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Place of the Year 2018 nominee spotlight: Mexico

Mexico has had an eventful 2018, both on the national and international stage. With conversations centered on immigration, natural disasters, economic advancements, and political protests, the country and its people have been front and center.

On November 5, Mexico City received their first wave of migrants from a large group of people travelling through Mexico towards the United States. Approximately 450 people have taken temporary shelter in a stadium, as authorities in Mexico City have prepared food, shelter, medical and legal advisers, drinking water, and have had residents donate clothes and shoes for travelers. The group of about 5,000 people—known as a caravan—set off from Honduras. Many of the migrants plan to seek asylum in the United States, saying they are fleeing from persecution, poverty, and violence in their home countries. US President Donald Trump has said that he will use the military to completely shut the US-Mexico border if necessary, and has threatened to cut aid to Guatemala, El Salvador, and Honduras, three of the countries migrants are fleeing. The US president has even deployed troops to the border to keep the migrants out.

Mexican immigration has remained a popular talking point within United States political conversation during the 2018 election season, contributing to great polarization and tension. The number of family members arrested at the US-Mexico border rose to roughly 16,658 in September, a 31 percent increase over the previous month, and the most recorded in a single month since fiscal year 2012 when the Border Patrol started compiling records.

Mexico has also endured multiple natural disasters in 2018. One earthquake hit Mexico City right after the Mexican national soccer team defeated Germany in the World Cup, leading to initial speculation that the quake had been caused by jubilant fans. This was proven untrue shortly after, however—it was in fact an entirely natural earthquake. On the Pacific coast of Mexico, it has been a difficult hurricane season. At the beginning of November, Tropical Storm Xavier became the 22nd named tropical storm of the 2018 eastern Pacific hurricane season, making this year’s hurricane season the most active since 1992.

GIF by Nicole Piendel for Oxford University Press

In economic news, Mexico, the United States, and Canada agreed on a revised trade deal to replace NAFTA in early October, called USMCA. It is expected to be signed by the end of November, and then will be sent to Congress for approval. Despite the cooperation, however, tensions remain high as immigration remains a talking point in both countries.

Mexican citizens are becoming more and more politically engaged in protest of their leadership’s decisions. In late October, Mexico’s President-elect López Obrador announced that he would respect the result of a referendum that rejected a partially built $13 billion airport for Mexico City. Following the announcement, Mexico’s peso declined more than 3 percent against the US dollar, with the interbank rate ending at 20.06 pesos to $1. Banco BASE said it was the biggest single-day drop since November 9, 2016, following Donald Trump’s election as US president. There has been a public backlash, with a protest of 5,500 people marching in Mexico City on November 11. The protesters questioned the constitutionality of the cancellation decision, and expressed their lack of trust in Obrador.

Do you want to learn more about Mexico and immigration? Try these titles: Mexico: What Everyone Needs to Know, Mexico: What Everyone Needs to Know Second Edition, Borders: A Very Short Introduction, and Citizenship: A Very Short Introduction.

You can also learn more about natural disasters such as those plaguing Mexico with these titles: Climate: A Very Short Introduction, and Weather: A Very Short Introduction.

Finally, if you’re interested in learning more about the culture of Mexico, listen to this recent episode of our podcast, the Oxford Comment. Culturally, societal changes in post-revolutionary Mexico of the 1920’s produced shifts in urban women’s activity and mobility that were reflected in their dress and appropriation of indigenous stylistic and symbolic traditions. Women today continue to use traditional forms, such as embroidered huipiles, as a means of expressing their identities and rights through fabric. Listen to William Beezley, Professor of History at the University of Arizona and Editor in Chief of the Oxford Research Encyclopedia of Latin American History, as he moderates a roundtable discussion with historians Stephanie Wood and Susie Porter about Mexican women’s self-expression through textiles and dress. For all Oxford Comment episodes, find us on Spotify.

Place of the Year 2018 Shortlist

Featured image credit: “ancient-architecture-backlit-building” by Rafael Guajardo. CC0 via Pexels.

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The Oxford Handbook of Clinical Medicine is recruiting!

We’re looking for medics to join our team to contribute to the eleventh edition of the Oxford Handbook of Clinical Medicine.

Unique among medical texts, the Oxford Handbook of Clinical Medicine is a complete and concise guide to the core areas of medicine that also encourages thinking about the world from the patient’s perspective, offering a holistic, patient-centred approach.

Loved and trusted by millions for over three decades, the Oxford Handbook of Clinical Medicine continues to be a truly indispensable companion for the practice of modern medicine.

You’ve read it, you’ve used it, you’ve made your notes in it, and this is your chance to join the writing team for the new edition! We’re looking for contributors who are:

Interested in the practice and philosophy of medicine and ready to challenge the status quo.Committed to excellence, with a talent for writing.Proficient at time management and meeting deadlines.Any level from final year medical student all the way to specialty or GP trainee.

The project will require serious commitment and hard work outside of your normal working hours. We intend to write the new edition during 2019-20, followed by 12 months of editing and proof reading. In return, you will have the opportunity to contribute to the world’s best-selling medical handbook.

If you are interested in being involved, please submit the following information:

NameEmail address Postal address Telephone number 2-page CV The specialty you are most interested in writing on, and conversely any that you feel unqualified to write on

We will need you to demonstrate your writing style and personal take on medicine by completing the following:

Choose your favourite chapter from the Oxford Handbook of Clinical Medicine and write an ‘aside’ of 100–200 words, bringing in personal experience, art, history, literature, or philosophy in order to shed new light on your chosen subject and to give the reader some insight to use in their day-to-day practice of medicine. You can choose anything related to the practice of medicine or philosophy of medicine, as long as it is relevant to the Handbook and is entertaining, thoughtful, and illuminating. Accompanying figures or diagrams are welcomed. Such asides have contributed to the continued success of the Oxford Handbook of Clinical Medicine for over 30 years—show us what unique wisdom you can add!

Additionally, we’d like you to tell us two things about the Oxford Handbook of Clinical Medicine that could be improved, and what you would do to change them. You should sum up your thoughts in no more than 200 words.

Entries should be emailed to OHCMrecruitment@oup.com by 4pm GMT on 12th December, 2018.

Our Privacy Policy sets out how Oxford University Press handles your personal information, and your rights to object to your personal information being used for marketing to you or being processed as part of our business activities.

We will only use your personal information to process your application.

Featured image credit: ‘Science laboratory, with focus on human body anatomy model’. Used under license from Shutterstock.

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Stan Lee on what is a superhero

What is a superhero? What is a supervillain? What are the traits that define and separate these two? What cultural contexts do we find them in? And why we need them? Editors Robin S. Rosenberg, PhD and Peter Coogan, PhD collected a series of essays examining these questions from both major comic book writers and editors, such as Stan Lee and Danny Fingeroth, and leading academics in psychology and cultural studies, such as Will Brooker and John Jennings. The following essay by legendary comic book writer, editor, publisher, and producer Stan Lee is extracted from What is a Superhero? and entitled “More Than Normal, But Believable”.

A superhero is a person who does heroic deeds and has the ability to do them in a way that a normal person couldn’t. So in order to be a superhero, you need a power that is more exceptional than any power a normal human being could possess, and you need to use that power to accomplish good deeds. Otherwise, a policeman or a fireman could be considered a superhero. For instance, a good guy fighting a bad guy could be just a regular police story or detective story or human-interest story. But if it’s a good guy with a superpower who is fighting a bad guy, it becomes a superhero story. If the good guy is doing something that a normal human being couldn’t do, couldn’t accomplish, then I assume he becomes a superhero.

Not surprisingly, then, the first thing I would think of when trying to create a character is, what superpower will I give him or her? I’ll make somebody who can throw fireballs and fl y in the air. I’ll have somebody who can crawl on walls and shoot webs like a spider. So, automatically, those characters become superheroes. Of course, if they were evil, they would be supervillains, because the same rule applies: to be a supervillain, you have to be a villain, but you also have to have a superpower, just like a superhero has to. The word super is really the key.

Photo by Gage Skidmore [CC BY-SA 3.0]

But there’s no formula for creating characters. With Iron Man, I knew I wanted someone in an iron suit, and so his powers came from that. With Spider-Man, I knew I wanted someone with spider powers, so the name and costume came with that. It doesn’t matter whether you start with the character’s code name, his powers, or his costume; none of these conventions of the genre works better than the others as a starting place for creating a superhero. It just depends on whether you get lucky and what sells.

There doesn’t necessarily have to be a connection between the personality of the alter ego and the powers of the superhero. When we created the Fantastic Four, I knew that I wanted each of them to have distinct powers. Even though Reed is mentally bright and flexible, Johnny is a bit of a hothead, Sue is a shrinking violet, and Ben is a big lug—which fits with their powers—I could have made Sue go on and on and speak with big words, or made Johnny the intellectual, or given Reed a temper. The powers of the characters don’t necessarily have to reflect the personalities of the characters, and the Fantastic Four would have been just as successful if there had been no link between their personalities and their powers. It just depends on how it works out. That’s the way things were back then.

The problem with telling superhero stories is that it naturally follows that you need a supervillain. You need a foe who can make the story interesting, someone who’s at least as powerful as—and hopefully even more powerful than—the hero, because that makes the story fun. The viewer or the reader has to think to himself or herself, how is our hero ever going to get out of this? How is he ever going to beat the villain? We have to keep the reader on the edge of his or her seat. So the most important thing is to have a supervillain who is equally as colorful as and even more powerful than the hero apparently is.

I try to make the characters seem as believable and realistic as possible. In order to do that, I have to place them in the real world, or, if the story is set in an imaginary world, I have to try to make that imaginary world as realistic-seeming as possible, so the character doesn’t exist in a vacuum. He has to have friends, enemies, people he’s in love with, people he doesn’t love—just like any human being. I try to take the superhero and put him in as normal a world as possible, and the contrast between him and his power and the normal world is one of the things that make the stories colorful and believable and interesting.

Superman was the start of the whole superhero thing. He had the superpowers and wore that costume with the bright colors and silly cape. It’s the costume that was different. Zorro didn’t have superpowers, Doc Savage * didn’t have superpowers; they could just do things a little better than the rest of us. The Shadow † could be a superhero because he could make himself unseen, and if he appeared in a comic book today, he might be a superhero, though he doesn’t really wear a costume. I’m not an expert on the Shadow, but I think he just had a dark business suit and a sort of raincoat and a slouch hat. Superman’s costume was different because of the bright colors, that silly cape, those red boots, his belt, and his chest symbol. I mean, it’s ridiculous, because you really don’t need a costume to fly or fight bad guys. If I had superpowers, I wouldn’t wear a costume.

But it does serve as a way of colorfully identifying the superhero, and it also announces him. When he gets into a fight with a bad guy, the costume sort of explains that he’s the good guy.

Although a costume isn’t required of superheroes, the fans love costumes. The characters are more popular if they wear costumes. (Don’t ask me why.) In the first issue of the Fantastic Four, I didn’t have them wear costumes. I received a ton of mail from fans saying that they loved the book, but they wouldn’t buy another issue unless we gave the characters costumes. I didn’t need a house to fall on me to realize that—for whatever reason—fans love costumed heroes.

I think people are fascinated by superheroes because when we were young we all liked fairy tales, and fairy tales are stories of people with superpowers, people who are super in some way—giants, witches, magicians, always people who are bigger than life. Well, as we got older, we outgrew fairy tales. Most people don’t read fairy tales when they’re grown-ups, but I don’t think we ever outgrow our love for those kinds of stories, stories of people who are bigger and more powerful and more colorful than we are. So superhero stories, to me, are like fairy tales for grown-ups. I don’t know why, but the human condition is such that we love reading about people who can do things that we can’t do and who have powers that we wish we had.

* Editors’ note: Doc Savage is Clark Savage, Jr., a pulp adventurer whose adventures were published by Street and Smith from 1933 to 1949 and who has seen numerous paperback and comic book revivals. He is also the subject of a campy 1975 feature film, Doc Savage: The Man of Bronze, starring Ron Ely.

† The Shadow is a dark pulp vigilante who debuted in 1931 and went on to be the subject of a radio series, movie serials, paperbacks, comics, and a feature film. On radio he was voiced by Orson Welles and other actors, and he was played by Alec Baldwin in the 1994 film. He is often depicted as having the power to “cloud men’s minds” in order to be invisible. Writer Bill Finger was influenced by the depiction of the Shadow when he co-created Batman.

Feature image credit: Stan Lee speaking at the 2014 Phoenix Comicon at the Phoenix Convention Center in Phoenix, Arizona. Photo by Gage Skidmore. CC BY 2.0 via Wikimedia Commons.

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Sick of sickness! Recovering a happier history

Horrible histories are not just for young readers: adult historians also seem to have a penchant for painful tales of disaster and distress. This is especially apparent in the realm of medical history, where it has been said that before the birth of modern pharmaceutics the complete recovery of health was so rare that it barely existed as a concept.

A foray into the diaries and letters of early modern patients and their families reveals a happier history, however. Scattered amidst heartrending accounts of suffering and death, are joyful recoveries. In 1652, 11-year-old , a clergyman from Oxfordshire, described getting better as a transformation from “sicknesse to health…from sadnesse to mirth, from paine to ease, from prison to libertie, from death to life.” Patients enjoyed the blissful ease of abated pain, and cherished the freedom and sociability that came after a spell in the “lonely prison” of the sickchamber. They took pleasure in being able to carry out simple actions, which prior to illness would have generated no comment.

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Place of the Year 2018 nominee spotlight: Pacific Ocean

A study in March of 2018 revealed that the Great Pacific Garbage Patch (GPGP), the world’s largest collection of ocean garbage, has grown to more than 600,000 square miles. That’s twice the size of Texas, or three times the size of France. The mass weighs 88,000 tons, a number which is 16 times higher than previous estimations indicated. The trash in the patch originates from around the Pacific Rim, including nations in Asia and North and South America.

The title of “Great Pacific Garbage Patch” is deceiving; contrary to popular belief, the GPGP is not one large and continuous mass of easily visible marine debris that can be identified from a satellite. Higher concentrations of trash can be found in the GPGP, but much of the debris is made up of small pieces of floating plastic not immediately evident to the human eye. This debris is dispersed over a large expanse of area, and throughout the top portion of the water column.

The GPGP is devastating for marine life. Much of the plastic has deteriorated into micro-plastics as a result of sun exposure, waves, marine life, and temperature changes. Once they break down to this small size, micro-plastics are difficult to remove. Micro-plastics make up 8% of the total mass of the GPGP, but 94% of the estimated 1.8 trillion pieces of garbage floating in the area. They are often mistaken for food by marine animals, resulting in malnutrition and serious threats to the animals’ behavior, health, and existence.

There are serious consequences for human beings and our economy as a result of the GPGP. Through a process called bio-accumulation, chemicals found in plastics will enter the body of the animal that feeds on it, which will consequently be passed to humans as they eat the animal. Through this process, micro-plastics can enter the food chain. The pollutants they contain become more concentrated as they work their way up the chain to top level predators such as sharks, seals and polar bears. According to the United Nations, the approximate environmental damage caused by plastic to marine ecosystems represents $13 billion.

Watch the video below to hear Judith Weis, author of Marine Pollution: What Everyone Needs to Know take a look at one of the major culprits behind marine pollution: microfibers and micro plastics.

The Pacific Ocean has faced other difficulties this year as well. In 2018 the eastern Pacific Ocean saw its most active hurricane season on record. The season started on May 15, and has had three Category 5 hurricanes east of the international date line. This is only the third eastern Pacific season to have three Category 5’s. Meteorologists measure the intensity and duration of all the storms that form with a metric Accumulated Cyclone Energy (ACE). The average season-to-date ACE for late October is 125.7 units; as of October 23, the storms had created 311 units, more than two and half times the expectation. Of the dozen hurricanes in the eastern Pacific, 83 percent rapidly intensified at some point, an increase from the historical average of 79 percent. The most drastic change of any of the storms was in late August when Hurricane Norman’s peak winds increased 80 mph in only 24 hours. In under 48 hours, Hurricane Willa went from a low-end tropical storm to a Category 5. These hurricanes impacted areas such as Hawaii, Mexico, and the Southwestern United States.

Interested in learning more? Check out the following titles: A Farewell to Ice: A Report From the Arctic, Oceans: a Very Short Introduction, and from the What Everyone Needs to Know® series: Climate Change, Marine Pollution, and Environmental Protection.

Place of the Year 2018 Shortlist

Featured image credit: “beach-pacific-coastline-ocean-coast” by RogerMosley. CC0 via Pixabay.

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Resisting slavery

He ran away from bondage in Jamaica and became the leader of what the newspapers described as “a very desperate gang of Negro Slaves”. He had a mutilated hand. He was accused of robbery and several murders. Between 1780 and 1781, he evaded all attempts at capture. A royal proclamation was issued, offering a reward of £100 for his arrest (to which was later added £200 for his head), the promise of emancipation for any slave who should take or kill him, and a further £5 for the apprehension of each of his followers.

Have you already guessed the identity of this fugitive? Once known by the name of “Bristol”, he gained notoriety as “Three-Fingered Jack”; the slave (anti)hero whose actions so fascinated the eighteenth-century imagination that his story was variously told and retold in popular treatises, novels, chapbooks, and plays.

On stage, Jack’s exploits first appeared in the form of a pantomime written by John Fawcett, which premiered at the Haymarket in 1800, and was later adapted by William Murray into a melodrama headlining the so-called “African Roscius”, Ira Aldridge, in c.1827. The plays shared the same title of Obi; or, Three-Fingered Jack, and enjoyed transatlantic sell-out success, even though the shift to melodrama (a mixed genre, blending music and action) demanded and enabled important changes to the original, including the introduction of a speaking part for Jack.

The popularity of theatregoing in the eighteenth and early nineteenth centuries helped ensure that “Three-Fingered Jack” became a household name. But if Obi capitalised upon Jack’s exploits, it was not confined to them alone. As the biographer and playwright James Boaden would later recall, “we became acquainted with the Obi woman, with Tuckey, and Jenkannoo [sic], Juashee [sic] and Quashee’s wife.” A few misspellings aside, Boaden’s remark is notable for the prominence he affords to Jonkanoo, the most minor part to appear in the pantomime’s published list of male dramatis personae.

Unique to the dramatization of Jack’s history and exotic enough to warrant the addition of an explicit gloss to his name, Jonkanoo was described by the pantomime’s Prospectus as “a grotesque personage, with a ludicrous false head, and head-dress, presiding as Master of Ceremonies at negro balls in Jamaica.” But was Jonkanoo distastefully, or terrifyingly, “grotesque”? Why, exactly, was he “ludicrous”? What kind of “false head and headdress” did he wear?

Jonkanoo makes his first appearance at the end of Act 1. Lauded in song as “merry Jonkanoo”, “One funny big man […] master of all”, he leads the revelries on the eve of Quashee and Sam’s expedition against Jack. Jonkanoo must have cut a figure that was larger than life. Yet he secured no more than a passing mention from one of the play’s many early reviewers.

The popularity of theatregoing in the eighteenth and early nineteenth centuries helped ensure that “Three-Fingered Jack” became a household name. But if Obi capitalised upon Jack’s exploits, it was not confined to them alone.

More knowledgeable theatregoers may have recognised in Jonkanoo a character of ethnographic curiosity. His name is one of the many accepted spellings for the Jamaican slave festivities known as John Canoe, John Connú, Jonkonnu, Junkanoo, and Jankunu (among other variants) that spread across the West Indies and reached as far as the southern United States. Combining music, dance, and masquerade at Christmastime, Jonkonnu took on new forms as its historical and geographical reach widened. Early costumes were described as “primitive”, consisting of repurposed foliage and animal parts; but by the end of the eighteenth century, a distinctive Jonkonnu economy had emerged, with slaves wearing silk and lace that showed off their masters’ wealth. In The Bahamas, where Jonkonnu is still performed and has become a lucrative tourist attraction, preparations for the Boxing Day and New Year’s Day parades begin up to six months in advance. Corporate sponsorship helps finance the high costs involved, with groups competing for the cash prizes awarded for best music, costume, choreography and choice of theme.

The etymology of “Jonkonnu” has been hotly debated since the early nineteenth century. Noting its kinship to Scottish Mummery, some commentators suggested that the label referred to the use of recycled costumes described as junk enoo (junk enough) in Scots dialect. Others speculated that the use of masks had occasioned the French label gens l’inconnu (trans. unknown people), although this seems improbable, since Jonkonnu originated in the British, rather than French colonies. Perhaps the most romantic, if also attractive, theory is that Jonkonnu pays homage to Jon Konny, the Gold Coast tribal chief who, in 1717, took command of the Brandenburg African Company’s trading fort and, for seven years, successfully prevented the Dutch from taking possession.

Isaac Belisario’s lithograph of ‘Jaw-Bone, or House John-Canoe’ (1837) is the best-known visual record of a nineteenth-century Jonkonnu performer. The dancer wears a militarized costume and a disproportionately large – if not quite “ludicrous” – headdress representing a multi-storied plantation house. In a slave society such as Jamaica, a black dancer in a white mask carrying a model plantation house on his head conveyed a powerful message: at his mercy, the system could topple. The Prospectus suggests that “Mr. Hawtin” – the actor who first played Jonkanoo – also wore an elaborate head-dress, although we do not know what shape this took, while in Murray’s melodrama, Quashee notably instructs the other slaves to “run and tell merry Jonkanoo to get him big head on, and all dansa, dansa, like mad”.

But if topicality opened up the potential for new readings, it also threatened foreclosure; in order to reap commercial success, Fawcett needed to avoid partisanship and keep in line with dramatic censorship laws.

Verisimilitude was, however, unlikely to have been a genuine aim of either the pantomime or melodrama versions of Obi. When Obi premiered in in 1800, the violent slave revolution in Saint Domingue was still underway. Armed rebellion in the French colony lasted from 1791 to 1804, resulting in the abolition of slavery, an end to French rule, and the establishment of the modern state of Haiti as an independent black republic. The revolution in Saint Domingue would have radically inflected Obi’s theme of marronage (escaping slavery) and the subversive energies embodied by its investment in the Jonkonnu tradition. But if topicality opened up the potential for new readings, it also threatened foreclosure; in order to reap commercial success, Fawcett needed to avoid partisanship and keep in line with dramatic censorship laws.

Obi’s production and reception histories are limited by what the Haitian historian Michel-Rolph Trouillot describes as the silences of the archive. The play’s first reviewers have left no explicit commentary on the impressions made by Jonkanoo; the published pantomime text is only skeletal; while descriptions of the Jamaican Jonkonnu tradition are determined by what the white population saw, felt, and ventured to know. But if the effects and affect exerted by Jonkanoo on stage are thus difficult to confidently ascertain, his dynamic presence is importantly – and pressingly – still within our ability to scope.

Featured image credit: ‘Plate III, Negres au Travail’. CC BY 4.0 via Wellcome Collection.

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World antibiotic awareness: are we doing enough?

Microorganisms resistant to treatment pose as one of the biggest threats to global healthcare and have been identified to be present globally. This current healthcare crisis is more generally known as antimicrobial resistance (AMR), and refers to the ability of bacteria, viruses or parasites to stop an antimicrobial (antibiotics, antivirals and antimalarials) from working. If untreated, AMR could be responsible for ten million deaths per year by 2050.

As well as threatening the welfare of the population, and increasing the spread of disease, AMR can have a dramatic effect on the country’s GDP. When bacteria are resistant and a disease can’t be treated by first-line antibiotics, more expensive medicines must be used. This increases healthcare costs across sectors and increases economic pressure. In the UK alone, infections as a result of drug-resistant bacteria currently cost the NHS £180 million a year. This figure is only set to rise if actions and plans to slow resistance and increase awareness are not put into practice.

Without treatment guidelines, antibiotics tend to be both over-prescribed and overused by health workers and vets, especially in those countries which may not have access to the latest recommendations. Antibiotics are only effective against bacterial infections, and prescribing for viral infections further adds to the overprescribing dilemma.

When prescribed, patients not finishing their treatment further add to the problem and expose the bacteria to lower concentration levels of antibiotics. With this not all bacteria are killed, and eventually, an entire resistant bacterial population evolves. These bacteria then do not respond to treatment with conventional antibiotics and resistant diseases, such as MRSA and C.difficile emerge. With constant urbanisation, especially in lower income countries, coupled with a lack of hygiene and inadequate sanitation, diseases spread more easily through the densely populated area.

Image credit: People City Poor by Sanshiro. CC0 via Pixabay.

In countries where there are no sale restrictions i.e. no required prescription needed for animal or human use, there tend to be higher levels of resistance. In developing countries, the sale of counterfeit medicines on the black market is a main contributor to the problem. The World Health Organization (WHO) estimates one in ten drug products in low and middle-income countries are either substandard or falsified, with regards to the active ingredient. These medicines aren’t as effective as legitimate products and so surviving bacteria are able to build up resistance to these as well as the authentic drugs. According to an analysis by the WHO, these regions are less likely to have national regulatory standards or the ability to enforce them effectively.

You might be thinking ‘why can’t we make more drugs?’ The problem is that big pharma companies don’t get the returns they want manufacturing antimicrobial drugs than they would do for other therapeutic areas, such as cancer treatments. As a result, the antibiotic pipeline stream is rapidly drying up, with less than ten big pharmaceutical companies still investing in research and development of this drug class. With resistance growing and the opportunities to combat associated diseases shrinking – what are we currently doing and is it enough?

The WHO Global Action Plan on Antimicrobial Resistance outlines five key objectives:

– To improve awareness and understanding of antimicrobial resistance

– To strengthen surveillance and research

– To reduce the incidence of infection

– To optimize the use of antimicrobial medicines

– To ensure sustainable investment in countering antimicrobial resistance

This plan calls for a coordinated global approach to tackling antibiotic resistance, across sectors such as human and animal health as well as agriculture. Whilst the challenge against antibiotic resistance is extensively recognized, many countries do not have the policies in place to confront the problem. Stakeholders and policymakers need to ensure a robust national plan is in place and as well as improving surveillance of these infections and implementing policies, it is equally important to educate on the proper use of antibiotics. Whilst primarily a prevention strategy, educating the public on the consequences of improper use should also be seen as a high priority – so everyone understands the importance of the matter.

The UK government objective to reduce inappropriate prescription of antibiotics by half in 2020 is underway and with two years left to go, progress has been made. Since implementation of the current strategy in 2013, the use of antibiotics has decreased by 2% in humans and by 10% for animals. Elsewhere in Europe, a north-south gradient has been observed with lower levels of resistance in Scandinavian countries, compared to higher rates in Southern Europe. However, generally, most countries have policies in place and levels of public awareness around AMR are relatively high.

The level of priority in the United States is similar to that of the UK. Again, it is not just the citizen’s health that is affected. In 2008, the United States lost approximately $35 billion as a result of hospital stays, premature deaths and sick pay due to antibiotic-resistant infections. Extensive national strategy plans are in place from the Centers for Disease Control and Prevention at all levels of society from public awareness to healthcare practitioners. In order to address the lack of drugs themselves, The Generating Antibiotics Incentive Now Act was meant to incentivise the development of new antibiotics by fast-tracking approval and guaranteeing market exclusivity. As of last year, less than ten drugs have triumphed via this route, and so this serves as a perfect example that tackling AMR is not as easy as it sounds.

Image credit: Partnership for Transition in Côte d’Ivoire by EU Civil Protection and Humanitarian Aid Operations. CC BY-ND 2.0 via Flickr.

With the largest country population, accounting for nearly 20% of the global figure, China has a higher responsibility than most in fighting antibiotic resistance. Health officials have recognized this and in the last ten years, considerable time and money have been invested into the development of suitable strategies. The barrier lies within the complicated structure of the Chinese healthcare system and the recent transition to a market economy. There are huge incentives for healthcare providers to prescribe more expensive drugs, due to the decrease in government subsidies and the need to create their own revenue. As a result, many policies target doctors and health facilities themselves and the privilege for some hospitals to mark-up drug prices has now been revoked.

In other regions, implementation of strategies and plans against AMR are a lot less promising, and in 2017 it was reported that just two out of 47 African countries had an active plan. This is of huge concern, as antibiotics are one of the most commonly prescribed medicines on the continent. Over 30% of the African population is able to access antibiotics without a prescription, and of these, 25% obtained them from unauthorized sources. Ghana is the country flying the flag and leading by example, with the most robust plan compared to its neighbours. Launched only earlier this year, a few years behind the WHO plan; it is still too early to evaluate the success of the five-year plan, however, you could argue any strategy is a good strategy.

The framework is mostly there, and if not, the resources to build framework certainly are. However, the importance of the strategy is only fully showcased when put into action; when rates of antibiotic-resistant diseases fall, countries maintain their capital and welfare, and the population is fully aware of just how much of a threat AMR is.

Featured image credit: Headache Pain Pills by stevepb. CC0 via Pixabay .

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Remaking Europe after the First World War

In the wake of the November 11, 1918 armistice between Germany and the Allies, high-minded idealism confronted a mélange of very unpleasant realities. All the belligerents had claimed to be fighting for a noble set of aims, and the United States President, Woodrow Wilson, went further. He proposed the creation of a supranational agency, the League of Nations, to govern international relations in a pacific age of transparent, altruistic diplomacy.

The peace settlement, Wilson anticipated, would incorporate these universal values, which encapsulated the moral rectitude of the Allied coalition. Meanwhile, for the defeated Central Powers, Wilson’s vision appeared to betoken a moderate, even visionary, peace. However, given the scale of the slaughter, endured at ruinous expense, it was never going to be so easy. Added to which, propaganda on both sides had excoriated the enemy as perfidious, even demonic. This fueled popular demand for vengeance and reparation on the Allied side, but simultaneously persuaded the defeated Germans that their country was not deserving of punishment. Any German government that admitted otherwise risked being branded treasonous and would always struggle to gain parliamentary approval for compliance with the peace terms.

As for the peace treaties, those with Germany’s allies were hastily drafted as afterthoughts to the German treaty and resulted in Hungary and Austria losing swathes of Magyar and German-speaking territory. These losses were bitterly resented. In Turkey’s case the treaty was overthrown by force of arms. However, the key treaty, Versailles, was with Germany. Unfortunately, but probably unavoidably, this settlement amounted to a brittle compromise, hard fought behind closed doors, between the major Allies; a process which perforce excluded Germany from the negotiating table, yet also left France particularly dissatisfied. Of all the Allies, France had made the greatest sacrifice yet it remained vulnerable to a future German military revival. But the same treaty came as a profound shock to the Germans, for rather than gaining admission to a benign new international order, they were abruptly confronted with the harsh reality of defeat.

Versailles, then, has sometimes been branded as a ceasefire that barely endured for two decades rather than offering any realistic prospect of a durable peace. That the US Congress refused to ratify the settlement did it few favours. However, some historians have been more forgiving, arguing that given the circumstances, Versailles was a reasonable achievement. Enforcement, they continue, was the key, but in the face of German recalcitrance and Allied bickering, enforcement was found sorely wanting.

However, perspectives change if Franco-German relations are placed at the heart of the story. As the German Ambassador at Paris, Leopold von Hoesch, put it in June 1930:

What does Germany mean to London, Rome, or Washington? A great power among several great powers, alongside many other important issues and interests. What does Germany mean to France? The focal point of French policy, against which all other issues play second fiddle. It does not appear very different from a German point of view when it comes to ranking the French problem.
The fundamental synergies of this key relationship were arguably so deep-seated that not even twelve years of Hitlerism could destroy it. On the contrary, since the Second World War we have witnessed the creation and cementing of the Franco-German axis, which has served as the cornerstone of European integration and a stable and essentially peaceful European order.

This special relationship, where vital national interests are pursued through a process of transnational collaboration, was founded on deep-seated synergies between the French and German economies, with particular focus on the two countries’ heavy industrial sectors (coal and steel) and, from the mid-1920s, on France’s increasing financial strength. French capital offered to kick start Germany’s potentially powerful, but chronically undercapitalised economy. French and German policymakers and businessmen also began to question the inherent viability of freestanding national economies. Only a more integrated European economy would be capable of competing with the continental giants of the USA and, potentially, the Soviet Union.

In May 1930 the French Foreign Minister, Aristide Briand, submitted plans to the League of Nations for a European Union, which attracted qualified German support. In September 1931 Franco-German collaboration took a major step forward when the two countries signed the Berlin Agreement. This provided for a bilateral customs union and wider economic integration, eventually to be extended across the continent. Post-war historians and politicians were slow to recognise the importance of this template for contemporary European integration, not least because these inter-war initiatives failed. The political and economic traumas of the Great Depression proved stronger than the efforts to respond positively to the challenges of the day. And in sharp contrast to the post-1945 era, the USA held aloof and looked to its own interests, while the British were at best uncomprehending and obstructive. As the French (Belgian-born) economist and senior League of Nations official Daniel Serruys complained, it was “so difficult to talk with British officials: many of them did not seem to understand the continental theory or talk the continental language.”

However, the legacy of the 1918 Armistice, of the Versailles Treaty, and of inter-war diplomacy clearly amounted to much more than Hitler and another war. The post-1945 planners did look back to the inter-war era for negative and positive lessons, and many had participated as younger men in the more visionary of inter-war efforts to build constructively and imaginatively on Versailles. And if few of the more senior inter-war advocates of European union survived to witness the fall of Hitler, those that did, surely, celebrated post-1945 events as the realisation of their own ambitions.

Feature image credit: “Through the Poppy Fields” by Marten Bjork via Unsplash.

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Russian disinformation – How worried should we be?

The Russian government’s use of disinformation, i.e. intentionally misleading content, has raised serious concern not only among Russia’s neighbors, but also in Western nations more broadly. Responses to the perceived threat range from attempts to monitor the disinformation, to U.S. court’s legal indictment of Russian individuals and companies.

How serious is the threat of Russian disinformation towards Western societies?

The Kremlin’s denial of its military involvement in Crimea offers a classical example of the potential dangers behind well-orchestrated disinformation campaigns. The relation between Ukraine and Russia has reached a new low after the violent clashes between pro-Western Euromaidan protestors and the police. As a result of this, the country’s president at that time, Viktor Yanukovich, fled to Russia in February 2014 before he was formally removed from his position by the parliament. Shortly thereafter, a group of Crimeans went on the streets to protest against new pro-Western government in Kiev. The protests evolved into something much more volatile: Unidentified soldiers began seizing the Supreme Council of Crimea, capturing important infrastructure and surrounding Ukrainian army bases.

The Russian federation denied any connection to the soldiers, claiming that they were local rebels. The seized parliament in Crimea issued a referendum. Allegedly, this resulted in a 96.77% vote (with a 83.1% voter turnout) in the Autonomous Republic of Crimea to join the Russian federation, according to the occupational authorities. Within just 4 weeks and with almost no shots fired, Russia succeeded in capturing a part of Ukraine’s territory.

We know now that the soldiers were Russian, because Vladimir Putin himself later admitted that Russia carried out the military operation in Crimea. At that time, however, the disinformation campaign may have created a fog of confusion. Was Ukraine at war and if yes, with whom? Should the rest of the world confront Russia? The overwhelmed Ukrainian forces decided to withdraw from Crimea.

The wave of pro-Kremlin disinformation struck Crimea through Russian government-controlled TV channels – television being the main source of information in both Ukraine and Russia. However, the disinformation campaign also unfolded on social media through false news and fake accounts that amplified the narratives that benefitted the Russian government. The wave of disinformation arguably created a fog of confusion at a critical moment as to whether Ukraine was at war or with whom. The use of disinformation in Ukraine would foreshadow the current fear that Russia would use of social media to manipulate with the Western audience.

Many commentators have pointed to the Russian government’s meddling in the 2016 U.S. election to argue that Kremlin is capable of affecting U.S. elections through propaganda and disinformation campaigns combined with cyber-attacks. These arguments often emphasize the recent revelations, where tech-giants admitted that the Russian Internet Agency, popularly known as the “troll factory”, succeeded in flooding the platforms with fake accounts.

For example, Twitter has revealed that the Russian agency received engagement from at least 1.4 million individuals in U.S. – either through likes, shares, replies, or comments. Similarly, the agency has covertly uploaded content that reached the news feeds of 126 million users in the U.S. according to Facebook.

Often, these fake profiles posed as concerned Americans, NGO’s or news outlets. The Russian agency exploited already existing news about socially divisive issues such as race, gun control or LGBT rights. By doing so, the accounts attempted to fuel the political clashes online or to mobilize protestors onto the streets.

These revelations suggest that the Russian agency is not just willing, but also capable of reaching a relatively large proportion of the U.S. audience. However, one must keep two things in mind when interpreting the findings: 1) the scope of the Russian campaign in relative terms and 2) the distinction between exposure to Russian content and its effect.

The numbers presented by the tech firms, if we assume that they are true, still represent only a small proportion of the vast volume of online content that is generated on a daily basis. Not all of the users may have actively seen, not to say remembered, the manipulative information in their feed.

According to Facebook’s General Counsel, 11.4 million users may have seen the Russian Internet Research Agency’s fake ads in their news feed between 2015 and 2017. While the number seems large, it accounts for only 0.004% of the content in the users’ total news feed during the same period. One must note that the full reach of the campaign was higher, since users also shared and discussed the content with their friends. However, even if one multiplies the number above by 100, the agency’s content remains a drop in the vast sea of information. The fact that Russia could covertly reach 126 million Facebook users with manipulative content is highly worrisome. However, these numbers should be seen in relative terms.

Similarly, our new study on disinformation about the downing of Malaysia Airlines Flight 17 in 2014, written by Mareike Hartmann, Rebecca Adler-Nissen and myself, puts disinformation in a broader perspective. We find that for each English-language tweet that supports the pro-Kremlin narratives about who shot down the civilian airplane, killing all passengers on board, there are approximately two tweets that directly challenge these narratives. The wave of counter disinformation is largely driven by journalists and civil society groups. In short, it is too early to say that Russia has won the global struggle for truth.

Lastly, it is important to remember that exposure to disinformation or fake accounts does not mean that the content has an effect on the audience’s political attitudes or behavior. Western societies are concerned with Russia’s influence on electoral outcomes. However, numerous communication studies provide a more nuanced view: Changing people’s voting behavior is very difficult. A recent meta-study of existing research indicates that the best estimate of the effect of political advertisement on US Americans’ political candidate preferences is zero. The studies that do show an effect often emphasize that the effect size is small. However, there are currently few studies that specifically examine the effect of Russian state-sponsored content on the American audience.

This does not mean that Russia’s information campaigns cannot further entrench already existing polarization in many Western societies or influence the political agendas during elections. That fact that governments around the world – not only Russia – are willing to invest resources in covert propaganda campaigns highlights the importance of the issue. State and non-state actors alike may succeed in deceiving the public and damaging our trust in key societal institutions.

Indeed, the Ukrainian experience stands as a stark reminder that disinformation campaigns must be taken seriously and understood properly. However, the debate on Russian online influence in countries such as U.S. is likely to exaggerate its effects.

Western societies need a well-informed and sober understanding of state-orchestrated disinformation campaigns if we are to address the issues at hand. Such an understanding requires more research on online disinformation and its effects.

Featured image credit: Person typing on computer keyboard by Soumil Kumar. CC0 Public Domain via Pexels.

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Remembering the final moments of The Great War [excerpt]

11 November 2018 marks 100 years since the end of The Great War. Victory came at a great cost, seeing millions of fatalities in one of the deadliest wars in history.

In the below excerpt from The Last Battle, World War I historian Peter Hart shares testimonies about the war’s end from the men who fought until the eleventh hour.

That morning, the 2/15th London Regiment was released from the haunting prospect of an assault over the River Scheldt at Avelghem.

When this bloody war is over / Oh, how happy I shall be / When I get my civvie clothes on / No more soldiering for me.

We never sang the above ditty joyously, because so far as we could see the war was never going to end. It was sung only on those occasions when, as a small carrying party for example, we waited at some dreary ration dump to collect rations and take them up the line, or, after having drunk more than enough vin blanc, we sat in some estaminet feeling doleful. And now, to our great surprise and joy, it was ‘Après la Guerre’. —Corporal Charles Hennessey, 2/15th (Civil Service Rifl es), London Regiment, 90th Brigade, 36th Division

The army was not a uniform body of automatons. Hidden behind the khaki was a wide variety of personalities – all responding to peace in dissimilar ways – much as men had responded differently to the challenges of war. In a few moments, everything had changed.

It was a strange feeling to ride back to the battery in the quiet that followed 11 o’clock. One had got used to the background noise of shellfire. Near the front it seemed a continuous orchestration of deep and echoing sound, punctuated by the sharper rat-tattat of rifle or machine-gun fire. The landscape was different: no observation balloons to be seen, no plumes of smoke from the shell bursts or burning buildings, no aeroplanes glinting in the sky. Peace seemed a very strange and new experience. —Major Richard Foot, ‘D’ Battery, 310th Brigade, Royal Field Artillery, 62nd Division

Men of U. 64th Regiment, 7th Infantry Division, celebrate the news of the Armistice, November 11, 1918. Image credit: “US 64th regiment celebrate the Armistice” provided by the U.S. National Archive. Public domain via Wikimedia Commons.

They had become accustomed to the roar of the guns, the rumble of transport wheels, the bellowed orders and the crunch of marching feet.

That quiet – that quietness – we couldn’t get used to it. We’d been deafened by gunfire for years! We were never without the sound of gunfire; either in your sector, the next sector, or somewhere within ear range! Suddenly all was quiet! We wanted to talk in whispers as if we were in church or something. —Private Donald Hodge, 7th Royal West Kent Regiment, 55th Brigade, 18th Division

Many could hardly believe it. Their lives had been shaped by the war. Every day, every action, every thought was dominated by the requirement to somehow survive while carrying out their duties beneath the looming spectre of death. Then suddenly that shadow was lifted.

Nobody would believe it. The war couldn’t be over. It had been on for years. It was so unreal, we had got into the habit of feeling, ‘Oh well, I suppose sometime this show will end!’ But we still didn’t see the end in sight at all. We thought, ‘Well, my godfather! The war’s over!’ Eventually of course it sunk in. Then naturally we thought, ‘Oh, where do we go from here?’ Just that sort of feeling that we’d been sacked, we’d been kicked out of a job. A terribly empty feeling. —Captain George Jameson, C Battery, 72nd Brigade, Royal Field Artillery

Many accounts refer to a strange emptiness caused by the removal of war from their mental landscape. In consequence, with some units there was no discernible excitement when the news came through. This phlegmatic approach was partially a public demonstration of the legendary British ‘stiff-upper lip’, but it was also deep-rooted in the stultifying effect of entrenched war-weariness. Many men required to control their innermost feelings in battle had become emotionally desensitised. The Armistice was too big an event, just too important for them to properly process what was happening to them. They no longer had the emotional vocabulary to respond appropriately.

We were too far gone, too exhausted really, to enjoy it. All we could do was just go back to our billets; there was no cheering, no singing, we had no alcohol at all. We simply celebrated the Armistice in silence and thankfulness that it was all over. It was such a sense of anti-climax. We were drained of all emotion. —Corporal Clifford Lane, 2nd Bedfordshire Regiment, 54th Brigade, 18th Division

Yet, for all that, many units responded with a riotous sense of release, once, that is, they had escaped the vigilant gaze of their offi cers. Private Norman Cliff soon found that even the Guards could be tempted to displays of excitement.

I rushed back to the billet and amid a din of riotous cheering seized my rifl e, equipment and all my belongings and flung the whole lot in the air. Others followed suit. A kind of frenzied madness seized us and we were no longer responsible for our antics and foolery. All the frustration, resentment, exasperation, sorrow, hope and despair had been bottled up for long harrowing years. Sudden relief was bound to cause an explosion. As suddenly, quietness returned. Feelings welled up that were too deep for expression. A dumbness fell upon us, and a solemn thoughtful mood took over; but not for long. Our excitement could not be contained. I had renounced everything to become Guardsman Cliff ‘for the duration of the war’. The war was over. I was ‘Civilian Cliff’ again. —Private Norman Cliff, 1st Grenadier Guards, 3rd Brigade, Guards Division.

Featured image credit: “The announcing of the armistice on November 11, 1918, was the occasion for a monster celebration in Philadelphia… – NARA – 533478” provided by the U.S. National Archives and Records Administration. Public domain via Wikimedia Commons .

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