The state is using a new untested method that’s prompted backlash.
A controversial Alabama execution taking place on Thursday has reignited scrutiny of the death penalty and highlighted the enduring nature of the practice despite attempts to end it.
Physicians and human rights experts have condemned the execution — which relies on an untested method known as nitrogen hypoxia — because there are concerns it could be painful and inhumane. Alabama is planning to use this method on an inmate named Kenneth Smith, after the state botched his first scheduled execution in 2022 when it couldn’t find an accessible vein for a lethal injection. Smith was sentenced to the death penalty after he was convicted of capital murder in 1988.
Using nitrogen hypoxia, the state will place a mask over Smith’s head that contains nitrogen instead of oxygen, an action that will eventually suffocate him.
Though a slim majority of Americans still back executions — Gallup’s November 2023 polling found a new low of 53 percent to be in favor of executing convicted murders — support has been declining for three decades, since a peak in 1994. Medical and ethical questions have also led critics to call for the abolition of the death penalty. And Gallup found that, for the first time, more people now feel the death penalty is unfairly applied than those who believe it’s fairly applied.
These stances have gained steam in recent years, with some pharmaceutical companies refusing to supply lethal drugs and equipment to conduct executions. Corporations like Pfizer and Johnson & Johnson are among those that block the sale of drugs and medical supplies for this purpose. Politically, the idea has begun to take hold as well. As part of his presidential policy platform in 2020, President Joe Biden said he’d work to abolish the federal death penalty, a proposal he’s been scrutinized for failing to follow through on. More than 20 states have also abolished the death penalty.
States like Texas, Florida, and Alabama have held out against this pressure, arguing that the death penalty is a fitting punishment and deterrent against violent crime. These states’ insistence on using the death penalty in an environment where there are fewer avenues for killing people has also led them to embrace more extreme measures, like firing squads and nitrogen hypoxia.
Alabama’s decision to pursue an untested method only adds to longstanding concerns that have been raised about the death penalty, while underscoring how committed some states are to keeping it.
The ongoing fight over the death penalty, briefly explained
Critiques regarding the use of capital punishment have increased in the last decade as opponents have emphasized the racial disparities in its application, identified worries about how humane it is, and cited cases when innocent people have been convicted. Among the chief problems that have been raised are that people of color are much more likely to be sentenced to executions than white defendants and evidence that it does little to deter violent crime.
Ethical concerns are also a major part of the equation. Smith’s attorneys have argued, for instance, that the state may not be able to conduct his execution without concerning side effects that draw out the killing. There are also worries that Smith could choke during the process if he vomits while it’s taking place. And as UN human rights officials have warned, nitrogen hypoxia could “amount to torture or other cruel, inhuman or degrading treatment.”
Lawyers for the state of Alabama, meanwhile, have defended the practice and said that it will be painless, that Smith will be unconscious within seconds. Similar methods have also been used in assisted suicides in Europe. In recent weeks, Smith’s counsel put in a last-ditch plea to block the execution on the grounds that it violates his constitutional protections against “cruel and unusual punishment,” but the Supreme Court declined to do so.
“I think the various practical problems of the death penalty have generated a public opinion movement against it,” says Frank Baumgartner, a political science professor at the University of North Carolina at Chapel Hill who has specialized in the study of capital punishment. “It started with innocence but has spread to botched executions, cost overruns, time delays, [and] lack of deterrence value.”
Democrats, in particular, have embraced efforts to roll back or get rid of the death penalty entirely. In the Gallup survey, just 32 percent of Democrats said the death penalty should be applied to someone who committed murder while 81 percent of Republicans said the same.
Actions by Republican-led states, like Alabama, have underscored the contrast between the two parties. Those who favor the continued application of capital punishment argue that it deters violent crimes, that it’s fitting retribution for crimes like murder, and that it brings justice to the families of victims. The case for the death penalty is also often made in conjunction with other “law and order” rhetoric during times when violent crime rates are high.
The use of the death penalty overall, however, has been on the decline. Although 27 states still allow the death penalty, 14 of those have not conducted any executions in the past 10 years, according to CNN. Executions have dwindled since 1999, which marked a recent high when nearly 100 people were killed. In 2023, 24 people were executed across five states.
These declines are due to political backlash toward capital punishment, changes in the law that have raised the legal bar for such sentences, declines in crime in recent decades, and better representation for capital defendants.
“I think anytime a state engages in a highly controversial act concerning the death penalty, it adds one more pebble on top of a pebble mountain of opposition,” says Deborah Denno, a Fordham University law professor who has specialized in the study of capital punishment. “That said, the death penalty is deeply rooted in the US — it’s part of our identity — and it’s going to take a massive number of pebbles to change that fact.”
“He doesn’t want us to solve the border problem because he wants to blame Biden for it.”
For years, Republicans have professed fury over a crisis at the US-Mexico border. For months, many in the GOP have insisted they could only support further aid to Ukraine if it was paired with tougher border security measures to address that crisis.
So President Joe Biden accepted their conditions, giving up Democrats’ longtime demands on immigration and conceding much of what the right wanted — and as recently as Monday, a bipartisan deal seemed near.
But now, Republicans may be backing out. Not because of the substance of the deal, but because it might hurt Donald Trump’s chances of retaking the White House.
That’s what Senate Minority Leader Mitch McConnell told Republican senators in a closed-door meeting, according to Jake Sherman of Punchbowl News, saying “the politics” had put them “in a quandary.”
“When we started this, the border united us and Ukraine divided us,” McConnell said, per Sherman. But, he went on, “The politics on this have changed.” The issue is that “the nominee” — Trump — wants to campaign on immigration. “We don’t want to do anything to undermine him.”
Some pro-deal senators pushed back on how these remarks were reported Thursday, claiming McConnell wasn’t affirmatively declaring the talks dead or separating the two issues. Sen. Mitt Romney (R-UT) said instead that McConnell was “ambiguous” about a path forward.
But it’s clear what McConnell was alluding to: that Trump wants there to be chaos at the border while Biden is president, because he thinks such chaos will help defeat the incumbent. Trump does not want congressional Republicans making a deal with Biden to address the actual substantive problem because that would make Biden look good.
Romney confirmed that interpretation. “The border is a very important issue for Donald Trump,” he told reporters Thursday. “And the fact that he would communicate to Republican senators and congresspeople that he doesn’t want us to solve the border problem because he wants to blame Biden for it is really appalling.”
If Republicans do kill the deal, it would make all their protestations about how much they supposedly care about this issue look hollow, and the GOP would come off looking tremendously cynical. They claim to believe the migrant surge of the past few years is destroying the country, but they’d be happy to let it continue unaddressed for another year if it means they win an election.
Why Republicans thought a difficult immigration deal was the key to passing Ukraine aid
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Alex Wong/Getty
The reason the immigration talks got as far as they did was because of an entirely different issue: Ukraine aid.
The national security establishment in both parties strongly supports further aid to Ukraine, believing that without it, the country’s resistance to Russia’s invasion might collapse. Many GOP senators, including McConnell, share that view, as did former speaker Kevin McCarthy and some House Republicans. But the MAGA right is strongly against further Ukraine aid. And with Republicans in control of the House, they’ve exerted pressure on their chamber’s leaders not to bring a “clean” Ukraine bill to a vote.
So, last year, various Republicans gradually glommed on to the idea of linking Ukraine aid to something they thought Trump supporters (and really all Republicans) wanted: border security.
To McConnell and the faction of Republicans truly trying to pass Ukraine aid, the theory was that forcing Biden into major border security concessions would be a “win” for the right and help make the bill more palatable for Republicans fearing backlash from the base (like new speaker Mike Johnson).
GOP leaders argued to their senators that this was the best chance they’d ever have to get Democrats to accept tough border measures — because, they said, Democrats would surely never agree to a deal with President Trump if he wins. And Republican senators, even anti-MAGA and pro-Ukraine ones like Mitt Romney, presented a united front in negotiations, saying Ukraine aid simply couldn’t pass unless Biden played ball on immigration.
Biden did play ball. And this was a big deal. The longtime reason for congressional gridlock on immigration was that Democrats insisted tougher border measures be paired with an agreement to legalize the status of unauthorized immigrants already living here. But in these talks, Democrats dropped that demand. The bill would be full of restrictionist measures and have nothing on legalization.
As I wrote in December, Biden made this shift in part to try to get the Ukraine aid and in part because he and other Democrats had concluded that the border status quo was unacceptable — that it was both a substantive mess and a political liability for their party.
The talks have been lengthy and difficult, and have at times provoked outrage from both the left and the right. But NBC News reported, citing a source, that as recently as Monday the major policy sticking points had been “largely resolved,” suggesting a deal could be finalized relatively soon.
But it all might fall apart — due to Trump’s campaign needs
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Anna Moneymaker/Getty
The prospects for the Senate deal have always been questionable in the House. Johnson has spoken of linking Ukraine aid to border security in a way that has surface similarities to Senate Republicans’ strategy. But he’s also said he’d demand far more than it seemed plausible for Republicans to get from Biden, and he hasn’t sounded thrilled with the emerging Senate framework.
In his few months since becoming speaker, Johnson has floundered about trying to please the right wing in the House. But now he has another problem: Trump.
Last week, Johnson appeared on Fox News, and host Laura Ingraham opened her interview by saying, “The president [Trump] actually just got off the phone with me right before the show, and he said he has spoken to you about this deal, and that he is against it, and he urged you to be against this deal.” She added, “President Trump was extremely adamant about that.”
Trump has publicly condemned the potential deal, writing last week on Truth Social, “I do not think we should do a Border Deal, at all, unless we get EVERYTHING needed to shut down the INVASION of Millions & Millions of people, many from parts unknown, into our once great, but soon to be great again, Country!”
When Republicans in the House and Senate have publicly criticized the deal, they have tended to say it simply wouldn’t be tough enough. Sen. Ted Cruz (R-TX) called it a “stinking pile-of-crap bill” and claimed it wouldn’t actually solve the border crisis. And it is unclear how much it would change the fundamental situation, since border arrivals are driven to a significant extent by factors outside of the US’s control.
But McConnell’s comments on “the politics” seem to reveal what he thinks is driving Trump’s recalcitrance. Indeed, Trump’s biggest fear might be that the bill will work, because then he’ll have a harder time attacking Biden. And in truth, he wouldn’t be wrong in that political analysis. A bipartisan border security deal would indeed make Biden look good — that’s one reason he’s been so eager for that deal.
Such blatant hackery, though, reveals the selfishness that’s always been core to who Trump is — he’s happy to throw the country under the bus for his own personal gain, as most famously demonstrated in his attempt to shred democracy rather than admit defeat in the 2020 election.
“The reality is that we have a crisis at the border,” Romney told CNN Thursday. And Trump, he said, was telling Republicans not to do anything about it, saying instead, “Hey, save that problem. Don’t solve it. Let me take credit for solving it later.”
The no good, very bad case against malaria bednets, explained.
Marc Andreessen, the billionaire venture capitalist and early web browser developer, thinks we’re giving too many insecticidal bednets to people exposed to malaria, tweeting, “Mosquito nets are a triple threat — dangerous to people, dangerous to fish, and dangerous to fishing ecosystems and the communities they feed.”
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That mosquito nets are dangerous to people would be news to basically any public health professional who’s ever studied them. A systematic review by the Cochrane Collaboration, probably the most respected reviewer of evidence on medical issues, found that across five different randomized studies, insecticide-treated nets reduce child mortality from all causes by 17 percent, and save 5.6 lives for every 1,000 children protected by nets. That implies that the 282 million nets distributed in 2022 alone saved about 1.58 million lives. In one year.
So … what the hell is Andreessen even talking about?
To understand why someone who has historically been more interested in crypto art than global health is suddenly tweeting about malaria, you have to know a little bit about Andreessen’s grudges. Andreessen’s VC firm, Andreessen Horowitz (a16z), has invested in a lot in AI companies lately, and he has aligned himself with a faction known as “effective accelerationists,” who favor aggressive progress in AI with minimal regulation or guardrails.
The effective accelerationists, or e/acc, define themselves in large part by their opposition to effective altruists, the social movement that began by focusing on cost-effective global health interventions and has more recently advocated for tough regulations to prevent AI from going awry (Future Perfect, the section running this article, is broadly inspired by EA ideas). Effective altruists have long been identified with anti-malarial bednets, a prime example of the very cheap, very effective global health causes they favor.
So, largely to stick it to the people who want AI regulation, Andreessen has committed himself to attacking one of the best methods of preventing malaria. If that doesn’t make sense to you, don’t worry; you’re not the one acting ridiculous.
But it’s worth taking the critique here at least marginally seriously. Do bednets have serious downsides, related to misuse for fishing, that their advocates are simply ignoring?
In a word: no. In multiple words: The finding that bednets save lives is not affected, at all, by the minority of people who use bednets to fish, rather than to protect themselves from malaria. Some of these people use nets that are several years old with insecticide that’s worn off, and are no longer effective at killing mosquitos. There is little research on what fishing with these nets actually does to fish or people — but also little reason to think the magnitudes of these effects are remotely near the number of lives saved by nets.
Bednets and fishing nets
Andreessen’s objection is rooted in something that’s been true of bednets for decades: sometimes, people use them as fishing nets instead.
This has occasionally popped up as an objection to bednet programs, notably in a 2015 New York Times article. One related argument is that the diversion of nets toward fishing means they’re not as effective an anti-malaria program as they initially appear.
That’s simply a misunderstanding of how the research on bednets works. The scientists who study these programs, and the charities that operate them, are well aware that some share of people who get the nets don’t use them for their intended purpose.
The Against Malaria Foundation, for instance, a charity that funds net distribution in poor countries, conducts extensive “post-distribution monitoring,” sending surveyors into villages that get the nets and having them count up the nets they find hanging in people’s houses, compared to the number previously distributed. When conducted six to 11 months after distribution, they find that about 68 percent of nets are hanging up as they’re supposed to; the percent gradually falls over the years, and by the third year the nets have lost much of their effectiveness.
So does this mean that bednets are only 68 percent as effective as previously estimated? No. Studies of bednet programs do not assume full takeup, because that would be a dumb thing to assume. Instead, they evaluate programs where some villages or households randomly get free bednets, and compare outcomes (like mortality or malaria cases) between the treated people who got the nets and untreated people who didn’t.
For instance, take a 2003 paper evaluating a randomized trial of net distribution in Kenya (this was one of the papers included in the Cochrane review). The researchers’ own surveys show that about 66 percent of nets were used as intended. The researchers did not exclude the one-third of households not using the nets from the study. Instead, they simply compared death rates and other metrics in the villages randomized to receive nets to those metrics in villages randomized to not get them. That comparison already bakes in the fact that a third of households who received the nets weren’t using them.
So estimates like “bednets reduce child mortality by 17 percent” are already assuming that not everybody is using the nets as intended. This just isn’t a problem for the impact estimates.
But is it a problem for fisheries? Andreessen cites one recent article to make this case. It’s not clear to me he actually read it.
The authors start by acknowledging that bednets have saved millions of lives, and even that the use of nets for fishing makes sense for many people. It’s a free way to get food you need to survive in regions often reliant on subsistence farming. Moreover, the authors note that “The worldwide collapse of tropical inland freshwater fisheries is well documented and occurred before the scale-up of ITNs.” At worst, you can accuse nets of making an existing problem worse.
The bigger question the authors raise is that insecticides are toxic. That’s, of course, the point: They’re meant to kill mosquitoes. The question, then, is whether they are toxic to fish or humans when used for fishing. The authors’ conclusion is maybe, but we have no research indicating one way or another. “To our knowledge there is currently a complete lack of data to assess the potential risks associated with pyrethroid insecticide leaching from ITNs,” the authors conclude. They are not sure if the amount leaching from nets is enough to be toxic to fish; they’re not fully sure that the insecticide leaches into the water at all, though they suspect it does. Even less clear is how these insecticides might affect humans who then eat fish that might be exposed to them.
I asked the study’s lead author, David Larsen, chair of the department of public health at Syracuse’s Falk College of Sport & Human Dynamics and an expert on malaria and mosquito-borne illnesses, for his reaction to Andreessen citing his work. He found the idea that one should stop using bednets because of the issues the paper raises ridiculous:
Andreessen is missing a lot of the nuance. In another study we discussed with traditional leaders the damage they thought ITNs [insecticide-treated nets] were doing to the fisheries. Although the traditional leaders attributed fishery decline to ITN fishing, they were adamant that the ITNs must continue. Malaria is a scourge, and controlling malaria should be the priority. In 2015 ITNs were estimated to have saved more than 10 million lives — likely 20-25 million at this point.
… ITNs are perhaps the most impactful medical intervention of this century. Is there another intervention that has saved so many lives? Maybe the COVID-19 vaccine. ITNs are hugely effective at reducing malaria transmission, and malaria is one of the most impactful pathogens on humanity. My thought is that local communities should decide for themselves through their processes. They should know the potential risk that ITN fishing poses, but they also experience the real risk of malaria transmission.
He notes that the fish toxicity issue is real and worth investigating further; a colleague, the University of Florida’s Joe Bisesi, is investigating this and, preliminarily, the insecticide does seem to harm fish. Just because an intervention like bednets is effective at its primary purpose doesn’t mean it doesn’t have unintended consequences, and it’s worth investigating those fully.
But, as Larsen says, people like him, me, and Andreessen aren’t the people affected here. The people affected, in rural Africa and other malarial regions, overwhelmingly want bednets as a tool to help them survive.
Put your money where your mouth is
Luckily for Andreessen and like-minded folks, people genuinely worried about fisheries and insecticidal toxicity in Africa have other options. They can support the Malaria Consortium, for instance, which instead of bednets offers seasonal chemoprevention, an approach in which people in malarial regions get preventive medicines meant to reduce their risk of infections. If you’ve traveled to a malarial region, you may have gotten these drugs yourself from a travel medicine clinic; I did before a trip to Burma. There are no fishing-related concerns with chemoprevention, and it also saves lives very cost-effectively.
One could also fund work on malaria vaccines. The R21 vaccine, recently approved by the World Health Organization, is 75 percent effective against infection, and stakeholders like the vaccine distribution group GAVI and the Global Fund to Fight AIDS, Tuberculosis and Malaria are currently working out a plan to fund a mass rollout. Bednet skeptics could easily donate to those groups, or fund advocacy to get governments like the US to increase their commitments to the Global Fund and GAVI to ensure the vaccination effort is adequately funded.
The broader point Andreessen was trying to make by attacking bednets, in his words, was that, “It is very, very hard to intervene in other people’s lives — particularly from a distance — and not make things worse.” It is indeed really hard, and requires a lot of research — but luckily people have done that research, and even if for whatever reason bednets don’t clear the bar for you, there are plenty of effective interventions against malaria and other diseases that don’t raise any issues around fishing.
The question, then, is whether that moves you to support these causes, or if attacking bednets is just an excuse for one’s own inaction. I don’t know Andreessen’s own donation history; maybe he’s been giving to the Malaria Consortium this whole time. If so, god bless. If not, he should consider taking his own arguments a bit more seriously.