Breaking Down the Ending of Netflix’s 3 Body Problem Adaptation

Warning: This post contains spoilers for 3 Body Problem.

The question of how humanity would react to the discovery of alien life is a pretty popular one in science fiction. From H. G. Wells’ The War of the Worlds to M. Night Shyamalan’s Signs to Denis Villeneuve’s Arrival, a slew of the genre’s biggest names have put their own spin on the so-called “first contact” trope, delving into how humans would handle extraterrestrial beings invading Earth.

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But in Season 1 of 3 Body Problem, now streaming on Netflix, all of the action takes place while the story’s aliens, known as the San-Ti, are still around 400 years away. Adapted from Chinese author Liu Cixin’s acclaimed Remembrance of Earth’s Past book trilogy, the eight-episode narrative jumps back and forth through time to explore how a fateful decision in 1960s China echoes across the decades to impact a group of scientists—and humankind as a whole—in 2024.

What is 3 Body Problem about?

Created by Game of Thrones showrunners David Benioff and D.B. Weiss and True Blood‘s Alexander Woo, the first season of 3 Body Problem largely draws on the first book in Cixin’s series, The Three-Body Problem (published as a novel in 2008 and translated into English by Ken Liu in 2014), while weaving in plot points and characters from the second and third books, The Dark Forest and Death’s End, and changing some details.

The show opens on the day astrophysics prodigy Ye Wenjie (played as a young woman by Zine Tseng and later in life by Rosalind Chao), is forced to watch as her professor father is beaten to death by a group of Red Guards during the first months of China’s Cultural Revolution. From there, it leaps nearly 60 years into the future to modern-day England, where Detective Da Shi (Benedict Wong) has been tasked with investigating the apparent suicides of a number of renowned scientists. As the story unfolds, we learn that after being recruited to work at a secret military base where China was attempting to establish contact with extraterrestrials, a disillusioned Ye chose to alert an alien civilization to Earth’s location despite being warned they were hostile.

In the present, with the technologically hyper-advanced San-Ti drawing ever closer to Earth, the lives of a tight-knit group of scientists known as the Oxford Five—Jin Cheng (Jess Hong), Saul Durand (Jovan Adepo), Auggie Salazar (Eiza González), Jack Rooney (John Bradley), and Will Downing (Alex Sharp)—become increasingly entwined with humanity’s struggle to survive.

Read More: Netflix’s 3 Body Problem Transforms a Dense Sci-Fi Novel Into a Smart, Gripping Thriller

How does 3 Body Problem end?

After Ye seeks out Saul to tell him her cryptic, “Never play with God,” joke prior to her death, the Season 1 finale of 3 Body Problem opens with an assassination attempt on Saul that sends him on a harrowing journey to the United Nations in New York. Once there, he learns that he has been unwillingly selected as one of three Wallfacers, the individuals chosen by the UN to formulate and direct defense strategies against the San-Ti. Due to the San-Ti’s ability to intercept all forms of human communication via the proton-sized supercomputers known as Sophons they sent ahead to Earth, the Wallfacers are instructed to secretly develop these plans entirely within their own minds, sharing them with no one until the time is right to execute.

Saul repeatedly attempts to refuse the assignment, but his protests are treated as though he may simply be trying to mislead the San-Ti by throwing them off his scent. The UN Secretary-General tells Saul that there is only an indirect reason he was chosen, and that he will know what that was when the time is right.

Eventually, given the power to demand basically anything he wants, Saul insists that he be taken to Cape Canaveral to watch the spy probe carrying Will’s cryogenically frozen brain be launched into space—an initiative of Jin’s dubbed the Staircase Project. Unfortunately, the launch doesn’t go as planned and Will’s probe goes careening far off course from the path that would have led it to the San-Ti fleet.

Despite the seemingly dire straits humanity is up against, the season ends on a hopeful note, with Da Shi reminding Jin and Saul how resilient insects have been against humans’ attempts to eradicate them in a callback to the San-Ti’s, “You are bugs,” message.

What’s next for 3 Body Problem?

Although Netflix has yet to officially renew 3 Body Problem, its showrunners have said they are already working on a second season that is set to pretty much follow the arc of Cixin’s second book.

“The second book is far better than the first, and the third book just completely blew my mind,” Benioff told the Hollywood Reporter. “So I feel if we survive to the second season, we’re going to be in a good place. Things wildly escalate and there’s one scene, if we get to it, we’re golden—like when we got to the Red Wedding on Thrones.”

In total, the creators have said they are hoping the show will run for three to four seasons. “The third book is massive. It’s twice as long, I think, as the other two books,” Benioff told Collider. “So maybe that’s one season, maybe it’s two. But I think we’d need at least three, maybe four seasons to tell the whole story.”

source https://time.com/6958215/3-body-problem-netflix-ending-explained/

Capitalism Can’t Solve Climate Change

Amidst the gathering gloom about climate change and continuing growth in global greenhouse-gas emissions, the one bright spot appears to be clean energy development. 2023 saw another, much-trumpeted record for renewables installations worldwide, with an estimated 507 GW of new generating capacity being nearly 50 percent higher than 2022’s figure.

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The positivity is misplaced. Even on the transition from dirty to clean power, the world is still failing. The International Energy Agency (IEA) has estimated that both electricity generation from coal and gas, and total power-sector CO₂ emissions, continued to grow in 2023, to all-time highs of 17,252 TWh and 13,575 Mt CO₂, respectively. In other words, even as renewables are growing fast, they are not yet growing fast enough to displace dirty power generation, which remains the single largest source of greenhouse-gas emissions.

Worse still, the world is failing on the energy transition for reasons that strike at the heart of capitalist economies, and which will therefore be very difficult to surmount. The core issue here is easy to state. Most countries are relying predominantly on the private sector to drive faster renewables investment; private firms invest on the basis of expected profits; but profitability in renewables is rarely attractive.

Stick with an approach to climate change mitigation in which the private sector continues to be seen as the savior, and we are setting ourselves up to continue to fail.

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Veiled by discussion of headline global trends in new renewables capacity investment is the fact that almost all the incremental progress is currently being made in one country: China. Trumpeting 2023’s 50 percent growth in annual global capacity installations as a global achievement is wrongheaded, given that China by itself delivered nearly 80 percent of the increment.

And the IEA, for its part, expects China to continue to be the sole meaningful over-achiever. It recently revised upwards by 728 GW its forecast for total global renewables capacity additions in the period 2023–27. China’s share of this upward revision? Almost 90 percent.

While China surges ahead, the rest of the world remains stuck.

This raises a crucial question. What is different about the development of solar and wind resources in China from the rest of the world?

The main answer is that in China, such development is capitalist in only a very limited sense. Certainly, the entities centrally involved in building out new solar and wind farms in China are companies. But almost all are state-owned. Take wind. Nine of the country’s top 10 wind developers are owned by the government, and such state-owned players control in excess of 95 percent of the market.

Moreover, the state is far from being a passive shareholder in these companies. The companies are best seen as instruments wielded by the state in the service of achieving its industrial, geopolitical, and – increasingly – environmental objectives.

The best example of this concerns the gargantuan ‘clean energy bases’ first announced by President Xi Jinping in 2021. To be built mainly in the Gobi and other desert areas by 2030, these new bases will have a combined capacity of in excess of 550 GW – more than Europe’s total solar and wind capacity at the time of this writing.

Such development is as far from ‘capitalist’ as is imaginable. This is the state, in its most centralized and authoritative form mustering whatever resources it needs at its disposal to ensure that it delivers what it has said it will deliver.

Add to this the fact that the banks financing all the new renewables development in China are generally also state-owned and directed, and a stark reality comes into focus. This is essentially central planning in action.

Does the profit motive figure? To be sure, it does. But usually only marginally, and it is ridden roughshod over whenever Beijing deems fit.

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In the West, by contrast, the energy transition has effectively been outsourced to the private sector. Governments are by and large relying on private firms, driven by the profit motive, to substitute carbon-free for fossil-fuel-based power generation resources.

Of course, this does not mean that governments in the West play no role in the energy transition at all. They fashion and (indirectly) regulate the markets in which renewables developers and generators operate. They set targets for the scale and speed of decarbonization – although it is debatable how seriously such targets are, and should be, taken.

Most importantly of all, Western governments all provide support mechanisms of various kinds designed to incentivize new renewables investment, whether it is the United States’ tax credits or the feed-in tariffs and premiums more familiar in non-US markets.

But in two key senses, this is a very different government role than in China.

Firstly, Western governments do not direct renewables development. They merely ‘nudge’. The Chinese authorities nudge too, but always with a willingness to move into hands-on direction mode when necessary.

Secondly, Western governments typically do not own and operate renewables generating facilities. The lion’s share of such facilities – more than 95 percent of installed capacity – are owned and operated by the private sector: the exact mirror image of the renewables ownership picture in China.

The West’s reliance on the private sector to decarbonize power generation is proving a major problem, and for a strikingly simple reason, albeit one that is almost never acknowledged.

Under capitalism, profit expectations drive companies’ investment decisions. Developing and operating solar and wind farms and selling the electricity they generate, however, generally is not a very profitable business.

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How profitable are wind and solar power generation? What sort of returns do investors earn? Inevitably, there is no single, consistent answer: returns vary – often considerably – both historically and geographically. But most analyses of the issue conclude that an internal rate of return of around 5–8 percent would be what investors on average expect and achieve.

Little wonder, then, that companies accustomed to much higher returns than this serially thumb their noses at renewables. Most notable here are the big U.S. oil and gas companies, which typically do not proceed with new hydrocarbon projects unless returns of a minimum of 15 percent are anticipated. Asked at his company’s 2015 annual meeting why Exxon continued to snub solar and wind, CEO Rex Tillerson responded witheringly, ‘we choose not to lose money on purpose’.

Why are renewables returns so low? Numerous factors conspire to drive down profits, but one is particularly important: competition. Generating and selling electricity – an undifferentiated commodity – is an intensely competitive business in most Western countries, and the growth of renewables has made it even more so. Barriers to entry are low, and sources of market power more or less non-existent. There is no OPEC-like cartel in renewable electricity.

The alarming upshot – marginal profitability and hence stuttering investment in new capacity – obtains across the West even though the costs of key components declined significantly in the 2010s. Lacking market power, renewables generators were unable to capture the upside of these cost reductions.

And the upshot obtains even though robust government support for renewables remains a ubiquitous feature of the Western political-economic landscape. Even as such support helps render new investment viable, it seldom insulates generating firms from competitive pressures. Indeed, some support mechanisms, such as the reverse auctions used in many countries to award renewables contracts, structurally encourage and exacerbate price competition.

In short, Western governments’ renewables subsidies rarely occasion strong profits. More commonly, they allow just about sufficient profit to keep the sector afloat. Noting that his own firm, Berkshire Hathaway, received tax credits when building wind farms, Warren Buffett once conceded: ‘That’s the only reason to build them. They don’t make sense without the tax credit’.

The ongoing necessity of subsidy for renewables development is evidenced by what happens when subsidies are withdrawn or even just substantively reduced. As occurred for instance in the UK’s onshore wind sector in 2018 and Vietnam’s solar sector in 2021, investment collapses.

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The consequence of all this is that Western policymakers face a choice that will only get starker as emissions continue and global temperatures further rise.

That choice is between two unpalatables. One is to moderate the still-strong faith in the ability of markets and the profit motive to deliver an accelerated energy transition, with governments instead adopting a much more directive role.

The alternative? To face a growing risk of climate catastrophe.

source https://time.com/6958606/climate-change-transition-capitalism/

Don’t Be Surprised If Your Doctor Starts Charging You for Email

Doctors are starting to charge for responding to email, and other offline tasks. Is it justified or just extra costs in an endless stream of medical bills?

It’s 6 pm and you might expect your doctor’s workday to be complete after a busy patient load. Yet for majority, work has just begun. It’s time to open their patient portal, review test results, answer piles of patient email. Then they do whatever needs to be done, like ordering more tests or consults.

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Patient portals have improved access to test results and physicians. Day or night, you can review your results and pose questions such as, “What does this lab value mean?”, “Can you refill my prescription?”, “My x-ray shows a pulmonary nodule. What is that?”, or “Can I have a referral to see a specialist?” Patient portals have become an innovative and cost-free way for patients and doctors to communicate. Instead of dropping a co-pay for a traditional appointment or signing up a telehealth visit, a portal post often does the trick.

Here’s the problem: doctors are traditionally only paid for real-time encounters. There’s been no extra pay for responding to email or following up on many offline requests. Many doctors spend tons of time—often after hours—on unreimbursed activity.

Extra uncompensated tasks increasingly weigh down physicians spiritually and emotionally. Drowning in heaps of unpaid work, the toll is physician productivity, family life, and ultimately mental health. It is sometimes referred to as “burnout.” Others call it “moral injury,” creating a deeper and more complex psychological crisis.

Here’s what changing: emailing in patient portals may soon not be so free anymore. In 2020, the Centers for Medicare and Medicaid Services (CMS) released a new billing code where doctors can charge for answering patient-initiated emails that require at least five minutes. Doctors can bill up to once a week per patient for total time spent. Excluded are emails related to scheduled appointments, refilling prescriptions, follow-up after procedures, or within seven days of a visit. The insurer then decides whether to pay for it directly or pass the costs onto the patient.

Read More: Why It Takes Forever to Get a Doctor’s Appointment

A recent study of insured patients by the Peterson-Kaiser Family Foundation (KFF) found that doctors charge on average $39 per email. Patients with out-of-network benefits pay about $25 per email. Certainly, in the context of all the money we spend on healthcare, this seems nominal. But costs can add up if multiple emails are sent.

Yet, the KFF study found the frequency of claims related to patient portal emails to be low: averaging about 1 in every 192 office visit claims in 2021. This shows that in the first few years of the ability to bill, doctors hadn’t started charging patients.

Why? First and foremost, doctors may not want to alienate patients or disincentivize asking their health questions. Billing for portal messages may also be cumbersome, particularly because some messages are billable while others aren’t. Finally, some doctors may not even know you can bill for email.

There are reasons to believe that doctors charging for patient emails may catch on. One big driver is declining physician reimbursement. The amount doctors can charge for visits for Medicare patients has not kept up with inflation over the last two decades. There is also downward pressure on commercial payments through laws like the No Surprises Act (NSA), which outlaws balance billing. Billing for emails allows doctors to fill some of these gaps.

The KFF study found that in 82% of cases the insurance company just paid the bill. But as the frequency of billing ramps up, insurers will likely start passing on more of costs onto patients. 

Billing for patient portal messages also raises an ethical dilemma with doctors, specifically whether charges are justified. If we look at traditional business practices, it’s clearly reasonable. Working after traditional business hours and not receiving compensation violates labor law. Additionally with the advent of concierge medicine and other newer models such as direct primary care, subscription-based fees charged by such practice models will incorporate responding to email.

What’s clear is this: workable solutions, both ethically and economically, are necessary to address the deluge of communications—whether via traditional email, patient portals or phone calls—that physicians encounter.

Until the time comes that artificial intelligence (AI) can reliably and accurately answer patient questions and perform other important functions and tasks, physicians or their proxies will be required to empty their inboxes beyond the hours spent involved in direct patient care.

source https://time.com/6958414/doctor-charging-you-for-email/

Brazil’s Bolsonaro Indicted Over Alleged Falsification of His Own Vaccination Data

(SAO PAULO) — Former Brazilian President Jair Bolsonaro was formally accused Tuesday of falsifying his COVID-19 vaccination data, marking the first indictment for the embattled far-right leader, with more allegations potentially in store.

The federal police indictment released by the Supreme Court alleged that Bolsonaro and 16 others inserted false information into a public health database to make it appear as though the then-president, his 12-year-old daughter and several others in his circle had received the COVID-19 vaccine.

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Police detective Fábio Alvarez Shor, who signed the indictment, said in his report that Bolsonaro and his aides changed their vaccination records in order to “issue their respective (vaccination) certificates and use them to cheat current health restrictions.”

“The investigation found several false insertions between November 2021 and December 2022, and also many actions of using fraudulent documents,” Shor added.

During the pandemic, Bolsonaro was one of the few world leaders who railed against the vaccine, openly flouting health restrictions and encouraging other Brazilians to follow his example. His administration ignored several offers from pharmaceutical company Pfizer to sell Brazil tens of millions of shots in 2020, and he openly criticized a move by Sao Paulo state’s governor to buy vaccines from Chinese company Sinovac when no other doses were available.

Brazil’s prosecutor-general’s office will have the final say on whether to use the indictment to file charges against Bolsonaro at the Supreme Court. The case stems from one of several investigations targeting Bolsonaro, who governed between 2019 and 2022.

Bolsonaro lawyer Fábio Wajngarten called his client’s indictment “absurd” and said he did not have access to it.

“When he was president, he was completely exonerated from showing any kind of certificate on his trips. This is a political persecution and an attempt to void the enormous political capital that has only grown,” Wajngarten said.

The former president denied any wrongdoing during questioning in May 2023.

Police accuse Bolsonaro and his aides of tampering with the health ministry’s database shortly before he traveled to the U.S. in December 2022, two months after he lost his reelection bid to Luiz Inácio Lula da Silva.

Bolsonaro needed a certificate of vaccination to enter the U.S., where he remained for the final days of his term and the first months of Lula’s term.

If convicted for falsifying health data, the 68-year-old politician could spend up to 12 years behind bars or as little as two years, according to legal analyst Zilan Costa. The maximum jail time for a charge of criminal association is four years, he said.

“What Bolsonaro will argue in this case is whether he did insert the data or enable others to do it, or not. And that is plain simple: Either you have the evidence or you don’t. It is a very serious crime with a very harsh sentence for those convicted,” Costa told The Associated Press.

Shor also said he is awaiting information from the U.S. Justice Department to “clarify whether those under investigation did make use of the false vaccination certificates upon their arrival and stay in American territory.”

If so, further charges could be leveled against Bolsonaro, Shor wrote without specifiying in which country.

Bolsonaro retains staunch allegiance among his political base, as shown by an outpouring of support last month, when an estimated 185,000 people clogged Sao Paulo’s main boulevard to decry what they — and the former president — characterize as political persecution.

Brazil’s top electoral court has already ruled Bolsonaro ineligible to run for office until 2030, on the grounds that he abused his power during the 2022 campaign and cast unfounded doubts on the country’s electronic voting system.

Other investigations include one seeking to determine whether Bolsonaro tried to sneak two sets of expensive diamond jewelry into Brazil and prevent them from being incorporated into the presidency’s public collection. Another relates to his alleged involvement in the Jan. 8, 2023, uprising in the capital of Brasilia, soon after Lula took power. The uprising resembled the Capitol riot in Washington two years prior. He has denied wrongdoing in both cases.

Shor wrote that the indictment will be folded into the investigation of Jan. 8, which is being overseen by Supreme Court Justice Alexandre de Moraes. That justice authorized the unsealing of the indictment.

source https://time.com/6958395/jair-bolsonaro-indicted-vaccine-data/

U.N. Weather Agency Issues ‘Red Alert’ on Climate Change After Record Heat in 2023

GENEVA — The U.N. weather agency is sounding a “red alert” about global warming, citing record-smashing increases last year in greenhouse gases, land and water temperatures and melting of glaciers and sea ice, and is warning that the world’s efforts to reverse the trend have been inadequate.

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The World Meteorological Organization said there is a “high probability” that 2024 will be another record-hot year.

The Geneva-based agency, in a “State of the Global Climate” report released Tuesday, ratcheted up concerns that a much-vaunted climate goal is increasingly in jeopardy: That the world can unite to limit planetary warming to no more than 1.5 degrees Celsius (2.7 degrees Fahrenheit) from pre-industrial levels.

“Never have we been so close – albeit on a temporary basis at the moment – to the 1.5° C lower limit of the Paris agreement on climate change,” said Celeste Saulo, the agency’s secretary-general. “The WMO community is sounding the red alert to the world.”

Read more: 2023 Was the Hottest Year Ever and 2024 May Be Even Worse

The 12-month period from March 2023 to February 2024 pushed beyond that 1.5-degree limit, averaging 1.56 C (2.81 F) higher, according to the European Union’s Copernicus Climate Service. It said the calendar year 2023 was just below 1.5 C at 1.48 C (2.66 F), but a record hot start to this year pushed beyond that level for the 12-month average.

“Earth’s issuing a distress call,” U.N. Secretary-General Antonio Guterres said. “The latest State of the Global Climate report shows a planet on the brink. Fossil fuel pollution is sending climate chaos off the charts.”

Omar Baddour, WMO’s chief of climate monitoring, said the year after an El Niño event — the cyclical warming of the Pacific Ocean that affects global weather patterns — normally tends to be warmer.

“So we cannot say definitively about 2024 is going to be the warmest year. But what I would say: There is a high probability that 2024 will again break the record of 2023, but let’s wait and see,” he said. “January was the warmest January on record. So the records are still being broken.”

The latest WMO findings are especially stark when compiled in a single report. In 2023, over 90% of ocean waters experienced heat wave conditions at least once. Glaciers monitored since 1950 lost the most ice on record. Antarctic sea ice retreated to its lowest level ever.

“Topping all the bad news, what worries me the most is that the planet is now in a meltdown phase — literally and figuratively given the warming and mass loss from our polar ice sheets,” said Jonathan Overpeck, dean of the University of Michigan School for Environment and Sustainability, who wasn’t involved in the report.

Saulo called the climate crisis “the defining challenge that humanity faces” and said it combines with a crisis of inequality, as seen in growing food insecurity and migration.

WMO said the impact of heatwaves, floods, droughts, wildfires and tropical cyclones, exacerbated by climate change, was felt in lives and livelihoods on every continent in 2023.

“This list of record-smashing events is truly distressing, though not a surprise given the steady drumbeat of extreme events over the past year,” said University of Arizona climate scientist Kathy Jacobs, who also wasn’t involved in the WMO report. “The full cost of climate-change-accelerated events across sectors and regions has never been calculated in a meaningful way, but the cost to biodiversity and to the quality of life of future generations is incalculable.”

But the agency also acknowledged “a glimmer of hope” in trying to keep the Earth from running too high a fever. It said renewable energy generation capacity from wind, solar and waterpower rose nearly 50% from 2022 to a total of 510 gigawatts.

The report comes as climate experts and government ministers are to gather in the Danish capital, Copenhagen, on Thursday and Friday to press for greater climate action, including increased national commitments to fight global warming.

“Each year the climate story gets worse; each year WMO officials and others proclaim that the latest report is a wake-up call to decision makers,” said University of Victoria climate scientist Andrew Weaver, a former British Columbia lawmaker.

“Yet each year, once the 24-hour news cycle is over, far too many of our elected ‘leaders’ return to political grandstanding, partisan bickering and advancing policies with demonstrable short-term outcomes,” he said. “More often than not everything else ends up taking precedence over the advancement of climate policy. And so, nothing gets done.”

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Borenstein reported from Washington, D.C.

source https://time.com/6958370/un-wmo-climate-change-red-alert/

The Most Exciting New Advances in Managing COPD

The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, is the world’s preeminent COPD research and advocacy organization. Founded in 1997 in collaboration with the U.S. National Institutes of Health and the World Health Organization, one of GOLD’s stated aims is to “improve prevention and treatment of this lung disease.”

In its 2023 global strategy report, GOLD changed its definition of COPD—which many in the profession viewed as overdue. Specifically, the new definition emphasized the heterogeneity of COPD in terms of its underlying drivers and long-term disease course.

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“If you look at the new GOLD guidelines, they’re really acknowledging that there’s more of an inflammatory component to COPD than we initially thought,” says Dr. Laren Tan, a pulmonary disease and critical care specialist and chair of the Department of Medicine at Loma Linda University Health in California.

Tan says the recognition that COPD can take unconventional forms is crucial to tailoring appropriate care to the individual patient. “We’re now approaching COPD in terms of trying to identify subgroups of patients that have this underlying inflammatory state,” he says. “If we don’t uncover this inflammatory component, that can lead to worse outcomes.”

Here, Tan and other experts in the field describe how this new understanding of inflammation is informing treatment. And it’s just one of several recent advances in COPD care and management. From innovative new lung valves to refinements in the deployment of inhaled therapies and vaccines, the landscape of COPD care and treatment is changing.

The newest drug therapies

Arguably the most buzzed about advancement in the COPD treatment landscape is the emergence of new biologic therapies, says Dr. Meilan Han, a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. Biologics are injected medications derived from living cells or other biologic material that are able “to target very specific immune pathways,” Han explains.

Essentially, these drugs are intended to narrowly shift or block the operation of the immune system, thereby switching off or moderating the types of inflammation or other immune reactions that drive some COPD exacerbations while simultaneously leaving the remainder of the immune system unaffected. The drugs are already used to treat related pulmonary conditions, like asthma, and there’s reason to believe they’re about to enter the COPD arena.

“The exciting news is that there is a drug that looks like it will work for COPD, and that may soon have [U.S. Food and Drug Administration] approval,” Han says. That medication, dupilumab, is already approved for the treatment of asthma. In July 2023, a study published in the New England Journal of Medicine found that patients with so-called Type 2 inflammation—defined by the elevated presence of blood eosinophils—benefited from dupilumab. The patients experienced “fewer exacerbations, better lung function and quality of life, and less severe respiratory symptoms than those who received placebo,” the study found.

“What we’d seen in the last few years prior to this was that companies were fleeing respiratory drug development because a lot of studies had failed,” Han explains. “Dupilumab is just one drug, but it opens up the door for a lot more research and exploration of biologics for the treatment of COPD.” She notes that there are multiple trials examining additional biologics that target new pathways. “I’m hoping this is just the tip of the iceberg, and soon we’ll have many more new therapies,” she adds.

While biologics are garnering the most attention, experts say that smaller, more incremental improvements in care are having a greater impact on the day-to-day lives of COPD patients.

For example, phosphodiesterase inhibitors have long been used to help treat the mucous production and accumulation that so many COPD patients experience, Tan says. “The new phosphodiesterase inhibitors help relax airway smooth muscle and also help to clear out mucus from airways,” he says. “But patients take this as a tablet, which unfortunately comes with a lot of side effects, such as GI issues.” To prevent these side effects and improve the drug’s efficacy, researchers have looked into the development of inhalable forms of these drugs, and Tan says there’s promising data that these work.

Staying in the inhaler space, one of the greatest challenges in COPD care—and, for that matter, in the care of asthma and other lung conditions—is the problem of poor patient adherence to medications. Inhalers are often a mainstay of symptom management, but it can be a struggle for people to use an inhaler consistently, especially when treatment involves more than one type of inhaled drug.

This problem of adherence led to the development of combination inhalers—a single device that allows a patient to take two or even three medications simultaneously. “They’ve taken all these inhalers and put them into one device,” Han says. “This makes it easier for patients to take their medications, and this has led to a reduced frequency of exacerbations.”

In parallel with the emergence of combination inhalers, research has revealed that, for some COPD patients, the blend of three inhaled medicines may be superior to the old two-drug approach. “For most patients, we prescribe two long-acting bronchodilators,” says Dr. Peter Barnes, a professor of thoracic medicine at the National Heart and Lung Institute in the U.K. These are a long-acting muscarinic antagonist, or LAMA, coupled with a long-acting β₂-agonist, or LABA. While this LABA/LAMA combination is nothing new, Barnes says that adding a third medicine—an inhaled corticosteroid—has proven helpful in patients with high blood levels of eosinophils. “These three can now be combined in single inhaler, called a triple inhaler,” he says.

Plus, some of the first research studies on the long-term benefits of these triple inhalers have found that they may reduce mortality among patients who use them. “When used appropriately in combination, these drugs can save lives,” Han says.

Read More: Severe Asthma Patients on Ways Their Doctors Could Improve Treatment

Valves, telemedicine, and other advances

Lung volume reduction surgery, or LVRS, is one of the most common surgical procedures for the treatment of COPD. The procedure, which has been around since the 1950s, involves the removal of the most diseased parts of lung tissue in order to allow better, less-restricted lung expansion during breathing. “When you take that diseased part out, that helps to restore the lung’s natural mechanics,” Han says.

But this surgery comes with downsides. “It’s a major surgery with a long recovery time, and the risk for complications is high,” Tan says. These complications include unintended air leakages, pneumonia, and heart issues such as arrhythmias.

In just the past few years, a new and milder intervention has emerged. Two different companies have developed valves that can be placed in the airway using a minimally invasive procedure, and that allow trapped air to escape the damaged lung. “These are essentially a one-way valve that allows air to go out of the affected areas of the lungs,” Tan explains. “This helps improve ventilation and breathlessness.” The procedure, known as bronchoscopic lung volume reduction, mimics the effects of the older surgery, but is reversable.

Aside from new drugs and surgical procedures, vaccines are another area that should lead to better symptom management. “With COPD, a lot of common viruses—things like respiratory viruses—can contribute to periodic flare-ups or exacerbations,” Han says. Vaccines can help prevent these viral infections, and more are becoming available all the time. “The ramp-up of vaccine development we saw during the pandemic—I’m hopeful we’ll continue to see new vaccines for things like rhinovirus that have a major impact on COPD,” she says.

Experts say there have also been helpful advances in the way COPD patients and their care providers interact. 

“Pulmonary rehab doesn’t get much buzz, but we know it’s critical for a patient’s daily functioning,” Tan says. Pulmonary rehab often involves group education courses that teach people with COPD how to adjust their lifestyles—for example, by incorporating safe forms of exercise, or learning to prepare healthier meals—in order to improve their symptoms and functionality.

Unfortunately, reimbursement and insurance coverage for pulmonary rehab is poor. Plus, attending the group sessions can be difficult or inconvenient for people who don’t live close to their center of care. “But during the pandemic, we found that we can offer pulmonary rehab remotely through telehealth, and I think that’s been a gamechanger,” Tan says. While many of those pandemic-era telehealth programs have since been suspended, they acted as a proof-of-concept—a demonstration that pulmonary rehab courses can be offered virtually—that Tan hopes will eventually increase access and reduce costs for people with COPD.

Smoking cessation is another area that has witnessed some noteworthy advancements, Tan says. A majority of COPD patients are current or former smokers, and a lot have trouble quitting despite the help of medications and patches or other nicotine-replacement aids. “Now we’re starting to see people using an AI-powered app to help them quit,” he says. 

Earlier this year, the Fred Hutchinson Cancer Center launched a free QuitBot AI app. The app offers personalized smoking cessation support—answering questions and providing evidence-based pre- and post-quit-date education materials—that can help people stick with it.

Meanwhile, researchers at Johns Hopkins University have found that combining psychedelics with cognitive behavioral treatments can lead to remarkable cessation rates. One study found that 80% of people were able to stay cigarette-free six months after the treatment—an unheard-of success rate for smoking cessation therapies.

Read More: How Alternative Medicine Can Help People With Asthma

What’s next?

In many branches of medicine, researchers and providers have turned their attention to better, more comprehensive diagnostics. With the help of advanced genetic testing, blood analyses, and other cutting-edge assessment tools, doctors can get a clearer picture of a patient’s underlying disease state, which can guide them toward the most efficacious and precise treatments—and, as a result, improving outcomes and reducing side-effects or other quality-of-life challenges.

This, experts say, is where COPD care is headed. “We know now there are multiple subtypes of COPD—that the inflammatory sub-profile differs from patient to patient,” Tan says. “But the inflammatory process is extremely complex.” It will take time to map the different inflammatory pathways and processes at play, and years of work to identify or develop new medicines that treat those specific instigators of inflammation. But all of this is underway. And, as the latest research on biologics suggests, this form of precision medicine is going to be part of the COPD conversation for a long time to come.

“I’ve been doing this for 20 years, and this is the first time I feel like we’re at an inflection point where I’m anticipating a lot of new therapies within the next five years,” Han says. 

For people with COPD—and their care providers—the future looks bright.

source https://time.com/6903546/copd-treatment-advances/

The Next Tech Backlash Will Be About Hygiene

For centuries it was biology that made humans sick. Today, it is often stress.

So argues Dr Gabor Maté about the unrecognized toll that “normal” modern life has on your mental and physical health. Dr. Maté’s research, which struck a chord in 2023, invites reflection on the roll out of generative AI into daily life in 2024.

[time-brightcove not-tgx=”true”]

As half of British teens report feeling addicted to social media, and as the U.S. surgeon general offers a rare caution against its health risks, the infusion of generative AI into social media appears to threaten our basic hygiene, meaning “the conditions or practices conducive to maintaining health and preventing disease.”

Dr Maté and AI may seem like unlikely bedfellows. AI attends (purportedly) to the statistical dynamics of the mind. Dr Maté, in contrast, diagnoses interplay between human minds and bodies. Comparing the two lends perspective on our global polycrisis and the stress load that AI could help make into a new “normal.”

AI companies raised $27bn in 2023; a tidy sum they will now need to recoup. In 2024, 49% of the global population will go to the polls; a lump-in-the-throat test for generative AI, persuasive technology, and democracy. There is plenty of room here for stress, but also for relief. As technophiles trial human-computer interactions for profit and power, I am called by Dr Maté and other observers (like Tricia Hersey and Ivan Illich) to consider a relevant lesson from the history of medicine.

The medical profession has long struggled with a phenomenon called iatrogenesis. It puts into words a recurring dilemma: what to do when attempts to solve a problem only make it worse? Medical treatments, for instance, can often make us more sick. “The medical establishment has become a major threat to health,” argued Illich in a famous polemic from 1974. 

A wealth of research shows that AI is, in many ways, iatrogenic: it deepens misogyny, racism, financial fraud and the climate crisis. One additional—yet overlooked—risk, I argue, is poor hygiene.

How much digital is… enough?

Americans now spend eight hours a day consuming digital media, which is longer than they sleep. As with the presence of sugar in foods, we face something of a collective addiction to technological gratification. 

Digital tools have become iatrogenic: they harm us as we “use” them to try and improve our lives. Withdrawal takes many forms, both individual (e.g., a digital Sabbath, deleting a dating app) and collective (e.g. employees refusing work emails after 6pm, bubbling tech protest, a “no laptops” café).

Generative AI amplifies the siren song of digital media, luring us to converse with a “famous” avatar or digital “girlfriend”, snap a photo of every meal to calculate our calorie count, or decide, against all odds, where to park. The list of indulgences goes on. Big Tech salivates over the prospect of a personalized AI assistant that knows just how to reach you… and reach you… and reach you… This is Silicon Valley’s goal for 2024.

More than Luddism

To my eye, each new AI product and service amounts to a decision about daily hygiene. What does “healthy” AI mean to you? What does it mean for your children or extended family? I cannot help but wonder what the aggregate of these individual decisions will bring out as new social norms in the 2020s and beyond. If becoming a vegetarian signals a want to limit one’s meat consumption (a norm acknowledged around the globe) what is the word for limiting one’s exposure to AI? 

It is not, I wager, Luddism. That noble effort speaks with force to the political economy of our digital dilemma but it does not, I’d argue, speak as readily to the kitchen-table pains of our weary bodies, as Dr Maté does. If the latter movement had a name, I don’t think it would be Luddism. That group responded to their historical moment as we must respond to ours.

AI Ethics, sadly, is not it either. Binding “AI” to “Ethics” rhetorically makes it difficult to imagine them separately. This limits us—arbitrarily—to futures that necessitate AI. What then becomes of the countless scenarios in which AI is unnecessary or vastly inferior (due to its iatrogenic qualities) to another toolset?

A new hope

That leads us back to you and your daily life with AI. In a previous industrial revolution, it was regular people in search of time together that gave us beloved cultural institutions like the weekend. Social norms bubbled up from below, not above. What does this mean for AI?

In eighteenth century Paris, the historian Lorraine Daston argues, government-led attempts to dictate urban hygiene norms tended to fizzle out. Police pushed for citizens to sweep their steps by 7am each day. Citizens refused. 

At stake in these seemingly trivial stand-offs was an entire vision of the future, Daston writes. Competition over hygiene among major European cities created a “First version of modernity, a modernity that had as yet very little to do with science and technology… and everything to do with orderliness, predictability, and, yes, rules.”

Our gift to future generations, then, may be a diffuse (at first) yet discernible (eventually) set of rules, or etiquette, for where AI is wanted and, more importantly, where it is not. This “regulatory” trend will not need to be led by bureaucrats in Washington, Brussels or Beijing. It will be led by regular people.

It may be children who gain protections first. In labor history, Britain’s Ten Hours Movement countered early industrial capitalism by winning rights for children (1833) then women (1844) then men (1847). Today, debate over the Kids Online Safety Act eyes a similar path: why not protect adults too?

As with the shifting perception of oil and cigarettes over the past fifty years, the future of AI might surprise inhabitants of our present day. In response to burnout, digital fatigue, algorithmic-racism, -sexism, -ableism, -authoritarianism, and a global mental health crisis, is the prospect of an unprecedented coalition against digital maximalists and their presumptions of “AI-first.”

This counter movement takes a million forms: knobs and dials—not screens—in cars, keeping smart devices off WiFi, dating offline (rather than through Tinder), prototype AI blockers, doomscroll limits. In the UK, mobile phones have just been banned from schools. In the not so distant future, one can imagine a “Home” mode on your phone, like “Airplane” mode, that only allows messages from friends and family, not work. 

I call this design ethos “decomputerization.” The word does not yet appear in the Oxford English Dictionary. When input into Gmail or Microsoft Word, it is underlined in red.

Even if it is taboo to some, decomputerization is in the air. “I needed to take a radical approach and remove myself from my relationship with machines in this world,” wrote (of all people!) a co-founder of Daft Punk. In Oct, Kendrick Lamar debuted, and sold out, “a smartphone built for minimal usage.”

Ecology-first vs digital-first

The final outcome of this contest will be decided by nine planetary boundaries. “Digitization is a climate disaster,” warns Ben Tarnoff, “If corporations and governments succeed in making vastly more of our world into data, there will be less of a world left for us to live in.”

As the polycrisis deepens, Silicon Valley may find itself outmanned (and/or outvoted) on deciding what the future has in store. New research suggests that by 2030, data centers for large-scale AI could “draw up to 21% of the world’s electricity supply.” Already today, with use around 1-3%, contests over water-usage fester in Taipei and Monterrey, with families and farmers resisting AI’s thirsty supply chain.

The fight between “digital-first” and “ecology-first” will cast new light on the power of bottom-up versus top-down regulation of AI. For you and I, daily hygiene decisions about surveillance at work, phone use at home, dating norms, or media and election standards will shape where automation is durably welcome and where it is not. 

In other words, the shape of AI’s integration into our world may trace the limits of our finite mental and physical health. This connection lends Dr. Maté’s insights about our emotions, bodies, and daily stresses greater priority than one might assume. 

Perhaps the future will not be quite so digital (and unhygienic) after all.

source https://time.com/6957890/next-tech-backlash-hygiene/