Kategori: News in English

The Anatomy of Melancholy was written more than 400 years ago, but Robert Burton’s masterpiece is strangely modern. Although it brims with quaint language and Latin quotes, it also resembles a medical textbook: a compendium of the symptoms, causes, prognoses and treatments of human misery.

Take Burton’s discussion of “love-melancholy”. Its symptoms include leanness, loss of appetite, hollow eyes, fear, sorrow, disturbed sleep, suspicion, sighing, moaning, peevishness and pallor, “as one who trod with naked foot upon a snake”. It has dietary, climatic and astrological causes. Burton is not optimistic about recovery, but suggests “good counsel and persuasion” may help.

Love-melancholy is no longer recognised as an illness, but Burton showed how it could be diagnosed. From Greek roots meaning “to know apart” or distinguish, diagnosis takes place in countless consulting rooms around the globe. In essence, this process of discerning illness from symptoms is no different from any other kind of categorisation, like identifying birds or car models.

Review: Age of Diagnosis – Suzanne O’Sullivan (Hachette)

Diagnosis may be an everyday activity, but it is a contentious one. There has been a staggering rise in the prevalence of many medical conditions and the cultural attention we pay them. Diagnostic labels saturate our language, firehosed by social media. The stigma attached to some diagnoses, such as depression and attention deficit hyperactivity disorder, has waned to the point where many people actively seek and embrace them.

But as diagnosis has risen in prominence, it has become a magnet for criticism. New diagnostic manuals are lashed for turning ordinary life problems into pathologies. Mental health professionals argue we should abandon diagnosis altogether, or replace its categories with spectra. Countless video clips on social media channels like TikTok peddle expansive and inaccurate definitions of illness, while others push back against self-diagnosis.

Suzanne O’Sullivan.
Penguin Random House

British neurologist Suzanne O’Sullivan enters this battlefield with her timely new book, The Age of Diagnosis. O’Sullivan is a seasoned clinician and science writer who has seen firsthand how the diagnostic landscape has changed. We have taken diagnosis too far, she argues, and our cultures, health systems and selves are suffering the consequences.

Her perspective is a necessary one, complementing the concerns about overdiagnosis and “concept creep” raised by writers whose backgrounds are primarily in research and theory. As someone who works at the clinical frontline, and whose compassion for her patients is clear, O’Sullivan’s views cannot be written off as out of touch or uncaring.

Overdiagnosis and medicalisation

O’Sullivan’s case rests on two pivotal concepts: overdiagnosis and medicalisation. We might imagine that overdiagnosis occurs when diagnoses are made in the absence of illness, but O’Sullivan’s definition is more subtle. A condition is overdiagnosed, she writes, when the costs of the diagnosis outweigh its benefits.

This definition draws attention away from knotty ontological questions about the boundaries of illness and towards the pragmatic question of whether diagnosis is helpful. “A diagnosis is supposed to lead to something,” O’Sullivan writes, and if it doesn’t lead to something good, it is unwarranted.

Ideally, a diagnosis should deliver the benefits of effective treatment while doing no harm. In practice, many diagnoses carry stigma, undermine our sense of self and future, and have self-fulfilling negative (“nocebo”) effects. O’Sullivan argues we systematically underestimate the costs of diagnosis and overestimate its benefits. This is especially so for milder forms of illness, where the benefits of treatment are often minimal.

Medicalisation is the tendency for concepts of illness to expand to encompass a widening range of human experience. New conditions can be invented and old ones stretched to include milder phenomena. Ordinary variations in human biology can be defined as disease risks, as in “predictive diagnosis”, when the likelihood of developing a condition is calculated based on genetic tests or other health information.

Medicalisation leads us to see the world through the lens of pathology. By expanding concepts of illness into the zone of ordinary unhappiness, O’Sullivan argues, it fosters overdiagnosis.

Attributing more to sickness

O’Sullivan believes overdiagnosis and medicalisation are rife. Rates of some diagnoses are rising, not due to declining population health or enhanced detection, she suggests. Instead, “borderline medical problems are becoming ironclad diagnoses”. “We are not getting sicker,” she writes, “we are attributing more to sickness.”

This trend has several adverse consequences. Overdiagnosis leads to overtreatment. Because diagnoses are not inert labels, it can actively create illness and distress. It can waste resources and divert them from areas of greater need.

Chapters of the book explore these themes in a range of health conditions, many psychiatric or neurological. They offer an informative combination of clinical case study, clearly articulated science, and sober reflection on social implications.

A chapter on autism chronicles the steady expansion of this condition. Originally a severely disabling and vanishingly rare condition of childhood that disproportionately affected boys, it has become one that encompasses people with relatively benign challenges, she writes. Increasingly, it is diagnosed in adults and the sex ratio is gradually becoming more balanced.

For O’Sullivan, these developments reflect “diagnostic creep” and questionable theorising. The autism phenotype has become overstretched, she argues: concepts such as “masking” allow people with relatively mild visible social impairments to be included. Many people find autism diagnoses validating, she argues, but evidence they produce benefits for everyday functioning is scarce. She also warns autistic identities may be stigmatised and self-limiting.

Concepts such as ‘masking’ allow people with relatively mild visible social impairments to be included in autism diagnoses.
Ian Talmacs/Unsplash

Meanwhile, heterogeneous samples and shifting diagnostic sands make it well-nigh impossible for researchers to develop reliable, cumulative knowledge about autism. It has become a moving target: a paradigm case of philosopher Ian Hacking’s “looping effects”, by which our classifications influence the people they classify – and are then influenced by them.

Critical of neurodiversity

Similar concerns are raised about attention deficit hyperactivity disorder (ADHD). Like autism, the diagnosis has increased rapidly and received many more adult and female cases. O’Sullivan notes the unavoidable subjective elements involved. All 18 “symptoms” must be judged to occur “often” to be considered present, a judgement known to vary between people. These symptoms must be appraised as “negatively impacting” social, academic or occupational activities, another intrinsically vague benchmark.

Autistic and ADHD actor Chloe Hayden.
Bianca De Marchi/AAP

O’Sullivan is critical of the “neurodiversity” view of ADHD, which holds that the condition is a form of difference to be celebrated rather than a disorder to be fixed. She denies that its essence is neurological and challenges the “biologising” focus on brain processes. That focus oversimplifies ADHD, overlooking its social and environmental determinants. “I am a psychologiser,” she announces, sceptical of biological reductionism.

The recent trend for ADHD to be adopted as an identity also comes in for criticism. O’Sullivan sees this identity as more constraining than liberating. Viewing ADHD as an enduring and inbuilt aspect of one’s brain promotes passivity, and the bogus binary between the neurodivergent and the neurotypical creates an unhelpful “us versus them”, she writes.

O’Sullivan acknowledges that many people find self-acceptance in the diagnosis. However, its additional benefits are unclear, she suggests, especially among relatively mild cases. For example, stimulant medication may not compensate for the adverse impacts of diagnostic labelling for children with less severe ADHD. Similarly, study accommodations such as extra time on tests have little effect on performance. In the absence of tangible benefits and the presence of potential costs, she argues, ADHD is likely to be overdiagnosed.

Overscreening cancer

Although many of the book’s examples scrutinise mental health, The Age of Diagnosis roams wider. O’Sullivan gives equal weight to Huntington’s disease, Lyme disease, long COVID and rare genetic conditions, among others. In these conditions, tensions often arise between advocacy groups and medical scientists. The former typically agitate for broader and sometimes questionable diagnoses. O’Sullivan makes no secret of where she stands:

Scientific answers aren’t at the convenience of the majority opinion. Understanding patient experience is fundamental in setting research priorities, but scientific process must still be systematic, methodical, rigorous and open to any answer.

In a powerful chapter on genetic screening for cancer, Sullivan finds it often fails to deliver health benefits but succeeds in pathologising normal biological variations. All screening tests have false positives, but these can be significantly more common than true positives. False positives are not cost-free and the benefits of accurate early detection are not straightforward.

Breast cancer screening.
Torin Halsey/Times Record News/AAP

Positive tests can have damaging psychological and sometimes physical consequences, she writes. These include dread-filled time waiting for disease to manifest and unnecessary interventions. Some screening tests massively overestimate the likelihood that positive tests will develop into illness requiring treatment.

Even if screening reduces progression to a particular fatal disease, it may not reduce deaths by all causes combined. O’Sullivan cites one meta-analysis showing that with the exception of large bowel cancer, cancer screening did not extend the lifespan at all. It is instructive that people who are properly apprised of the potential risks and benefits of screening often forego it, even when the benefits are relatively unambiguous.

Fixing the diagnosis problem

What to do? O’Sullivan is not one to wring hands. She offers a range of remedies, some directed at medical practice and some to the culture at large.

From the standpoint of medicine, O’Sullivan’s key recommendation is to take overdiagnosis much more seriously. Greater scrutiny is required whenever definitions of disorders are loosened or new screening tests are developed. Deeper scepticism about the aggregate benefit for patients’ quality of life is also needed. More attention must be paid to the potential downsides of diagnosis.

A more nuanced understanding of diagnosis itself is required. Often the problem is not diagnosis itself, but doing it too mechanically and taking it too literally. Diagnosis is a clinical art, not something decided by a superficial checklist or lab test.

O’Sullivan makes an evidence-based case for the importance of clinical judgement, informed by intimate and holistic awareness of the patient’s life circumstances. That kind of awareness is the best done by generalists, endangered as they are in our age of specialists.

Humanistic care is essential, but it is not enough. There is an urgent need to arrest the proliferation of diagnoses. O’Sullivan observes that patients increasingly present with multiple diagnostic labels, and discusses the poignant case of a young woman with nine.

The problems this trend poses should be obvious. Multiple diagnoses draw in multiple specialists, call for different treatments, make the coordination of care a major challenge, and become all-absorbing for the patient. The stickiness of diagnostic labels means that conditions are added but rarely subtracted.

Frequently the multiple diagnoses are not meaningfully distinct “co-morbid” ailments, but different expressions of a single underlying emotional disturbance, O’Sullivan suggests. Splintering this disturbance into a motley assortment of diagnoses fragments treatment. Like the fabled blind men who palpated different parts of an elephant, identifying it as a snake, spear, tree trunk, rope and wall, it also gets the ontology of the illness wrong.

Changing the culture of diagnosis

Responsibility for solving this problem should not fall on health professionals alone, however. It requires cultural change as well. Once upon a time we could blame the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) for medicalising experience and shrinking normality. But now inflationary trends in diagnosis are driven more by social media and well-meaning efforts to boost awareness.

The DSM may have helped to create a diagnostic culture, but it is laypeople who are now stretching its concepts and bandying about illness labels to diagnose themselves and others. This change is often seen as a welcome democratisation of mental health, a belated recognition of the value of “lived experience”, and a form of resistance to the biomedical model. However, its effect has been to pathologise everyday life as much as to normalise mental ill health.

Inflationary trends in diagnosis are based less on the DSM than social media and well-meaning awareness raising.

The pitfalls of these expansive concepts are now well documented in the research literature. People who apply diagnostic labels to their depressed mood tend to deal with it ineffectively. Making anxiety central to one’s identity is linked to coping poorly with it. Those who define adversities as traumas are more likely to respond in post-traumatic ways to unpleasant experiences.

Holding expansive concepts of mental illness leads people to self-diagnose at relatively low levels of distress. Applying diagnostic labels to mild or marginal cases of suffering leads people to think recovery is less likely and troubles less controllable. Findings such as these indicate that whatever benefits baggy diagnostic concepts may have, they also have a significant downside.

A growing ‘dediagnosis’ movement

The realisation that rising awareness of and attention to mental illness may be backfiring is beginning to dawn. There is little evidence it is improving our mental health – which continues to decline globally as awareness grows, especially among the young. However, there is reason to worry it may be doing the opposite.

A similar story might be told about other forms of illness. It is not hard to believe elevated concerns about risk and the medicalisation of normal losses of physical function can drive a joyless pursuit of perfect health and happiness.

O’Sullivan is correct in diagnosing our “age of diagnosis” and she makes a strong case for moving beyond it. It is hard to say what a post-diagnostic age might look like and how the pendulum might be wrestled back. It will surely require significant reform on the part of health systems and a serious reckoning with the rise of screening tools.

In this connection, it is gratifying to see an emerging movement for “dediagnosis” within medicine. It will have to be accompanied by a transformation in how the public thinks about diagnosis. O’Sullivan’s masterful book could help bring such an alliance into being.

The Age of Diagnosis shows us how we got into our pathological predicament – and indicates how we might get out. Läs mer…

The Australian Music Venue Foundation launched this month to advocate for and potentially administer an arena ticket levy to support grassroots live music venues. Funds would be raised through a small levy, approximately A$1 per ticket, on the price of tickets to large music events, over 5,000 capacity.

The foundation is partly modelled on the United Kingdom’s Music Venue Trust, a charity and advocacy body founded in 2014 that has advocated for a big ticket levy.

While the proposed levy would certainly help to level the playing field between grassroots music venues and the big end of touring, the Music Venue Trust was founded on much more radical principles and ambitions than simple redistribution.

Socialising live music

Although the Music Venue Trust has moved into advocacy and policy work, such as vocal support for the big ticket levy, the trust’s original and continuing mission is to socialise grassroots music venues. This means they work to help venues transition away from for-profit models and towards alternative ownership structures.

The trust’s “Own Our Venues” campaign spawned Music Venue Properties, a charitable landlord funded by the broader music community. The scheme has now purchased five grassroots venues around the UK, leased on the condition they continue to run as live music venues.

The goal is to take the profit motive out of running a venue. Surplus is reinvested into venue spaces, ensuring their long-term sustainability.

As the trust’s founder and CEO Mark Davyd states, “[the community] is the best person to own a venue”.

We don’t want money going to private landlords, we want it in the cultural economy because that’s the way we generate more great artists and give more people the opportunity to be involved in music.

Acknowledging that such radical ambitions require funding, the trust have been long term advocates for a big ticket levy. However, this advocacy has always accompanied their greater goal of socialising live music venues.

The trust have helped to change the broader cultural understanding of grassroots venues in the UK. Between 2014 and 2022, the proportion of music venues in the country run as not-for-profit ventures increased from 3% to 26%.

The Australian context

Melbourne’s Gasometer Hotel and Brisbane’s The Bearded Lady are the latest small, but culturally significant, live music venues to face closure. The number of venues licensed for live music in Australia is falling, with the greatest reductions in the small-to-medium range.

The recent parliamentary inquiry into the live music industry found costs like insurance and rent have risen sharply in the last five years. Meanwhile, income from alcohol sales – a core revenue source for smaller venues – has dropped in connection with changing youth culture, the cost-of-living crisis, and excises hitched to inflation.

Costs to run music venues have increased, while income from avenues like alcohol sales have fallen.
Frankie Cordoba/Unsplash

Surveys of young people and other groups affirm that Australians value live music, and most people would like to attend more. The most commonly cited barrier is cost, followed by distance from appropriate venues, especially in regional areas.

An arena ticket levy was a key recommendation of the inquiry, with the committee recommending government agency Music Australia should manage the funds.

The committee proposed a levy could enable Music Australia to fund:

performances with minimum pay rates for musicians
capital improvements to venues, such as sound-proofing or disability access
festivals promoting regional, all-ages, First Nations and community participation.

Neither the Labor government nor the opposition have indicated a position on this recommendation, which would require legislation.

The industry proposal

The Australian Music Venue Foundation is asking big music businesses to opt in to an industry-managed ticket levy to fund grassroots live music.

While there has been advocacy for such a voluntary arrangement in the UK, this is yet to come to fruition. The UK government’s deadline for the arrangement of a voluntary scheme by the end of March is approaching, opening up the alternative scenario of a legislated mandatory levy.

Australian advocates believe they may have the relationships to create a different outcome, arguing all industry players have a stake in a healthy music ecosystem.

In the proposed Australian scheme, the recipients and use of funding would be decided by a board of industry professionals. This raises questions around potential conflicts of interest. The foundation has applied for charity status, which requires transparency around operations and finances. However, there are broader questions about priorities.

The foundation argues all levels of the industry have a stake in their being a healthy ecosystem of venues.
Austin/Unsplash

If the scheme gets up, the foundation will need to consider whether to restrict its support to Australian-owned, independent venues of a certain size. Alternatively, funds may be available to venues that are part-owned by the same major, for-profit, international companies paying into the scheme.

To replace the proposed government levy, the foundation would also need to find ways of supporting access to live music for regional, all-ages, First Nations, and other disadvantaged communities, as recommended by the inquiry’s report.

To ensure benefits flow to artists, venue support could also be made conditional on paying a minimum performer’s fee, something venue’s have previously opposed.

The foundation could promote social objectives such as performer diversity, patron safety, and environmental sustainability, but there are no guarantees of this under an industry-led scheme.

These examples demonstrate the issues that can arise when economic redistribution is managed within an industry, rather than by government.

Lofty ambitions

The Music Venue Trust has successfully argued for grassroots music venues as a public good, worthy of longterm community and public investment as well as a structural approach to support.

Through their work, they have provided a new narrative for live music in the UK, supporting innovative ownership and operating models that go beyond the default of a commercially-leased space run as a for-profit small business.

Ambition and innovation has made the trust much more than another industry association advocating for the interests of a particular group of businesses. The Australian Music Venue Foundation should aspire to similar heights if it is to have the same level of influence and impact. Läs mer…

Plant behaviour may seem rather boring compared with the frenetic excesses of animals. Yet the lives of our vegetable friends, who tirelessly feed the entire biosphere (including us), are full of exciting action. It just requires a little more effort to appreciate.

One such behaviour is the dynamic opening and closing of millions of tiny mouths (called stomata) located on each leaf, through which plants “breathe”. In this process they let out water extracted from the soil in exchange for precious carbon dioxide from the air, which they need to produce sugar in the sunlight-powered process of photosynthesis.

Opening the stomata at the wrong time can waste valuable water and risk a catastrophic drying-out of the plant’s vascular system. Almost all land plants control their stomata very precisely in response to light and humidity to optimise growth while minimising the damage risk.

How plants evolved this extraordinary balancing act has been the subject of considerable debate among scientists. In a new paper published in PNAS we used lasers to find out how the earliest stomata may have operated.

Tiny valves, global consequences

Much depends on the way stomata behave: plant productivity, sensitivity to drought, and indeed the pace of the global carbon and water cycles.

However, they are difficult to observe in action. Each stomata is like a tiny, pressure-operated valve. They have “guard cells” surrounding an opening or pore which lets water vapour out and carbon dioxide in.

When pressure increases in stomata guard cells, the pore opens – and vice versa.
Artemide / Shutterstock

When fluid pressure increases inside the stomata’s guard cells, they swell up to open the pore. When pressure drops, the cells deflate and the pore closes. To understand stomata behaviour, we wanted to be able to measure the pressure in the guard cells – but it’s not easy.

Lasers, bubbles and evolution

Enter Craig Brodersen of Yale University with a newly developed microscope-guided laser. It can create microscopic bubbles inside the individual cells that operate the stomatal pore.

When Brodersen spent a sabbatical at the University of Tasmania (where I am based), we found we could determine the pressure inside stomatal cells by tracking the size of these bubbles and how quickly they collapsed. This involved theoretical calculations guided by bubble expert Philippe Marmottant, of the French National Centre for Scientific Research (CNRS) in Grenoble.

This new tool gave us the perfect opportunity to explore how the behaviour of stomata is different among major plant groups. The aim was to test our hypothesis that the evolution of stomatal behaviour follows a predictable trajectory through the history of plant evolution.

We argue it began with a relatively simple ancestral passive control state, currently represented in living ferns and lycophytes, and developed to a more active hormonal control mechanism seen in modern conifers and flowering plants.

Against this hypothesis, some researchers have previously reported complex behaviours in some of the most ancient of stomata-bearing plants, the bryophytes. We wanted to test this finding using our newly developed laser instrument.

400 million years of development

What we found was firstly that our laser pressure probe technique worked extremely well. We made nearly 500 measurements of stomatal pressure dynamics in the space of a few months. This was a marked improvement on the past 45 years, in which fewer than 30 similar measurements had been made.

Secondly, we found that the stomata of our representative bryophytes (hornworts and mosses) lacked even the most basic responses to light found in all other land plants.

The stomata of hornworts and mosses showed no response to changes in light.
Gondronx Studio / Shutterstock

This result supported our earlier hypothesis that the first stomata found in ancestors of the modern bryophytes 450 million years ago should have been very simple valves. They would have lacked the complex behaviours seen in modern flowering plants.

Our results suggest that stomatal behaviour has changed substantially through the process of evolution, highlighting critical changes in functionality that are preserved in the different major land plant groups that currently inhabit the Earth.

How plants will survive the future

We can now say with confidence that stomata in mosses, ferns, conifers and flowering plants all behave in very different ways. This has an important corollary: they will all respond differently to the heaving changes in atmospheric temperature and water availability that they face now and into the near future. Predicting stomatal behaviour in the future will help us to predict these impacts and highlight plant vulnerability.

In terms of agricultural benefit, our new laser method should be fast and sensitive enough to reveal even small differences in the the behaviour of closely related plants. This may help to identify crop variants that use water in a more efficient or productive way, which will assist plant breeders to find varieties that better translate increasingly unpredictable soil water supplies into food.

So next time you look upon a leaf, consider the frantic pace of dynamic calculation and adjustment of millions of little mouths, reacting as your breath falls upon them. Realise that our own fate, tied to the performance of forests and crops in future climates, hangs on the behaviour of the stomata of different species. A good reason for us to understand these unassuming little valves. Läs mer…

Australia’s BreastScreen program offers women regular mammograms (breast X-rays) based on their age. And this screening for breast cancer saves lives.

But much has changed since the program was introduced in the early 90s. Technology has developed, as has our knowledge of which groups of women might be at higher risk of breast cancer. So how we screen women for breast cancer needs to adapt.

In a recent paper, we’ve proposed a fundamental shift away from an age-based approach to a screening program that takes into account women’s risk of breast cancer.

We argue we could save more lives if screening tests and schedules were personalised based on someone’s risk.

We don’t yet know exactly how this might work in practice. We need to consult with all parties involved, including health professionals, government and women, and we need to begin Australian trials.

But here’s why we need to rethink how we screen for breast cancer in Australia.

Why does breast screening need to change?

Australia’s BreastScreen program was introduced in 1991 and offers women regular mammograms based on their age. Women aged 50–74 are targeted, but screening is available from the age of 40.

The program is key to Australia’s efforts to reduce the burden of breast cancer, providing more than a million screens each year.

Women who attend BreastScreen reduce their risk of dying from breast cancer by 49% on average.

Breast screening saves lives because it makes a big difference to find breast cancers early, before they spread to other parts of the body.

Despite this, around 75,000 Australian women are expected to die from breast cancer over the next 20 years if we continue with current approaches to breast cancer screening and management.

Who’s at high risk, and how best to target them?

International evidence confirms it is possible to identify groups of women at higher risk of breast cancer. These include:

women with denser breasts (where there’s more glandular and fibrous tissue than fatty tissue in the breasts) are more likely to develop breast cancer, and their cancers are harder to find on standard mammograms
women whose mother, sisters, grandmother or aunts have had breast or ovarian cancer, especially if there are multiple relatives and the cancers occurred at young ages
women who have been found to carry genetic mutations that lead to a higher risk of breast cancer (including women with multiple moderate risk mutations, as indicated by what’s known as a polygenic risk score).

For some higher-risk women, could MRI be an option?
VesnaArt/Shutterstock

Women in these and other high-risk groups might warrant a different form of screening. This could include screening from a younger age, screening more frequently, and offering more sensitive tests such as digital breast tomosynthesis (a 3D version of mammography), MRI or contrast-enhanced mammography (a type of mammography that uses a dye to highlight cancerous lesions).

But we don’t yet know:

how to best identify women at higher risk
which screening tests should be offered, how often and to whom
how to staff and run a risk-based screening program
how to deliver this in a cost-effective and equitable way.

The road ahead

This is what we have been working on, for Cancer Council Australia, as part of the ROSA Breast project.

This federally funded project has estimated and compared the expected outcomes and costs for a range of screening scenarios.

For each scenario we estimated the benefits (saving lives or less intense treatment) and harms (overdiagnosis and rates of investigations in women recalled for further investigation after a screening test who are found to not have breast cancer).

Of 160 potential screening scenarios we modelled, we shortlisted 19 which produced the best outcomes for women and were the most cost effective. The shortlisted scenarios tended to involve either targeted screening technologies for higher-risk women or screening technologies other than mammography for all screened women.

For example, in our estimates, making no change to the target age range or screening intervals but offering a more sensitive screening test to the 20% of women deemed to be at highest risk would save 113 lives over ten years.

Alternatively, commencing targeted screening from age 40 and offering a more sensitive screening test annually to the 20% of women at highest risk, and three-yearly screening (of the current kind) to the 30% of women at lowest risk, would save 849 lives over ten years.

However, less frequent screening of the lower risk group was expected to lead to small increases in breast cancer deaths in that group.

How do we best assess women for their risk of breast cancer? At this stage, there’s no one answer.
Tint Media/Shutterstock

We also outlined 25 recommendations to put into action, and set out a five-year roadmap of how to get there. This includes:

a large scale trial to find out what is feasible, effective and affordable in Australia
making sure women at higher risk in different parts of Australia are offered suitable options regardless of where they live and who they see
better data collection and reporting to support risk-based screening
testing how we assess women for their risk of breast cancer, including whether these assessments work as intended and make sense to women from a range of backgrounds
clinical studies of screening technologies to determine the best delivery models and associated costs
ongoing engagement with groups including women, health professionals and government.

Breast cancer screening review out soon

Federal health minister Mark Butler said a review of the BreastScreen program would consider our recommendations. The results of this review are expected soon.

We’re not alone in calling for a move towards risk-based breast cancer screening. This is backed by national and international submissions to government, policy briefing documents and the Breast Cancer Network Australia.

We’ve provided an evidence-based roadmap towards better screening for breast cancer. Now is the time to commit to this journey.

We acknowledge Louiza Velentzis from the Daffodil Centre, and Paul Grogan and Deborah Bateson from the University of Sydney, who co-authored the paper mentioned in this article. Läs mer…

In December 2024, the editorial board of the Journal of Human Evolution resigned en masse following disagreements with the journal’s publisher, Elsevier. The board’s grievances included claims of inadequate copyediting, misuse of artificial intelligence (AI), and the high fees charged to make research articles publicly available.

The previous year, more than 40 scientists who made up the entire academic board of a leading journal for brain imaging also walked off the job. The journal in question, Neuroimage, is also published by Elsevier, which the former board members accused of being “too greedy”.

Elsevier has previously denied using AI and has disputed that its business practices are untoward.

Mass resignations of journal editors are becoming more frequent. They highlight the tension between running a for-profit publishing business and upholding research integrity.

From a niche to a multibillion-dollar business

The world’s first academic journal was called Philosophical Transactions of the Royal Society. It was established in 1665 as a publication that allowed scientists to share their work with other scientists.

For a long time, academic journals were a niche branch of publishing. They were run by and for research communities. But this started to change from the second world war onwards.

The expansion of research, combined with an influx of commercial publishing players and the rise of the internet in the 1990s, have transformed journal publishing into a highly concentrated and competitive media business.

Elsevier is the biggest player in this business. It publishes roughly 3,000 journals and in 2023 its parent company, Relx, recorded a profit of roughly A$3.6 billion. Its profit margin was nearly 40% – rivalling tech giants such as Microsoft and Google.

Along with Elsevier, Springer Nature, Wiley, SAGE, and Taylor & Francis make up what are known as the “big five” in academic publishing. Collectively, these publishers are responsible for roughly 50% of all research output.

Many of the most trusted and prestigous research journals are owned by commercial publishers. For example, The Lancet is owned by Elsevier.

A key factor in their profitability is volunteer labour provided by researchers. Traditional models of peer review are a good example of this. Academics provide publishers with content, in the form of journal articles. They also review their peers’ work for free. University libraries then pay for access to the final published journal on behalf of their research community.

Alongside the pressure on academics to publish, the push to “speed up science” through these systems of peer-review only contribute to issues of trust in research.

In 2023, academic publisher Elsevier recorded a profit of roughly $3.6 billion.
T.Schneider/Shutterstock

Profit at the expense of research integrity

The increasing frequency of editorial board resignations reflects the tension between researchers trying to uphold scientific and research integrity, and publishers trying to run a for-profit business answerable to shareholders.

Research is most often built on spending taxpayers’ money.

Yet there is often little alignment between the profit imperatives of large, multinational publishers and the expectations of the communities and funding bodies that pay for the costs of research.

For example, for-profit publishing models mean the results of research often end up locked behind paywalls. This has implications for the dissemination of research findings. It also means the public may not be able to access information they need most, such as medical research.

The business of academic publishing also doesn’t always sit comfortably with the values and motives of scholarly inquiry and researchers.

Publishers may focus on maximising shareholder gains by publishing research outputs, rather than on the content of the research or the needs of the research community.

As Arash Abizadeh, a former editor of Philosophy & Public Affairs – a leading political philosophy journal – wrote in The Guardian in July 2024:

Commercial publishers are incentivised to try to publish as many articles and journals as possible, because each additional article brings in more profit. This has led to a proliferation of junk journals that publish fake research, and has increased the pressure on rigorous journals to weaken their quality controls.

The world’s first academic journal, Philosophical Transactions of the Royal Society, was established in 1665.
Henry Oldenburg/Philosophical Transactions, CC BY

Better publishing practices

What could alternative academic publishing practices that safeguard the integrity of research look like?

The “publish-review-curate” model is one example.

This model has been adopted by community research
initiative MetaROR. It involves authors publishing their work as “preprints” which are immediately accessible to the community.

The work then goes through an open peer review process. Finally, an assessment report is produced based on the reviews.

This model aims to accelerate the dissemination of knowledge. It also aims to encourage a more transparent, collaborative, and constructive review process.

Another important advantage of preprints is that they are not locked behind paywalls. This makes it faster and easier for research communities to share new findings with other researchers quickly.

There are some drawbacks to this model. For example, preprints can cause confusion if they are publicised by the media too early.

The question of who should pay for and maintain online preprint servers, on which global research communities depend, is also a subject of continuing debate.

As the academic ecosystem continues to evolve, we will need publishing models that can adapt to the changes and needs of the research community and beyond. Läs mer…

Of all the contradictions and ironies of Donald Trump’s second presidency so far, perhaps the most surprising has been his shutting down the US Agency for Global Media (USAGM) for being “radical propaganda”.

Critics have long accused the agency – and its affiliated outlets such as Voice of America, Radio Free Europe and Radio Free Asia – of being a propaganda arm of US foreign policy.

But to the current president, the USAGM has become a promoter of anti-American ideas and agendas – including allegedly suppressing stories critical of Iran, sympathetically covering the issue of “white privilege” and bowing to pressure from China.

Propaganda is clearly in the eye of the beholder. The Moscow Times reported Russian officials were elated by the demise of the “purely propagandistic” outlets, while China’s Global Times celebrated the closure of a “lie factory”.

Meanwhile, the European Commission hailed USAGM outlets as a “beacon of truth, democracy and hope”. All of which might have left the average person understandably confused: Voice of America? Wasn’t that the US propaganda outlet from World War II?

Well, yes. But the reality of USAGM and similar state-sponsored global media outlets is more complex – as are the implications of the US agency’s demise.

Public service or state propaganda?

The USAGM is one of several international public service media outlets based in western democracies. Others include Australia’s ABC International, the BBC World Service, CBC/Radio-Canada, France Médias Monde, NHK-World Japan, Deutsche Welle in Germany and SRG SSR in Switzerland.

Part of the Public Media Alliance, they are similar to national public service media, largely funded by taxpayers to uphold democratic ideals of universal access to news and information.

Unlike national public media, however, they might not be consumed – or even known – by domestic audiences. Rather, they typically provide news to countries without reliable independent media due to censorship or state-run media monopolies.

The USAGM, for example, provides news in 63 languages to more than 100 countries. It has been credited with bringing attention to issues such as protests against COVID-19 lockdowns in China and women’s struggles for equal rights in Iran.

On the other hand, the independence of USAGM outlets has been questioned often, particularly as they are required to share government-mandated editorials.

Voice of America has been criticised for its focus on perceived ideological adversaries such as Russia and Iran. And my own research has found it perpetuates stereotypes and the neglect of African nations in its news coverage.

Leaving a void

Ultimately, these global media outlets wouldn’t exist if there weren’t benefits for the governments that fund them. Sharing stories and perspectives that support or promote certain values and policies is an effective form of “public diplomacy”.

Yet these international media outlets differ from state-controlled media models because of editorial systems that protect them from government interference.

The Voice of America’s “firewall”, for instance, “prohibits interference by any US government official in the objective, independent reporting of news”. Such protections allow journalists to report on their own governments more objectively.

In contrast, outlets such as China Media Group (CMG), RT from Russia, and PressTV from Iran also reach a global audience in a range of languages. But they do this through direct government involvement. CMG subsidiary CCTV+, for example, states it is “committed to telling China’s story to the rest of the world”.

Though RT states it is an autonomous media outlet, research has found the Russian government oversees hiring editors, imposing narrative angles, and rejecting stories.

A Voice of America staffer protests outside the Washington DC offices on March 17 2025, after employees were placed on administrative leave.
Getty Images

Other voices get louder

The biggest concern for western democracies is that these other state-run media outlets will fill the void the USAGM leaves behind – including in the Pacific.

Russia, China and Iran are increasing funding for their state-run news outlets, with China having spent more than US$6.6 billion over 13 years on its global media outlets. China Media Group is already one of the largest media conglomerates in the world, providing news content to more than 130 countries in 44 languages.

And China has already filled media gaps left by western democracies: after the ABC stopped broadcasting Radio Australia in the Pacific, China Radio International took over its frequencies.

Worryingly, the differences between outlets such as Voice of America and more overtly state-run outlets aren’t immediately clear to audiences, as government ownership isn’t advertised.

An Australian senator even had to apologise recently after speaking with PressTV, saying she didn’t know the news outlet was affiliated with the Iranian government, or that it had been sanctioned in Australia.

Switched off

Trump’s move to dismantle the USAGM doesn’t come as a complete surprise, however. As the authors of Capturing News, Capturing Democracy: Trump and the Voice of America described, the first Trump administration failed in its attempts to remove the firewall and install loyalists.

This perhaps explains why Trump has resorted to more drastic measures this time. And, as with many of the current administration’s legally dubious actions, there has been resistance.

The American Foreign Service Association says it will challenge the dismantling of the USAGM, while the Czech Republic is seeking EU support to keep Radio Free Europe and Radio Liberty on the air.

But for many of the agency’s journalists, contractors, broadcasting partners and audiences, it may be too late. Last week the New York Times reported some Voice of America broadcasts had already been replaced by music. Läs mer…

More children are being permanently excluded from their school in England. In the 2023-24 autumn term, over 1,000 more pupils were excluded than in the autumn term the previous year. Rates of permanent exclusion have risen rapidly since the pandemic, with no sign of slowing down.

What is perhaps unexpected is that the rate of permanent exclusions is rising much faster among girls than boys. Girls are also more at risk of “hidden” or “grey” exclusions – when a pupil stops going to school but isn’t formally excluded. But partly because schools are seen as environments in which girls are more likely to thrive than boys, the issues girls face may be overlooked.

Stereotypes of schools as places where “good girls” are the hardworking majority – and boys are the disruptive ones – have repercussions for both girls and teachers.

In my research I interviewed 12 girls at risk of permanent exclusion aged between 12 and 16 in two different secondary schools and one pupil referral unit. I found that they struggled with being heard.

Girls in my study were unanimous that they wanted teachers to listen and take time for them, but felt this did not happen. They resorted to shouting before they could be shouted at. “When they shout it doesn’t mean we’re going to listen, we’re going to shout back,” one said.

Girls reported teachers did not know them, listen or allow them to explain and so responded with aggression: “Why should I bother about them when they ain’t bothered about me?”

Consequences of exclusion

Research from Agenda Alliance, a charity, has found that 74% of girls in youth custody were previously permanently excluded, compared to 63% of boys. After permanent exclusion, girls (unlike boys) are more likely to suffer significant mental health issues.

There has been very little progress in managing girls’ behaviour over the last two decades. Research has found consistent reports of girls being sidelined in education as far back as the 1970s.

Research also suggests that girls using their voice in ways that do not fit gender stereotypes – such as being loud and shouting at teachers – was particularly problematic. This damaged relationships with teachers.

In my research, girls believed both male and female teachers were sexist, singling them out for behaviour ignored in boys. This resulted in a deeply held sense of unfairness, particularly when teachers simply linked behaviour to their hormones. “Certain teachers overlook the girls, they pin it on your hormones,” one said.

This results in girls feeling they have no voice, and avoiding some lessons, teachers or situations by truanting – inside school or not attending at all – or by trying to “get in before they [teachers] do” and behaving aggressively.

These two extremes mean girls either end up using their voice in ways schools cannot manage, or remain systematically silenced: not present at school at all. Neither helps them to address the problems they are experiencing and the resulting behaviour.

Appearance and behaviour

I also found that girls struggled with how visible they were at school. Many girls in my study talked about facing sanctions over their uniform. They argued that teachers punished them for minor infringements, and that there was a double standard: teachers could wear two pairs of earrings, for instance, but they could not. One said that staff “don’t care about education it’s about earrings and that”.

Girls felt singled out in ways boys were not, suggesting teachers were sexist and only interested in them looking right.

Girls felt they received too much scrutiny over their appearance.
Rawpixel.com/Shutterstock

However, girls told me that modifying their uniform was central to fitting in with peers and not being bullied. This results in girls treading a fine line between not standing out too much to other girls and not attracting the censure of staff.

Girls reported being too visible in other ways. They told me that trips to the toilet were policed by staff standing outside. Girls also felt too visible in class, with significant anxiety expressed in my research about being picked on in class. “My face goes all blotchy and I start shaking, it’s hard to breathe,” one said.

This fear was so significant girls chose to walk out of lessons rather than face embarrassment in front of their peers. “If a teacher picks on me to answer a question I just won’t come to the next lesson,” one girl said. They chose this despite risking being put in isolation – working in seclusion away from the rest of the school and their peers, where they once again became invisible. “It’s like a prison, they boarded up the windows and don’t listen to you.”

With some schools shifting to zero-tolerance approaches, permanent exclusion – once a last resort – may now be perceived as a reasonable response to school improvement drives.

Striking the balance between being appropriately seen and heard is a challenge for many girls in school, even those who appear to manage it successfully. But for those who struggle, the current and widespread problems in schools make it less likely that teachers will “take more notice of how you behave, [because] there might be something behind it”. Without significant and widespread change in schools, more girls will either disappear from the system or be silenced by it. Läs mer…

An Ontario court has approved the liquidation of nearly all Hudson’s Bay Company’s stores, marking the end of Canada’s oldest company, which has been in operation for 355 years. The liquidation is set to begin March 24, and will continue until June 15, leaving only six stores in operation.

The court’s decision came shortly after Hudson’s Bay filed for creditor protection, signalling the company’s struggle to manage its mounting debt.

With widespread layoffs sure to follow, this corporate collapse is both shocking and distressing. But the court documents suggest it was not unexpected. Hudson’s Bay lost $329.7 million in the 12 months leading up to Jan. 31, 2025. As of that date, Hudson’s Bay had only $3.3 million in cash and owed more than $2 billion in debt and leases.

The final straw appears to have been trade tensions between Canada and the U.S., with the increased geopolitical and economic uncertainty leading lenders to shun Hudson’s Bay as it sought more financing, according to court documents.

What bankruptcy looks like

The downfall of a major company like Hudson’s Bay brings with it a wave of financial jargon. Understanding the differences between insolvency, bankruptcy, restructuring and liquidation is crucial to fully grasp the situation.

Insolvency occurs when a business runs out of cash and cannot pay its bills. At the start of March, it was $5 million behind on rent and supplier payments, and within days of missing payroll.

Bankruptcy is a legal process under Canada’s Companies’ Creditors Arrangement Act where a company files for protection from its creditors. The goal is to avoid the social and economic costs of liquidation, preserve jobs and protect the interests of affected stakeholders. If granted, the judge sets a “stay period” where the company works out a restructuring plan with its creditors.

Pedestrians pass the Hudson’s Bay building in downtown Calgary on March 20, 2025.
THE CANADIAN PRESS/Jeff McIntosh

Hudson’s Bay has more than 2,000 creditors, including $430 million in secured term loans, $724 million in mortgages and $512 million to unsecured creditors, mostly owed to suppliers. Hudson’s Bay also owes payroll remittances, federal sales taxes and over $60 million in customer gift cards and loyalty points. Gift cards are good until April 6.

A restructuring wipes out the equity holders and allows a company to negotiate a reduction in its debts. The business continues to operate under the supervision of a court-appointed monitor, using interim financing to pay bills. If successful, the company re-emerges from bankruptcy and continues to do business.

If restructuring is not successful, the company asks the court for permission to liquidate. Liquidation means a “fire sale” of all assets such as inventory, shelving, real estate, leases and trademarks. Items are sold at a deep discount, leading to potential bargains.

The Ontario Superior Court denied the initial request to liquidate on March 14, telling Hudson’s Bay and its creditors to “lower the temperature” and work on a deal. With only limited progress and some concessions made to support Hudson’s Bay’s joint venture with RioCan REIT, the court gave permission for the liquidation on March 21.

Many will lose, some will win

The collapse of Hudson’s Bay will leave many facing financial losses, while a select few stand to gain.

Secured creditors, some suppliers and Hudson’s Bay pensioners are expected to be protected by the courts. However, many others, including thousands of customers and more than 1,800 unsecured creditors, will suffer a financial hit.

The hardest impact will be felt by the more than 9,300 employees losing their jobs. Employees will lose their income, health and disability benefits, and life insurance, significantly impacting families across the country.

However, employees will not lose their pension benefits. The company’s pension plan is fully funded and in surplus position. This was not the case for Sears Canada when it went bankrupt in 2018. A surplus means the value of investments is greater than the promised benefits and is good news for retirees.

Read more:
Sears Canada tarnishes the gold standard of pensions

Mall landlords will also lose out. Hudson’s Bay drove foot traffic in malls across the country where it was the anchor-tenant. There will likely be painful ripple effects for smaller Hudson’s Bay store owners, including falling sales, defaults on mortgages and business failures.

That said, some stand to benefit. For example, the American financial services company Restore Capital LLC is providing interim debtor-in-possession (DIP) financing, charging a hefty fee in the process. The lawyers and accountants involved in the bankruptcy may also benefit.

Priority of proceeds

When a company is liquidated, the proceeds from selling its assets are used to repay claimants based on their priority in bankruptcy. This is sometimes referred to as the waterfall of “who gets what.” Think of it as a queue with people lining up to get paid.

Interim DIP financing is paid off first, together with legal and accounting fees related to the bankruptcy. Essential operating costs during the restructuring are also paid, including employee wages.

Shoppers browse at a Hudson’s Bay in Toronto on March 17, 2025.
THE CANADIAN PRESS/Christopher Katsarov

Next come secured creditors. These lenders provided funding backed by specific assets, known as collateral. Collateral may include inventory and real estate. A similar process happens on a personal residence; if a homeowner defaults on their mortgage payments, the bank may take possession of the house.

Third in line are debts granted priority by the courts. Employees receive unpaid wages up to a certain cap, just under $9,000, under the federal Wage Earner Protection Program. Pension benefits are paid out and outstanding payroll and sales tax remittances are paid.

As the pool of assets gets smaller, unsecured creditors are paid off next including suppliers, landlords and employees owed additional wages or termination benefits.

Last in the queue from the wind-up are equity holders — the residual claimants — who control the company through their common and preferred shares.

In 2020, Hudson’s Bay’s CEO Richard Baker and a group of investors took the company private, meaning it was no longer publicly traded on the Toronto Stock Exchange, buying out shareholders for approximately $2 billion. This stake is now wiped out.

Disappointing, but not surprising

Hudson’s Bay’s current financial situation is disappointing, but not surprising. The COVID-19 pandemic made times tough for brick-and-mortar retailers. On top of this, under-investment and a failed e-commerce strategy left the company struggling to compete in an increasingly digital retail landscape.

With tariffs and trade uncertainty hurting the Canadian economy, the unfolding trade war is expected to have far-reaching consequences for Canadian households and businesses. Hudson’s Bay was not immune to these effects.

In the end, Hudson’s Bay backed itself into a corner, arguably waiting too long to secure funding and ultimately losing control of its own destiny. Its bankruptcy is a major blow to Canadian retail, marking the end of a era for a company that lasted more than three-and-a-half centuries. Läs mer…

Google announced the launch of AI Overviews, its generative artificial intelligence-fuelled search feature, in May 2023. Initially named Search Generative Experience, AI Overviews offers Google users AI-generated answers by sourcing and summarizing information from different websites.

These AI responses are positioned at the top of the page for immediate visibility. The aim is to improve user experience by providing an alternative and more straightforward way to access information while enhancing the relevance of search results.

This feature has slowly been offered to the public, having initially been made available exclusively in the United States. AI Overviews is available worldwide and has been rolled out to more than 100 additional countries, including Canada.

AI Overviews represents a key effort by Google to capitalize on the rapid emergence of generative AI technology amid fierce competition between AI-enabled search engines in the market. It’s a direct response to Open AI’s SearchGPT and Microsoft Bing’s Deep Search, which is powered by OpenAI’s ChatGPT.

At the same time, conversational AI chatbots like ChatGPT, Microsoft’s Copilot and Google’s Gemini continue to resonate with users worldwide. Google’s investment in AI is critical to its ability to stay in the AI race among the other tech giants.

Concerns about AI-assisted search

The implementation of AI Overviews, however, has raised concerns among businesses, website managers and online advertisers.

AI Overviews represents a key effort by Google to capitalize on the rapid emergence of generative AI technology.
(Shutterstock)

Critics worry this feature could decrease traffic to their websites if users were to rely too heavily on AI Overviews and ignore the links to websites displayed in the search results.

Paid advertisements and sponsored content play a pivotal role in the revenue streams of companies and website operators. If traffic to websites diminishes, the incentive for these companies to invest in these advertising formats could decline, potentially disrupting the multi-billion-dollar online advertising industry.

To better understand this, we conducted a study at HEC Montréal’s Tech3Lab to investigate the potential impact of search generative AI features like AI Overviews on user perceptions and behaviours compared to those associated with regular online search queries.

User search behaviour and perceptions

We developed a set of four Google search scenarios, either AI-assisted or non-AI-assisted. The two AI-assisted scenarios included an AI-generated overview at the top of the search results, while the two non-AI-assisted scenarios consisted of a regular Google search experience.

For each scenario pair, participants performed a search for informational purposes and another search related to a product purchase. During each search task, users’ click behaviour (the number of clicks), cognitive load (the mental effort required to process information) and visual attention were measured.

We used pupillometry — measuring pupil size and reactivity — and analyzed screen recordings to track these metrics. After completing each task, participants shared their perceptions through questionnaires.

Liz Reid, Google head of Search, speaks at a Google I/O event in Mountain View, Calif., May 14, 2024.
(AP Photo/Jeff Chiu)

Through this experimental approach, we were able to achieve two goals. First, we determined whether AI-generated overviews in search results significantly impact user perceptions of the relevance, usefulness and satisfaction with search results.

Second, we observed whether such generative AI summaries significantly impacted user behaviour in terms of the number of clicks on links appearing in the search results. This provided insight into the potential impact generative AI summaries might have on organic search traffic.

What did we find?

The results of our study suggest that the presence of AI-generated overviews has no significant impact on user perceptions of relevance, usefulness and satisfaction with search results. There was also no significant impact on the clickthrough rate — the ratio of clicks on a link — on links in the search results.

The presence of AI Overviews did not significantly reduce the users’ interaction with Google’s classic list of suggested pages. While this finding indicates AI Overviews might not lead to an immediate or significant shift in website traffic, it’s important to note that user interactions could evolve over time as people become more familiar with this new feature.

As such, the competition among the market leaders operating in the online search space will likely continue to intensify. For example, earlier this month, Google rolled out a new feature called AI mode that delivers additional AI-generated results for some users.

Tech giants like Google and Microsoft will continue to vie for dominance in the market, aiming to create more engaging, higher-value search experiences for their online users.

Co-researchers Alexander J. Karran, Thadde Rolon-Merette, Eugene Yuzan Guo, Fabien Poivré and Mehdi Benbousta co-authored this article. Läs mer…

Infectious disease outbreaks have a bad habit of piling on at the worst possible times.

The 1918 flu pandemic, also known as the Spanish flu, caught the world by surprise just as the First World War was coming to an end. It was responsible for killing three to five per cent of the world’s population (50-100 million people, equivalent to about 400 million today).

Now, as we reflect on five years since the declaration of the COVID-19 pandemic and face economic uncertainty imposed by the United States administration — as well as lingering conflicts in places such as the Middle East and Ukraine — it’s the steady march of avian influenza, or “bird flu,” that poses an imminent threat to humanity.

Walter Reed hospital flu ward in Washington, D.C. during the flu epidemic of 1918-19, which killed three to five per cent of the world’s population.
(Shutterstock)

Bird flu has been causing a flurry of human infections, especially in U.S. cattle workers. If the virus learns to spread effectively from human to human, it could change the course of history. Even though our weary world already feels maxed out, we have to make room to avert yet another crisis.

Read more:
Bird flu in cattle: What are the concerns surrounding the newly emerging bovine H5N1 influenza virus?

The good news is that we know how to minimize risk and mobilize resources quickly, before the virus starts moving from human-to-human.

Heading off a bird flu pandemic

Knowing what to do and actually doing it, though, are very different, as we saw all too well five years ago when COVID-19 shut down much of the world, killing more than seven million people worldwide. And it’s not through with us yet.

The question is whether we will act in time to head off a bird flu pandemic. The Spanish Flu was the first of five influenza pandemics since the end of the First World War.

A sixth is inevitable without co-ordinated global action. Otherwise, the only questions are when it will it come and how bad it will be.

Read more:
Combatting the measles threat means examining the reasons for declining vaccination rates

Infectious diseases constitute a permanent threat to society, especially as vaccine hesitancy and misinformation grow. Fighting pandemics needs to be a full-time, ongoing priority for governments everywhere.

A biosecurity warning sign is seen on a locked gate at a commercial poultry farm in Abbotsford, B.C., in November 2024.
THE CANADIAN PRESS/Darryl Dyck

After the arrival of COVID-19, there were some impressive investments in infrastructure and science to support pandemic preparedness, but many were essentially one-time projects.

Canada needs to establish permanent capacity to prevent and respond to health emergencies. Government agencies specifically dedicated to supporting the development of medical countermeasures for pathogens that pose a pandemic risk, like the recently established Health Emergencies Readiness Canada (HERC), are a step in the right direction.

However, we must also re-prioritize investments in the fundamental research that is the birthplace of new medical and non-medical solutions to pandemic preparedness — where we currently lag far behind essentially all of our G7 counterparts. This has never been more important than in the current global political context.

The cost of acting to prevent or limit a pandemic is infinitesimal compared to the price of letting one happen, whether one measures the toll in human lives, or in dollars.

The world needs to adopt a collective mentality that we are “all in” on prevention if we want to maximize our chances of avoiding the next pandemic. We cannot sit on our hands and hope we get lucky. That strategy has failed us in the past and will doom us in the future.

H5N1 avian flu

Today, as we stand on the brink of an avian influenza pandemic that could be significantly worse than COVID-19, too much of the world seems unaware, unprepared or largely disengaged.

Bird flu has been causing a flurry of human infections.
(AP Photo/Erin Hooley)

Globally, more than 900 humans are known to have been infected by H5N1 avian influenza so far. The death rate associated with these human infections is a staggering one in two, placing it on par with threats such as Ebola.

Death rates resulting from human infections of the most prevalent currently circulating H5N1 virus in the U.S. (clade 2.3.4.4b) have been much lower — though the very narrow demographic characteristics of the individuals that have been infected leaves many questions regarding the true danger that this virus poses to the population at-large.Avian influenza has become more prevalent than ever in our environment. Having adapted to spread efficiently among cattle and other mammals, the virus will follow its biological imperative to adapt and survive.

No responsible country can ignore the possibility that person-to-person spread could start anywhere and quickly wash over the planet.

Read more:
An ounce of prevention: Now is the time to take action on H5N1 avian flu, because the stakes are enormous

Certainly, Canada is treating the issue seriously, as I know from my work with the Public Health Agency of Canada, the National Advisory Committee on Immunization, the Ontario Immunization Advisory Committee and other bodies.

But the effort to stop or at least slow avian influenza needs to include all countries and to engage everyday people, especially those who work directly with birds, cattle and other wild and domestic animals.

Targeted interventions

The best tactics to stave off a pandemic, at least at this point, are relatively unintrusive, targeted interventions. It’s critical that farm workers, veterinarians and others who work with animals follow careful protocols such as wearing masks and goggles, sanitizing equipment and continuing to cull poultry flocks where exposure is identified.

We also need to educate hunters about protective measures to lower their risk of exposure.

It’s critical that farm workers, veterinarians and others who work with animals follow careful protocols.
THE CANADIAN PRESS/Ryan Remiorz

Most mitigation measures are entirely non-medical — though offering vaccines to those at high risk of exposure, as Finland has done, would be prudent. It’s much easier to target vaccination programs to high-risk groups than to organize a global vaccine campaign after a pandemic has begun.

We need to encourage these groups to take every possible action to protect themselves — and therefore the world — and to provide financial supports that enable them to comply without cost.

If avian flu becomes established among humans, which could happen rapidly and with very little warning, COVID-19 has shown that only a swift, decisive and truly global approach can fend off disaster.

A significant lesson from COVID-19 is that we have to support pandemic prevention and response efforts for people in every corner of the world, however remote they may be, and that we must reach vulnerable populations within wealthy countries, such as elderly, frail and marginalized people, and those affected by poverty. These are the people always impacted most by infectious diseases.

A selective distribution of resources among the planet’s wealthiest populations will not provide the protection the world needs and will only enlarge and extend the reach of a new pandemic.

We must remember what it was like to close down schools, workplaces and public gatherings and to have hospitals overflowing with patients as clinicians risked their lives to care for them.

We could have saved so many people and so much money by taking the threat more seriously from the outset, including providing better public education about evidence-based measures such as masking and vaccines.

It’s past time we made pandemic prevention and response a permanent priority, no matter what else is happening in the world. Läs mer…