolition of the liquor trade was a major political issue—one that split the country, brought thousands onto the streets in demonstrations, and influenced the outcome of elections. Between 1911 and 1925 referenda to either limit or prohibit the sale of alcohol were held in most States. While moves to bring about abolition failed, Fitzgerald notes that almost one in three Australian voters expressed their support for prohibition of alcohol in their State (145). Today, the temperance movement’s platform has largely been forgotten, killed off by the practical example of the United States, where prohibition of the legal sale of alcohol served only to hand control of the liquor traffic to organised crime. Coffee Houses and the Enlightenment Although tea has long been considered the beverage of sobriety, it was coffee that came to be regarded as the very antithesis of alcohol. When the first coffee house opened in London in the early 1650s, customers were bewildered by this strange new drink from the Middle East—hot, bitter, and black as soot. But those who tried coffee were, reports Ellis, soon won over, and coffee houses were opened across London, Oxford, and Cambridge and, in the following decades, Europe and North America. Tea, equally exotic, entered the English market slightly later than coffee (in 1664), but was more expensive and remained a rarity long after coffee had become ubiquitous in London (Ellis 123-24). The impact of the introduction of coffee into Europe during the seventeenth century was particularly noticeable since the most common beverages of the time, even at breakfast, were weak “small beer” and wine. Both were safer to drink than water, which was liable to be contaminated. Coffee, like beer, was made using boiled water and, therefore, provided a new and safe alternative to alcoholic drinks. There was also the added benefit that those who drank coffee instead of alcohol began the day alert rather than mildly inebriated (Standage 135). It was also thought that coffee had a stimulating effect upon the “nervous system,” so much so that the French called coffee une boisson intellectuelle (an intellectual beverage), because of its stimulating effect on the brain (Muskett 71). In Oxford, the British called their coffee houses “penny universities,” a penny then being the price of a cup of coffee (Standage 158). Coffee houses were, moreover, more than places that sold coffee. Unlike other institutions of the period, rank and birth had no place (Ellis 59). The coffee house became the centre of urban life, creating a distinctive social culture by treating all customers as equals. Egalitarianism, however, did not extend to women—at least not in London. Around its egalitarian (but male) tables, merchants discussed and conducted business, writers and poets held discussions, scientists demonstrated experiments, and philosophers deliberated ideas and reforms. For the price of a cup (or “dish” as it was then known) of coffee, a man could read the latest pamphlets and newsletters, chat with other patrons, strike business deals, keep up with the latest political gossip, find out what other people thought of a new book, or take part in literary or philosophical discussions. Like today’s Internet, Twitter, and Facebook, Europe’s coffee houses functioned as an information network where ideas circulated and spread from coffee house to coffee house. In this way, drinking coffee in the coffee house became a metaphor for people getting together to share ideas in a sober environment, a concept that remains today. According to Standage, this information network fuelled the Enlightenment (133), prompting an explosion of creativity. Coffee houses provided an entirely new environment for political, financial, scientific, and literary change, as people gathered, discussed, and debated issues within their walls. Entrepreneurs and scientists teamed up to form companies to exploit new inventions and discoveries in manufacturing and mining, paving the way for the Industrial Revolution (Standage 163). The stock market and insurance companies also had their birth in the coffee house. As a result, coffee was seen to be the epitome of modernity and progress and, as such, was the ideal beverage for the Age of Reason. By the 19th century, however, the era of coffee houses had passed. Most of them had evolved into exclusive men’s clubs, each geared towards a certain segment of society. Tea was now more affordable and fashionable, and teahouses, which drew clientele from both sexes, began to grow in popularity. Tea, however, had always been Australia’s most popular non-alcoholic drink. Tea (and coffee) along with other alien plants had been part of the cargo unloaded onto Australian shores with the First Fleet in 1788. Coffee, mainly from Brazil and Jamaica, remained a constant import but was taxed more heavily than tea and was, therefore, more expensive. Furthermore, tea was much easier to make than coffee. To brew tea, all that is needed is to add boiling water, coffee, in contrast, required roasting, grinding and brewing. According to Symons, until the 1930s, Australians were the largest consumers of tea in the world (19). In spite of this, and as coffee, since its introduction into Europe, was regarded as the antidote to alcohol, the temperance movement established coffee palaces. In the early 1870s in Britain, the temperance movement had revived the coffee house to provide an alternative to the gin taverns that were so attractive to the working classes of the Industrial Age (Clarke 5). Unlike the earlier coffee house, this revived incarnation provided accommodation and was open to men, women and children. “Cheap and wholesome food,” was available as well as reading rooms supplied with newspapers and periodicals, and games and smoking rooms (Clarke 20). In Australia, coffee palaces did not seek the working classes, as clientele: at least in the cities they were largely for the nouveau riche. Coffee Palaces The discovery of gold in 1851 changed the direction of the Australian economy. An investment boom followed, with an influx of foreign funds and English banks lending freely to colonial speculators. By the 1880s, the manufacturing and construction sectors of the economy boomed and land prices were highly inflated. Governments shared in the wealth and ploughed money into urban infrastructure, particularly railways. Spurred on by these positive economic conditions and the newly extended inter-colonial rail network, international exhibitions were held in both Sydney and Melbourne. To celebrate modern technology and design in an industrial age, international exhibitions were phenomena that had spread throughout Europe and much of the world from the mid-19th century. According to Davison, exhibitions were “integral to the culture of nineteenth century industrialising societies” (158). In particular, these exhibitions provided the colonies with an opportunity to demonstrate to the world their economic power and achievements in the sciences, the arts and education, as well as to promote their commerce and industry. Massive purpose-built buildings were constructed to house the exhibition halls. In Sydney, the Garden Palace was erected in the Botanic Gardens for the 1879 Exhibition (it burnt down in 1882). In Melbourne, the Royal Exhibition Building, now a World Heritage site, was built in the Carlton Gardens for the 1880 Exhibition and extended for the 1888 Centennial Exhibition. Accommodation was required for the some one million interstate and international visitors who were to pass through the gates of the Garden Palace in Sydney. To meet this need, the temperance movement, keen to provide alternative accommodation to licensed hotels, backed the establishment of Sydney’s coffee palaces. The Sydney Coffee Palace Hotel Company was formed in 1878 to operate and manage a number of coffee palaces constructed during the 1870s. These were designed to compete with hotels by “offering all the ordinary advantages of those establishments without the allurements of the drink” (Murdoch). Coffee palaces were much more than ordinary hotels—they were often multi-purpose or mixed-use buildings that included a large number of rooms for accommodation as well as ballrooms and other leisure facilities to attract people away from pubs. As the Australian Town and Country Journal reveals, their services included the supply of affordable, wholesome food, either in the form of regular meals or occasional refreshments, cooked in kitchens fitted with the latest in culinary accoutrements. These “culinary temples” also provided smoking rooms, chess and billiard rooms, and rooms where people could read books, periodicals and all the local and national papers for free (121). Similar to the coffee houses of the Enlightenment, the coffee palaces brought businessmen, artists, writers, engineers, and scientists attending the exhibitions together to eat and drink (non-alcoholic), socialise and conduct business. The Johnson’s Temperance Coffee Palace located in York Street in Sydney produced a practical guide for potential investors and businessmen titled International Exhibition Visitors Pocket Guide to Sydney. It included information on the location of government departments, educational institutions, hospitals, charitable organisations, and embassies, as well as a list of the tariffs on goods from food to opium (1–17). Women, particularly the Woman’s Christian Temperance Union (WCTU) were a formidable force in the temperance movement (intemperance was generally regarded as a male problem and, more specifically, a husband problem). Murdoch argues, however, that much of the success of the push to establish coffee palaces was due to male politicians with business interests, such as the one-time Victorian premiere James Munro. Considered a stern, moral church-going leader, Munro expanded the temperance movement into a fanatical force with extraordinary power, which is perhaps why the temperance movement had its greatest following in Victoria (Murdoch). Several prestigious hotels were constructed to provide accommodation for visitors to the international exhibitions in Melbourne. Munro was responsible for building many of the city’s coffee palaces, including the Victoria (1880) and the Federal Coffee Palace (1888) in Collins Street. After establishing the Grand Coffee Palace Company, Munro took over the Grand Hotel (now the Windsor) in 1886. Munro expanded the hotel to accommodate some of the two million visitors who were to attend the Centenary Exhibition, renamed it the Grand Coffee Palace, and ceremoniously burnt its liquor licence at the official opening (Murdoch). By 1888 there were more than 50 coffee palaces in the city of Melbourne alone and Munro held thousands of shares in coffee palaces, including those in Geelong and Broken Hill. With its opening planned to commemorate the centenary of the founding of Australia and the 1888 International Exhibition, the construction of the Federal Coffee Palace, one of the largest hotels in Australia, was perhaps the greatest monument to the temperance movement. Designed in the French Renaissance style, the façade was embellished with statues, griffins and Venus in a chariot drawn by four seahorses. The building was crowned with an iron-framed domed tower. New passenger elevators—first demonstrated at the Sydney Exhibition—allowed the building to soar to seven storeys. According to the Federal Coffee Palace Visitor’s Guide, which was presented to every visitor, there were three lifts for passengers and others for luggage. Bedrooms were located on the top five floors, while the stately ground and first floors contained majestic dining, lounge, sitting, smoking, writing, and billiard rooms. There were electric service bells, gaslights, and kitchens “fitted with the most approved inventions for aiding proficients [sic] in the culinary arts,” while the luxury brand Pears soap was used in the lavatories and bathrooms (16–17). In 1891, a spectacular financial crash brought the economic boom to an abrupt end. The British economy was in crisis and to meet the predicament, English banks withdrew their funds in Australia. There was a wholesale collapse of building companies, mortgage banks and other financial institutions during 1891 and 1892 and much of the banking system was halted during 1893 (Attard). Meanwhile, however, while the eastern States were in the economic doldrums, gold was discovered in 1892 at Coolgardie and Kalgoorlie in Western Australia and, within two years, the west of the continent was transformed. As gold poured back to the capital city of Perth, the long dormant settlement hurriedly caught up and began to emulate the rest of Australia, including the construction of ornately detailed coffee palaces (Freeman 130). By 1904, Perth had 20 coffee palaces. When the No. 2 Coffee Palace opened in Pitt Street, Sydney, in 1880, the Australian Town and Country Journal reported that coffee palaces were “not only fashionable, but appear to have acquired a permanent footing in Sydney” (121). The coffee palace era, however, was relatively short-lived. Driven more by reformist and economic zeal than by good business sense, many were in financial trouble when the 1890’s Depression hit. Leading figures in the temperance movement were also involved in land speculation and building societies and when these schemes collapsed, many, including Munro, were financially ruined. Many of the palaces closed or were forced to apply for liquor licences in order to stay afloat. Others developed another life after the temperance movement’s influence waned and the coffee palace fad faded, and many were later demolished to make way for more modern buildings. The Federal was licensed in 1923 and traded as the Federal Hotel until its demolition in 1973. The Victoria, however, did not succumb to a liquor licence until 1967. The Sydney Coffee Palace in Woolloomooloo became the Sydney Eye Hospital and, more recently, smart apartments. Some fine examples still survive as reminders of Australia’s social and cultural heritage. The Windsor in Melbourne’s Spring Street and the Broken Hill Hotel, a massive three-story iconic pub in the outback now called simply “The Palace,” are some examples. Tea remained the beverage of choice in Australia until the 1950s when the lifting of government controls on the importation of coffee and the influence of American foodways coincided with the arrival of espresso-loving immigrants. As Australians were introduced to the espresso machine, the short black, the cappuccino, and the café latte and (reminiscent of the Enlightenment), the post-war malaise was shed in favour of the energy and vigour of modernist thought and creativity, fuelled in at least a small part by caffeine and the emergent café culture (Teffer). Although the temperance movement’s attempt to provide an alternative to the ubiquitous pubs failed, coffee has now outstripped the consumption of tea and today’s café culture ensures that wherever coffee is consumed, there is the possibility of a continuation of the Enlightenment’s lively discussions, exchange of news, and dissemination of ideas and information in a sober environment. References Attard, Bernard. “The Economic History of Australia from 1788: An Introduction.” EH.net Encyclopedia. 5 Feb. (2012) ‹http://eh.net/encyclopedia/article/attard.australia›. Blainey, Anna. “The Prohibition and Total Abstinence Movement in Australia 1880–1910.” Food, Power and Community: Essays in the History of Food and Drink. Ed. Robert Dare. Adelaide: Wakefield Press, 1999. 142–52. Boyce, Francis Bertie. “Shall I Vote for No License?” An address delivered at the Convention of the Parramatta Branch of New South Wales Alliance, 3 September 1906. 3rd ed. Parramatta: New South Wales Alliance, 1907. Clarke, James Freeman. Coffee Houses and Coffee Palaces in England. Boston: George H. Ellis, 1882. “Coffee Palace, No. 2.” Australian Town and Country Journal. 17 Jul. 1880: 121. Davison, Graeme. “Festivals of Nationhood: The International Exhibitions.” Australian Cultural History. Eds. S. L. Goldberg and F. B. Smith. Cambridge: Cambridge UP, 1989. 158–77. Denby, Elaine. Grand Hotels: Reality and Illusion. London: Reaktion Books, 2002. Ellis, Markman. The Coffee House: A Cultural History. London: Weidenfeld & Nicolson, 2004. Federal Coffee Palace. The Federal Coffee Palace Visitors’ Guide to Melbourne, Its Suburbs, and Other Parts of the Colony of Victoria: Views of the Principal Public and Commercial Buildings in Melbourne, With a Bird’s Eye View of the City; and History of the Melbourne International Exhibition of 1880, etc. Melbourne: Federal Coffee House Company, 1888. Fitzgerald, Ross, and Trevor Jordan. Under the Influence: A History of Alcohol in Australia. Sydney: Harper Collins, 2009. Freeland, John. The Australian Pub. Melbourne: Sun Books, 1977. Johnson’s Temperance Coffee Palace. International Exhibition Visitors Pocket Guide to Sydney, Restaurant and Temperance Hotel. Sydney: Johnson’s Temperance Coffee Palace, 1879. Mitchell, Ann M. “Munro, James (1832–1908).” Australian Dictionary of Biography. Canberra: National Centre of Biography, Australian National U, 2006-12. 5 Feb. 2012 ‹http://adb.anu.edu.au/biography/munro-james-4271/text6905›. Murdoch, Sally. “Coffee Palaces.” Encyclopaedia of Melbourne. Eds. Andrew Brown-May and Shurlee Swain. 5 Feb. 2012 ‹http://www.emelbourne.net.au/biogs/EM00371b.htm›. Muskett, Philip E. The Art of Living in Australia. New South Wales: Kangaroo Press, 1987. Standage, Tom. A History of the World in 6 Glasses. New York: Walker & Company, 2005. Sydney Coffee Palace Hotel Company Limited. Memorandum of Association of the Sydney Coffee Palace Hotel Company, Ltd. Sydney: Samuel Edward Lees, 1879. Symons, Michael. One Continuous Picnic: A Gastronomic History of Australia. Melbourne: Melbourne UP, 2007. Teffer, Nicola. Coffee Customs. Exhibition Catalogue. Sydney: Customs House, 2005.

Abstract:

Photo by Agni B on Unsplash ABSTRACT The number of scientific articles published per year has been steadily increasing; so have the instances of misconduct in medical research. While increasing scientific knowledge is beneficial, it is imperative that research be authentic and bias-free. This article explores why fraud and other misconduct occur, presents the consequences of the phenomenon, and proposes measures to eliminate unethical practices in medical research. The main reason scientists engage in unethical practices is the pressure to publish which is directly related to their academic advancement and career development. Additional factors include the pressure to get research funds, the pressure from funding sources on researchers to deliver results, how scientific publishing has evolved over the years, and the over-publication of research in general. Fraud in medical research damages trust and reliability in science and potentially harms individuals. INTRODUCTION Since the introduction of Evidence-Based Medicine (EBM) in the early 1990s, scientific articles published per year have increased steadily. No one knows the exact number of scientific articles published per year, but several estimates point to around 2,000,000.[1] EBM aims to integrate the clinical experience and the best available scientific knowledge in managing individual patients.[2] The EBM model is based on the accumulation of as much clinical and research data as possible, which has propelled a significant rise in research. Unfortunately, its incentive structure has also led to a rise in research misconduct. “Fraud in science has a long history.”[3] Cases of misconduct began to surface in the late 1980s and increased during the 1990s. Experts suggest that today fraud is “endemic in many scientific disciplines and in most countries.”[4] In recent reporting, the majority of cases of scientific fraud involved falsification and fabrication of the data, while plagiarism was much less frequent. 8 percent of scientists and 10 percent of medical and life-sciences researchers admitted to falsifying data at least once between 2017 and 2021 in a Dutch study of 6,813 researchers, while more than half engaged in at least one questionable research practice.[5] Questionable research practices include research design flaws or unfairness in decisions surrounding publication or grants.[6] In an older study, closer to 2 percent of those surveyed reported having engaged in falsification or fabrication,[7] while in a more recent survey of 3,000 scientists with NIH grants in the United States, 0.3 percent of the scientists responding admitted fabricating research data and 1.4 percent of them admitted plagiarizing.[8] These numbers are almost certainly not reflective of the true incidence of fraud as many scientists admitted that they engaged in a range of behaviors beyond fabrication, falsification, and plagiarism that undermine the integrity of science, such as changing the results of a study under pressure from a funding source or failing to present data that contradicts one’s previous research. It is also unclear whether surveys are the best method to investigate misconduct because a scientist answering the survey may be unsure of anonymity and may not be truthful. This article explores why misconduct occurs, presents the consequences, and proposes measures to eliminate unethical practices in medical research. In the 1999 Joint Consensus Conference on Misconduct in Biomedical Research, “scientific fraud” was defined as any “behavior by a researcher, intentional or not, that falls short of good ethical and scientific standards.”[9] ANALYSIS l. The Scientific Publishing Landscape There are several reasons scientists may commit misconduct and engage in unethical practices. There is an increasing pressure to publish, which the motto "publish or perish reflects.”[10] The number of scientific papers published by a researcher is directly related to their academic advancement and career development. Similarly, academic institutions rely on scientific publications to gain prestige and access research grants. Pressure to get research grants may create environments that make it challenging to research integrity. Researchers are often tempted to alter their data to fulfill the desired results, separately report the results of one research in multiple end publications, commonly referred to as “salami publication,” or even simultaneously submit their scientific articles to more than one journal. This creates a vicious cycle in which the need for funding leads to scientific misconduct, which in turn secures more research funding. Meanwhile, the pressure from the funding sources cannot be overlooked either. Although researchers must report the role of the funding sources, selection and publication bias often may advantage articles that support the interests of the financial sponsor. Disclosure does not alter the conflict of interest. The growing number of scientific articles published per year has practically overwhelmed the peer-review system. Manuscript submissions are often reviewed superficially or assigned to inexperienced reviewers; therefore, misconduct cases may go unnoticed. The rise of “predatory” journals that charge authors publication fees and do not review work for authenticity and the dissemination of information through preprints has worsened the situation. The way that profits influence scientific publishing has very likely contributed to the phenomenon of misconduct. The publishing industry is a highly profitable business.[11] The increased reliance on funding from sources that expect the research to appear in prestigious, open-access journals often creates conflicts of interest and funding bias. On the other hand, high-impact journals have not given space to navigate through negative results and previous failures. Nonsignificant findings commonly remain unpublished, a phenomenon known as “the file drawer problem.” Scientists often manipulate their data to fit their initial hypothesis or change their hypothesis to fit their results, leading to outcome-reporting bias. ll. Misconduct Concerning the Reporting and Publishing Data The types of misconduct vary and have different implications for the scientist’s career and those relying on the research. For example, plagiarism is generally not punished by law currently unless it violates the original author’s copyright. Nevertheless, publishers who detect plagiarism implement penalties such as rejection of the submitted article and expulsion of the author. While plagiarism can be either accidental or deliberate, in either case, it is a serious violation of academic integrity as it involves passing off someone else’s “work or ideas” as one’s own.[12] Plagiarism can be “verbatim” (copying sentences or paragraphs from previously published work without using quotation marks or referencing the source) or rephrasing someone’s work or ideas without citing them. In “mosaic” plagiarism, the work plagiarized comes from various sources. “Self-plagiarism” is defined as an author’s reproduction of their previous publications or ideas in the same or altered words. According to most scientific journals, all authors of an article in part must have contributed to the conception and design of the study, drafted the article, revised it critically, or approved of its final version.[13] The use of a ghost author (usually a professional writer who is not named an author) is generally not ethical, as it undermines the requirement that the listed authors created the article. Moreover, wasteful publication is another practice that contributes to misconduct. Wasteful publication includes dividing the results of one single study into multiple end publications (“salami slicing”), republishing the same results in one or more articles, or extending a previously published article by adding new data without reaching new conclusions. Wasteful publication not only skews the scientific databases, but also wastes the time of the readers, the editors, and the reviewers. It is considered unethical because it unreasonably increases the authors’ citation records. Authors caught engaging in such behaviors may be banned from submitting articles for years while the submitted article is automatically rejected. Wasteful publication is an example of how the pressure to publish more articles leads to dishonest behavior, making it look like a researcher has conducted more studies and has more experience. Conflicts of interest are not strictly prohibited in medicine but require disclosure. Although disclosure of financial interests is a critical step, it does not guarantee the absence of bias. Researchers with financial ties to a pharmaceutical company funding their research are more likely to report results that favor the sponsor, which eventually undermines the integrity of research.[14] Financial sponsors should not be allowed to influence publication; rather authors need to publish their results based on their own decisions and findings. lll. Misconduct in Carrying Out Scientific Research Studies Common forms of fabrication include concealing negative results, changing the results to fit the initial hypothesis or selective reporting of the outcomes. Falsification is the manipulation of experimental data that leads to inaccurate presentation of the research results. Falsified data includes deliberately manipulating images, omitting, or adding data points, and removing outliers in a dataset for the sake of manipulating the outcome. In contrast to plagiarism, this type of misconduct is very difficult to detect. Scientists who fabricate or falsify their data may be banned from receiving funding grants or terminated from their institutions. Falsification and fabrication are dangerous to the public as they can result in people giving and receiving incorrect medical advice. Relying on falsified data can lead to death or injury or lead patients to take a drug, treatment, or use a medical device that is less effective than perceived. Thus, some members of the scientific community support the criminalization of this type of misconduct.[15] Research involving human participants requires respect for persons, beneficence, justice, voluntary consent, respect for autonomy, and confidentiality. Violating those principles constitutes unethical human experimentation. The Declaration of Helsinki is a statement of ethical principles for biomedical research involving human subjects, including research on identifiable human material and data. Similarly, research in which animals are subjects is also regulated. The first set of limits on the practice of animal experimentation was the Cruelty to Animals Act passed in 1876 by the Parliament of the United Kingdom. Currently, all animal experiments in the EU should be carried out in accordance with the European Directive (2010/63/EU),[16] and in the US, there are many state and federal laws governing research involving animals. The incentives to compromise the ethical responsibilities surrounding human and animal practices may differ from the pressure to publish, yet some are in the same vein. They may generally include taking shortcuts, rushing to get necessary approvals, or using duress to get more research subjects, all actions that reflect a sense of urgency. lV. Consequences of Scientific Misconduct Fraud in medical research damages science by creating data that other researchers will be urged to follow or reproduce that wastes time, effort, and funds. Scientific misconduct undermines the trust among researchers and the public’s trust in science. Meanwhile, fraud in medical trials may lead to the release of ineffective or unsafe drugs or processes that could potentially harm individuals. Most recently, a study conducted by Surgisphere Corporation supported the efficacy of hydroxychloroquine for the treatment of COVID-19 disease.[17] The scientific article that presented the results of the study was retracted shortly after its release due to concerns raised over the validity of the data. Scientific misconduct is associated with reputational and financial costs, including wasted funds for research that is practically useless, costs of an investigation into the fraudulent research, and costs to settle litigation connected with the misconduct. The retraction of scientific articles for misconduct between 1992 and 2002 accounted for $58 million in lost funding by the NIH (which is the primary source of public funds for biomedical research in the US).[18] Of retracted articles, over half are retracted due to “fabrication, falsification, and plagiarism.”[19] Yet it is likely that many articles that contain falsified research are never retracted. A study revealed that of 12,000 journals reviewed, most of the journals had never retracted an article. The same study suggests that some journals have improved oversight, but many do not.[20] V. Oversight and Public Interest Organizations The Committee on Publication Ethics (COPE) was founded in 1997 and established practices and policies for journals and publishers to achieve the highest standards in publication ethics.[21] The Office of Research Integrity (ORI) is an organization created in the US to do the same. In 1996, the International Conference of Harmonization (ICH) adopted the international Good Clinical Practice (GCP) guidelines.[22] Finally, in 2017 the Parliamentary Office of Science and Technology (POST) initiated a formal inquiry into the trends and developments on fraud and misconduct in research and the publication of research results.[23] Despite the increasing efforts of regulatory organizations, scientific misconduct remains a major issue. To eliminate unethical practices in medical research, we must get to the root of the problem: the pressures put on scientists to increase output at the expense of quality. In the absence of altered incentives, criminalization is a possibility. However, several less severe remedies for reducing the prevalence of scientific misconduct exist. Institutions first need to foster open and frank discussion and promote collegiality. Reducing high-stakes competition for career advancement would also help realign incentives to compromise research ethics. In career advancement, emphasis should be given to the quality rather than the quantity of scientific publications. The significance of mentorship by senior, experienced researchers over lab assistants can bolster ethical training. Adopting certain codes of conduct and close supervision of research practices in the lab and beyond should also be formalized. The publication system plays a critical role in preserving research integrity. Computer-assisted tools that detect plagiarism and other types of misconduct need to be developed or upgraded. To improve transparency, scientific journals should establish clear authorship criteria and require that the data supporting the findings of a study be made available, a movement that is underway. Preprint repositories also might help with transparency, but they could lead to people acting on data that has not been peer-reviewed. Finally, publishing negative results is necessary so that the totality of research is not skewed or tainted by informative studies but does not produce the results researchers hoped. Consistently publishing negative results may create a new industry standard and help researchers see that all data is important. CONCLUSION Any medical trial, research project, or scientific publication must be conducted to develop science and improve medicine and public health. However, the pressures from the pharmaceutical industry and academic competition pose significant threats to the trustworthiness of science. Thus, it is up to every scientist to respect and follow ethical rules, while responsible organizations, regulatory bodies, and scientific journals should make every effort to prevent research misconduct. - [1] World Bank. “Scientific and technical journal articles”. World Development Indicators, The World Bank Group. https://data.worldbank.org/indicator/IP.JRN.ARTC.SC?year_low_desc=true. [2] Masic I, Miokovic M, Muhamedagic B. “Evidence Based Medicine - New Approaches and Challenges.” Acta Inform Med. 2008;16(4):219-25. https://www.bibliomed.org/mnsfulltext/6/6-1300616203.pdf?1643160950 [3] Dickenson, D. “The Medical Profession and Human Rights: Handbook for a Changing Agenda.” Zed Books. 2002;28(5):332. doi: 10.1136/jme.28.5.332. [4] Ranstam J, Buyse M, George SL, Evans S, Geller NL, Scherrer B, et al. “Fraud in Medical Research: an International Survey of Biostatisticians, ISCB Subcommittee on Fraud. Control Clin Trials. 2000;21(5):415-27. doi: 10.1016/s0197-2456(00)00069-6. [5] Gopalakrishna, G., Riet, G. T., Vink, G., Stoop, I., Wicherts, J. M., & Bouter, L. (2021, “Prevalence of questionable research practices, research misconduct and their potential explanatory factors: a survey among academic researchers in The Netherlands.” MetaArXiv. July 6, 2021. doi:10.31222/osf.io/vk9yt; Chawla, Dalmeet Singh, “8% of researchers in Dutch survey have falsified or fabricated data.” Nature. 2021. https://www.nature.com/articles/d41586-021-02035-2 (The Dutch study’s author suggests the results could be an underestimate; she also notes an older similar study that found 4.5 percent.) [6] Chawla. [7] Fanelli D. How many scientists fabricate and falsify research? A systematic review and meta-analysis of survey data. PLoS One. 2009;4(5):e5738. doi:10.1371/journal.pone.0005738 [8] Martinson BC, Anderson MS, de Vries R. “Scientists behaving badly” Nature. 2005;435(7043):737-8. https://www.nature.com/articles/435737a. [9] Munby J, Weetman, DF. Joint Consensus Conference on Misconduct in Biomedical Research: The Royal College of Physicians of Edinburgh. Indoor Built Environ. 1999;8:336–338. doi: 10.1177/1420326X9900800511. [10] Stephen Beale “Large Dutch Survey Shines Light on Fraud and Questionable Research Practices in Medical Studies Published in Scientific Journals,” The Dark Daily, Aug 30, 2021. https://www.darkdaily.com/2021/08/30/large-dutch-survey-shines-light-on-fraud-and-questionable-research-practices-in-medical-studies-published-in-scientific-journals/ [11] Buranyi S. Is the staggeringly profitable business of scientific publishing bad for science? The Guardian. June 27, 2017. https://www.theguardian.com/science/2017/jun/27/profitable-business-scientific-publishing-bad-for-science [12] Cambridge English Dictionary. https://dictionary.cambridge.org/us/dictionary/english/plagiarism [13] International Committee of Medical Journal Editors. Defining the Role of Authors and Contributors http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html [14] Resnik DB, Elliott KC. “Taking Financial Relationships into Account When Assessing Research.” Accountability in Research. 2013;20(3):184-205. doi: 10.1080/08989621.2013.788383. [15] Bülow W, Helgesson G. Criminalization of scientific misconduct. Med Health Care and Philos. 2019;22:245–252. [16] Directive 2010/63/EU of the European Parliament and of the Council of 22 September 2010 on the protection of animals used for scientific purposes. Official Journal of the European Union. https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2010:276:0033:0079:en:PDF [17] Mehra MR, Desai SS, Ruschitzka F, Patel AN. “RETRACTED: Hydroxychloroquine or Chloroquine with or without a Macrolide for Treatment of COVID-19: a Multinational Registry Analysis.” The Lancet. 2020. doi: 10.1016/S0140-6736(20)31180-6. [18] Stern AM, Casadevall A, Steen RG, Fang FC. “Financial Costs and Personal Consequences of Research Misconduct Resulting in Retracted Publications,” eLife. 2014;3:e02956. doi: 10.7554/eLife.02956. [19] Brainard, Jeffrey and Jia You, “What a massive database of retracted papers reveals about science publishing's ‘death penalty': Better editorial oversight, not more flawed papers, might explain flood of retractions,” Science, Oct 25, 2018 https://www.science.org/content/article/what-massive-database-retracted-papers-reveals-about-science-publishing-s-death-penalty [20] Brainard and You. [21] Doherty M, Van De Putte Lbacope. Guidelines on Good Publication Practice; Annals of the Rheumatic Diseases 2000;59:403-404. [22] Dixon JR Jr. The International Conference on Harmonization Good Clinical Practice Guideline. Qual Assur. 1998 Apr-Jun;6(2):65-74. doi: 10.1080/105294199277860. PMID: 10386329. [23] “Research Integrity Terms of Reference.” Science and Technology Committee, 14 Sept. 2017, committees.parliament.uk/committee/135/science-and-technology-committee/news/100920/research-integrity-terms-of-reference/.

Abstract:

There is a moment in Al Gore’s 2006 documentary An Inconvenient Truth devised to expose the sheer audacity of fossil fuel lobby groups in the United States. In their attempts to address significant scientific consensus and growing public concern over climate change, these groups are resorting to what Gore’s film suggests are grotesque distortions of fact. A particular example highlighted in the film is the Competitive Enterprise Institute’s (CPE—a lobby group funded by ExxonMobil) “pro” energy industry advertisem*nt: “Carbon dioxide”, the ad states. “They call it pollution, we call it life.” While on the one hand employing rhetoric against the “inconvenient truth” that carbon dioxide emissions are ratcheting up the Earth’s temperature, these advertisem*nts also pose a question – though perhaps unintended – that is worth addressing. Where does life reside? This is not an issue of essentialism, but relates to the claims, materials and technologies through which life as a political object emerges. The danger of entertaining the vested interests of polluting industry in a discussion of climate change and its biopolitics is countered by an imperative to acknowledge the ways in which multiple positions in the climate change debate invoke and appeal to ‘life’ as the bottom line, or inviolable interest, of their political, social or economic work. In doing so, other questions come to the fore that a politics of climate change framed in terms of moral positions or competing values will tend to overlook. These questions concern the manifold practices of life that constitute the contemporary terrain of the political, and the actors and instruments put in this employ. Who speaks for life? And who or what produces it? Climate change as a matter of concern (Latour) has gathered and generated a host of experts, communities, narratives and technical devices all invested in the administration of life. It is, as Malcom Bull argues, “the paradigmatic issue of the new politics,” a politics which “draws people towards the public realm and makes life itself subject to the caprices of state and market” (2). This paper seeks to highlight the politics of life that have emerged around climate change as a public issue. It will argue that these politics appear in incremental and multiple ways that situate an array of actors and interests as active in both contesting and generating the terms of life: what life is and how we come to know it. This way of thinking about climate change debates opposes a prevalent moralistic framework that reads the practices and discourses of debate in terms of oppositional positions alone. While sympathies may flow in varying directions, especially when it comes to such a highly charged and massively consequential issue as climate change, there is little insight to be had from charging the CPE (for example) with manipulating consumers, or misrepresenting well-known facts. Where new and more productive understandings open up is in relation to the fields through which these gathering actors play out their claims to the project of life. These fields, from the state, to the corporation, to the domestic sphere, reveal a complex network of strategies and devices that seek to secure life in constantly renovated terms. Life Politics Biopolitical scholarship in the wake of Foucault has challenged life as a pre-given uncritical category, and sought to highlight the means through which it is put under question and constituted through varying and composing assemblages of practitioners and practices. Such work regards the project of human well-being as highly complex and technical, and has undertaken to document this empirically through close attention to the everyday ecologies in which humans are enmeshed. This is a political and theoretical project in itself, situating political processes in micro, as well as macro, registers, including daily life as a site of (self) management and governance. Rabinow and Rose refer to biopolitical circuits that draw together and inter-relate the multiple sites and scales operative in the administration of life. These involve not just technologies, rationalities and regimes of authority and control, but also politics “from below” in the form of rights claims and community formation and agitation (198). Active in these circuits, too, are corporate and non-state interests for whom the pursuit of maximising life’s qualities and capabilities has become a concern through which “market relations and shareholder value” are negotiated (Rabinow and Rose 211). As many biopolitical scholars argue, biopower—the strategies through which biopolitics are enacted—is characteristic of the “disciplinary neo-liberalism” that has come to define the modern state, and through which the conduct of conduct is practiced (Di Muzio 305). Foucault’s concept of governmentality describes the devolution of state-based disciplinarity and sovereignty to a host of non-state actors, rationalities and strategies of governing, including the self-managing subject, not in opposition to the state, but contributing to its form. According to Bratich, Packer and McCarthy, everyday life is thus “saturated with governmental techniques” (18) in which we are all enrolled. Unlike regimes of biopolitics identified with what Agamben terms “thanopolitics”—the exercise of biopower “which ultimately rests on the power of some to threaten the death of others” (Rabinow and Rose 198), such as the Nazi’s National Socialism and other eugenic campaigns—governmental arts in the service of “vitalist” biopolitics (Rose 1) are increasingly diffused amongst all those with an “interest” in sustaining life, from organisations to individuals. The integration of techniques of self-governance which ask the individual to work on themselves and their own dispositions with State functions has broadened the base by which life is governed, and foregrounded an unsettled terrain of life claims. Rose argues that medical science is at the forefront of these contemporary biopolitics, and to this effect “has […] been fully engaged in the ethical questions of how we should live—of what kinds of creatures we are, of the kinds of obligations that we have to ourselves and to others, of the kinds of techniques we can and should use to improve ourselves” (20). Asking individuals to self-identify through their medical histories and bodily specificities, medical cultures are also shaping new political arrangements, as communities connected by shared genetics or physical conditions, for instance, emerge, evolve and agitate according to the latest medical knowledge. Yet it is not just medicine that provokes ethical work and new political forms. The environment is a key site for life politics that entails a multi-faceted discourse of obligations and entitlements, across fields and scales of engagement. Calculating Environments In line with neo-liberal logic, environmental discourse concerned with ameliorating climate change has increasingly focused upon the individual as an agent of self-monitoring, to both facilitate government agendas at a distance, and to “self-fashion” in the mode of the autonomous subject, securing against external risks (Ong 501). Climate change is commonly represented as such a risk, to both human and non-human life. A recent letter published by the Royal Australasian College of Physicians in two leading British medical journals, named climate change as the “biggest global health threat of the twenty-first century” (Morton). As I have argued elsewhere (Potter), security is central to dominant cultures of environmental governance in the West; these cultures tie sustainability goals to various and interrelated regimes of monitoring which attach to concepts of what Clark and Stevenson call “the good ecological citizen” (238). Citizenship is thus practiced through strategies of governmentality which call on individuals to invest not just in their own well-being, but in the broader project of life. Calculation is a primary technique through which modern environmental governance is enacted; calculative strategies are seen to mediate risk, according to Foucault, and consequently to “assure living” (Elden 575). Rationalised schemes for self-monitoring are proliferating under climate change and the project of environmentalism more broadly, something which critics of neo-liberalism have identified as symptomatic of the privatisation of politics that liberal governmentality has fostered. As we have seen in Australia, an evolving policy emphasis on individual practices and the domestic sphere as crucial sites of environmental action – for instance, the introduction of domestic water restrictions, and the phasing out of energy-inefficient light bulbs in the home—provides a leading discourse of ethico-political responsibility. The rise of carbon dioxide counting is symptomatic of this culture, and indicates the distributed fields of life management in contemporary governmentality. Carbon dioxide, as the CPE is keen to point out, is crucial to life, but it is also—in too large an amount—a force of destruction. Its management, in vitalist terms, is thus established as an effort to protect life in the face of death. The concept of “carbon footprinting” has been promoted by governments, NGOs, industry and individuals as a way of securing this goal, and a host of calculative techniques and strategies are employed to this end, across a spectrum of activities and contexts all framed in the interests of life. The footprinting measure seeks to secure living via self-policed limits, which also—in classic biopolitical form—shift previously private practices into a public realm of count-ability and accountability. The carbon footprint, like its associates the ecological footprint and the water footprint, has developed as a multi-faceted tool of citizenship beyond the traditional boundaries of the state. Suggesting an ecological conception of territory and of our relationships and responsibilities to this, the footprint, as a measure of resource use and emissions relative to the Earth’s capacities to absorb these, calculates and visualises the “specific qualities” (Elden 575) that, in a spatialised understanding of security, constitute and define this territory. The carbon footprint’s relatively simple remit of measuring carbon emissions per unit of assessment—be that the individual, the corporation, or the nation—belies the ways in which life is formatted and produced through its calculations. A tangled set of devices, practices and discourses is employed to make carbon and thus life calculable and manageable. Treading Lightly The old environmental adage to “tread lightly upon the Earth” has been literalised in the metaphor of the footprint, which attempts both to symbolise environmental practice and to directly translate data in order to meaningfully communicate necessary boundaries for our living. The World Wildlife Fund’s Living Planet Report 2008 exemplifies the growing popularity of the footprint as a political and poetic hook: speaking in terms of our “ecological overshoot,” and the move from “ecological credit to ecological deficit”, the report urges an attendance to our “global footprint” which “now exceeds the world’s capacity to regenerate by about 30 per cent” (1). Angela Crombie’s A Lighter Footprint, an instruction manual for sustainable living, is one of a host of media through which individuals are educated in modes of footprint calculation and management. She presents a range of techniques, including carbon offsetting, shifting to sustainable modes of transport, eating and buying differently, recycling and conserving water, to mediate our carbon dioxide output, and to “show […] politicians how easy it is” (13). Governments however, need no persuading from citizens that carbon calculation is an exercise to be harnessed. As governments around the world move (slowly) to address climate change, policies that instrumentalise carbon dioxide emission and reduction via an auditing of credits and deficits have come to the fore—for example, the European Union Emissions Trading Scheme and the Chicago Climate Exchange. In Australia, we have the currently-under-debate Carbon Pollution Reduction Scheme, a part of which is the Australian Emissions Trading Scheme (AETS) that will introduce a system of “carbon credits” and trading in a market-based model of supply and demand. This initiative will put a price on carbon dioxide emissions, and cap the amount of emissions any one polluter can produce without purchasing further credits. In readiness for the scheme, business initiatives are forming to take advantage of this new carbon market. Industries in carbon auditing and off-setting services are consolidating; hectares of trees, already active in the carbon sequestration market, are being cultivated as “carbon sinks” and key sites of compliance for polluters under the AETS. Governments are also planning to turn their tracts of forested public land into carbon credits worth billions of dollars (Arup 7). The attachment of emission measures to goods and services requires a range of calculative experts, and the implementation of new marketing and branding strategies, aimed at conveying the carbon “health” of a product. The introduction of “food mile” labelling (the amount of carbon dioxide emitted in the transportation of the food from source to consumer) in certain supermarkets in the United Kingdom is an example of this. Carbon risk analysis and management programs are being introduced across businesses in readiness for the forthcoming “carbon economy”. As one flyer selling “a suite of carbon related services” explains, “early action will give you the edge in understanding and mitigating the risks, and puts you in a prime position to capitalise on the rewards” (MGI Business Solutions Worldwide). In addition, lobby groups are working to ensure exclusions from or the free allocation of permits within the proposed AETS, with degrees of compulsion applied to different industries – the Federal Government, for instance, will provide a $3.9 billion compensation package for the electric power sector when the AETS commences, to enable their “adjustment” to this carbon regime. Performing Life Noortje Mares provides a further means of thinking through the politics of life in the context of climate change by complicating the distinction between public and private interest. Her study of “green living experiments” describes the rise of carbon calculation in the home in recent years, and the implementation of technologies such as the smart electricity meter that provides a constantly updating display of data relating to amounts and cost of energy consumed and the carbon dioxide emitted in the routines of domestic life. Her research tracks the entry of these personal calculative regimes into public life via internet forums such as blogs, where individuals notate or discuss their experiences of pursing low-carbon lifestyles. On the one hand, these calculative practices of living and their public representation can be read as evidencing the pervasive neo-liberal governmentality at work in contemporary environmental practice, where individuals are encouraged to scrupulously monitor their domestic cultures. The rise of auditing as a technology of self, and more broadly as a technique of public accountability, has come under fire for its “immunity-granting role” (Charkiewicz 79), where internal audits become substituted for external compliance and regulation. Mares challenges this reading, however, by demonstrating the ways in which green living experiments “transform everyday material practices into practices of public involvement” that (118) don’t resolve or pin down relations between the individual, the non-human environment, and the social, or reveal a mappable flow of actions and effects between the public realm and the home. The empirical modes of publicity that these individuals employ, “the careful recording of measurements and the reliable descriptions of sensory observation, so as to enable ‘virtual witnessing’ by wider audiences”, open up to much more complex understandings than one of calculative self-discipline at work. As “instrument[s] of public involvement” (120), the experiments that Mares describe locate the politics of life in the embodied socio-material entanglements of the domestic sphere, in arrangements of humans and non-human technologies. Such arrangements, she suggests, are ontologically productive in that they introduce “not only new knowledge, but also new entities […] to society” (119), and as such these experiments and the modes of calculation they employ become active in the composition of reality. Recent work in economic sociology and cultural studies has similarly contended that calculation, far from either a naturalised or thoroughly abstract process, relies upon a host of devices, relations, and techniques: that is, as Gay Hawkins explains, calculative processes “have to be enacted” (108). Environmental governmentality in the service of securing life is a networked practice that draws in a host of actors, not a top-down imposition. The institution of carbon economies and carbon emissions as a new register of public accountability, brings alternative ways to calculate the world into being, and consequently re-calibrates life as it emerges from these heterogeneous arrangements. All That Gathers Latour writes that we come to know a matter of concern by all the things that gather around it (Latour). This includes the human, as well as the non-human actors, policies, practices and technologies that are put to work in the making of our realities. Climate change is routinely represented as a threat to life, with predicted (and occurring) species extinction, growing numbers of climate change refugees, dispossessed from uninhabitable lands, and the rise of diseases and extreme weather scenarios that put human life in peril. There is no doubt, of course, that climate change does mean death for some: indeed, there are thanopolitical overtones in inequitable relations between the fall-out of impacts from major polluting nations on poorer countries, or those much more susceptible to rising sea levels. Biosocial equity, as Bull points out, is a “matter of being equally alive and equally dead” (2). Yet in the biopolitical project of assuring living, life is burgeoning around the problem of climate change. The critique of neo-liberalism as a blanketing system that subjects all aspects of life to market logic, and in which the cynical techniques of industry seek to appropriate ethico-political stances for their own material ends, are insufficient responses to what is actually unfolding in the messy terrain of climate change and its biopolitics. What this paper has attempted to show is that there is no particular purchase on life that can be had by any one actor who gathers around this concern. Varying interests, ambitions, and intentions, without moral hierarchy, stake their claim in life as a constantly constituting site in which they participate, and from this perspective, the ways in which we understand life to be both produced and managed expand. This is to refuse either an opposition or a conflation between the market and nature, or the market and life. It is also to argue that we cannot essentialise human-ness in the climate change debate. For while human relations with animals, plants and weathers may make us what we are, so too do our relations with (in a much less romantic view) non-human things, technologies, schemes, and even markets—from carbon auditing services, to the label on a tin on the supermarket shelf. As these intersect and entangle, the project of life, in the new politics of climate change, is far from straightforward. References An Inconvenient Truth. Dir. Davis Guggenheim. Village Roadshow, 2006. Arup, Tom. “Victoria Makes Enormous Carbon Stocktake in Bid for Offset Billions.” The Age 24 Sep. 2009: 7. Bratich, Jack Z., Jeremy Packer, and Cameron McCarthy. “Governing the Present.” Foucault, Cultural Studies and Governmentality. Ed. Bratich, Packer and McCarthy. Albany: State University of New York Press, 2003. 3-21. Bull, Malcolm. “Globalization and Biopolitics.” New Left Review 45 (2007): 12 May 2009 . < http://newleftreview.org/?page=article&view=2675 >. Charkiewicz, Ewa. “Corporations, the UN and Neo-liberal Bio-politics.” Development 48.1 (2005): 75-83. Clark, Nigel, and Nick Stevenson. “Care in a Time of Catastrophe: Citizenship, Community and the Ecological Imagination.” Journal of Human Rights 2.2 (2003): 235-246. Crombie, Angela. A Lighter Footprint: A Practical Guide to Minimising Your Impact on the Planet. Carlton North, Vic.: Scribe, 2007. Di Muzio, Tim. “Governing Global Slums: The Biopolitics of Target 11.” Global Governance. 14.3 (2008): 305-326. Elden, Stuart. “Governmentality, Calculation and Territory.” Environment and Planning D: Society and Space 25 (2007): 562-580. Hawkins, Gay. The Ethics of Waste: How We Relate to Rubbish. Sydney: University of New South Wales Press, 2006. Latour, Bruno. “Why Has Critique Run Out of Steam?: From Matters of Fact to Matters of Concern.” Critical Inquiry 30.2 (2004): 225-248. Mares, Noortje. “Testing Powers of Engagement: Green Living Experiments, the Ontological Turn and the Undoability and Involvement.” European Journal of Social Theory 12.1 (2009): 117-133. MGI Business Solutions Worldwide. “Carbon News.” Adelaide. 2 Aug. 2009. Ong, Aihwa. “Mutations in Citizenship.” Theory, Culture and Society 23.2-3 (2006): 499-505. Potter, Emily. “Footprints in the Mallee: Climate Change, Sustaining Communities, and the Nature of Place.” Landscapes and Learning: Place Studies in a Global World. Ed. Margaret Somerville, Kerith Power and Phoenix de Carteret. Sense Publishers. Forthcoming. Rabinow, Paul, and Nikolas Rose. “Biopower Today.” Biosocieties 1 (2006): 195-217. Rose, Nikolas. “The Politics of Life Itself.” Theory, Culture and Society 18.6 (2001): 1-30. World Wildlife Fund. Living Planet Report 2008. Switzerland, 2008.

Abstract:

On 19 January 1975, Australia’s first youth station 2JJ (Double Jay) launched itself onto the nation’s airwaves with a NASA-style countdown and You Only Like Me ‘Cause I’m Good in Bed by Australian band Skyhooks. Refused airtime by the commercial stations because of its explicit sexual content, this song was a clear signifier of the new station’s intent—to occupy a more radical territory on Australian radio. Indeed, Double Jay’s musical entrée into the highly restrictive local broadcasting environment of the time has gone on to symbolise both the station’s role in its early days as an enfant terrible of radio (Inglis 376), and its near 40 years as a voice for youth culture in Australia (Milesago, Double Jay). In this paper we explore the proposition that Double Jay functioned as an outlet for youth counterculture in Australia, and that it achieved this even with (and arguably because of) its credentials as a state-generated entity. This proposition is considered via brief analysis of the political and musical context leading to the establishment of Double Jay. We intend to demonstrate that although the station was deeply embedded in “the system” in material and cultural terms, it simultaneously existed in an “uneasy symbiosis” (Martin and Siehl 54) with this system because it consciously railed against the mainstream cultures from which it drew, providing a public and active vehicle for youth counterculture in Australia. The origins of Double Jay thus provide one example of the complicated relationship between culture and counterculture, and the multiple ways in which the two are inextricably linked. As a publicly-funded broadcasting station Double Jay was liberated from the industrial imperatives of Australia’s commercial stations which arguably drove their predisposition for formula. The absence of profit motive gave Double Jay’s organisers greater room to experiment with format and content, and thus the potential to create a genuine alternative in Australia broadcasting. As a youth station Double Jay was created to provide a minority with its own outlet. The Labor government committed to wrenching airspace from the very restrictive Australian broadcasting “system” (Wiltshire and Stokes 2) to provide minority voices with room to speak and to be heard. Youth was identified by the government as one such minority. The Australian Broadcasting Commission (ABC) contributed to this process by enabling young staffers to establish the semi-independent Contemporary Radio Unit (CRU) (Webb) and within this a youth station. Not only did this provide a focal point around which a youth collective could coalesce, but the distinct place and identity of Double Jay within the ABC offered its organisers the opportunity to ignore or indeed subvert some of the perceived strictures of the “mothership” that was the ABC, whether in organisational, content and/or stylistic terms. For these and other reasons Double Jay was arguably well positioned to counter the broadcasting cultures that existed alongside this station. It did so stylistically, and also in more fundamental ways, At the same time, however, it “pillaged the host body at random” (Webb) co-opting certain aspects of these cultures (people, scheduling, content, administration) which in turn implicated Double Jay in the material and cultural practices of those mainstream cultures against which it railed. Counterculture on the Airwaves: Space for Youth to Play? Before exploring these themes further, we should make clear that Double Jay’s legitimacy as a “counterculture” organisation is observably tenuous against the more extreme renderings of the concept. Theodore Roszak, for example, requires of counterculture something “so radically disaffiliated from the mainstream assumptions of our society that it scarcely looks to many as a culture at all” (5). Double Jay was a brainchild of the state: an outcome of the Whitlam Government’s efforts to open up the nation’s airwaves (Davis, Government; McClelland). Further, the supervision of this station was given to the publicly funded Australian national broadcaster, the ABC (Inglis). Any claim Double Jay has to counterculture status then is arguably located in less radical invocations of the term. Some definitions, for example, hold that counterculture contains value systems that run counter to culture, but these values are relational rather than divorced from each other. Kenneth Leech, for example, states that counterculture is "a way of life and philosophy which at central points is in conflict with the mainstream society” (Desmond et al. 245, our emphasis); E.D. Batzell defines counterculture as "a minority culture marked by a set of values, norms and behaviour patterns which contradict those of the dominant society" (116, our emphasis). Both definitions imply that counterculture requires the mainstream to make sense of what it is doing and why. In simple terms then, counterculture as the ‘other’ does not exist without its mainstream counterpoint. The particular values with which counterculture is in conflict are generated by “the system” (Heath and Potter 6)—a system that imbues “manufactured needs and mass-produced desires” (Frank 15) in the masses to encourage order, conformity and consumption. Counterculture seeks to challenge this “system” via individualist, expression-oriented values such as difference, diversity, change, egalitarianism, and spontaneity (Davis On Youth; Leary; Thompson and Coskuner‐Balli). It is these kinds of counterculture values that we demonstrate were embedded in the content, style and management practices within Double Jay. The Whitlam Years and the Birth of Double Jay Double Jay was borne of the Whitlam government’s brief but impactful period in office from 1972 to 1975, after 23 years of conservative government in Australia. Key to the Labor Party’s election platform was the principle of participatory democracy, the purpose of which was “breaking down apathy and maximising active citizen engagement” (Cunningham 123). Within this framework, the Labor Party committed to opening the airwaves, and reconfiguring the rhetoric of communication and media as a space of and for the people (Department of the Media 3). Labor planned to honour this commitment via sweeping reforms that would counter the heavily concentrated Australian media landscape through “the encouragement of diversification of ownership of commercial radio and television”—and in doing so enable “the expression of a plurality of viewpoints and cultures throughout the media” (Department of the Media 3). Minority groups in particular were to be privileged, while some in the Party even argued for voices that would actively agitate. Senator Jim McClelland, for one, declared, “We say that somewhere in the system there must be broadcasting which not only must not be afraid to be controversial but has a duty to be controversial” (Senate Standing Committee 4). One clear voice of controversy to emerge in the 1960s and resonate throughout the 1970s was the voice of youth (Gerster and Bassett; Langley). Indeed, counterculture is considered by some as synonymous with a particular strain of youth culture during this time (Roszak; Leech). The Labor Government acknowledged this hitherto unrecognised voice in its 1972 platform, with Minister for the Media Senator Doug McClelland claiming that his party would encourage the “whetting of the appetite” for “life and experimentation” of Australia’s youth – in particular through support for the arts (160). McClelland secured licenses for two “experimental-type” stations under the auspices of the ABC, with the youth station destined for Sydney via the ABC’s standby transmitter in Gore Hill (ABCB, 2). Just as the political context in early 1970s Australia provided the necessary conditions for the appearance of Double Jay, so too did the cultural context. Counterculture emerged in the UK, USA and Europe as a clear and potent force in the late 1960s (Roszak; Leech; Frank; Braunstein and Doyle). In Australia this manifested in the 1960s and 1970s in various ways, including political protest (Langley; Horne); battles for the liberalisation of censorship (Hope and Dickerson, Liberalisation; Chipp and Larkin); sex and drugs (Dawson); and the art film scene (Hope and Dickerson, Happiness; Thoms). Of particular interest here is the “lifestyle” aspect of counterculture, within which the value-expressions against the dominant culture manifest in cultural products and practices (Bloodworth 304; Leary ix), and more specifically, music. Many authors have suggested that music was pivotal to counterculture (Bloodworth 309; Leech 8), a key “social force” through which the values of counterculture were articulated (Whiteley 1). The youth music broadcasting scene in Australia was extremely narrow prior to Double Jay, monopolised by a handful of media proprietors who maintained a stranglehold over the youth music scene from the mid-50s. This dominance was in part fuelled by the rising profitability of pop music, driven by “the dreamy teenage market”, whose spending was purely discretionary (Doherty 52) and whose underdeveloped tastes made them “immune to any sophisticated disdain of run-of-the-mill” cultural products (Doherty 230-231). Over the course of the 1950s the commercial stations pursued this market by “skewing” their programs toward the youth demographic (Griffen-Foley 264). The growing popularity of pop music saw radio shift from a “multidimensional” to “mono-dimensional” medium according to rock journalist Bruce Elder, in which the “lowest-common-denominator formula of pop song-chat-commercial-pop-song” dominated the commercial music stations (12). Emblematic of this mono-dimensionalism was the appearance of the Top 40 Playlist in 1958 (Griffin-Foley 265), which might see as few as 10–15 songs in rotation in peak shifts. Elder claims that this trend became more pronounced over the course of the 1960s and peaked in 1970, with playlists that were controlled with almost mechanical precision [and] compiled according to American-devised market research methods which tended to reinforce repetition and familiarity at the expense of novelty and diversity. (12) Colin Vercoe, whose job was to sell the music catalogues of Festival Records to stations like 2UE, 2SER and SUW, says it was “an incredibly frustrating affair” to market new releases because of the rigid attachment by commercials to the “Top 40 of endless repeats” (Vercoe). While some air time was given to youth music beyond the Top 40, this happened mostly in non-peak shifts and on weekends. Bill Drake at 2SM (who was poached by Double Jay and allowed to reclaim his real name, Holger Brockmann) played non-Top 40 music in his Sunday afternoon programme The Album Show (Brockmann). A more notable exception was Chris Winter’s Room to Move on the ABC, considered by many as the predecessor of Double Jay. Introduced in 1971, Room to Move played all forms of contemporary music not represented by the commercial broadcasters, including whole albums and B sides. Rock music’s isolation to the fringes was exacerbated by the lack of musical sales outlets for rock and other forms of non-pop music, with much music sourced through catalogues, music magazines and word of mouth (Winter; Walker). In this context a small number of independent record stores, like Anthem Records in Sydney and Archie and Jugheads in Melbourne, appear in the early 1970s. Vercoe claims that the commercial record companies relentlessly pursued the closure of these independents on the grounds they were illegal entities: The record companies hated them and they did everything they could do close them down. When (the companies) bought the catalogue to overseas music, they bought the rights. And they thought these record stores were impinging on their rights. It was clear that a niche market existed for rock and alternative forms of music. Keith Glass and David Pepperell from Archie and Jugheads realised this when stock sold out in the first week of trade. Pepperell notes, “We had some feeling we were doing something new relating to people our own age but little idea of the forces we were about to unleash”. Challenging the “System” from the Inside At the same time as interested individuals clamoured to buy from independent record stores, the nation’s first youth radio station was being instituted within the ABC. In October 1974, three young staffers—Marius Webb, Ron Moss and Chris Winter— with the requisite youth credentials were briefed by ABC executives to build a youth-style station for launch in January 1975. According to Winter “All they said was 'We want you to set up a station for young people' and that was it!”, leaving the three with a conceptual carte blanche–although assumedly within the working parameters of the ABC (Webb). A Contemporary Radio Unit (CRU) was formed in order to meet the requirements of the ABC while also creating a clear distinction between the youth station and the ABC. According to Webb “the CRU gave us a lot of latitude […] we didn’t have to go to other ABC Departments to do things”. The CRU was conscious from the outset of positioning itself against the mainstream practices of both the commercial stations and the ABC. The publicly funded status of Double Jay freed it from the shackles of profit motive that enslaved the commercial stations, in turn liberating its turntables from baser capitalist imperatives. The two coordinators Ron Moss and Marius Webb also bypassed the conventions of typecasting the announcer line-up (as was practice in both commercial and ABC radio), seeking instead people with charisma, individual style and youth appeal. Webb told the Sydney Morning Herald that Double Jay’s announcers were “not required to have a frontal lobotomy before they go on air.” In line with the individual- and expression-oriented character of the counterculture lifestyle, it was made clear that “real people” with “individuality and personality” would fill the airwaves of Double Jay (Nicklin 9). The only formula to which the station held was to avoid (almost) all formula – a mantra enhanced by the purchase in the station’s early days of thousands of albums and singles from 10 or so years of back catalogues (Robinson). This library provided presenters with the capacity to circumvent any need for repetition. According to Winter the DJs “just played whatever we wanted”, from B sides to whole albums of music, most of which had never made it onto Australian radio. The station also adapted the ABC tradition of recording live classical music, but instead recorded open-air rock concerts and pub gigs. A recording van built from second-hand ABC equipment captured the grit of Sydney’s live music scene for Double Jay, and in so doing undercut the polished sounds of its commercial counterparts (Walker). Double Jay’s counterculture tendencies further extended to its management style. The station’s more political agitators, led by Webb, sought to subvert the traditional top-down organisational model in favour of a more egalitarian one, including a battle with the ABC to remove the bureaucratic distinction between technical staff and presenters and replace this with the single category “producer/presenter” (Cheney, Webb, Davis 41). The coordinators also actively subverted their own positions as coordinators by holding leaderless meetings open to all Double Jay employees – meetings that were infamously long and fraught, but also remembered as symbolic of the station’s vibe at that time (Frolows, Matchett). While Double Jay assumed the ABC’s focus on music, news and comedy, at times it politicised the content contra to the ABC’s non-partisan policy, ignored ABC policy and practice, and more frequently pushed its contents over the edges of what was considered propriety and taste. These trends were already present in pockets of the ABC prior to Double Jay: in current affairs programmes like This Day Tonight and Four Corners (Harding 49); and in overtly leftist figures like Alan Ashbolt (Bowman), who it should be noted had a profound influence over Webb and other Double Jay staff (Webb). However, such an approach to radio still remained on the edges of the ABC. As one example of Double Jay’s singularity, Webb made clear that the ABC’s “gentleman’s agreement” with the Federation of Australian Commercial Broadcasters to ban certain content from airplay would not apply to Double Jay because the station would not “impose any censorship on our people” – a fact demonstrated by the station’s launch song (Nicklin 9). The station’s “people” in turn made the most of this freedom with the production of programmes like Gayle Austin’s Horny Radio p*rn Show, the Naked Vicar Show, the adventures of Colonel Chuck Chunder of the Space Patrol, and the Sunday afternoon comic improvisations of Nude Radio from the team that made Aunty Jack. This openness also made its way into the news team, most famously in its second month on air with the production of The Ins and Outs of Love, a candid documentary of the sexual proclivities and encounters of Sydney’s youth. Conservative ABC staffer Clement Semmler described the programme as containing such “disgustingly explicit accounts of the sexual behaviour of young teenagers” that it “aroused almost universal obloquy from listeners and the press” (35). The playlist, announcers, comedy sketches, news reporting and management style of Double Jay represented direct challenges to the entrenched media culture of Australia in the mid 1970s. The Australian National Commission for UNESCO noted at the time that Double Jay was “variously described as political, subversive, offensive, p*rnographic, radical, revolutionary and obscene” (7). While these terms were understandable given the station’s commitment to experiment and innovation, the “vital point” about Double Jay was that it “transmitted an electronic reflection of change”: What the station did was to zero in on the kind of questioning of traditional values now inherent in a significant section of the under 30s population. It played their music, talked in their jargon, pandered to their whims, tastes, prejudices and societal conflicts both intrinsic and extrinsic. (48) Conclusion From the outset, Double Jay was locked in an “uneasy symbiosis” with mainstream culture. On the one hand, the station was established by federal government and its infrastructure was provided by state funds. It also drew on elements of mainstream broadcasting in multiple ways. However, at the same time, it was a voice for and active agent of counterculture, representing through its content, form and style those values that were considered to challenge the ‘system,’ in turn creating an outlet for the expression of hitherto un-broadcast “ways of thinking and being” (Leary). As Henry Rosenbloom, press secretary to then Labor Minister Dr Moss Cass wrote, Double Jay had the potential to free its audience “from an automatic acceptance of the artificial rhythms of urban and suburban life. In a very real sense, JJ [was] a deconditioning agent” (Inglis 375-6). While Double Jay drew deeply from mainstream culture, its skilful and playful manipulation of this culture enabled it to both reflect and incite youth-based counterculture in Australia in the 1970s. References Australian Broadcasting Control Board. Development of National Broadcasting and Television Services. ABCB: Sydney, 1976. Batzell, E.D. “Counter-Culture.” Blackwell Dictionary of Twentieth-Century Social Thought. Eds. Williams Outhwaite and Tom Bottomore. Oxford: Blackwell, 1994. 116-119. Bloodworth, John David. “Communication in the Youth Counterculture: Music as Expression.” Central States Speech Journal 26.4 (1975): 304-309. Bowman, David. “Radical Giant of Australian Broadcasting: Allan Ashbolt, Lion of the ABC, 1921-2005.” Sydney Morning Herald 15 June 2005. 15 Sep. 2013 ‹http://www.smh.com.au/news/Obituaries/Radical-giant-of-Australian-broadcasting/2005/06/14/1118645805607.html›. Braunstein, Peter, and Michael William Doyle. Eds. Imagine Nation: The American Counterculture of the 1960s and '70s New York: Taylor and Francis, 2002. Brockman, Holger. Personal interview. 8 December 2013. Cheney, Roz. Personal interview. 10 July 2013. Chipp, Don, and John Larkin. Don Chipp: The Third Man. Adelaide: Rigby, 2008. Cunningham, Frank. Theories of Democracy: A Critical Introduction. London: Routledge, 2002. Davis, Fred. On Youth Subcultures: The Hippie Variant. New York: General Learning Press, 1971. Davis, Glyn. "Government Decision‐Making and the ABC: The 2JJ Case." Politics 19.2 (1984): 34-42. Dawson, Jonathan. "JJJ: Radical Radio?." Continuum: Journal of Media & Cultural Studies 6.1 (1992): 37-44. Department of the Media. Submission by the Department of the Media to the Independent Inquiry into Frequency Modulation Broadcasting. Sydney: Australian Government Publishers, 1974. Desmond, John, Pierre McDonagh, and Stephanie O'Donohoe. “Counter-Culture and Consumer Society.” Consumption Markets & Culture 4.3 (2000): 241-279. Doherty, Thomas. Teenagers and Teenpics: The Juvenilization of American Movies in the 1950s. Boston: Unwin Hyman, 1988. Elder, Bruce. Sound Experiment. Unpublished manuscript, 1988. Australian National Commission for UNESCO. Extract from Seminar on Entertainment and Society, Report on Research Project. 1976. Frolows, Arnold. Personal interview. 10 July 2013. Frank, Thomas. The Conquest of Cool: Business Culture, Counterculture, and the Rise of Hip Consumerism. Chicago: University of Chicago Press, 1997. Gerster, Robin, and Jan Bassett. Seizures of Youth: The Sixties and Australia. Melbourne: Hyland House, 1991. Griffen-Foley, Bridget. Changing Stations: The Story of Australian Commercial Radio, Sydney: UNSW Press, 2009. Harding, Richard. Outside Interference: The Politics of Australian Broadcasting. Melbourne: Sun Books, 1979. Heath, Joseph, and Andrew Potter. Nation of Rebels: Why Counterculture Became Consumer Culture. New York: Harper Collins, 2004. Hope, Cathy, and Adam Dickerson. “The Sydney and Melbourne Film Festivals, and the Liberalisation of Film Censorship in Australia”. Screening the Past 35 (2012). 12 Aug. 2014 ‹http://www.screeningthepast.com/2012/12/the-sydney-and-melbourne-film-festivals-and-the-liberalisation-of-film-censorship-in-australia/›. Hope, Cathy, and Adam Dickerson. “Is Happiness Festival-Shaped Any Longer? The Melbourne and Sydney Film Festivals and the Growth of Australian Film Culture 1973-1977”. Screening the Past 38 (2013). 12 Aug. 2014 ‹http://www.screeningthepast.com/2013/12/‘is-happiness-festival-shaped-any-longer’-the-melbourne-and-sydney-film-festivals-and-the-growth-of-australian-film-culture-1973-1977/›. Horne, Donald. Time of Hope: Australia 1966-72. Sydney: Angus and Robertson, 1980. Inglis, Ken. This Is the ABC: The Australian Broadcasting Commission, 1932-1983. Melbourne: Melbourne University Press, 1983. Langley, Greg. A Decade of Dissent: Vietnam and the Conflict on the Australian Homefront. Sydney: Allen and Unwin, 1992. Leary, Timothy. “Foreword.” Counterculture through the Ages: From Abraham to Acid House. Eds. Ken Goffman and Dan Joy. New York: Villard, 2007. ix-xiv. Leech, Kenneth. Youthquake: The Growth of a Counter-Culture through Two Decades. London: Sheldon Press, 1973. Martin, J., and C. Siehl. "Organizational Culture and Counterculture: An Uneasy Symbiosis. Organizational Dynamics, 12.2 (1983): 52-64. Martin, Peter. Personal interview. 10 July 2014. Matchett, Stuart. Personal interview. 10 July 2013. McClelland, Douglas. “The Arts and Media.” Towards a New Australia under a Labor Government. Ed. John McLaren. Victoria: Cheshire Publishing, 1972. McClelland, Douglas. Personal interview. 25 August 2010. Milesago. “Double Jay: The First Year”. n.d. 8 Oct. 2012 ‹http://www.milesago.com/radio/2jj.htm›. Milesago. “Part 5: 1971-72 - Sundown and 'Archie & Jughead's”. n.d. Keith Glass – A Life in Music. 12 Oct. 2012 ‹http://www.milesago.com/Features/keithglass5.htm›. Nicklin, Lenore. “Rock (without the Roll) around the Clock.” Sydney Morning Herald 18 Jan. 1975: 9. Robinson, Ted. Personal interview. 11 December 2013. Roszak, Theodore. The Making of a Counter Culture. New York: Anchor, 1969. Semmler, Clement. The ABC - Aunt Sally and Sacred Cow. Carlton: Melbourne University Press, 1981. Senate Standing Committee on Education, Science and the Arts and Jim McClelland. Second Progress Report on the Reference, All Aspects of Television and Broadcasting, Including Australian Content of Television Programmes. Canberra: Australian Senate, 1973. Thompson, Craig J., and Gokcen Coskuner‐Balli. "Countervailing Market Responses to Corporate Co‐optation and the Ideological Recruitment of Consumption Communities." Journal of Consumer Research 34.2 (2007): 135-152. Thoms, Albie. “The Australian Avant-garde.” An Australian Film Reader. Eds. Albert Moran and Tom O’Regan. Sydney: Currency Press, 1985. 279–280. Vercoe, Colin. Personal interview. 11 Feb. 2014. Walker, Keith. Personal interview. 11 July 2013. Webb, Marius. Personal interview. 5 Feb. 2013. Whiteley, Sheila. The Space between the Notes: Rock and the Counter-Culture. London: Routledge, 1992. Wiltshire, Kenneth, and Charles Stokes. Government Regulation and the Electronic Commercial Media. Monograph M43. Melbourne: Committee for Economic Development of Australia, 1976. Winter, Chris. Personal interview. 16 Mar. 2013.

Abstract:

My thesis is that new media, starting with analog broadcast and going through digital convergence, blur the line between work time and free time. The technology that we are adopting has transformed free time into potential and actual labour time. At the dawn of the modern age, work shifted from tasked time to measured time. Previously, tasked time intermingled work and leisure according to the vagaries of nature. All this was banished when industrial capitalism instituted the work clock (Mumford 12-8). But now, many have noticed how post-industrial capitalism features a new intermingling captured in such expressions as "24/7" and "multi-tasking." Yet, we are only beginning to understand that media are driving a return to the pre-modern where the hour and the space are both ambiguous, available for either work or leisure. This may be the unfortunate side effect of the much vaunted "interactivity." Do you remember the old American TV show Dobie Gillis (1959-63) which featured the character Maynard G. Krebs? He always shuddered at the mention of the four-letter word "work." Now, American television shows makes it a point that everyone works (even if just barely). Seinfeld was a bold exception in featuring the work-free Kramer; a deliberate homage to the 1940s team of Abbott and Costello. Today, as welfare is turned into workfare, The New York Times scolds even the idle rich to adopt the work ethic (Yazigi). The Forms of Broadcast and Digital Media Are Driving the Merger of Work and Leisure More than the Content It is not just the content of television and other media that is undermining the leisured life; it is the social structure within which we use the media. Broadcast advertisem*nts were the first mode/media combinations that began to recolonise free time for the new consumer economy. There had been a previous buildup in the volume and the ubiquity of advertising particularly in billboards and print. However, the attention of the reader to the printed commercial message could not be controlled and measured. Radio was the first to appropriate and measure its audience's time for the purposes of advertising. Nineteenth century media had promoted a middle class lifestyle based on spending money on home to create a refuge from work. Twentieth century broadcasting was now planting commercial messages within that refuge in the sacred moments of repose. Subsequent to broadcast, home video and cable facilitated flexible work by offering entertainment on a 24 hour basis. Finally, the computer, which juxtaposes image/sound/text within a single machine, offers the user the same proto-interactive blend of entertainment and commercial messages that broadcasting pioneered. It also fulfills the earlier promise of interactive TV by allowing us to work and to shop, in all parts of the day and night. We need to theorise this movement. The theory of media as work needs an institutional perspective. Therefore, I begin with Dallas Smythe's blindspot argument, which gave scholarly gravitas to the structural relationship of work and media (263-299). Horkheimer and Adorno had already noticed that capitalism was extending work into free time (137). Dallas Smythe went on to dissect the precise means by which late capitalism was extending work. Smythe restates the Marxist definition of capitalist labour as that human activity which creates exchange value. Then he considered the advertising industry, which currently approaches200 billion in the USA and realised that a great deal of exchange value has been created. The audience is one element of the labour that creates this exchange value. The appropriation of people's time creates advertising value. The time we spend listening to commercials on radio or viewing them on TV can be measured and is the unit of production for the value of advertising. Our viewing time ipso facto has been changed into work time. We may not experience it subjectively as work time although pundits such as Marie Winn and Jerry Mander suggest that TV viewing contributes to the same physical stresses as actual work. Nonetheless, Smythe sees commercial broadcasting as expanding the realm of capitalism into time that was otherwise set aside for private uses. Smythe's essay created a certain degree of excitement among political economists of media. Sut Jhally used Smythe to explain aspects of US broadcast history such as the innovations of William Paley in creating the CBS network (Jhally 70-9). In 1927, as Paley contemplated winning market share from his rival NBC, he realised that selling audience time was far more profitable than selling programs. Therefore, he paid affiliated stations to air his network's programs while NBC was still charging them for the privilege. It was more lucrative to Paley to turn around and sell the stations' guaranteed time to advertisers, than to collect direct payments for supplying programs. NBC switched to his business model within a year. Smythe/Jhally's model explains the superiority of Paley's model and is a historical proof of Smythe's thesis. Nonetheless, many economists and media theorists have responded with a "so what?" to Smythe's thesis that watching TV as work. Everyone knows that the basis of network television is the sale of "eyeballs" to the advertisers. However, Smythe's thesis remains suggestive. Perhaps he arrived at it after working at the U.S. Federal Communications Commission from 1943 to 1948 (Smythe 2). He was part of a team that made one last futile attempt to force radio to embrace public interest programming. This effort failed because the tide of consumerism was too strong. Radio and television were the leading edge of recapturing the home for work, setting the stage for the Internet and a postmodern replication of the cottage industries of pre and proto-industrial worlds. The consequences have been immense. The Depression and the crisis of over-production Cultural studies recognises that social values have shifted from production to consumption (Lash and Urry). The shift has a crystallising moment in the Great Depression of 1929 through 1940. One proposal at the time was to reduce individual work hours in order to create more jobs (see Hunnicut). This proposal of "share the work" was not adopted. From the point of view of the producer, sharing the work would make little difference to productivity. However, from the retailer's perspective each individual worker would accumulate less money to buy products. Overall sales would stagnate or decline. Prominent American economists at the time argued that sharing the work would mean sharing the unemployment. They warned the US government this was a fundamental threat to an economy based on consumption. Only a fully employed laborer could have enough money to buy down the national inventory. In 1932, N. A. Weston told the American Economic Association that: " ...[the labourers'] function in society as a consumer is of equal importance as the part he plays as a producer." (Weston 11). If the defeat of the share the work movement is the negative manifestation of consumerism, then the invasion by broadcast of our leisure time is its positive materialisation. We can trace this understanding by looking at Herbert Hoover. When he was the Secretary of Commerce in 1924 he warned station executives that: "I have never believed that it was possible to advertise through broadcasting without ruining the [radio] industry" (Radio's Big Issue). He had not recognised that broadcast advertising would be qualitatively more powerful for the economy than print advertising. By 1929, Hoover, now President Hoover, approved an economics committee recommendation in the traumatic year of 1929 that leisure time be made "consumable " (Committee on Recent Economic Changes xvi). His administration supported the growth of commercial radio because broadcasting was a new efficient answer to the economists' question of how to motivate consumption. Not so coincidentally network radio became a profitable industry during the great Depression. The economic power that pre-war radio hinted at flourished in the proliferation of post-war television. Advertisers switched their dollars from magazines to TV, causing the demise of such general interest magazines as Life, The Saturday Evening Postet al. Western Europe quickly followed the American broadcasting model. Great Britain was the first, allowing television to advertise the consumer revolution in 1955. Japan and many others started to permit advertising on television. During the era of television, the nature of work changed from manufacturing to servicing (Preston 148-9). Two working parents also became the norm as a greater percentage of the population took salaried employment, mostly women (International Labour Office). Many of the service jobs are to monitor the new global division of labour that allows industrialised nations to consume while emerging nations produce. (Chapter seven of Preston is the most current discussion of the shift of jobs within information economies and between industrialised and emerging nations.) Flexible Time/ Flexible Media Film and television has responded by depicting these shifts. The Mary Tyler Moore Show debuted in September of 1970 (see http://www.transparencynow.com/mary.htm). In this show nurturing and emotional attachments were centered in the work place, not in an actual biological family. It started a trend that continues to this day. However, media representations of the changing nature of work are merely symptomatic of the relationship between media and work. Broadcast advertising has a more causal relationship. As people worked more to buy more, they found that they wanted time-saving media. It is in this time period that the Internet started (1968), that the video cassette recorder was introduced (1975) and that the cable industry grew. Each of these ultimately enhanced the flexibility of work time. The VCR allowed time shifting programs. This is the media answer to the work concept of flexible time. The tired worker can now see her/his favourite TV show according to his/her own flex schedule (Wasser 2001). Cable programming, with its repeats and staggered starting times, also accommodates the new 24/7 work day. These machines, offering greater choice of programming and scheduling, are the first prototypes of interactivity. The Internet goes further in expanding flexible time by adding actual shopping to the vicarious enjoyment of consumerist products on television. The Internet user continues to perform the labour of watching advertising and, in addition, now has the opportunity to do actual work tasks at any time of the day or night. The computer enters the home as an all-purpose machine. Its purchase is motivated by several simultaneous factors. The rhetoric often stresses the recreational and work aspects of the computer in the same breath (Reed 173, Friedrich 16-7). Games drove the early computer programmers to find more "user-friendly" interfaces in order to entice young consumers. Entertainment continues to be the main driving force behind visual and audio improvements. This has been true ever since the introduction of the Apple II, Radio Shack's TRS 80 and Atari 400 personal computers in the 1977-1978 time frame (see http://www.atari-history.com/computers/8bits/400.html). The current ubiquity of colour monitors, and the standard package of speakers with PC computers are strong indications that entertainment and leisure pursuits continue to drive the marketing of computers. However, once the computer is in place in the study or bedroom, its uses fully integrates the user with world of work in both the sense of consuming and creating value. This is a specific instance of what Philip Graham calls the analytical convergence of production, consumption and circulation in hypercapitalism. The streaming video and audio not only captures the action of the game, they lend sensual appeal to the banner advertising and the power point downloads from work. In one regard, the advent of Internet advertising is a regression to the pre-broadcast era. The passive web site ad runs the same risk of being ignored as does print advertising. The measure of a successful web ad is interactivity that most often necessitates a click through on the part of the viewer. Ads often show up on separate windows that necessitate a click from the viewer if only to close down the program. In the words of Bolter and Grusin, click-through advertising is a hypermediation of television. In other words, it makes apparent the transparent relationship television forged between work and leisure. We do not sit passively through Internet advertising, we click to either eliminate them or to go on and buy the advertised products. Just as broadcasting facilitated consumable leisure, new media combines consumable leisure with flexible portable work. The new media landscape has had consequences, although the price of consumable leisure took awhile to become visible. The average work week declined from 1945 to 1982. After that point in the US, it has been edging up, continuously (United States Bureau of Labor Statistics). There is some question whether the computer has improved productivity (Kim), there is little question that the computer is colonising leisure time for multi-tasking. In a population that goes online from home almost twice as much as those who go online from work, almost half use their online time for work based activities other than email. Undoubtedly, email activity would account for even more work time (Horrigan). On the other side of the blur between work and leisure, the Pew Institute estimates that fifty percent use work Internet time for personal pleasure ("Wired Workers"). Media theory has to reengage the problem that Horkheimer/Adorno/Smythe raised. The contemporary problem of leisure is not so much the lack of leisure, but its fractured, non-contemplative, unfulfilling nature. A media critique will demonstrate the contribution of the TV and the Internet to this erosion of free time. References Bolter, Jay David, and Richard Grusin. Remediation: Understanding New Media. Cambridge, MA: MIT Press, 2000. Committee on Recent Economic Changes. Recent Economic Changes. Vol. 1. New York: no publisher listed, 1929. Friedrich, Otto. "The Computer Moves In." Time 3 Jan. 1983: 14-24. Graham, Philip. Hypercapitalism: A Political Economy of Informational Idealism. In press for New Media and Society2.2 (2000). Horkheimer, Max, and Theodor W. Adorno. Dialectic of Enlightenment. New York: Continuum Publishing, 1944/1987. Horrigan, John B. "New Internet Users: What They Do Online, What They Don't and Implications for the 'Net's Future." Pew Internet and American Life Project. 25 Sep. 2000. 24 Oct. 2001 <http://www.pewinternet.org/reports/toc.asp?Report=22>. Hunnicutt, Benjamin Kline. Work without End: Abandoning Shorter Hours for the Right to Work. Philadelphia: Temple UP, 1988. International Labour Office. Economically Active Populations: Estimates and Projections 1950-2025. Geneva: ILO, 1995. Jhally, Sut. The Codes of Advertising. New York: St. Martin's Press, 1987. Kim, Jane. "Computers and the Digital Economy." Digital Economy 1999. 8 June 1999. October 24, 2001 <http://www.digitaleconomy.gov/powerpoint/triplett/index.htm>. Lash, Scott, and John Urry. Economies of Signs and Space. London: Sage Publications, 1994. Mander, Jerry. Four Arguments for the Elimination of Television. New York: Morrow Press, 1978. Mumford, Lewis. Technics and Civilization. New York: Harcourt Brace, 1934. Preston, Paschal. Reshaping Communication: Technology, Information and Social Change. London: Sage, 2001. "Radio's Big Issue Who Is to Pay the Artist?" The New York Times 18 May 1924: Section 8, 3. Reed, Lori. "Domesticating the Personal Computer." Critical Studies in Media Communication17 (2000): 159-85. Smythe, Dallas. Counterclockwise: Perspectives on Communication. Boulder, CO: Westview Press, 1993. United States Bureau of Labor Statistics. Unpublished Data from the Current Population Survey. 2001. Wasser, Frederick A. Veni, Vidi, Video: The Hollywood Empire and the VCR. Austin, TX: U of Texas P, 2001. Weston, N.A., T.N. Carver, J.P. Frey, E.H. Johnson, T.R. Snavely and F.D. Tyson. "Shorter Working Time and Unemployment." American Economic Review Supplement 22.1 (March 1932): 8-15. <http://links.jstor.org/sici?sici=0002-8282%28193203%2922%3C8%3ASWTAU%3E2.0.CO%3B2-3>. Winn, Marie. The Plug-in Drug. New York: Viking Press, 1977. "Wired Workers: Who They Are, What They're Doing Online." Pew Internet Life Report 3 Sep. 2000. 24 Oct. 2000 <http://www.pewinternet.org/reports/toc.asp?Report=20>. Yazigi, Monique P. "Shocking Visits to the Real World." The New York Times 21 Feb. 1990. Page unknown. Links http://www.pewinternet.org/reports/toc.asp?Report=20 http://www.pewinternet.org/reports/toc.asp?Report=22 http://www.atari-history.com/computers/8bits/400.html http://www.transparencynow.com/mary.htm http://www.digitaleconomy.gov/powerpoint/triplett/index.htm http://links.jstor.org/sici?sici=0002-8282%28193203%2922%3C8%3ASWTAU%3 E2.0.CO%3B2-3 Citation reference for this article MLA Style Wasser, Frederick. "Media Is Driving Work" M/C: A Journal of Media and Culture 4.5 (2001). [your date of access] < http://www.media-culture.org.au/0111/Wasser.xml >. Chicago Style Wasser, Frederick, "Media Is Driving Work" M/C: A Journal of Media and Culture 4, no. 5 (2001), < http://www.media-culture.org.au/0111/Wasser.xml > ([your date of access]). APA Style Wasser, Frederick. (2001) Media Is Driving Work. M/C: A Journal of Media and Culture 4(5). < http://www.media-culture.org.au/0111/Wasser.xml > ([your date of access]).

Abstract:

IntroductionThe Internet (especially in the so-called Web 2.0 phase), digital media and file-sharing networks have thrust copyright law under public scrutiny, provoking discourses questioning what is fair in the digital age. Accessible hardware and software has led to prosumerism – creativity blending media consumption with media production to create new works that are freely disseminated online via popular video-sharing Web sites such as YouTube or genre specific music sites like GYBO (“Get Your Bootleg On”) amongst many others. The term “prosumer” is older than the Web, and the conceptual convergence of producer and consumer roles is certainly not new, for “at electric speeds the consumer becomes producer as the public becomes participant role player” (McLuhan 4). Similarly, Toffler’s “Third Wave” challenges “old power relationships” and promises to “heal the historic breach between producer and consumer, giving rise to the ‘prosumer’ economics” (27). Prosumption blurs the traditionally separate consumer and producer creating a new creative era of mass customisation of artefacts culled from the (copyrighted) media landscape (Tapscott 62-3). Simultaneously, corporate interests dependent upon the protections provided by copyright law lobby for augmented rights and actively defend their intellectual property through law suits, takedown notices and technological reinforcement. Despite a lack demonstrable economic harm in many cases, the propertarian approach is winning and frequently leading to absurd results (Collins).The balance between private and public interests in creative works is facilitated by the doctrine of fair use (as codified in the United States Copyright Act 1976, section 107). The majority of copyright laws contain “fair” exceptions to claims of infringement, but fair use is characterised by a flexible, open-ended approach that allows the law to flex with the times. Until recently the defence was unique to the U.S., but on 2 January Israel amended its copyright laws to include a fair use defence. (For an overview of the new Israeli fair use exception, see Efroni.) Despite its flexibility, fair use has been systematically eroded by ever encroaching copyrights. This paper argues that copyright enforcement has spun out of control and the raison d’être of the law has shifted from being “an engine of free expression” (Harper & Row, Publishers, Inc. v. Nation Enterprises 471 U.S. 539, 558 (1985)) towards a “legal regime for intellectual property that increasingly looks like the law of real property, or more properly an idealized construct of that law, one in which courts seeks out and punish virtually any use of an intellectual property right by another” (Lemley 1032). Although the copyright landscape appears bleak, two recent cases suggest that fair use has not fallen by the wayside and may well recover. This paper situates fair use as an essential legal and cultural mechanism for optimising creative expression.A Brief History of CopyrightThe law of copyright extends back to eighteenth century England when the Statute of Anne (1710) was enacted. Whilst the length of this paper precludes an in depth analysis of the law and its export to the U.S., it is important to stress the goals of copyright. “Copyright in the American tradition was not meant to be a “property right” as the public generally understands property. It was originally a narrow federal policy that granted a limited trade monopoly in exchange for universal use and access” (Vaidhyanathan 11). Copyright was designed as a right limited in scope and duration to ensure that culturally important creative works were not the victims of monopolies and were free (as later mandated in the U.S. Constitution) “to promote the progress.” During the 18th century English copyright discourse Lord Camden warned against propertarian approaches lest “all our learning will be locked up in the hands of the Tonsons and the Lintons of the age, who will set what price upon it their avarice chooses to demand, till the public become as much their slaves, as their own hackney compilers are” (Donaldson v. Becket 17 Cobbett Parliamentary History, col. 1000). Camden’s sentiments found favour in subsequent years with members of the North American judiciary reiterating that copyright was a limited right in the interests of society—the law’s primary beneficiary (see for example, Wheaton v. Peters 33 US 591 [1834]; Fox Film Corporation v. Doyal 286 US 123 [1932]; US v. Paramount Pictures 334 US 131 [1948]; Mazer v. Stein 347 US 201, 219 [1954]; Twentieth Century Music Corp. v. Aitken 422 U.S. 151 [1975]; Aronson v. Quick Point Pencil Co. 440 US 257 [1979]; Dowling v. United States 473 US 207 [1985]; Harper & Row, Publishers, Inc. v. Nation Enterprises 471 U.S. 539 [1985]; Luther R. Campbell a.k.a. Luke Skyywalker, et al. v. Acuff-Rose Music, Inc. 510 U.S 569 [1994]). Putting the “Fair” in Fair UseIn Folsom v. Marsh 9 F. Cas. 342 (C.C.D. Mass. 1841) (No. 4,901) Justice Storey formulated the modern shape of fair use from a wealth of case law extending back to 1740 and across the Atlantic. Over the course of one hundred years the English judiciary developed a relatively cohesive set of principles governing the use of a first author’s work by a subsequent author without consent. Storey’s synthesis of these principles proved so comprehensive that later English courts would look to his decision for guidance (Scott v. Stanford L.R. 3 Eq. 718, 722 (1867)). Patry explains fair use as integral to the social utility of copyright to “encourage. . . learned men to compose and write useful books” by allowing a second author to use, under certain circ*mstances, a portion of a prior author’s work, where the second author would himself produce a work promoting the goals of copyright (Patry 4-5).Fair use is a safety valve on copyright law to prevent oppressive monopolies, but some scholars suggest that fair use is less a defence and more a right that subordinates copyrights. Lange and Lange Anderson argue that the doctrine is not fundamentally about copyright or a system of property, but is rather concerned with the recognition of the public domain and its preservation from the ever encroaching advances of copyright (2001). Fair use should not be understood as subordinate to the exclusive rights of copyright owners. Rather, as Lange and Lange Anderson claim, the doctrine should stand in the superior position: the complete spectrum of ownership through copyright can only be determined pursuant to a consideration of what is required by fair use (Lange and Lange Anderson 19). The language of section 107 suggests that fair use is not subordinate to the bundle of rights enjoyed by copyright ownership: “Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work . . . is not an infringement of copyright” (Copyright Act 1976, s.107). Fair use is not merely about the marketplace for copyright works; it is concerned with what Weinreb refers to as “a community’s established practices and understandings” (1151-2). This argument boldly suggests that judicial application of fair use has consistently erred through subordinating the doctrine to copyright and considering simply the effect of the appropriation on the market place for the original work.The emphasis on economic factors has led courts to sympathise with copyright owners leading to a propertarian or Blackstonian approach to copyright (Collins; Travis) propagating the myth that any use of copyrighted materials must be licensed. Law and media reports alike are potted with examples. For example, in Bridgeport Music, Inc., et al v. Dimension Films et al 383 F. 3d 400 (6th Cir. 2004) a Sixth Circuit Court of Appeals held that the transformative use of a three-note guitar sample infringed copyrights and that musicians must obtain licence from copyright owners for every appropriated audio fragment regardless of duration or recognisability. Similarly, in 2006 Christopher Knight self-produced a one-minute television advertisem*nt to support his campaign to be elected to the board of education for Rockingham County, North Carolina. As a fan of Star Wars, Knight used a makeshift Death Star and lightsaber in his clip, capitalising on the imagery of the Jedi Knight opposing the oppressive regime of the Empire to protect the people. According to an interview in The Register the advertisem*nt was well received by local audiences prompting Knight to upload it to his YouTube channel. Several months later, Knight’s clip appeared on Web Junk 2.0, a cable show broadcast by VH1, a channel owned by media conglomerate Viacom. Although his permission was not sought, Knight was pleased with the exposure, after all “how often does a local school board ad wind up on VH1?” (Metz). Uploading the segment of Web Junk 2.0 featuring the advertisem*nt to YouTube, however, led Viacom to quickly issue a take-down notice citing copyright infringement. Knight expressed his confusion at the apparent unfairness of the situation: “Viacom says that I can’t use my clip showing my commercial, claiming copy infringement? As we say in the South, that’s ass-backwards” (Metz).The current state of copyright law is, as Patry says, “depressing”:We are well past the healthy dose stage and into the serious illness stage ... things are getting worse, not better. Copyright law has abandoned its reason for being: to encourage learning and the creation of new works. Instead, its principal functions now are to preserve existing failed business models, to suppress new business models and technologies, and to obtain, if possible, enormous windfall profits from activity that not only causes no harm, but which is beneficial to copyright owners. Like Humpty-Dumpty, the copyright law we used to know can never be put back together.The erosion of fair use by encroaching private interests represented by copyrights has led to strong critiques leveled at the judiciary and legislators by Lessig, McLeod and Vaidhyanathan. “Free culture” proponents warn that an overly strict copyright regime unbalanced by an equally prevalent fair use doctrine is dangerous to creativity, innovation, culture and democracy. After all, “few, if any, things ... are strictly original throughout. Every book in literature, science and art, borrows, and must necessarily borrow, and use much which was well known and used before. No man creates a new language for himself, at least if he be a wise man, in writing a book. He contents himself with the use of language already known and used and understood by others” (Emerson v. Davis, 8 F. Cas. 615, 619 (No. 4,436) (CCD Mass. 1845), qted in Campbell v. Acuff-Rose, 62 U.S.L.W. at 4171 (1994)). The rise of the Web 2.0 phase with its emphasis on end-user created content has led to an unrelenting wave of creativity, and much of it incorporates or “mashes up” copyright material. As Negativland observes, free appropriation is “inevitable when a population bombarded with electronic media meets the hardware [and software] that encourages them to capture it” and creatively express themselves through appropriated media forms (251). The current state of copyright and fair use is bleak, but not beyond recovery. Two recent cases suggest a resurgence of the ideology underpinning the doctrine of fair use and the role played by copyright.Let’s Go CrazyIn “Let’s Go Crazy #1” on YouTube, Holden Lenz (then eighteen months old) is caught bopping to a barely recognizable recording of Prince’s “Let’s Go Crazy” in his mother’s Pennsylvanian kitchen. The twenty-nine second long video was viewed a mere twenty-eight times by family and friends before Stephanie Lenz received an email from YouTube informing her of its compliance with a Digital Millennium Copyright Act (DMCA) take-down notice issued by Universal, copyright owners of Prince’s recording (McDonald). Lenz has since filed a counterclaim against Universal and YouTube has reinstated the video. Ironically, the media exposure surrounding Lenz’s situation has led to the video being viewed 633,560 times at the time of writing. Comments associated with the video indicate a less than reverential opinion of Prince and Universal and support the fairness of using the song. On 8 Aug. 2008 a Californian District Court denied Universal’s motion to dismiss Lenz’s counterclaim. The question at the centre of the court judgment was whether copyright owners should consider “the fair use doctrine in formulating a good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law.” The court ultimately found in favour of Lenz and also reaffirmed the position of fair use in relation to copyright. Universal rested its argument on two key points. First, that copyright owners cannot be expected to consider fair use prior to issuing takedown notices because fair use is a defence, invoked after the act rather than a use authorized by the copyright owner or the law. Second, because the DMCA does not mention fair use, then there should be no requirement to consider it, or at the very least, it should not be considered until it is raised in legal defence.In rejecting both arguments the court accepted Lenz’s argument that fair use is an authorised use of copyrighted materials because the doctrine of fair use is embedded into the Copyright Act 1976. The court substantiated the point by emphasising the language of section 107. Although fair use is absent from the DMCA, the court reiterated that it is part of the Copyright Act and that “notwithstanding the provisions of sections 106 and 106A” a fair use “is not an infringement of copyright” (s.107, Copyright Act 1976). Overzealous rights holders frequently abuse the DMCA as a means to quash all use of copyrighted materials without considering fair use. This decision reaffirms that fair use “should not be considered a bizarre, occasionally tolerated departure from the grand conception of the copyright design” but something that it is integral to the constitution of copyright law and essential in ensuring that copyright’s goals can be fulfilled (Leval 1100). Unlicensed musical sampling has never fared well in the courtroom. Three decades of rejection and admonishment by judges culminated in Bridgeport Music, Inc., et al v. Dimension Films et al 383 F. 3d 400 (6th Cir. 2004): “Get a license or do not sample. We do not see this stifling creativity in any significant way” was the ruling on an action brought against an unlicensed use of a three-note guitar sample under section 114, an audio piracy provision. The Bridgeport decision sounded a death knell for unlicensed sampling, ensuring that only artists with sufficient capital to pay the piper could legitimately be creative with the wealth of recorded music available. The cost of licensing samples can often outweigh the creative merit of the act itself as discussed by McLeod (86) and Beaujon (25). In August 2008 the Supreme Court of New York heard EMI v. Premise Media in which EMI sought an injunction against an unlicensed fifteen second excerpt of John Lennon’s “Imagine” featured in Expelled: No Intelligence Allowed, a controversial documentary canvassing alleged chilling of intelligent design proponents in academic circles. (The family of John Lennon and EMI had previously failed to persuade a Manhattan federal court in a similar action.) The court upheld Premise Media’s arguments for fair use and rejected the Bridgeport approach on which EMI had rested its entire complaint. Justice Lowe criticised the Bridgeport court for its failure to examine the legislative intent of section 114 suggesting that courts should look to the black letter of the law rather than blindly accept propertarian arguments. This decision is of particular importance because it establishes that fair use applies to unlicensed use of sound recordings and re-establishes de minimis use.ConclusionThis paper was partly inspired by the final entry on eminent copyright scholar William Patry’s personal copyright law blog (1 Aug. 2008). A copyright lawyer for over 25 years, Patry articulated his belief that copyright law has swung too far away from its initial objectives and that balance could never be restored. The two cases presented in this paper demonstrate that fair use – and therefore balance – can be recovered in copyright. The federal Supreme Court and lower courts have stressed that copyright was intended to promote creativity and have upheld the fair doctrine, but in order for the balance to exist in copyright law, cases must come before the courts; copyright myth must be challenged. As McLeod states, “the real-world problems occur when institutions that actually have the resources to defend themselves against unwarranted or frivolous lawsuits choose to take the safe route, thus eroding fair use”(146-7). ReferencesBeaujon, Andrew. “It’s Not the Beat, It’s the Mocean.” CMJ New Music Monthly. April 1999.Collins, Steve. “Good Copy, Bad Copy: Covers, Sampling and Copyright.” M/C Journal 8.3 (2005). 26 Aug. 2008 ‹http://journal.media-culture.org.au/0507/02-collins.php›.———. “‘Property Talk’ and the Revival of Blackstonian Copyright.” M/C Journal 9.4 (2006). 26 Aug. 2008 ‹http://journal.media-culture.org.au/0609/5-collins.php›.Donaldson v. Becket 17 Cobbett Parliamentary History, col. 953.Efroni, Zohar. “Israel’s Fair Use.” The Center for Internet and Society (2008). 26 Aug. 2008 ‹http://cyberlaw.stanford.edu/node/5670›.Lange, David, and Jennifer Lange Anderson. “Copyright, Fair Use and Transformative Critical Appropriation.” Conference on the Public Domain, Duke Law School. 2001. 26 Aug. 2008 ‹http://www.law.duke.edu/pd/papers/langeand.pdf›.Lemley, Mark. “Property, Intellectual Property, and Free Riding.” Texas Law Review 83 (2005): 1031.Lessig, Lawrence. The Future of Ideas. New York: Random House, 2001.———. Free Culture. New York: Penguin, 2004.Leval, Pierre. “Toward a Fair Use Standard.” Harvard Law Review 103 (1990): 1105.McDonald, Heather. “Holden Lenz, 18 Months, versus Prince and Universal Music Group.” About.com: Music Careers 2007. 26 Aug. 2008 ‹http://musicians.about.com/b/2007/10/27/holden-lenz-18-months-versus-prince-and-universal-music-group.htm›.McLeod, Kembrew. “How Copyright Law Changed Hip Hop: An interview with Public Enemy’s Chuck D and Hank Shocklee.” Stay Free 2002. 26 Aug. 2008 ‹http://www.stayfreemagazine.org/archives/20/public_enemy.html›.———. Freedom of Expression: Overzealous Copyright Bozos and Other Enemies of Creativity. United States: Doubleday, 2005.McLuhan, Marshall, and Barrington Nevitt. Take Today: The Executive as Dropout. Ontario: Longman Canada, 1972.Metz, Cade. “Viacom Slaps YouTuber for Behaving like Viacom.” The Register 2007. 26 Aug. 2008 ‹http://www.theregister.co.uk/2007/08/30/viacom_slaps_pol/›.Negativland, ed. Fair Use: The Story of the Letter U and the Numeral 2. Concord: Seeland, 1995.Patry, William. The Fair Use Privilege in Copyright Law. Washington DC: Bureau of National Affairs, 1985.———. “End of the Blog.” The Patry Copyright Blog. 1 Aug. 2008. 27 Aug. 2008 ‹http://williampatry.blogspot.com/2008/08/end-of-blog.html›.Tapscott, Don. The Digital Economy: Promise and Peril in the Age of Networked Intelligence. New York: McGraw Hill, 1996.Toffler, Alvin. The Third Wave. London, Glasgow, Sydney, Auckland. Toronto, Johannesburg: William Collins, 1980.Travis, Hannibal. “Pirates of the Information Infrastructure: Blackstonian Copyright and the First Amendment.” Berkeley Technology Law Journal, Vol. 15 (2000), No. 777.Vaidhyanathan, Siva. Copyrights and Copywrongs: The Rise of Intellectual Property and How It Threatens Creativity. New York; London: New York UP, 2003.

Abstract:

In the heady expansion of capital’s productive capacity during the post-war period, E.P. Thompson wondered optimistically at potentials accruing to humanity by accelerating automation. He asked, “If we are to have enlarged leisure, in an automated future, the problem is not ‘how are men going to be able to consume all these additional time-units of leisure?’ but ‘what will be the capacity for experience of the men who have this undirected time to live?’” (Thompson 36). Indeed, linear and economistic variants of Marxian materialism have long emphasised that the socialisation of production by the use of machinery will eventually free us from work. At the very least, the underemployment produced by the automation of pivotal labour roles is supposed to create a political subject capable of agitating successfully against bourgeois and capitalist hegemony. But contrary to these prognostications, the worker of 2019 is caught up in a process of generalising work far beyond what is considered necessary by tradition, or at least the convention of what David Harvey calls “embedded liberalism” (11). As Anne Helen Peterson wrote in a recent Buzzfeed article,even the trends millennials have popularized — like athleisure — speak to our self-optimization. Yoga pants might look sloppy to your mom, but they’re efficient: you can transition seamlessly from an exercise class to a Skype meeting to child pickup. We use Fresh Direct and Amazon because the time they save allows us to do more work. (Peterson)For the work-martyr, activity in its broadest Aristotelian sense is evaluated by and subordinated to the question of efficiency and productivity. Occupations of time that were once considered external to “work” as matters of “life” (to use Kathi Weeks’s vocabulary) are reconceived as waste when not deployed in the service of value-generation (Weeks 15).The point here, then, is to provide some answers for why the decrease in socially-necessary labour time in an age of automation has not coincided with the Thompsonian expansion of free time. The current dilemma of the neoliberal “work-martyr” is traceable to the political responses generated by crises in production during the depression and the stagflationary disaccumulation of the 1960s-70s, and the major victory in the “battle for ideas” was the transformation of the political subject into human capital. This “intensely constructed and governed” suite of possible values is tasked, according to Wendy Brown, “with improving and leveraging its competitive positioning and with enhancing its (monetary and nonmonetary) portfolio value across all of its endeavours and ventures” (Brown 10). Connecting the creation of this subject in relation to personal or free time is important partly because of time’s longstanding importance to philosophies of subjectivity. But more to the point, the focus on time is important because it serves to demonstrate the economic foundations of the incursion of capitalist governance into the most private domains of existence. Against the criticism of Marx’s ‘abstract’ theory of value, one can see that the laws of capitalist accumulation make their mark in all parts of contemporary human being, including temporality. By tracing the emergence of afterwork as the unpaid continuation of the accumulation of value, one can show how each subject increasingly ‘lives’ capital. This marks a turning point in political economy. When work spills over a temporal limit, its relationship to reproduction is finally blurred to the point of indistinction. What this means for value-creation in 2019 is something in urgent need of critique.State ReproductionAccording to the Marxian theory, labour’s minimum cost is abstractly determined by the price of the labourer’s necessities. Once they have produced enough objects of value to cover these costs, the rest of their work is surplus value in the hands of the capitalist. The capitalist’s aim, then, is to extend the overall working-day for as long beyond the minimum as possible. Theoretically, the full 24 hours of the day may be used. The rise of machine production in the 19th century allowed the owners to make this theory a reality. The only thing that governed the extension of work-time was the physical minimum of labour-power’s reproduction (Marx 161). But this was on the provision that all the labourer’s “free” time was to be spent regrouping their energies. Anything in excess of this was a privilege: time wasted that could have been spent in the factory. “If the labourer consumes his disposable time for himself”, says Marx, “he robs the capitalist” (162).This began to change with the socialisation of the work process and the increase in technical proficiency that labour demanded in early 20th-century industry. With the changes in the sophistication of the manufacture process, the labourer came to be factored in the production process less as an “appendage of the machine” and more as a collection of decisive skills. Fordism based itself around the recognition that capital itself was “dependent on a family-based reproduction” (Weeks 27). In Ford’s America, the sense that work’s intensity might supplant losses in the working day propelled owners of production to recognise the economic need of ensuring a robust culture of social reproduction. In capital’s original New Deal, Ford provided an increase in wages (the Five Dollar Day) in exchange for a rise in productivity (Dalla Costa v). To preserve the increased rhythm of industrial production required more than a robust wage, however. It required “the formation of a physically efficient and psychologically disciplined working class” (Dalla Costa 2). Companies began to hire sociologists to investigate how workers spent their spare time (Dalla Costa 8). They led the charge in a what we might call the first “anthropological revolution” of the American 20th century, whereby the improved wage of the worker was underpinned by the economisation of their reproduction. This was enabled by the cheapening of social necessities (and thus a reduction in socially-necessary labour time) in profound connection to the development of household economy on the backs of unpaid female labour (Weeks 25).This arrangement between capital and labour persisted until 1929. When the inevitable crisis came, however, wages faltered, and many workers joined the ranks of the unemployed. Unable to afford even the basics of their own reproduction, the working-class looked to the state. They created political and social pressure through marches, demonstrations, attacks on shops and the looting of supply trucks (Dalla Costa 40). The state held out against them, but the crisis in production eventually reached such a point of intensity that the government was forced to intervene. Hoover instituted the Emergency Relief Act and Financial Reconstruction Corporation in 1932. This was expanded the following year by FDR’s New Deal, transforming Emergency Relief into a federal institution and creating the Civil Works Association to stimulate the job market (Dalla Costa 63). The security of the working class was decisively linked to the state through the wage guarantees, welfare measures and even the legal guarantee of collective bargaining.For the most part, the state’s intervention in social reproduction took the pressure off industry by ensuring that the workforce would remain able to handle its burdens and that the unemployed would remain employable. It guaranteed a minimum wage for the employed to ensure that demand didn’t collapse, and provided care outside the workforce to women, children and the elderly.Once the state took responsibility for reproduction, however, it immediately became interested in how free time could be made efficient and cost effective. Abroad, they noted the example of European statist and corporativist approaches. Roosevelt sent a delegation to Europe to study the various measures taken by fascist and United Front governments to curb the effects of economic crisis (Dogliani 247). Among these was Mussolini’s OND (Opera Nazionale Dopolavoro) which sought to accumulate the free time of workers to the ends of production. Part of this required the responsibilisation of the broader community not only for regeneration of labour-power but the formation of a truly fascist political subject.FDR’s social reform program was able to reproduce this at home by following the example of workers’ community organisation during the depression years. Throughout the early ‘30s, self-help cooperatives, complete with “their own systems of payment in goods or currency” emerged among the unemployed (Dalla Costa 61). Black markets in consumer goods and informal labour structures developed in all major cities (Dalla Costa 34). Subsistence goods were self-produced in a cottage industry of unpaid domestic labour by both men and women (Dalla Costa 71). The paragon of self-reproducing communities was urbanised black Americans, whose internal solidarity had saved lives throughout the depression. The state took notice of these informal economies of production and reproduction, and started to incorporate the possibility of community engineering into their national plan. Roosevelt convened the Civilian Conservation Corps to absorb underemployed elements of the American workforce and recover consumer demand through direct state sponsorship (wages) (Dogliani, 247). The Committee of Industrial Organisation was transformed into a “congress” linking workers directly to the state (Dalla Costa 74). Minium wages were secured in the supreme court in 1937, then hiked in 1938 (78). In all, the state emerged at this time as a truly corporativist entity- the guarantor of employment and of class stability. From Social Reproduction to Human Capital InvestmentSo how do we get from New Deal social engineering to yoga pants? The answer is deceptively simple. The state transformed social reproduction into a necessary part of the production process. But this also meant that it was instrumentalised. The state only had to fund its workforce’s reproduction so long as this guaranteed productivity. After the war, this was maintained by a form of “embedded liberalism” which sought to provide full employment, economic growth and welfare for its citizens while anchoring the international economy in the Dollar’s gold-value. However, by providing stable increases in “relative value” (wages), this form of state investment incentivised capital flight and its spectacular consequent: deindustrialisation. The “embedded liberalism” of the state-capital-labour compromise began to breakdown with a new crisis of accumulation (Harvey 11-12). The relocation of production to non-union states and decolonised globally-southern sites of hyper-exploitation led to an ‘urban crisis’ in the job market. But as capitalist expansion carried on abroad, inflation kept dangerous pace with the rate of unemployment. This “stagflation” put irresistible pressure on the post-war order. The Bretton-Woods policy of maintaining fixed interest rates while pinning the dollar to gold was abandoned in 1971 and exchange rates were floated all over the world (Harvey 12). The spectre of a new crisis loomed, but one which couldn’t be resolved by the simple state sponsorship of production and reproduction.While many solutions were offered in place of this, one political vision singled out the state’s intervention into reproduction as the cause of the crisis. The ‘neoliberal’ political revolution began at the level of individual groups of capitalist agitants seeking governmental influence in a crusade against communism. It was given its first run on the historical pitch in Chile as part of the CIA-sponsored Pinochet revanchism, and then imported to NYC to deal with the worsening urban crisis of the 1970s. Instead of focusing on production (which required state intervention to proceed without crisis), neoliberal theory promulgated a turn to monetisation and financialisation. The rule of the New York banks after they forced the City into near-bankruptcy in 1975 prescribed total austerity in order to make good on its debts. The government was forced by capital itself to withdraw from investment in the reproduction of its citizens and workers. This was generalised to a federal policy as Reagan sought to address the decades-long deficit during the early years of his presidential term. Facilitating the global flow of finance and the hegemony of supranational institutions like the IMF, the domestic labour force now became beholden to an international minimum of socially-necessary labour time. At the level of domestic labour, the reduction of labour’s possible cost to this minimum had dramatic consequences. International competition allowed the physical limitations of labour to, once again, vanish from sight. Removed from the discourse of reproduction rights, the capitalist edifice was able to focus on changing the ratio of socially necessary labour to surplus. The mechanism that enabled them to do so was competition among the workforce. With the opening of the world market, capital no longer had to worry about the maintenance of domestic demand.But competition was not sufficient to pull off so grand a feat. What was required was a broader “battle of ideas”; the second anthropological revolution of the American century. The protections that workers had relied upon since the Fordist compromise and the corporativist solution eroded as the new “class-power” of the bourgeoisie levelled neoliberal assaults against associated labour (Harvey 23). While unions were gradually disempowered to fight the inevitable tide of deindustrialisation and capital flight, individual workers were coddled by a stream of neoliberal propaganda promising “Freedom” to those who would leave the stifling atmosphere of collective association. The success of this double enervation crippled union power, and the capitalist could rely increasingly on internal workplace wage stratification to regulate labour at an enterprise level (Dalla Costa 25). Incentive structures transformed labour rights into privileges; imagining old entitlements as concessions from above. In the last thirty years, the foundation of worker protections at large has, according to Brown, become illegible (Brown 38).Time and ValueThe reduction of time needed to produce has not coincided with an expansion of free time. The neoliberal anthropological revolution has wormed its way into the depth of the individual subject’s temporalising through a dual assault on labour conditions and propaganda. The privatisation of reproduction means that its necessary minimum is once again the subject of class struggle. Time spent unproductively outside the workplace now not only robs the capitalist, but the worker. If an activity isn’t a means to increase one’s “experience” (the vector of employability), it is time poorly spent. The likelihood of being hired for a job, in professional industries especially, is dependent on your ability to outperform others not only in your talents and skills, but in your own exploitability. Brown points out that the groups traditionally defined by the “middle strata … works more hours for less pay, fewer benefits, less security, and less promise of retirement or upward mobility than at any time in the past century” (Brown 28-29).This is what is meant by the transformation of workers into ‘human capital’. As far as the worker is concerned, the capitalist no longer purchases their labour-power: they purchase the sum of their experiences and behaviours. A competitive market has emerged for these personality markers. As a piece of human capital, one must expend one’s time not only in reproduction, but the production of their own surplus value. Going to a play adds culture points to your brand; speaking a second language gives you a competitive edge; a robust Instagram following is the difference between getting or missing out on a job. For Jess Whyte, this means that the market is now able to govern in place of the state. It exercises a command over people’s lives in and out of the workplace “which many an old tyrannical state would have envied” (Whyte 20).There is a question here of change and continuity. A survey of the 20th century shows that the reduction of ‘socially necessary labour time’ does not necessarily mean a reduction in time spent at work. In fact, the minimum around which capitalist production circulates is not worktime but wages. It is only at the political level that the working class prevented capital from pursuing this minimum. With the political victory of neoliberalism as a “restoration of class power” to the bourgeoisie, however, this minimum becomes a factor at the heart of all negotiations between capital and labour. The individual labourer lying at the heart of the productive process is reduced to his most naked form: human capital. This capital must spend all its time productively for its own benefit. Mundane tasks are avoidable, as stipulated by the piece of human capital sometimes known as Anne Helen Peterson, if they “wouldn’t make my job easier or my work better”. People are never really after-work under neoliberalism; their spare time is structurally adjusted into auxiliary labour. Competition has achieved what the state could never have dreamed of: a total governance of spare hours. This governance unites journalists tweeting from bed with Amazon workers living where they work, not to mention early-career academics working over a weekend to publish an article in an online journal that is not even paying them. These are all ways in which the privatisation of social reproduction transforms afterwork into unpaid overtime.ReferencesBrown, Wendy. Undoing the Demos: Neoliberalism’s Stealth Revolution. New York: Zone Books, 2015.Dalla Costa, Maria. Family, Welfare, and the State: Between Progressivism and the New Deal. Brooklyn: Common Notions, 2015.Harvey, David. A Brief History of Neoliberalism. Oxford: Oxford UP, 2005.Engels, Friedrich, and Karl Marx. The Marx-Engels Reader. Ed. R.C. Tucker. New York: Norton, 1978.Marx, Karl. Capital: A Critical Analysis of Capitalist Production. Vol. 1 and 2. Trans. E. Aveling and E. Untermann. Hertfordshire: Wordsworth Classics of World Literature, 2013.Peterson, Anne Helen. “How Millennials Became the Burnout Generation.” Buzzfeed. 10 Oct. 2019 <https://www.buzzfeednews.com/article/annehelenpetersen/millennials-burnout-generation-debt-work>.Postone, Moishe. Time, Labour and Social Domination. Cambridge: Cambridge UP, 1993.Thompson, E.P. “Time, Work-Discipline, and Industrial Capitalism.” In Stanley Aronowitz and Michael J. Roberts, eds., Class: The Anthology. Hoboken: Wiley, 2018.Wang, Jackie. Carceral Capitalism. Los Angeles: Semiotext(e), 2018.Weeks, Kathi. The Problem with Work: Feminism, Marxism, Antiwork Politics, and Postwork Imaginaries. Durham: Duke UP, 2011.Whyte, Jessica. “The Invisible Hand of Friedrich Hayek: Submission and Spontaneous Order.” Political Theory (2017): 1-29.

Abstract:

The Australian Government has been actively evaluating how best to merge the functions of the Australian Communications Authority (ACA) and the Australian Broadcasting Authority (ABA) for around two years now. Broadly, the reason for this is an attempt to keep pace with the communications media transformations we reduce to the term “convergence.” Mounting pressure for restructuring is emerging as a site of turf contestation: the possibility of a regulatory “one-stop shop” for governments (and some industry players) is an end game of considerable force. But, from a public interest perspective, the case for a converged regulator needs to make sense to audiences using various media, as well as in terms of arguments about global, industrial, and technological change. This national debate about the institutional reshaping of media regulation is occurring within a wider global context of transformations in social, technological, and politico-economic frameworks of open capital and cultural markets, including the increasing prominence of international economic organisations, corporations, and Free Trade Agreements (FTAs). Although the recently concluded FTA with the US explicitly carves out a right for Australian Governments to make regulatory policy in relation to existing and new media, considerable uncertainty remains as to future regulatory arrangements. A key concern is how a right to intervene in cultural markets will be sustained in the face of cultural, politico-economic, and technological pressures that are reconfiguring creative industries on an international scale. While the right to intervene was retained for the audiovisual sector in the FTA, by contrast, it appears that comparable unilateral rights to intervene will not operate for telecommunications, e-commerce or intellectual property (DFAT). Blurring Boundaries A lack of certainty for audiences is a by-product of industry change, and further blurs regulatory boundaries: new digital media content and overlapping delivering technologies are already a reality for Australia’s media regulators. These hypothetical media usage scenarios indicate how confusion over the appropriate regulatory agency may arise: 1. playing electronic games that use racist language; 2. being subjected to deceptive or misleading pop-up advertising online 3. receiving messaged imagery on your mobile phone that offends, disturbs, or annoys; 4. watching a program like World Idol with SMS voting that subsequently raises charging or billing issues; or 5. watching a new “reality” TV program where products are being promoted with no explicit acknowledgement of the underlying commercial arrangements either during or at the end of the program. These are all instances where, theoretically, regulatory mechanisms are in place that allow individuals to complain and to seek some kind of redress as consumers and citizens. In the last scenario, in commercial television under the sector code, no clear-cut rules exist as to the precise form of the disclosure—as there is (from 2000) in commercial radio. It’s one of a number of issues the peak TV industry lobby Commercial TV Australia (CTVA) is considering in their review of the industry’s code of practice. CTVA have proposed an amendment to the code that will simply formalise the already existing practice . That is, commercial arrangements that assist in the making of a program should be acknowledged either during programs, or in their credits. In my view, this amendment doesn’t go far enough in post “cash for comment” mediascapes (Dwyer). Audiences have a right to expect that broadcasters, production companies and program celebrities are open and transparent with the Australian community about these kinds of arrangements. They need to be far more clearly signposted, and people better informed about their role. In the US, the “Commercial Alert” <http://www.commercialalert.org/> organisation has been lobbying the Federal Communications Commission and the Federal Trade Commission to achieve similar in-program “visual acknowledgements.” The ABA’s Commercial Radio Inquiry (“Cash-for-Comment”) found widespread systemic regulatory failure and introduced three new standards. On that basis, how could a “standstill” response by CTVA, constitute best practice for such a pervasive and influential medium as contemporary commercial television? The World Idol example may lead to confusion for some audiences, who are unsure whether the issues involved relate to broadcasting or telecommunications. In fact, it could be dealt with as a complaint to the Telecommunication Industry Ombudsman (TIO) under an ACA registered, but Australian Communications Industry Forum (ACIF) developed, code of practice. These kind of cross-platform issues may become more vexed in future years from an audience’s perspective, especially if reality formats using on-screen premium rate service numbers invite audiences to participate, by sending MMS (multimedia messaging services) images or short video grabs over wireless networks. The political and cultural implications of this kind of audience interaction, in terms of access, participation, and more generally the symbolic power of media, may perhaps even indicate a longer-term shift in relations with consumers and citizens. In the Internet example, the Australian Competition and Consumer Commission’s (ACCC) Internet advertising jurisdiction would apply—not the ABA’s “co-regulatory” Internet content regime as some may have thought. Although the ACCC deals with complaints relating to Internet advertising, there won’t be much traction for them in a more complex issue that also includes, say, racist or religious bigotry. The DVD example would probably fall between the remits of the Office of Film and Literature Classification’s (OFLC) new “convergent” Guidelines for the Classification of Film and Computer Games and race discrimination legislation administered by the Human Rights and Equal Opportunity Commission (HREOC). The OFLC’s National Classification Scheme is really geared to provide consumer advice on media products that contain sexual and violent imagery or coarse language, rather than issues of racist language. And it’s unlikely that a single person would have the locus standito even apply for a reclassification. It may fall within the jurisdiction of the HREOC depending on whether it was played in public or not. Even then it would probably be considered exempt on free speech grounds as an “artistic work.” Unsolicited, potentially illegal, content transmitted via mobile wireless devices, in particular 3G phones, provide another example of content that falls between the media regulation cracks. It illustrates a potential content policy “turf grab” too. Image-enabled mobile phones create a variety of novel issues for content producers, network operators, regulators, parents and viewers. There is no one government media authority or agency with a remit to deal with this issue. Although it has elements relating to the regulatory activities of the ACA, the ABA, the OFLC, the TIO, and TISSC, the combination of illegal or potentially prohibited content and its carriage over wireless networks positions it outside their current frameworks. The ACA may argue it should have responsibility for this kind of content since: it now enforces the recently enacted Commonwealth anti-Spam laws; has registered an industry code of practice for unsolicited content delivered over wireless networks; is seeking to include ‘adult’ content within premium rate service numbers, and, has been actively involved in consumer education for mobile telephony. It has also worked with TISSC and the ABA in relation to telephone sex information services over voice networks. On the other hand, the ABA would probably argue that it has the relevant expertise for regulating wirelessly transmitted image-content, arising from its experience of Internet and free and subscription TV industries, under co-regulatory codes of practice. The OFLC can also stake its claim for policy and compliance expertise, since the recently implemented Guidelines for Classification of Film and Computer Games were specifically developed to address issues of industry convergence. These Guidelines now underpin the regulation of content across the film, TV, video, subscription TV, computer games and Internet sectors. Reshaping Institutions Debates around the “merged regulator” concept have occurred on and off for at least a decade, with vested interests in agencies and the executive jockeying to stake claims over new turf. On several occasions the debate has been given renewed impetus in the context of ruling conservative parties’ mooted changes to the ownership and control regime. It’s tended to highlight demarcations of remit, informed as they are by historical and legal developments, and the gradual accretion of regulatory cultures. Now the key pressure points for regulatory change include the mere existence of already converged single regulatory structures in those countries with whom we tend to triangulate our policy comparisons—the US, the UK and Canada—increasingly in a context of debates concerning international trade agreements; and, overlaying this, new media formats and devices are complicating existing institutional arrangements and legal frameworks. The Department of Communications, Information Technology & the Arts’s (DCITA) review brief was initially framed as “options for reform in spectrum management,” but was then widened to include “new institutional arrangements” for a converged regulator, to deal with visual content in the latest generation of mobile telephony, and other image-enabled wireless devices (DCITA). No other regulatory agencies appear, at this point, to be actively on the Government’s radar screen (although they previously have been). Were the review to look more inclusively, the ACCC, the OFLC and the specialist telecommunications bodies, the TIO and the TISSC may also be drawn in. Current regulatory arrangements see the ACA delegate responsibility for broadcasting services bands of the radio frequency spectrum to the ABA. In fact, spectrum management is the turf least contested by the regulatory players themselves, although the “convergent regulator” issue provokes considerable angst among powerful incumbent media players. The consensus that exists at a regulatory level can be linked to the scientific convention that holds the radio frequency spectrum is a continuum of electromagnetic bands. In this view, it becomes artificial to sever broadcasting, as “broadcasting services bands” from the other remaining highly diverse communications uses, as occurred from 1992 when the Broadcasting Services Act was introduced. The prospect of new forms of spectrum charging is highly alarming for commercial broadcasters. In a joint submission to the DCITA review, the peak TV and radio industry lobby groups have indicated they will fight tooth and nail to resist new regulatory arrangements that would see a move away from the existing licence fee arrangements. These are paid as a sliding scale percentage of gross earnings that, it has been argued by Julian Thomas and Marion McCutcheon, “do not reflect the amount of spectrum used by a broadcaster, do not reflect the opportunity cost of using the spectrum, and do not provide an incentive for broadcasters to pursue more efficient ways of delivering their services” (6). An economic rationalist logic underpins pressure to modify the spectrum management (and charging) regime, and undoubtedly contributes to the commercial broadcasting industry’s general paranoia about reform. Total revenues collected by the ABA and the ACA between 1997 and 2002 were, respectively, $1423 million and $3644.7 million. Of these sums, using auction mechanisms, the ABA collected $391 million, while the ACA collected some $3 billion. The sale of spectrum that will be returned to the Commonwealth by television broadcasters when analog spectrum is eventually switched off, around the end of the decade, is a salivating prospect for Treasury officials. The large sums that have been successfully raised by the ACA boosts their position in planning discussions for the convergent media regulatory agency. The way in which media outlets and regulators respond to publics is an enduring question for a democratic polity, irrespective of how the product itself has been mediated and accessed. Media regulation and civic responsibility, including frameworks for negotiating consumer and citizen rights, are fundamental democratic rights (Keane; Tambini). The ABA’s Commercial Radio Inquiry (‘cash for comment’) has also reminded us that regulatory frameworks are important at the level of corporate conduct, as well as how they negotiate relations with specific media audiences (Johnson; Turner; Gordon-Smith). Building publicly meaningful regulatory frameworks will be demanding: relationships with audiences are often complex as people are constructed as both consumers and citizens, through marketised media regulation, institutions and more recently, through hybridising program formats (Murdock and Golding; Lumby and Probyn). In TV, we’ve seen the growth of infotainment formats blending entertainment and informational aspects of media consumption. At a deeper level, changes in the regulatory landscape are symptomatic of broader tectonic shifts in the discourses of governance in advanced information economies from the late 1980s onwards, where deregulatory agendas created an increasing reliance on free market, business-oriented solutions to regulation. “Co-regulation” and “self-regulation’ became the preferred mechanisms to more direct state control. Yet, curiously contradicting these market transformations, we continue to witness recurring instances of direct intervention on the basis of censorship rationales (Dwyer and Stockbridge). That digital media content is “converging” between different technologies and modes of delivery is the norm in “new media” regulatory rhetoric. Others critique “visions of techno-glory,” arguing instead for a view that sees fundamental continuities in media technologies (Winston). But the socio-cultural impacts of new media developments surround us: the introduction of multichannel digital and interactive TV (in free-to-air and subscription variants); broadband access in the office and home; wirelessly delivered content and mobility, and, as Jock Given notes, around the corner, there’s the possibility of “an Amazon.Com of movies-on-demand, with the local video and DVD store replaced by online access to a distant server” (90). Taking a longer view of media history, these changes can be seen to be embedded in the global (and local) “innovation frontier” of converging digital media content industries and its transforming modes of delivery and access technologies (QUT/CIRAC/Cutler & Co). The activities of regulatory agencies will continue to be a source of policy rivalry and turf contestation until such time as a convergent regulator is established to the satisfaction of key players. However, there are risks that the benefits of institutional reshaping will not be readily available for either audiences or industry. In the past, the idea that media power and responsibility ought to coexist has been recognised in both the regulation of the media by the state, and the field of communications media analysis (Curran and Seaton; Couldry). But for now, as media industries transform, whatever the eventual institutional configuration, the evolution of media power in neo-liberal market mediascapes will challenge the ongoing capacity for interventions by national governments and their agencies. Works Cited Australian Broadcasting Authority. Commercial Radio Inquiry: Final Report of the Australian Broadcasting Authority. Sydney: ABA, 2000. Australian Communications Information Forum. Industry Code: Short Message Service (SMS) Issues. Dec. 2002. 8 Mar. 2004 <http://www.acif.org.au/__data/page/3235/C580_Dec_2002_ACA.pdf >. Commercial Television Australia. Draft Commercial Television Industry Code of Practice. Aug. 2003. 8 Mar. 2004 <http://www.ctva.com.au/control.cfm?page=codereview&pageID=171&menucat=1.2.110.171&Level=3>. Couldry, Nick. The Place of Media Power: Pilgrims and Witnesses of the Media Age. London: Routledge, 2000. Curran, James, and Jean Seaton. Power without Responsibility: The Press, Broadcasting and New Media in Britain. 6th ed. London: Routledge, 2003. Dept. of Communication, Information Technology and the Arts. Options for Structural Reform in Spectrum Management. Canberra: DCITA, Aug. 2002. ---. Proposal for New Institutional Arrangements for the ACA and the ABA. Aug. 2003. 8 Mar. 2004 <http://www.dcita.gov.au/Article/0,,0_1-2_1-4_116552,00.php>. Dept. of Foreign Affairs and Trade. Australia-United States Free Trade Agreement. Feb. 2004. 8 Mar. 2004 <http://www.dfat.gov.au/trade/negotiations/us_fta/outcomes/11_audio_visual.php>. Dwyer, Tim. Submission to Commercial Television Australia’s Review of the Commercial Television Industry’s Code of Practice. Sept. 2003. Dwyer, Tim, and Sally Stockbridge. “Putting Violence to Work in New Media Policies: Trends in Australian Internet, Computer Game and Video Regulation.” New Media and Society 1.2 (1999): 227-49. Given, Jock. America’s Pie: Trade and Culture After 9/11. Sydney: U of NSW P, 2003. Gordon-Smith, Michael. “Media Ethics After Cash-for-Comment.” The Media and Communications in Australia. Ed. Stuart Cunningham and Graeme Turner. Sydney: Allen and Unwin, 2002. Johnson, Rob. Cash-for-Comment: The Seduction of Journo Culture. Sydney: Pluto, 2000. Keane, John. The Media and Democracy. Cambridge: Polity, 1991. Lumby, Cathy, and Elspeth Probyn, eds. Remote Control: New Media, New Ethics. Melbourne: Cambridge UP, 2003. Murdock, Graham, and Peter Golding. “Information Poverty and Political Inequality: Citizenship in the Age of Privatized Communications.” Journal of Communication 39.3 (1991): 180-95. QUT, CIRAC, and Cutler & Co. Research and Innovation Systems in the Production of Digital Content and Applications: Report for the National Office for the Information Economy. Canberra: Commonwealth of Australia, Sept. 2003. Tambini, Damian. Universal Access: A Realistic View. IPPR/Citizens Online Research Publication 1. London: IPPR, 2000. Thomas, Julian and Marion McCutcheon. “Is Broadcasting Special? Charging for Spectrum.” Conference paper. ABA conference, Canberra. May 2003. Turner, Graeme. “Talkback, Advertising and Journalism: A cautionary tale of self-regulated radio”. International Journal of Cultural Studies 3.2 (2000): 247-255. ---. “Reshaping Australian Institutions: Popular Culture, the Market and the Public Sphere.” Culture in Australia: Policies, Publics and Programs. Ed. Tony Bennett and David Carter. Melbourne: Cambridge UP, 2001. Winston, Brian. Media, Technology and Society: A History from the Telegraph to the Internet. London: Routledge, 1998. Web Links http://www.aba.gov.au http://www.aca.gov.au http://www.accc.gov.au http://www.acif.org.au http://www.adma.com.au http://www.ctva.com.au http://www.crtc.gc.ca http://www.dcita.com.au http://www.dfat.gov.au http://www.fcc.gov http://www.ippr.org.uk http://www.ofcom.org.uk http://www.oflc.gov.au Links http://www.commercialalert.org/ Citation reference for this article MLA Style Dwyer, Tim. "Transformations" M/C: A Journal of Media and Culture <http://www.media-culture.org.au/0403/06-transformations.php>. APA Style Dwyer, T. (2004, Mar17). Transformations. M/C: A Journal of Media and Culture, 7, <http://www.media-culture.org.au/0403/06-transformations.php>

Abstract:

Photograph by Gonzalo Echeverria (2010)“I must plunge again and again in the water of doubt” (Wittgenstein 1e). The Holy Grail in the phenomenology of religion (and, to a lesser extent, the sociology of religion) is a definition of religion that actually works, but, so far, this seems to have been elusive. Classical definitions of religion—substantive (e.g. Tylor) and functionalist (e.g. Durkheim)—fail, in part because they attempt to be in three places at once, as it were: they attempt to distinguish religion from non-religion; they attempt to capture what religions have in common; and they attempt to grasp the “heart”, or “core”, of religion. Consequently, family resemblance definitions of religion replace certainty and precision for its own sake with a more pragmatic and heuristic approach, embracing doubt and putting forward definitions that give us a better understanding (Verstehen) of religion. In this paper, I summarise some “new” definitions of religion that take this approach, before proposing and defending another one, defining religion as non-propositional and “apophatic”, thus accepting that doubt is central to religion itself, as well as to the analysis of religion.The question of how to define religion has had real significance in a number of court cases round the world, and therefore it does have an impact on people’s lives. In Germany, for example, the courts ruled that Scientology was not a religion, but a business, much to the displeasure of the Church of Scientology (Aldridge 15). In the United States, some advocates of Transcendental Meditation (TM) argued that TM was not a religion and could therefore be taught in public schools without violating the establishment clause in the constitution—the separation of church and state. The courts in New Jersey, and federal courts, ruled against them. They ruled that TM was a religion (Barker 146). There are other cases that I could cite, but the point of this is simply to establish that the question has a practical importance, so we should move on.In the classical sociology of religion, there are a number of definitions of religion that are quite well known. Edward Tylor (424) defined religion as a belief in spiritual beings. This definition does not meet with widespread acceptance, the notable exception being Melford Spiro, who proposed in 1966 that religion was “an institution consisting of culturally patterned interaction with culturally postulated super-human beings” (Spiro 96, see also 91ff), and who has bravely stuck to that definition ever since. The major problem is that this definition excludes Buddhism, which most people do regard as a religion, although some people try to get round the problem by claiming that Buddhism is not really a religion, but more of a philosophy. But this is cheating, really, because a definition of religion must be descriptive as well as prescriptive; that is, it must apply to entities that are commonly recognised as religions. Durkheim, in The Elementary Forms of Religious Life, proposed that religion had two key characteristics, a separation of the sacred from the profane, and a gathering together of people in some sort of institution or community, such as a church (Durkheim 38, 44). However, religions often reject a separation of the sacred from the profane. Most Muslims and many Calvinist Christians, for example, would insist strongly that everything—including the ostensibly profane—is equally subject to the sovereignty of God. Also, some religions are more oriented to a guru-pupil kind of relationship, rather than a church community.Weber tried to argue that religion should only be defined at the end of a long process of historical and empirical study. He is often criticised for this, although there probably is some wisdom in his argument. However, there seems to be an implicit definition of religion as theodicy, accounting for the existence of evil and the existence of suffering. But is this really the central concern of all religions?Clarke and Byrne, in their book Religion Defined and Explained, construct a typology of definitions, which I think is quite helpful. Broadly speaking, there are two types of classical definition. Firstly, there are substantive definitions (6), such as Tylor’s and Spiro’s, which posit some sort of common “property” that religions “have”—“inside” them, as it were. Secondly, functionalist definitions (Clarke and Byrne 7), such as Durkheim’s, define religion primarily in terms of its social function. What matters, as far as a definition of religion is concerned, is not what you believe, but why you believe it.However, these classical definitions do not really work. I think this is because they try to do too many things. For a strict definition of religion to work, it needs to tell us (i) what religions have in common, (ii) what distinguishes religion on the one hand from non-religion, or everything that is not religion, on the other, and (iii) it needs to tell us something important about religion, what is at the core of religion. This means that a definition of religion has to be in three places at once, so to speak. Furthermore, a definition of religion has to be based on extant religions, but it also needs to have some sort of quasi-predictive capacity, the sort of thing that can be used in a court case regarding, for example, Scientology or Transcendental Meditation.It may be possible to resolve the latter problem by a gradual process of adjustment, a sort of hermeneutic circle of basing a definition on extant religions and applying it to new ones. But what about the other problem, the one of being in three places at once?Another type identified by Clarke and Byrne, in their typology of definitions, is the “family resemblance” definition (11-16). This derives from the later Wittgenstein. The “family resemblance” definition of religion is based on the idea that religions commonly share a number of features, but that no one religion has all of them. For example, there are religious beliefs, doctrines and mythos—or stories and parables. There are rituals and moral codes, institutions and clergy, prayers, spiritual emotions and experiences, etc. This approach is of course less precise than older substantive and functional definitions, but it also avoids some of the problems associated with them.It does so by rethinking the point of defining religion. Instead of being precise and rigorous for the sake of it, it tries to tell us something, to be “productive”, to help us understand religion better. It eschews certainty and embraces doubt. Its insights could be applied to some schools of philosophy (e.g. Heideggerian) and practical spirituality, because it does not focus on what is distinctive about religion. Rather, it focuses on the core of religion, and, secondarily, on what religions have in common. The family resemblance approach has led to a number of “new” definitions (post-Durkheim definitions) being proposed, all of which define religion in a less rigorous, but, I hope, more imaginative and heuristic way.Let me provide a few examples, starting with two contrasting ones. Peter Berger in the late 1960s defined religion as “the audacious attempt to conceive of the entire universe as humanly significant”(37), which implies a consciousness of an anthropocentric sacred cosmos. Later, Alain Touraine said that religion is “the apprehension of human destiny, existence, and death”(213–4), that is, an awareness of human limitations, including doubt. Berger emphasises the high place for human beings in religion, and even a sort of affected certainty, while Touraine emphasises our place as doubters on the periphery, but it seems that religion exists within a tension between these two opposites, and, in a sense, encompasses them both.Richard Holloway, former Bishop of Edinburgh in the Scottish Episcopal Church and arch-nemesis of the conservative Anglicans, such as those from Sydney, defines religion as like good poetry, not bad science. It is easy to understand that he is criticising those who see religion, particularly Christianity, as centrally opposed to Darwin and evolution. Holloway is clearly saying that those people have missed the point of their own faith. By “good poetry”, he is pointing to the significance of storytelling rather than dogma, and an open-ended discussion of ultimate questions that resists the temptation to end with “the moral of the story”. In science (at least before quantum physics), there is no room for doubt, but that is not the case with poetry.John Caputo, in a very energetic book called On Religion, proposes what is probably the boldest of the “new” definitions. He defines religion as “the love of God” (1). Note the contrast with Tylor and Spiro. Caputo does not say “belief in God”; he says “the love of God”. You might ask how you can love someone you don’t believe in, but, in a sense, this paradox is the whole point. When Caputo says “God”, he is not necessarily talking in the usual theistic or even theological terms. By “God”, he means the impossible made possible (10). So a religious person, for Caputo, is an “unhinged lover” (13) who loves the impossible made possible, and the opposite is a “loveless lout” who is only concerned with the latest stock market figures (2–3). In this sense of religious, a committed atheist can be religious and a devout Catholic or Muslim or Hindu can be utterly irreligious (2–3). Doubt can encompass faith and faith can encompass doubt. This is the impossible made possible. Caputo’s approach here has something in common with Nietzsche and especially Kierkegaard, to whom I shall return later.I would like to propose another definition of religion, within the spirit of these “new” definitions of religion that I have been discussing. Religion, at its core, I suggest, is non-propositional and apophatic. When I say that religion is non-propositional, I mean that religion will often enact certain rituals, or tell certain stories, or posit faith in someone, and that propositional statements of doctrine are merely reflections or approximations of this non-propositional core. Faith in God is not a proposition. The Eucharist is not a proposition. Prayer is not, at its core, a proposition. Pilgrimage is not a proposition. And it is these sorts of things that, I suggest, form the core of religion. Propositions are what happen when theologians and academics get their hands on religion, they try to intellectualise it so that it can be made to fit within their area of expertise—our area of expertise. But, that is not where it belongs. Propositions about rituals impose a certainty on them, whereas the ritual itself allows for courage in the face of doubt. The Maundy Thursday service in Western Christianity includes the stripping of the altar to the accompaniment of Psalm 22 (“My God, my God, why hast Thou forsaken me”), ending the service without a dismissal (Latin missa, the origin of the English “mass”) and with the church in darkness. Doubt, confusion, and bewilderment are the heart and soul of this ritual, not orthodox faith as defined propositionally.That said, religion does often involve believing, of some kind (though it is not usually as central as in Christianity). So I say that religion is non-propositional and apophatic. The word “apophatic”, though not the concept, has its roots in Greek Orthodox theology, where St Gregory Palamas argues that any statement about God—and particularly about God’s essence as opposed to God’s energies—must be paradoxical, emphasising God’s otherness, and apophatic, emphasising God’s essential incomprehensibility (Armstrong 393). To make an apophatic statement is to make a negative statement—instead of saying God is king, lord, father, or whatever, we say God is not. Even the most devout believer will recognise a sense in which God is not a king, or a lord, or a father. They will say that God is much greater than any of these things. The Muslim will say “Allahu Akhbar”, which means God is greater, greater than any human description. Even the statement “God exists” is seen to be well short of the mark. Even that is human language, which is why the Cappadocian fathers (Saints Basil the Great, Gregory of Nyssa, and Gregory Naziansus) said that they believed in God, while refusing to say that God exists.So to say that religion is at its core non-propositional is to say that religious beliefs are at their core apophatic. The idea of apophasis is that by a process of constant negation you are led into silence, into a recognition that there is nothing more that can be said. St Thomas Aquinas says that the more things we negate about God, the more we say “God is not…”, the closer we get to what God is (139). Doubt therefore brings us closer to the object of religion than any putative certainties.Apophasis does not only apply to Christianity. I have already indicated that it applies also to Islam, and the statement that God is greater. In Islam, God is said to have 99 names—or at least 99 that have been revealed to human beings. Many of these names are apophatic. Names like The Hidden carry an obviously negative meaning in English, while, etymologically, “the Holy” (al-quddu-s) means “beyond imperfection”, which is a negation of a negation. As-salaam, the All-Peaceful, means beyond disharmony, or disequilibrium, or strife, and, according to Murata and Chittick (65–6), “The Glorified” (as-subbuh) means beyond understanding.In non-theistic religions too, an apophatic way of believing can be found. Key Buddhist concepts include sunyata, emptiness, or the Void, and anatta, meaning no self, the belief or realisation that the Self is illusory. Ask what they believe in instead of the Self and you are likely to be told that you are missing the point, like the Zen pupil who confused the pointing finger with the moon. In the Zen koans, apophasis plays a major part. One well-known koan is “What is the sound of one hand clapping?” Any logical answers will be dismissed, like Thomas Aquinas’s statements about God, until the pupil gets beyond logic and achieves satori, or enlightenment. Probably the most used koan is Mu—Master Joshu is asked if a dog has Buddha-nature and replies Mu, meaning “no” or “nothing”. This is within the context of the principle that everything has Buddha-nature, so it is not logical. But this apophatic process can lead to enlightenment, something better than logic. By plunging again and again in the water of doubt, to use Wittgenstein’s words, we gain something better than certainty.So not only is apophasis present in a range of different religions—and I have given just a few examples—but it is also central to the development of religion in the Axial Age, Karl Jaspers’s term for the period from about 800-200 BCE when the main religious traditions of the world began—monotheism in Israel (which also developed into Christianity and Islam), Hinduism and Buddhism in India, Confucianism and Taoism in China, and philosophical rationalism in Greece. In the early Hindu traditions, there seems to have been a sort of ritualised debate called the Brahmodya, which would proceed through negation and end in silence. Not the silence of someone admitting defeat at the hands of the other, but the silence of recognising that the truth lay beyond them (Armstrong 24).In later Hinduism, apophatic thought is developed quite extensively. This culminates in the idea of Brahman, the One God who is Formless, beyond all form and all description. As such, all representations of Brahman are equally false and therefore all representations are equally true—hence the preponderance of gods and idols on the surface of Hinduism. There is also the development of the idea of Atman, the universal Self, and the Buddhist concept anatta, which I mentioned, is rendered anatman in Sanskrit, literally no Atman, no Self. But in advaita Hinduism there is the idea that Brahman and Atman are the same, or, more accurately, they are not two—hence advaita, meaning “not two”. This is negation, or apophasis. In some forms of present-day Hinduism, such as the International Society for Krishna Consciousness (commonly known as the Hare Krishnas), advaita is rejected. Sometimes this is characterised as dualism with respect to Brahman and Atman, but it is really the negation of non-dualism, or an apophatic negation of the negation.Even in early Hinduism, there is a sort of Brahmodya recounted in the Rig Veda (Armstrong 24–5), the oldest extant religious scripture in the world that is still in use as a religious scripture. So here we are at the beginning of Axial Age religion, and we read this account of creation:Then was not non-existent nor existent: there was no realm of air, no sky beyond it.Death was not then, nor was there aught immortal.Darkness there was: at first concealed in darkness this All was indiscriminated chaos.All that existed then was void and form less.Sages who searched with their heart's thought discovered the existent's kinship in the non-existent.Who verily knows and who can here declare it, whence it was born and whence comes this creation?The Gods are later than this world's production. Who knows then whence it first came into being?He, the first origin of this creation, whether he formed it all or did not form it,Whose eye controls this world in highest heaven, he verily knows it, or perhaps he knows not.(Rig Veda Book 10, Hymn 129, abridged)And it would seem that this is the sort of thought that spread throughout the world as a result of the Axial Age and the later spread of Axial and post-Axial religions.I could provide examples from other religious traditions. Taoism probably has the best examples, though they are harder to relate to the traditions that are more familiar in the West. “The way that is spoken is not the Way” is the most anglicised translation of the opening of the Tao Te Ching. In Sikhism, God’s formlessness and essential unknowability mean that God can only be known “by the Guru’s grace”, to quote the opening hymn of the Guru Granth Sahib.Before I conclude, however, I would like to anticipate two criticisms. First, this may only be applicable to the religions of the Axial Age and their successors, beginning with Hinduism and Buddhism, Taoism and Confucianism, and early Jewish monotheism, followed by Jainism, Christianity, Islam and so on. I would like to find examples of apophasis at the core of other traditions, including Indigenous Australian and Native American ones, for example, but that is work still to be done. Focusing on the Axial Age does historicise the argument, however, at least in contrast with a more universal concept of religion that runs the risk of falling into the ahistorical hom*o religiosus idea that humans are universally and even naturally religious. Second, this apophatic definition looks a bit elitist, defining religion in terms that are relevant to theologians and “religious virtuosi” (to use Weber’s term), but what about the ordinary believers, pew-fillers, temple-goers? In response to such criticism, one may reply that there is an apophatic strand in what Niebuhr called the religions of the disinherited. In Asia, devotion to the Buddha Amida is particularly popular among the poor, and this involves a transformation of the idea of anatta—no Self—into an external agency, a Buddha who is “without measure”, in terms of in-finite light and in-finite life. These are apophatic concepts. In the Christian New Testament, we are told that God “has chosen the foolish things of this world to shame the wise, the weak to shame the strong…, the things that are not to shame the things that are” (1 Corinthians 1:27). The things that are not are the apophatic, and these are allied with the foolish and the weak, not the educated and the powerful.One major reason for emphasising the role of apophasis in religious thought is to break away from the idea that the core of religion is an ethical one. This is argued by a number of “liberal religious” thinkers in different religious traditions. I appreciate their reasons, and I am reluctant to ally myself with their opponents, who include the more fundamentalist types as well as some vocal critics of religion like Dawkins and Hitchens. However, I said that I would return to Kierkegaard, and the reason is this. Kierkegaard distinguishes between the aesthetic, the ethical and the religious. Of course, religion has an aesthetic and an ethical dimension, and in some religions these dimensions are particularly important, but that does not make them central to religion as such. Kierkegaard regarded the religious sphere as radically different from the aesthetic or even the ethical, hence his treatment of the story of Abraham going to Mount Moriah to sacrifice his son, in obedience to God’s command. His son was not killed in the end, but Abraham was ready to do the deed. This is not ethical. This is fundamentally and scandalously unethical. Yet it is religious, not because it is unethical and scandalous, but because it pushes us to the limits of our understanding, through the waters of doubt, and then beyond.Were I attempting to criticise religion, I would say it should not go there, that, to misquote Wittgenstein, the limits of my understanding are the limits of my world, whereof we cannot understand thereof we must remain silent. Were I attempting to defend religion, I would say that this is its genius, that it can push back the limits of understanding. I do not believe in value-neutral sociology, but, in this case, I am attempting neither. ReferencesAldridge, Alan. Religion in the Contemporary World. Cambridge: Polity, 2000.Aquinas, Thomas. “Summa of Christian Teaching”. An Aquinas Reader. ed. Mary Clarke. New York: Doubleday, 1972.Armstrong, Karen. The Great Transformation. New York: Alfred A. Knopf, 2006.Barker, Eileen. New Religious Movements: a Practical Introduction. London: HMSO, 1989.Berger, Peter. The Social Reality of Religion. Harmondsworth: Penguin, 1973.Caputo, John. On Religion. London: Routledge, 2001.Clarke, Peter, and Peter Byrne, eds. Religion Defined and Explained. New York: St Martin’s Press. 1993.Durkheim, Emile. The Elementary Forms of Religious Life. New York: Free Press, 1995.Holloway, Richard. Doubts and Loves. Edinburgh: Caqnongate, 2002.Jaspers, Karl. The Origin and Goal of History. Westport, Connecticut: Greenwood Press, 1977.Kierkegaard, Søren. Either/Or. London: Penguin, 1992.———. Fear and Trembling. London: Penguin, 1986.Murata, Sachiko, and William Chittick. The Vision of Islam. St Paul, Minnesota: Paragon House, 1994.Niebuhr, H. Richard. The Social Sources of Denominationalism. New York: Holt, 1929.Spiro, Melford. “Religion: Problems of Definition and Explanation.” Anthropological Approaches to the Study of Religion. Ed. Michael Banton. London: Tavistock, 1966. 85–126.Touraine, Alain. The Post-Industrial Society. London: Wilwood House, 1974.Tylor, Edward. Primitive Culture. London: Murray, 1903.Weber, Max. The Sociology of Religion. Boston: Beacon Press, 1991.Wittgenstein, Ludwig. Remarks on Frazer’s Golden Bough. Nottingham: Brynmill Press, 1979.

Abstract:

Dear Colleagues, In the previous editorial paper published by Balat et al. [1] as an Early View Article a few months ago, it was reported that there were changes in the Editorial Team of the European Journal of Therapeutics (Eur J Ther). During these few months, while the preparations for the new issue (June 2023, volume 29, Issue 2) continued, the editorial board also was revised. We would like to inform you that the Editorial Board has been strengthened by academics who are competent in their fields from many countries of the world and will continue to be strengthened in the future. As it is known, Eur J Ther started broadcasting in 1990 as a Journal of the Faculty of Medicine University of Gaziantep (In Turkish: Gaziantep Üniversitesi Tıp Fakültesi Dergisi). In the first paper titled “While Starting” (In Turkish: Başlarken) of the first issue, Prof. Sabri Güngör, who was the first Editor-in-Chief, stated that the aim of the journal is to have an influential place in the field of science [2]. Over the past three decades, the journal has continued to advance. At the present time, it is inevitable to reorganise the editorial board of the journal and enrich it with leading international editors in order to move the journal to better places. This editorial will explain essential developments in the journal in the last few months, and the new Editorial Board Members of the Eur J Ther will be introduced. Changes are inevitable, and we are delighted to announce that this issue marks several significant improvements. Specifically, we bolstered our editorial team with esteemed international academics and expanded our pool of referees. Consequently, the evaluation period for the submitted articles was significantly reduced. In the last two months, the journal metrics are as follows: Acceptance rate: %29 Average time until the final decision: 24.4 days Average time to publish as Accepted/Early View Article, after acceptance: 4.8 days. Thanks to these improvements, as you will notice, there are 25 articles in this issue. In this way, this issue has been the issue in which most articles have been published so far. In addition, applications were made to DOAJ (Directory of Open Access Journals) and BASE (Bielefeld Academic Search Engine), among the most essential open-access databases in the world, in May 2023. Moreover, cited references to the previous and/or alternative names of the journal (Gaziantep Medical Journal, Gaziantep Med J, Gaziantep Tıp Dergisi and Gaziantep Üniversitesi Tıp Fakültesi Dergisi) in Web of Science that were not reflected in the journal metrics were identified and reported to the Web of Science. Some of these correction requests have been finalized and corrected, and thus the total number of citations and the H-index of the journal increased [3]. After all these data are updated, it will be seen that the citation values of the Eur J Ther will increase even more. We will also update the guidelines for the authors and reviewers with respect to the ICMJE [4] and EQUATOR Network [5], which will enhance the quality of research in the medical fraternity. Additionally, the use of DOI for articles published in the journal started in 2011 (2011, volume 17, Issue 2). In order to facilitate the recognition and access of the articles, DOIs have also been defined for all articles published in previous issues. Editors Ayşe Balat, MD, became the new Editor-in-Chief of Eur J Ther for the second time, the first between 2007-2010. She is a Professor in Pediatrics and a specialist in Pediatric Nephrology and Rheumatology. She has been working as Vice President of Gaziantep University since October 2020. She was the Dean of Gaziantep University Medical Faculty (2007-2010), President of the Mediterranean Kidney Society (MKS) between 2015 to 2018, and Secretary beginning in 2018. She is also President of the International Association for the History of Nephrology (IAHN) since 2022. In Gaziantep, she first established Pediatric Nephrology and Pediatric Rheumatology Units, and the first peritoneal dialysis was performed by her. She has several studies published in international and national peer-reviewed scientific journals (H-Index: 26, i10-index: 59 and approximately 2500 citations). She was the Guest Editor of the International Journal of Nephrology in 2012 (special issue titled “Devil’s Triangle in Kidney Diseases: Oxidative Stress, Mediators, and Inflammation”). She is a member of many national and international associations related to her field, including membership in the Turkish Pediatric Nephrology Association board in the past. She has several scientific presentation awards at national and international congresses. She has been joined as an “invited speaker” at 20 International Meetings. As of 2007, she organizes World Kidney Day activities within the scope of the “Survival is not Enough” program (in the first rank among European pediatric nephrologists as an organizer of those activities). Recently, she was elected as a “lifelong member of the Academy of Medicine and Surgical Sciences” of the University of Naples, which is one of the four important academies in Naples. Şevki Hakan Eren, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Eren graduated from the Medical School, University of Gaziantep, Turkey and completed Emergency training at Cumhuriyet University. He has been working as a Professor at Gaziantep University, Department of Emergency Medicine, Gaziantep, Turkey. He is interested in traumatology, and toxicology. Mehmet Sait Menzilcioğlu, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr. Menzilcioğlu graduated from the Medical School, University of Gaziantep, Turkey and completed Radiology training at the same University. He has been working as an Associate Professor at Gaziantep University, Department of Radiology, Gaziantep, Turkey. He is interested in neuroradiology, ultrasonography, doppler Ultrasonography, Computerized Tomography, Magnetic Resonance Imaging, interventional radiology, and obstetric sonography. İlhan Bahşi, MD, PhD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Bahşi is also on the Editorial Board of the Journal of Craniofacial Surgery, Frontiers in Neuroanatomy, and Mersin University School of Medicine Lokman Hekim Journal of History of Medicine and Folk Medicine. In addition, he has published more than 80 articles (H-index: 12 and i10-index: 15) and has been a referee for more than 600 academic papers in many internationally indexed journals. Dr Bahşi, who has been working in the Department of Anatomy at the Gaziantep University Faculty of Medicine since 2012, completed his doctorate education in 2017 and obtained the title of PhD. Besides anatomy, he is particularly interested in the history of medicine, medical ethics, and education. İlkay Doğan, PhD, is the new Editorial Board member of the Eur J Ther for Statistics and Methodology. He is in the Department of Biostatistics at the Gaziantep University Faculty of Medicine. His professional focus lies in research about Structural Equation Modeling, Multivariate Analysis. With a wealth of experience spanning over 15 years across multiple disciplines, including veterinary, nursing, sport and medicine, Dr Doğan has held various notable articles. He is a member of the Turkish Biostatistics Association. Ahmet Acıduman, MD, PhD, graduated from Ege University Faculty of Medicine in 1987 and later specialized in Neurosurgery in 1997. Dr Acıduman further expanded his academic credentials by completing a PhD in the History of Medicine and Ethics in 2005. Currently, he is a Professor in the Department of History of Medicine and Ethics at Ankara University Faculty of Medicine. With a notable record of over 200 academic publications, Dr Acıduman’s contributions to the field continue. Bilal Çiğ, PhD, is a new Editorial board member of the Eur J Ther. Associate Prof Bilal Çiğ is a Postdoctoral researcher at King's College London Wolfson Card. He has been investigating the roles of ion channels in neurological diseases using the patch clamp technique for nearly 15 years. For the past few years, he has focused on the interactions of TRPA1 and Kir 4.1 channels in demyelination. He has 40 SCI-E and international publications, with about 1300 citations. Tsvetoslav Georgiev, MD, PhD, holds an esteemed position as an associate professor at the First Department of Internal Medicine in Varna, Bulgaria, while also working as a clinician at the University Hospital St. Marina. He has successfully defended his doctoral dissertation in 2018 at the Medical University in Sofia. Having obtained a specialization in rheumatology that same year, Dr Georgiev has extensive expertise in this intricate field of medicine. He further expanded his knowledge and skills by attending comprehensive courses on imaging diagnostics and musculoskeletal ultrasound in rheumatology held in various locations. Dr Georgiev has been involved in formulating the Bulgarian consensus on osteoarthritis and EULAR recommendations for the non-pharmacological core management of osteoarthritis. Notably, Dr Georgiev has received recognition for his outstanding contributions as a reviewer, earning awards in 2019 and 2021 from the Korean Academy of Medical Sciences. Davut Sinan Kaplan, PhD, is a new Editorial Board Member of the Eur J Ther. Dr Kaplan is an Associate Professor in the Department of Physiology at Gaziantep University Faculty of Medicine. He is also the Graduate School of Health Sciences’ Director. He has taken involved in a wide variety of research with animal models. His research generally focuses on Endocrinology, Metabolism, Physical Activity, and Breast Milk. He has mentored a large group of master’s and PhD students. He has served for many years as a member of the local animal experiments ethics committee. Mehmet Karadağ, MD, is a new Editorial Board Member of the Eur J Ther for Psychiatry. Dr. Karadag is an Associate Professor of Child and Adolescent Psychiatry. He is in the Department of Child and Adolescent Psychiatry at the Gaziantep University School of Medicine. He has experience on Posttraumatic Stress, Attention Deficit Hyperactivity, Autism Spectrum, Anxiety, Depressive Disorders and EMDR Therapy. He is also EMDRIA accredited EMDR Consultant. Murat Karaoglan, MD, is a new Editorial Board Member of the Eur J Ther for Endocrinology. Dr. Karaoglan is an Associate Professor of Pediatric Endocrinology. He is in the Department of Pediatric Endocrinology at the Gaziantep University School of Medicine. He has experience on growth disorder, diabetology and disorder of sexual development. Waqar M. Naqvi, PhD, is a faculty in the Department of Physiotherapy at the College of Health Sciences, Gulf Medical University, Ajman, UAE. His professional focus lies in the development of the research ecosystem within healthcare education, with a particular interest in AI, AR, VR, Sensors, and innovation in health sciences. With a wealth of experience spanning over 14 years across multiple countries, including India, Canada, Cameroon, Hong Kong, and Saudi Arabia, Dr Naqvi has held various notable positions. These include his roles as the Associate Director of Research at the NKP Salve Institute of Medical Sciences, Acting Dean and Vice Dean of the Physiotherapy College, Convener for the International Admission Office, International Accreditation and Quality Assurance Wing, Staff Selection Committee, and Coordinator for a Staff-Student Exchange Program. In recognition of his outstanding contributions, Dr Naqvi was honored with the Distinguished Service Award and Young Achiever Award from the Indian Association of Physiotherapy. Dr Naqvi is widely recognized for his expertise in conducting seminars and workshops on research, publications, and intellectual property rights. Specializing as a research trainer in the fields of medicine, dentistry, physiotherapy, and health sciences, Dr Naqvi's unwavering commitment to research excellence and his genuine passion for mentoring aspiring researchers are instrumental in shaping the future of healthcare. He firmly believes in the power of evidence-based practice and actively advocates for its implementation. Ali Nasimi is a neuroscientist in the field of central regulation of the cardiovascular system. Victor Nedzvetsky, PhD, DrSc is a full professor of Physiology, Biochemistry and Lab Diagnostics, where coordinates courses on Neurochemistry, Molecular and Cell Biology. Additionally, he is a vice-director of “The Biosafety Center” research and development company (Ukraine). He obtained PhD in biochemistry at Dnipropetrovsk University, Ukraine (1990). After postdoctoral training, he received a degree of Doctor Science at Kyiv National University (2006). Since 2015 he was involved as an invited professor of Bingol University, Turkey as a supervisor of PhD projects on genetic and molecular biology. He has participated in both the education and research work of the Dept. Art and Science of Bingol University from 2015 to 2021. His current research interests are focused on intestinal barrier function, brain blood barrier, astrocytes, cognitive deficits, bioactive compounds as anticancer agents, nanomaterials, and neuroprotection. He is the author of over 230 research publications and ten patents. He is a member of the editorial board of the journal “Regulatory Mechanisms of Biosystems”. Raphael Olszewski, DDS, MD, PhD, DrSc is a full professor of oral surgery and dentomaxillofacial radiology at the Université Catholique de Louvain (UCLouvain), Brussels, Belgium. Professor Olszewski is an oral surgeon and member of the Department of Oral and Maxillofacial Surgery at Cliniques Universitaires Saint Luc, UCLouvan, Brussels, Belgium. Prof Olszewski is the Editor-in-Chief of NEMESIS: Negative effects in medical sciences: oral and maxillofacial surgery. Janusz Ostrowski, MD, PhD. Internal medicine, nephrology, and public health specialist. Former Head of the Department of Internal Medicine and Nephrology at the Provincial Hospital in Wloclawek, Poland. Director for Peritoneal Dialysis in Diaverum Company Poland. Secretary of the Historical Section of the Polish Society of Nephrology. Former President of the International Association for the History of Nephrology. Professor, Vice Dean of the School of Public Health and Head of the Department of the History of Medicine in the Centre of Postgraduate Medical Education in Warsaw, Poland. Ayşe Aysima Özçelik, MD, is a new Editorial Board member of Eur J Ther for Neurology. She is the head of the pediatric neurology department and works at Gaziantep University Faculty of Medicine. She is the regional manager for the treatment of spinal muscular atrophy disease. She is an experienced physician in the treatment and follow-up of genetic neurological disorders, epilepsy, and neuromuscular diseases. Maria Piagkou, DDS, MD, MSc, PhD is a new Editorial Board member of Eur J Ther for Neurology. She is an associate professor at the Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens. She is a Deputy Vice-President of the Hellenic Association of Public Health in Greece and a President of the printed material handling committee of the National Organization for Medicines. She has twenty-one years of teaching activity in the field of anatomy, focused on head and neck, oral and maxillofacial area, as well as on skull base anatomy and anatomical variants. Her main areas of interest are head and neck anatomy and surgery, skull base anatomy, oral surgery, maxillofacial and dental trauma, rehabilitation, intraoral fixation after condylar fractures, and teeth replantation. She is an associate editor in 2 journals of Anatomy and acts as Editorial Board Member in six other journals. She authored six chapters in neuroanatomy and oral and maxillofacial surgery and thoracic surgery books, two monographs, and edited the translation of 9 books. She is a reviewer in 30 international scientific journals. She authored 156 publications in PubMed, 91 abstracts in 26 international congresses, and 318 abstracts in Greek scientific meetings. She is General Secretary of the Sports Medicine Association of Greece and treasurer of the Hellenic Association of Anatomy. Halima Resić, MD, PhD is a Professor of Internal medicine – nephrology in Sarajevo. Professor Resić studied medicine at the University of Belgrade where she also undertook a clinical fellowship in nephrology. She finished her postgraduate studies also at the University of Belgrade in 1987. Professor Resić worked at the Clinical Centre of Belgrade from 1972. to 1992. In 1993. She worked at the Marmara University of Istanbul. Also, in the period from 1994. to 1996. she took part in projects for refugees in Munich with the support of the Ministry of Health of the city of Munich. From 1996. till 2019. professor Resić worked at the Clinical Center University of Sarajevo, where she was head of the Clinic of Hemodialysis. In 2001. She obtained her PhD degree in Nephrology. She became a professor at the Medical Faculty of the University of Sarajevo in 2013. Professor Resić published about 180 professional and scientific papers in relevant journals. She has been a president of organizations of a few national congress and nephrology schools, and also an active participant of ERA congress and WCN congress. She has also been invited lecturer in over 60 different international and national congresses. Professor Resić was President of the BANTAO Society (2017-2019), and President of the Mediterian Kidney Society. She has been President of the Society of Nephrology, Dialysis and Kidney Transplantation in Bosnia and Herzegovina (2010-2020) and also, she is President of Donor’s network of Bosnia and Herzegovina. She is a member of ERA EDTA and ISN, and also a member of the Committee of SRC by ISN. She is a member of the Council of EAPE (European Association of Professor Emerita). She is also vice president of IANUBIH (International Academy of Science and Arts in Bosnia and Herzegovina) and a member of the board of South Eastern Europe by ISN. In her carrier, she obtains many international awards for her work in the field of Nephrology. Aldo Rogelis Aquiles Rodrigues is a new Editorial Board member of Eur J Ther for Neurology. Currently, he is an associate professor in physiology at the Federal University of Triângulo Mineiro, MG, Brazil since 2006. Before that, he worked as a research associate at the Department of Neurophysiology, Madison, USA from 2002 to 2005. He has experience in auditory neurons electrophysiology, enteric neurons and ion channels in general. Domenico Santoro is a Full Professor of Nephrology, Director of the Division of Nephrology and Coordinator of the Nephrology Fellowship Program University of Messina, AOU G. Martino – Messina. He is s a clinical expert in glomerular disorders with a scientific formation at the section of renal Pathology of the CSMC UCLA Los Angeles. He collaborated in genetic studies in glomerular disease. He coordinates as principal investigators several studies in glomerular disease both in clinical/therapeutical as well genetic aspects. He is the Associate Editor of the Journal of Nephrology and MBC Nephrology. Author of more than 270 scientific publications indexed on Scopus, H-index in Scopus: 38; H-index in Google Scholar: 46. Onur Taydaş, MD, is a new Editorial Board Member of the Eur J Ther for Radiology. Dr Taydas is an Associate Professor in the Department of Radiology at the Sakarya University School of Medicine. He has a Turkish Society of Radiology Proficiency Certificate, a European Diploma in Radiology, and a Turkish Interventional Radiology Diploma. He has experience in neuroradiology, musculoskeletal radiology, and interventional radiology. Gregory Tsoucalas (or Tsoukalas), born in 1974 and originated from the Island of Skopelos in the center of the Aegean Sea, he had studied Medicine in the University of Saint Kliment Ohridski in Sofia Bulgaria. He had then continued his studies in Lyon France and Athens Greece. He had been a Nuclear Medicine-Oncology-End stage physician in Saint Savvas Anticancer Hospital of Athens. He had after that moved to the city of Volos where he had been a physician in the Saint George Clinic for Alzheimer and Related Dementia Syndromes-End stage. He had finally moved to the General Clinic Anassa of Volos in the Internal Pathology Department. He currently holds the position of the Assistant professor of the History of Medicine, and head of the Department of History of Medicine and Medical Deontology, Medical School, University of Crete, Heraklion, Greece. Specialized in Nuclear Medicine, MSc in Palliative Medicine and PhD in the History of Medicine from National and Kapodistrian University of Athens, History of Medicine Diploma from Claude Bernard Lyon 1 University, post-doc in Anatomy from Democritus University of Thrace, Anthropology Course Diploma from Leiden University. He holds diplomas in Mastology and Clinical Nutrition for the related European Societies. He is the General Secretary of the Hellenic Branch of the Balkan Medical Union. Interested in the fields of History of Medicine, Deontology, Bioethics, Anatomy and Humanities, he is the writer of more than 200 articles in the PubMed database and more than 200 in other bases. He loves books and had published 10, while he had participated with chapters in various publications. Member of the International Society of the History of Medicine he had presented more than 130 speeches and 50 lectures in international level. Member of DELTOS (Hellenic Society) he had presented more than 400 speeches in local level. He enjoys more than 2500 citations, H-index: 17, and i10-index: 41. Hamit Yıldız, MD, PhD, is the new editorial Board member for Internal Medicine. Dr Yildiz is an internal medicine specialist and practices in Gaziantep University Hospital. He is Board Certified in Internal Medicine. He completed his internship at Gaziantep University in Gaziantep and also graduated with a PhD in molecular biology. He has more than ten years of experience as a specialist who focuses on patients with diabetes, hypertension and thyroid diseases. His special interest is recombinant DNA technologies and the development of biotechnological drugs. Betül Yılmaz Furtun, MD, FASE, FAAP, is a new Editorial Board Member for the Eur J Ther. She is an Associate Professor of Pediatrics at the Texas Children's Hospital, Baylor College of Medicine and Associate Medical Director of the Fetal Cardiology/Fetal Cardiac Intervention Program at Texas Children's Hospital. Dr Yilmaz Furtun is also a Course Director of Fetal Cardiology Education/Curriculum Development for advanced and categorical cardiology fellows and an Associate Director of the Fetal Care Center Steering Committee for fetal cardiology at Texas Children's Hospital. Dr Yilmaz Furtun is a pediatric cardiologist with expertise in advanced imaging modalities including fetal echocardiography, transthoracic and transesophageal echocardiography. Dr Yilmaz Furtun completed her pediatrics training at Washington University in St. Louis, pediatric cardiology training at Columbia University Medical Center, New York Presbyterian Hospital, and fetal cardiology/advanced imaging training at Cincinnati Children's Hospital. Dr Yilmaz Furtun actively participates in fetal and pediatric echocardiography laboratory protocol development and fetal and echocardiography lab and Fetal Care Center quality and improvement initiatives. Dr Yilmaz Furtun has been a member of the American Society of Echocardiography, the International Society of Ultrasound in Obstetrics and Gynecology, the Fetal Heart Society as well as American College of Cardiology. Dr Yilmaz Furtun’s clinical and research focus relates to cardiac imaging by echocardiography and fetal echocardiography. She utilizes her experience in these areas to study how we can use non-invasive imaging modalities for investigating normal and abnormal cardiac function in patients with congenital heart disease and in fetuses with cardiac compromise. Her primary research interests focus on fetal cardiovascular assessment and cardiac dysfunction in patients with congenital heart disease, in fetuses with congenital abnormalities, and in multiple gestation pregnancies complicated by twin-twin transfusion syndrome. Matthew Zdilla, DC, is a new Editorial Board Member for the Eur J Ther. Dr Zdilla was educated at the University of Pittsburgh and Northeast College of Health Sciences. He serves as an Associate Professor at the West Virginia University School of Medicine in the United States of America. He is an award-winning, internationally recognized clinical anatomist who has published scores of high-impact research papers regarding human diversity and the impact of anatomical variation on clinical procedures. In addition to his experience as an accomplished researcher, Zdilla brings his experience as an ad hoc reviewer for nearly 40 journals to the European Journal of Therapeutics. Joseph Schmidt, MFA has taught academic writing for the University of Louisville and various campuses of The City University of New York (CUNY). An accomplished poet, he has contributed content to, and edited a number of small literary journals. At Gaziantep University, he has lent his editorial and native English language talents to some of his Turkish colleagues in the sciences. He teaches in the university’s School of Foreign Languages (YDO).

Abstract:

Photo by 14825144 © Alita Xander | Dreamstime.com ABSTRACT The US government's approach to the War on Drugs has created laws to deter people from using illicit drugs through negative punishment. These laws have not controlled illicit drug use, nor has it stopped the opioid pandemic from growing. Instead, these laws have created a negative bias surrounding addiction and have negatively affected particularly vulnerable patient populations, including pregnant women with substance use disorder and newborns with neonatal abstinence syndrome. This article highlights some misconceptions and underscores the challenges they face as they navigate the justice and healthcare systems while also providing possible solutions to address their underlying addiction. INTRODUCTION Pregnant women with substance use disorder require treatment that is arguably for the benefit of both the mother and the fetus. Some suggest that addiction is a choice; therefore, those who misuse substances should not receive treatment. Proponents of this argument emphasize social and environmental factors that lead to addiction but fail to appreciate how chronic substance use alters the brain’s chemistry and changes how it responds to stress, reward, self-control, and pain. The medical community has long recognized that substance use disorder is not simply a character flaw or social deviance, but a complex condition that requires adequate medical attention. Unfortunately, the lasting consequences of the War on Drugs have created a stigma around addiction medicine, leading to significant treatment barriers. There is still a pervasive societal bias toward punitive rather than rehabilitative approaches to addiction. For example, many women with substance use disorder lose custody of their baby or face criminal penalties, including fines and jail time.[1] These punitive measures may cause patients to lose trust in their physicians, ultimately leading to high-risk pregnancies without prenatal care, untreated substance misuse, and potential lifelong disabilities for their newborns.[2] As a medical student, I have observed the importance of a rehabilitative approach to addiction medicine. Incentivizing pregnant women with substance use disorder to safely address their chronic health issues is essential for minimizing negative short-term and long-term outcomes for women and their newborns. This approach requires an open mind and supportive perspective, recognizing that substance use disorder is truly a medical condition that requires just as much attention as any other medical diagnosis.[3] BACKGROUND The War on Drugs was a government-led initiative launched in 1970 by President Richard M. Nixon with the aim of curtailing illegal drug use, distribution, and trade by imposing harsher prison sentences and punishments.[4] However, it is worth noting that one can trace the roots of this initiative back further. In 1914, Congress enacted the Harrison Narcotics Tax Act to target the recreational use of drugs such as morphine and opium.[5] Despite being in effect for over four decades, the War on Drugs failed to achieve its intended goals. In 2011, the Global Commission on Drug Policy released a report that concluded that the initiative had been futile, as “arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”[6] One study published in the International Journal of Drug Policy in the same year found that funding drug law enforcement paradoxically contributed to increasing gun violence and homicide rates.[7] The Commission recommended that drug policies focus on reducing harm caused by drug use rather than solely on reducing drug markets. Recognizing that many drug policies were of political opinion, it called for drug policies that were grounded in scientific evidence, health, security, and human rights.[8] Unfortunately, policy makers did not heed these recommendations. In 2014, Tennessee’s legislature passed a “Fetal Assault Law,” which made it possible to prosecute pregnant women for drug use during pregnancy. If found guilty, pregnant women could face up to 15 years in prison and lose custody of their child. Instead of deterring drug use, the law discouraged pregnant women with substance use disorder from seeking prenatal care. This law required medical professionals to report drug use to authorities, thereby compromising the confidentiality of the patient-physician relationship. Some avoided arrest by delivering their babies in other states or at home, while others opted for abortions or attempted to go through an unsafe withdrawal prior to receiving medical care, sacrificing the mother's and fetus's wellbeing. The law had a sunset provision and expired in 2016. During the two years this law was in effect, officials arrested 124 women.[9] The fear that this law instilled in pregnant women with substance use disorder can still be seen across the US today. Many pregnant women with substance use disorders stated that they feared testing positive for drugs. Due to mandatory reporting, they were not confident that physicians would protect them from the law.[10] And if a woman tried to stop using drugs before seeking care to avoid detection, she often ended up delaying or avoiding care.[11] The American College of Obstetricians and Gynecologists (ACOG) recognizes the fear those with substance use disorders face when seeking appropriate medical care and emphasizes that “obstetric–gynecologic care should not expose a woman to criminal or civil penalties, such as incarceration, involuntary commitment, loss of custody of her children, or loss of housing.”[12] Mandatory reporting strains the patient-physician relationship, driving a wedge between the doctor and patient. Thus, laws intended to deter people from using substances through various punishments and incarceration may be doing more harm than good. County hospitals that mainly serve lower socioeconomic patients encounter more patients without consistent health care access and those with substance use disorders.[13] These hospitals are facing the consequences of the worsening opioid pandemic. At one county hospital where I recently worked, there has been a dramatic increase in newborns with neonatal abstinence syndrome born to mothers with untreated substance use disorders during pregnancy. Infants exposed to drugs prenatally have an increased risk of complications, stillbirth, and life-altering developmental disabilities. At the hospital, I witnessed Child Protective Services removing two newborns with neonatal abstinence syndrome from their mother’s custody. Four similar cases had occurred in the preceding month. In the days leading up to their placement with a foster family, I saw both newborns go through an uncomfortable drug withdrawal. No baby should be welcomed into this world by suffering like that. Yet I felt for the new mothers and realized that heart-wrenching custody loss is not the best approach. During this period, I saw a teenager brought to the pediatric floor due to worsening psychiatric symptoms. He was born with neonatal abstinence syndrome that neither the residential program nor his foster family could manage. His past psychiatric disorders included attention deficit disorder, conduct disorder, major depressive disorder, anxiety disorder, disruptive mood dysregulation disorder, intellectual developmental disorder, and more. During his hospitalization, he was so violent towards healthcare providers that security had to intervene. And his attitude toward his foster parents was so volatile that we were never sure if having them visit was comforting or agitating. Throughout his hospital course, it was difficult for me to converse with him, and I left every interview with him feeling lost in terms of providing an adequate short- and long-term assessment of his psychological and medical requirements. What was clear, however, was that his intellectual and emotional levels did not match his age and that he was born into a society that was ill-equipped to accommodate his needs. Just a few feet away from his room, behind the nurses’ station, were the two newborns feeling the same withdrawal symptoms that this teenager likely experienced in the first few hours of his life. I wondered how similar their paths would be and if they would exhibit similar developmental delays in a few years or if their circ*mstance may follow the cases hyped about in the media of the 1980s and 1990s regarding “crack babies.” Many of these infants who experienced withdrawal symptoms eventually led normal lives.[14] Nonetheless, many studies have demonstrated that drug use during pregnancy can adversely impact fetal development. Excessive alcohol consumption can result in fetal alcohol syndrome, characterized by growth deficiency, facial structure abnormalities, and a wide range of neurological deficiencies.[15] Smoking can impede the development of the lungs and brain and lead to preterm deliveries or sudden infant death syndrome.[16] Stimulants like methamphetamine can also cause preterm delivery, delayed motor development, attention impairments, and a wide range of cognitive and behavioral issues.[17] Opioid use, such as oxycodone, morphine, fentanyl, and heroin, may result in neonatal opioid withdrawal syndrome, in which a newborn may exhibit tremors, irritability, sleeping problems, poor feeding, loose stools, and increased sweating within 72 hours of life.[18] In 2014, the American Association of Pediatrics (AAP) reported that one newborn was diagnosed with neonatal abstinence syndrome every 15 minutes, equating to approximately 32,000 newborns annually, a five-fold increase from 2004.[19] The AAP found that the cost of neonatal abstinence syndrome covered by Medicaid increased from $65.4 million to $462 million from 2004 to 2014.[20] In 2020, the CDC published a paper that showed an increase in hospital costs from $316 million in 2012 to $572.7 million in 2016.[21] Currently, the impact of the COVID-19 pandemic on the prevalence of newborns with neonatal abstinence syndrome is unknown. I predict that the increase in opioid and polysubstance use during the pandemic will increase the number of newborns with neonatal abstinence syndrome, thereby significantly increasing the public burden and cost.[22] In the 1990s, concerns arose about the potentially irreparable damage caused by intrauterine exposure to cocaine on the development of infants, which led to the popularization of the term “crack babies.”[23] Although no strong longitudinal studies supported this claim at the time, it was not without merit. The Maternal Lifestyle Study (NCT00059540) was a prospective longitudinal observational study that compared the outcomes of newborns exposed to cocaine in-utero to those without.[24] One of its studies revealed one month old newborns with cocaine exposure had “lower arousal, poorer quality of movements and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes.”[25] Another study showed that at one month old, heavy cocaine exposure affected neural transmission from the ear to the brain.[26] Long-term follow up from the study showed that at seven years old, children with high intrauterine cocaine exposure were more likely to have externalizing behavior problems such as aggressive behavior, temper tantrums, and destructive acts.[27] While I have witnessed this behavior in the teenage patient during my pediatrics rotation, not all newborns with intrauterine drug exposure are inevitably bound to have psychiatric and behavioral issues later in life. NPR recorded a podcast in 2010 highlighting a mother who used substances during pregnancy and, with early intervention, had positive outcomes. After being arrested 50 times within five years, she went through STEP: Self-Taught Empowerment and Pride, a public program that allowed her to complete her GED and provided guidance and encouragement for a more meaningful life during her time in jail. Her daughter, who was exposed to cocaine before birth, had a normal childhood and ended up going to college.[28] From a public health standpoint, more needs to be done to prevent the complications of substance misuse during pregnancy. Some states consider substance misuse (and even prescribed use) during pregnancy child abuse. Officials have prosecuted countless women across 45 states for exposing their unborn children to drugs.[29] With opioid and polysubstance use on the rise, the efficacy of laws that result in punitive measures seems questionable.[30] So far, laws are not associated with a decrease in the misuse of drugs during pregnancy. Millions of dollars are being poured into managing neonatal abstinence syndrome, including prosecuting women and taking their children away. Rather than policing and criminalizing substance use, pregnant women should get the appropriate care they need and deserve. I. Misconception One: Mothers with Substance Use Disorder Can Get an Abortion If an unplanned pregnancy occurs, one course of action could be to terminate the pregnancy. On the surface, this solution seems like a quick fix. However, the reality is that obtaining an abortion can be challenging due to two significant barriers: accessibility and mandated reporting. Abortion laws vary by state, and in Tennessee, for instance, abortions are banned after six weeks of gestation, typically when fetal heart rhythms are detected. An exception to this is in cases where the mother's life is at risk.[31] Unfortunately, many women with substance use disorders are from lower socioeconomic backgrounds and cannot access pregnancy tests, which could indicate they are pregnant before the six-week cutoff. If a Tennessee woman with substance use disorder decides to seek an abortion after six weeks, she may need to travel to a neighboring state. However, this is not always a feasible option, as the surrounding states (WV, MO, AR, MI, AL, and GA) also have restrictive laws that either prohibit abortions entirely or ban them after six weeks. Moreover, she may be hesitant to visit an obstetrician for an abortion, as some states require physicians by law to report their patients' substance use during pregnancy. For example, Virginia considers substance use during pregnancy child abuse and mandates that healthcare providers report it. This would ultimately limit her to North Carolina if she wants to remain in a nearby state, but she must go before 20 weeks gestation.[32] For someone who may or may not have access to reliable transportation, traveling to another state might be impossible. Without resources or means, these restrictive laws have made it incredibly difficult to obtain the medical care they need. II. Misconception Two: Mothers with SUD are Not Fit to Care for Children If a woman cannot take care of herself, one might wonder how she can take care of another human being. Mothers with substance use disorders often face many adversities, including lack of economic opportunity, trauma from abuse, history of poverty, and mental illness.[33] Fortunately, studies suggest keeping mother and baby together has many benefits. Breastfeeding, for example, helps the baby develop a strong immune system while reducing the mother’s risk of cancer and high blood pressure.[34] Additionally, newborns with neonatal abstinence syndrome who are breastfed by mothers receiving methadone or buprenorphine require less pharmacological treatment, have lower withdrawal scores, and experience shorter hospital stays.[35] Opioid concentration in breastmilk is minimal and does not pose a risk to newborns.[36] Moreover, oxytocin, the hormone responsible for mother-baby bonding, is increased in breastfeeding mothers, reducing withdrawal symptoms and stress-induced reactivity and cravings while also increasing protective maternal instincts.[37] Removing an infant from their mother’s care immediately after birth would result in the loss of all these positive benefits for both the mother and her newborn. The newborns I observed during my pediatrics rotation probably could have benefited from breastfeeding rather than bottle feeding and being passed around from one nurse to the next. They probably would have cried less and suffered fewer withdrawal symptoms had they been given the opportunity to breastfeed. And even if the mothers were lethargic and unresponsive while going through withdrawal, it would still have been possible to breastfeed with proper support. Unfortunately, many believe mothers with substance use disorder cannot adequately care for their children. This pervasive societal bias sets them up for failure from the beginning and greatly inhibits their willingness to change and mend their relationship with their providers. It is a healthcare provider’s duty to provide non-judgmental care that prioritizes the patient’s well-being. They must treat these mothers with the same empathy and respect as any other patient, even if they are experiencing withdrawal. III. Safe Harbor and Medication-Assisted Treatment Addiction is like any other disease and society should regard treatment without stigma. There is no simple fix to this problem, given that it involves the political, legal, and healthcare systems. Punitive policies push pregnant women away from receiving healthcare and prevent them from receiving beneficial interventions. States need to enact laws that protect these women from being reported to authorities. Montana, for example, passed a law in 2019 that provides women with substance use disorders safe harbor from prosecution if they seek treatment for their condition.[38] Medication-assisted treatment with methadone or buprenorphine is the first line treatment option and should be available to all pregnant women regardless of their ability to pay for medical care.[39] To promote continuity of care, health officials could include financial incentives to motivate new mothers to go to follow-up appointments. For example, vouchers for groceries or enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may offset financial burdens and allow a mother to focus on taking care of her child and her recovery. IV. Mandated Substance Abuse Programs Although the number of people sentenced to state prisons for drug related crimes has been declining, it is still alarming that there were 171,300 sentencings in 2019.[40] Only 11 percent of the 65 percent of our nation’s inmates with substance use disorder receive treatment, implying that the other 89 percent were left without much-needed support to overcome their addiction.[41] It is erroneous to assume that their substance use disorder would disappear after a period without substance use while behind bars. After withdrawal, those struggling with substance use disorder may still have cravings and the likelihood of relapsing remains high without proper medical intervention. Even if they are abstinent for some time during incarceration, the underlying problem persists, and the cycle inevitably continues upon release from custody. In line with the recommendations by Global Commission on Drug Policy and the lessons learned from the failed War on Drugs, one proposed change in our criminal justice system would be to require enrollment and participation in assisted alcohol cessation programs before legal punishment. Policy makers must place emphasis on the safety of the patient and baby rather than the cessation of substance use. This would incentivize people to actively seek medical care, restore the patient-physician relationship, and ensure that they take rehabilitation programs seriously. If the patient or baby is unsafe, a caregiver could intervene while the patient re-enrolls in the program. Those currently serving sentences in prisons and jails can treat their substance use disorder through medication assisted treatment, cognitive behavioral therapy, and programs like Self Taught Empowerment and Pride (STEP). Medication assisted treatment under the supervision of medical professionals can help inmates achieve and maintain sobriety in a healthy and safe way. Furthermore, cognitive behavioral therapy can help to identify triggers and teach healthier coping mechanisms to prepare for stressors outside of jail. Finally, multimodal empowerment programs can connect people to jobs, education, and support upon release. People often leave prisons and jail without a sense of purpose, which can lead to relapse and reincarceration. Structured programs have been shown to decrease drug use and criminal behavior by helping reintegrate productive individuals into society.[42] V. Medical Education: Narcotic Treatment Programs and Suboxone Clinics Another proactive approach could be to have medical residency programs register with the Drug Enforcement Administration (DEA) as Narcotic Treatment Programs and incorporate suboxone clinics into their education and rotations. Rather than family medicine, OB/GYN, or emergency medicine healthcare workers having to refer their patients to an addiction specialist, they could treat patients with methadone for maintenance or detoxification where they would deliver their baby. Not only would this educate and prepare the future generation of physicians to handle the opioid crisis, but it would allow pregnant women to develop strong patient-physician relationships. CONCLUSION Society needs to change from the mindset of tackling a problem after it occurs to taking a proactive approach by addressing upstream factors, thereby preventing those problems from occurring in the first place. Emphasizing public health measures and adequate medical care can prevent complications and developmental issues in newborns and pregnant women with substance use disorders. Decriminalizing drug use and encouraging good health habits during pregnancy is essential, as is access to prenatal care, especially for lower socioeconomic patients. Many of the current laws and regulations that policy makers initially created due to naïve political opinion and unfounded bias to serve the War on Drugs need to be changed to provide these opportunities. To progress as a society, physicians and interprofessional teams must work together to truly understand the needs of patients with substance use disorders and provide support from prenatal to postnatal care. There should be advocation for legislative change, not by providing an opinion but by highlighting the facts and conclusions of scientific studies grounded in scientific evidence, health, security, and human rights. There can be no significant change if society continues to view those with substance use disorders as underserving of care. Only when the perspective shifts to compassion can these mothers and children receive adequate care that rehabilitates and supports their future and empowers them to raise their children. - [1] NIDA. 2023, February 15. Pregnant People with Substance Use Disorders Need Treatment, Not Criminalization. https://nida.nih.gov/about-nida/noras-blog/2023/02/pregnant-people-substance-use-disorders-need-treatment-not-criminalization [2] Substance Use Disorder Hurts Moms and Babies. National Partnership for Women and Families. June 2021 [3] All stories have been fictionalized and anonymized. [4] A History of the Drug War. Drug Policy Alliance. https://drugpolicy.org/issues/brief-history-drug-war [5] The Harrison Narcotic Act (1914) https://www.druglibrary.org/Schaffer/library/studies/cu/cu8.html [6] The War on Drugs. The Global Commission on Drug Policy. Published June 2011. https://www.globalcommissionondrugs.org/reports/the-war-on-drugs [7] Werb D, Rowell G, Guyatt G, Kerr T, Montaner J, Wood E. Effect of drug law enforcement on drug market violence: A systematic review. Int J Drug Policy. 2011;22(2):87-94. doi:10.1016/j.drugpo.2011.02.002 [8] Global Commission on Drug Policy, 2011 [9] Women NA for P. Tennessee’s Fetal Assault Law: Understanding its impact on marginalized women - New York. Pregnancy Justice. Published December 14, 2020. https://www.pregnancyjusticeus.org/tennessees-fetal-assault-law-understanding-its-impact-on-marginalized-women/ [10] Roberts SCM, Nuru-Jeter A. Women’s perspectives on screening for alcohol and drug use in prenatal care. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2010;20(3):193-200. doi:10.1016/j.whi.2010.02.003 [11] Klaman SL, Isaacs K, Leopold A, et al. Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance. J Addict Med. 2017;11(3):178-190. doi:10.1097/ADM.0000000000000308 [12] Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2011/01/substance-abuse-reporting-and-pregnancy-the-role-of-the-obstetrician-gynecologist [13] R. Ghertner, G Lincoln The Opioid Crisis and Economic Opportunity: Geographic and Economic Trends. ASPE. Office of Assistant Secretary for Planning and Evaluation. DHHS Revised September 11, 2018 https://aspe.hhs.gov/reports/economic-opportunity-opioid-crisis-geographic-economic-trends [14] Midon, M. Z., Gerzon, L. R., & de Almeida, C. S. (2021). Crack and motor development of babies living in an assistance shelter. ABCS Health Sciences, 46, e021215-e021215. And for example, see Crack Babies: Twenty Years Later : NPR https://www.npr.org/templates/story/story.php?storyId=126478643 [15] Williams JF, Smith VC, the Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. Pediatrics. 2015;136(5):e20153113. doi:10.1542/peds.2015-3113 [16] CDC Tobacco Free. Smoking During Pregnancy. Centers for Disease Control and Prevention. Published April 11, 2022. https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm [17] Abuse NI on D. What are the risks of methamphetamine misuse during pregnancy? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/methamphetamine/what-are-risks-methamphetamine-misuse-during-pregnancy [18] CDC. Basics About Opioid Use During Pregnancy | CDC. Centers for Disease Control and Prevention. Published July 21, 2021. https://www.cdc.gov/pregnancy/opioids/basics.html [19] Honein MA, Boyle C, Redfield RR. Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infants. Pediatrics. 2019;143(3):e20183801. doi:10.1542/peds.2018-3801 [20] Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants with Medicaid: 2004–2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520 [21] Strahan AE, Guy GP Jr, Bohm M, Frey M, Ko JY. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatr. 2020;174(2):200-202. doi:10.1001/jamapediatrics.2019.4791 [22] Ghose R, Forati AM, Mantsch JR. Impact of the COVID-19 Pandemic on Opioid Overdose Deaths: a Spatiotemporal Analysis. J Urban Health Bull N Y Acad Med. 2022;99(2):316-327. doi:10.1007/s11524-022-00610-0 [23] Mayes LC, Granger RH, Bornstein MH, Zuckerman B. The Problem of Prenatal Cocaine Exposure: A Rush to Judgment. JAMA. 1992;267(3):406-408. doi:10.1001/jama.1992.03480030084043 [24] NICHD Neonatal Research Network. The Maternal Lifestyle Study. clinicaltrials.gov; 2016. https://clinicaltrials.gov/ct2/show/study/NCT00059540 [25] Lester BM, Tronick EZ, LaGasse L, et al. The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants. Pediatrics. 2002;110(6):1182-1192. doi:10.1542/peds.110.6.1182 [26] Lester BM, Lagasse L, Seifer R, et al. The Maternal Lifestyle Study (MLS): effects of prenatal cocaine and/or opiate exposure on auditory brain response at one month. J Pediatr. 2003;142(3):279-285. doi:10.1067/mpd.2003.112 [27] Bada HS, Bann CM, Bauer CR, et al. Preadolescent behavior problems after prenatal cocaine exposure: Relationship between teacher and caretaker ratings (Maternal Lifestyle Study). Neurotoxicol Teratol. 2011;33(1):78-87. doi:10.1016/j.ntt.2010.06.005 [28] N, P, R. Crack Babies: Twenty Years Later. NPR. Published May 3, 2010. https://www.npr.org/templates/story/story.php?storyId=126478643 [29] Miranda L, Dixon V, September CRP on, 30, 2015. How States Handle Drug Use During Pregnancy http://projects.propublica.org/graphics/maternity-drug-policies-by-state [30] NCDAS: Substance Abuse and Addiction Statistics [2023]. NCDAS. https://drugabusestatistics.org/ [31] (Tenn. Code Ann. § 39-15-216). [32] Institute G. Interactive Map: US Abortion Policies and Access After Roe. https://states.guttmacher.org/policies/ [33] Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. J Addict. 2013;2013:579310. doi:10.1155/2013/579310 [34] CDC. Five Great Benefits of Breastfeeding. Centers for Disease Control and Prevention. Published July 27, 2021. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html [35] Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013;102(11):1060-1066. doi:10.1111/apa.12378 [36] Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med Off J Acad Breastfeed Med. 2012;7:269-274. doi:10.1089/bfm.2011.0096 [37] Pedersen CA, Smedley KL, Leserman J, et al. Intranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects. Alcohol Clin Exp Res. 2013;37(3):484-489. doi:10.1111/j.1530-0277.2012.01958.x [38] Montana SB0289. https://leg.mt.gov/bills/2019/billhtml/SB0289.htm [39] Mullins N, Galvin SL, Ramage M, Gannon M, Lorenz K, Sager B, Coulson CC. Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Study. J Addict Med. 2020 May/Jun;14(3):185-192. doi: 10.1097/ADM.0000000000000562. PMID: 31567599. [40] Drug Related Crime Statistics [2023]: Offenses Involving Drug Use. NCDAS. https://drugabusestatistics.org/drug-related-crime-statistics/ [41] Association APH. Online only: Report finds most U.S. inmates suffer from substance abuse or addiction. Nations Health. 2010;40(3):E11-E11. [42] Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) | NIDA Archives. Published January 17, 2018. http://archives.nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition

Abstract:

Photo by National Cancer Institute on Unsplash INTRODUCTION Gift-giving by patients or their families to physicians has happened since there were patients and physicians, and in many places, it’s still quite common. It’s also potentially problematic, and the why and how of it offer important insight into the physician-patient relationship and human relationships more broadly. Yet ethicists, regulators, and the public have not paid much systematic attention. In the United States, no federal or state legislation directly addresses it. Only in the past two decades did the American Medical Association (AMA) release guidance to physicians about it. That guidance, which permits physicians to accept certain gifts by certain patients under certain circ*mstances, namely, when it will not influence their medical judgment or cause hardship to the gift-giver, is vague and incomplete – indeed, it’s all of 200 words.[1] Other physician professional organizations have little to add.[2] A few academics and opinion columnists have studied or reflected on the psychology of gift-giving and -receiving and recommended everything from categorical rejection of patient gifts[3] to erring on the side of accepting them, provided they are of modest value, and the motivation behind them can be discerned.[4] However, insufficient attention has been paid to the when and where of those gifts or the significance of clinic-, hospital- or other systems-level ethical safeguards. ANALYSIS When deciding whether they will accept a gift from a patient or their family, physicians must balance the possibility that the gift could cloud medical judgment, lead to favoritism, exploitation, and slippery slopes, or pressure other patients to give, and perhaps even debase the meaning of medical treatment, against the prospect that gift-giving could increase patient trust and satisfaction, as well as empower patients and respect their autonomy and culture.[5] Performing this harm-benefit calculation case by case is challenging and time-consuming. Unsurprisingly, many physicians opt simply to tell would-be gift-giving patients that they appreciate the sentiment, but, as a rule, they accept no gifts. I submit many physicians do this also because they are unaware of how meaningful giving a gift can be for patients or anyone in a disadvantaged position with respect to the gift recipient. They may also not know that there are simple accountability mechanisms they can institute that may prevent many of the possible adverse consequences of gift-giving and -receiving in the context of the physician-patient or physician-patient-family relationship. Unfortunately, many instances in which accepting a gift would have led to net benefit are foregone. It is my belief a consensus could quickly be formed about which types of gifts would clearly be wrong to accept. Few would defend the physician who agrees to use a patient’s villa in the Bahamas or welcomes expensive jewelry or lewd photos. The timing and intent of a gift also matter. Few would forgive the physician who accepted even a modestly valuable voucher to eat at a patient’s restaurant while their eligibility for transplant was being debated or after they had run out of opioid painkillers and were denied a prescription renewal. On the other hand, I doubt even Charles Weijer or the College of Physicians and Surgeons of Prince Edward Island, which views accepting gifts from patients as “boundary crossing,”[6] would demand an orthopedic surgeon turn down the happy picture a pediatric patient drew after recovering from a hip injury and resuming sports. They are also unlikely to criticize an oncology team that graciously receives a fruitcake baked by the sister of an elderly cancer patient after the decision was made and agreed to, around Christmastime, not to initiate another round of chemotherapy. These unlikely refusals may be because rejecting those gifts, all things considered, would seem cruel. But it might also be because there is disagreement about what constitutes a gift: whether it must be a tangible object (are heartfelt thank-yous and hugs not also “gifts”?) or whether it must be something that requires the physician actively do something, e.g., get on a plane. These disagreements about definitions may also partially underlie disagreements about practice. Suppose a patient in a sparsely populated, heavily wooded part of Maine takes it upon himself to offer a sack of apples from his orchard to his internist, who regularly waives fees for those who cannot pay them or will make a house call at any time of the night. In that case, the internist may not consider the apples a gift. He may not think of them as payment or re-payment either. They may exist in some in-between category, much like the knitted slippers brought in by a patient in whose culture “thank you” is seldom said. But clearly, some things are widely perceived as gifts or to have substantial gift-like character. Should they, at least, be rejected? I don’t think so. The act of gift-giving and -receiving can be a sort of ritual and gradually lead to trust and closeness.[7] Perhaps a shy patient whose wife previously sent chocolates to his physician around Christmastime will come to see the physician as a part of his extended family. Perhaps he needs to do so to feel comfortable talking about his erectile dysfunction. Gifts can be expressions of caring.[8] Perhaps an elderly Texan patient imagines her younger physician, whom she has known for thirty years and often sees at the grocery store, as her son and asks to prepare a homecoming mum (traditionally a chrysanthemum flower corsage) for his children’s school dance. Perhaps doing so will give her purpose, make her feel useful, as all her own children have moved away. Giving gifts may also provide patients with a sense of control and help them feel as if less of a power imbalance exists between them and their physician. Perhaps a young judge, who is not used to not being in control, and was previously misdiagnosed with rheumatoid arthritis, is now struggling to come to terms with his Lupus. Perhaps giving the physician who made the correct diagnosis a moderately-priced bottle of scotch restores his confidence or sense of pride to. Gifts are also undoubtedly important to the recipient. When medical providers receive a gift, they may interpret it as a sign that they are valued. While it would be wrong to practice medicine to receive gifts or expect them, there are times, like when ERs and ICUs are overwhelmed because of a viral pandemic,[9] which threatens the will to continue working, and most anything (within reason) that bolsters resolve can be considered good. There is also no obvious distinction between the satisfaction physicians normally receive on seeing their patients recover or being thanked or smiled at and what they feel when they receive a small or “token” gift, like a plate of homemade cookies. The point is that the physician-patient relationship is a human one. Many advocate it should be personal, that physicians should be emotionally invested in their patients, care about and have compassion for them in ways that professional oaths do not fully capture.[10] This dynamic is particularly important in primary care or when the physician-patient relationship continues for long periods. According to one Israeli study, many patients even wish for a relationship with their physician akin to friendship. Those who felt they had such a relationship were more satisfied with their care than those who believed the relationship was business-like.[11] The precedent for this “friendship between unequals” goes back at least to the time of Erasmus, some five hundred years ago.[12] There may be good reasons for physicians to draw the line before friendship, but if accepting certain gifts builds intimacy, and that intimacy does not cross over into an inappropriate relationship, e.g., a sexual or romantic relationship, and if it has the chance to improve healthcare outcomes through improved mood or early disclosure of problems, I think it should be done. Physicians have a prima facie duty to do good for their patients.[13] Most physicians want to do good for their patients and respect their traditions and preferences. I suspect that accepting the gifts from the patients in the examples above would do a lot of good, or at least that rejecting them could do significant harm, including making them or their families feel estranged from the medical community, impeding future care. Physicians might be more comfortable accepting gifts if receiving gifts would not subject them to scrutiny or penalty. They also may feel better if they knew that receiving gifts would not harm their patients and that rejecting gifts might. They should document all gifts they receive.[14] This will enable them to detect if gifts from a particular patient are increasing in frequency or lavishness or changing markedly in character, which could warrant attention. I maintain this “Gift Log” should be maintained in common with everyone at the clinic or in the relevant hospital department and potentially made available to hospital administration for audit. Investigation might be necessary if a gift is given (and accepted) with no explicable context, e.g., not near holiday season or after a treatment milestone is achieved. When possible, gifts should be shared communally, such as placing fruit baskets or chocolates in the staff room. Other gifts, like artwork, can be displayed on the walls. Others should be encouraged to hold physicians accountable if they feel patients who have given gifts receive preferential treatment, including something as seemingly small as priority for appointment bookings. Appearances matter and even the appearance of impropriety can affect the public’s trust in medicine. The culture of medicine has already changed such that nurses now reproach physicians they feel violate the standard of care,[15] and this would be an extension of that trend. Depending on the set-up of the practice, a staff member can be designated for receiving gifts and politely declining those that ought to be declined. Staff members should tell patients, who give gifts in full view of other patients, that they cannot do so in the future. Physicians can politely rebuff patients who wish to give inappropriate gifts, or gifts at inappropriate times and suggest they donate to charity instead. Medical practices and hospitals should develop a gift policy in consultation with staff and patients to avoid needlessly rejecting gifts that benefit both doctor and patient and to avoid pressuring patients into giving gifts. The policy should be flexible to account for the crucial human element in any provider-patient relationship and the cultural nuances of any practice setting. Psychiatrists, who work with particularly vulnerable patients, may need to be more vigilant when accepting gifts.[16] CONCLUSION Though we tend to think health innovation occurs in urban medical centers and spreads outward, there may be something big-city physicians can learn from their rural colleagues about personalized patient-physician relationships. The value of gifts is only one example. Normalizing the acceptance of patient gifts in appropriate restricted circ*mstances has the added benefit of shining a spotlight on the acceptance of patient gifts in dubious ones. By bringing an already fairly common practice into the open and talking about it, we can create policies that respect patients as persons, prevent abuse, and deconstruct the stereotype of the austere and detached physician. While there is no reason to think that gift-giving would get out of control if appropriate safeguards are put in place, the medical community can always re-evaluate after a period, or an individual medical practice can re-evaluate based on the circ*mstances of their practice environment. Gift-giving, especially when gifts are of small monetary value, should be recognized as a culturally appropriate gesture with meaning far beyond that monetary value. It is best governed by reasonable gift-giving policies, not banned altogether. - [1] Council on Ethical and Judicial Affairs. “Ethics of Patient-Physician Relationships.” In AMA Code of Medical Ethics, 11. Chicago: American Medical Association, 2021. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-1.pdf. [2] Sulmasy, Lois Snyder, and Thomas A. Bledsoe. “American College of Physicians Ethics Manual.” Annals of Internal Medicine 170, no. 2_Supplement (January 15, 2019): S1–32. https://doi.org/10.7326/M18-2160; Committee on Bioethics. “Pediatrician-Family-Patient Relationships: Managing the Boundaries.” Pediatrics 124, no. 6 (December 1, 2009): 1685–88. https://doi.org/10.1542/peds.2009-2147. [3] Weijer, Charles. “No: Gifts Debase the True Value of Care.” Western Journal of Medicine 175, no. 2 (August 2001): 77. [4] Lyckholm, Laurie J. “Should Physicians Accept Gifts From Patients?” JAMA 280, no. 22 (December 9, 1998): 1944–46. https://doi.org/10.1001/jama.280.22.1944; Spence, Sean A. “Patients Bearing Gifts: Are There Strings Attached?” BMJ 331, no. 7531 (December 22, 2005): 1527–29. https://doi.org/10.1136/bmj.331.7531.1527; Gaufberg, Elizabeth. “Should Physicians Accept Gifts from Patients?” American Family Physician 76, no. 3 (August 1, 2007): 437; Caddell, Andrew, and Lara Hazelton. “Accepting Gifts from Patients.” Canadian Family Physician 59, no. 12 (December 2013): 1259–60. [5] See above commentators and Drew, Jennifer, John D. Stoeckle, and J. Andrew Billings. “Tips, Status and Sacrifice: Gift Giving in the Doctor-Patient Relationship.” Social Science & Medicine 17, no. 7 (January 1, 1983): 399–404. https://doi.org/10.1016/0277-9536(83)90343-X. [6] College of Physicians and Surgeons of Prince Edward Island. “Respecting Boundaries.” Accessed April 4, 2021. https://cpspei.ca/respecting-boundaries/. [7] The Atlantic’s Marketing Team. “What Gifting Rituals from Around the Globe Reveal About Human Nature.” The Atlantic, 2018. https://www.theatlantic.com/sponsored/hennessy-2018/what-gifting-rituals-around-globe-reveal-about-human-nature/2044/. [8] Parker-Pope, Tara. “A Gift That Gives Right Back? The Giving Itself.” The New York Times, December 11, 2007, sec. Health. https://www.nytimes.com/2007/12/11/health/11well.html. [9] Harlan, Chico, and Stefano Pitrelli. “As Coronavirus Cases Grow, Hospitals in Northern Italy Are Running out of Beds.” Washington Post. Accessed April 4, 2021. https://www.washingtonpost.com/world/europe/italy-coronavirus-patients-lombardy-hospitals/2020/03/12/36041dc6-63ce-11ea-8a8e-5c5336b32760_story.html. [10] Frankel, Richard M. “Emotion and the Physician-Patient Relationship.” Motivation and Emotion 19, no. 3 (September 1, 1995): 163–73. https://doi.org/10.1007/BF02250509. [11] Magnezi, Racheli, Lisa Carroll Bergman, and Sara Urowitz. “Would Your Patient Prefer to Be Considered Your Friend? Patient Preferences in Physician Relationships.” Health Education & Behavior 42, no. 2 (April 1, 2015): 210–19. https://doi.org/10.1177/1090198114547814. [12] Albury, W. R., and G. M. Weisz. “The Medical Ethics of Erasmus and the Physician-Patient Relationship.” Medical Humanities 27, no. 1 (June 2001): 35–41. https://doi.org/10.1136/mh.27.1.35. [13] Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th edition. New York: Oxford University Press, 2012. [14] Caddell and Hazelton, 2013. [15] See, e.g. Peplau, Hildegard E. “A Glance Back in Time: Nurse-Doctor Relationships.” Nursing Forum 34, no. 3 (1999): 31–35. https://doi.org/10.1111/j.1744-6198.1999.tb00991.x and Ahmad, Ahmir. “The Doctor-Nurse Relationship: Time for Change?” British Journal of Hospital Medicine (2005), September 27, 2013. https://doi.org/10.12968/hmed.2009.70.Sup4.41642. [16] Hundert, Edward M. “Looking a Gift Horse in the Mouth: The Ethics of Gift-Giving in Psychiatry.” Harvard Review of Psychiatry 6, no. 2 (January 1, 1998): 114–17. https://doi.org/10.3109/10673229809000319.