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Beyond COVID-19: the issues skeptical activists across Europe are facing

There is no question about COVID-19 being the hottest topic on every skeptic’s mind currently, but it isn’t the only pseudoscience out there. This month, I would like to explore the issues faced by European skeptic groups before and during COVID.

The issues are grouped into categories, which, as you will see, can be overlapping, and boil down to what I believe is at the crux of all the issues: quality education.

I am far from the first to say that the way education systems are set up across Europe are still beholden to the method of accessing and the availability of information as it was, well, pretty much when public schooling was established by Maria Theresa in 1774. Sure, the classrooms have smartboards and offer computer classes now, but there is only limited space to encourage and give space to independent thought. Most importantly, children are not given tools to weigh new information, confront their own biases and prejudices, and recognize the difference between having an open mind versus accepting whatever comes their way. It’s partly due to the pan-European (maybe I’d go so far as to say international) issue of underfunded education, low educator salary, and high student to teacher ratio. Also, it’s because the methods of educating future teachers to educate are frozen in time. Now, I’m not saying this is absolutely universal, or that we can’t find exceptions. We do see things changing, but the speed of systemic change sorely lacks behind the pace of the shift in information gathering.

The topics and issues I’ve outlined here do not form an exhaustive list, but dealing with their proponents is certainly exhausting enough. If you live outside of Europe, the vast majority will be familiar to you, too – which just shows that pseudoscience, woo, and quackery are without borders, and we as skeptics have to keep working to overcome ours.

Pseudomedicine

The Physical

Herbs and spices surrounding a pestle and mortar on a white surface

Also known as CAM, Alternative Medicine is here to stay, no matter how harmful it can be, directly, indirectly, or both. A healer by any other name would smell as fishy. And they do. Metaphorically. I don’t go around smelling them.

Homeopaths, naturopaths, autopaths (that’s the one where you rub your spit on your forehead to get rid of cancer), TCM practitioners, energetic healers… No matter how well-meaning they are, they take advantage of medical workers’ overworked-ness and the limited allotted time physicians spend with patients. They do this by offering an ear without time-constraint – for a hefty price – to give advice or to administer their version of ‘care’, which can hardly be called that.

Science-y Pseudomedicine

Lately, there has been a surge of what I like to call science-y pseudomedicine coming in from the West. This includes the CDS/MMS movement (diluted bleach drinking), Functional Medicine practitioners, magnetotherapy, high-Vitamin C doses, and interest in thermography as an unfailing cancer-diagnosing method, as well as the creation of fake diagnoses such as chronic Lyme disease or Leaky Gut syndrome. Patients with chronic Lyme do present with actual symptoms and often end up being diagnosed with MS or ALS. Still, the fake diagnosis leads to them wasting valuable time during which treatment to slow the onset could have been administered.

Another issue is the mushroom-like popping up of various pseudomedical clinics, which usually have medical doctors, but the care on offer is a far cry from science-based medicine. Though many pseudomedical methods have originated worldwide, they tend to get extra clout and popularity after rising to the USA’s spotlight and then moving eastwards to Europe.

For example, the yoni-egging and vagina-steaming practices truly hit it’s heyday after GOOP made it a thing. Interestingly enough, the proponents of these practices do not connect themselves to GOOP but only promote the story GOOP created – it being that both of these practices are ancient pearls of wisdom done by women for millennia. Similarly, in the last few years, we’ve seen a rise in Europe of teething amber necklaces and bracelets after they went through the USA’s wash cycle.

Credentials

A whole new special area of pseudoscience is weird or fake credentials. Most of Europe is very particular about the use and misuse of academic titles. This is something quite well-regulated. However, I would be amiss to say that there aren’t attempts to pretend to be a Ph.D. or an actually certified specialist. It is interesting to see the influx of imported titles from the US, which here mean nothing entirely, but are trotted out to amaze the public – often successfully. The practice of handing (bogus) title-included certificates is growing its roots, as is the adding of various letter combinations, before unseen, before or after one’s name.

The Mental

If you are not on a self-discovery journey led by a life coach who was not a very successful IT guy a year ago, who even are you?

Self-development is all the rage. You can uncover your true manly-man masculinity or your inner goddess in male and female circles. You can discover the concentrated energy in your pelvic area in a Quantra workshop. It’s a mix of quantum physics and tantra; if you ever get the chance, visit one; for the rest of your life, you will always have a story to tell in awkward silences. You can go retro with some good ol’ Scientology auditing. If you prefer a less beepy and wiry way to create false memories, check out a regressive therapist. To honestly know who you are, all you have to do is take a personality test using the Thomas Erikson method or try Human Design. Its creators have managed to fool some psychologists that this poorly disguised Forer sheet is a thing.

The word mind written on paving slabs

In all seriousness, it was expected that mental health care’s destigmatization will leave the door open for all kinds of alternative mental health therapies. Of course, psychology as a discipline has a layer of its own pseudoscience covering evidence-based treatments, such as a Freudian fascination with Freud and Jung, not to mention the replication crisis and all that jazz. It’s definitely an area we as skeptics have to do a better and more thoughtful job of addressing.

Anthroposophy

A special mention goes to this particular school of thought, since not only do they have their own schools, banks, and medicine, they do their part in trying to shut up their apostates, as is the case with Gregoire Perra, currently being sued for writing a reveal-all blog. He is under the attack of three law-suits. You can find out more and support him on the Waldorf Watch News.

The Miracle that Is Weed

Yes, the tales of the cannabis cure-all have reached our shores, too…

I’ll be back next month to continue my round-up of pan-European pseudoscience, so check back for more from me then!

Time Team’s archaeologists showed us how experts can ruthlessly unpick a hoax

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I love rugby. I’ve played the game since I was 7 years old, and if it wasn’t for a rash decision to try and tackle someone using only my throat, I would still be turning out for Old Streetonians every week.

There are many reasons to love the sport. Tries are cool, but as a lumbering forward with a top speed somewhere behind an asthmatic rock and a turning circle like an oil tanker with a fetish for cliffs, they have never really been in my part of my skill set.

Instead what I adore is the way a team can build pressure. The percussive thump of charging into the line becomes a drumbeat of inevitability. A well drilled rugby team can beat you by suffocation; every player in the team throwing themselves into contact until you realise that it isn’t a case of if they will score, but when. I love this tension, whether playing or watching. It ratchets up the anticipation so that when the breakthrough finally comes it’s the culmination of collective action, a team coming together to wear their opponents thin until they snap.

I remember having this same feeling when I watched season 8 episode 3 of the TV show Time Team. These 50 minutes of television, available in full on All 4, are what convinced me I wanted to be an archaeologist. They are a damn near perfect example of how an archaeological investigation done properly uses evidence, reasoning and critical thinking. It is also a perfect example of a team of experts working together to really, crushingly, brutally make the point that they are not to be fucked with.

The site is Llygadwy in Wales and the episode starts out as usual with the excitable Tony Robinson springing into shot from an unexpected angle and talking with well-practiced enthusiasm about the excavations at hand.

A neolithic tomb in Sweden

The site includes what appear to be an interesting collection of features. These are a Neolithic megalith (big standing stone), a Norman watch tower, a Neolithic tomb, a ‘chapel’ with early Christian symbols carved on it and, most impressive of all, a natural spring packed full of metal artefacts and topped with a collection of stones carved with human faces.

Tony strokes a random dog that runs into shot, says that the team only have three days to find out why all these different sites are clustered together and the credits roll. We are off!

THUMP

The seeds of doubt are sown straight away. Tony gives the introduction and describes the site as an ‘historical theme park’ and points out that no local archaeologist wanted to be involved in the program because they thought it might be an elaborate hoax (come on guys! A spoiler alert would be nice).

Next the team look at the finds the landowner claims to have found in the spring. It’s an impressive assemblage, containing Bronze Age axes, Roman coins, figurines and broches. In any other episode this would be the punchline to the dig. Show the woollen clad muddy folk digging for two parts, get Tony to worry they might not find anything and then come back from the second break with a dirty great big piece of pot and the audience bursts into spontaneous applause and throws their undergarments at the screen. Here though the finds are looked at with some interest, but it feels more like the opening moves in a game of chess. Lay out the pieces, make it all look safe, set the trap.

THUMP

Day 1, the trenches are opened, and excavations begin. The team talk about the spring and how it might be a holy site. An exciting prospect given their rarity (exciting and unexpectedly rare will become a bit of a theme as the programme progresses). Like good archaeologists they approach the site with an open mind and let the evidence lead them. I find this incredible given that the alarm bells were already ringing for me after the landowner refuses to give an interview about the site and offers up his son-in-law as a sacrificial spokesperson instead. Creighton (for that is his name) lets slip that some of the stones of the Neolithic tomb had been ‘stood up’ by the family- a bit of low-level fiddling but no worse than that…

THUMP

A single find turns up in the spring dig and the geophysical survey isn’t showing any features. Everyone is now using strong language for a British teatime archaeology show like ‘worry’ and ‘concerning’. Then the audience is introduced to another ‘exciting and unexpectedly rare’ find- a head stone normally only found in France. Why is it here then? More furrowed brows and the promise to look into it in more detail.

Then a change in pace, Phil Harding finds a flint tool and a piece of Neolithic pottery. No worries here, it all looks good, though caution is still the watchword. Though these finds appear to be kosher they don’t prove the stones are legit – the only way that can be understood is to look at the finds in the holes in which the stones are placed. Caution is quickly shown to be a wise move as a piece of modern pottery and a bit of clay drainpipe are discovered. The ‘Neolithic’ stones can’t be more than a few hundred years old.

THUMP

The finds from the landowner have now been sorted into a chronology, but once again things are looking odd. The coins that are in the assemblage are overly represented in the 3rd century AD. This might not seem like much until you think about what the spring site is supposed to be, namely an area of pagan worship, so why is it only seemingly starting to get going at a point where Christianity is spreading through the Empire?

THUMP

The Norman tower has a fireplace that has never been used and stone supports that are the wrong way up. Then there are stories of a C19th Vicar who travelled the world with an antiquarian’s eye. A map shows the tower suddenly appearing in the C19th century and as such it is identified as a folly. A trench in the ‘chapel’ finds nothing but animal dung marking it down as a barn.

THUMP

So far it seems like the site holds the interesting tale of an eccentric Vicar building a clump of curios, but then things take a turn for the modern and, potentially, more sinister motivations. A sword is found, it is ‘unexpected and rare’. The expert says it most likely was made in Switzerland – the kind of find that could put a site firmly on the map. It’s just a shame then that it is resting on top of a piece or barbed wire! Samples of wire are taken and compared to fences around the site. A match is found at the bottom of the field.

Roman coins

THUMP

The experts have a problem with the landowner’s finds, the colours of the metals are different suggesting they laid in different types of soil.

THUMP

‘Ancient’ marks are scratched through the surface discolouration of a statue meaning they must have been added much later.

THUMP

The barbed wire also runs under a service trench, which was laid in 1992 meaning the sword must have been buried after that date.

THUMP

THUMP

SNAP

The episode ends with an incredible piece of theatrics. Creighton is brought back out for another interview. Tony opens proceedings by saying the sword is beautiful and Creighton agrees, a smile spreading across his face like the shockwave of a particularly smug bomb. This happiness collapses just as suddenly as it appeared when Tony mentions ‘disappointments’ (the harshest word in his lexicon).

Do yourself a favour, watch this interview. Watch someone try to grasp at the thinnest of straws before realising that there is no way out. It is a moment you don’t often get to see and certainly not one that gets caught on camera. It is experts, doing their jobs well as a team and building up evidence that completely blows apart a hoax for everyone to see.

It is an exciting and unexpectedly rare thing.

The COVID-19 vaccines are a sign for cautious optimism – but it is still early days

As a skeptic, especially one with some level of public platform, I think a lot about responsibility. I think about our responsibility to patients with cancer who choose to go down the alternative medicine route, and how to defend their right to choose while championing good science and challenging pseudoscience. I think about our responsibility to support inclusivity, diversity and representation and creating safe and comfortable spaces for people of all backgrounds – all races, all genders, all levels of ability or disability; all humans. I think about our responsibility to use our voices for the promotion of critical thinking, while knowing when the best course of action is to stay quiet and let others speak.

But most of all, I think about our responsibility to truth, without causing harm. That last part is the important part we’re sometimes prone to forgetting. But I’m thinking about it more and more when it comes to the current climate – the global pandemic we are living through.

The COVID-19 pandemic is a perfect example of how public behaviour is influenced by a whole array of things, and how just sharing the truth and the science isn’t enough to convince people to do the right thing. It turns out the public is made up of humans, who have feelings and hopes and needs and beliefs.

So, I’ve been reluctant to write or talk all that much about COVID-19. I don’t want to judge people for making the best decisions they can, in a climate where they’re exposed to a lot of confusing information, misinformation, disinformation and poor communication. I don’t want to muddy the waters further by being yet another scientist throwing in their two pence. And yet, I watch on as COVID-deniers claim the virus doesn’t exist; as lockdown protesters fight against reasonable precautions put in place to save lives; as anti-maskers march in huge groups without masks; as we slide rapidly into what will surely be a crisis of anti-vax ideology influencing people’s choices to have the vaccines that will allow us to save lives – and I wonder what our responsibility is, as skeptics? How can we help?

I don’t have an answer. I’m sorry. I know skeptics across the world are feeling these things too and I wish I could give you the answer.

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically.

I do think, though, that knowledge and understanding is power. And knowledge and understanding does puncture some of the fear that contributes to the difficulty of making decisions.

We will all have a decision to make in the next few months: do we take the vaccine(s) that will have been approved more rapidly than any vaccine in human history? I’m sure many of us will feel the responsibility of supporting our families and friends in making the decision for themselves too.

I can, at least, tell you what I will (probably) do: take the vaccine when it is available. But I think knowledge and understanding is power. So, let’s talk about the vaccines.

Vaccination for COVID-19

At the time of writing, there are three companies who have provided efficacy data for three vaccine options. These vaccines are of two different types:

1. mRNA vaccine

The Pfizer vaccine and the Moderna vaccines are both mRNA vaccines using a lipid nanoparticle delivery system. They work by bringing mRNA – the molecule your cells need to make proteins – into your cells and asking the cells to make a protein that is part of the Sars-Cov-2 virus called the spike protein. This protein can then teach your immune system to make antibodies against that protein, so if you ever encounter the virus itself, you’re prepared to fight it off. The nice thing about mRNA vaccines is that your body never sees any virus – many vaccines use either dead (inactivated) or weakened (live-attenuated) viral particles to train the body’s immune system. mRNA vaccines are much quicker and easier to produce, so we can make doses of the vaccine much more quickly and more safely. Handily, they don’t need manufacturers to handle loads of Sars-Cov-2 virus to make their vaccine, they just need to handle the mRNA, which is inert.

The downside is that the mRNA vaccines are quite sensitive and they usually need to be stored at -80°C, which requires some pretty complex infrastructure to transport and store them at that temperature.

mRNA vaccines are a relatively new idea, and we’ve never had any approved for use in humans. This means that an approval for Sars-Cov-2 vaccination would be a real landmark.

2. Non-replicating viral vector

The Oxford/AstraZeneca vaccine is a non-replicating viral vector. It’s made from a virus similar to the cold virus, but one that usually infects chimpanzees, called an adenovirus. The virus has been modified so it can’t replicate, which means it won’t amplify through the body when it is introduced into a human. The genetic material inside the virus has been modified to contain the gene for that same spike protein of the Sars-Cov-2 virus. So, the adenovirus gets into your cells, makes the protein, and this teaches your immune system to recognise that protein in case you ever encounter the Sars-Cov-2 virus.

This solution uses a vaccine method that we’ve used before (although it’s still pretty new, too), so we have a bit more history to go on. It’s also much cheaper, at £3 per vaccine for the AstraZeneca vaccine, compared to £15 for the Pfizer one and £25 for the Moderna one, plus it doesn’t have the same storage issues as the mRNA vaccines. But the very early data so far suggests it might not be quite as effective without some extra optimisation.

The data

So far, most of what we have is interim data, which means it’s enough to have an idea of efficacy of these vaccines, but not enough to be sure. The data has also only been released by press release, rather than peer-reviewed publication, and therefore some of the information we need to make an independent analysis on the findings is missing. That’s ok when time is of the essence, but it means some of the data so far raise a few more questions than answers.

The Pfizer and BioNTech Vaccine

Pfizer logo

Pfizer have now reached the point at which they stated they would have enough data to make a comment on clinical efficacy (their endpoint); of the 41,135 participants who have had both doses of the vaccine (which are given three weeks apart), 170 people have developed COVID-19 at least 7 days after the second dose. Of those 170 people who have the infection, 162 were in the placebo arm of the trial – they did not have the vaccine against Sars-Cov-2. Only 8 participants with COVID-19 had been given the test vaccine. Which means the vaccine has 95% efficacy for reducing COVID-19. This only applies to symptomatic cases of Sars-Cov-2 infection, because Pfizer are only testing for the Sars-Cov-2 virus in symptomatic participants. We don’t know the impact of the vaccine on Sars-Cov-2 transmission, which is obviously an important gap in our knowledge.

Pfizer also say that they have a 94% efficacy rate in participants over the age of 65; this is really good news, since COVID-19 is particularly problematic in older people and vaccines are sometimes less effective in this age group too.

The study identified severe cases of COVID-19 in 10 participants, only one of those participants had had the vaccine, the rest were in the placebo arm of the trial.

The Moderna Vaccine

moderna logo

Moderna have released the interim findings for their vaccine. Their study has vaccinated 30,000 participants and their endpoint is 151 cases of COVID-19. So far, they have detected symptomatic COVID-19 in 95 participants; 90 of those participants were in the placebo arm and 5 of them had had the vaccine. This gives an efficacy rate of 95%. Moderna are also only testing people with symptoms, so we don’t have information on whether the vaccine reduces transmission. They have identified severe cases of COVID-19 in 11 cases and all of those cases were in the placebo arm.

The Oxford University and AstraZeneca Vaccine

The AstraZeneca study is slightly more complicated – it is split into two trials across two regions: 12,390 participants in the UK and 10,300 in Brazil. In the UK, participants either receive two full doses of the vaccine, or a half dose followed by a full dose of the vaccine. In Brazil participants receive two full doses of the vaccine.

AstraZeneca logo

They have released interim data indicating that 131 people have developed symptomatic COVID-19 at least 14 days after the second dose. When they pooled the data, the vaccine has 70% efficacy, which is lower than the Moderna and Pfizer vaccines but still very good for a vaccine. However, when analysing only the data for the dosing regimen that used the lower dose first, they found an efficacy rate of 90%.

AstraZeneca are taking nasal swabs as part of their trial in order to assess asymptomatic transmission – though it is unclear whether the efficacy data released so far includes this information. There were no severe cases of COVID-19 in the vaccinated group.

In conclusion

All in all, it’s promising data that we have multiple vaccination options that reduce symptomatic cases of COVID-19 and the cases of severe disease. Hopefully we’ll have more data to come from these studies as they reach their remaining endpoints and publish their findings.

There were no serious safety concerns in any of the trials, and the three companies all worked to include a wide range of patient demographics – including BAME and older participants, two demographics that we know are most affected by this virus.

But it’s still early days – we are lacking information on whether we see a reduction of transmission and we know very little about asymptomatic cases. We also know virtually nothing about the long-lasting effect of these vaccines – with time we will need to establish how long the protection conferred by these vaccine options lasts and whether we will need multiple dosing options.

Still, I think it’s far to say that it’s impressive to have so many good vaccine options within a year, and that should be celebrated as a win for science.

Special thanks to Health Nerd, Gideon M-K for some useful discussion about these vaccines.

How religion trumped science in America’s coronavirus response

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If asked why America’s response to the COVID-19 pandemic was so poor compared to other wealthy nations, many observers might limit their response to five letters: T-R-U-M-P. Trump’s initial downplaying of the virus, his reluctance to model proper mask wearing, his refusal to use all the resources at his disposal to secure sufficient personal protective equipment, his promotion of unproven remedies, his impatience to end state wide lockdowns, and his repeated assurances that the problem was going away each exacted a toll paid in human lives – and this is far from an exhaustive list of his administration’s missteps.

With such a cornucopia of culpability at our disposal, it is tempting to lay the blame for this entirely at the feet of the president. But we should be wary of such totality. After all, America will rid itself of the Trump presidency long before it rids itself of the virus.

I’d argue that the Trump administration – supported by evangelical Christians, staffed by evangelical Christians, and beholden to evangelical Christians – has been less the cause of the pandemic’s spread than the means. And while it would be ridiculous to suggest that religion or religiosity somehow created COVID-19, it would be equally ridiculous to ignore the prominent role it played in exacerbating the disaster.

Unqualified leadership

While the resources at the US government’s disposal are among the best in the world, in many instances their potential was severely undermined by grossly inept leadership. For example, Robert Redfield, the current head of the Center for Disease Control (CDC), was considered for the same role under the George W. Bush administration, but was ultimately rejected due to his controversial work promoting an ineffective HIV vaccine. But Redfield made himself a darling of the Christian right through his vocal opposition to condom use in the fight against HIV. There was little question at the time of his appointment that his connection to evangelical activists was key to his nomination.

Redfield’s case is hardly unique. From climate change denialists running the Department of the Interior and the Environmental Protection Agency (EPA) to a former Energy Secretary who failed to call for the dissolution of his own department only because he could not remember what it was called, the Trump administration has elevated leaders to head scientific departments that were not simply unqualified, but hostile to science. This includes the Vice President, the ostensible head of the White House’s Coronavirus Task Force, whose most relevant experience in the realm of public health was presiding over one of the worst rural outbreaks of HIV/AIDS in American history while the governor of Indiana.

The common thread throughout these appointments is a commitment to the goals of the Christian right on subjects like abortion, contraception, euthanasia, climate change, and stem cell research. Ultimately, this means that a willingness to deny evidence in favor of one’s bias – normally a disqualification from leadership – becomes a prerequisite.

Exemption

In Masterpiece Cakeshop v. Colorado Civil Rights Commission, the US Supreme Court found in favor of Jack Phillips, a baker who refused to sell a wedding cake to a same-sex couple. But the court did not find that he had a right to refuse service to the couple. Instead, it ruled that the Colorado Civil Rights Commission, the first body to adjudicate the dispute, failed to treat Jack Phillips religious objections with “neutral and respectful consideration.” The term appears three times in the majority decision, and once more in a concurrence by Justice Elana Kagan.

But what does it mean to treat a religious objection with “neutral and respectful consideration”? From a legal perspective, nobody knows.  Until Justice Kennedy invented it in 2018, the term appeared nowhere in American law – in no constitution, statute, rule, regulation, or prior case.  So rather than creating clarity, as is the goal of Supreme Court decisions, Masterpiece Cakeshop instead created a new layer of uncertainty; leaving each future judge to interpret the term as they saw fit. And because the examples cited in the decision are dubious, it has led many judges and lawmakers to be overbroad in their interpretation. There is, after all, no legal penalty for being too neutral and respectful.

It should come as no surprise then, that when governors set about issuing pandemic guidelines against large gatherings, eighty percent of states offered at least some exemption to religious organizations. This ranged from stretching the term “essential services” to include in person worship services (22 states) to allowing religious groups to continue to meet without restriction (15 states). This remained true even as church services were increasingly identified as super spreader events. Fearful of legal challenges and political backlash, state officials on both sides of the political aisle were reluctant to declare in-person worship “nonessential.”

Defiance

But even where sufficient restrictions were put in place, many pastors openly defied them. Christian leaders like Rodney Howard-Browne in Tampa Bay, Florida and Tony Spell in Baton Rouge, Louisiana made national names for themselves through their negligent refusal to cancel in-person services in their megachurches; proudly exposing over a thousand attendees at a time to the deadly contagion.

Lakewood megachurch photo by ToBeDaniel https://en.wikipedia.org/wiki/it:User:ToBeDaniel (CC BY 3.0)

A stadium sized congregation of people
Lakewood Megachurch

Others took their complaints to court. A trio of churches sued California Governor Gavin Newsome over his state’s restrictions, calling the public health guidelines a violation of their first amendment rights to free exercise of religion. An Albuquerque megachurch sued the state of New Mexico, claiming that the state’s limitations on gatherings didn’t even allow him to livestream his church’s services, as to do so would require a staff of at least 29 people.

Most of these lawsuits were dismissed by the courts, but this was not always the case. Kansas Governor Laura Kelly was hesitant to restrict church services, but after growing evidence suggested they were major contributors to the ongoing outbreak in her state, she updated her guidelines and revoked some previous exemptions for religious gatherings. This provoked a high stakes legal battle with her state’s Legislative Coordinating Council, which was complicated by a bizarre decision from Trump judicial appointee John Broomes that temporarily blocked Kelly’s guidelines and delayed the state’s ability to react to the ongoing outbreak.

These are only a few examples of the many ways religion continues to hobble America’s pandemic response. In addition to being reliable super spreaders, America’s religious leaders have also been wanton fonts of misinformation, echoing claims that the threat is overblown, that the virus is a Democratic hoax, or that it is powerless against the divine protection of Christ almighty. They promoted quack cures and denigrated potentially life-saving ones. They chose bigotry over common sense relief measures. They dismissed the importance of expertise.

These problems will not go away with the changing of the presidential guard. They will continue to hamper America’s pandemic response under a Biden administration. And, in a world increasingly reliant on scientific literacy to solve its most pressing problems, they will await the next crisis as well.

Outbreak: A Crisis of Faith – How Religion Ruined Our Global Pandemic by Noah Lugeons, prefaced by Andrew Torrez, is currently available in paperback and ebook.  

Real in what sense? Consensually torturing skeptics over the nature of ‘realness’

Much of skepticism boils down to trying to show if something is real or not. Cryptids? Not real. Climate change? Real. Homeopathy? Not real. Aliens? Probably real, but unlikely to traverse galaxies just to play tag with the Airforce and harass some farmers.

However, we rarely stop and unpack what we mean by “real”, taking it as obvious in context. Naturally, I couldn’t leave that fact well enough alone, so I developed a form of consensual recreational torture I call The Enlightening Round. At the end of every Embrace the Void podcast, I present my guest with a list of things and force them to tell me if each thing is real or not real.

To be clear, the stakes could not be lower. The guests are not allowed to define what they mean by “real”, which leaves them endless room for hedging after the fact. Despite these very low stakes, guests consistently express a great deal of anxiety at giving the answer they believe is correct and believe signals the right commitments to listeners. Here is the current list, if you’d like to test yourself at home. Notice your mental and emotional states as you move through the list:

  • Is anything real?
  • The External World?
  • Colors
  • Phemomenal consciousness
  • Free will
  • Selves/persons
  • Genders
  • Races
  • Species
  • Morality
  • Rights
  • Knowledge
  • God/Gods
  • Society
  • Money
  • Numbers
  • Fictional characters
  • Holes
  • Chairs
  • Sandwiches
  • Science
  • Natural Laws
  • Beauty
  • Love
  • Causality
  • Time

Some readers will find this relatively easy, and I suspect the majority of folks who find it relatively easy will say the majority of the things are real. These lucky souls have likely not spent much time around philosophers and similar academics, and should keep that up if they know what’s good for them.

Why is this so painful for the rest of us? Especially for folks who spend a lot of time thinking about what’s real? The answer, I believe, is that we’re rarely asked to think about the reality of more than a small cluster of these concepts at a time, and we’re basically never asked to try to give a consistent account of realness that effectively encompasses all of them. That obscures the fact that it’s extremely difficult to define ‘real’, driving many a guest to rail at the very notion of real simpliciter and demanding they be allowed to make clear in what sense certain things are real. It’s all in good fun, but the angst is quite real.

A friend of the show, Jeremiah Traeger, has actually compiled hard data on guests’ answers and the resulting correlations between concepts. Here’s some trolling masquerading as science:

the correlation between answers of real or not real on any two concepts.
how frequently a guest has said that a particular thing is real - the highest bar is for anything, the lowest for fictional characters.

The first chart conveys the correlation between answers of real or not real on any two concepts. For example, the most powerful non-trivial correlation was between ‘sandwiches’ and ‘chairs’, with a correlation of ~0.85, where 1 would equal a perfect correlation and convey that every guest who says chairs are real also says sandwiches are real or vice versa. The second chart lays out how frequently a guest has said that a particular thing is real, with it being most likely they will say that “anything” is real, and least likely they say that fictional characters are real. The sample size at this point is around 60 guests.

The torturous nature of The Enlightening Round is made more acute by the strategic organizing of the concepts in question. While not part of the original test, I’ve started to open the enlightening round by asking if anything is real, as a way to prime the guest against cheap talk that ends up claiming nothing is real. At the time of our last data compilation no guest had said that nothing is real, though we have since had one guest choose that solution to try to avoid this philosophical Kobayashi Maru.

From the primer question, I move to the external world, which feels easy for folks until it’s followed by colors, a notoriously difficult to categorize set of secondary properties. Interestingly, many guests say colors aren’t real but both the external world and phenomenal consciousness are real, which makes one wonder how all the components of color can be real while color itself is not. I suspect this is indicative of folks seeing “simple” processes, processes they see as existing entirely in the external or internal world, as real, while seeing complex or intersubjective processes and their products as not real.

In my mind, free will and selves are fundamentally inseparable. I believe you can’t have free will without selves/persons. That view is clearly not universal though. As the second chart shows, some portion of folks see selves as real while denying those selves free will. This of course raises the issue that the definition of ‘real’ isn’t the only factor in play here, as guests are likely often working with radically different definitions of each of these concepts.

Gender, race, and species form the next cluster, as they’re all categories for groups of entities where there is substantial debate how much they are socially constructed. My sense is that the variation in responses on these three suggests that guests likely tend to see species as the least socially constructed, followed by gender and finally race. This is not to say that all guests associate social construction with anti-realness, only that some do and I suspect that explains the variation for these concepts.

The remainder of the concepts are more of a grab bag, with pairings like morality and rights or society and money producing stumbling blocks along the way. On advice from my numbers guy, I’ve kept in fictional characters as a kind of baseline test, and because it’s deeply amusing to see how many folks say fictional characters are real but god/gods is not. Folks sometimes wonder what the point is of asking about both sandwiches and chairs, especially when they appear so strongly correlated in guests’ minds. To me, ‘sandwiches’ is about whether taxonomies are real, and chairs is about whether complex objects exist or are all really just “processes arranged chair wise”. Each of these of course ties into metaphysical questions that philosophers will probably wrestle with for as long as we still exist.

Naturally, folks often ask me how I would answer the challenge, and I’ve been subjected to versions of the enlightening round on other podcasts. If forced to give one universal definition of ‘real’, I side with Philip K. Dick in defining ‘real’ as anything that doesn’t go away, no matter how hard you stop believing in it. I think this accurately conveys what folks actually mean when they use the term ‘real’, while avoiding slipping into assumptions about the nature of ‘real’ things and why they don’t go away even when you stop believing in them. It gives a straightforward explanation of the material world studied by the natural sciences, while also allowing that hallucinations, like the ones PKD himself experienced, are also real as long as they persist even when the person ceases to believe in them.

While I find this definition valuable, I’ve noticed that I also sometimes think of ‘real’ as less of a discrete property and more of a corrective to the ways people think about the world. For example, I frequently argue that morality is real. When I make those arguments, I mean ‘real’ in the sense above, but I also choose to emphasize the realist side of the argument because, in my experience, people tend to see morality as “not real” in ways that seem harmful to me. Even if it turned out to be true that moral realism and moral anti-realism blend into each other when you get far enough into the weeds, I think it is valuable to emphasize the realist interpretation as long as it feels like we as society are leaning too far in the other direction.

So, after enough procrastination and affording myself the freedom I deny my guests, the freedom to define their terms, here are my current answers to the enlightening round. They’re probably all wrong, but they’re my wrong. Before you throw shade, see if you can get through it yourself without regretting your decisions:

  • Is anything real? Yes
  • The External world? Real
  • Colors Real
  • Phemomenal consciousness Real
  • Free will Not Real
  • Selves/Persons Not Real
  • Genders Not Real
  • Races Not Real
  • Species Not Real
  • Morality Real
  • Rights Real
  • Knowledge Real
  • God/Gods Not Real
  • Society Not Real
  • Money Not Real
  • Numbers Real
  • Fictional characters Not Real
  • Holes Not Real
  • Chairs Not Real
  • Sandwiches Not Real
  • Science Not Real
  • Natural Laws Real
  • Beauty Real
  • Love Real
  • Causality Not Real
  • Time Not Real

Four perspectives on peer review: why it goes wrong, and why we need to fix it

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Before anyone publishes anything in a reputable science journal, their article has to pass ‘peer review’. It is thus a process of evaluating the work of scientists by external experts, i.e. peers. This function renders peer review crucial for checking the validity of science. Even though this seems both necessary and commendable, there has been plenty of criticism of the method.

How does peer review work?

Peer review is a form of self-regulation by qualified members of a profession within the relevant field and normally involves multiple steps:

  1. The authors send their manuscript to a journal of their choice and ask the editor to consider it for publication.
  2. The journal editor takes a good look at it to decide whether to reject it straight away (for instance, because the subject area is not of interest to the journal) or whether to send it out to referees for examination.
  3. The referees (usually 2 or 3) then have the opportunity to refuse or accept the invitation to review the submission.
  4. If they accept, they review the paper and send their reports to the editor (usually according to a deadline set by the editor).
  5. Based on these reports, the editor now tries to come to a decision about publication; if the referees are not in agreement, a further referee might have to be recruited.
  6. Even if the submission is potentially publishable, the referees will usually have raised several points that need addressing. In such cases, the editor sends the submission back to the original authors asking them to revise their manuscript.
  7. The authors would then do their revision and re-submit their paper.
  8. Now the editor can decide to either publish it or send it back to the referees asking them whether, in their view, their criticisms have been adequately addressed.
  9. Depending on the referees’ verdicts, the editor makes the final decision and informs all the involved parties accordingly.
  10. If the paper was accepted, it now goes into production.
  11. When this process is finished, the authors receive the proofs for final a check.
  12. Eventually, the paper is published and the readers of the journal finally have a chance to scrutinise it.
  13. This frequently prompts comments which the editor might decide to publish in the journal.
  14. In this case, the authors of the original paper would normally get invited to write a reply.
  15. Finally, the comments and the reply are published in the journal side by side.

The whole process takes time, sometimes lots of time. I have had papers that took around two years from submission to publication. This delay seems tedious and, if the paper is important, unacceptable (if the article is not important, it should arguably not be published at all). Equally unacceptable is the fact that referees are expected to do their reviewing for free. The consequence is that many referees do their reviewing not as thoroughly as might be expected.

The reviewer’s perspective

At Exeter, I had more than enough opportunity to see the problems of peer review from the reviewers perspective. At a time, I used to accept doing about 5 reviews per week, roughly 60% for the many (often somewhat dubious) journals of alternative medicine and the rest for mainstream publications; in total, I surely have reviewed well over 1000 papers.

Written notes on the chi square statistical test

I often recommended inviting a statistician to do a specialist review of the stats. Only rarely were such suggestions accepted by the journal editors. Often I recommended rejecting a submission because it was simply too poor quality, and occasionally, I told the editor that I had a strong suspicion of the paper being fraudulent. The editors very often (I estimate in about 50% of cases) ignored my suggestions and published the papers nonetheless. If the editor did follow my advice to reject a paper, I regularly saw it published elsewhere later (usually in a less well-respected journal).

With ‘open’ peer review (where the authors are being told who reviewed their submission), infuriated authors sometimes contacted me directly (which they are not supposed to do) after seeing my criticism of their paper. Occasionally this resulted in unpleasantness, once or twice even in threats (from them, I hasten to add). Eventually I realised that improving the standards of science in the realm of alternative medicine was a Sisyphean task, became quite disenchanted with the task and accepted to do fewer and fewer reviews. Today, I do only very few – maybe one or two per month.

The author’s perspective

I also had, of course, the opportunity to experience the peer review process from the author’s perspective. Most scientists will have suffered from unfair or incompetent reviews and many will have experienced the frustrations of the seemingly endless delays. Once (before my time in alternative medicine) a reviewer rejected my paper and soon after published results that were uncannily similar to mine. In alternative medicine, researchers tend to be very emotionally attached to their subject. I once received reviewer’s comments which started with the memorable sentence: “This article is staggering in its incompetence…”

The editor’s perspective

As the founding editor of three medical journals, I have had 40 years of experiencing peer review as an editor. This often seemed like trying to sail between the devil and the deep blue sea. Editors naturally want to fill their journals with the best science they can find. But, all too often, they receive the worst science they can imagine. They are constantly torn by tensions pulling them in opposite directions. And they somehow have to cope not just with poor quality submissions but also with reviewers who miss deadlines and do their work shoddily.

The investigator’s perspective

Finally, I also had the pleasure to do some research on the topic of peer review. Sometime in the mid-1990s, when such research was still highly unusual, we were invited to the offices of the BMJ where the then BMJ-editor, Richard Smith, discussed with us the idea of doing some research on aspects of the peer review process. Together with the late John Garrow, we designed a randomised trial and conducted a proper study. Once we had written up the results, an ironic thing occurred: our paper did not pass the peer review process of the BMJ. So, eventually we published it elsewhere. Here is its abstract:

A study was designed to test the hypothesis that experts who review papers for publication are prejudiced against an unconventional form of therapy. Two versions were produced (A and B) of a ‘short report’ that related to treatments of obesity, identical except for the nature of the intervention. Version A related to an orthodox treatment, version B to an unconventional treatment. 398 reviewers were randomized to receive one or the other version for peer review. The primary outcomes were the reviewers’ rating of ‘importance’ on a scale of 1-5 and their verdict regarding rejection or acceptance of the paper. Reviewers were unaware that they were taking part in a study. The overall response rate was 41.7%, and 141 assessment forms were suitable for statistical evaluation. After dichotomization of the rating scale, a significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25), was found. This observation mirrored that of the visual analogue scale for which the respective medians and interquartile ranges were 67% (51% to 78.5%) for version A and 57% (29.7% to 72.6%) for version B. Reviewers showed a wide range of responses to both versions of the paper, with a significant bias in favour of the orthodox version. Authors of technically good unconventional papers may therefore be at a disadvantage in the peer review process. Yet the effect is probably too small to preclude publication of their work in peer-reviewed orthodox journals.

How can we improve peer review?

Unfortunately, there are few easy solutions to the many problems of peer review. It often seemed to me that peer review is the worst idea for checking the science that is about to be published… except for all the other ideas. If peer review is to survive – and I think it probably will – there are a few things that could, from my point of view, be done to improve it.

An academic paper with a pair of glasses resting on top.

We should make it much more attractive to the referees. Payment would be the obvious way to achieve this; the big journals like the BMJ, LANCET, NEJM, etc. could easily afford that. But recognising reviewing academically would, in my opinion, be even more important. At present, academic careers depend strongly on publications; if they also depended on reviewing, experts would queue up to act as referees.

The reports of the referees could get independently evaluated according to sensible criteria. These data could then be conflated and published as a marker of academic standing. Referees who fail to do a reliable job would thus spoil their chances of getting re-invited for this task and, in turn, of getting the academic promotions they are aiming at.

We need to speed up the entire review process. Waiting months on months is hugely counter-productive for all concerned. Fortunately, most journals are already doing what they can to make peer review acceptably swift.

Today many journals ask authors for the details of potential reviewers of their submission. Subsequently, they send the paper in question to these individuals for peer review. I find this quite ridiculous! No author I know of has ever resisted the temptation to name people for this purpose who are friends or owe a favour. Journals should afford the extra work to identify reviewers who are the best independent experts on any particular subject.

Of course, none of my suggestions are simple or fool-proof or even sure to work at all. But surely it is worth trying to get peer-review right. The quality of future science seems to depend on it.

Sean Ellis 1966 – 2020

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Sean Ellis was one of those people who, despite appearing quiet and unassuming, was very active and widely known. His final illness was very brief, an aggressive brain tumour. He died peacefully early on Saturday morning and without any distress, his family all having seen him the evening before.

He was proud of his ‘Desmond’, having left university with a 2:2 (Tutu). He was a very bright student but had too many interests to focus solely on grades.

He worked as a GPU architect, a highly specialised and leading role in computer hardware and software design. But while he enjoyed his work, it was a fraction of his life; his family, Tamasin, James and Thomas, came first. He was also politically active, being a campaigner for the NHS Action Party and sponsor of its leader who stood in his constituency. He made himself a constant thorn in the side of his local MP, Jeremy Hunt. He was also a regular at the Anti-Brexit marches, with his elaborate electronic placards provoking frequent photo stops.

Part of the winning Pod Delusion team in 2013

But the part of his life he was perhaps most widely known for was his involvement with skepticism in the UK. He became involved with the Hampshire Skeptics in Winchester, becoming its treasurer very early on and staying in that role until he was no longer able. He was a frequent contributor to the multiple Ockham-Award winning Pod Delusion. His pieces being witty and clever: favourites included the ones about Quantum Santa and the 3D Quark printer in Argos.

His wit and knowledge made him a quiz team delight. The year his team won the QED Quiz cup the rest of the team agreed that their skill was in choosing him as their teammate.

Most of all though, during the last weeks of his life the comment most heard was ‘Please tell him how much we love him.’ And there’s a lesson in there for all of us. We need to tell our friends that we love them while we still have them with us. It is good that Sean could at least hear this in so many words while he was still able to understand what it meant.

It’s easier to decry ‘kids today’ than it is to look honestly at the world we’ve made

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Sewage pipes can be fun! There’s one a few minutes’ walk from my childhood home which spans across a small valley. In the centre it looms about 40 feet (12 metres) above the river which runs below. Back in the late 80s the young me and my fearless friends used to clamber past the safety barrier and walk across it. Even in the rain. Sometimes we would spin around theatrically at the high point. The more bravado the better. The older and moderately wiser me now looks back with a mixture of nostalgia and bemusement at our stupidity.

With some notable assistance, I’ve managed to produce three children of my own since then. None of them have ‘walked the piperope’ like I did, but I’m happy to report that my first two made it to adulthood relatively unscathed, and I have high hopes for the third. It seems however that there’s a sentiment from sections of the generation above me (and some of my generation too) that we’ve overstepped the mark somewhere in our protective parenting, and our children are lesser for it. The general accusation is that mollycoddling parents and certain societal changes have produced generations of lazy, disrespectful, over-sensitive children with a badly inflated sense of entitlement and self-importance. These accusations may crop up during awkward conversations with elderly relatives, but they are much more prevalent in the form of clickbait tabloid articles and social media snipery.

“They have trouble making decisions. They would rather hike in the Himalayas than climb a corporate ladder. They have few heroes, no anthems, no style to call their own. They crave entertainment, but their attention span is as short as one zap of a TV dial.”

Proceeding with Caution, Time, 2001

Regression to the meme

The idea that kids these days have somehow lost their way isn’t a new one, but the internet certainly makes it easier to fire off shots into the echo-chamber, as this frequently shared meme shows:

Top panel: "1300s: I'm dying of plague" written over a representation of many people in a street as one is carried away on a stretcher, second panel: "1800s: I'm working 16 hour days" written over an image of children working on a steam train, third panel "1900s: I'm off to fight a war" written over an image of soldiers, final panel "2000s: I'm offended" written over some teenage girls crying. Underneath is written "Kids today have it so easy".

Many who have shared this will not even have noticed the watermark of right wing organisation Turning Point USA on the image. Considering that Turning Point USA is a right-wing organization which has effectively acted as an on-ramp for white supremacists, even those who found this meme lighthearted have to concede it has a more sinister undertone. Others will no doubt be well aware of this, and will be delighted to perpetuate their myth of the ‘good old days’ as part of a larger mission to Make Everything Great Again.

“What really distinguishes this generation from those before it is that it’s the first generation in American history to live so well and complain so bitterly about it.”

The Boring Twenties, Washington Post, 1993

Old-rage pensioners

There are of course plenty of other memes with benign sources that sustain similar strawman-style sentiment towards the younger generations, but are we simply being made aware of the bitterness of a vocal minority due to adverse algorithms, or does this genuinely reflect the prevailing sentiment? The answer is that it’s hard to tell: a 2017 Scottish Government Survey of public attitudes to young people was a mixed bag, but showed generally positive attitudes towards young people. However, going back a little further to 2011, the Intergenerational Foundation’s survey painted a different picture, with older generations viewing their youngers as unfriendly, incompetent and having low moral standards. It also showed a distinct difference in perception of British youth compared to their counterparts in 28 other European Countries. So, there’s clearly something going on, and it may well be worse here in the UK than elsewhere across the continent.

“…in youth clubs were young people who would not take part in boxing, wrestling or similar exercises which did not appeal to them. The ‘tough guy’ of the films made some appeal but when it came to something that led to physical strain or risk they would not take it.”

YOUNG PEOPLE WHO SPEND TOO MUCH, DUNDEE EVENING TELEGRAPH, 1945

Offence post

The idea that young people are ‘snowflakes’ who get offended at the drop of a hat is a pervasive trope in sections of society, and doubtlessly feeds into the negative judgements of their elders. But, do young people really get offended too easily these days? Well, that’s subjective to say the least. It’s certainly easier to make your disapproval public thanks to the internet. It’s not unrealistic to think that the youth of yesteryear may have been more socially aware and vocal if there had been easier means to do so, and a world of information (and misinformation) at their fingertips. Add to this the fact that the social attitudes of young people, according to a 2014 survey, “continue the gradual shift towards increasingly liberal/permissive social attitudes about gender equality, sexuality, race and ethnicity”. It could therefore be argued that it’s less about how easily they’re offended, and more about what offends them that could be troubling to segments of the older generation.

That picture is blurred by a number of factors: The stories we hear in the papers and on social media tend to be the more extreme and occasionally ridiculous examples, a phenomenon which has been somewhat unpleasantly named ‘nutpicking’. Certain tabloids are also desperate to play the ‘snowflake’ card at every opportunity as well, exemplified by The Sun’s approach to criticism of popular 90s sitcom Friends, which turned into an indulgent festival of millienial-bashing

“We defy anyone who goes about with his eyes open to deny that there is, as never before, an attitude on the part of young folk which is best described as grossly thoughtless, rude, and utterly selfish.”

The Conduct of Young People, Hull Daily Mail, 1925

Snow-fakes!

Looking behind the curtain though, this type of millennial mauling could be seen as some kind of coping mechanism for people my age (47) and older who grew up in a time plagued by some highly questionable social attitudes, who don’t relish the thought that they might have said and done things they’re no longer proud of. As I look back at some of the entertainment I enjoyed and values I held in the past it makes me uncomfortable to say the least. In many ways I’m ashamed of the younger me. It must be much easier to push back on that feeling and direct the blame outwards. It’s classic school bully behaviour. Honest introspection is rarely enjoyable, and the mild irritation of cognitive dissonance offers a path of lower resistance.

The caricature of millennial fragility is particularly frustrating, because being in touch with your emotions and expressing them honestly and openly in public is not something to be frowned upon. For a simple illustration of this why not Google the name of the tabloid of your choice along with terms like male stigma mental health: You’ll no doubts find reams of articles encouraging openness, communication, self-expression, and being in touch with your emotions. Why is it then that those very same publications will vilify the younger generation for espousing those values? It’s hard to see their occasional tips of the hat towards mental health as anything other than examples of the “virtue signalling” they so frequently criticise.

“The world is passing through troublous times. The young people of today think of nothing but themselves. They have no reverence for parents or old age. They are impatient of all restraint. They talk as if they knew everything, and what passes for wisdom with us is foolishness with them. As for the girls, they are forward, immodest and unladylike in speech, behavior and dress.”

From a sermon preached by Peter the Hermit in A.D. 1274

Youth clubbed

There are of course valid concerns, which merit some attention. In terms of laziness, childhood obesity continues to be a problem, but then again so is adult obesity. With poor diet and low levels of physical activity the primary cited as the primary causal factors, it’s easier to blame turkey twizzlers and mobile phones than it is to blame poverty and the continuous closure of playparks and youth centres.

Meme headed "So glad I grew up"
Image one: children playing in a stream and underneath written "doing this", image two: children looking a their phones written underneath "not this". Underneath "Share if you agree!".

The increased use of mobile phones and screentime are symptomatic of larger changes going on in society. Perhaps one of the few silver linings of the covid-19 crisis is that people of all ages have learned that living a sizeable portion of your life online can be rewarding and fulfilling, particularly when face to face contact isn’t really an option. Personally speaking I’d rather exchange messages with my internet buddies across the world than have a chat over the garden fence with my nice but somewhat dull neighbours (don’t worry, they won’t be reading this – and even if they do I’ll say it’s the folks on the other side).

“[Young people] are high-minded because they have not yet been humbled by life, nor have they experienced the force of circumstances. They think they know everything, and are always quite sure about it.”

Attributed to Aristotle, 4th Century BC

No kidding

I miss a lot of things about being young; innocence, energy, my hair, and a lack of lower back pain to name but a few. Nostalgia is fun in small doses, and so is vicariously reliving some of the fun parts of growing up through my children. But there’s a darker side to that: A horde of new challenges out there that have to be dealt with, like global warming, zero-hour contracts, tuition fees, cyber bullying, and the lack of affordable houses. Add those to the challenges that were already there, and suddenly an opportunity to be young again doesn’t look so enticing. With all that in mind, it’s strange that some people can look at the youth of today and be so certain that they’re doing it all wrong.