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<title>18 October, 2023</title>
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<title>Covid-19 Sentry</title><meta content="width=device-width, initial-scale=1.0" name="viewport"/><link href="styles/simple.css" rel="stylesheet"/><link href="../styles/simple.css" rel="stylesheet"/><link href="https://unpkg.com/aos@2.3.1/dist/aos.css" rel="stylesheet"/><script src="https://unpkg.com/aos@2.3.1/dist/aos.js"></script></head>
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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>Forecasting regional-level COVID-19 hospitalisation in England as an ordinal variable using the machine learning method</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background COVID-19 causes substantial pressure on healthcare, with many healthcare systems now needing to prepare for and mitigate the consequences of surges in demand caused by multiple overlapping waves of infections. Therefore, public health agencies and health system managers also now benefit from short-term forecasts for respiratory infections that allow them to manage services better. However, the availability of easily implemented effective tools for generating precise forecasts at the individual regional level still needs to be improved. Methods We extended prior work on influenza to forecast regional COVID-19 hospitalisations in England for the period from 19th March 2020 to 31st December 2022, treating the number of hospital admissions in each region as an ordinal variable. We further developed the XGBoost model used previously to forecast influenza to enable it to exploit the ordering information in ordinal hospital admission levels. We incorporated different types of data as predictors: epidemiological data including weekly region COVID-19 cases and hospital admissions, weather conditions and mobility data for multiple categories of locations (e.g., parks, workplaces, etc). The impact of different discretisation methods and the number of ordinal levels was also considered. Results We find that the inclusion of weather data consistently increases the accuracy of our forecasts compared with models that rely only on the intrinsic epidemiological data, but only by a small amount. Mobility data brings about a more substantial increase in our forecasts. When both weather and mobility data are used in addition to the epidemiological data, the results are very similar to the model with only epidemiological data and mobility data. Conclusion Accurate ordinal forecasts of COVID-19 hospitalisations can be obtained using XGBoost and mobility data. While uniform ordinal levels show higher apparent accuracy, we recommend N-tile ordinal levels which contain far richer information.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.17.23297138v1" target="_blank">Forecasting regional-level COVID-19 hospitalisation in England as an ordinal variable using the machine learning method</a>
</div></li>
<li><strong>Socioeconomic inequalities in COVID-19 infection and vaccine uptake among children and adolescents in Catalonia, Spain</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
IMPORTANCE The relationship between socioeconomic deprivation and COVID-19 infection and vaccination among children and adolescents remains unclear. OBJECTIVE To investigate the association between deprivation and COVID-19 vaccine uptake and infection among children and adolescents before and after the vaccination rollout in Catalonia, Spain. DESIGN AND SETTING Population-based cohort study using primary care electronic health records from the Information System for Research in Primary Care. Individuals were followed 3 months before the start of the vaccination campaign in Spain and 3 months after the vaccination rollout among adolescents and children. PARTICIPANTS Children (5-11 years) and adolescents (12-15 years) with at least 1 year of prior history observation available and without missing deprivation data. EXPOSURE Deprivation, assessed using an ecological socioeconomic deprivation index (SDI) score for census tract urban areas and categorized into quintiles. MAIN OUTCOMES AND MEASURES COVID-19 infection and COVID-19 vaccination. For each outcome, we calculated cumulative incidence and crude Cox proportional-hazard models by SDI quintiles, and estimated hazard ratios (HRs) of COVID-19 infection and vaccine uptake relative to the least deprived quintile, Q1. RESULTS Before COVID-19 vaccination rollout, 290,625 children and 179,685 adolescents were analyzed. Increased HR of deprivation was associated with a higher risk of COVID-19 infection in both children (Q5: 1.55 [95% CI, 1.47 - 1.63]) and adolescents (Q5: 1.36 [95% CI, 1.29 - 1.43]). After the rollout, this pattern changed among children, with lower risk of infection in more deprived areas (Q5: 0.62 [95% CI, 0.61 - 0.64]). Vaccine uptake was higher among adolescents (72.6%) than children (44.8%), but in both age groups, non-vaccination was more common among those living in more deprived areas (39.3% and 74.6% in Q1 vs. 26.5% and 66.9% in Q5 among children and adolescents, respectively). CONCLUSIONS AND RELEVANCE In this cohort study, children and adolescents living in deprived areas were at higher risk of COVID-19 non-vaccination. Socioeconomic disparities in COVID-19 infection were also evident before vaccine rollout, with a higher infection risk in deprived areas across age groups. Our findings suggest that changes in the association between deprivation and infections among children after the vaccine rollout were likely due to testing disparities.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.17.23297134v1" target="_blank">Socioeconomic inequalities in COVID-19 infection and vaccine uptake among children and adolescents in Catalonia, Spain</a>
</div></li>
<li><strong>Addressing Label Noise for Electronic Health Records: Insights from Computer Vision for Tabular Data</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The analysis of extensive electronic health records (EHR) datasets often calls for automated solutions, with machine learning (ML) techniques, including deep learning (DL), taking a lead role. One common task involves categorizing EHR data into predefined groups. However, the vulnerability of EHRs to noise and errors stemming from data collection processes, as well as potential human labeling errors, poses a significant risk. This risk is particularly prominent during the training of DL models, where the possibility of overfitting to noisy labels can have serious repercussions in healthcare. Despite the well-documented existence of label noise in EHR data, few studies have tackled this challenge within the EHR domain. Our work addresses this gap by adapting computer vision (CV) algorithms to mitigate the impact of label noise in DL models trained on EHR data. Notably, it remains uncertain whether CV methods, when applied to the EHR domain, will prove effective, given the substantial divergence between the two domains. We present empirical evidence demonstrating that these methods, whether used individually or in combination, can substantially enhance model performance when applied to EHR data, especially in the presence of noisy/incorrect labels. We validate our methods and underscore their practical utility in real-world EHR data, specifically in the context of COVID-19 diagnosis. Our study highlights the effectiveness of CV methods in the EHR domain, making a valuable contribution to the advancement of healthcare analytics and research.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.17.23297136v1" target="_blank">Addressing Label Noise for Electronic Health Records: Insights from Computer Vision for Tabular Data</a>
</div></li>
<li><strong>Neutrophilia with damage to the blood-brain barrier and neurovascular unit following acute lung injury</strong> -
<div>
Background: Links between acute lung injury (ALI), infectious disease, and neurological outcomes have been frequently discussed over the past few years, especially due to the COVID-19 pandemic. Yet, much of the cross-communication between organs, particularly the lung and the brain, has been understudied. Here, we have focused on the role of neutrophils in driving changes to the brain endothelium with ensuing microglial activation and neuronal loss in a model of ALI. Methods: We have applied a three-dose paradigm of 10g/40l intranasal lipopolysaccharide (LPS) to induce neutrophilia accompanied by proteinaceous exudate in bronchoalveolar lavage fluid (BALF) in adult C57BL/6 mice. Brain endothelial markers, microglial activation, and neuronal cytoarchitecture were evaluated 24hr after the last intranasal dose of LPS or saline. C57BL/6-Ly6g(tm2621(Cre-tdTomato)Arte (Catchup mice) were used to measure neutrophil and blood-brain barrier permeability following LPS exposure with intravital 2-photon imaging. Results: Three doses of intranasal LPS induced robust neutrophilia accompanied by proteinaceous exudate in BALF. ALI triggered central nervous system pathology as highlighted by robust activation of the cerebrovascular endothelium (VCAM1, CD31), accumulation of plasma protein (fibrinogen), microglial activation (IBA1, CD68), and decreased expression of proteins associated with postsynaptic terminals (PSD-95) in the hippocampal stratum lacunosum moleculare, a relay station between the entorhinal cortex and CA1 of the hippocampus. 2-photon imaging of Catchup mice revealed neutrophil homing to the cerebral endothelium in the blood-brain barrier and neutrophil extravasation from cerebral vasculature 24hr after the last intranasal treatment. Conclusions: Overall, these data demonstrate ensuing brain pathology resulting from ALI, highlighting a key role for neutrophils in driving brain endothelial changes and subsequent neuroinflammation. This paradigm may have a considerable translational impact on understanding how infectious disease with ALI can lead to neurodegeneration, particularly in the elderly.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.16.562508v1" target="_blank">Neutrophilia with damage to the blood-brain barrier and neurovascular unit following acute lung injury</a>
</div></li>
<li><strong>Dual Ethanolamine Head Groups in Ionizable Lipids Facilitate Phospholipid-free Stable Nanoparticle Formulation for Augmented and Safer mRNA Delivery</strong> -
<div>
The accelerated advent of mRNA-based therapeutics and vaccines, highlighted by the battle against SARS-CoV-2, underscores the urgency to refine lipid nanoparticles (LNPs) for efficient mRNA delivery. In this work, we introduce a novel series of ionizable lipids characterized by double ethanolamine head groups, significantly amplifying mRNA binding affinity. A succinct three-component formulation is subsequently delineated, obviating the conventional dependency on phospholipids inherent in traditional four-component LNPs. Intriguingly, this formulation enables particle formation under neutral pH conditions, a notable departure from the acidic milieu traditionally required, attributable to the enhanced nonionic interactions predominating in mRNA encapsulation. The resultant particles exhibit exceptional stability, superior mRNA encapsulation efficiency, and maintain robust delivery efficacy. When deployed as a vaccine platform, the formulation elicited pronounced humoral and T-cell immune responses, concurrently exhibiting a favorable toxicity profile with a reduced induction of pro-inflammatory cytokines such as IL-6. Our exploration suggests that by fine-tuning the non-electrostatic interactions between the ionizable lipid and mRNA, the dynamics of particle formation can be considerably divergent from the prevailing paradigms of mRNA-LNP formation, hinting at a broader horizon for lipid optimization within the realm of mRNA delivery systems.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.13.562139v1" target="_blank">Dual Ethanolamine Head Groups in Ionizable Lipids Facilitate Phospholipid-free Stable Nanoparticle Formulation for Augmented and Safer mRNA Delivery</a>
</div></li>
<li><strong>Psychological resilience factors and their association with weekly stressor reactivity during the COVID-19 outbreak in Europe</strong> -
<div>
Recently, cross-sectional relationships between psycho-social resilience factors (RFs) and resilience, operationalized as an outcome of low reactivity of mental health to stressor exposure (low ‘stressor reactivity’) during the first wave of the COVID-19 pandemic, were reported. Extending these findings, we here examine prospective relationships and weekly dynamics between the same RFs and stressor reactivity in a longitudinal sample during the aftermath of the first wave in several European countries. Over five weeks of app-based assessments, participants weekly reported stressor exposure, mental health problems, RFs, and demographic data, in one of six different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558) and longitudinally (N=200), using mixed effects models and mediation analyses. RFs at baseline, including positive appraisal style, optimism, self-efficacy, perceived good stress recovery, and perceived social support, were negatively associated with stressor reactivity (SR) scores, not only cross-sectionally (baseline SR scores) but also prospectively (average SR scores across subsequent weeks). In both analyses, positive appraisal style mediated the effects of perceived social support on SR. In the analyses of weekly RF-SR dynamics, RFs positive appraisal (of stressors generally and specifically of the Corona crisis) and general self-efficacy were negatively associated with SR in a contemporaneous, but not lagged fashion. We identify psychological RFs which prospectively predict resilience and co-fluctuate with weekly stressor reactivity within individuals. The prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood-congruency or other temporal bias effects. We further confirm an important role for positive appraisal in resilience.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/f7sy3/" target="_blank">Psychological resilience factors and their association with weekly stressor reactivity during the COVID-19 outbreak in Europe</a>
</div></li>
<li><strong>Novel risk loci for COVID-19 hospitalization among admixed American populations</strong> -
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The genetic basis of severe COVID-19 has been thoroughly studied and many genetic risk factors shared between populations have been identified. However, reduced sample sizes from non-European groups have limited the discovery of population-specific common risk loci. In this second study nested in the SCOURGE consortium, we have conducted the largest GWAS meta-analysis for COVID-19 hospitalization in admixed Americans, comprising a total of 4,702 hospitalized cases recruited by SCOURGE and other seven participating studies in the COVID-19 Host Genetic Initiative. We identified four genome-wide significant associations, two of which constitute novel loci and first discovered in Latin-American populations (BAZ2B and DDIAS). A trans-ethnic meta-analysis revealed another novel cross-population risk locus in CREBBP. Finally, we assessed the performance of a cross-ancestry polygenic risk score in the SCOURGE admixed American cohort.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.08.11.23293871v2" target="_blank">Novel risk loci for COVID-19 hospitalization among admixed American populations</a>
</div></li>
<li><strong>Cross-sector collaboration reduces SARS-CoV-2 risk in deer</strong> -
<div>
One Health helps achieve optimal health outcomes for people, animals, plants, and their shared environments. We describe a multidisciplinary effort to better understand and mitigate SARS-CoV-2 spread in white-tailed deer across One Health sectors. We first framed the risk problem with three governance sectors that manage captive and wild deer and human public health. The framing included the objectives for each sector, interactions that facilitate human-to-deer and deer-to-deer transmission, and alternatives intended to reduce risk. We then developed a dynamic compartmental model that linked wild and captive deer herds and humans and simulated SARS-CoV-2 dynamics. For baseline conditions, we estimated that median SARS-CoV-2 prevalence in wild and captive herds varied between 0.03-0.07, incidence between 0.68-1.46, and probability of persistence between 0.64-0.97 across 120-day simulations. We then tested single-sector alternatives alone and in combination with other sector actions. We found that single sector alternatives varied in their ability to reduce transmission and that the best performing alternative required collaborative actions among wildlife management, agricultural management, and public health agencies.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.10.13.562192v1" target="_blank">Cross-sector collaboration reduces SARS-CoV-2 risk in deer</a>
</div></li>
<li><strong>Who Bought All the Toilet Paper? Conspiracy Theorists Are More Likely to Stockpile During the COVID-19 Pandemic</strong> -
<div>
The current COVID-19 pandemic has changed many people’s lives. Some people have responded to the rising of the pandemic by engaging in panic buying behaviors, a phenomenon that has not been well-understood in the past. People who believe in these conspiracies may experience a heightened sense of powerlessness and vulnerability. As a result, they may be particularly susceptible to palliatively and compensatorily engage in the panic buying behaviors (i.e., stockpiling). Supporting this idea, two studies using data from the U.K. (cross-sectional) and the U.S. (longitudinal) show that people who endorse COVID-19 conspiracy theories are more likely to engage in stockpiling behaviors in the past as well as in the future.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/z2g34/" target="_blank">Who Bought All the Toilet Paper? Conspiracy Theorists Are More Likely to Stockpile During the COVID-19 Pandemic</a>
</div></li>
<li><strong>Antecedents and consequences of COVID-19 conspiracy beliefs: a systematic review</strong> -
<div>
Belief in COVID-19 conspiracy theories can have severe consequences; it is therefore crucial to understand this phenomenon. We present a narrative synthesis of COVID-19 conspiracy belief research from 85 international articles, identified and appraised through a systematic review. We identify a number of significant antecedents of COVID-19 conspiracy beliefs (individual differences, personality traits, demographic variables, attitudes, thinking styles and biases, group identity, trust in authorities, and social media use) and their consequences (protective behaviours, self-centred and misguided behaviours such as hoarding and pseudoscientific health practices, vaccination intentions, mental health, and other negative social consequences such as discrimination and violence). We conclude that understanding both the antecedents and consequences of conspiracy beliefs is highly important to tackle them, whether in the COVID-19 pandemic or future threats, such as that of climate change.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/psyarxiv/u8yah/" target="_blank">Antecedents and consequences of COVID-19 conspiracy beliefs: a systematic review</a>
</div></li>
<li><strong>Fast, accurate ranking of engineered proteins by receptor binding propensity using structure modeling</strong> -
<div>
Deep learning-based methods for protein structure prediction have achieved unprecedented accuracy. However, the power of these tools to guide the engineering of protein-based therapeutics remains limited due to a gap between the ability to predict the structures of candidate proteins and the ability to assess which of those proteins are most likely to bind to a target receptor. Here we bridge this gap by introducing Automated Pairwise Peptide-Receptor AnalysIs for Screening Engineered proteins (APPRAISE), a method for predicting the receptor binding propensity of engineered proteins. After generating models of engineered proteins competing for binding to a target using an established structure-prediction tool such as AlphaFold-Multimer or ESMFold, APPRAISE performs a rapid (under 1 CPU second per model) scoring analysis that takes into account biophysical and geometrical constraints. As a proof-of-concept, we demonstrate that APPRAISE can accurately classify receptor-dependent vs. receptor-independent adeno-associated viral vectors and diverse classes of engineered proteins such as miniproteins targeting the SARS-CoV-2 spike, nanobodies targeting a G-protein-coupled receptor, and peptides that specifically bind to transferrin receptor or PD-L1. APPRAISE is accessible through a web-based notebook interface using Google Colaboratory (https://tiny.cc/APPRAISE). With its accuracy, interpretability, and generalizability, APPRAISE promises to expand the utility of protein structure prediction and accelerate protein engineering for biomedical applications.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.01.11.523680v2" target="_blank">Fast, accurate ranking of engineered proteins by receptor binding propensity using structure modeling</a>
</div></li>
<li><strong>The impact of self-isolation on psychological wellbeing and how to reduce it: a systematic review</strong> -
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Self-isolation is a public health measure used to prevent the spread of infection, and which can have an impact on the psychological wellbeing of those going through it. It is likely that self-isolation will be used to contain future outbreaks of infectious disease. We synthesised evidence on the impact of home self-isolation on psychological wellbeing of the general public during the COVID-19 pandemic. This systematic review was registered on PROSPERO (CRD42022378140). We searched Medline, PsycINFO, Web of Science, Embase, and grey literature (01 January 2020 to 13 December 2022). Our definition of wellbeing included adverse mental health outcomes and adaptive wellbeing. Studies that investigated isolation in managed facilities, children, and healthcare workers were excluded. We followed PRISMA and synthesis without meta-analysis (SWiM) guidelines. We extracted data on the impact of self-isolation on wellbeing, and factors associated with and interventions targeting wellbeing during self-isolation. We included 36 studies (most were cross sectional, two were longitudinal cohort studies, three assessed interventions, and five were qualitative). The mode quality rating was high-risk. Depressive and anxiety symptoms were most investigated. Evidence for an impact of self-isolation on wellbeing was often inconsistent in quantitative studies, although qualitative studies consistently reported a negative impact on wellbeing. However, people with pre-existing mental and physical health needs consistently reported increased symptoms of mental ill health during self-isolation. Studies reported modifiable stressors that have been reported in previous infectious disease contexts, such as inadequate support, poor coping strategies, inadequate and conflicting information, and the importance of regular contact from trusted healthcare professionals. However, interventions targeting psychological wellbeing were rare and evaluative studies of these had high or very high risk of bias. When implementing self-isolation directives, public health officials should prioritise support for more vulnerable individuals who have pre-existing mental or physical health needs, lack support, or who are facing significant life stressors. Clinicians can play a key role in identifying and supporting those most at risk. Focus should be directed toward interventions that address loneliness, worries, and misinformation, whilst monitoring and identifying individuals in need of additional support.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.16.23296895v1" target="_blank">The impact of self-isolation on psychological wellbeing and how to reduce it: a systematic review</a>
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<li><strong>Covid-19 Related Generalized Anxiety Disorder Among Health Care Workers In A Hospital In The Greater Accra Region</strong> -
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Background The emergence of Coronavirus disease 2019 (COVID-19) an infectious disease caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has caused a lot of harm to humanity. Healthcare workers who are the leading the charge in the fight against the virus can experience mental health challenges with anxiety being an important illness. Anxiety can become morbid quickly and ultimately affect function, hence the need to study its prevalence among HCWs, since they are a high-risk population. Studies across various regions worldwide reported elevated levels of anxiety amongst HCWs during the SARS, Ebola, and H1N1 pandemics. Nevertheless, Generalized Anxiety Disorder (GAD), an easily measured and ubiquitous member of the family of anxiety disorders has hardly been researched. However, new studies in Togo, China, India and Mexico have reported elevated levels of GAD in HCWs during the COVID-19 pandemic. Given the complexities surrounding mental health care in Ghana, and Africa as a whole it would be expedient to uncover the prevalence of GAD among HCWs during the pandemic. Hence, a study at Family Health Hospital will provide information about the prevalence of COVID-19 related GAD among Health care workers representative of Ghana. Aim The aim of this study was to establish the prevalence of COVID-19 related GAD amongst healthcare workers, in a tertiary hospital in Accra. Methods A descriptive cross-sectional study design using a self-administered questionnaire was employed. Nine-two (92) HCWs in the study area were sampled. A consecutive sampling technique was used to select the respondents for the study. The study was analyzed using SPSS version 25. The results were presented in summary tables and analyzed using frequencies and percentages. Chi square test performed on categorical data to test association between selected variables and their outcome with COVID-19 related GAD. Results The GAD level among nurses was 55.4%, and for doctors it was 30.4%. The GAD level among medical laboratory technicians and pharmacists were 7.6% and 6.5% respectively. Furthermore being age 50-69 years was a significant risk factor for developing GAD during the COVID-19 pandemic in Ghana. Female HCWs were more likely to experience GAD. However, only 13.1% of the HCWs were considered to have Corona phobia. Perception of workplace as being high risk was positively correlated with mild to moderate forms of anxiety. However, perception of organizational support as being guaranteed in case one succumbed to the virus and confidence in PPE availability was not reported to be strong protective factors against GAD among HCWs. Conclusion COVID-19 related GAD is a challenge amongst HCWs especially nurses in FHH. The management of the FHH should set up certain services such as psychological help lines, peer support programs as well as run a sensitization campaign to cater for the wellbeing of doctors as well as encourage mental health seeking behavior.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.16.23297097v1" target="_blank">Covid-19 Related Generalized Anxiety Disorder Among Health Care Workers In A Hospital In The Greater Accra Region</a>
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<li><strong>The landscape of biomedical research</strong> -
<div>
The number of publications in biomedicine and life sciences has rapidly grown over the last decades, with over 1.5 million papers now being published every year. This makes it difficult to keep track of new scientific works and to have an overview of the evolution of the field as a whole. Here we present a 2D map of the entire corpus of biomedical literature, and argue that it provides a unique and useful overview of the life sciences research. We based our atlas on the abstract texts of 21 million English articles from the PubMed database. To embed the abstracts into 2D, we used the large language model PubMedBERT, combined with t-SNE tailored to handle samples of our size. We used our atlas to study the emergence of the Covid-19 literature, the evolution of the neuroscience discipline, the uptake of machine learning, the distribution of gender imbalance in academic authorship, and the distribution of retracted paper mill articles. Furthermore, we present an interactive web version of our atlas that allows easy exploration and will enable further insights and facilitate future research.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.04.10.536208v3" target="_blank">The landscape of biomedical research</a>
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<li><strong>Trends in Nationally Notifiable Infectious Diseases in Humans and Animals During the COVID-19 Pandemic in South Korea</strong> -
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Non-pharmaceutical interventions (NPIs) were implemented to cope with the coronavirus disease 2019 (COVID-19) pandemic in South Korea. These interventions could also have affected other infectious diseases, but there have been no comprehensive studies regarding their impacts. This study examined trends in notifiable infectious diseases in both humans and animals during the COVID-19 pandemic. Autoregressive integrated moving average (ARIMA) models were developed for each disease using data from 2016 to 2019, and the incidences for 2020 to 2021 were predicted. Subsequently, the predicted numbers of cases were compared with actual observations. Our findings indicated a substantial reduction in human respiratory infectious diseases during implementation of NPIs. However, human gastrointestinal infectious diseases and livestock diseases did not show a significant decrease. The results revealed that the preventive effect sizes of NPIs varied among diseases and indicated the potential for side effects, suggesting that complementary interventions are needed to minimize these negative effects.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.10.16.23297064v1" target="_blank">Trends in Nationally Notifiable Infectious Diseases in Humans and Animals During the COVID-19 Pandemic in South Korea</a>
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<h1 data-aos="fade-right" id="from-clinical-trials">From Clinical Trials</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Rural Tailored Communication to Promote SARS-CoV-2 Antibody Testing in Saliva</strong> - <b>Conditions</b>: SARS-CoV2 Infection <br/><b>Interventions</b>: Behavioral: General SARS-CoV-2 Communication; Behavioral: Rural-Targeted SARS-CoV-2 Communication <br/><b>Sponsors</b>: Michigan State University; National Cancer Institute (NCI); Johns Hopkins University <br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Cognitive Rehabilitation Therapy for COVID-19</strong> - <b>Conditions</b>: Post-Acute COVID-19 Syndrome <br/><b>Interventions</b>: Behavioral: Compensatory Cognitive Training for COVID-19; Behavioral: Holistic Cognitive Education <br/><b>Sponsors</b>: VA Office of Research and Development <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>COVID Rehabilitation</strong> - <b>Conditions</b>: Rehabilitation; Post-Acute COVID-19 Syndrome; Post-Infectious Disorders <br/><b>Interventions</b>: Behavioral: One day course; Behavioral: Individual follow-ups <br/><b>Sponsors</b>: University Hospital of North Norway; University of Bergen; Oslo University Hospital; Norwegian University of Science and Technology <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Food Effects of GST-HG171 Tablets Combined With Ritonavir in Healthy Chinese Participants</strong> - <b>Conditions</b>: COVID-19 Respiratory Infection <br/><b>Interventions</b>: Drug: GST-HG171/ritonavir; Drug: ritonavir <br/><b>Sponsors</b>: Fujian Akeylink Biotechnology Co., Ltd. <br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Phase 3 Open-Label Controlled Trial of Convalescent Plasma in Early COVID-19 Infection</strong> - <b>Conditions</b>: Covid19 <br/><b>Interventions</b>: Drug: Convalescent Plasma; Other: Standard of Care <br/><b>Sponsors</b>: Larkin Community Hospital <br/><b>Withdrawn</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Improving Post COVID-19 Syndrome With Hyperbaric Oxygen Treatments</strong> - <b>Conditions</b>: Post COVID-19 Condition; Post-COVID-19 Syndrome; Post-COVID Syndrome; COVID-19; Fatigue; Fatigue Syndrome, Chronic <br/><b>Interventions</b>: Device: Monoplace Hyperbaric Chamber (Class III medical device). <br/><b>Sponsors</b>: Sunnybrook Health Sciences Centre <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Education of Medical Staff to Post Acute Covid susTained sYmptoms</strong> - <b>Conditions</b>: Post-acute COVID-19 Syndrome <br/><b>Interventions</b>: Other: Training in the management of functional disorders; Other: Reimbursement of 3 long consultations <br/><b>Sponsors</b>: Assistance Publique - Hôpitaux de Paris; ANRS, Emerging Infectious Diseases <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Pharmacist Management of Paxlovid eVisits</strong> - <b>Conditions</b>: COVID-19; Quality of Care <br/><b>Interventions</b>: Other: Pharmacist Care; Other: AFM Pool Care <br/><b>Sponsors</b>: Kaiser Permanente <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Equity Evaluation of Fact Boxes on Informed COVID-19 and Influenza Vaccination Decisions - Study Protocol</strong> - <b>Conditions</b>: COVID-19; Influenza <br/><b>Interventions</b>: Other: Fact box <br/><b>Sponsors</b>: Harding Center for Risk Literacy <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>ACTIVATE in Public Housing</strong> - <b>Conditions</b>: Pneumonia; Influenza; Varicella Zoster; Meningitis; COVID-19; Vaccine Hesitancy <br/><b>Interventions</b>: Behavioral: Increasing Willingness and Uptake of Influenza, Pneumonia, Meningitis, HZV, and COVID-19 Vaccination <br/><b>Sponsors</b>: Charles Drew University of Medicine and Science <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Early Awake Alterning Prone Positioning Combined With Non-invasive Oxygen Therapy in Patients With COVID-19.</strong> - <b>Conditions</b>: COVID-19 Pneumonia <br/><b>Interventions</b>: Other: Prone position; Other: Standard treatment <br/><b>Sponsors</b>: Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran <br/><b>Terminated</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>tDCS in the Management of Post-COVID Disorders</strong> - <b>Conditions</b>: Long COVID <br/><b>Interventions</b>: Device: Transcranial Direct Current Stimulation (tDCS); Behavioral: Motor Training; Behavioral: Cognitive Training <br/><b>Sponsors</b>: Universidade Federal de Pernambuco; São Paulo State University <br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effects of a Home-Based Exercise Intervention in Subjects With Long COVID</strong> - <b>Conditions</b>: Long COVID-19; Post-COVID-19 Syndrome <br/><b>Interventions</b>: Other: home-based concurrent exercise <br/><b>Sponsors</b>: University of Vienna <br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Study of the Vector Vaccine GamCovidVac-M (Altered Antigenic Composition)</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Biological: GamCovidVac-M vector vaccine for the prevention of COVID-19 with altered antigenic composition <br/><b>Sponsors</b>: Gamaleya Research Institute of Epidemiology and Microbiology, Health Ministry of the Russian Federation <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Study of the Vector Vaccine GamCovidVac for the Prevention of COVID-19 With Altered Antigenic Profile With Participation of Adult Volunteers</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Biological: GamCovidVac vector vaccine for the prevention of COVID-19 (with altered antigenic profile) <br/><b>Sponsors</b>: Gamaleya Research Institute of Epidemiology and Microbiology, Health Ministry of the Russian Federation <br/><b>Not yet recruiting</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Inhaled nitric oxide: can it serve as a savior for COVID-19 and related respiratory and cardiovascular diseases?</strong> - Nitric oxide (NO), as an important gaseous medium, plays a pivotal role in the human body, such as maintaining vascular homeostasis, regulating immune-inflammatory responses, inhibiting platelet aggregation, and inhibiting leukocyte adhesion. In recent years, the rapid prevalence of coronavirus disease 2019 (COVID-19) has greatly affected the daily lives and physical and mental health of people all over the world, and the therapeutic efficacy and resuscitation strategies for critically ill…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Protective effect of olopatadine hydrochloride against LPS-induced acute lung injury: via targeting NF-κB signaling pathway</strong> - CONCLUSION: In nutshell, inhibition of NF-κB pathway by Olo resulted in protection and reduced mortality in LPS- induced ALI and thus has potential to be used clinically to arrest disease progression in ALI/ARDS, since the drug is already in the market. However, the findings warrant further extensive studies, and also future studies can be planned to elucidate its role in COVID-19-associated ARDS or cytokine storm.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Molecular insights and optimization strategies for the competitive binding of engineered ACE2 proteins: a multiple replica molecular dynamics study</strong> - The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to spread globally, and rapid viral evolution and the emergence of new variants pose challenges to pandemic control. During infection, the spike protein of SARS-CoV-2 interacts with the human ACE2 protein via its receptor binding domain (RBD), and it is known that engineered forms of ACE2 can compete with wild-type (WT) ACE2 for binding to inhibit infection. Here, we conducted multiple replica…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Andrographolide inhibits infectious bronchitis virus-induced apoptosis, pyroptosis, and inflammation</strong> - CONCLUSIONS: In this study, we delved into the antiviral properties of APL in the context of chicken macrophage (HD11) infection with IBV. Our findings confirm that andrographolide effectively inhibits apoptosis, pyroptosis, and inflammation by IBV infection. Furthermore, this inhibition was verified on chicken embryos in vivo. This inhibition suggests a substantial potential for APL as a therapeutic agent to mitigate the harmful effects of IBV on host cells.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Betaine prevents cognitive dysfunction by suppressing hippocampal microglial activation in chronic social isolated male mice</strong> - Chronic social isolation (SI) stress, which became more prevalent during the COVID-19 pandemic, contributes to abnormal behavior, including mood changes and cognitive impairment. Known as a functional nutrient, betaine has potent antioxidant and anti-inflammatory properties in vivo. However, whether betaine can alleviate the abnormal behavior induced by chronic SI in mice remains unknown. In this study, we investigated the efficacy of betaine in the treatment of behavioral changes and its…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Block of the Angiotensin Pathways Affects Flow-Volume Spirometry in Patients with SARS-CoV-2 Infection</strong> - BACKGROUND: Angiotensin Converting Enzyme 2 (ACE2) is an endothelial cell receptor used by SARS-CoV- 2 virus to enter cells. Pulmonary function tests (PFTs), mainly spirometry, are the main diagnostic tools for most respiratory diseases. PFTs are mandatory for assessing the response to therapy.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Differential specificity of SARS-CoV-2 main protease variants on peptide versus protein-based substrates</strong> - The SARS-CoV-2 main protease (M^(pro) ) holds significant importance as a biological target in combating coronaviruses due to its importance in virus replication. Considering the emergence of novel SARS-CoV-2 variants and the mutations observed in the M^(pro) sequence, we hypothesized that these mutations may have a potential impact on the protease’s specificity. To test this, we expressed M^(pro) corresponding to the original strain and variants Beta1, Beta2 and Omicron, and analyzed their…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>DHA and EPA inhibit porcine coronavirus replication by alleviating ER stress</strong> - The 2019 coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) highlighted significant gaps in our mechanisms to prevent and control cross-species transmission of animal coronaviruses. Porcine epidemic diarrhea virus (PEDV), transmissible gastroenteritis virus (TGEV), and porcine delta coronavirus (PDCoV) are common porcine coronaviruses with similar clinical features. In the absence of effective drugs and methods of prevention and…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Autoantibodies against Angiotensin-converting enzyme 2 and immune molecules are associated with COVID-19 disease severity</strong> - Increased inflammation caused by SARS-CoV-2 infection can lead to severe coronavirus disease 2019 (COVID-19) and long-term disease manifestations referred to as post-acute sequalae of COVID (PASC). The mechanisms of this variable long-term immune activation are poorly defined. Autoantibodies targeting immune factors such as cytokines, as well as the viral host cell receptor, angiotensin-converting enzyme 2 (ACE2), have been observed after SARS-CoV-2 infection. Autoantibodies to immune factors…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Point of care detection of SARS-CoV-2 antibodies and neutralisation capacity-lateral flow immunoassay evaluation compared to commercial assay to inform potential role in therapeutic and surveillance practices</strong> - CONCLUSION: High sensitivity, specificity, and PPV were demonstrated for the POC LFA for the detection of anti-S-RBD antibodies in comparison to the commercial assay. The LFA was not a reliable determinant of the neutralisation capacity of identified antibodies. POC LFA are useful tools in sero-epidemiology settings, pandemic preparedness and may act as supportive tools in treatment decisions through the rapid identification of anti-Spike antibodies.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The clinical relevance of OSM in inflammatory diseases: a comprehensive review</strong> - Oncostatin M (OSM) is a pleiotropic cytokine involved in a variety of inflammatory responses such as wound healing, liver regeneration, and bone remodeling. As a member of the interleukin-6 (IL-6) family of cytokines, OSM binds the shared receptor gp130, recruits either OSMRβ or LIFRβ, and activates a variety of signaling pathways including the JAK/STAT, MAPK, JNK, and PI3K/AKT pathways. Since its discovery in 1986, OSM has been identified as a significant contributor to a multitude of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Synthesis and Biological Evaluation of Benzothiazolyl-pyridine Hybrids as New Antiviral Agents against H5N1 Bird Flu and SARS-COV-2 Viruses</strong> - A novel series of benzothiazolyl-pyridine hybrids 8a-h and 14a-e were produced from the reaction of enamine derivative 4 with each of the arylcyanoacetamides 5a-h and cyanoacetohydrazides 9a-e. The new products were characterized by spectral techniques (IR, ¹H NMR, ^(13)C NMR, and MS). Biological evaluation of 8a-h and 14a-e in vitro against H5N1 and SARS-COV-2 viruses showed that several compounds had significant activity. Compounds 8f-h, which contain fluorine atoms, have better activity…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Exploration of 1,2,3-triazolo fused triterpenoids as inhibitors of human coronavirus 229E targeting the viral nsp15 protein</strong> - The coronavirus disease-19 (COVID-19) pandemic has raised major interest in innovative drug concepts to suppress human coronavirus (HCoV) infections. We previously reported on a class of 1,2,3-triazolo fused betulonic acid derivatives causing strong inhibition of HCoV-229E replication via the viral nsp15 protein, which is proposedly related to compound binding at an intermonomer interface in hexameric nsp15. In the present study, we further explored the structure-activity relationship (SAR), by…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Anti-SARS-CoV-2 activity of cyanopeptolins produced by Nostoc edaphicum CCNP1411</strong> - Despite the advances in contemporary medicine and availability of numerous innovative therapies, effective treatment and prevention of SARS-CoV-2 infections pose a challenge. In the search for new anti-SARS-CoV-2 drug candidates, natural products are frequently explored. Here, fifteen cyanopeptolins (CPs) were isolated from the Baltic cyanobacterium Nostoc edaphicum and tested against SARS-CoV-2. Of these depsipeptides, the Arg-containing structural variants showed the strongest inhibition of…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Discovery of druggable potent inhibitors of serine proteases and farnesoid X receptor by ligand-based virtual screening to obstruct SARS-CoV-2</strong> - The coronavirus, a subfamily of the coronavirinae family, is an RNA virus with over 40 variations that can infect humans, non-human mammals and birds. There are seven types of human coronaviruses, including SARS-CoV-2, is responsible for the recent COVID-19 pandemic. The current study is focused on the identification of drug molecules for the treatment of COVID-19 by targeting human proteases like transmembrane serine protease 2 (TMPRSS2), furin, cathepsin B, and a nuclear receptor named…</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Biden’s Middle East Burden</strong> - Visiting Israel, the President will express support for a traumatized nation, but he must also try to steer it from the blindness of rage. - <a href="https://www.newyorker.com/news/daily-comment/bidens-middle-east-burden">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Journalist Exposes the Philippines’ Extralegal Killings</strong> - The reporter Patricia Evangelista discusses the country’s drug wars, Rodrigo Duterte’s murderous rhetoric, and how she manages the difficulties of covering trauma. - <a href="https://www.newyorker.com/news/q-and-a/a-journalist-exposes-the-philippines-extralegal-killings">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Can White House Diplomacy Help Prevent Escalation in Gaza and Beyond?</strong> - It is not a simple matter for the Biden Administration to be, on the one hand, the backstop for Israel’s looming actions in Gaza and, on the other, a voice for strategic caution and the initiator of a diplomatic track. - <a href="https://www.newyorker.com/news/daily-comment/can-white-house-diplomacy-help-prevent-escalation-in-gaza-and-beyond">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Symbiotic, Democracy-Eroding Relationship Between Donald Trump and Jim Jordan</strong> - Jordan is a perfect ally for Trump, and a walking embodiment of a radicalized G.O.P. That won’t change, even if his Speaker bid fails because enough Republicans from Biden-majority districts hold the line. - <a href="https://www.newyorker.com/news/our-columnists/the-symbiotic-democracy-eroding-relationship-between-donald-trump-and-jim-jordan">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>How Jane McAlevey Transformed the Labor Movement</strong> - The renowned organizer and theorist has a terminal-cancer diagnosis. But she has long been fighting the clock. - <a href="https://www.newyorker.com/news/persons-of-interest/how-jane-mcalevey-transformed-the-labor-movement">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>The horrifying, nearly forgotten history behind Killers of the Flower Moon</strong> -
<figure>
<img alt="Buffalo graze next to an oil rig in Osage County, Oklahoma." src="https://cdn.vox-cdn.com/thumbor/5ziyHzq-YKXDi6_AwiKjij6R7zM=/1107x0:3160x1540/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72767722/1575975991.0.jpg"/>
<figcaption>
A herd of buffalo shares the plains of The Nature Conservancy’s Tall Grass Prairie Preserve with pump jacks on March 30, 2007, in Osage County, Oklahoma. The discovery of oil in the region in the late 1890s set the stage for one of the most horrific periods in American history: The Osage Murders. | Mayra Beltran/Houston Chronicle via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A century later, we still don’t know the full, stomach-churning extent of the Osage murders.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pJztWa">
The neighborhood dogs had all begun to die, and that was why Rita Smith’s husband was sure they’d be next.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7HtQfA">
Rita was one of the few remaining members of the Osage Nation following nearly a century of brutal displacement. Throughout the 19th century, the government <a href="https://www.okhistory.org/publications/enc/entry.php?entry=OS001">repeatedly forced</a> the Osage to relocate from their current lands in Kansas to, finally, a much smaller, desolate reservation in northern Oklahoma. With the <a href="https://www.osagenation-nsn.gov/news-events/news/did-you-know">discovery of oil on Osage land</a> in the late 1890s, however, the <a href="https://osagenews.org/museum-to-host-community-reception-to-build-photographic-archive-of-original-allottees/">2,229 tribe members</a> who were left suddenly came into tremendous amounts of personal wealth, and prosperity finally seemed to be once more within the community’s grasp. But now, a ring of unknown murderers had begun to target members of the tribe — including Rita’s family.
</p>
<aside id="JpV1oN">
<div>
</div>
</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AxR5fk">
Between 1921 and 1923, Rita’s sister Anna Brown, her cousin, and possibly even her mother, Lizzie Kyle, had all died suspiciously alongside a string of other deaths — at least 24 Osage Nation members and several of their allies. Some, like Anna, had been killed with a bullet to the back of the head; others, like Lizzie, had apparently died from strychnine or other more obscure poisons. There were even rumors that Rita’s white husband, Bill, had killed his first wife, Rita’s sister Minnie, a few years earlier. He had married Rita shortly after. Rita’s other sister, Mollie, had also married a white man, Ernest Burkhart, the nephew of a rich and influential rancher, William Hale. Under Hale’s patronage, the family had prospered — but now they were dying, one by one.
</p>
<div class="p-fullbleed-block">
<figure class="e-image">
<img alt="Four black-and-white photographs of Osage women." src="https://cdn.vox-cdn.com/thumbor/se8EUliHTwhV6a7uu8KSAeK_D8I=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007961/minnie_anna_rita_lizzie.jpg"/> <cite>Bettmann Archive</cite>
<figcaption>
Four women of the Kyle family all died suspicious deaths, from left to right: Minnie Smith (d. 1921); Anna Kyle Brown (d. 1921); Rita Smith (d. 1923); their mother, Lizzie Q. Kyle (d. 1921). The surviving sister, Mollie, narrowly escaped a similar fate.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PJIspr">
Rita and Bill had become so spooked by the possibility that they were next on the list of vigilante killings that after hearing intruders on their property, they’d moved to a safer part of town. Not long after they settled in, however, the neighborhood’s ever-vigilant dogs began to die, and Bill grew increasingly paranoid. He saw their silencing as akin to disabling an alarm system — and a sign that despite their best efforts, the anonymous death-dealers were inching closer to them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JBVnY8">
He was right.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pcty5P">
In the early morning hours of March 10, 1923, Bill, Rita, and their housekeeper Nettie Brookshire all died when a bomb that had been planted beneath their house exploded — yet another tragedy of what became known as the Osage Reign of Terror.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RmjF8t">
All of these events, and the harrowing FBI investigation that followed, form the subject of <em>Killers of the Flower Moon</em>, journalist David Grann’s meticulously researched 2017 book about the murders, as well as its highly anticipated upcoming film adaptation by Martin Scorsese. The film boasts many Indigenous actors, including breakout star Lily Gladstone, alongside an A-list ensemble including familiar Scorsese collaborators like Leonardo DiCaprio and Robert De Niro — and a somewhat quizzical range of famous singer-songwriters. The formidable cast size reflects just how far-reaching and convoluted the real murders and the efforts to solve them were.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pkNOdh">
As with all <a href="https://www.vox.com/true-crime">true crime</a>, the ethics of discussing <em>Killers of the Flower Moon</em> as a narrative are tricky. Grann constructs his nonfiction account like a classic murder mystery, with a series of grim “twists” that may or may not be genuinely shocking, depending on how cynical you are. As the trailers make clear, Scorsese upends this narrative, with the “who” behind the Osage murders being not nearly as compelling as the why and the how. Still, if you’d like to avoid spoilers, proceed with caution (and maybe tap out before the last section).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TFvQ9R">
While Scorsese takes the “who” as a given, the deep irony remains that the only reason the “why” might still shock viewers is that the Osage Reign of Terror simply isn’t well enough known. The systematic murders of an Indigenous community — the rare case to warrant a federal investigation from the then-nascent bureau that would become the FBI — may have been an undeniable media sensation in their day. Yet nearly 100 years later, the Osage murders wound up being little more than a 20th-century history footnote. (A date-stamped search for the murders returns <a href="https://www.google.com/search?q=%22osage+reign+of+terror%22%7C%22osage+indian+murders%22%7C%22osage+murders%22&amp;newwindow=1&amp;sca_esv=571618306&amp;tbs=cdr%3A1%2Ccd_max%3A2015&amp;ei=FBgiZfKQCKGf5NoPtP6LqA8&amp;ved=0ahUKEwjy6qTft-WBAxWhD1kFHTT_AvUQ4dUDCBA&amp;uact=5&amp;oq=%22osage+reign+of+terror%22%7C%22osage+indian+murders%22%7C%22osage+murders%22&amp;gs_lp=Egxnd3Mtd2l6LXNlcnAiPiJvc2FnZSByZWlnbiBvZiB0ZXJyb3IifCJvc2FnZSBpbmRpYW4gbXVyZGVycyJ8Im9zYWdlIG11cmRlcnMiSMoXUPoQWPoQcAJ4AJABAJgBWKABWKoBATG4AQPIAQD4AQHiAwQYASBBiAYB">less than 100 results</a> on Google prior to 2016, the year before <em>Flower Moon</em> was published.)
</p>
<div class="p-fullbleed-block">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/JVhuWMohQvCR0VDLj6ctWrSZ__s=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007870/before_after.jpg"/> <cite>Bettmann Archive</cite>
<figcaption>
The Smiths’ house in 1923, before and after the bombing.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4sDt10">
Erased alongside the murders, arguably a 20th-century genocide on American soil, were the appalling circumstances that enabled them. Not only were the investigations into the murders hampered by systemic indifference, but the murders could arguably only have happened because of decades of blatant system-wide racism that forced the Osage people to fight for their autonomy. At the time the murders began, they were even fighting for control of their own finances and assets, thanks to a <a href="https://www.vox.com/culture/22565683/britney-spears-conservatorship-testimony">Britney-style conservatorship</a> that robbed them of access to their newfound oil wealth amid an environment of galling corruption. This story, the true American horror story of a community enduring a death wave for over a decade, makes for harrowing drama.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DL4j0m">
But the full truth of the Osage murders, and the dehumanization at their root, makes it almost more unbelievable that they were ever solved at all — if, indeed, they actually were.
</p>
<h3 id="RQlgg1">
How the Osage got unfathomably rich — and the exploitative conservatorships that came with that money
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UyW2JH">
For thousands of years, the Osage Nation resided on a vast stretch of territory that extended from the Ohio River across the Mississippi and into Oklahoma and across southern Kansas. In the 19th century, however, as white settlers encroached on their territory and anti-Indigenous sentiment flourished, the US government began a series of forced relocations, resettling the Osage repeatedly until finally, by the 1870s, the government forced the Osage to relocate to northern Oklahoma. The government had intentionally resettled the Osage to some of the worst farmland in Oklahoma — only to accidentally relocate them to the richest oil deposits in the country. In the late 1890s, the oil reserves were discovered, and the Osage people suddenly came into possession of confounding amounts of wealth, abruptly becoming <a href="https://www.npr.org/2023/03/23/1165619070/osage-headrights-killers-of-the-flower-moon-fletcher-lawsuit">the richest community on the planet</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wEudR2">
And then, as they had so often before, the vultures began circling.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9Z7LSu">
The massive land rush that followed the discovery of the oil swelled the prairie with grifters, grafters, scammers, and quick-buck seekers, all of whom arrived with the goal of exploiting the Indigenous people and their newfound wealth. <a href="https://thorpe.law.ou.edu/treatises/partiv.html">Tribal allotments</a> established between 1905 and 1907 meant that all of the existing Osage land was legally reserved to the remaining tribal members. But outsiders could still obtain leases to mine and drill the land in exchange for a share of the profits. At the peak of the oil rush in the 1920s, auctions for oil leases regularly generated millions of dollars. Outsiders could also marry into Osage families, which would allow them to access Osage money.
</p>
<div class="c-wide-block">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/NsjqV1grM7bfacm-uRV9YQLGgjg=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007889/Million_Dollar_Elm_20003716.JPG"/> <cite>Courtesy of the <a class="ql-link" href="https://www.bartlesvillehistory.com/" target="_blank">Bartlesville Area History Museum</a></cite>
<figcaption>
This tree became known in the region as the “Million-Dollar Elm” because of the millions of dollars in oil and natural gas leases that were regularly auctioned beneath it.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iAXrSg">
As white fortune hunters flocked to the countryside hoping to secure deals and access to the land, the government, via the Bureau of Indian Affairs, mandated that nearly all members of the Osage be appointed a white “guardian” who would manage (control) their money for them. Members of the tribe had to get permission to access their own bank accounts, have their purchases approved, withdraw their own money — nearly always with entirely racist assumptions embedded in the judgments about which Osage “deserved” to have access to their own money. It was in effect <a href="https://theconversation.com/the-disturbing-history-of-how-conservatorships-were-used-to-exploit-swindle-native-americans-165140">exactly like</a> a modern-day <a href="https://www.vox.com/policy/23856608/portland-homeless-tent-encampments-forced-treatment-guardianships">conservatorship</a>, with all of the built-in potential for exploitation that has given the legal structure its <a href="https://www.vox.com/culture/23832310/michael-oher-blind-side-adoption-tuohy-white-savior">still-terrible</a> <a href="https://www.vox.com/culture/22565683/britney-spears-conservatorship-testimony">reputation</a>. The system often resulted in guardians simply withholding or stealing the money completely from the Osage, who rarely had a means of redress within the US legal system because of the conscious indifference or racism of local, state, and federal authorities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UwbHtU">
“I have a diploma from Lawrence, and they’ve put a guardian over me,” an Osage tribe member named John Goodskin told <a href="https://harpers.org/archive/1920/11/lo-the-rich-indian/">Harper’s Monthly</a> in November 1920. “I fought in France for this country, and yet I am not allowed even to sign my own checks … I’m a prisoner in this place.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FiEvMA">
To understand how the eventual string of murders could have gone unchecked for so long, it’s vital to understand both how exploitative the guardianship system was and how the community revolved around it. White community members sought oil leases and then through guardianship gained further control over the Osage. In order to make this system work, you needed people who were willing to exploit the Osage as their guardians and people who were willing to look the other way while they did it, often in exchange for bribes or access of their own. This meant you needed people within every part of the social and legal system. “They have all the law and all the machinery on their side,” Goodskin told Harper’s.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MNV0LU">
Thus an entire ecosystem of greed and graft quickly arose around the Osage capital of Pawhuska and neighboring Osage city of Fairfax, keeping the money flowing and keeping the white locals, including the newcomers, in control of it. “Many of the county courts are influenced by political considerations, and … Indian guardianships are the plums to be distributed to the faithful friends of the judges as a reward for their support at the polls,” <a href="https://digitalprairie.ok.gov/digital/collection/culture/id/6553/">wrote</a> Indigenous activist Zitkala-S̈a in 1924. Once established, the entire white community became incentivized to participate in this system of greed. And once the Osage citizens began dying, it was in the white locals’ best economic interests to let them keep dying.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vKf4xT">
That’s because of how the law concerning the Osage Nation’s shares in the oil fields, known as their headrights, worked. It was illegal for the headrights, the Osages’ most valuable asset, to be sold or given away. But if any member of the Osage Nation died, their headright would pass to their legal heir. This person might be their white spouse, who was often conveniently also their guardian. Or the headright might go to a relative or heir whose guardian already had complete control over their accounts — so that the money would effectively go straight to them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XAmPXu">
In other words, marrying an Osage who then died, or being appointed guardian over an Osage who suddenly came into an inheritance after someone else died, was the only way for a white man to gain more access to the profits from all that oil. The law concerning the inviolability of Osage headrights, intended to make them less vulnerable to exploitation, instead meant that to their corrupt guardians, the Osage were more valuable dead than alive.
</p>
<div class="c-wide-block">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/iMHJrOJBYY2Ij6y1eoVZqbj1W14=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007921/GettyImages_514689540.jpg"/> <cite>Bettmann Archive</cite>
<figcaption>
President Calvin Coolidge poses with an Osage delegation in front of the White House on January 20, 1924.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LDoHgF">
And thanks to the lure of the oil fields, corruption was everywhere. It ran so rampant in the region that, according to FBI records accessed by Grann in <em>Flower Moon</em>, when one of the killers was finally apprehended, he referred to the murders as simply “the state of the game.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xt4j9I">
It became so unchecked that in 1923, the <a href="https://www.fbi.gov/history/famous-cases/osage-murders-case">Osage Nation formally requested</a> that the federal government take over the investigation into the Reign of Terror because there seemed to be no hope for justice from anywhere else.
</p>
<h3 id="F3908z">
The Osage murders became so prolific that the nation’s first federal investigative agency had to get involved
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bDijvU">
Until that point, the state’s attempts to investigate had gone completely off the rails. Local law enforcement had been, at best, thoroughly intimidated into totally halting their investigations. The best efforts at solving the crimes had been waged by cadres of private investigators working for the families of the victims. Thus far, however, leads had gone nowhere, evidence had mysteriously vanished, plausible theories turned out to be rumors without substance, the region’s unbridled corruption tainted the available case information, witnesses abruptly vanished or stopped talking, and everyone who seemed to be getting somewhere turned up dead.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0n7xep">
As alarm and hysteria about the deaths spread, a white man named Barney McBride traveled to Washington, DC, to seek federal help in solving the murders. While there, he was attacked, beaten, and fatally stabbed more than 20 times. Three other investigators similarly died by foul play just as they seemed to be getting close to the truth: One was drugged and pushed down a flight of stairs; another was gunned down; the third, a local prosecutor, was thrown from a train while reportedly on his way to reveal the killers’ identities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YeOB6Q">
The bombing of the Smith house, however, brought about a turning point in the murder investigation. The high death toll, as well as the sheer menace involved in a triple-homicide house bombing, finally garnered the attention of national media and prompted the intervention of the federal government and the Bureau of Investigation, the fledgling organization that would ultimately become the FBI.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YlNNot">
The bureau detectives, led by Tom White, a former Texas Ranger turned bureau veteran, had the herculean task of sorting through a landscape of rumors and misinformation and finding people — anyone — who was a) willing to tell the truth and b) not already dead. No sooner would one lead appear than it would turn out that the lead had already been killed, often under awfully convenient circumstances. Yet working mostly undercover, White and his detectives quickly gained a hypothesis of the murders — a truly chilling conspiracy to kill that led back to the family at the heart of it all.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Lxz5AD">
<strong>Note: </strong>From here on, we will discuss the real-life criminals behind the Osage murders, whose identities constitute major spoilers for both the book and the film <em>Killers of the Flower Moon</em>. If you want to remain unspoiled for either, you should stop reading now.
</p>
<h3 id="Cnm8dE">
The “who” of this whodunnit is almost as shocking as the “why”
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VfcD5p">
It’s a testament to how unproductive the local justice system had been in its efforts to bring the Osage killers to rights that when the FBI took over in the summer of 1925, it only took White and his men three months to find real answers. Those three months, however, were spent unearthing a devastatingly large community plot to orchestrate the murders of Osage tribe members. This plot was either enacted, enabled, or silently complied with by apparently dozens of members of Fairfax’s white society — everyone from judges to pastors to coroners to private detectives to a range of henchmen.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KzXRXc">
At the center of all of it was a single man: William K. Hale, a self-made Fairfax cattle rancher who spent decades steadily amassing power and land in a <em>There Will Be Blood</em>-style saga of bribes, intimidation, murder, and ruthlessness. Hale did all of this while cloaking himself in a public disguise of gentility and charity; he called himself “the Reverend” and was known for lavishly donating to charity and constantly working on behalf of the Osage people.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="W2k1UJ">
But Hale also steadily took control over nearly every part of the social and legal systems of the region: He gained an appointment as a deputy sheriff, which meant he could come and go in jails at will and could easily manipulate criminals to work for him from behind bars. He had local officials in his pocket, openly terrified to disobey him. Even doctors in the area apparently aided him in discreetly poisoning their patients on his behalf. Hale “had everything fixed from the road-overseer to the governor,” Hale’s nephew stated in a deposition.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KL5a2d">
His ultimate goal, carried out via a string of brazen insurance scams, murder plots, for-hire killings, and fraud, was to amass his fortune by taking it from the Osage people. (This revelation comes as a shock in Grann’s retelling of the murder investigation; one might argue that Scorsese’s choice to cast Robert DeNiro as Hale in the film adaptation gives away the game upfront.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p9jd4z">
What Tom White and his agents were able to prove centers around the Osage family that Bill Smith married into, which is also the family that Hale’s nephew, Ernest Burkhart, married into. It’s unclear how early Hale’s grand design took form, but what it ultimately coalesced into was this: systematically killing off all of Burkhart’s in-laws until all of their inheritances had passed on to Burkhart’s wife, Mollie. (In Scorsese’s film, Mollie is played by breakout star Gladstone, with DiCaprio in the role of Ernest.)
</p>
<div class="c-float-left">
<figure class="e-image">
<img alt="Portrait of Mollie Burkhart" src="https://cdn.vox-cdn.com/thumbor/QeuGadP8yt6M6IeOWdqSFD0dfAw=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007989/514954594.jpg"/> <cite>Bettmann Archives</cite>
<figcaption>
Mollie Burkhart, the surviving member of the Kyle family sisters.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dkMrz0">
Mollie had outlived her three sisters, several cousins, and her mother. By the time White finally arrested Hale, she was being slowly poisoned — allegedly via injections directly from her doctor under the guise of administering insulin — with the apparent expectation that when she died, her family’s entire fortune would pass to Ernest Burkhart. Burkhart was fully aware of and assisted in the plot to kill his in-laws, including helping facilitate the bombing of the Smiths.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BmRVH4">
It’s unclear when Burkhart learned about his uncle’s plot. It’s a horrifying possibility that he married Mollie with the intent to orchestrate her murder. It’s also possible he learned of the plot to kill Mollie afterward and went along with it, or perhaps learned of it but then proved reluctant to carry it out; after all, this was a woman he’d been married to for decades and had three children with. The possibility he had no knowledge she was being poisoned seems remote. In the final chapters of <em>Flower Moon</em>, Grann offers the chilling possibility that Burkhart not only had full complicity, but had even intended for his wife Mollie and two of their children to die alongside her sister Rita in the bombing of the Smith house.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qYTNTV">
Equally unclear is whether Hale’s plot stopped with Mollie or ultimately included killing off Burkhart as well. Burkhart seemed genuinely remorseful and pleaded guilty to his role in the killing of Mollie’s sister Rita Smith, her husband Bill Smith, and their servant Nettie Brookshire. (The man who allegedly planted the bomb had died under suspicious circumstances that implicated Hale as the mastermind.) After this, Hale allegedly attempted to get one witness to kidnap and kill his nephew before Burkhart could testify against him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0tCxin">
Ultimately, despite multiple hung juries (whose members had been bribed by Hale’s attorney), Hale and another man, a career criminal named John Ramsey, were convicted of killing Mollie’s cousin Roan Horse, also known as Henry Roan, in an insurance scam. They were each given life imprisonment. Hale’s other nephew, Bryan Burkhart, helped facilitate the murder of Mollie’s other sister Anna Brown, but after his own trial resulted in a hung jury, he was given immunity in order to testify against the man who pulled the trigger. That man, Kelsie Morrison (whom Grann implicates in a similar plot to murder his wife and her entire family), was also convicted. Although Hale was implicated in dozens of deaths, he was only convicted for one. Both he and Burkhart were eventually paroled, and Burkhart applied for and received a pardon from the state of Oklahoma over the objections of outraged Osage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9gWf7y">
For her part, Mollie initially supported her husband and believed in Ernest’s innocence, but after learning the full scope of his involvement in the murders, and comprehending just how much death he actively took part in, she divorced him. In 1931, she successfully sued for an end to her own guardianship and finally gained full control over the family fortune others had tried so hard to take.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cK8whq">
It’s impossible to know the full range of crimes that Hale and his coconspirators committed. That’s due to a range of reasons. For one, records have been lost and might not have been kept well at the time. For another, Hale wasn’t the only white man in the area trying to attain access to Osage wealth via force, violence, coercion, and murder. For another, since at one point local law enforcement simply stopped investigating the murders, the total number of people murdered in the Osage Reign of Terror might never be known. In <em>Flower Moon</em>, Grann cites estimates in the hundreds of victims — and that’s just within the Osage community. Hale also seems to have ruthlessly orchestrated the murders of dozens of people who either investigated the murders, helped him commit them, or had knowledge of them.
</p>
<div class="p-fullbleed-block">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/HrCDlrjpapPhfP0q-3WKM8_QPng=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25007992/OsageDancers_3x30.jpg"/> <cite>Courtesy of the <a class="ql-link" href="https://www.bartlesvillehistory.com/" target="_blank">Bartlesville Area History Museum</a></cite>
<figcaption>
In this panorama of the Osage Nation taken in the early 1920s, William Hale can be seen standing among the Osage on the left (in a golf cap and glasses).
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="U7MUL8">
The specter of death seems to have been all but expected during this period. Even a cursory look into the murders leads immediately to unexpectedly dark places — like the time Hale somehow <a href="https://casetext.com/case/united-states-v-hale">legally acquired</a> the inheritance of a <a href="https://www.findagrave.com/memorial/89242340/charles-bigheart">12-year-old boy</a>, Charles Bigheart, who suddenly passed away under unknown circumstances, just five years before his father George was suspiciously poisoned to death, allegedly by Hale. Grann, in researching his book, seemed unable to help but stumble across more murders committed by more people — one, a banker in league with Hale, was suspected by FBI agents but never prosecuted; another woman likely murdered her husband for his headright and later narrowly escaped being murdered herself. The earliest victim Grann encountered was bludgeoned to death in 1918 by friends who later posed as her family members in order to access her accounts. The most recent victim he learned about was allegedly poisoned in 1931.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Glp7it">
Once Grann began looking at specific white men who had multiple guardianships entrusted to them, he realized that many of them seemed to be systematically offing their charges without an apparent second thought. Some simply denied their wards access to <a href="https://www.vox.com/health-care">health care</a> and let them die. One wealthy woman was held captive and tortured by her husband until the government interceded, as part of yet another alleged town conspiracy to take her wealth. Many guardians seemed to have no qualms about killing children in order to knock off potential obstacles to the prize. And countless members of white society were engaged in helping the guardians make such deaths appear nominally unsuspicious.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PfooeR">
“Virtually every element of society was complicit in the murderous system,” Grann ultimately concludes after taking in the sheer scope of the killings, “a vast criminal operation that was reaping millions and millions of dollars.” The social system that had begun as an ecosystem of greed had evolved into an ecosystem of death, reaping tragedy and trauma that still haunts the Osage and their descendants. The laws around headrights have changed, but they are <a href="https://www.npr.org/2023/03/23/1165619070/osage-headrights-killers-of-the-flower-moon-fletcher-lawsuit">still fraught legal subjects</a>, though the Osage wealth has long since dried up, literally, alongside the depleted oil fields. And although the deaths of Indigenous peoples living in the US may not be organized by the steady hand of a single man like William Hale, they still face <a href="https://www.nytimes.com/2012/02/21/us/on-indian-reservations-higher-crime-and-fewer-prosecutions.html">far higher death rates with lower rates </a>of criminal investigations and prosecutions than white Americans. Missing and Murdered Indigenous Women has become a <a href="https://www.bia.gov/service/mmu/missing-and-murdered-indigenous-people-crisis">grim acronym</a> in the annals of <a href="https://www.vox.com/criminal-justice">criminal justice</a> due to the need for increased awareness of such cases.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="m47ko8">
The Osage murders illustrate something profoundly dark about the lie of American identity. The trope is that anyone can find success and happiness — that there’s something mythic and magical about “American” ambition and success. Throughout the 19th and early 20th centuries, the government’s approach to Indigenous Americans was to mold them into docile citizens via forced boarding school attendance (Roan Horse, later killed by Hale, was forced to change his name at one such school), forced religious conversions, and the systematic destruction of Indigenous American cultures. The lie that Indigenous peoples were fed as they were forced to assimilate into white culture was that once they had done so successfully, they would be rewarded with greater freedom and autonomy; they would receive their chance to participate in the American dream.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="g0XLJg">
Yet as Goodskin pointed out to Harper’s in 1920, that promise, always hollow, completely vanished as soon as actual independence and autonomy were within reach.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mrL1Xa">
“In the old days, before we had money, it was easy enough,” he said, describing the plight of the Osage who had a guardian. “All you had to do was not get drunk. But now your good behavior has nothing at all to do with it. Your money draws ’em and you’re absolutely helpless.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZAbTOk">
In other words, after having fully disenfranchised Indigenous Americans, there was never going to be a version of the “model” Indigenous American that white society could actually tolerate. The discovery of oil on Osage land is what the American dream is supposedly all about. It should have afforded the Osage power, freedom, and agency alongside all that cash.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GsCw9P">
Instead, at the very moment they should have attained everything they were promised, they had less control over their own lives — and deaths — than ever.
</p></li>
<li><strong>A surprisingly radical proposal: Make people happier — not just wealthier and healthier</strong> -
<figure>
<img alt="Three slices of land illustrate different ways of well-being and ladders link them together, with people climbing between." src="https://cdn.vox-cdn.com/thumbor/dwhL-bhJkXYIL-IIgZnhTGNUCFQ=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72634305/PeteGamlen_Vox_QualityofLife.0.jpg"/>
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Pete Gamlen for Vox
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We finally have good data on what makes people happy. Why are we afraid to use it?
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If I gave you $5,000 right now and asked you to spend it in whatever way would help people the most, what would you do?
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That amount of money can buy 1,000 malaria-preventing bed nets that will, on average, end up <a href="https://www.givewell.org/cost-to-save-a-life">saving one kid’s life</a>. Or it can boost the income of five poor families by giving each $1,000. Or it can treat 30 people for depression by paying for a few months of <a href="https://www.vox.com/future-perfect/22765423/cbt-therapy-developing-world-strongminds">group therapy</a> that evidence suggests can have lasting effects.
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Which is best?
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Nobody knows for sure, and that’s a problem facing everyone, from regular people wanting to spend a few bucks on charity to governments with millions to invest in public policy. It’s hard to figure out which does the most good — saving one life, reducing poverty for a few, or treating mental illness for dozens — and even asking the question can feel morally icky. Yet we can’t escape it if we want our money to help people as much as possible.
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Economists love things they can measure objectively, like the number of deaths in a village or the number of dollars in an account. So over the past century, they’ve focused on measuring health and wealth. The best policy programs for society are deemed to be the ones that save the most lives, say, or increase gross domestic product (GDP) by the widest margin.
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And there’s a good rationale for using a metric like GDP as a shorthand for well-being: There is a very high correlation between a nation’s GDP per capita and its self-reported life satisfaction. Just look at this chart, showing the low levels of well-being among the world’s poorest nations.
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<img alt=" " src="https://cdn.vox-cdn.com/thumbor/KwBnPHWE9sxq6NKG8tBGGuexcuc=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24903891/gdp_vs_happiness__1_.png"/>
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In other words, GDP is a very strong predictor of life satisfaction.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xMhby0">
But a strong predictor is not a perfect predictor. As we’ve gathered more data on the happiness of different populations, it’s become clear that increasing wealth and health <a href="https://ourworldindata.org/happiness-and-life-satisfaction#economic-growth-and-happiness">do not always</a> go hand in hand with increasing happiness. By the economists’ objective measures, people in rich countries like the US should be doing great — and yet Americans are only becoming <a href="https://www.vox.com/the-highlight/2019/11/13/20953899/how-to-be-happy-positive-psychology-mindfulness-language">more miserable</a>. And people in some higher-GDP European countries like Portugal and Italy report lower life satisfaction than people in lower-GDP Latin American countries.
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What’s going on here? How do we explain the gaps in life satisfaction that objective metrics like GDP don’t explain?
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<img alt=" " src="https://cdn.vox-cdn.com/thumbor/4VUjMBlXzWlQdUjeYPfb7qNurDo=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24903833/continent_version_GDP_pc_vs_Happiness_By_culture.png"/>
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Nowadays, a <a href="https://www.happierlivesinstitute.org/">growing</a> <a href="https://weall.org/about-weall">chorus</a> <a href="https://katherinetrebeck.com/#about">of</a> <a href="https://www.brookings.edu/books/the-pursuit-of-happiness-an-economy-of-well-being-paperback-edition/#:~:text=Economy%20and%20Development-,In%20The%20Pursuit%20of%20Happiness%2C%20renowned%20economist%20Carol%20Graham%20explores,of%20happiness%E2%80%9D%20into%20public%20policymaking.">experts</a> argues that helping people is ultimately about making them happier — not just wealthier or healthier — and the best way to find out how happy people are is to just ask them directly. This camp says we should focus a lot more on subjective well-being: how happy people are, or how satisfied they are with their lives, based on what they say matters most to them — not just based on objective metrics like GDP. Subjective well-being can tell us things that objective metrics can’t.
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It’s a revolution in thinking that’s gathering force in policy and charity circles alike, and it’s starting to upend conventional wisdom about the best ways to do good.
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Here’s one eye-popping example from the charity world. The <a href="https://www.happierlivesinstitute.org">Happier Lives Institute</a>, a research center aiming to identify evidence-based ways to improve happiness, wanted to find out which is better at boosting well-being: giving people cash or giving them therapy. So HLI ran <a href="https://www.happierlivesinstitute.org/report/donating-money-buying-happiness/">a direct comparison</a> — involving evidence from some 80 studies and 140,000 participants — between GiveDirectly, an organization that gives cash transfers, and StrongMinds, an organization that provides group therapy for people with depression. Both serve very poor people in sub-Saharan Africa.
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Surprisingly, HLI found that the therapy was nine times more cost-effective than the cash at improving self-reported well-being. Some evaluators <a href="https://www.givewell.org/international/technical/programs/strongminds-happier-lives-institute">disagree with</a> this finding, taking issue with, for example, how HLI’s analysis assumes that improving someone’s depression score by some amount is equivalent to improving their overall life satisfaction by that same amount; these evaluators argue StrongMinds is less cost-effective than HLI’s findings suggest. Nevertheless, the findings have served as a challenge to how empirically driven <a href="https://www.vox.com/philanthropy">philanthropy</a> allocates funding.
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Changes are afoot in the policy world, too. At the international level, UN Secretary-General António Guterres made a push in May for nations to <a href="https://www.un.org/sites/un2.un.org/files/our-common-agenda-policy-brief-beyond-gross-domestic-product-en.pdf">track progress beyond GDP</a>. <a href="https://weall.org/wego">Governments</a> from Scotland and Wales to Finland and Iceland have already begun to move well-being to the center of their policymaking.
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In 2019, <a href="https://www.vox.com/future-perfect/2019/6/8/18656710/new-zealand-wellbeing-budget-bhutan-happiness">New Zealand</a> became the first country to make well-being the organizing principle of its national budget. The budget required all new spending to go toward specific well-being goals, such as bolstering its population’s <a href="https://www.vox.com/mental-health">mental health</a>. That prompted immediate results, like an influx of over $200 million into services for survivors of domestic and sexual violence, the nation’s largest-ever investment in that issue.
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Around the world, a new focus on improving subjective well-being is causing a paradigm shift in how we try to do good. But the approach is beset with controversy. Some say it goes too far. And others say it’s not going far enough.
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<h3 id="dIe3qU">
How subjective well-being went from hot to not — and back again
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If you asked me, “What’s the ultimate purpose of life?” and I answered “wealth” or “health,” you might find that kind of weird. We value those things not in themselves, but because they tend to improve our well-being — how happy or satisfied we are with life. Well-being is the thing we really care about.
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This perspective, common among philosophers for centuries, reached peak popularity in the 18th century. Early utilitarians like English philosopher Jeremy Bentham argued that happiness should be the single currency by which we compare the value of different goods, including wealth and health. Adam Smith pored over economic methods with the goal of fostering happiness for the people. And Thomas Jefferson wrote that “the life and happiness of the people is the first and only object of good government.”
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But the 1920s saw a huge reversal, as behaviorism became fashionable among psychologists like Ivan Pavlov (yes, the dog guy) and economists like Lionel Robbins. The behaviorist school of thought argued that we can’t know what people are thinking or feeling inside, so trying to understand people’s subjective experiences is pointless.
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“Basically, economists wanted to be more scientific,” explained Michael Plant, who leads the Happier Lives Institute. “They thought something only counts as science if it’s objectively measurable. Feelings aren’t objectively measurable, therefore they are not science.”
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So economists turned away from squishy concepts like happiness and toward objective proxies for well-being, like GDP. In the postwar period, GDP became the go-to way for measuring well-being, even though the concept’s inventor, Simon Kuznets, warned that “the welfare of a nation can scarcely be inferred from a measurement of national income.”
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Economists also embraced metrics used to assess the value of different health <a href="https://www.vox.com/policy">policies</a>. One of these is the quality-adjusted life year (QALY). One QALY is equal to one year of life in fantastic health. So the more QALYs a policy secures for a population, the better it’s deemed to be.
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Starting in the 1970s, though, the intellectual pendulum began to swing back toward subjective well-being, thanks to a few key developments.
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First, economists started to rethink their assumptions about human behavior. They had long been assuming that people behave “rationally” — simply making the choices that will get them what they want. But in the 1970s, the behavioral economics researchers Daniel Kahneman and Amos Tversky <a href="https://www.newyorker.com/books/page-turner/the-two-friends-who-changed-how-we-think-about-how-we-think">argued that each of us is actually a pretty irrational mess</a>, shot through with cognitive biases, often behaving in ways that don’t maximize our happiness because we’re not great at predicting what will make us happy. That means you can’t just look at people’s behavior to determine what makes them happy — you have to survey them about how happy they are and try to tease out the causes.
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Second, economist Richard Easterlin showed in 1974 that richer doesn’t necessarily mean happier. Case in point: since World War II, Easterlin noted, the US had enjoyed a lot of economic growth, yet Americans’ level of well-being had barely budged. This became known as the Easterlin Paradox, and although it remains <a href="https://ourworldindata.org/happiness-and-life-satisfaction#the-easterlin-paradox">contested</a>, it was pivotal in getting people to realize that it’s important to measure subjective well-being and not just GDP.
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Partly as a result, in the 1970s, countries began collecting survey data on their populations. A typical survey question asked: “Overall, how satisfied are you with your life nowadays?” For 50 years, the data trickled in.
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<h3 id="gZX52e">
Subjective well-being stages its comeback
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With the exception of <a href="https://ophi.org.uk/policy/bhutan-gnh-index/">Bhutan, whose king asserted</a> in the 1970s that “Gross National Happiness is more important than Gross Domestic Product,” nobody made much noise about the well-being data until around 2009. Then the global financial crisis hit.
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Amid all the suffering, economists <a href="https://www.brookings.edu/wp-content/uploads/2017/02/global_20170201_adapting-to-adversity.pdf">realized</a> they knew very little about how people adapt to crises and which policies would best mitigate negative impacts on well-being. So national happiness became the subject of policy conferences and <a href="https://qz.com/work/1248972/yales-beloved-happiness-class-is-now-on-the-internet-for-free/">college courses</a>. France commissioned a study on it from economists Amartya Sen, Joseph Stiglitz, and Jean-Paul Fitoussi, who <a href="https://thenewpress.com/books/mismeasuring-our-lives">concluded</a> that an overemphasis on GDP had blinded policymakers to other aspects of societal well-being.
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In 2011, the OECD released its first <a href="http://www.oecdbetterlifeindex.org/">well-being report</a> on its member countries, and in 2012, the UN began releasing its annual <a href="https://worldhappiness.report/">world happiness report</a>. And individual countries began to collect data on well-being in more sophisticated ways.
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First of all, they designed surveys carefully, to avoid priming respondents in ways that might bias their happiness scores. For example, asking someone to think about politics right before you ask them about their life satisfaction is a big no-no. Surveys were also better able to control for culture-specific reporting differences, like whether it’s socially acceptable to complain about life.
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Another challenge with surveys, pointed out by Sen, was that a person’s self-reported well-being could simply adapt to whatever social environment someone has grown accustomed to, so it may not reflect real deprivations in that environment — especially ones that have been around long enough to be normalized.
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“Just because somebody poor in Guatemala says they’re happy at a daily level, that doesn’t mean we should say they’re all fine, let’s not worry about them,” said Carol Graham, a public policy professor at the University of Maryland and a senior scientist at Gallup, who has <a href="https://www.brookings.edu/people/carol-graham/">written prolifically</a> about how to measure subjective well-being.
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This had been a serious problem with early surveys, in part because they only used a single, general measure of well-being. They didn’t make distinctions between a long-term measure like life satisfaction and a short-term, affective measure like contentment or stress. So researchers weren’t able to tease out the difference between enduring life satisfaction and a brief bout of cheerfulness.
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Experts developed ways to deal with this. Take the UK, a global leader in measuring subjective well-being. About a decade ago, the government’s Office for National Statistics began including these four questions (dubbed the ONS4), each with a 0-10 score, in their annual population survey:
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4U127Z">
Overall, how satisfied are you with your life nowadays?
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FRi6ob">
Overall, to what extent do you feel that the things you do in your life are worthwhile?
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<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NkKCzJ">
Overall, how happy did you feel yesterday?
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On a scale where 0 is “not at all anxious” and 10 is “completely anxious,” overall, how anxious did you feel yesterday?
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The first question is designed to get a broad sense of people’s overall life satisfaction, which tends to be pretty stable over time. The second is about meaning or purpose in life. The third and fourth questions are more like a snapshot in time, intended to give a short-term measure of affect — happiness or contentment on one hand, and stress or anxiety on the other.
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Now, the UK government gathers two types of well-being data: the subjective data based on the ONS4 questions above, and <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/ukmeasuresofnationalwellbeing/dashboard">more objective data on things that are known to feed into societal well-being</a>, from health and wealth, to the unemployment rate and crime rate, to time spent in nature and volunteering. The government uses both the subjective and objective measures — 52 in total — to guide public spending.
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Other nations are also making policy based on a mix of subjective and objective measures of well-being. After New Zealand passed its groundbreaking well-being budget, for instance, its government began measuring progress using 61 well-being measures that track things like loneliness and trust in government institutions. It did not do away with GDP, but it went beyond it. As then-Prime Minister Jacinda Ardern <a href="https://weall.org/resource/new-zealand-implementing-the-wellbeing-budget">noted</a>, “GDP alone does not guarantee improvement to our living standards.”
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Lingering skepticism about subjective well-being data — and how experts are tackling it
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Lots of people are still skeptical of efforts to measure subjective well-being. That’s understandable — the word “subjective” is right there in the name.
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Take Elie Hassenfeld, the co-founder and CEO of the charity evaluator GiveWell. He’s used to metrics like QALYs, and he’s definitely got doubts about measuring subjective well-being with questions like “Overall, how satisfied are you with your life nowadays?”
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“What are you measuring exactly when you ask this question? I don’t really know what it means for someone to say ‘I’m a 6 out of 10’ in the way that I know what it means for someone to not have a broken arm,” he told me.
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“And to the extent that I could know what it means for someone, I wouldn’t know what it means for someone else,” he continued. In other words, does one person’s 6 correspond to another person’s 6? This is an <a href="https://www.happierlivesinstitute.org/report/the-comparability-of-subjective-scales/">open question</a> that needs further research.
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Hassenfeld also questions whether a measure of subjective well-being gets at the things we really care about, things that make life worthwhile. “My grandfather survived the Holocaust and came over and worked seven days a week, 18 hours a day, owning a diner for so many years,” he said. “And I don’t think that in any of those years, he would’ve given a high answer to a subjective well-being question. But he saved up enough money to send my mom and aunt to college, and there’s meaning there.”
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What Hassenfeld is getting at is this: We don’t have to feel happy in the moment to feel that our lives are worth living. Part of our happiness rests not in the present, but in the meaning we derive from working toward our goals in the future — and in the hope we have that we’ll be able to actually achieve those goals.
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It’s a critique that Graham takes seriously. “People in some poor countries tend to score higher than you’d think they’d score, and part of that is because they have hope for progress — they think things can get better,” she said. “Whereas in rich countries, where you have big sectors of the population that are declining relative to their peers, then they don’t have hope for the future.”
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Graham’s most recent book, <a href="https://press.princeton.edu/books/hardcover/9780691233437/the-power-of-hope"><em>The Power of Hope: How the Science of Well-Being Can Save Us From Despair</em></a>, argues that hope needs to be part of well-being metrics. She has already convinced one pretty important reader: the UK government, which recently expanded its battery of survey questions. “I’m really thrilled that hope is now a measure,” Graham told me.
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Plant, of the Happier Lives Institute, agrees that how much meaning or hope you have in your life may affect how happy you are. But, he said, that’s probably already reflected in people’s answers to happiness questions. “Part of the virtue of the subjective approach is that people can bring whatever matters to them into their assessments. So, how much meaning you have in your life could be an input into that.”
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And when he looks at a survey like the World Happiness Report, he feels confident that it’s capturing something pretty close to reality. The data makes sense. Many of the top 10 happiest countries, according to that survey’s 2020–2022 <a href="https://happiness-report.s3.amazonaws.com/2023/WHR+23.pdf">rankings</a>, are the ones with strong social safety nets combined with high GDP per capita, especially the Nordic countries. By contrast, the bottom 10 countries are nations that have been wracked by poverty, violence, or both:
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Looking at this type of data, Plant said, “I don’t have much time for feelings-measurement skepticism. I think the counterarguments there just aren’t very strong.”
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nV8siY">
Even skeptics like Hassenfeld do believe that subjective well-being data is getting at something real. In a recent <a href="https://80000hours.org/podcast/episodes/elie-hassenfeld-givewell-critiques-and-lessons/">podcast interview</a>, he said, “I think the pro of subjective well-being measures is that it’s one more angle to use to look at the effectiveness of a program. It seems to me it’s an important one, and I would like us to take it into consideration.” This warming toward subjective well-being is a big deal, given that his organization, GiveWell, influences how <a href="https://www.givewell.org/about/impact">over $500 million</a> is spent on charity each year.
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Should subjective well-being be the <em>only</em> measure?
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According to Plant, well-being data is now robust enough that we should feel emboldened to go further than nations like New Zealand have gone.
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“To be a full-blown well-being budget, you would actually compare things in terms of units of well-being, which the New Zealand government isn’t doing,” Plant told me. He believes each<em> </em>policy<em> </em>should be evaluated according to how many well-being units it produces, and policymakers should invest in the intervention that comes out on top.
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Right now, New Zealand and other nations are using dozens of measures to assess policy outcomes, some that capture subjective well-being directly and others that capture objective facts that relate to well-being. But how is anyone supposed to compare two policies with precision, Plant reasons, when one outcome is in units of well-being and the other is in dollars? That’s apples to oranges.
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Instead, Plant argues we should compare how much good different things do in a single “currency” — specifically, how many well-being-adjusted life years, or Wellbys, they produce. Producing one Wellby means increasing life satisfaction by one point (on the 0-10 life satisfaction scale) for one year. It’s a metric that some economists, <a href="https://worldhappiness.report/ed/2021/living-long-and-living-well-the-wellby-approach/">including those behind the World Happiness Report</a>, are coming to embrace. If we were to evaluate every policy in terms of how many Wellbys it produces, that would allow for direct apples-to-apples comparisons.
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“I’m pretty bullish about just using well-being as the [single] measure,” Plant told me.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8YhXxw">
So far, however, no government has fully thrown away more conventional metrics in favor of using only Wellbys. Graham thinks doing that would be a bad idea. “The Wellby is a reasonable measure. Many of my colleagues are in favor of it,” she said. But she’s adamant that it should not be the only measure. “I’m not interested in replacing GDP or all the other objective measures,” she explained, because what’s most useful is “when you find gaps between objective and subjective measures, and then you can ask what’s driving that.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="olu3Mw">
“Take the paradox of unhappy growth in rapidly growing countries like <a href="https://www.brookings.edu/articles/why-did-the-chinese-become-less-happy-during-their-growth-boom/">China</a> and <a href="https://www.theguardian.com/inequality/2022/apr/17/rich-countries-that-let-inequality-run-rampant-make-citizens-unhappy">India</a>, where life satisfaction falls and suicides rise at periods of rapid growth,” Graham said. “GDP captures the growth rate, and subjective well-being measures capture how people are experiencing and feeling about life. Rapid growth brings uncertainty, cultural change, and rises in inequality, all things people do not like. These things usually even out over time but periods of change, especially rapid change, tend to be unhappy ones.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hh6Z24">
And in the US, Graham noted, “GDP levels and unemployment rates suggest prosperity and stability.” But they mask extremely high levels of inequality — one of the reasons why Americans are becoming more miserable — and high levels of despair, including rising mortality due to deaths of despair. “GDP alone cannot tell that story.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sbxRNM">
On the flip side, subjective well-being alone also may not tell the full story. People in poor countries sometimes score higher on happiness than their income levels would predict, but their happiness could stem from the hope that things will improve. We shouldn’t let it occlude the fact that they’ve been forced into situations of deprivation because of global injustice. “You still need to look at their life expectancy, their disease rate, and so on,” Graham said. “That’s why I think you need both kinds of measures. They capture what we wouldn’t otherwise notice.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KQwJMz">
Likewise, when I asked Hassenfeld if he could imagine GiveWell ever completely doing away with objective measures like QALYs and only using subjective well-being to compare cost-effectiveness across charities, he demurred. “I mean, never say never,” he said. “But I think it’s unlikely that we would ultimately go all-in on this metric.”
</p>
<h3 id="mq4izU">
Should we prioritize saving lives or improving them? And who gets to decide?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HIDm81">
When you’re deciding what to fund, it’s definitely helpful if you can directly compare how much good different things do in a single currency. But whether the currency you use is GDP or QALYs or Wellbys or something else, the good life isn’t reducible to a universal mathematical equation. It’ll always depend on your philosophical assumptions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="d1mvaZ">
If you have to choose between extending and improving lives, one philosophical question you’ll have to face is this: Is it worse for a little kid to die, or an adult? In Western philosophy, there are three main views one could take on this.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NqDt9t">
According to deprivationism, it’s best to save the youngest kids, because they stand to be deprived of the most good years if they die now.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6etxmS">
According to the time-relative interest school of thought, it’s best to save someone older because they’ve got the psychological capacity to think about their future self, so they have more interest in getting to become that older self.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bGSJXV">
And according to Epicureanism, death isn’t actually bad for the person who dies (how can something be bad for them if they don’t exist?). So it makes sense to give more weight to living well, not living long.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pAoujk">
Which of these philosophical views you subscribe to can dramatically alter the cost-effectiveness of the charities or policies you’re evaluating.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VmqAWW">
Plant’s team <a href="https://www.happierlivesinstitute.org/report/the-elephant-in-the-bednet/">showed this</a> by comparing how much good three charities do — StrongMinds, GiveDirectly, and the Against Malaria Foundation (AMF) — in terms of how many Wellbys each produces. It turned out saving lives by preventing malaria was a bit more cost-effective than StrongMinds, but only if you held the philosophical view most favorable to saving lives. If you embraced a different assumption, like deprivationism, AMF’s cost-effectiveness nosedived to 12 times <em>less</em> cost-effective than StrongMinds, or around the same as GiveDirectly.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PwYOFE">
The crucial point here is that because no one philosophical view is objectively right — this comes down to your own personal values and opinions — the issue can’t just be mathematized away.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="86l8r6">
And there’s a growing consensus that those on the receiving end of charity or policy decisions should be the ones whose values and opinions carry the day; anything else would be paternalistic. Governments like those of Wales and New Zealand have directly sought the input of their populations to ask what matters most to them. And the charity world is catching on, too.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UCho7h">
A few years ago, GiveWell asked extremely poor people in Ghana and Kenya about their “<a href="https://www.vox.com/future-perfect/2019/12/20/21009803/givewell-survey-kenya-ghana-saving-lives-poverty">moral weights</a>.” How do<em> they </em>weigh saving lives versus improving lives (say, by reducing poverty)? The respondents came out very strongly in favor of saving lives, especially young lives.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3XPLZn">
It was a good impulse to survey recipients about their preferences, but there were two unfortunate things about how it was done. First, the questions were formulated in a complicated way that could have confused respondents, since they required a solid understanding of probabilities. And second, instead of just basing its spending decisions on the stated preferences of the respondents, GiveWell also polled its own <a href="https://docs.google.com/document/d/1hOQf6Ug1WpoicMyFDGoqH7tmf3Njjc15Z1DGERaTbnI/edit">staff and donors</a> for their personal views and folded those into its decision-making.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ehqfas">
“They decided to weight [the views] on the basis of the answer they thought was most sensible in the first place. That’s circular,” Plant said. “I’m inclined to go the other way — to say, this is really complicated, it’s unpleasant to think about, and people will make different choices.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Urrums">
That probably feels like an annoying place to end up. But it’s true. We’ve now got more sophisticated methods for measuring subjective well-being, but it’s still complicated. It feels morally uncomfortable to think about the questions this type of measurement raises. And, most importantly, these questions are not answerable through math alone — some of this will always be about values, and those are, well, subjective.
</p>
<ul>
<li><strong>Why so much is going wrong at the same time</strong> -
<figure>
<img alt="An illustration shows a map of earth in alarming, bright colors, broken into sections which radiate out in every direction." src="https://cdn.vox-cdn.com/thumbor/lZoHGTqOlCPq_ExSBOQfeWZBVHg=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72767654/Vox_Polycrisis_ClaireMerchlinsky.0.jpg"/>
<figcaption>
Claire Merchlinsky for Vox
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Lots of things are going wrong. Does that make it a polycrisis?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vtFYhW">
Is the world facing a “<a href="https://polycrisis.org/">polycrisis</a>”? Is there even such a thing?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4lLel7">
First <a href="https://cascadeinstitute.org/wp-content/uploads/2022/04/What-is-a-global-polycrisis-v2.pdf">coined</a> in the late 1990s, the term entered the zeitgeist earlier this year, when “polycrisis” became the neologism du jour at the most recent <a href="https://www.vox.com/23572710/polycrisis-davos-history-climate-russia-ukraine-inflation">World Economic Forum meeting in Davos</a>. Its use evoked the world’s current tangled mess of problems — pandemic, war, climate extremes, energy shortages, inflation, rising authoritarianism, and the like — and the term caught on.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tSJCvA">
Inevitably, critics have multiplied since then — as have crises, such as <a href="https://www.vox.com/2023/10/7/23907683/israel-hamas-war-news-updates-october-2023">the violence now convulsing Israel and Gaza</a>. Those on the political center and right say the polycrisis concept is nothing more than a <a href="https://www.washingtonpost.com/business/so-were-in-a-polycrisis-is-that-even-a-thing/2023/01/21/cf05856e-9963-11ed-a173-61e055ec24ef_story.html">fancy buzzword</a>. Sure, a lot of bad stuff is happening in the world, but that’s always been the case. As historian Niall Ferguson has <a href="https://www.cnbc.com/2023/01/17/idea-of-de-globalization-is-a-mirage-says-historian-niall-ferguson.html">scoffed</a>, the polycrisis is “just history happening.” For Ferguson and other critics, the concept merely recycles old alarmist, <a href="https://www.vox.com/23572710/polycrisis-davos-history-climate-russia-ukraine-inflation">Malthusian</a> tropes. We can count on well-established <a href="https://noahpinion.substack.com/p/against-polycrisis">counterbalancing forces</a>, they argue, including free markets’ price mechanism, to keep today’s crises from causing widespread harm.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iysPpS">
Meanwhile, critics on the <a href="https://developingeconomics.org/2023/01/27/whose-polycrisis/">left</a> say that the polycrisis idea distracts attention, perhaps deliberately, from the real driver of humanity’s traumas: relentless, predatory globalized capitalism.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RaWRu0">
The ruckus the term has sparked, though, suggests it’s tapping some irksome truths.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HzGOT8">
One is the assertion — implicit in the notion of polycrisis — that what’s happening today is essentially new. This idea particularly vexes critics on the political center or right, because it suggests that dominant economic and social structures need to radically change to accommodate our new reality. These critics would rather believe that humanity has been in similar circumstances before; and since we’ve coped well before (supposedly), we’ll cope again without changing things much.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="13IqYC">
Groupthink helps sustain this comfortable belief. Even Adam Tooze, the Columbia University historian who has been among the most thoughtful proponents of the polycrisis concept, makes the case for novelty only tepidly, <a href="https://adamtooze.substack.com/p/chartbook-192-on-deglobalisation">saying</a> the world exhibits a bewildering synthesis of long-established trends and new phenomena.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XTIAKD">
But in reality, new phenomena are now reconfiguring and even overwhelming old trends at an <a href="https://www.climatecentral.org/climate-matters/2022-u-s-temperatures-and-billion-dollar-disasters">accelerating rate</a>. We’ve moved so far and so fast outside our species’ previous experience that many elites don’t have the cognitive frame to grasp our situation, even were they inclined to do so.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="a1kz4S">
To see how novel today’s world really is — and how this novelty is helping to generate today’s polycrisis — let’s compare humanity’s past and present state on four key measures. This list isn’t remotely exhaustive, but it’s easily enough to make the case.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mDh90V">
The most basic measure is …
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hkLM8e">
<strong>1. Total human energy consumption:</strong> Driven largely by soaring use of cheap <a href="https://www.vox.com/fossil-fuels">fossil fuels</a>, our energy consumption has increased sixfold since 1950. Since that date, we’ve consumed about <a href="https://www.nature.com/articles/s43247-020-00029-y#:~:text=Since%201950%20CE%2C%20energy%20consumption,80%25%20of%20the%20economy86">60 percent</a> of all the energy we’ve produced in our species’ existence.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="K9rv9i">
No other factor has so transformed the economics of human civilization. Prior to the first Industrial Revolution in the 18th century, societies used between half and three-quarters of their economic output to get the energy they needed; since 1950, that proportion has fallen to less than 10 percent.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jj8aVL">
And as we’ve metabolized immense quantities of fossil fuels, we’ve also transformed the physical and ecological face of the planet, most importantly by shifting …
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="no46JU">
<strong>2. Earth’s energy balance:</strong> From the evolution of modern humans to the 20th century, the amount of energy arriving on Earth from space (mainly visible light from the sun) was roughly balanced by the amount going back out (mainly in the form of heat and reflected light). But now less energy is going out than coming in, because our greenhouse gas emissions are trapping more heat in the atmosphere. The imbalance is <a href="https://arxiv.org/pdf/2212.04474">at least 0.9 watts per square meter</a> at the planet’s surface.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kMtePd">
Perhaps that doesn’t seem like a big deal. But the extra energy adds up fast. It’s equivalent to placing a standard 1,200-watt hotplate turned to its maximum setting — enough to boil a quart of water in <a href="https://socratic.org/questions/a-1-200-watt-heater-is-used-for-raising-the-temperature-of-1-liter-of-water-to-b#:~:text=3)%20The%20water%20density%20is%201.0g%2FmL.&amp;text=The%20heater%20supplies%201200%20J,278.9s%20or%204.65%20minutes.">five minutes</a> — in the middle of each patch of Earth’s surface the size of an <a href="https://www.angi.com/articles/lot-size-index.htm">average American lot</a>. Aggregated across Earth’s entire surface, it’s the amount of energy that would be released by detonating 600,000 Hiroshima-size atomic bombs every day.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GKJyGF">
Injected into our oceans and atmosphere, this extra energy is not just heating things up, as we’ve seen with <a href="https://www.vox.com/climate/2023/7/5/23784587/hottest-day-heat-wave-recorded-temperature-climate-change">off-the-chart temperatures</a> this past summer. It’s also revving up the planet’s hydrologic system — the cycle of water between Earth’s surface and the air — which in turn is supercharging the increasingly extreme storms, floods, droughts, and wildfires appearing everywhere now. It’s like we’ve unleashed a massive beast, a Behemoth or Leviathan, that’s rampaging across the planet’s surface. Each year, as more and more energy arrives at Earth’s surface than goes back out, we pump more energy into the beast — so it gets bigger and does more damage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LxYysP">
This change in the planet’s physical properties is causing knock-on effects on global food output, mass migration, economic growth, and civil stability that are already sucking <a href="https://www.nature.com/articles/d41586-022-03573-z">trillions of dollars</a> of wealth out of the global <a href="https://www.vox.com/economy">economy</a>. All by itself, it’s enough to establish that humanity’s situation is now fundamentally different.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GnR5Nz">
But we’ve also seen a huge increase in …
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RbYGeq">
<strong>3. The human population’s total biomass:</strong> In the 125 years between 1800 and 1925, the world’s population <a href="https://www.worldometers.info/world-population/world-population-by-year/">approximately doubled</a>, from 1 billion to 2 billion. In the near-100 years since, it has quadrupled again, to 8 billion, with a total mass of just under <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013851/">400 million metric tons</a>. Vastly higher energy inputs to agriculture — for mechanization, irrigation, fertilizer production, and the like — made this faster growth possible. Without fossil fuels, in other words, our population would be a fraction of what it is today. In fact, about a third of the carbon in our bodies, totaling about 3 kilograms on average, originated in the coal, oil, or natural gas we’ve collectively burned. The carbon atoms have passed from the atmosphere through our crops’ photosynthesis and into our bodies through food consumption.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PHZ4P9">
Mushed all together, our total biomass would fill a cube about 750 meters on a side. That might not seem like much, except that we now constitute the <a href="https://www.pnas.org/doi/10.1073/pnas.2204892120#supplementary-materials">second most massive</a> single species on the planet. Cows come in first, with a total biomass about 5 percent larger than us. Sometime in the last two decades, as our population grew, we supplanted <a href="https://www.sciencedirect.com/science/article/abs/pii/S0967063708002513?via%3Dihub">Antarctic krill</a> for the No. 2 spot. (Both <a href="https://www.vox.com/climate">global warming</a> and overfishing <a href="https://news.mongabay.com/2022/08/climate-change-and-overfishing-threaten-once-endless-antarctic-krill/">threaten</a> to deplete krill biomass further.) Domesticated sheep, which are also a single species, rank No. 4.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CUav16">
By itself, growth in our biomass isn’t a reason for alarm. But it helps cause today’s polycrisis in combination with soaring …
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FLnBEP">
<strong>4. Connectivity of the human population:</strong> Aircraft, container ships, fiber-optic cables, satellites, oil tankers, and pipelines are all conduits for unprecedented circum-planetary flows of matter, energy, organisms, and information. Between <a href="https://databank.worldbank.org/home.aspx">1980 and 2020</a>, the number of air passengers nearly tripled, to 1.8 billion annually; air freight increased sixfold, to 180 billion ton-kilometers per year; and internet usage rose from virtually zero to 60 percent of the world’s population. Between <a href="https://unctadstat.unctad.org/datacentre/">1980 and 2022</a>, the total value of world merchandise trade increased 12-fold to nearly $25 trillion (at current prices), while container port traffic has more than tripled since 2000, to almost 800 million 20-foot equivalent units in 2020.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TvfhPz">
Abundant fossil fuel energy and innovations such as containerization boosted this connectivity, by permitting ever-greater amounts of stuff to be carried along the world’s conduits at relatively low cost. The end of the Cold War in the 1990s was also essential, because it allowed international diffusion of neoliberal economic norms and institutions that supported globalization of trade. (Rivalry between the US and <a href="https://www.vox.com/china">China</a> is now <a href="https://www.nber.org/papers/w31661?utm_campaign=ntwh&amp;utm_medium=email&amp;utm_source=ntwg11">weakening</a> this regime.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="woUX3U">
But the most vital cause of higher connectivity has been the ongoing collapse in the cost of communication. Decades of exponential improvements in computing power and in the communication systems that this power enables have driven the price of generating, storing, and distributing a bit of information to near zero. Billions of us around the world now carry in our pockets a computer that would have filled 50 Pentagons in the mid-1950s. We can use it to link almost instantaneously with nearly any of the other billions of computers. And because this communication is so cheap, we move among ourselves quantities of information that would have been incomprehensible barely more than a generation ago.
</p>
<h3 id="3F6i2R">
Discrete changes, one big polycrisis
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="s7KRH2">
Of the four changes I’ve highlighted, only the sharp increase in Earth’s energy imbalance is unequivocally a bad thing, at least for human well-being. But all four are markers of an unprecedented transformation in humanity’s circumstances — an explosive rise in human population, material consumption, connectivity, and global environmental impact beginning around 1950 that <a href="https://www.washingtonpost.com/opinions/a-new-version-of-earth/2016/04/21/4cc841dc-055d-11e6-b283-e79d81c63c1b_story.html">some scientists call</a> the “great acceleration.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mFW49h">
The acceleration of overall change is important. Yet even more important are the less-recognized <a href="https://cascadeinstitute.org/technical-paper/global-polycrisis-the-causal-mechanisms-of-crisis-entanglement/">causal interactions</a> among discrete changes like the four I’ve highlighted. And it’s these interactions that are generating today’s polycrisis.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S3hjYd">
Here’s an example. Scientists have <a href="https://www.science.org/doi/10.1126/science.1225244">shown</a> that ecological, technological, or social systems that are both highly connected and highly homogeneous are especially prone to cascading failures — that is, to failures that resemble a row of dominoes falling over. High connectivity lets a disruption — for instance, a pathogen or external shock — move quickly from one part of a system to other parts; high homogeneity ensures the disruption’s impact is similar across those parts.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="bPqCkT">
Think of a field planted with rows of genetically identical corn. The close proximity of the stalks ensures high connectivity, so a blight can easily jump from one plant to another. Their genetic homogeneity ensures that the blight will be equally harmful across all plants. This is a major reason modern industrial agriculture relies so heavily on pesticides.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="k6qksB">
The human population is now just like that field of corn. We’re a highly connected, largely genetically identical biomass, except in this case, we’re vastly more massive and our “field” extends across much of the planet’s surface. And, sure enough, we’re exhibiting a monocrop’s vulnerability to pathogens, so we’re using (and in some cases overusing) <a href="https://www.vox.com/future-perfect/22922018/antibiotic-resistance-epidemic-drug-resistant-infections">antibiotics</a> and antivirals just the way we use pesticides on our crops.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DBmbiW">
Of course, because we’re a single species, we’ve always been genetically homogeneous, and for millennia we’ve also been somewhat connected by travel and trade, which is why humanity has long experienced pandemics. But the combination of our homogeneity with our recently multiplied biomass, and now our extraordinary connectivity, has created a qualitatively new situation. While in the 19th century, cholera took <a href="https://en.wikipedia.org/wiki/1826%E2%80%931837_cholera_pandemic">years</a> to spread around the planet, and in 1918 influenza took <a href="https://ap.gilderlehrman.org/history-by-era/essays/influenza-pandemic-1918%E2%80%931919">months</a>, now infectious pathogens travel to the other side of the world in <a href="https://www.cdc.gov/museum/timeline/covid19.html">weeks</a>. Our species has become by far Earth’s most inviting medium for the rapid evolution and propagation of pathogens.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rwdcwN">
Climate change is playing a role, too. By disrupting habitats and forcing wild animals into <a href="https://www.nature.com/articles/s41586-022-04788-w">closer proximity</a> to our populations, it’s increasing the risk that pathogens not recognized by our immune systems will jump from animals to humans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="llXbFx">
It turns out that the field-of-corn analogy also applies to our world’s financial systems, much of our shared technological and manufacturing infrastructure, and many of our food systems, because these systems are not only highly connected but also increasingly homogeneous. Globally networked corporations like <a href="https://www.vox.com/meta">Meta</a>, <a href="https://www.vox.com/microsoft">Microsoft</a>, Unilever, Cargill, and <a href="https://www.vox.com/tesla">Tesla</a> lower their costs and grow by standardizing their products across diverse national markets. Similarly, global institutions like the <a href="https://www.iso.org/home.html">International Organization for Standardization</a> or the <a href="https://www.fsb.org/about/history-of-the-fsb/#:~:text=The%20FSB%20was%20established%20in,and%20mandate%2C%20and%20organisational%20structure.">Financial Stability Board</a> increase their economic and political clout by bringing more people and nations under their rules’ ambit. Both processes have caused a progressive standardization of goods, services, and procedures.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uHdS08">
Nearly everywhere in the world, for example, national economic systems, including central banks, ministries of finance, and the like, now have similar designs. Financial instruments like types of <a href="https://www.vox.com/stock-market">stocks</a>, bonds, and their derivatives are similar nearly everywhere, too, as are core industrial processes, antibiotics, germplasm for essential crops and livestock, fast food restaurants, clothing, language of commerce, consumerist notions of the good life, and even blockbuster <a href="https://www.vox.com/movies">movies</a>. For some kinds of goods and services — those that become more useful as more people use them (exhibiting what economists call “<a href="https://thebusinessprofessor.com/en_US/economic-analysis-monetary-policy/network-externalities-defined">positive network externalities</a>”) — standardization can be self-reinforcing, leading to market domination by a few products and producers. All over the planet, for instance, people choose from a handful of social media platforms and among basically two operating systems for both <a href="https://gs.statcounter.com/os-market-share/desktop/worldwide">desktop computers</a> (including laptops) and <a href="https://gs.statcounter.com/os-market-share/tablet/worldwide">tablets</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DJDAEh">
And, sure enough, this diversity decline is combining with hyperconnectivity to produce cascading failures when key systems are hit by sudden shock. The pandemic snarled just-in-time <a href="https://www.vox.com/recode/2022/10/19/23410720/supply-chain-fix-holidays-pandemic">supply chains</a> of standardized goods that stretched worldwide, catalyzing global inflation. Ransomware attacks exploiting standardized software now regularly cause ramifying damage to vital services, including <a href="https://www.nytimes.com/2023/08/05/us/cyberattack-hospitals-california.html">health</a> and <a href="https://www.nytimes.com/2021/05/08/us/politics/cyberattack-colonial-pipeline.html">energy</a> infrastructure. Sometime in the not-distant future, extreme weather will likely hit <a href="https://www.sciencealert.com/researchers-weve-underestimated-the-risk-of-simultaneous-crop-failures-worldwide">multiple breadbaskets simultaneously</a>, leading to <a href="https://iopscience.iop.org/article/10.1088/1748-9326/ab4864">disruption</a> in the worldwide trade of standardized grains that provides a large fraction of humanity’s calories.
</p>
<h3 id="if35wR">
The way forward
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yVhpz6">
But this isn’t a counsel of despair. There’s much we can do to defuse the polycrisis. Most obviously, given that Earth’s worsening energy imbalance seems to be emerging as the single most powerful driver of crises across multiple ecological, economic, and social systems, humanity needs to cut greenhouse gas emissions to near zero as fast as possible. Realistically, though, we won’t cut them deeply enough soon enough to keep the imbalance from having devastating impacts, not least on the world’s food supply. So, within the next couple of decades, humanity will <a href="https://foreignpolicy.com/2023/05/23/solar-geoengineering-radiation-modification-srm-regulation-climate-change/">almost certainly intervene</a> to increase the atmosphere’s reflectivity to sunlight — perhaps by pumping sulfur dioxide crystals into the stratosphere — until emission cuts really take effect.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Dgv1Ry">
For other polycrisis drivers, we can leverage the ways connectivity and homogeneity interact to attenuate their impact, but how we do this will depend on which crises in which systems we’re trying to mitigate. If we want to make pandemics less common and severe, for instance, we can’t do anything about our genetic homogeneity, and our total biomass, at least in the short to medium term, will remain high; we can, however, tweak our physical connectivity when necessary. Travel restrictions should become a regular part of humanity’s response to outbreaks of novel viral diseases. And, yes, despite liberal hand-wringing about the human rights implications of these restrictions, <a href="https://www.sciencedirect.com/science/article/pii/S0163445321003601">they do work</a> to slow disease spread, by allowing societies to prepare and helping them flatten the infection curve.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jdABMc">
When it comes to reducing the incidence and harm of cascading failures in food, technological, and economic systems, we’ll likely find lowering homogeneity more effective, because the world is deeply committed to trade and especially to information connectivity. This could mean targeted interventions — perhaps through tax incentives and regulations — that encourage companies to diversify the world’s food supplies, software ecosystems, and financial instruments.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FzrD54">
But the thing we must do most urgently is gain a better understanding of the polycrisis’s underlying mechanisms. Why are so many of the world’s critical systems tipping into negative territory simultaneously? We have only <a href="https://cascadeinstitute.org/technical-paper/global-polycrisis-the-causal-mechanisms-of-crisis-entanglement/">bits and pieces of the answer</a> at the moment, largely because universities, corporations, think tanks, and governments compartmentalize their expertise and attention into categories that align with the systems — economic, health, climate, geopolitical, and the like — that they see in the world. So they tend not to see interactions among these systems that propel the polycrisis, which means they’re far less able to intervene effectively.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EISXVx">
Once again, the problem starts at the top: Our societies’ elites, and the institutions they populate and constitute, simply don’t have the cognitive frame to grasp what’s going on. They can improve their grasp, but first they should stop telling themselves that there’s nothing new happening in the world.
</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Gods Plan, Race For The Stars, Timeless Romance and Empress Royal excel</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Rasputin, Ataash and Fidato show out</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Same-sex marriage will one day become reality, says India’s fastest woman Dutee Chand</strong> - Dutee said the marriage between same-sex should not be seen in terms of urban-rural, upper-lower, caste, creed or religion</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Volleyball bounces off the net of National Games in Goa</strong> - Busy with Asian Games in the last few months, ad hoc committee says it did not have time to conduct Nationals to select teams for Goa.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Shane Bond parts ways with Mumbai Indians</strong> - Bond made the decision to part ways with MI after the five-time IPL champions appointed Lasith Malinga as their bowling coach for season 2024</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Congress has no faith in either Constitution or Supreme Court: BJP responds to Adani coal invoicing allegations</strong> - After Rahul Gandhi attacked the PM on alleged inflated invoicing of coal imports by the Adani group, the BJP said the matter was already being heard in the SC; pivots to accuse Congress of corruption</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Flash floods caused ₹233.56 cr expected loss in Teesta-VI hydro project in Sikkim</strong> - The company further said that all assets/works of Teesta-VI HE project are insured under the Construction All Risk (CAR) Policy, subject to excess clause and loss limit</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ethics Committee calls BJP MP Dubey, advocate Dehadrai for statement in complaint against Moitra</strong> - Ms. Moitra has hit back, saying she “welcomes any move against her.”</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Kochi Metro Rail Ltd seeks to allay fears over issues in construction of water metro terminals</strong> - Fort Kochi Water Metro terminal construction is progressing, and the work is being supervised by KMRL and the general consultant Aecom consortium, says KMRL</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>BRS MLC Kavitha calls Rahul ‘Election Gandhi’, asks him to visit Telangana as tourist and taste ‘Ankapur chicken’</strong> - Congress party could not provide basic amenities to the people: Kavitha</p></li>
</ul>
<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Europe antisemitism: Berlin synagogue hit as attacks rise</strong> - Berlin’s Jewish community is shaken after two petrol bombs are thrown at a synagogue.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Vladimir Putin feted at Xi Jinping’s global Belt and Road summit</strong> - Russia and China’s leaders took centre stage at a forum attended by leaders from the Global South.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine uses US-supplied ATACMS for the first time, says Zelensky</strong> - The ATACMS weapons were reportedly used in air strikes that destroyed Russian helicopters.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Sweden investigating damage to Baltic undersea cable</strong> - A gas pipeline between Finland and Estonia is believed to have been damaged at the same time, Sweden says.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Brussels shooting: Police shoot dead attacker who killed Swedes</strong> - Two died and one person was injured in the Monday attack coinciding with a Sweden football match.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>COVID antiviral Paxlovid to see price increase following 400% vaccine hike</strong> - The new price is not set, but one analyst suggested it could be up to 5x higher. - <a href="https://arstechnica.com/?p=1976723">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The most insane “robocall mitigation plans” that telcos filed with the FCC</strong> - FCC received blank pages, a Windows Printer Test, and an “indiscernible object.” - <a href="https://arstechnica.com/?p=1976614">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Apple introduces a new Pencil for the iPad—its cheapest yet</strong> - A cheaper option is welcome, but Apple’s Pencil lineup is now a bit confusing. - <a href="https://arstechnica.com/?p=1976577">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Mazda’s DMCA takedown kills a hobbyist’s smart car API tool</strong> - Financial risk too great for dev working “in my spare time to help others.” - <a href="https://arstechnica.com/?p=1976526">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>“Cisco buried the lede.” &gt;10,000 network devices backdoored through unpatched 0-day</strong> - An unknown threat actor is exploiting the vulnerability to create admin accounts. - <a href="https://arstechnica.com/?p=1976348">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Texan walks into a pub in Ireland and clears his voice to the crowd of drinkers.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He says, “I hear you Irish are a bunch of hard drinkers. I’ll give $500 American dollars to anybody in here who can drink 10 pints of Guinness back-to-back.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The room is quiet and no one takes up the Texan’s offer. One man even leaves. Thirty minutes later the same gentleman who left shows back up and taps the Texan on the shoulder. “Is your bet still good?”, asks the Irishman.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Texan says yes and asks the bartender to line up 10 pints of Guinness. Immediately the Irishman tears into all 10 of the pint glasses drinking them all back-to-back. The other pub patrons cheer as the Texan sits in amazement.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Texan gives the Irishman the $500 and says, “If ya don’t mind me askin’, where did you go for that 30 minutes you were gone?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Irishman replies, “Oh…I had to go to the pub down the street to see if I could do it first”.
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Reddtko"> /u/Reddtko </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17aeyeu/a_texan_walks_into_a_pub_in_ireland_and_clears/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17aeyeu/a_texan_walks_into_a_pub_in_ireland_and_clears/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>As the man made his way to his seat at the World Cup Final, he couldn’t help but feel excited.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
But as he sat down by the pitch, he noticed the seat next to him was empty. “What a waste,” he thought to himself. “Who would have a seat like this and not use it?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Curiosity getting the best of him, he leaned over to his neighbour and asked if someone would be sitting there. “No,” the neighbour replied. “The seat is empty.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The man couldn’t believe it. “This is incredible,” he exclaimed. “But seriously, who in their right mind would pass up the chance to watch the World Cup Final from this seat?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
That’s when the neighbour dropped a bombshell. “Actually, the seat belongs to me. I was supposed to come with my wife, but she passed away. This is the first World Cup Final we haven’t been to together since we got married.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The man’s heart sank. “Oh, I’m so sorry to hear that. That’s terrible.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
But then he had an idea. “Couldn’t you find someone else to take her seat? A friend, relative, or even a neighbour?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The neighbour shook his head. “No,” he said. “They’re all at the funeral.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Reddtko"> /u/Reddtko </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17afbh1/as_the_man_made_his_way_to_his_seat_at_the_world/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17afbh1/as_the_man_made_his_way_to_his_seat_at_the_world/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A man who likes a drink…</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A man who liked a drink was warned by his long-suffering wife that if he comes home drunk one more time she will leave him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The next evening he is out with his colleagues after work, drinks way too much and is sick all down his jacket.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He explains that his wife is likely to leave him when a colleague says “Tell you what you do… put twenty bucks in your inside pocket and explain that someone else was sick on you and gave you money for the cleaning bill”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
After agreeing that it was a fine idea, he goes home where upon his wife spots the sick and starts to have a go at him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He says “No, listen dear. Some chap threw up on me and gave me twenty to get it cleaned”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The wife replied “So why do you have 2 twenties in your hand?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Ah,” answered the man “the other twenty is from the chap that shat in my pants”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/DoorbellEndoscopy"> /u/DoorbellEndoscopy </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17actkf/a_man_who_likes_a_drink/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17actkf/a_man_who_likes_a_drink/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A drug addict stumbles upon a magic lamp</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A drug addict stumbles upon a shiny lamp. As soon as he picked it up, … pufff… a Genie appeared from the smokes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“I shall grant you <strong>three wishes</strong>!”, the genie said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The drug addict, without hesitation: “Let’s do a line of cocaine for both of us”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Poof… A line of cocaine appeared on a golden plate, they snort, and trip for the next 2 hours.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“So, what shall your second wish be?”, the genie asks.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Let’s do another line!”, the addict replies.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Pooof… golden plate, two lines. They snort again, and trip again for the next 2 hours.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“What would be your third wish, Master?”, the genie asks.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The addict, again without hesitation: “Let’s do it again”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Poof… golden plate, two lines of cocaine, they snort and trip balls for the next 4 hours.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The genie high AF turns to the addict and says: “Alright, what’s your next wish?”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/ad-on-is"> /u/ad-on-is </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/179zlm5/a_drug_addict_stumbles_upon_a_magic_lamp/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/179zlm5/a_drug_addict_stumbles_upon_a_magic_lamp/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>With the economic downturn everyone needs to hustle.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
So this middle-aged guy goes to the doctors for his check-up.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the doctor looks in his eyes, ears, throat etc. Gets him to cough.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And then says “you have got terribly dirty balls”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the guy says, “look I am a very busy guy, let’s get on with the blood pressure etc”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the doctor says “but you’ve got terribly dirty balls”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the guy says “OK, but just let’s get this over with, I have to get back to work”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When the guy gets home he says to his wife “Do you want to hear what the doctor said about my health?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the wife says “look I am really busy, these days I don’t even have enough time to wipe my own arse”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
And the guy says “and that’s another thing I need to talk to you about!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/jimph"> /u/jimph </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/17ad75e/with_the_economic_downturn_everyone_needs_to/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/17ad75e/with_the_economic_downturn_everyone_needs_to/">[comments]</a></span></p></li>
</ul>
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