Doctor’s bills often come with sticker shock for patients − but health insurance could be reinvented to provide costs upfront

You have scheduled an appointment with a health care provider, but no matter how hard you try, no one seems to be able to reliably tell you how much that visit will cost you. Will you have to pay US$20, $1,000 – or even more?

Patients are increasingly on the hook for health care costs through deductibles, co-pays and other fees. As a result, patients are demanding credible cost information before appointments to choose where they seek care and control their budget.

Yet, in spite of recent legislation and regulations, upfront information on patient out-of-pocket costs is still difficult to obtain from both health care providers and insurers.

Predicting out-of-pocket costs

Why is it so difficult to tell patients in advance how much their care is going to cost?

This is a question health economists like me try to answer. Although the fundamental reason is simply the unpredictable nature of health care, the fact that it translates to unpredictable out-of-pocket costs for patients is a policy choice.

Health insurance plans in the U.S. such as Medicare and Medicare Advantage, as well as most individual and group plans, leave a percentage of the cost of care for patients to settle out of pocket. These include deductibles – the amount patients have to pay for a service before their insurance kicks in – or coinsurance, a percentage of the cost of care that patients must pay after they have met their deductible.

Understandably, most patients want to know their out-of-pocket costs before a doctor’s office visit or a trip to the hospital. However, the cost of care – and thus the percentage of the cost patients will pay – often isn’t available until after care has been delivered. This is because of the way health care providers are paid for their work.

How many health care services you’ll need for a given illness or procedure can be unpredictable.
DNY59/E+ via Getty Images

Health care providers typically seek payments for each patient retrospectively, based on the volume and intensity of services they have delivered. But both are hard to predict. A physician usually needs to see a patient before deciding how to address their health care needs. Sometimes, an extra test or imaging scan is needed to confirm a diagnosis or plan treatment.

Crucially, a variety of unexpected complications can occur even during routine procedures. Addressing these unforeseen complications often requires providing unanticipated services and involving other health care providers who might not have been part of the visit otherwise. And these extra services cost money.

As long as policymakers keep health care payments tied to the volume and intensity of performed medical services – which are uncertain – and patient cost-sharing tied to health care payments, patients will not be able to know what their out-of-pocket costs will be in advance. Simply making health care service prices publicly available will not change that.

What can be done to guarantee out-of-pocket costs before patients have their appointments?

Health care delivery as a supply chain

One idea researchers have proposed is to reorganize health care delivery into a supply chain. This would shift production risk to health care providers similarly to how other complex products are offered to consumers.

Consider air travel tickets. Consumers taking a flight from one city to another receive services from multiple entities, such as airlines, airports, aviation fuel suppliers and catering companies. Many of these entities face operational uncertainties such as departure delays or variable fuel consumption due to unpredictable weather. But airlines – as the final link in the supply chain – provide consumers with upfront prices for the entire trip.

The No Surprises Act reduces patient bills from out-of-network providers.

In health care, the principal provider from whom a patient seeks care could serve as the price-guaranteeing entity. They would collect a single, guaranteed price for the appointment and compensate other providers involved as needed. Some researchers have proposed aspects of this idea as a potential way to reduce surprise billing from out-of-network emergency physicians working at in-network hospitals.

However, such a major reorganization of health care delivery would be extremely challenging, as it would require all providers to enter into new contractual arrangements with each other. It would not only cause a legal undertaking of unprecedented scale, but it could also end up being financially devastating for small physician practices.

Co-payment-only health plans

There are other approaches to providing patients with reliable, upfront prices that would not require a complete overhaul of the health care system. The U.S. already has much of the needed infrastructure in place: health insurance.

A primary purpose of health insurance is to protect beneficiaries from financial shocks. Health insurers could modify the benefit design of policies to ensure patients obtain guaranteed out-of-pocket cost information before receiving care.

One way to achieve that would be saying goodbye to deductibles and coinsurance and having insured patients pay for their care only in the form of co-payments – fixed dollar amounts per encounter, such as $20 per doctor’s visit, $35 per prescription drug fill or $500 per hospital stay. Some insurance plans already offer this.

However, this approach removes incentives for patients to seek care from providers that offer quality services at a low price. It also could potentially increase monthly health insurance costs, also called premiums.

Improving how health care is delivered could make for more transparent out-of-pocket costs for patients.
skynesher/E+ via Getty Images

Innovative health insurance design

Based on my own research, I propose that an alternative solution to providing patients with reliable, upfront prices could be implementing episode-based cost-sharing into health insurance plans.

Under this model, health insurers would create bundles of services that patients may receive during a health care visit. This approach would provide patients with a single upfront price for the entire bundle based only on factors known in advance, such as their health insurance benefits and who their principal health care provider is. For example, you would have a guaranteed price tag for the cost of going to the hospital to give birth to a child or replace a joint.

Any deviation from the ultimate cost of care due to unforeseen situations patients have little control over would be borne by the insurer. That is what insurers do for a living – they know how to manage risk. Such a modification to health insurance benefit design would protect patients from unexpected health care costs, while preserving the incentive to seek care with high-value providers. It would also help keep health insurance premiums intact.

Seeking care for a health concern is already stressful. It does not have to be more stressful because of cost uncertainty. Several approaches to help patients know how much their care is going to cost in advance are available for policymakers to consider. In the meantime, patients may need to pick up the phone, call their hospital billing office and hope that the amount they obtain will be close to the amount they will eventually find on their medical bills. Läs mer…

What would it mean if President-elect Trump dismantled the US Department of Education?

In her role as former chief executive of World Wrestling Entertainment, Linda McMahon oversaw an enterprise that popularized the “takedown” for millions of wrestling fans. But as President-elect Donald Trump’s nominee for secretary of education, the Trump loyalist may be tasked with taking down the very department Trump has asked her to lead.

If Trump does dismantle the Department of Education as he has promised to do, he will have succeeded at something that President Ronald Reagan vowed to do in 1980. Just like Trump, Reagan campaigned on abolishing the department, which at the time was only a year old. Since then, the Republican Party platform has repeatedly called for eliminating the Education Department, which oversees a range of programs and initiatives. These include special funding for schools in low-income communities – known as Title I – and safeguarding the rights of students with disabilities.

As an education policy researcher who has studied the federal role in addressing student-equity issues, I see the path to shuttering the department as filled with political and practical obstacles. Republicans may therefore opt to instead pursue a series of proposals they see as more feasible and impactful, while still furthering their bigger-picture education agenda.

To better understand how the proposal to eliminate the Education Department would fit within the larger educational agenda of the incoming administration, I believe it’s helpful to revisit the history of the Education Department and the role it has played over the past five decades.

Department of Education history and roles

By the time Congress established the department in 1979,
the federal government was already an established player in educational policy and funding.

For instance, the Higher Education Act of 1965 began the federal student loan program. In 1972, Congress created the Basic Educational Opportunity Grant, the predecessor program to today’s Pell Grants. The G.I. Bill of 1944, which, among other things, funded higher education for World War II veterans, preceded them both.

At the K-12 level, federal involvement in vocational education began with the Smith-Hughes Act of 1917. Federal attention to math, science and foreign language education began in 1958 with the National Defense Education Act.

Two laws passed during the Lyndon Johnson administration then gave the federal government its modern foothold in education: the Civil Rights Act of 1964 and the Elementary and Secondary Education Act of 1965. The 1964 law provided antidiscrimination protections enforced by the Education Department’s Office for Civil Rights. The 1965 law, which is currently reauthorized as the Every Student Succeeds Act of 2015, includes Title I, which sends extra funding to schools with high populations of low-income students.

In 1975, Congress added the law currently known as the Individuals with Disabilities in Education Act, or IDEA. The law helps schools provide special education services for students with disabilities. IDEA also sets forth rules designed to ensure that all students with disabilities receive a free and appropriate public education.

Department had early Republican support

When Congress created the Education Department, it divided the former Department of Health, Education, and Welfare into two agencies. One was the Education Department. The other was Health and Human Services, also known as HHS. Although President Jimmy Carter championed the move, it was bipartisan. The Senate bill to create the new department had 14 Republican co-sponsors.

Within a year, however, support for and opposition to the Education Department had become strongly partisan. Reagan campaigned on eliminating what he referred to as “President Carter’s new bureaucratic boondoggle.”

Those bureaucracies, however, existed before Carter and the new department. The only major addition was the Office of Educational Research and Improvement, which served primarily as the research arm of the Education Department. That office has since been replaced by the Institute of Education Sciences.

Congressional support needed

To dissolve the Education Department, both houses of Congress would have to agree, which is unlikely. In 2023, an amendment was proposed in the House to shut down the department. It failed by a vote of 161-265, with 60 Republicans joining all Democrats in opposing the measure.

Even assuming that sufficient pressure were exerted on Republicans in 2025 to garner almost complete Republican House support, the bill would likely need 60 votes in the Senate to overcome a filibuster – meaning that at least seven Democrats would have to support termination.

But what would such termination entail? The department’s functions and programs would need to be assigned to new institutional homes, since terminating a program’s department doesn’t terminate the program. That said, this shuffling process would likely be complicated and chaotic, harming important programs for K-12 and university students.

While details about what reorganization would look like remain to be seen, one option was proposed by Trump during his first term: merging the Education Department with the Labor Department.

Another approach is set forth in the Heritage Foundation’s Project 2025, a detailed policy blueprint that, among other things, specifies landing places for the Education Department’s major functions and programs. A CNN review found that over 100 people involved with Project 2025 worked in the first Trump administration.

The Project 2025 blueprint calls for the lion’s share of programs, including Title I and IDEA, to be moved to HHS – which already administers Head Start. Most vocational education programs would be moved to the Labor Department. The Office for Civil Rights would be moved to the Justice Department. And the Pell Grant program and the student loan program would be moved to the Treasury Department.

Part of a larger education agenda

In the scenario where existing Education Department programs are transferred to other agencies, those programs could continue without being closed or drastically cut. But Trump and Project 2025 have articulated a set of plans that do make radical changes. Trump has said he supports a federal voucher – or a “universal school choice” – plan, likely funded through federal tax credits. This idea is set forth in the proposed Educational Choice for Children Act, which is backed by Project 2025. Perhaps tellingly, Trump’s announcement of the McMahon nomination highlighted school-choice goals; it did not mention abolishing the department.

President Donald J. Trump, 45th President of the United States of America, right, listens as 25th Administrator of the US Small Business Administration, Linda McMahon, left, speaks during a press conference in Swannanoa, North Carolina in the aftermath of Hurricane Helene.
The Washington Post via Getty Images

Project 2025 also lays out other changes and program cuts, including ending the Head Start early childhood education program and phasing out Title I over 10 years, and converting most IDEA funds into a voucher or “savings account” for eligible parents.

Beyond these initiatives, Trump’s campaign shared his plan to target a variety of culture-war issues. This includes cutting federal funding for any school or program that involves “critical race theory, gender ideology, or other inappropriate racial, sexual, or political content onto our children.”

What we can expect

My expectation is that the Trump administration’s most likely and immediate changes will be in the form of executive orders that alter how laws will be implemented. For example, Trump may use an executive order to remove protections for transgender students.

Subsequently, I also expect some congressional budgetary changes to education programs. Based on past votes, I expect overwhelming but not universal Republican congressional support for Trump’s educational agenda. Using the budget reconciliation process, which circumvents the filibuster, a majority vote can make changes to revenue or spending. Accordingly, Congress may agree to program cuts and perhaps even to move some programmatic funding into education vouchers for individual parents.

As for closing the Education Department, which probably would not qualify for the reconciliation process, Secretary-designate McMahon may find that takedown to be a politically difficult one to achieve. Läs mer…

Fast fashion may seem cheap, but it’s taking a costly toll on the planet − and on millions of young customers

Fast fashion is everywhere – in just about every mall, in the feeds of influencers on social media promoting overconsumption, and in ads constantly popping up online.

Its focus on the continual production of new clothing is marked by speedy fashion cycles that give it its name. Fast fashion is intended to quickly copy high-end designs, but with low-quality materials, resulting in poorly made clothing intended to be worn once or twice before being thrown away.

One of fast fashion’s leading companies, Zara, has a mission to put clothes in stores 15 days after the initial design. Another, Shein, adds up to 2,000 new items to its website daily.

While others in the fashion industry are working toward more sustainable clothing, fast fashion is focused on profit. The market’s value was estimated at about US$100 billion in 2022 and growing quickly. It’s a large part of the reason global clothing production doubled from 2000 to 2014.

An artist used 7,000 articles of clothing for an art installation protesting waste in fashion in The Netherlands.
Mouneb Taim/Middle East Images/Middle East Images/AFP via Getty Images

The big winners in this game are the corporations. The industry has a reputation for exploiting workers and for excessive pollution and extraordinary waste. Consumers are pulled into an unhealthy, spiraling pressure to buy more as cheap clothes fall apart fast.

Fast fashion also has a growing impact on the global climate. It is responsible for an estimated 8% to 10% of global greenhouse gas emissions, and its emissions are projected to grow quickly as the industry expands.

I teach courses that explore fast fashion and sustainability. The industry’s growth seems unstoppable – but a combination of legislation and willpower might just rein it in.

Understanding the harm

About 60% of fast-fashion items are made from synthetic textiles derived from plastics and chemicals that start their life as fossil fuels. When this synthetic clothing is laundered or thrown in landfills to decompose, it can release microplastics into the environment. Microplastics contain chemicals including phthalates and bisphenol A that can affect the health of humans and animals.

Natural fibers have their own impacts on the environment. Growing cotton requires large quantities of water, and pesticides can run off from farmlands into streams, rivers and bays. Water is also used in chemically treating and dyeing textiles. A 2005 United Nations-led report on cotton’s water use estimated that, on average, a single cotton T-shirt requires about 700 gallons (2,650 liters) of water from crop to clothing rack, with about 300 gallons (1,135 liters) of that water used for irrigation.

Garment workers in China manufacture dyed blue jeans. In many places, those dyes eventually wash into streams.
Lucas Schifres/Getty images

The chemicals used to process textiles for clothing for the fashion industry also contaminate wastewater with heavy metals, such as cadmium and lead, and toxic dyes. And that wastewater ends up in waterways in many countries, affecting the environment and wildlife.

Fast fashion’s high output also creates literally mountains of waste. More than 90 million tons of textile waste ends up in landfills globally each year, by one estimate, adding to greenhouse gases as it slowly decomposes. Only a small percentage of discarded clothing is recycled.

From fashionista to environmental guardian

In many cultures, people’s self-perception is intimately connected to fashion choices, reflecting culture and alliances.

The allure of buying new items comes from many sources. Influencers on social media play into FOMO – the fear of missing out. Cheap items can also lead to impulse buys.

Research shows that shopping can also create a euphoric sense of happiness. However, fast fashion’s speed and marketing can also train consumers into “psychological obsolescence,” causing them to dislike purchases they previously enjoyed, so they quickly replace them with new purchases.

Famous personalities may be helping to push back on this trend. Social media explodes when a first lady or Kate Middleton, the Duchess of York, wears an outfit more than once. The movement #30wearschallenge is starting with small steps, by urging consumers to plan to wear every piece of clothing they buy at least 30 times.

Upcycling – turning old clothing into new clothing items – and buying sustainable and high-quality clothes that can last for years is being promoted by the United Nations and other organizations, including alliances in the fashion industry.

Reselling used clothing can reduce waste. Princess Laurentien of The Netherlands, left, opened this vintage clothing store in The Hague in early 2024, with the proceeds going to charity.
Patrick van Katwijk/Getty Images

Some influencers are also promoting more sustainable fashion brands. Research has shown that peer influence can be a powerful driver for making more sustainable choices. The largest market for fast fashion is Gen Z, ages 12 to 27, many of whom are also concerned about climate change and might reconsider their fast-fashion buys if they recognized the connections between fast fashion and environmental harm.

Some governments are also taking steps to reduce waste from fashion and other consumer products. The European Union is developing requirements for clothing to last longer and prohibiting companies from throwing out unsold textiles and footwear. France has pending legislation that, if passed, would ban publicity for fast-fashion companies and their products, require them to post the environmental impact of their products, and levy fines for violations.

Changes in consumer habits, new technologies and legislation can each help reduce demand for unsustainable fashion. The cost of cheap clothes worn a few times also adds up. Next time you buy clothing, think about the long-term value to you and the planet. Läs mer…

Fifty years after the discovery of Lucy, it’s time to ‘decolonise paleoanthropology’ says leading Ethiopian fossil expert – podcast

On November 24 1974, renowned American paleoanthropologist Donald Johanson spotted “a piece of elbow with humanlike anatomy” poking out of a rocky hillside in northern Ethiopia. It was the first fossil of a partial skeleton belonging to “Lucy”, an ancient female hominin who took the story of human evolution back beyond 3 million years for the first time.

This autumn also marks the 100th anniversary of the discovery of the “Taung child”, a fossilised skull in South Africa that was key in our understanding that ancient humans first evolved in Africa – something we take now take for granted.

Yet, despite largely centring on the African continent as the “cradle of mankind”, the narrative of hominin fossil discovery is striking for its lack of African scientists. In this week’s episode of The Conversation Weekly podcast, and in a Q&A for our Insights series, leading Ethiopian paleoanthropologist Yohannes Haile-Selaisse explains why the story of ancient human origins is so western-centric, and why this needs to change.

Haile-Selassie says that many of the fossils that made western scientists famous were actually discovered by local Africans, who were only acknowledged at the end of a scientific publication:

For a long time, African scholars were never part of telling the human story; nor could they – and indeed, me – actively participate in the analysis of the fossils they found. Up to the 1990s, long after Lucy was found, we were only present in the form of labourers and fossil hunters.

Haile-Selassie is now director of the Institute of Human Origins at Arizona State University in the US. In the decades after Lucy’s discovery, he was responsible for some of the most remarkable ancient human fossil finds in his home country of Ethiopia, including that of Ardipithecus kadabba in 1997. He recalls that memorable moment:

Part of the jaw was just lying there on the surface. Deep inside, something immediately told me I had found the earliest human ancestor – more than 5 million years old. The thought made me go numb for a few seconds … Literally, no hominin fossils from that age had ever been discovered before.

Schoolchildren inspect the fossilised skeleton of Lucy, on display at the National Museum of Ethiopia, Addis Ababa.
Xinhua/Alamy Stock Photo

But Haile-Selassie warns that for research to continue unearthing such important fossils in Ethiopia and across Africa, a major change in the support for African institutions and scientists is needed – in order to “decolonise paleoanthropology”:

[To make] progress in the future, African paleosciences has to be one of the agenda items that we need to talk about. Without that, we just can’t continue making progress in Ethiopia or in Tanzania or in Kenya or in South Africa, right? It cannot be dominated like the old days by foreign researchers.

Such increased support, he says, could lead to important discoveries in parts of Africa that, to date, have not yielded ancient hominin fossils:

There are so many areas in Africa that haven’t been explored … Now, people are thinking about exploring West Africa for human ancestors. They might end up finding fossils in there as well … And that’s why we need to have a firm foundation established, so the next generation [of African scientists] doesn’t have to deal with the lack of infrastructure that we [faced].

On the other hand, Haile-Selassie warns that lack of western investment in African institutions could lead to restrictions being imposed on future exploration. He suggests countries in Africa may “make their antiquity flows tighter” in terms of who is allowed to research there in future.

Listen to the full episode of The Conversation Weekly podcast to hear an interview with Yohannes Haile-Selaisse by Mike Herd, Insights editor at The Conversation.

This episode of The Conversation Weekly was produced and written by Mend Mariwany and Gemma Ware is the executive producer. Sound design was by Michelle Macklem, and our theme music is by Neeta Sarl.

You can find us on Instagram at theconversationdotcom or via e-mail. You can also subscribe to The Conversation’s free daily e-mail here.

Listen to The Conversation Weekly via any of the apps listed above, download it directly via our RSS feed or find out how else to listen here. Läs mer…

‘Deep inside, something told me I had found the earliest human ancestor; I went numb’ – Yohannes Haile-Selassie on his lifetime quest to discover ancient humanity

Fifty years ago, the discovery of a partial skeleton amid the barren desert landscape of northern Ethiopia transformed our understanding of where humans came from, and how we developed into Homo sapiens.

“Lucy” was first spotted on November 24 1974 by the American paleoanthropologist Donald Johanson and his student assistant Tom Gray. Named after the Beatles’ Lucy in the Sky with Diamonds, a popular song in the their team’s camp at the time, it was immediately clear she was a female, because of her small adult size, and that she had walked upright, unlike chimpanzees.

Lucy was also very old – at almost 3.2 million years, she was anointed as the then-earliest known (distant) ancestor of modern humans. Over the following decades, rather fittingly given her name, she became a “paleo-rock star”, going on a US tour from 2006 following a deal with the Ethiopian authorities.

Lucy’s discovery marked a critical moment in our understanding of the origins of humanity – and of Ethiopia’s place at the heart of this story. Many other important fossils have since been discovered in the same Afar region – including by Yohannes Haile-Selassie, one of Ethiopia’s leading paleoanthropologists and the director of the Institute of Human Origins at Arizona State University (ASU) in the US. His two Ardipithecus discoveries in the 1990s – while still a student – pushed understanding of our ancient origins back beyond 5 million years, changing some of the widely accepted beliefs about human evolution.

Read more:
Fifty years after the discovery of Lucy, it’s time to ’decolonise paleoanthropology’ says leading Ethiopian fossil expert – podcast

Yet in this longform interview, Haile-Selassie is critical that the study of ancient humans still fails to acknowledge and support the fundamental role of African scientists and institutions. Like many of his colleagues, he is now calling for paleoanthropology to be “decolonised”, warning that otherwise, some African countries could take action to restrict future exploration of key sites across the continent:

There has to be a mutually beneficial way of doing things from now on. Western scientists can’t continue this ‘helicoptering in and out’ approach to fossil discovery. A lot of African countries have realised this and, unless we act fast, they’re probably going to tighten up who should be allowed to do research in their countries.

In this longform Q&A series by Insights, leading academics describe key moments in their scientific lives, and how they changed their understanding of the world.

Yohannes, you were a 14-year-old schoolboy in Ethiopia when Lucy was discovered. What are your memories of this landmark moment in your country’s history?

In fact, on the day Lucy was found – Sunday, November 24 1974 – Ethiopians woke up to some other devastating news. The previous night, Ethiopia’s military regime had executed more than 60 ministers and generals of Emperor Haile-Selassie’s regime. The announcement of Lucy’s discovery probably came up later that week, but I doubt many people paid attention to it amid all the turmoil, with the military regime taking control of Ethiopia.

Personally, I have no recollection of the announcement of Lucy’s discovery. I grew up in a Christian family, so as far as I knew at that time, it was God who created humans and I wouldn’t have understood the significance of Lucy.

Of course, over time, her discovery brought the idea of Ethiopia as a “cradle of mankind” to the forefront of public consciousness around the world. With that came national pride – today, Ethiopia brands itself the “land of origins”. Lucy played a big part in that.

Lucy (Australopithecus afarensis).
Sabena Jane Blackbird/Alamy Stock Photo

Yet even now, the narrative of ancient human discovery appears to omit many of the African researchers and institutions that played key roles in this story?

Many of the fossils that made western scientists famous were actually found by local Africans, who were only acknowledged at the end of a scientific publication. For a long time, African scholars were never part of telling the human story; nor could they actively participate in the analysis of the fossils they found. Up to the 1990s, long after Lucy was found, we were only present in the form of labourers and fossil hunters.

So, when we celebrate the 50th anniversary of Lucy, we shouldn’t forget that a reappraisal of the role of African scientists in our understanding of ancient humans is long overdue. Specifically, we need to decolonise paleoanthropology.

What does that mean in practice?

Without the proper infrastructure, African countries are going to be stuck in the same old cycle where they are expected to facilitate western scientists’ research – with institutions getting some income from laboratory service fees, and some locals being paid field per diems, but that’s about it. If you ask anyone who works in Kenya, Tanzania, Ethiopia or South Africa, they will tell you things have to change, particularly in terms of local scholar training and involvement in the actual research. That’s why this movement of decolonising palaeontology is becoming really vibrant now.

We need a firm foundation established, so the next generation of African scientists doesn’t have to deal with issues, like lack of infrastructure, that we faced. This requires a change in terms of how we think about paleoanthropology – and how we think about Africa in general. African institutions don’t have the resources or trained manpower to develop programs like this – and most African countries have a lot of pressing social, political and economic concerns, so paleoanthropology is not going to be their highest priority.

Yohannes Haile-Selassie speaking about the development of African paleoanthropology and other paleosciences. ASU Institute of Human Origins.

To what extent is your own success in breaking down the ‘glass wall’ of ancient human exploration a result of your most famous fossil discoveries?

I’ve found so many important fossils in the Middle Awash [a key research area in the Afar region] that I can’t exactly say one is more important than the other. But the first one that really made an impact was “Ardi” (from the full species name Ardipithecus ramidus) in 1994, which I found when I was still a graduate student at the University of California at Berkeley. Just as Lucy resulted in a major paradigm shift 50 years ago, Ardi again transformed the way we think about human origins.

The first piece I spotted was a finger bone, but in time we found Ardi’s near-complete skeleton. Another female, she had complete hands, feet and more skull bones that were missing from Lucy. She was dated at 4.4 million years old – 1.2 million years older than Lucy, and an entirely new genus of a hominin, Ardipithecus, that looked unlike anything that had been found before.

Three years later, you discovered an even older hominin fossil in the same area …

Once you get used to finding good fossils, you don’t tend to get as excited when you find another. But there’s one discovery I will never forget – the extraordinary feeling when I found the partial jaw of Ardipithecus kadabba in December 1997, a species I went on to name four years later.

Part of the jaw was just lying there on the surface. And deep inside, something immediately told me I had found the earliest human ancestor – more than 5 million years old. The thought made me go numb for a few seconds – I’ve never had that kind of feeling again. Literally no hominin fossils from that age had ever been discovered before.

The first thing I did was stand up and look 360 degrees around me, to check I wasn’t at one of the other, younger geological parts of the Middle Awash. My Ethiopian compatriot, Giday WoldeGabriel, and I had been surveying this new area for a few years. I was still looking for a topic for my dissertation – my advisor had told me: “Go look for fossils in the older deposits [more than 5 million years old], find as many as you can, and describe them.”

I’m trained as an osteology student, so I can easily distinguish fragments of an ancient human skeleton from other fossils. And the jaw still had one tooth on it – so it was really easy for me to identify. After that, we surface-scraped and found a lot more teeth from the same jaw. Everybody was so excited.

Ardipithecus kadabba.
Yohannes Haile-Selassie, Author provided (no reuse)

What happens when you find such a special fossil?

The first thing you do is go out and look for more. The next day, we went back to another little patch and found a fragment of arm bone from a different individual. And for the next three days, wherever we went, we found a tooth, a fragment of arm bone, or something. We’d been looking for early human ancestors in this area for so many years – and now all of a sudden, we were finding one piece almost every single day.

During survey and exploration, we were sometimes staying in a “fly camp” for days – just a few tents, some water, and basic food like spaghetti and bread. While in the camp, we washed the fossils then packed them up to take back to the laboratory in Addis Ababa. Until that stage, the fossils are totally under your control and you can look at them every day, show them to whoever you want and let them touch the fossils. But once the fossils were back in the national museum, access would be limited to you and your collaborators – the curators are the custodians from then on.

What’s the secret of being a successful fossil hunter?

There is no magic formula. You don’t learn it in classrooms. It’s all about how you train yourself and your eyes to focus on smaller objects when you are in the field. Of course, knowing skeletal elements and what they look like helps – but most importantly, you must be able to distinguish a fossil bone from a rock, or something else that might look like a fossil.

Most of the most important early human ancestor fossils found in Ethiopia, Kenya and Tanzania were found by our local collaborators who don’t have a degree, or may not even have been to school at all. This means there are many great fossil hunters who make significant discoveries but aren’t involved in their scientific interpretation; and then there are some paleoanthropologists who are not such good fossil hunters but great in interpreting the fossil evidence.

You don’t have to have a degree to be a good fossil hunter. But finding good fossils is sometimes a matter of luck as well.

Yohannes Haile-Selassie: ‘searching for our ancestors in the Afar desert.’ TEDx Talks.

And sometimes it can be very dangerous …

The Afar region is mostly dry desert – so one of the major challenges is the risk of getting caught up in a conflict between two of the local clans of nomadic pastoralists, if they are fighting over water or grazing land. When you’re caught between two different clans clashing, that’s the worst time. This has been going on for hundreds of years, and it can be really risky. You could be shot at by people who are just feeling suspicious of your presence there.

I mean, you’re going into somebody else’s territory – people who have lived there for millennia. For the clans, it’s about water and grazing. As long as you don’t interfere with that, they’re fine. Their culture is very different from ours, but we respect it as much as we respect our own.

We try to hire as many of them as we can, depending on our needs and budget. We hire the same people for a long time and eventually, we become like family – that’s how we’ve been doing the work for decades, going back again and again, finding all these great fossils. Most of the time it works really well and when we leave for the field season, they can’t wait until we come back the next year. This may not be the case everywhere though.

Is climate change making it harder to work in these areas?

It’s a desert area, so the water resource has always been limited. There’s one river that flows all year round, and it’s the only water we all have access to. But climate change is resulting in less grass for the animals to graze on, so the people we work with sometimes move farther away from their usual area looking for grazing land – and sometimes that gets them into conflict with other clans. Some years, we don’t see a good number of our usual workers because they went somewhere else with their animals.

This is nothing new – it’s been happening for many, many centuries. But climate change is altering a lot of things on the landscape, and increasing the risk of deadly conflicts as different clans try to access limited resources.

The Afar desert, northern Ethiopia.
Marica van der Meer/Arterra Picture Library/Alamy Stock Photo

Is there a reason why so many ancient humans have been found in a relatively small part of Ethiopia?

The Afar desert in Ethiopia was not a desert in the deep past. It was a place where life, including some of our earliest ancestors, flourished for millions of years. But the fact this area is located in a tectonically active region with three of Earth’s plates slowly pulling apart, creating a deep rift valley between them – the rifting has facilitated the past life history of the area to resurface in the form of fossils. In that sense, the region is geologically unique and not seen anywhere else in the world.

So, we cannot conclusively say these early human ancestors whose fossils we are finding in the East African Rift valley never lived anywhere else. The problem is we don’t have, or haven’t yet found, many ancient sediments of equivalent age outside eastern Africa where we can look for fossils of ancient human ancestors.

There are some very important exposed sediments outside the East African Rift system – for example in Chad in Central Africa, where the very earliest hominin fossils have been found, dating back between 6 and 7 million years. But a much wider geographic distribution of early human ancestors, at least within the tropics, cannot be ruled out. That is why continued survey and exploration outside the known sites in East and South Africa is of paramount importance.

Are there specific new areas that scientists should be looking?

There are so many areas in Africa that haven’t yet been explored but need to be. You haven’t heard anything about hominin fossils from West Africa, right? But now, people are thinking about exploring that region in search of human ancestors.

The story of human origins is not like the law of gravity – once figured out and done. New fossil discoveries will always help us understand it better. And there are some questions we cannot answer until we find more fossils and larger sample size from even deeper time – such as identifying the common ancestor humans shared with chimpanzees some 8 million years ago. What would it look like? How did it move about?

Yohannes Haile-Selassie with colleagues in the field in Ethiopia.
Yohannes Haile-Selassie, Author provided (no reuse)

Meanwhile, the science of studying existing hominin fossils is getting better all the time, aided by prevailing technology…

We’ve collected hundreds if not thousands of early human ancestors over the last 50 years since Lucy was discovered. When she was found in 1974, all we could study was what was visible on the external surface of her bones – taking measurements and so on. But now, we have the technology to scan her skeleton and look at the internal structure of the bones.

So, even if we don’t have any new fossils emerging, those we already have in our museums and laboratories will keep generating a lot of knowledge because we’re improving the technology; the way we analyse the fossils.

Are there any important specimens found in Ethiopia that have still not been returned?

In the old days, the reason western scientists took them out of Ethiopia was because the country had no laboratory to study them in. Or at least, that was a good excuse. But once Ethiopia had a laboratory, they had to go back. The laboratory at that time wasn’t big enough, but it was a good start. And the one we have now, in the National Museum of Ethiopia in Addis Ababa, is a state-of-the-art, four-storey building in which we can keep and study all of the fossils from anywhere in Ethiopia – including Lucy.

In the old days, another excuse was: you don’t even have enough space to store them if we return them, right? “No, we do” was the response – so the message even in the late 1980s was just send our fossils back. All of the Ethiopian hominins are back in Ethiopia now, in part because of the tough stance the government took when it invoked its moratorium on fossil exploration between 1982 and 1989. All of a sudden, the government said: “No permits. We’re stopping exploration until we can get a new antiquities law, and ensure more control over our own cultural heritage, including ancient human fossils.”

Lucy on display in the National Museum of Ethiopia, Addis Ababa.
Edwin Remsberg/Alamy Stock Photo

Are you optimistic about the future of paleoscience in Ethiopia?

The fieldwork is not going to stop even after we are done. There is a new generation of scientists – including many from Ethiopia, I hope – who are going to continue our work. But their approach, their methodology, their “search engine” is all going to look very different, and hopefully much better, from the way we did it.

But as the fossil evidence continues to come out of Africa, we have to also be able to conduct the research in the countries where those fossils are being found. Our efforts to better understand the human story cannot be dominated, like the old days, by western researchers shuttling in and out, without community engagement or leaving any meaningful impact on the countries yielding all these fossils.

African institutions with paleoanthropological resources need external help, and it’s only fair that western researchers with resources help these institutions as much as they can. Honestly, it’s for their own good too. But it is up to each country in Africa to identify what support it needs. Everything is in their hands. If they say: “If you don’t help us with this, we’re not going to let you do research,” then that’s it, it’ll stop. So, we have to make sure we don’t get to that stage.

Is ‘brain drain’ a big worry for you?

Definitely. I can give you one example: myself – I live in the US and work at ASU. At the time, there were few other options for me. But even today, African students come out to the US for training and often don’t go back to their own country. To reduce brain drain, we need more paleoanthropology programs in African universities and other local institutions to counteract this tradition. No one would want to leave their homeland if they had the same opportunities they long for abroad.

I’ve been asked how come there are no trained scholars from the areas where these fossils are actually coming from, such as the Afar region. I didn’t have an immediate answer to that – but since then, the lack of a paleoanthropology program in that region, where Lucy and so many fossils have been discovered, has become a real concern to me. Now, I’m trying to build a collaboration between ASU and Samara University, so we can start a paleoanthropology masters program there. I hope many of my colleagues working in the Afar region will help me on this.

This is where online teaching becomes really important as well, so that African students don’t have to move abroad in the first place to get their education. ASU has been renowned for its online teaching even before COVID sped it up – it’s a pioneer. And that’s another means that we have to help African universities develop new programs by collaborating with western universities like ASU.

I am deeply interested in helping develop paleoanthropology programs in Ethiopia and elsewhere, because we need to increase the number of local African scholars who can actively and meaningfully participate in telling what is perhaps the most important story of all: where did humans come from, and how did we get here?

Disclosure statement: Yohannes Haile-Selassie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

For you: more from our Insights series:

To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. Subscribe to our newsletter. Läs mer…

Grattan on Friday: Marles plays a defensive bat on nuclear as the government rushes to get though late work

Richard Marles is an ambitious man who hasn’t given up the dream of one day reaching the top job. But, despite being deputy prime minister, his profile is much lower than that of Treasurer Jim Chalmers, the candidate considered most likely to succeed Anthony Albanese as Labor’s leader.

The treasurer was at his most hyperactive this week, with an economic statement to parliament, reforms to superannuation, and a new set of priorities (investment in housing, the energy transition, and infrastructure) for the Future Fund, the nation’s $230 billion sovereign wealth fund. The latter immediately opened the government to opposition claims it was trying to bend the independent fund to its will (Chalmers’ retort was to accuse the opposition of wanting less investment in these areas).

But it was Marles’ dead-bat performance in question time that was most useful to the government in this penultimate parliamentary week of the year.

The government appeared blindsided, and the opposition was delighted, by a US–UK agreement to accelerate the deployment of “cutting-edge” nuclear technology. The agreement was released during the COP29 climate conference in Baku, which Energy Minister Chris Bowen was attending.

Australia refused to be party to the agreement; the government’s awkward position was accentuated by the UK government’s statement on the agreement initially (mistakenly) saying Australia was expected to join.

On Tuesday and Wednesday Marles, acting prime minister while Albanese was overseas, kept his answers on script, sticking to the formula that Australia doesn’t – and under Labor wouldn’t – have a domestic nuclear industry and so wasn’t signing up. He couldn’t smother the issue, but he did limit the smoke.

The parliamentary week had started badly for the government, with the opposition refusing to support its plan for caps on universities’ foreign students.

This had been a surprise, and adds a layer of uncertainty to a university sector already in considerable chaos, with the finances of some institutions in deep trouble, leading to extensive job cuts.

The government continued to pile new legislation into a stretched parliament, notably bills for a ban on children under 16 accessing social media, and for a far-reaching shakeup of electoral donations and spending. The Coalition is supporting both.

The social media ban has been panned by some (though not all) experts, but will be very popular with parents. Platforms, rather than parents or children, will have the responsibility for compliance, facing hefty fines for systematic breaches.

The legislation is “about helping families”, Communications Minister Michelle Rowland told parliament in Thursday’s question time. Unusually, her opposition counterpart David Coleman jumped up immediately to support her, saying “this issue of the safety of Australian children online from social media is one of the defining issues of our era”.

Like the social media ban, the electoral changes are also on track to be passed next week, given a deal between the major parties. But they have sparked angst from the minor players including the teals.

There is general agreement “big money” should be taken out of politics. However, one person’s “big money” is another person’s positive support to “level the playing field” for new players.

Most would see Clive Palmer’s about $120 million spend for the last election as over the top. But many would take a different attitude to the $13 million spent by Simon Holmes à Court’s Climate 200, that helped a number of teals become MPs.

When it comes to electoral reform, it’s a matter of balance – curbing excess but enabling aspirants who do not have the backing of big parties or incumbency to have reasonable access. There’ll be continuing argument about whether the government’s package has that balance right.

The Liberals’ interest in signing up was not unexpected, in light of their vulnerability to teals and other independents. Although the changes don’t come in for this election, the Liberals want to contain what could be a longer-term trend.

So does Labor. It has not yet been hit like the Liberals have by the wave of community candidates (although it lost its previously safe NSW seat of Fowler to one). But with a primary vote around 30% and no sign the public disillusionment with the main parties is waning, it knows the risk that’s looming. It also has the challenge of Greens candidates in its inner-city seats.

The electoral legislation has given the teals an issue for next year’s poll. They can use it to boost the case for their own re-election (before the system changes) and it possibly opens the way for them to say that if there is a minority government they might press for changes to make the arrangements, in their view, “fairer”.

Meanwhile, voters’ attention remains firmly on matters closer to the kitchen table. They don’t see much good news. The prospect of interest rate falls appears to be receding even further into the depths of 2025, and the economy is likely to remain stagnant for the time being.

Chalmers, in his economic statement, was upbeat. We’re having a “soft landing”, he said. Inflation is falling. Treasury is expecting a “gradual recovery in the economy”. Real wages are growing (slowly).

People’s experiences and perceptions are, however, baked in hard. The Freshwater poll in the Australian Financial Review this week found the top issue of concern to people, the cost of living, had risen in the past month by 5 points to 77%. When people were asked about managing key issues, the Coalition had a 12-point lead on cost of living and a 17-point lead on economic management.

By Thursday, Albanese was back in parliament after his week away at APEC and the G20. He was just in time to hear his old rival Bill Shorten, the former Labor leader who came close to being prime minister, deliver his valedictory.

It had a salutary message in what, for Australia, is a time of division.

“I’m a proud moderate,” Shorten said. “Being in the centre is an acknowledgement that Australians hold broad, diverse views. The majority in the middle should never be hostage to the intolerant few on the zealous fringe.” Läs mer…

Grattan on Friday: Marles plays a defensive bat on nuclear as the government rushes to get through late work

Richard Marles is an ambitious man who hasn’t given up the dream of one day reaching the top job. But, despite being deputy prime minister, his profile is much lower than that of Treasurer Jim Chalmers, the candidate considered most likely to succeed Anthony Albanese as Labor’s leader.

The treasurer was at his most hyperactive this week, with an economic statement to parliament, reforms to superannuation, and a new set of priorities (investment in housing, the energy transition, and infrastructure) for the Future Fund, the nation’s $230 billion sovereign wealth fund. The latter immediately opened the government to opposition claims it was trying to bend the independent fund to its will (Chalmers’ retort was to accuse the opposition of wanting less investment in these areas).

But it was Marles’ dead-bat performance in question time that was most useful to the government in this penultimate parliamentary week of the year.

The government appeared blindsided, and the opposition was delighted, by a US–UK agreement to accelerate the deployment of “cutting-edge” nuclear technology. The agreement was released during the COP29 climate conference in Baku, which Energy Minister Chris Bowen was attending.

Australia refused to be party to the agreement; the government’s awkward position was accentuated by the UK government’s statement on the agreement initially (mistakenly) saying Australia was expected to join.

On Tuesday and Wednesday Marles, acting prime minister while Albanese was overseas, kept his answers on script, sticking to the formula that Australia doesn’t – and under Labor wouldn’t – have a domestic nuclear industry and so wasn’t signing up. He couldn’t smother the issue, but he did limit the smoke.

The parliamentary week had started badly for the government, with the opposition refusing to support its plan for caps on universities’ foreign students.

This had been a surprise, and adds a layer of uncertainty to a university sector already in considerable chaos, with the finances of some institutions in deep trouble, leading to extensive job cuts.

The government continued to pile new legislation into a stretched parliament, notably bills for a ban on children under 16 accessing social media, and for a far-reaching shakeup of electoral donations and spending. The Coalition is supporting both.

The social media ban has been panned by some (though not all) experts, but will be very popular with parents. Platforms, rather than parents or children, will have the responsibility for compliance, facing hefty fines for systematic breaches.

The legislation is “about helping families”, Communications Minister Michelle Rowland told parliament in Thursday’s question time. Unusually, her opposition counterpart David Coleman jumped up immediately to support her, saying “this issue of the safety of Australian children online from social media is one of the defining issues of our era”.

Like the social media ban, the electoral changes are also on track to be passed next week, given a deal between the major parties. But they have sparked angst from the minor players including the teals.

There is general agreement “big money” should be taken out of politics. However, one person’s “big money” is another person’s positive support to “level the playing field” for new players.

Most would see Clive Palmer’s about $120 million spend for the last election as over the top. But many would take a different attitude to the $13 million spent by Simon Holmes à Court’s Climate 200, that helped a number of teals become MPs.

When it comes to electoral reform, it’s a matter of balance – curbing excess but enabling aspirants who do not have the backing of big parties or incumbency to have reasonable access. There’ll be continuing argument about whether the government’s package has that balance right.

The Liberals’ interest in signing up was not unexpected, in light of their vulnerability to teals and other independents. Although the changes don’t come in for this election, the Liberals want to contain what could be a longer-term trend.

So does Labor. It has not yet been hit like the Liberals have by the wave of community candidates (although it lost its previously safe NSW seat of Fowler to one). But with a primary vote around 30% and no sign the public disillusionment with the main parties is waning, it knows the risk that’s looming. It also has the challenge of Greens candidates in its inner-city seats.

The electoral legislation has given the teals an issue for next year’s poll. They can use it to boost the case for their own re-election (before the system changes) and it possibly opens the way for them to say that if there is a minority government they might press for changes to make the arrangements, in their view, “fairer”.

Meanwhile, voters’ attention remains firmly on matters closer to the kitchen table. They don’t see much good news. The prospect of interest rate falls appears to be receding even further into the depths of 2025, and the economy is likely to remain stagnant for the time being.

Chalmers, in his economic statement, was upbeat. We’re having a “soft landing”, he said. Inflation is falling. Treasury is expecting a “gradual recovery in the economy”. Real wages are growing (slowly).

People’s experiences and perceptions are, however, baked in hard. The Freshwater poll in the Australian Financial Review this week found the top issue of concern to people, the cost of living, had risen in the past month by 5 points to 77%. When people were asked about managing key issues, the Coalition had a 12-point lead on cost of living and a 17-point lead on economic management.

By Thursday, Albanese was back in parliament after his week away at APEC and the G20. He was just in time to hear his old rival Bill Shorten, the former Labor leader who came close to being prime minister, deliver his valedictory.

It had a salutary message in what, for Australia, is a time of division.

“I’m a proud moderate,” Shorten said. “Being in the centre is an acknowledgement that Australians hold broad, diverse views. The majority in the middle should never be hostage to the intolerant few on the zealous fringe.” Läs mer…

A common nasal decongestant lacks evidence but is still sold in the UK

For years, the drug phenylephrine has been a popular choice for relieving nasal congestion, however, the US Food and Drug Administration (FDA) is considering removing oral phenylephrine medicines from pharmacy shelves. Recent FDA findings suggest it lacks effectiveness.

Phenylephrine became widely used in cold and flu products as a safer alternative to pseudoephedrine. While pseudoephedrine is effective, it carries some misuse risks – with criminals using it to make methamphetamine. However, recent studies question whether phenylephrine is effective when taken orally.

In the UK and other countries, there is now a discussion about the ethics of continuing to sell it. So, should the UK take action?

There are pros and cons to removing phenylephrine from UK shelves. On one hand, continuing to sell a potentially ineffective product could harm public trust in over-the-counter (OTC) medicines. Consumers expect these products to be both safe and effective – not just safe – so evidence against phenylephrine may undo that trust.

As studies continue to question the effectiveness of oral phenylephrine, some experts suggest it may be time to reconsider its place in the UK. Fortunately, alternatives exist. As mentioned, pseudoephedrine is effective as a nasal decongestant, but it comes with purchase restrictions. Phenylephrine nasal sprays may also offer more direct relief.

Phenylephrine and pseudoephedrine both relieve nasal congestion by constricting blood vessels in the nasal passages, which reduces swelling and helps ease breathing. However, their effectiveness depends on how well the drug reaches these target tissues.

Pseudoephedrine is generally considered the more effective option, enters the bloodstream and reaches nasal tissues, acting directly on blood vessels to reduce congestion. Phenylephrine, though, is less effective when taken orally, as it is largely broken down before it can reach the nasal tissues in sufficient amounts.

When swallowed, phenylephrine is quickly broken down by the liver and gut, a process called “first-pass metabolism”, which significantly reduces the amount that reaches the bloodstream and nasal tissues.

Because little phenylephrine survives this process, it doesn’t effectively reduce swelling in the nasal blood vessels, offering limited congestion relief. Research from several studies shows little evidence that oral phenylephrine effectively relieves nasal congestion. Findings suggest it may work no better than a placebo.

When swallowed, phenylephrine breaks down quickly in the stomach.
Carlos David / Alamy Stock Photo

Phenylephrine works better as a nasal spray, acting primarily on nasal linings with minimal absorption into the bloodstream. But prolonged use of decongestant sprays can lead to “rebound congestion”, a condition where nasal passages become increasingly congested as the effect of the spray wears off, often worsening symptoms over time.

The medication causes blood vessels in the nasal passages to become less responsive over time. This can create a cycle of dependency and congestion. To avoid this, these sprays are recommended for short-term use only.

While some products recommend limiting use to seven days, many health professionals suggest keeping it to three days to reduce the risk of rebound congestion.

Still available in the UK – for now

In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) has stated that no new safety concerns have been identified with phenylephrine. However, the agency continues to monitor its safety and effectiveness.

While it is unclear if the MHRA will conduct a formal review, such a move would align with evidence-based standards and help protect consumer trust.

With phenylephrine’s effectiveness now in question, consumers might consider other options. Alternatives like pseudoephedrine and nasal sprays for short-term use can offer reliable relief. Läs mer…

A 50-year battle for truth: the Birmingham pub bombings and the price of injustice

When bombs tore through two crowded pubs in central Birmingham on the evening of November 21 1974, they claimed the lives of 21 people and injured 220 more. They also led to the wrongful conviction of six men.

The tragic events of that night and the subsequent wrongful convictions have left wounds that, even decades later, remain painfully open. The 50th anniversary of the Birmingham pub bombings serves as a stark reminder of the multiple victims created by miscarriages of justice.

The 1974 bombings occurred amid a climate of intense public fear surrounding a sustained campaign by the Provisional Irish Republican Army, which had already claimed many people’s lives.

Shortly after the bombings, six men, originally from Northern Ireland – Patrick Hill, Hugh Callaghan, Gerald Hunter, Richard Mcllkenny, William Power and John Walker – were arrested. After three days in police custody, four of the men had confessed to the crimes.

A type of forensic test, known as a Griess test, had also returned positive results for nitroglycerine on two of the men’s hands. According to a forensic scientist named Frank Skuse, this meant the men had handled explosives.

At their trial in 1975, the men claimed that the police had beaten the confessions out of them. Even a superficial examination of the statements obtained by police showed they were riddled with inaccuracies.

A Home Office explosives expert testified that everyday items like cigarette packets and playing cards, which the men had handled, could cause a positive Greiss test. But in court, this evidence was rubbished. All six were found guilty and sentenced to life in prison.

It took 16 years and two failed appeals before the convictions of the Birmingham Six, as they came to be known, were finally quashed. Their 1991 appeal exposed major flaws in the police evidence, concerns over the treatment of the men during interrogation, and the unreliability of the Griess test. The six men were freed, but the damage was irreparable.

The Birmingham Six outside the Old Bailey in London, after their convictions were quashed in 1991.
PA Images/Alamy

Almost all victims of wrongful conviction suffer significant and lifelong psychological, emotional, behavioural and physical trauma as a result of their ordeal. The Birmingham Six were no different.

A snapshot of their trauma was outlined by psychiatrist Adrian Grounds when he assessed two of the men after their release. He found that their ordeal had left them with the most severe form of post-traumatic stress disorder, of the kind he had only ever before observed in brain damaged accident victims or victims of war crimes.

Their families will have suffered profoundly as well, bearing the stigma of association and enduring emotional and psychological strain. Research on wrongful convictions reveals such trauma extends even to exonerees’ children, who often face bullying and develop mental health issues, including eating disorders.

Generational trauma can also ripple through families, affecting those who never even knew the exoneree but bear the emotional legacy of the injustice nonetheless.

Victims and families

The pain suffered by the Birmingham Six and their families is mirrored, however, by that experienced by the victims of the original bombings and their families.

While the swift arrest and punishment of the Birmingham Six could not undo the horrific events experienced, knowing that justice had been done may have brought some form of closure. But with the 1991 quashing of the convictions, old wounds were inevitably reopened.

For victims’ families, such revictimisation can trigger feelings of guilt, helplessness and shock, potentially more intense than after the original crime. And for the families of those harmed in the Birmingham pub bombings, subsequent generations have continued to suffer as they continue to campaign for the perpetrators to be brought to justice.

Protesters outside the High Court in London in 2018 demanding justice for the 21 victims of the Birmingham pub bombings.
PA Images/Alamy

Yet, there will inevitably be more victims of the criminal justice system’s handling of the pub bombings case. When someone is wrongly convicted, the true perpetrator of the crime remains at large.

Offenders who get away with serious crimes rarely cease their activities. In fact, they often commit additional acts of violence, creating even more victims of the original wrongful conviction.

Miscarriages of justice also harm the public purse. The average cost of a prison place in England and Wales currently stands at more than £50,000. While this is relative to inflation, taxpayers in the 1970s and 1980s spent a fortune keeping six innocent men in prison for 16 years.

They have since spent a sizeable sum on subsequent police reinvestigations into the case. And there is the possibility, in the future, that a costly public inquiry will take place.

If this weren’t enough, the justice system itself is also a victim of wrongful convictions like those of the Birmingham Six. Wrongful convictions erode public trust in our justice system to get it right.

One of the Birmingham Six, Patrick Hill, speaking to the BBC in 2011.

Indeed, around the time that the convictions of the Birmingham six were quashed, several other high-profile miscarriages of justice were revealed. As a result, there was a crisis of public confidence in criminal justice. This led to a Royal Commission on Criminal Justice and the creation of the Criminal Cases Review Commission, an independent body that investigates potential miscarriages of justice in Northern Ireland, England and Wales.

Those closest to the events of November 21 1974 have undoubtedly continued to suffer in the most unimaginable ways over the last 50 years, not least because the Birmingham Six are yet to receive an apology from the state. And the victims of the bombings and their families are yet to see the true perpetrators brought to justice by the state.

This case underlines the fact that wrongful convictions have a ripple effect – in other words, we are all the worse off when they happen. Läs mer…

Saving Lives, Changing Minds: How Portugal is Winning the War on Drugs

Portugal has taken a bold step in its way out of the drug crisis, addressing drug use by choosing to focus on health and support instead of punishment—and the results are remarkable. Since decriminalizing drug possession in 2001, drug-related deaths have dropped sharply, HIV infections have declined, and more people are accessing support services. Portugal’s approach is inspiring a global conversation about rethinking the war on drugs, shifting focus to prioritize public health over criminalization.
A New Approach: Help Instead of Punishment
Portugal’s drug policy shifts the focus from punishment to rehabilitation. Being caught with small amounts of drugs for personal use no longer leads to arrest or imprisonment. Instead, individuals are referred to “Commissions for the Dissuasion of Drug Addiction.” These teams—composed of psychologists, social workers, and legal experts—assess the individual’s situation.
Their aim is to understand why the person uses drugs and what kind of support they need, whether that’s counseling, treatment, or social services. This innovative approach treats drug use as a health issue rather than a crime, breaking down barriers that often prevent people from seeking help.
Real Results: Fewer Deaths, Better Health
The impact of this shift has been profound. Drug-related deaths in Portugal are now among the lowest in Europe. Before decriminalization, the country faced a public health crisis, with hundreds of deaths and rising HIV rates among drug users.
Today, these numbers have dropped significantly. Portugal’s harm reduction programs, such as the distribution of clean needles and access to voluntary therapy, have played a key role in these improvements. These services reduce the risk of infections like HIV and hepatitis while encouraging people to seek help without fear of legal consequences.
Portugal’s way out of the drug crisis: Building Trust and Preventing Harm
Another critical component of Portugal’s strategy is the establishment of drug consumption rooms. These spaces allow individuals to use drugs under medical supervision, preventing overdoses and ensuring immediate medical assistance when needed. They also provide clean equipment to reduce the spread of infectious diseases and serve as entry points for people to connect with healthcare services. For many, these safe spaces are the first step toward recovery.
Problematic Drug Use and Social Factors
One of the most striking outcomes of Portugal’s policy is the decline in “problematic” drug use—defined as frequent and high-risk use. This has decreased significantly, particularly among young people. Experts attribute this to a combination of decriminalization, education, and accessible support services that are designed to tackle not just the symptoms of drug use but also the root causes.
Portugal’s strategy goes further by addressing the social and economic factors that contribute to addiction. Programs focus on reintegrating individuals into society, offering job training, housing assistance, and social support. By addressing these root causes of addiction, Portugal aims to break the cycle of addiction and improve overall well-being.
A Model for the World?
Portugal’s success is an example of how compassionate, health-focused policies can address drug issues more effectively than punishment. The combination of decriminalization, harm reduction services, and efforts to tackle underlying social issues provides a comprehensive model for sustainable change.
This approach has inspired discussions in countries worldwide. For instance, nations like Canada and Switzerland have implemented similar harm reduction measures, although on a smaller scale. Yet many countries remain hesitant, clinging to punitive measures despite mounting evidence that they are less effective.
This work is licensed under the Creative Common License. It can be republished for free, either translated or in the original language. In both cases, please cite Kontrast / Sophie Wenkel as the original source/author and set a link to this article on TheBetter.news. https://thebetter.news/portugal-drug-policy/

The rights to the content remain with the original publisher. Läs mer…