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Content Special Edition: Burning Issues Next Event A Education B Resources: Water, Energy, Air, Food C Health D Climate Change / Sustainability E Economy / Stock Market / Poverty F BiodiversityG Waste / Pollution H Globalization Agenda Club of Amsterdam SearchSubmit your articleContactSubscribe Welcome to the Club of Amsterdam Journal. Nick Bostrom: “An existential risk is one that threatens the premature extinction of Earth-originating intelligent life or the permanent and drastic destruction of its potential for desirable future development. The materialization of such a risk would be an existential catastrophe. Although it is often difficult to assess the probability of existential risks, there are many reasons to suppose that the total such risk confronting humanity over the next few centuries is significant. Estimates of 10-20% total existential risk in this century are fairly typical among those who have examined the issue, though inevitably such estimates rely heavily on subjective judgment. The most reasonable estimate might be substantially higher or lower. But perhaps the strongest reason for judging the total existential risk within the next few centuries to be significant is the extreme magnitude of the values at stake. Even a small probability of existential catastrophe could be highly practically significant.” Nick Bostrom is Director of the Future of Humanity Institute, Oxford University and presents at our next event the future of the Future – Thursday, 3 November! …. interested in knowing more and sharing thoughts and ideas …. join us! The Club of Amsterdam identified some key ares of global challenges and dedicates this Journal to  “Burning Issues”.Felix Bopp, editor-in-chief Special Edition: Burning Issues Introduction “Burning Issues” is a contribution to a continuous dialogue that intends to motivate, connect, accelerate ideas, innovation, solutions … We invite you to join and share your ideas, experience, to report about projects, theories, more burning issues … For comments – please visit our blog Club of Amsterdam bloghttp://clubofamsterdam.blogspot.com Burning Issues A Education – Peter van GorselB Resources: Water, Energy, Air, Food – Michael AkeribC Health – Philip GagnerD Climate Change / Sustainability – Chandran Nair / Douglas Mulhall / Diana den HeldE Economy / Stock Market / Poverty – Hardy F. SchloerF Biodiversity – Biodiversity is life / Sustaining Life: How Human Health Depends on BiodiversityG Waste / Pollution – Douglas Mulhall / Diana den HeldH Globalization – Social Media Revolution / Madanmohan Rao Next Event the future of the FutureUtopia versus The End Of The World As We Know It Thursday, November 3, 2011Location: Volkskrantgebouw, Wibautstraat 150, 1091 GR AmsterdamThe conference language is English.In collaboration with Gendo The speakers and topics are Nick Bostrom, Director, Future of Humanity Institute,Oxford UniversityThe work futurists do, humanities great potential. Arjen Kamphuis, Co-founder, CTO, GendoThe Cassandra Syndrome, nobody likes a party pooper. Anders Sandberg, James Martin Research Fellow,Future of Humanity Institute, Oxford UniversityCognitive biases and what to do about them.The art of usable foresight. Moderated by Kwela Sabine Hermanns A Education Wealthy countries currently give $2 billion each year to help poor countries pay for basic education. They would need to give an additional $10 billion each year to put all children in school by 2015.Global Citizen Corps One in five adults in the developing world – almost 862 million people – cannot neither read nor write. Women’s illiteracy rates exceed 70 percent in more than 20 developing nations. The educational future of millions of children is also is bleak: 125 million primary school-aged children are not in school, two-thirds of whom are girls. Some 150 million children do not complete primary school, and another 200 million suffer in poor learning environments.CARE The worldwide e-learning industry is estimated to be worth over $48 billion according to conservative estimates. Developments in Internet and multimedia technologies are the basic enabler of e-learning. The five key sectors of the e-learning industry are consulting, content, technologies, services and support.Wikipedia Peter van Gorsel, Educational Business Developer, University of Amsterdam Peter spent many years in publishing before becoming Director of the Institute for Media and Information Management at the Hogeschool van Amsterdam. Since October 2010 he started his current assignment.Club of Amsterdam: Are the current educational standards and policies accurate to prepare future generations to this ever more globalized world? Which countries over the world seem best prepared? Peter van Gorsel: There is no perfect way to educate people because local, national and international culture plays a big part and young people are not cattle. So there is no global answer to what education should be and what policies will work and what policies not. The difference between countries are enormous and there seem to be no countries that are the best in everything. Each country has institutions that are very good in some area’s but those same countries are doing very bad in others. Nobody is really prepared for the uncertain future and unsure job market that will come out of this crisis. Education certainly can’t be everything to everybody. Education in a broad sense is preparing people for a fulfilling life and a rewarding job that matches their talent and capacities. Most educational thinking is still very much rooted in the 19th century and revolves around the transfer of static knowledge that the teachers grew up with and is strongly divided along lines that are blurring: academic, vocational, artistic etc. It also takes the position that teaching is something completely different form the outside world. Hence the walls between education, business and arts. Politicians often see education as a means to enhance economic development or a way to promote their view or policy. Funding is in such cases used as a lever to bring about changes that they want to see in educational systems. Top positions in education are therefore often a political more than a professional nomination. The world maybe globalized but education isn’t. Do we now face more challenges concerning education in a globalized world then the ones we already had such as illiteracy, the necessity to prepare generations for the future or women’s uprising through education? Peter van Gorsel: Future generations will have to deal with the effects of globalization and their careers will be much more erratic and unsure. Intensified competition for top jobs will be a feature of the future as well as strong division between high earners and the mass of workers below them bridging about stronger class divisions and erosion of educational systems as state support falls away. Students in western parts of the world seem to be especially unaware of this while they are the first ones that will have to face these harsher circumstances. The role of women will be more important than in the past both in education and inn the workplace. They, however, work and learn, differently from boys. Education should reflect that without bending too much in one direction. What role should technology play in our educational system in the context of a globalized and evermore technologically advanced world? Should we set limits to the use of technology in education and if so to what extent?Peter van Gorsel: Technology can never take the place of good and committed teachers. It can, however help teachers to work in a more interesting way and assist students with complicated projects and give them access to knowledge now beyond their reach and means. Technology is vital when we look at the education and training or those people already out there. Lifelong Learning is certainly one of the most important aspects of the future of education. Through blended learning, on line coaching and monitoring workers can stay up to date and abreast of the latest in their field. There are no limits to use of technology in education; there is however the fine balance between the time spent with technology and the time spent with teachers. B Resources: Water, Energy, Air, Food Resources WaterMore than 1 billion people have no access to clean and safe drinking water while over 2 billion lack access to adequate sanitation.Global Citizen Corps Agriculture currently uses 11 percent of the world’s land surface and uses 70 percent of all water withdrawn from aquifers, streams and lakes for crop production. Land and water resources are, however, unevenly distributed. Cultivated land area per person in low income countries is less than half that in high income countries, and its suitability for agriculture is generally lower.FAO – Food and Agriculture Organization of the United NationsEnergyCountries belonging to the Organisation for Economic Co-operation and Development (OECD) experienced their strongest demand for energy since 1984, up 3.5 percent. In contrast, power consumption in Non-OECD countries grew 7.5 percent in 2010.China’s 11.2% energy consumption growth made it the world’s largest energy consumer, pushing the U.S. from the top spot. China accounted for just over 20% of all the energy consumed in the world during 2010.World-proved oil reserves in 2010 were sufficient to meet 46.2 years of global production. The Middle East holds 752.5 million barrels of oil, more than half the world’s total. South and Central America is a distant second with 17 percent of proved oil reserves.Qatar’s proved natural gas reserves have exploded 98 percent since 1990 and today account for 13.5 percent of the world’s output, third highest behind Russia and Iran. Qatar’s natural gas production has experienced a similar rise, growing 30.7 percent in 2010.Coal supplies nearly 30 percent of global energy due to strong consumption demand from China and the developed world-where coal expenditure grew at the fastest pace in 30 years. The U.S. holds the largest reserves of coal (28 percent) but China accounts for roughly 48 percent of the world’s demand.Brazil’s use of hydroelectricity has increased 30 percent since 2000 and the country accounts for nearly 12 percent of the world’s total. China accounts for slightly more than 20 percent of worldwide consumption and saw its hydroelectric use increase by more than 5 percent in 2010.Consumption of renewable energy has skyrocketed 209 percent over the past 10 years, far outpacing coal’s 48 percent jump. Nearly one-quarter of the total renewable energy usage comes from the U.S. which uses 121 percent more renewable energy than it did a decade ago.China has surpassed the west to emerge as the world’s largest manufacturer and producer of solar panels. Wind, solar and biomass energy are expected to represent 8 percent of the country’s energy output by 2020.U.S. Global Investors AirClean air is considered to be a basic requirement of human health and well-being. However, air pollution continues to pose a significant threat to health worldwide. According to a WHO assessment of the burden of disease due to air pollution, more than 2 million premature deaths each year can be attributed to the effects of urban outdoor air pollution and indoor air pollution (caused by the burning of solid fuels). More than half of this disease burden is borne by the populations of developing countries .WHO – World Health Organisation Food925 million hungry people in 2010:Asia and Pacific 578 million, Sub-Saharan Africa 239 million, Latin America and the Caribbean 53 million, Near East and North Africa 37 mllion, Developed countries 19 million.FAO – Food and Agriculture Organization of the United Nations The number of hungry people has increased since 1995-97, though the number is down from last year. The increase has been due to three factors: 1) neglect of agriculture relevant to very poor people by governments and international agencies; 2) the current worldwide economic crisis, and 3) the significant increase of food prices in the last several years which has been devastating to those with only a few dollars a day to spend. 925 million people is 13.6 percent of the estimated world population of 6.8 billion. Nearly all of the undernourished are in developing countries.World Hunger Michael Akerib, independent higher education professional Part academic, part consultant, of multicultural background, fascinated by Russia, the Arctic, Brazil, natural resources, demography, new spaces, Biotechnology, post-humanity and many many more issues. A Halloween Story ‘You are confusing two concepts: answering the questions and formulating them correctly. Only the latter is required of an author.’ – ChekhovA message for Halloween: let us not listen to the witches that tell us to walk into an age of scarcity and perhaps even into the next dying out by destroying the strategic natural resources our earth has been endowed with: air, food, water and energy sources which are intricately woven to form our environment from which we derive our basic needs. Instead, let us resuscitate the voices of the fairies that were left drifting while we were only concerned with prices and that are telling us we need to avoid an impending disaster. They are telling us there is a problem and that a solution needs to be found as quickly as possible. So does the United Nations Environment Program which states in a recent report that if the right systems are implemented as of today, agriculture could feed 9 billion people AND become largely carbon neutral. The alternative would satisfy the witches: the inability to produce sufficient food would lead to mass migrations, famines of an unprecedented scale and global social movements as prices skyrocket to unprecedented levels and the poor suffer even more. The agro-industrial model, built over the last half-century, which sees the environment as a machine from which products must be extracted from unlimited resources with the help of technology; and the market as a global free-for-all arena, driven by price rather than quality – so as to reduce the percentage dedicated to food from our disposable income – is unable to sustainably feed a growing human population. We now consume more food than we produce, thus depleting stocks. We need to rethink not only agricultural production but also the policies of retailers – who have driven the prices down to levels at which farmers can no longer concentrate on quality – and the expectations of consumers. The very first step in any decision making process is becoming conscious of the problem and therefore of the need of a solution and this seems to have finally happened. For a humanist, the alternative model to ‘us or the planet’ is one that sees humans as a component of a broad biological system – a complex dynamic model that links man and the earth’s resources. Concrete steps to apply this model include stopping deforestation, in particular in tropical areas, as these prime biotopes are essential cogwheels in the water cycle and in reducing atmospheric carbon. Fertilizer addition to the soil needs to be reduced as it contaminates water tables and rivers. Methane release from animal manure, cattle in particular, also requires a substantial reduction. Land usage (including not only pasture but also land devoted to grain farming) to produce beef is colossal. Convincing consumers to eat other types of meat or, on a more technological vein, producing meat in the lab, would contribute to preserving our environment. Investments in agroecology would represent a big step forard in solving the food issue as well as allowing a satisfactory management of the three other resources. These investments can only be made by governments as major food companies are not interested in systems that offer a lower productivity per hectare. Investments must include storage facilities to enable farmers to store product rather than selling at harvest when prices are lowest. Investments must also be made in educating farmers to use these techniques and laws must also allow small farmers ownership of the land. Indeed, agroecology, by relying less on external outputs, offers the advantage of breaking the reliance of agriculture on energy which is required for fertilizers, pesticides and to drive agricultural machinery. Pests are controlled by a variety of methods, such as insect repellent plants or animals such as fish in the case of paddy rice. Prioritizing local production, as against global supply chains, also reduces the energy required to process food and transport it over long distances. This will not reduce the need for infrastructure to avoid produce spoilage which is a major source of waste in developing countries. Introducing such methods would cease making the small farmer ‘the global epicenter of extreme poverty’ as he is described in the Millennium Project. The reduction of food wastage should also become a matter of interest to retailers and consumers – statistics show that up to 30 to 50% of food products are thrown away. A pick up and recycling system in France, in particular to use this wastage as an energy source, has been shown to be profitable. Water scarcity, already a fact in many countries, and variability in rainfall (and let us not forget that 80% of crop-land uses rainfall as its water source) becomes less of a problem with new forms of agriculture, which includes better rain water harvesting, particularly if new varietals are developed which require less water. Small infrastructure building is essential to enable access of water for the poor living in arid areas. Yields, and therefore farmer income is increased. New desalination technology, using substantially lower amounts of energy, will enable countries to regulate water availability in periods of low rainfall. Our planet has a unique atmosphere that allows life and regulates the climate. An increase in the content of CO2, as is forecast from developing countries, would induce major changes in the earth’s ecological and geological system. Power generation is a major contributor to this state of affairs. We discussed above the importance of tropical forests as carbon sinks. On the supply side, agriculture is a major contributor of climate change as manure releases substantial quantities of methane. Coal usage in OECD countries should be gradually replaced by natural gas as CO2 emissions are heavily taxed. This is unlikely be the case in the rest of the world, and in China in particular. Transport also has a major impact as it consumes sizable quantities of energy essentially in the form of gasoline. While the number of vehicles is expected to increase sharply, particularly in Asia, more efficient engines and alternative energy sources, particularly in cars developed and sold in America, Europe and Japan, should contribute to slow the expansion of oil consumption. ‘Smart’ vehicles and roads could reduce consumption by up to 40%. As the world’s energy consumption increases, alternatives to oil will inevitably have to be used particularly as reduced availability of ‘black gold’ will drive prices upwards – whether peak oil is due to dwindling reserves or to the enormous amounts of capital required to locate and develop new deposits, oil production is set to fall. Reduced energy consumption would contribute to cleaner air by reducing the amount of pollutants released. Technology will be a major factor determining the choice of the substitute, whether it is by cleaning coal, developing advanced materials for solar energy or inventing groundbreaking technologies. Developing countries may well have considerable difficulties to access these new sources and remain contributors to atmospheric pollution and global warming. Greenhouse gas emissions could also be reduced if meat was grown in the laboratory as experiments under way appear to make it a clear possibility. For such programs to become reality, retailers must lend a hand by accepting products with a greater variability. Standardization is difficult, if not impossible, to achieve with sustainable agriculture. Higher prices of oil would undoubtedly assist in making this change in the agricultural paradigm. Such price increases could be a result of conflicts in producing countries – such as has recently been the case in Libya – or of the ability of China and the US to each secure captive production sources leading other buyers to pay premium prices. Major price increases in oil would lead once more to the transfer of wealth from consumers to producers, with the poorer countries, particularly in Africa, suffering most. Turbulence in the currency market, particularly a weak US dollar, has negative long-term repercussions on oil availability and therefore leads to higher prices. A concerted action by Central Bankers would help stabilize currencies – perhaps with the introduction of a new global currency or the return to an indexation on gold. The doorbell has just rung – children from the neighborhood were treat or tricking me. Having run out of sweets I offered them a ten dollar greenback which they turned down. Just like they turned down a 10 Euro bill. They asked for a gold coin, or a barrel of oil, but I did not have one. I am lucky to live in Switzerland and was able to give them a 10 franc note. They took it – no trick for me. I hope the same applies to all those of us who live on this planet. Seven billion at the latest count. C Health Cardiovascular diseases (diseases of the heart and blood vessels that can cause heart attacks and stroke) are the leading causes of death in the world. Healthy diet, regular physical activity and avoiding the use of tobacco would prevent most of these deaths.Mental disorders such as depression are among the 20 leading causes of disability worldwide.Extensively drug-resistant tuberculosis has been recorded in 45 countries.Worldwide, deaths of children under-five years of age declined from 93 to 72 deaths per 1,000 live births between 1990 and 2006.There are 9.2 million physicians, 19.4 million nurses and midwives, 1.9 million dentists and other dentistry personnel, 2.6 million pharmacists and other pharmaceutical personnel, and over 1.3 million community health workers worldwide, making the healthcare industry one of the largest segments of the workforce.WHO – World Health Organisation In 2003, healthcare costs paid to hospitals, physicians, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of the healthcare system, consumed 15.3 percent of the GDP of the United States, the largest of any country in the world. For United States, the health share of gross domestic product (GDP) is expected to hold steady in 2006 before resuming its historical upward trend, reaching 19.6 percent of GDP by 2016. In 2001, for the OECD countries the average was 8.4 percent with the United States (13.9%), Switzerland (10.9%), and Germany (10.7%) being the top three. US healthcare expenditures totaled US$2.2 trillion in 2006. According to Health Affairs, US$7,498 be spent on every woman, man and child in the United States in 2007, 20 percent of all spending.Wikipedia The world healthcare IT market is expected to grow from $99.6 billion in 2010 to $162.2 billion in 2015, at a CAGR of 10.2% from 2010 to 2015.marketsandmarkets.com Philip Gagner, Chief Scientist and Vice President, Schloer Consulting Group Schloer Consulting Group is presently developing large scale interoperable electronic health records (EHR) systems specifically designed to assist in the delivery of patient-oriented, biometrically secure healthcare on municipal, regional, and national levels. Philip has more than 30 years of experience in the computer and technology fields, including robotics, digital hardware design, software development, data communications, finance, and law. He earned a Juris Doctorate from Georgetown University, and has litigated some of the lead cases in software and technology law. In addition, his technical experience includes work as a researcher at the M.I.T. Artificial Intelligence Laboratory, hardware and software engineering as Senior Software Engineer at Digital Equipment Corporation, several years as a senior researcher at the Federal Judicial Center in Washington, D.C., and founder of Legal Data Systems, a software solutions company. Club of Amsterdam: With technology now present in all aspects of our daily lives it is not surprising that healthcare systems in high-income countries are depending more and more on technological and computer assisted devices for their functioning and services. The 2011 American healthcare system reform illustrates perfectly the computerization of a number of Medicare activities. Are the current security measures and regulation rules enough to guarantee the functioning of the system concerned with such an important issue as health? Philip Gagner: Let me, somewhat artificially, divide healthcare technologies into two parts: First are those that actually deliver healthcare (such as EEG machines and which I will label “medical devices”) and second are those that keep patient histories and perform billing and financial systems (which are generally called Electronic Healthcare Records systems). I think that, given current technologies, these must be viewed separately, although some devices such as sleep apnea PAP machines, some dialysis machines, and some insulin dispensers are both therapeutic and keepers of records. With regard to medical devices, the current security situation is appalling. At a recent Black Hat conference, a security researcher demonstrated how easily he could hack medical devices such as an insulin pump. The researcher, Jerome Radcliffe, was interested in the security of his own insulin pump and he discovered that there was essentially no security at all in the device: He could remotely control it with a simple radio transceiver, assisted by a java applet provided by the device manufacturer.1 More and more medical devices are being networked, and those networks are connected to the Internet. This is true both for home monitoring and for use in physicians’ offices and hospitals. The convenience of remote access (as well as remote control) makes such connections inevitable.2 The increasing use of wearable monitoring devices (often connected to smartphones) presents other security issues, both privacy issues and even the continued good health of their users. Connecting a device to a smart phone is easy. However, smart phones are notoriously easy to hack, and any system that uses them is vulnerable to denial of service, eavesdropping, man in the middle, and insertion of dangerously false data or commands. These devices are generally connected wirelessly, and the protocols that they use (CGM and serial Bluetooth, for example) are also fatally insecure. In addition to wearable sensors, hospital equipment is increasingly connected to networks, and the security used is generally non-existent or easy to compromise. If the possibility of remote commands to mis-delivery insulin is not sufficiently alarming, consider the group of researchers who were able to gain wireless access to a commercially available heart defibrillator and pacemaker. They were able to do so in an undetectable manner, and claimed that they could easily have set the device to kill the user, had the device been in a human body.3 Many millions of such devices are implanted or worn today, and tens of thousands more are prescribed or implanted each day. For existing devices, correcting even the most blatant security flaws is an intractable problem. As Gollakota et al. point out, such devices, have limited memory and limited possibility of upgrade. Replacing them would often require major surgery with high risks. In addition, using cryptographically secure techniques might actually endanger the patients, for example if doctors at a different hospital required emergency access to the device. For future devices, security can, and must, be built into the devices. Existing medical standards are inadequate, and all software (including crypto software) for medical devices has special requirements of reliability and proper fail-safe modes. All software is notoriously prone to unanticipated bugs, and the more complex the device, the more prone to bugs it becomes. Security for medical devices must be simple, and at the same time highly resistant to passive (e.g. unauthorized monitoring) and active attacks. Active attacks here mean attacks that issue unauthorized commands to the medical devices. Adopting rigorous medical device communication standards and thorough device testing can reduce the above problems for future devices. Today, there are no universally accepted standards, and there is little if any penetrability testing. Even so simple a method as wearing a removable metal shield over the implanted device can significantly reduce radio remote control hacking (see footnote 3), but these are not generally known to, or even thought about, by doctors. The difficulties of allowing access to authorized medical providers while denying it to unauthorized ones, ties the problems of device security to problems in electronic healthcare records (HER). The healthcare records industry is fragmented not only along national borders, but also within nations. In many countries there are multiple competing systems of EHR, with the United States being the worst example. Simply obtaining a patient’s electronic healthcare records can be such a bureaucratic and technical nightmare that doctors often merely fax them. This is even more true for records might be stored on incompatible systems, or systems with incompatible authorization protocols When healthcare records are stored electronically, there are no universally accepted security standards. There are various laws in various countries regarding patient privacy, but from a technical standpoint, these are meaningless. If my doctor has my records on an office computer, and a worker in the doctor’s office, on the same network, downloads a pirated electronic game containing computer viruses and Trojan horses, then all the policies and laws in the world have no effect. A famous case of public disclosure involved cancer records of the actress Farrah Fawcett and other celebrities. In 2008, an unauthorized employee with an administrative password was easily able to access them and sold them to the press.4 Security of EHR, like security of medical devices, is both a technological problem and a medical problem. As medical devices and medical records systems become more and more integrated, issues of security and privacy become issues of medical ethics and of sound medical practice. Just as doctors should not use equipment on which they has not been trained, neither should they use computer systems that they don’t understand. But, every day, in every country, they do. Social and legal systems must be changed to address these issues. First, we can no longer tolerate fragmentation of EHR standards. To be minimally medically acceptable, an EHR system must be able to forward records to at least the likely set of medical providers My company, Schloer Consulting, has designed a system that provides for electronic translation and interchange of EHR between all major standards, and uses biometric security and encrypted channels as integral components. This is not a perfect solution, but it is far superior to most systems. Devising secure technical solutions for EHR within one group – a nation, for example – is not that difficult, but it is expensive. It requires cooperation and enforced standards between providers, and between providers and payers.5 In the United States, such cooperation has been mandated by recently passed legislation, what Republicans there term “ObamaCare”. We do not think that this legislation goes far enough and it certainly does not solve, or even address, the problems globally. Medical device and EHR cyber security standards both must be rigorous, and both ought to require thorough penetration testing. The first murder by cyber attack probably has not occurred – although we would not know if it had – but in today’s world, it is a very real possibility. The first major releases of EHR have, indeed, occurred. Present security technologies for medical devices and records are totally inadequate. We can correct this with a combination of legal, ethical, and technological changes, but resources must be made available to do this. I do not see this happening to nearly the extent that is required. The Personalized Healthcare Initiative, a recently launched project in the USA, has set itself the goal of using clinical and genomic information to improve the effectiveness, safety and quality of treatment for patients by adapting treatments to each individual’s medical identity. Would this kind of project be possible on an international scale or are the established healthcare systems, such as the French one characterized by universal coverage, the most efficient system we can hope for at this scale? Philip Gagner:The US healthcare system is a disaster. People in the USA pay four times as much as most of the civilized world for healthcare, without significantly better outcomes (and in many cases, such as infant mortality, much worse outcomes). Despite the deplorable state of both its public and its private healthcare, the US remains a leader in medical technology research. One of the most ambitious and controversial high-tech programs is the Personalized Healthcare Initiative (PHCI). In the words of the US Department of Health and Human Services official documents: “The Personalized Health Care Initiative will improve the safety, quality and effectiveness of healthcare for every patient in the US. By using “genomics”, or the identification of genes and how they relate to drug treatment, personalized health care will enable medicine to be tailored to each person’s needs.”6 The PHC has two guiding principles and four goals:Principle 1: Provide federal leadership supporting research addressing individual aspects of disease and disease prevention with the ultimate goal of shaping preventive and diagnostic care to match each person’s unique genetic characteristics. Principle 2: Create a “network of networks” to aggregate anonymous health care data to help researchers establish patterns and identify genetic “definitions” to existing diseases.The four goals are generally to (1) link clinical with genetic information; (2) protect individuals from unauthorized or discriminatory use of genetic information; (3) ensure the accuracy and clinical validity of genetic testing; and (4) develop common policies for access to genomic databases. It is notable that neither of the two guiding principles explicitly includes either ethical or privacy concerns. The second goal (and to a limited extent the fourth) addresses individual privacy concerns but, as I read the descriptions of them, fail to recognize that privacy is, in fact, in conflict with the other goals and principles. PHCI builds on prior U.S. law, primarily the Genetic Information Nondiscrimination Act (GINA) that prohibits most uses of genetic information by employers and by health insurers. This law, according to the NIH National Human Genome Research Institute, is required to ensure that individual healthcare can flourish without patients worrying that test results may adversely affect their work or insurance situation. It is worth focusing on GINA because it is both an inspiration for, and intimately connected with, the implementation of PHCI and because the concern about whether patients will risk bad non-medical consequences from a medical test is a valid one. Employers are rationally less likely to hire and train an employee who carries a genetic marker for early death. Similarly, private insurance companies are less likely to provide health insurance to somebody who is more likely than average to develop a severe condition requiring expensive medical care, if they have the option. Employers are relatively easy to regulate. Their actions are, to the employees, quite public, and measures in the US such as work hours, minimum wage, and even anti-discrimination laws have been widely successful. Because this is another anti-discrimination statute, it also is likely to be widely observed and honored. Insurance companies are another matter. American insurance law does not protect people with non-genetic indicators of future bad health, such as cancer polyps or a negative X-ray diagnosis. In fact, GINA actually leaves them worse off, because, deprived of clearly relevant predictive data, insurers must rely on less reliable indicators or on secondary sources, such as treatments given. This means, at best, attempts to indirectly circumvent the prohibition, as well as the use of an inconsistent set of predictors. It means increased randomness as to outcomes, which in turn means that the overall variance in cost of insurance premiums will rise for the population. Because negative diagnosis can be inferred from treatment (and the use of this data is not prohibited), it means that patients will be less willing to undergo preventative care methodologies if they perceive them as likely to raise their premiums.7 Second, patients who receive bad news about their genetic testing will, rationally, opt-in for higher medical insurance coverage, and patients who receive good news will, rationally, opt for less. The outcome is an overall smaller population with more healthcare risks, and the GINA goal of spreading the risk through the population cannot possibly be satisfied. The distinction between genomic information and other medical information is, in my view, arbitrary and without any valid basis in science. If you consider a future where genetic testing technologies are low cost and commonplace, and where better genomic knowledge predicts more and more about human physiology (including disease processes), then such testing becomes just another medical tool, like a biopsy. The entire idea behind GINA, the distinction between genomic disease probabilities and observable current medical conditions is a false distinction, and the underlying policy problem is that insurers are permitted (in the United States) to discriminate by risk pool manipulation based on any medical test. In a society, such as the French medical system, where essentially 100% of the population is in the same risk pool, there is no discrimination by excluding those with genetic markers perceived as negative. Many of the features of PHCI and of GINA are based on policies to prevent such exclusion, but they do not solve the problem in a way likely to succeed, nor are such features necessary or desirable in other nations. Whether or not prohibiting discrimination by employers is another matter. To me, it seems probable that such a prohibition would be both necessary on moral and social grounds, and effective, and similar prohibits are found in French and other European nation laws. Other provisions of PHCI remain valid, and appear to hold great promise both for clinical treatment and public health. Genomics testing is still expensive, but far less so than it was a decade ago – by as much as 500%. This cost will continue to decrease, and equipment to sequence DNA and DNA fragments will be available at any large hospital in developed countries. With present technologies, much of the analysis required to perform genetic tests is done by highly trained people, but nearly all of this can, very likely, be automated. One researcher at George Washington University Hospital is developing large molecule detection devices that cost less than ten dollars and are disposable. These particular devices test for certain antibodies, but similar technologies are feasible for DNA marker testing. The medical risks of genomic testing – as distinguished from risks of genomic diagnosis – are almost non-existent for adults, and minor for infants and fetuses. Assuming that current cost reduction trends continue, and that an increasing number of disease processes are linked to genetic markers, demand by physicians and patients will increase. Pharmacogenetics, allowing the targeted prescription of drugs based on DNA and large molecule markers, has entered medical practice and has been successful.8 Low cost and large-scale genetic testing provides two very different benefits: First, it has clinical utility, that is, it can alert healthcare providers to increased probabilities of certain outcomes for an individual patient. Second, it can provide a database for medical research. These two benefits have two sets of parallel risks. In the clinical practice case, the risks include the psychological burden of knowing that one is at higher risk for a certain condition (which may lead to behavioral changes that are harmful to the individuals overall health, such as fad diets, wasting money on charlatan healers, or even taking unnecessary medications), and can include false complacency based on negative test results).9 By way of example, consider a newborn screened for genetic markers for cystic fibrosis. Early diagnosis of that condition is believed to significantly improve clinical outcomes by allowing prompt administration of pancreatic enzymes and treatment of infections.10 There are, of course, corresponding risks, and one can easily identify the risk of incorrect test results among them. Nevertheless, as a matter of clinical utility, one must determine whether the evidence-based benefits outweigh the evidence-based risks. From the public health viewpoint (which is the viewpoint in which the database referred to above is useful), there is a significant benefit to large scale genetic testing. But, since the public at large will carry the cost burden, the public health benefits and risks must also be measured. As a matter of basic research, the type of database envisioned by PHCI will be valuable, and a simple example is correlating gene markers on one DNA segment with those on another and comparing them with other observed health information. Such database mining has already found correlations, and has found areas for further (non genomic) research into specific disease processes. The problem here is that, to achieve the benefits, individual data including environmental data must be stored in the database. The more data that are stored, and the greater the degree of public access, the more difficult it becomes to protect (or obscure) the identity and privacy of the tested individuals. An example might be helpful here. Consider a database that contained the following information: A male individual, (name and exact address obscured in the database) mixed Caucasian-Asian ancestry brown hair, dark brown eyes (all easily determinable from DNA markers), born July 2009, early medical history includes persistent cough, stomach swelling, lives in a farming community near Nice, France, within 5 km of a fertilizer storage and processing facility, and has some genetic markers for cystic fibrosis. Given this information, it very likely would be possible, even easy, to identify the particular individual. At present, testing infants at birth for cystic fibrosis (particularly if there is a family history) is commonplace. But the results of that testing are not stored in a large and generally accessible database, and so are not available to neighbors, potential employers of other family members, the press, or charlatans hoping to peddle quackery to distressed parents. A large public database with highly personal and traditionally private information is, by its very nature, inconsistent with individual privacy. The more one limits access to such data, the less likely the data are to be used for useful research. The more access one provides, the fewer realistic assurance of privacy one can give. This problem cannot be solved by legislation or by technology – it is simply that two different but worthwhile goals are inconsistent. One must decide how important the privacy issues are, and how valuable the research results will be, and then adjust the database content and access to achieve the balance. In conclusion, he United States, first with GINA and later with PHCI, has determined to create a highly regulated national database of individual genomic information. The designers of the system are correctly concerned with the individual privacy issues and with public health risk issues, including those described here. The Obama administration has determined that the probable public benefits outweigh the public and individual risks, and this is likely the correct decision. But, it is in my view, a decision in an area fatally marred by the US healthcare payment and insurance coverage system. An insurance company that, in partial or complete defiance of the law, uses genomic information to reduce its payment risk will make greater profits than one that does not. Since the purpose of corporations is to maximize profits, this pressure to gain information will be intense. And although the US law prohibits using individual data, it does not, as I read it, prohibit using genomic information to create risk pools by statistically analyzing the data after removing individual identification. The smaller (the more specific) the risk pool, the more this becomes like discrimination against individuals. There is a large grey area of vagueness here, and insurance companies will undoubtedly exploit it. By contrast, in a system where healthcare coverage is universal, the calculus becomes much easier. Assuming that reasonable measures are taken to maximize privacy and minimize security and penetration risks, the benefit to the public of such a database seem to quite clearly outweigh the risks. Genomic markers generally indicate a probability, not a certainty, of medical conditions, and genes generally work in combination to produce physiological effects. Understanding probabilistic evidence in favor or against clinical therapeutic measures only comes with large populations11, and such a database is likely to reduce the number of expensive clinical trials. In addition, knowing what genetic predispositions exist in the population as a whole is valuable to public health officials. Genomic information, in databases or otherwise, is not different in kind from other medical information, it is just newer. The same measures that are necessary to protect people from disclosure of private matters are necessary for genomic information, not more and not less. Those features of PIHC that do not relate specifically to the US healthcare insurance industry can, and should, be adopted in other countries and, to the extent politically possible, the PIHC database should be extended to an international genomic database of the human race. 1) Hacking Medical Devices for Fun and Insulin: Breaking the Human SCADA System, Jerome Radcliffe, http://www.blackhat.com/html/bh-us-11/bh-us-11-briefings.html (retrieved October 19, 2011).2) Wearable Wireless Sensors, ABI Research, 3Q 20093) They Can Hear Your Heartbeats: Non-Invasive Security for Implantable Medical Devices. Gollakota, Hassanieh, Ransford, Katabi, Fu, In Proceedings of ACM SIGCOMM. August 2011.4) Los Angeles Times, May 09, 2009. (retrieved October 14, 2011) http://articles.latimes.com/2009/may/09/local/me-hospital95) In the data processing world, it is often said, jokingly, that the best things about standards are that (1) there are so many to choose from and (2) if you don’t like the existing ones, wait a month because they change so frequently. This is certainly true in healthcare records management, and the only feasible solution is to mandate, by government regulation, that systems must be compatible with (that is, capable of interchanging data with a certain standard of choice). Yet, this very requirement adds complexity and new security vulnerabilities.6) http://www.hhs.gov/myhealthcare/ (October 18, 2011).7) This analysis of insurance company reactions to GINA was first and cogently argued by Professor Russell Korokin, J.D., UCLA Center for Society and Genetics and UCLA Law School, and Dr. Rahul Rajkumar, M.D. J.D. of Brigham and Women’s Hospital, Boston, MA, USA. The conclusions from the argument, however, are mine, and not to be attributed to them.8) Genetic Testing in Clinical Practice, Lamberts and Uitterlinden, Annu. Rev. Med 2009, 60:431-42.9) What is the clinical utility of genetic testing? Scott D. Gross, M.D. and Muin J. Khoury, M.D. Ph.D., Genetics in Medicine, Vol. 8 No. 7 (July 2006).10) Ibid at 449.11) Genetic Testing in Clinical Practice, Annual Review of Medicine, Vol. 60: 431-442 (Volume publication date February 2009). D Climate Change / Sustainability Climate changeClimate change is an issue that already affects and will increasingly impact all nations. The complexity of the problem is intrinsically linked with overarching societal issues. Progress is required on effective mitigation, adaptation, reduction of greenhouse gas emissions, development of green technologies, and political support for the establishment of effective international and national policies.UNESCO Climate change affects the fundamental requirements for health – clean air, safe drinking water, sufficient food and secure shelter.The global warming that has occurred since the 1970s was causing over 140.000 excess deaths annually by the year 2004.Many of the major killers such as diarrhoeal diseases, malnutrition, malaria and dengue are highly climate-sensitive and are expected to worsen as the climate changes.Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope without assistance to prepare and respond.Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health.WHO – World Health Organisation Every ton of recycled paper saves almost 400 gallons of oil, three cubic yards of landfill and seventeen trees.Americans consumes six times more energy than the world average.The energy saved from one recycled aluminumcan will operate a television set for three hours.As many as 17 trees are required to make one ton of paper.Making aluminum from recycled aluminum uses 90 to 95 percent less energy than making aluminum from bauxite ore.The energy saved from recycling one glass bottle will light a 100-watt light bulb for four hours.NYU SustainabilitySustainability is the capacity to endure. For humans, sustainability is the long-term maintenance of well being, which has environmental, economic, and social dimensions, and encompasses the concept of stewardship, the responsible management of resource use. In ecology, sustainability describes how biological systems remain diverse and productive over time, a necessary precondition for human well-being. Long-lived and healthy wetlands and forests are examples of sustainable biological systems.WikipediaChandran Nair, founder and CEO, GIFT – Global Institute For Tomorrow His new book is entitled “Consumptionomics: Asia’s role in Reshaping Capitalism and Saving the Planet.” How to Accommodate 9 Billion and Save the EnvironmentWorld’s largest population centers, centered in Asia, cannot aspire to live like Americans Published by YaleGlobal / Yale Center for the Study of Globalization HONG KONG: At the height of the financial crisis in 2008 Asians were urged by Western politicians and economists to consume more to help rebalance the global economy. At the same time, during the run-up to the climate talks in Copenhagen, Asians, especially the Chinese, were scolded that they had to be responsible global citizens and reduce carbon emissions. Few global leaders and commentators dared connect the dots and openly acknowledge that asking Asians to reduce emissions while asking them to consume more simply did not add up. Now try imagining a world with three Americas. Difficult? But that’s where economists say we’re heading. Within two decades at most, China will overtake the US and become the world’s biggest economy. Within another 20 years, by 2050, India will be as big. And what will drive this? Human aspiration apparently – aided by free markets, technology and finance. As the cheerleader of globalization, Thomas Friedman has written: “World population is projected to rise from 6.7 billion to 9 billion between now and 2050, and more and more of those people will want to live like Americans.” This is unthinkable. If the United States is joined by two more economic masses as big – or bigger, as on current trends the American economy will also have trebled in size by mid-century – all aspiring to live like Americans, our planet’s resources will be stressed beyond imagination. Wherever we look – be it carbon emissions, oil and gas, food shortages, water, rare earths, fisheries or forests – there just isn’t enough for the world to soak up another two consumption-driven Americas. To stop heading down this road, Asian governments must immediately recognize that a bleak future lies ahead if Asians attempt to live out an aspiration to consume like Americans. The current debt crisis in the US, ultimately fueled by over-consumption, has even led China’s media to lecture the Americans that it’s “time to revisit the time-tested commonsense that one should live within one’s means.” Above all, Asia must reject the blinkered views of those who urge Asians to consume relentlessly – be they Western economists and leaders who want the region to become a “motor of growth” or Asian governments convinced that ever-expanding economies are what their populations need. Instead the world – and Asia first of all – must find alternative ways of promoting human development. Asian governments must shape expectations critically around the issue of rights with the clear focus on the following basic needs: food as well as security and safety, water and sanitation, low-cost housing, education and primary health care. It must be made clear, for example, that car ownership is not a right. Growing demand for non-essential goods and services must reflect true costs. Asian governments should look at the Arab spring and understand that what the people on the street want is not some utopian democratic state but a state that even with imperfections focuses on the key areas of human development and progress. Governments should wake up to the reality that in the region, the majority of people – more than 2 billion in total – still do not have equal access to the basic necessities of clean water/sanitation, housing or adequate nutrition.Asian nations will need frameworks of fiscal measures, land-use practices and new approaches to social organization that can create sustainable national economies. This requires shaping expectations through public education that aspiring to live like Americans is a bad idea for the creation of more equitable societies in a crowded world and unattainable. Resource management must be at the center of all policymaking, and putting a proper price on greenhouse gas emissions and the resources we use via taxes, licenses and other charges. Measures constraining resource usage must be extended to every area of life – at play and work. They must become an inherent part of all economic and social policy. Countries in the region must structure incentives to reward “more is less” activities. It’s not that people must be poor, rather consumption should be funneled in ways that do not increase the demands on our already-stressed resource base, deplete or degrade our environment, and put at risk the livelihood and health of hundreds of millions. A key step: fiscal and labor policies aimed at strengthening local economies that both reduce poverty and prevent mass migration to cities. Curbs on the resource-intensive practices of industrialized agriculture would further aid development. Where basic living needs are met, employment policies can explore other directions that reduce wasteful consumption, such as shorter working weeks or more training. People must be encouraged to regard quality-of-life issues as extending beyond the size of their disposable incomes. Energy networks using renewable sources in conjunction with pricing to penalize excessive use would be another likely target of state funding. But technologies, particularly government-supported ones, should be aimed at spreading well-being rather than only maximizing economic returns. It’s better to forestall environmental problems than expensively treat them.Another area to be challenged is how consumption-driven capitalism has developed techniques to displace traditional outlooks, and whether these can be countered. One example is today’s preference for owning over yesterday’s for doing. Previously children played games, now they have PlayStations. We should also revisit the possibilities offered by traditional cultural attitudes, such as the preference many Indians have for a vegetarian diet and an age-old way of life that is increasingly under threat as Indians seek to ape Western lifestyles. In education, ideas about constraints, the way we use and manage resources must be placed at the center of learning, especially in economics and business courses – not brainwashing, but aggressively countering the promotion of unfettered consumption that lies at the heart of modern commerce and advertising. For too long, schools and universities have been regarded as the training ground for economic growth, be it preparing people for the disciplines of company life or learning “marketable” skills. Instead, education should be redirected towards giving people an understanding of limits, the human impact on the world and the consequences. We should return to stressing the public interest rather than individual rights. This is in stark contrast to the arguments of consumption-driven capitalism with its claims that allowing everyone to pursue individual self-interest eventually leads to benefits for all. Governments must also back policies with constant reminders that being well-off involves balancing a range of factors, among them ensuring social equity and an environment fit to be handed on to future generations. This won’t be easy in Asia, especially in societies which for the last few decades have been repeatedly told that all limits can be overcome and prosperity can only come from conventional forms of consumption-driven economic growth. Required is a strong, confident state, one with an understanding that its legitimacy depends on changing direction and better serving the needs of the disenfranchised majority. If the governments of the region rise to this challenge, the decision-makers in Beijing, Delhi and Jakarta will determine whether our world has a future – not the capitals of Europe and America. Douglas Mulhall and Diana den Held for the Academic Chair ‘Cradle to Cradle for Innovation and Quality’ – Rotterdam School of Management, Erasmus University Club of Amsterdam: Sustainable area development needs to tackle the core environmental issues related to – amongst others – mobility, housing, consumption, connectivity. Reuben Abraham from the Center for Emerging Markets Solutions in India states that by 2050, it is expected that the world will be 80 percent urban. Both India and China are witnessing the greatest migrations in human history as hundreds of millions leave the countryside for urban areas.What are your thoughts on this? Is a global collaboration needed and also realistic? Douglas Mulhall and Diana den Held: First of all, if we really want to make this, we need to design buildings and area’s that contribute positively to their environment, not just be ‘less bad’. Sustainability as defined by current regulations and laws, is more part of the problem than the solution. Eco-efficiency that treats people as ‘human resources’ will not solve area development questions; it will only make them worse. That’s why C2C goes beyond sustainability. Diana den Held: It has now been shown that it is possible to make buildings that can clean the air, contribute to the biosphere and supply energy and clean water, but further steps are necessary, especially for area development. We really have to help each other speed up. That’s why I feel it is so important to work on and communicate about Cradle to Cradle® case studies, as we are doing here at the C2C® Chair at the Rotterdam School of Management. My favourite example of international cooperation is the Cradle to Cradle Islands project, led by the province of Friesland. No other project in the world has so many different cultures working together simultaneously on C2C. It’s silly when you think about it, but in present days, most islands depend on the mainland for their raw materials. Which makes islands perfect small scale pilots for resource management. And I’m not just talking about materials when I say that. Think of fresh water as well: the demand for water on the islands keeps increasing, mainly due to an increase in tourists and it’s always the highest when the offer is lowest: in summer. Most islands are connected to the mainland by large waterpipes, to ensure there is enough drinking water available. Recently the Minister of Environmental Protection Administration of Taiwan, Mr. Shu-hung Shen has, after been invited to do so by Prof. Dr. Braungart, announced Taiwan to become a honorary member of the Cradle to Cradle® Island community. Isn’t it fantastic to see how such a project now can grow from small pilot islands like Ameland and Texel, to an island this size and use the first results of the C2C Islands project directly in Taiwan strategies? Taiwan can take the next step, and together these islands can show others what they have experienced and learned. I think this is a beautiful example of international collaboration on Cradle to Cradle implementation, a.o. in area development. It’s not just possible. It’s being done. Right now. E Economy / Stock Market / Poverty Economy / Stock MarketIn 1980 the world’s financial assets, comprising banking assets, stock market capitalization and bond market value, amounted to 108% of the value of annual production, more or less in line with each other. 25 years later the total value of global financial assets amounted to $165 trillion, nearly four times the size of global GDP of $45 trillion. In 1980 bank deposits made up 42%of all financial securities. By 2005, this had fallen to 27%, the remaining deposits were being used by capital markets and investment banks to fuel corporate development. In the year to April 06, overall turnover on the foreign exchange markets averaged around $2.9 trillion a day. That’s around 60 times the value of the world’s GDP for the whole year, and more than 10 times the size of the combined daily turnover on all the world’s equity markets. Foreign exchange trading increased by 38% between April 2005 and April 2006, and has more than doubled since 2001.STWR – Share The World’s Resources PovertyDecades of economic globalization have created the widest ever gap between rich and poor, both within and between nations.STWR – Share The World’s Resources Global income is more than $31 trillion a year, but 1.2 billion people of the world’s population earn less than $1 a day.World Bank The Gross Domestic Product (GDP) of the poorest 48 nations (ie a quarter of the world’s countries) is less than the wealth of the world’s three richest people combined.World Centric Hardy F. Schloer, President and Managing Director, Schloer Consulting Group Hardy is a strong team builder, entrepreneur, accomplished scientist and visionary theoretical thinker with extensive people and public relation skills. Club of Amsterdam: Does the 2008-2009 crisis, by its consequences, need to be considered as the main economic challenge we now face; or was this crisis a painful highlight of the economic and financial defaults of our globalized economy? Hardy F. Schloer: The short answer is: Both. Nevertheless, a longer and more careful view at this subject, looking perhaps into the next 2 decades, reveals a much more complex picture. The current global economic and geopolitical situation, as it will develop between 2010 and 2030, expectations are not comforting, including the prognosis of conflict and deeper economic adversity. Nevertheless, an informed understanding of these current and future trends could contribute to innovative solutions to manage these events, at least on a case-to-case basis. The world continues in a fast transforming and unstable global framework of complex problems and multi-dimensional influences. A cluster of different types of crisis has now matured into a “perfect storm” that will transform the entire planet very extensively. These […]