Anorexia Nervosa: The Ethical Dilemma of Force Feeding

Tetyana Pekar

Anorexia nervosa (AN) affects 0.1-1 percent of the population and has the highest mortality rate of any psychiatric illness¹. Anorexia doesn’t discriminate against age, sexual orientation, gender, or race. Nor is it limited to Western countries or middle-class white girls. 

Occasionally, severe cases of anorexia nervosa gather media attention and a lot of controversy. At the heart of the matter is an ethical dilemma: whether and under what circumstances should patients be force-fed or allowed to starve themselves to death?

Several such cases have recently been publicized. The first case is a 32-year-old former medical student from Wales², known only as "E." E hasn’t had solid food for more than a year and has a body mass index (BMI) of 11-12—a normal BMI is 20-25. Although she does not want to die per se, E, above all, does not want to be fed. Her chances of recovery are between 10-20 percent, according to a consulting psychiatrist and eating disorder specialist. Those who know her well—including her parents—oppose further treatment and believe she deserves the right to die with dignity. 

The second case³ is of an anorexic known as "L." L is 29-years-old, and in the last 15 years, she has spent 90 percent of her time as an in-patient. She weighs just 45 lbs. Like E, L did not express a desire to die, but stated that “her severe anorexia ‘did not allow her to eat.’ ”

Typically, such ethical dilemmas are approached by attempting to grant the competent patient’s wishes, helping the patient, and considering the interests of all involved. The situation in anorexia nervosa, however, is much more complex. 

Anorexia nervosa patients are typically not psychotic and often do not pose an imminent risk to themselves—they are generally not suicidal, and don’t express an overt desire to die, although their actions certainly lead to a slow death. They are usually competent, and quite rational, they are “just unable" to eat enough to maintain a normal weight. 

Interestingly, the High Court judges ruled differently in these two cases. In the case of E, the judge ruled that she should be force-fed, alluding to the fact that E may not, at this time, fully appreciate that we only get one chance at life. In the case of L, however, the judge concluded that although nutrition and hydration should be offered to L, staff were not permitted to use "force" to administer food, water, or medicine. 

Charlotte Green⁴, a 35-year-old anorexia nervosa patient who spoke to the UK newspaper The Telegraph in response to these cases, stated that the duration and severity of the illness are important factors that must be considered whenever the decision to force-feed is made. 

For Green, who has been severely sick for over a decade and spent most of that time in treatment, the prospects of recovery are grim. “I have been ill for 15 years and it only gets harder… I want to be allowed responsibility for what happens next,” Green said.

Starvation alters the way our brains function. It is conceivable that once re-fed, these patients will be thankful for the decisions made on their behalf; certainly, there are patients with anorexia nervosa who were force-fed at one point and are now recovered. But, the opposite scenario could just as easily be true: forced feeding could cause more suffering for the patient and the family, as caregiving for a patient that refuses treatment is incredibly difficult. 

What if it is too late? We cannot force patients to recover—force feeding for life is unsustainable. 

Green—who has been sick for 15 years—doesn’t want any more money wasted on treatment, wasted because she doesn’t “engage” in it. “They [the psychiatrists] can make me pretend as much as they want to—but in the end I’m only pretending,” she adds. 

Shouldn’t patients in these situations be allowed to die with dignity? What are doctors to do when patients don’t want to die, but cannot eat? Refuse to eat. How do you treat someone for whom death is a better alternative than eating?

This is the illness talking. Winning. But, if treatment for decades has failed, does it ever come to a point where clinicians and parents can say, what’s been done has been done, we can’t do any more?

An astute commentator on a Facebook page for FEAST (Families Empowered and Supporting Treatment for Eating Disorders) wrote that “the biggest ethical issue here is in the failure to treat adequately while this woman (referring to the case of L) still had hope,” adding that “there may come a point of no return in some people’s AN.” 

Some, like Laura Collins, author of Eating with Your Anorexic, believe that allowing these patients to die is akin to murder. On the same Facebook thread, Collins wrote “To hospitalize without restoring normal health, to depend on the mentally ill patient's assessment, and to believe that the real person in there 'wants' to die [is murder]. We would do better for someone in a coma. This is a basic misunderstanding of the nature of anorexia nervosa. If they 'allow' her illness to kill her they are making themselves more comfortable, not her—she only gets one life and it is not her fault or choice that they've failed her so thoroughly (emphasis mine).” 

Although caregivers are not required to sacrifice themselves to save someone, especially if their prospects of recovery are grim, we cannot ignore or deny the important role that strong emotional reactions may have on the physicians' and caregivers' decisions with regard to treatment. To what extent are the decisions made by the judges based on making themselves, and the treatment team, feel comfortable? 

Historically, patients with anorexia nervosa have achieved a reputation of being notoriously difficult to treat. Resistant, deceitful, manipulative, greedy, selfish, and narcissistic are just some of the words that physicians have used to describe AN patients⁵. 

Caring for a patient with AN⁶ can be emotionally and financially draining, and this has grave implications for how patients are treated; particularly in cases where the decision to force-feed becomes unavoidable. 

The concern is that treatment might be withheld because patients are perceived as being difficult. Hebert and Weingarten, in their analysis of the ethics of forced feeding in anorexia nervosa⁷, worry “that an analysis of futility that uses only abstractions such as benefits and burden may simply be a post-facto rationalization of the strong negative feelings such patients evoke in others.” 

If the patient with anorexia nervosa is deemed incompetent, then is it up to the parents and physicians—who are likely mentally exhausted from years of treatment—to decide? If, on the other hand, the patient is deemed competent, but not suicidal—with no intention to die, but no ability to do what’s necessary to survive—do we grant the patient ability to refuse food when food refusal is at the very heart of this disorder? 

Appelbaum and Rumpf, in their paper titled Civil Commitment to the Anorexic Patient⁸ write that “denial is such an integral part of the disorder, even many anorexics who can recite lists of adverse outcomes associated with their disorders are, at the same time, quite sure that none of these events will ever happen to them. Although these patients are not globally incompetent, they may well be incompetent to make decisions about providing themselves with basic sustenance or obtaining medical care.” Is this letting anorexia win or is it acknowledging that this deadly illness is often intractable? 

For many of these cases perhaps it is too late. But one thing is clear: in all of these cases, those in charge of treatment (or financing treatment) have failed; even just by letting their patient’s disorder get this far. To deny someone treatment—as many insurance companies do—is to fail patients; to discharge patients when they are not ready because treating them is too hard, is to fail patients. To belittle, dismiss and minimize the grave nature of this illness is to fail these patients. 

Inability to eat enough to maintain a healthy weight is at the center of this disorder and allowing patients to refuse food under the guise of autonomy is admitting the illness won. 

We can do better. We have to. We need to provide better treatment—and provide it early on, before eating disorder behaviours become engrained. We need to educate health care professionals, medical students, families and partners about this disorder, because recovery is possible and death is preventable. 

References

1. Smink, R.E.F., van Hoeken, D. and Hoek, W.H. (2012). Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Curr Psychiatry Rep 14(4): 406-414.
2. Anorexic medical student should be fed against her will, judge rules. (2012, June 15). Telegraph. Available online: http://www.telegraph.co.uk/health/healthnews/9334118/Anorexic-medical-student-should-be-fed-against-her-will-judge-rules.html 
3. Anorexic woman not be force-fed, judge rules. (2012, August 24). BBC News UK. Available online: http://www.bbc.co.uk/news/uk-19369239
4. Donnelly, L. (2012, August 5). Anorexia: ‘You can’t force me to live’. Telegraph. Available online: http://www.telegraph.co.uk/health/healthnews/9451734/Anorexia-You-cant-force-me-to-live.html
5. Thompson-Brenner, H., Satir, D.A., Franko, D.L. and Herzog, D.B. (2012). Clinician reactions to patients with eating disorders: a review of the literature. 63(1):73-8. 
6. Treasure, J., Murphy, T., Szumkler, G., Todd, G., Gavan, K., and Joyce, J. (2001). The experience of caregiving for severe mental illness: a comparison between anorexia nervosa and psychosis. Soc Psychiatry PsychiatrEpidemiol36(7):343-347.
7. Hébert, P.C. and Weingarten, M.A. (1991). The ethics of forced feeding in anorexia nervosa. CMAJ 144(2):141-144.
8. Appelbaum, P.S. and Rumpf, T. (1998). Civil commitment of the anorexic patient. Gen Hosp Psychiatry 20(4):225-230.

Starve: Adventures in Male Body Image

Devin McDonald

I sit here with hunger in my stomach. I contemplate whether or not to eat something. I could continue to starve myself until 6pm or I could eat something more befitting of my caloric requirements. That's to say, not just coffee, almonds and Preventia; the current composition of my diet. Though I would like to say that this behavior is some sort of act of self discipline, asceticism, or religious fasting, it is more accurately a feature of my neurotic—if not wholly irrational—approach to weight loss. After returning from Japan earlier this year, I discovered that my weight had risen by about 10 lbs (apparently, ramen is much fattier than it looks). Upon discovering my body's adoption of ten butter sticks, I shifted my mental fortitude towards the practice of weight loss. My form of dieting consists largely of not eating, as opposed to more strategic formulations of planned meals or low calorie foods or whatever the diet de jour happens to be. I have been informed, perhaps ad nauseum, of the ill conceived nature of my plan. Yet I persist daily pondering whether to indulge in another packet of Preventia.

I am revealing all of this to you not because I think my dieting habits are especially interesting or something you ought to follow. In fact, I find writing this quite uncomfortable. It is not easy for me, as a heterosexual male, who for all intents and purposes is quite normal, to admit that I have body image issues. Nonetheless, I am writing about this because I think I am anything but an exception. I think I am part of a silent majority of men who struggle to find satisfaction with their body image. 

There is a notable public discourse on the body image pressures women face. It is even a feature of pop culture for women to dread over the vicissitudes of their weight or to dote over their public image. Yet this is rarely the case for men, only the vainest characters might obsess over their outfit or their physical condition (barring physical condition for sports). This is not to say that women do not face immense pressure about their body image, but rather that men face similar if not equal pressure to conform to an unattainable ideal—Adonis is just as coveted as Venus. The difference is that men have not had the same emotional release valves available to them.

The most dominant social construction of male body image is one of contradiction. Ostensibly we are taught to not care about what we look like. Real men are too busy logging forests or lifting rocks to bare any attention to their outward appearance. Clothing is a matter of utility. Skin is a matter of irritation. Selling body care products to men must be done either by appealing to the magnetic affect the product has in drawing women, or through the convenience of its use. Yet despite the assumption of apathy towards appearance there is still pressure to look like you are the captain of the rowing team; until we have become walking inverted triangles we have failed to acquire any sense of manhood. Notably, just as the vast majority of women’s bodies do not adhere to the super model body image, the vast majority of men do not adhere to any equivalent platonic ideal. 

What is perhaps most troubling about the paradoxical nature of male body image is the lack of avenues it avails to men to talk about their insecurities. It's not exactly poker table conversation to talk about your concern for your the extra weight around your hips, or your under-defined arms, all this between burps and gulps of beer. You're caught forfeiting your manhood lest you attempting to air any insecurities. 

Body images issues for women are increasingly within the scope of the public eye. Dove's famous campaign focused on accepting the diversity of the female form and the implication that there is no perfect body type is a good example. 

One need not look further than the use of steroids as a demonstration of male body images issues. So compelling is the need for the ideal body, some men pursue the use of both illegal and dangerous substances to assist in their endless chase of perfection. The US-based National Institute for Drug Use reports that the use of anabolic steroids can lead to “kidney impairment or failure; damage to the liver; and cardiovascular problems including enlargement of the heart, high blood pressure, and changes in blood cholesterol leading to an increased risk of stroke and heart attack.” The drug can also have long-term psychiatric complications including the notorious “roid rage,” in addition to other states of mental instability. 

Even worse perhaps, is the silence which surrounds the issue of male anorexia and bulimia. 20 percent of those with either of the two diseases is male but given the public image of body images condition one would think the condition only afflicts the female half of the population. The focus of treatment on women is strong enough to make it significantly harder for men to recover. Men afflicted with anorexia take, on average, one-third longer to recover. This is likely due to the immense difficulty one would have in admitting they have a problem and seeking help; I have difficulty imagining something harder than admitting to have a condition which is branded by the public as residing wholly in the sphere of the female. 

A recent GQ article chronicled the dire state of support for male anorexics and bulimics. They found that a majority of treatment centres did not admit male patients due to the gender focused nature of their treatment. If a male becomes an anorexic they face the dually troubling feat of both admitting their affliction and seeking out nearly non-existent treatment options. 

Making progress on body image issues for both men and women require that we move forward in our understanding of the state of mind that drives someone to starve themselves into ill health. Common features of anorexics are obsessive, perfectionist, and neurotic behaviors. We need to recognize that the juncture of these mental attributes and a society which drives its member to physical obsession are the cause of anorexia and bulimia. Bulimia arises not from the some innate female qualities but rather from the pressures mentioned above.

The intent of the essay is not to undermine the value of all the work that goes into supporting the pressures women face with regards to their body. They face just as steep a hill as men, if not steeper, as evidenced by the 80 percent of anorexics that are female. Rather the intent is bring to light and contribute to the growing dialogue about the issues men face with their bodies. Silence does not betoken apathy but often an inner struggle confronting the paradox of the ideal male. It is easy to appear not to have body images issues when you are a TV character who embodies everything that is the ideal. Yet, in reality not everyone can have a six-pack or shoulders like an ox. What we should recognize as a society is that not having those features is just fine. Just as the women in the Dove commercial are shown accepting their body, why can't men?

Fortunately, I am not anorexic nor bulimic but I cannot say with confidence this is due to a complete invulnerability. Rather, I feel this is in part due to the support I have available to me. I have a strong group of friend and a supportive family. I often feel that in other circumstances the obsessive, neurotic, and compulsive natures which often drive my ability could spur on a much more harrowing affliction than my occasional dieting. Yet there remains innumerable men who do not have the support systems I do, who may fall into a similar trap but find themselves in a hall of silence. 

“People don’t shape stereotypes. Stereotypes shape people.”

Arnav Agarwal 

Friday, June 29th, 5:20pm, Toronto. Public transit, back-seat. Rosa Parks might disagree, but sitting at the back of the bus carries its own sense of adventure. A young student belonging to an ethnic minority group walks onto the bus, dropping his coins into the machine at the front and picking up a transfer from the bus-driver. He walks to the back of the bus, a small grin on his face and skateboard in hand. As he finds a seat at the back, he peers out the window, and receives a smile from his friend on the exterior of the bus. Pulling open the window with a slight tug, he stretches his arm and quickly throws something out the window. A breeze propels his small paper ball floats under the bus. 

Outside, the boy’s friend—also an ethnic minority—bends underneath the bus to retrieve the seemingly discarded paper. He picks himself up, dusting off his pants before casually walking to the front of the bus, opens the ball, and shows a transfer ticket to the bus-driver before making his way to his friend. One transfer allowed three young people to board the bus, as they repeated the act twice more times within a span of three minutes. I was just as intrigued by the cleverness of this plan as I was shocked by how far people can go to save $3.25. 

As I shared this experience with one of my friends, he shook his head in disapproval. “Why are you even surprised?” he asked. “That’s their way. What do you expect?” While I couldn’t disagree more with his prejudice, he raised an important question: what do we expect? In a multicultural hub, marked by its dynamic diversity, we have engineered a society that has a mindset of its own. Some may see this as a good thing—conforming to a unified social perspective. They couldn’t be further from the truth. 

When we examine “at-risk” groups in educational institutions, minority ethnicities are often the highest on the list. Similar trends can be found in crime rates across the globe. A prime example of this is an article in the UK’s Daily Mail, which stated that authorities hold the black population responsible for both the majority of crimes committed and for being twice as likely to be victims of crime, despite only 12 percent of London’s 7.5 million people being black in ethnicity. The article, published in 2010 and titled “black men ‘to blame for most violent crime’…but they’re also the victims”, mentioned 67% of those caught for gun crimes in 2009-2010 in London were black, and the police held black men responsible for two-thirds of shootings and more than half the robberies and street crimes in London, according to figures released by Scotland Yard. A critical eye was placed on black women as well, with 52% of robberies, 45% of knife crimes, and 58% of gun crimes that police had an involvement with being placed on them.^[1] 

Is there something different about these ethnicities? Or are we looking for an answer that isn’t even out there? We often attribute qualities to certain groups, whether ethnic in nature or otherwise. There are numerous theories as to what gives rise to these stereotypes. These ethnic minority groups are no different. Several have come to take on a stereotype of violence, substance abuse, low academic performance, and uncivil activity. There are several theories—among which are the subculture of violence theory, the social control theory, and the macro-structural opportunity theory—which strive to find a definitive explanation for this behaviour. These ethnic groups have essentially come to take on an intricate identity in the public eye, which can be captured by one word: danger. 

But this is not about the trends themselves, but rather what gives rise to it. The answer to that is clear: the answer lies in the question itself. Stereotypes give rise to stereotypical behaviour. It may seem paradoxical; after all, doesn’t consistent human behaviour produce stereotypes? What is truly paradoxical, however, is how oblivious we are to the environment we create through stereotyping, which gives rise to these behavioural trends. A well-known case in psychology involved parents who deceived their child into believing they were female for over fourteen years of their life, until the child finally identified as being male in gender at the age of fourteen.^[2] How is society any different? By making a baseless perspective so commonplace in the social framework, we have almost laid out an expectation of “danger.” If an ethnic group is raised in an environment where it is marginalized by the views of the very society that nurtures it, what more are we to expect? It’s ironic that psychology is rooted in an ongoing debate regarding nature versus nurture. While it is clear that human behaviour isn’t shaped solely by the nature of an individual, we nurture our people in a hostile environment of negative expectations. 

Does this excuse the high rates of violence, the low rates of academic performance, or the offender’s crime on the public transit? Of course not. But it’s hard to expect a seed to flourish into a flower when the soil itself is arid and lacking. 

[1] http://www.dailymail.co.uk/news/article-1290047/Metropolitan-Police-crime-statistics-reveal-violent-criminals-black--victims.html 

[2] http://people.uncw.edu/bruce/psy%20265/pdfs/inter%201.pdf

New Insite: The Benefits of Safe Injection Sites

Mohamed Sarraj

Imagine you are a child walking home from school in a cluttered downtown core. You trip in a heap of garbage and turn to realize there’s more to it. A woman who looks to be around 30 years old is buried beneath the trash. She is riddled with needle tracks; her body has just expunged all waste to try to flush out the toxins that have left an expression of terror frozen on her face. She’d died alone, stripped of her humanity, left to rot in the sun by the trash. But she isn’t trash. She is somebody’s daughter, somebody’s sister, somebody’s mother. She does not deserve that. 

In many areas, the sight of such extremely disadvantaged people is as common as it is wrong. The problem exists, but what can be done about it? 

Safe injection sites give intravenous drug users a supervised and legal environment to inject. Safe needles are provided, medical attention is at hand, and detoxification and rehab facilities are usually in the same building. Vancouver’s safe injection site, Insite, is an answer to the East Side’s drug pandemic. Needles were strewn over the streets, alleyways were a sure place to find a dead body, and public injection was rife. Proponents of safe injection sites in Vancouver and elsewhere have argued that they directly save lives, reduce addiction, and improve public order.

It is important to note that safe injection sites cater to the disadvantaged who would otherwise be injecting on the streets. Infectious diseases arising from needle sharing—such as HIV or hepatitis—are a fatal pronouncement for these people who would often rather die than approach the medical system. But the prevention of infectious disease in safe injection sites also saves the wider public from these diseases, which will inevitably spread. In fact, a study in the Canadian Medical Association journal showed that Insite could save the healthcare system $20 million and significantly increase life span in the next ten years by stemming the spread of infectious disease.

Infectious disease is not the only concern. Drug overdose kills, and kills frequently. It begins with slow respiratory failure that renders the user unable to respond and soon unable to effectively move. Nobody has ever died of drug overdose at Insite because medical staff is on hand to help. In fact, Insite has cut overall overdose deaths in the area by 35 percent according to a study in the Lancet Medical Journal.

 Beside dumpsters in dark alleyways, let’s just say medical staff is rare, at best.

Almost counter-intuitively, safe injection sites can help people overcome their addictions. Drug addiction is a terrifying reality that many of society’s disadvantaged live with. It’s a waking and sleeping horror. But what do addicts get on top of it? They’re labelled as criminals, scum, and trash. They’re shunned and confined to shooting up in terrible conditions. To give them this baseline respect puts them a step closer to even the most basic healthcare we guarantee for all citizens. 

In a clean and secure environment, addicts can develop a closer trust with staff that is essential for the physician-patient relationship. Many addicts stay away from rehabilitation or treatment facilities because of alienation, fear, and distrust. Bringing them into the heart of healthcare is a crucial step to treatment and care. In 2010, Insite made 5,000 referrals to other services including onsite rehabilitation, with record completion rates. The model has been successful. 

Others say, however, that to expand these facilities is to legitimize and encourage drug use. But I would argue that being treated as someone who is sick, surrounded by medical staff, and constantly monitored does not attract those who do not use drugs. They are seen as a blessing by those who are currently addicted, but first-time drug users never plan on being addicted and would hardly think about safe injection sites when considering drugs to start with.

Yet some may say that it is the very negative conditions surrounding drug use that discourage it, and safe injection sites only alleviate the deterrents of drug use. These deterrents include death, alienation, and legal troubles. But again, initial drug use is hardly rational, and even so, a life with drugs in Vancouver, or anywhere, is still obviously worse than one without. Even assuming that safe injection sites may encourage some drug use, the effect is minimal, and it is still for the greatest good to expand the sites. 

The issue of perception also plays a big part in safe injection sites. In Vancouver, Insite reduced the amount of discarded needles and public injections. Many argue that seeing this particular public disorder encourages and creates an environment in which crime thrives. However, others argued before that Insite would have led to a migration of drug trafficking into Vancouver. The data show little to no negative impact on crime.

Strict illegality should never take precedence over a policy that can help save citizens, improve general health, and reduce addiction. Insite has worked in Vancouver and it can work in other parts of the country. People deserve better, and stigma should not push us into shying away from real problems.

¹ http://vancouver.ca/people-programs/safe-injection-site-and-needle-exchange.aspx

² http://www.canada.com/reginaleaderpost/story.html?id=a4c0517f-77d6-493a-abfe-391b377b0e28

³ http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext

⁴ http://supervisedinjection.vch.ca/research/supporting_research/

The Health Impact Fund: Driving Innovation to Improve Access to Medicines

Nicole Bechard, Anna Kobylianskii, Amro Qaddoura, and Harkanwal  Randhawa  

    

  One-third of the world’s population lacks access to essential medicines. In Asia and Africa, this figure rises to one-half of the population. Even more astounding, over 14 million people are killed by infectious diseases each year, 90 percent of whom reside in developing countries. The majority of these diseases can be treated and perhaps even cured with existing medicines. However, many of these drugs are too expensive for individuals to purchase and some drugs are completely unavailable in certain countries.      

This lack of access arises because some medically necessary drugs are simply unprofitable for drug companies to produce. Estimates for the cost of developing a new drug range from $800 million to more than $1 billion. Although these estimates are often criticized for being inflated, it is clear that drug innovation requires enormous investments by pharmaceutical companies. 

Typically, these investments are protected by patents that afford the innovator exclusive rights to produce and sell the drug for a set period of time. To profit—while recouping its research and development costs—pharmaceutical companies charge high prices for this drug while they have a monopoly over the market. Naturally, these prices cause the cost of medicines to be prohibitively high, limiting access to the medicine. 

Although public pressures on the pharmaceutical industry and increased competition from generic drugs have been of great help, the issue with access remains and many people worldwide still cannot fulfill their medicinal needs. Any solution that aims to increase access to medicine by decreasing their market price must also account for the fact that in order to drive innovation, there must be a financial incentive for pharmaceutical companies to invest in research and development.

The Health Impact Fund (HIF) is a proposed financing scheme for pharmaceuticals that would incentivize innovation based on the measured performance (health impact) of a drug. It is a pay-for-performance scheme that simultaneously addresses both the innovation and access to care problems. This is in contrast to the patent system, which is effective in encouraging innovation but primarily favours the development of highly profitable drugs rather than those that have the largest impact in society. By allowing innovators to be compensated based on the assessed health impact of their drug and having the drugs sold at cost, the HIF would provide financial incentive for innovation and increase access to lifesaving medications.

The HIF would be financed by countries that contribute to a fixed pool of funds, which would be paid out annually to eligible innovators. Pharmaceutical companies would have the opportunity to register their drugs with the HIF, and the assessed health impact of the drug during the previous year would determine the proportion of the fund that would be awarded for that drug. It is estimated that with a pool of $6 billion, the HIF would support a total of 20 drugs, each of which would be eligible for HIF funding for 10 years. This model could easily be expanded to more than 20 drugs if government and other donors increased their contributions. Essentially, this model provides a long-term and stable source of income that would encourage ongoing innovation. 

When assessing health impact, the HIF would take into account a variety of factors to estimate the difference between the health status of people who used the product in question and their estimated health status had that product not been available to them. To inform this assessment, the HIF would utilize data from many sources, including clinical trials, practical trials, sales data, sampling of product use, and data on the global burden of disease. Although the HIF system recognizes the significant difficulty incumbent to assessing health impact, it is a more informed reward mechanism than the one currently in place.

As of today, the HIF is planning its pilot projects. Since the HIF is currently a proposal, these pilots are necessary in order to test its effectiveness. The aim of the pilot is to reward a pharmaceutical manufacturer on the basis of measured health impact in a region. This pilot will allow the pay-for-performance approach to be field-tested and refined before it is implemented on a wider scale.

Ultimately, the HIF is an exciting and novel proposal that could fundamentally change the pharmaceutical industry and lower the cost of medicines, not only in lower-income countries, but in countries around the world. By harnessing the primary driving force behind corporations—financial gain—and tying it to health impact, the HIF is a practical solution to the critical access-to-medicine problem. If the Health Impact Fund is to become a reality, it requires the support and commitment of politicians, academics, and corporations around the world. 

1. Doctors Without Borders. Access to Medicines. 2012 [cited 2012 Oct 17]. Available from: http://www.doctorswithoutborders.org/news/issue.cfm?id=2379     

2. Mercurio B. Resolving the public health crisis in the developing world: problems and barriers of access to essential medicines. Northwestern University Journal of International Human Rights.  2007 Feb:5(1). Available from: http://www.law.northwestern.edu/jihr/v5/n1/1/     

3. Collier R. Drug development cost estimates hard to swallow. CMAJ. 2009  Feb;180(3):279-280. Available from: http://www.cmaj.ca/content/180/3/279.full  

4. Health Impact Fund. Proposal and Pilot. [cited 2012 Oct 17].  Available from: http://www.healthimpactfund.org/pilot.html  

5. Hollis A and Pogge T. The Health Impact Fund: Making New Medicines Accessible for All. Incentives for Global Health; 2008 [cited 2012 Oct 17]. Available from: http://www.healthimpactfund.org/e-­‐library.html    

Asian-Pacific Distraction Politics: The Diaoyu Islands

Stephen Zhao

Even at the best of times relations between China and Japan have been delicate. With memories of Imperialist Japan and the Second World War strongly engrained in Chinese public consciousness, diplomatic incidents with Japan tend to create an overreaction with the Chinese public. Recently, animosity between the two states has escalated to new levels with the dispute over ownership of the Senkaku/Diaoyu Islands.

The root of the disputes date back to 1968, when a UN report suggested that the islands may hold oil underneath them. In the 1970s, both Mainland China and Taiwan instated territorial claims towards these islands as a result of the new findings. These claims were of minor significance until 1996, when the Japanese Youth Federation repaired a lighthouse on one of the Senkaku Islands. As a result of these actions, anti-Japanese protests flared up across China. The streets were filled with protesters chanting anti-Japanese slogans and large portions of the public boycotted Japanese products. Although these protests eventually subsided, Japan and China never reached a concrete agreement regarding the ownership of the islands. The official diplomatic stance on the Islands was to agree to disagree. 

These islands now have returned to the forefront of Sino-Japanese relations following the Tokyo Municipality's decision to purchase the islands from their private owner, rendering them as official Japanese state property. Both state and private media in China reported this action as an unacceptable violation of China's sovereign rights. The inflammatory statements from every conceivable media outlet in China spurred a volatile reaction from the populace. Large swaths of angry Chinese rampaged through the streets, smashing anything Japanese – from stores to cars to consulates. As a result of the outrage, the Japanese suffered sizeable economic setbacks in the form of frozen inventories, heavy reductions in tourism, and waning market confidence in an already stagnant economy. In China, violence by protestors result in death while vandalism caused immense property damage. Across the nation, businesses and factories closed to protect themselves from unrest. 

One must wonder with all this madness:  who is right and who is wrong? The answer is no one and everyone. 

The timing of this diplomatic crisis could not be more perfect for these two countries. China is in the midst of a crucial power transition from the current Hu Jintao regime to its successors. If the public is preoccupied with Japan, they cannot disrupt the government transition with displays of disapproval or other seditious activities. Similarly, Japan is nearing an election. As economic indicators in Japan are rather lacklustre, the incumbent regime seeks to shore up support by showcasing strength in foreign policy. Escalating the Island dispute benefits both governments by directing the attention of their public spheres away from domestic affairs. However, this does not mean that this incident is a part of some insidious government scheme. 

While it may benefit the respective governments of China and Japan to take hardline stances on the issue, they only do so to appeal to the public sphere. Once the Chinese government brings attention to the island dispute through state media, applications for protests and demonstrations will flood in on their own accord. With September 18th being the 71st anniversary of the 1941 Japanese annexation of North East China, Japanese claims for the islands will undoubtedly provoke Chinese outcry as anti-Japanese sentiment run high in China. The outrage runs to such heights that the government in China must use its powers to restrain protesters from becoming too militant. Large segments of Japanese society view the nation's foreign policy as weak and unfit for a nation as large and economically influential as Japan. They see little reason for Japan's rather passive stance in international politics and some even question the point of Japanese pacifism. These people, although nowhere near being the majority of the Japanese population, are still significant enough to warrant political pandering. The development of the Senkaku Islands dispute is indicative of significant issues facing both Chinese and Japanese society. 

Both the claims of China and Japan are dodgy at best and reasonably, no party should be that outraged. The Chinese must look back at least four centuries until they see a point in time when they actually controlled the islands, and even then, the islands were nearly uninhabited and part of a Chinese vassal instead of China proper. The Japanese have only ever obtained the islands as a part of their colonial expansion in the late 19^th century – their best claim is still morally unsound.

 Japan keeps reviving the issue of the islands despite the nigh-impossibility of Chinese acquiescence to elicit support by appealing to a public opinion that reflects a disregard for history. Outside post-secondary education, Japanese history lessons generally omit the nation's dark past of mass slaughter and human rights abuse. Naturally without this context, many would believe that land acquired during Japan's colonial era is rightfully theirs. This dispute is only one of the myriad of problems associated with the Japanese government's use of revisionist history. Chinese society has similar problems: Instead of omitting historical details, Chinese education strongly emphasizes its oppressed past. The Chinese Communist Party shifted the basis of their legitimacy from communism to economic progress and nationalism which requires them to frame Chinese history in a manner that perpetuated anti-foreign sentiment. Despite how powerful China is in compared to Japan these nations, much of the Chinese public see all foreign disagreements with China as both bullying and oppressive. This opinion compels the public to demand a hardline stance from the government on issues of territorial sovereignty, though these demands usually remain unmet. 

The islands dispute and others like it will remain unresolved in the foreseeable future. The relevance of these issues stem from revisionist accounts of history which have inflamed nationalism. These diplomatic incidents will remain useful tools for the government to use as distractions. However, it is doubtful that military conflict will arise from the land claims, as China and Japan are too economically interdependent. A conflict with China would cripple Japan economically while Japan's alliance with the United States makes instigating military action a dangerous move for China. Even if the dispute does not result in force of arms, it will continue to plague Sino-Japanese relations and act as a destabilizing factor for the Asia-Pacific region. 

1 Malcolm Moore, “Military Conflict 'looms' between Japan and China,” The Telegraph, September 27^th, 2012. http://www.telegraph.co.uk/news/worldnews/asia/china/9571032/Military-conflict-looms-between-China-and-Japan.html 

2 “Senkaku Diaoyu Islands,” Global Security, October 24^th, 2012. http://www.globalsecurity.org/military/world/war/senkaku.htm 

3. “The Ryukyu Kingdom and Its Relationship with China and Japan”, Okinawa Peace Network of Los Angeles, October 24^th, 2012. http://www.uchinanchu.org/uchinanchu/history_early.htm 

Landmines - A Relic of History for Canada, a Pervasive Nightmare for the Less Fortunate

Ronald Leung

The horrors of war burn death and destruction deep into bodies and minds of soldiers and civilians alike. When it finally ends, widows and orphans are left to mourn. The lucky few who survive breathe a sigh of relief while tears are shed, monuments are erected, and funerals are conducted. Life moves on—and leaves behind prisoners, eternally trapped in the shadows of war.  

Landmines—what better than an artificial, expendable security guard that can keep enemies at bay with the hovering threat of dismemberment and death? Yet when the treaties are signed and the battle lines retreat, it’s not only the bodies that are left behind—no one bothers to reclaim the mines. Today, when recovery operations are in progress, 80 mines a day are still recovered in Belgium—ones that were armed in World War I.  

Canada was a leader in promoting landmine removal. In 1997, the federal government worked tirelessly to create what is now known as the Ottawa Treaty. Each state party that signs the treaty must—according to the official document—agree to never use anti-personnel mines. The treaty also requires state parties to never develop, produce, otherwise acquire, stockpile, retain or transfer to anyone, directly or indirectly, anti-personnel mines. Further, states parties must not assist, encourage or induce in any way anyone to engage in any activity prohibited to a state party under the convention. The International campaign to ban landmines (ICBL), which facilitated the treaty, received the Nobel Peace Prize in 1997 and has advocated endlessly with the aims of the treaty boiled down to three basic goals: disarmament, mine clearance, and victim assistance. Around 125 states entered in the initial signing, and today that list has increased to 160. Celebrities such as Diana, Princess of Wales, have personally traveled to landmine-infected areas such as Angola, Pakistan, and Bosnia to support landmine removal.  

That was all in the past, however. Fifteen years after that glorious moment of peace-keeping, Canada is slowly waning from the fight. The current federal government has repeatedly cut down on the funds granted to support agencies. What was once a steady stream of money has slowed to a trickle. From a landmark high of $49.2 million funding in 2007, over $30 million has now been cut with only $16.9 million earmarked this year for landmine recovery and removal. This pales in comparison to the 16 other countries that are investing more than $43 billion (USD) into companies making cluster bombs, most of whom still refuse to sign the Ottawa treaty. Three of the banks and financial intuitions that invest in producers of cluster bombs are Canadian. Canada’s inaction does extend beyond funding cuts, however; compared to countries such as Italy, Belgium, and Ireland, who have national legislation in place that forbids domestic investing in companies that produce landmines. Canada is heading in the wrong direction.  

  Critics such as Dan Livermore, once the Canadian special ambassador on mine action, charges that “Canada has dropped the ball and walked away, leaving the job unfinished.” Land laced with landmines is not only dangerous, but also wasteful, especially in less fortunate countries where resources are scarce. “No one can build a school in a field of landmines. Farmers won’t till the land. Do you think Walmart will come and open stores? Canada is the pillar of this movement. Nothing is more Canadian than this. We should be doing it” adds Rahul Singh, the founder of Global Medic, a non-profit organization based in Toronto.  

The Department of Foreign Affairs and International Trade disagrees, however. Canada has continued to hold a “leading role internationally in addressing the humanitarian impact and explosive remnants of war,” with “more than $200 million contributed” since 2006 “through 250 projects to this global effort,” spokesperson Jean-Bruno Villeneueve responds. “Canada remains deeply committed to this cause.”  

What’s ironic is that the United States has funded over $420 million to mine recovery and action between fiscal years 1999 and 2003 alone, the largest total for any government, yet they are still one of the 36 states who refuse to ratify the Ottawa Treaty. The last self-acknowledged use of mines by the U.S. was in the 1991 Kuwait and Iraq conflict in which over 117,634 landmines were scattered from airplanes. Over 90,000 antipersonnel mines were stored in regains close to the Iraq conflict since the launch of the invasion in March 2003. The United States also have a robust stockpile of landmines: 10.4 million, the third most in the world behind China and Russia, who store an outrageous 110 million and 60 million respectively, two countries that also refuse to ratify the treaty.  

How can Canadians even begin to picture the devastating effect of landmines? No modern war has been fought on Canadian soil and with the rugged mountains and abundance of green space all over the country, it can be hard to picture the hellish confinement and destruction of post-war landmines.  Yet the village of Ustipraca, Bosnia suffers from an epidemic of mines, despite sharing a similarly beautiful landscape: blue lakes, rolling green hills, and orchards stuffed with ripe fruit, a scene that wouldn’t be out of place in the rich Ontario countryside. The landmines were primarily used in the Balkan wars which ended almost 20 years ago. Bosnia remains as one of Europe’s poorest nations and the 1,340 square km of mine-covered land certainly does not contribute to their economic fate. In only three years of the Balkan wars, an estimated two million mines were primed.  

These mines still persist today. In 2011, there was a forest fire near the village, but firefighters couldn’t reach the fire because of the continued threat of landmines. Frequent explosions echoing around the hills set off by the heat of the flames confirmed this deadly suspicion. The local wildlife also suffer similar fates. Once in a while, a single landmine will detonate after being stepped on by a deer. Despite the rich soil and abundance of timber and fruit dotting the hills around Ustipraca, almost all of it is untouchable. Even the roads leading into the village are fraught with danger. Just two years ago, a local man discovered a landmine near the main street leading into Ustipraca. Three workers then began to section off the area for isolation and clearing when one of them stepped on another landmine. None survived.

The removal of landmines is also exhausting work. Metal detectors, despite being displayed in popular media as sure methods to search for underground metals, are unworkable because of the abundance of natural minerals in the soil. This leaves the physical search of mines involving a metal poker. The rod is slowly and careful extended into the ground at a 30-degree angle to see if it clicks against a landmine. Workers repeat the process, for a maximum of only five hours a day because it is just extremely psychologically tense and mentally draining. If a landmine is found, detonation occurs in a safe and controlled manner with workers at least 30 meters away.  

The large amount of warning signs scattered all over the Bosnian landscape are not enough to prevent needless death. Resources have become so desperate that people take the danger signs before an area is clear and sell it for scrap metal. This leads to devastating results, such as the death and injury of six railway workers last year, in addition to other innocent bystanders.  In central Bosnia, Tarik Bijelic passed away after triggering a landmine while gathering firewood near his rural home. He was only six years old.  

It’s easy for Canadians to forget about the troubles of these villagers in rural Bosnia. How many of us have even thought about the possibility of landmines in Canada? Already, this idea sounds ridiculous, and for good reason—yet others do not have the same fortune. Why should an idea so passionately advocated by Canada sputter and die in silence? Waging war and leaving landmines to continue the cycle of death decades later is unacceptable—but so is leaving a task half-finished. 

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to Ban Landmines." ICBL - International Campaign to Ban Landmines. N.p., n.d.

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landmine removal effort?." The Toronto Star 22 Sept. 2012: n. pag. The Star.

Web. 20 Oct. 2012.

Justice for All? The First Decade of the ICC

Michael Davison

From the concentration camps of Nazi-occupied Europe, to the killing fields of Cambodia, and the villages of Rwanda, the twentieth century was regarded as a turning point in the scale of conflict and its associated atrocities. Despite 19th century agreements on the laws of war, leaders committed crimes against humanity that went unchecked throughout the following century. When heads of state are accused of crimes against their own people, who will bring them to justice? Following the Holocaust, countries recognized the need for an international tribunal to convict such “untouchable” criminals. The ageless question posed by the Roman poet Juvenal was asked once again: “Who watches the watchmen?”

Following the 1945-46 Nuremberg Trials, the United Nations (UN) recognized the need “to study the desirability and possibility of establishing an international judicial organ for the trial of persons charged with genocide.” When genocides occurred in the former Yugoslavia and Rwanda in the 1990s, the UN created courts for the trying of these criminals on an ad hoc basis. But there was still demand for a permanent “court of last resort.” 

In response, UN member states met in 2002 to draft the Rome Statute, which established the International Criminal Court (ICC) to be located in the Hague, Netherlands. The ICC is the first permanent international court. It is a last resort, meaning it only acts when national institutions are unwilling or unable to do so themselves. Its purpose is to try persons accused of the most serious crimes of international concern: genocide, crimes against humanity, and war crimes. 

These goals may seem ambitious for a court consisting of only one Chief Prosecutor and 18 judges. Indeed, the ICC has now existed for a decade and has successfully convicted only one man, Thomas Lubanga, to 14 years in jail for the recruitment of child soldiers in the Democratic Republic of the Congo. It has issued warrants for 18 individuals following investigations in seven countries on the African continent. This limited success comes as a surprise, considering the 121 states that signed the statute. Surely there are more war criminals going untried by national courts, not just in Africa but across the globe? The urgent need for justice for all humans, in all countries must be obvious? The fact is that amidst criticism of the Court, it has been challenged by opponents and even hindered by those who claim to support it. 

The ICC has faced political opposition from many countries since its creation. The US has not ratified the Rome Statute, due to the refusal of the Rome Conference to give control of the Court to the UN Security Council (UNSC). The Bush Administration weakened the Court by making impunity agreements with other nations, threatening that these countries should not surrender accused US nationals to the ICC. These actions limit international recognition of the Court, and undermine its ability to act across all borders. The US government has recently taken a somewhat lighter stance toward the ICC. However, the Court’s scope will be limited until the US and 41 other UN member nations that have not signed the Rome Statute do so. 

Many warrants issued by the ICC are outstanding because of the Court’s inability to enforce itself. Instead it relies on the actions of willing countries, which have been limited. A good example is the charges brought against the current President of Sudan, Omar al-Bashir. The Sudanese President is accused of genocide and war crimes in the Darfur conflict. Although Sudan is not a signatory of the Rome Statute, the UNSC passed Resolution 1593 requesting Sudan’s compliance with ICC-issued arrests. Not only has the Sudanese government ignored these warrants, but signees to the Rome Statute including Malawi, Kenya, and Chad have refused to arrest Bashir during his visitations. Although it might be expected that Sudan would not comply, for the Court’s own financial and legal supporters to not uphold its rulings is a blow to its authority.

A different example involves the 2011 Libyan Civil War, in which Muammar Gaddafi, his son Saif al-Islam Gaddafi, and the head of military intelligence Abdullah Senussi were each indicted by the ICC for crimes against humanity. Recently, Saif and Abdullah were both captured by the new Libyan government in Tripoli. The ICC has requested that Libya hand them over for trial at The Hague, amidst fears from Amnesty International that the new Libyan government is unable to hold fair trials. Libya has refused to give up both criminals and insists that it will try them fairly in Tripoli, where they will face execution if found guilty. Following civil war, new governments often execute old leaders with haste. The ICC is meant to set an example for such inexperienced governments on the proper use of the rule of law. But the NATO member nations that support the Court and who intervened in Libya, including Canada and the UK, have not stepped forward to pressure the new Libyan government to extradite these criminals to The Hague. As a result, revenge rather than justice may be served in Tripoli.  

There have been many critics of the ICC. They note that the Court has cost $1.3 billion over the past decade, so far resulting in the conviction of only one man. Furthermore, it has only investigated conflicts in Africa. Western politicians such as the former British Prime Minister Tony Blair have been recommended for ICC investigation without success. In Blair’s case, individuals have accused him of exaggerating the danger posed by the Hussein regime, and therefore his declaration of war against Iraq constitutes a crime of aggression. However, the ICC has only recently defined the crime of aggression in 2010, and signees will decide in 2017 whether to activate ICC jurisdiction over this crime. Despite all this, few can deny the necessity of the investigations the ICC has opened, several of which began at the request of the concerned countries themselves. If these criticisms are addressed, it will provide the Court with an opportunity to increase its international credibility. 

The ICC’s first ten years must not be seen as a failure, but as a limited success. The very existence of the Court and its recognition by 121 UN member states is a giant step toward the recognition of human rights globally. Moving forward, the ICC must broaden its scope by encouraging more states to ratify its statute, as well as by addressing criticism that it focuses too heavily on the African continent. Until support for the Court broadens, it will continue to face challenges in investigating crimes and enforcing its arrest warrants. Importantly, signees to the Rome Statute should be willing to enforce the decisions of the ICC within their national boundaries. Until this is done, the Court’s ambitious mandate to enforce the universality of human rights will never be fully realized. 

References:

http://untreaty.un.org/cod/icc/general/overview.htm

http://www.guardian.co.uk/world/2012/sep/05/abdullah-senussi-trial-icc-tripoli

http://www.guardian.co.uk/law/2012/jul/10/icc-sentences-thomas-lubanga-14-years

http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=XVIII-10&chapter=18&lang=en

http://ejil.oxfordjournals.org/content/15/4/701.full.pdf

http://www.hrw.org/news/2010/07/13/sudan-icc-warrant-al-bashir-genocide

http://www.huffingtonpost.com/richard-hall/why-tony-blair-will-not-b_b_442989.html

http://www.iccnow.org/?mod=aggression

Fertile Research: The Limitations of Canadian Stem Cell Research

Megan Scarth

Few topics in modern science have attracted as much attention in recent years as stem cells. Stem cells have an enormous potential to treat a large number of debilitating diseases and injuries that affect millions of people worldwide, and this capacity arises from their ability to adapt into any cell in the body. Someone who suffers from heart disease, for example, may have healthy cardiac cells transplanted into them to aid their failing heart. Stem cells may even be used to grow a new limb for someone who has been in an accident. The limb’s basis in the patient’s own cells would reduce the risk of the body rejecting an otherwise foreign appendage. With so many possible uses in modern medicine, it is easy to understand why these cells are the subject of so much current research. This research, however, bound to the limitations of Canadian regulation, slowing down the rate of potentially life-saving breakthroughs that could be made. 

While the potential benefits of stem cells are undeniable, they have been subject to a large amount of controversy since their discovery; originally, stem cells were derived from the tissues of human embryos, which many pro-life activists deemed to be unethical (Naik 2012). Fortunately, since the advent of induced pluripotent stem cells in 2007, adult cells taken from almost anywhere in the body were, for the first time, able to be “induced” into acting like these embryonic stem cells, eliminating the need for human embryos (Naik 2012). Though governments are often slow to shift policy in response to scientific changes, progress is being made: last August the United States made headlines when its Court of Appeals ruled in favor of continuing its stem cell research after a difficult three-year battle with pro-life groups (Kaiser 2012).

Though stem cell research is legal here in Canada, it is often difficult for Canadian labs to secure the necessary funding for their work (Canadian Institutes of Health 2010). Unlike in Europe or the United States, Canadian law dictates that stem cell research must first be conducted on non-human subjects before any experiments, no matter how carefully-controlled, may be conducted on humans (Blackwell 2012). Not only does this raise the ethical concern of animal testing, but these experiments are usually extremely costly and time-consuming (Blackwell 2012). Many researchers lack the funds to perform them, and experts estimate that these laws will delay research in the field by approximately 10 years (Blackwell 2012). For the Canadians currently suffering from crippling injuries or life-threatening illnesses, a decade is simply too long to wait. Left with no other option, many of them have been forced to travel to countries such as China to seek unregulated and often dangerous treatment (Blackwell 2012). Now that stem cell research has been able to sidestep the moral issues surrounding the use of embryos, why is Canada still so hesitant to explore this promising new field?

That’s what Canadian researcher Dr. Armin Curt wants to know. After four years at the University of British Columbia, Curt moved to Switzerland where laws governing stem cell research are far less restrictive (Blackwell 2012). It was there that he made worldwide headlines when he became the first person to provide evidence that stem cells can be used to effectively treat patients suffering from spinal cord injuries (Adams 2012). Yet due to government-imposed regulations, this discovery was credited to Swiss scientists instead of Canadians (Blackwell 2012).

Despite its many drawbacks, there are, of course, benefits to conducting preliminary experiments on primates. These studies would allow scientists to refine their techniques and develop more effective and less dangerous methods of treatment before dealing with humans. This is important because while the positive effects of stem cell research on lab animals such as rats has been well-documented, very little research thus far has actually been conducted on people, mostly because the field is so new (Blackwell 2012). 

But is lowering these risks worth the wait, especially for the fatally-ill who would rather seek experimental treatment than none at all? It’s a difficult question to which there is no clear answer. In my opinion, however, the urgency with which this medical breakthrough is needed overshadows the gains to be had by delaying its progress. Fortunately, progress is still being made in this field, even if it is not necessarily happening in Canada. Scientists are hopeful that cures for many once-thought “untreatable” diseases will be found, though the speed at which they are researched is contingent on the ongoing debate. 

Adams, Stephen. “Stem Cells Help Paraplegics Regain Feeling.” The Telegraph. 4 Sept 2012. Ed. Tony Gallagher. 10 Oct 2012.  

Blackwell, Tom. “Canadian Stem Cell Trials Impeded by Federal Regulations, Doctors Say.” The National Post. 18 Sept 2012. Ed. Stephen Meurice. 10 Oct 2012.

Canadian Institutes of Health Research. “Updated Guidelines for Human Pluripotent Stem Cell Research.” Canadian Institutes of Health Research. 30 June 2010. 10 Oct 2012.

Kaiser, Jocelyn. “A Legal Win for Stem Cell Research, But Case May Not Be Over.” Science Insider. 24 August 2012. Ed. Bruce Alberts. 10 Oct 2012.

Naik, Gautam. “Stem-Cell Scientists Win Nobel Prize.” The Wall Street Journal. 8 Oct 2012. Ed. Alan Murray. 10 Oct 2010.

The Last European Dictator

Yanka

When people ask me where I am from, I am used to the confused expression on their face when I say “Belarus.” Until a few years ago, Belarus was not even a blip on the international radar. It was simply one of the many small countries that was cast from the former Soviet bloc. However, a number of recent events have made news headlines across the globe, and raised some level of international awareness on the startling realization that Belarus is the last dictatorship in Europe. 

Belarus is located along the borders of Russia, Ukraine, Lithuania and Latvia. A population of approximately 9.5m divided among 6 regions, is still very dependent on agriculture and other rural endeavors for its economic security. Most people in the region speak Russian, however Belarussian is still taught in schools and spoken in the smaller rural villages by the older population. The country has a strong cultural identity and even in political turmoil, the population shows respect for their country through widespread participation in numerous national holidays, especially ‘Victory Day’, celebrated on May 9 of each year in commemoration of victory in the Second World War. All such celebrations are marked by the involvement of veterans, as well as traditional style dance and song, including Belarussian language, poetry, and other public engagements. 

The President of the Republic of Belarus, Alexander Lukashenko, came to power in 1996. A farmer in his youth, his rise to leadership was a result of his combination of fear tactics, ambition, and outspokenness. He single-handedly abolished any semblance of parliamentary democracy, establishing one which he hand-picked. Simultaneous to this, he stregthened connections with the notorious Russian leader Vladimir Putin.

 His power continued unchecked for years until the 2010 election, at which point Lukashenko had been at the helm for an unbelievable 14 years. The elections which took place in December 2010 were brought to global attention due to the imprisonment and brutal treatment of the opposition leaders, all of whom—like Alexander Sannikov and the poet Vladimir Niklyaev—were well respected members of society. Their long-term incarceration, in conjunction with the mass arrests and beatings of the civilian population protesting Lukashenko’s so-called December 2010 win, finally brought to light the level of ongoing repression in Belarus. 

In addition to the elections, there were numerous other situations which revealed his astonishing level of brutality. In April 2011, the bombing of Oktiaborskaia Metro Station in Minsk made international news, including coverage by the CBC and BBC. First seen as an act of terrorism against the President’s residence across the street, the attack occurred during the evening rush hour, injuring over 200 people and leaving 15 dead. Soon after the event, doubts began to surface as to who was responsible for the attack. It was later revealed that the two men who were tried and convicted for the bombing were tortured for their confessions. The actions of Lukashenko’s regime have disillusioned the people of Belarus and the international audience. Moreover, they demonstrate his willingness to use extreme tactics to preserve his authoritarian power. 

More recently demonstrations dubbed the Silent Protests occurred in the main cities throughout Belarus in June 2011. Advertised through social media, the protests were carried out without any visible manifestation of dissent. The objective of the protests was to unite the youth of Belarus against the leadership of Lukashenko and figuratively represent their plight through silence. Though they may have believed that the nature of the protests would protect them from persecution, by the fourth protest in late June, the President responded by ordering mass arrests. The arrests entrapped not only participants in the protests but also innocent bystanders. The police did not stop to differentiate bystanders, using excessive force to detain the so-called culprits. For what reason, the government was not obligated to say. 

It saddens me that in the 21^st century, a European country can experience such drastic repression with so little international action. Fortunately, the events of the past few years have inspired the Western world to respond; Lukashenko is now barred from traveling both to North America and the UK. The increased attention on Belarus within international publications is another sign of progress. Growing international awareness about the repression present within Belarus may embolden Belarussians to voice their dissent. 

There is still a long way to go in order to triumph over Lukashenko’s grip on power. While one may be inclined to blame the Belarussian people for not being more persistent in their protests against the regime, the reader must consider that the older population of Belarus, survivors of the atrocities of WWII,  just want to live the rest of their lives in peace. Meanwhile, the lack of a cohesive opposition and the fear tactics of the regime including the blacklisting of artistic and cultural groups make it difficult for the youth to challenge the legitimacy of their country’s leadership.

Although there is no doubt that some level of repression will continue in Belarus for the near future, I am hoping that this article and others like it will inspire people to action. No one deserves to live in a country without the right of free speech, the right of assembly, and the numerous other freedoms that Canadians take for granted. Since the 2010 elections, the youth of Belarus are afraid that the “light of hope” has gone out in Belarus. With the upcoming election, I can only hope that with the increased international attention and the rising friction between the youth and the government, Lukashenko will no longer be able to emerge as President. I urge members Belarusian diaspora not to vote, as our ballots can be altered in order to fit with the needs of the current regime. I urge anyone interested in further information on Belarus, its politics and its history, to look at the BBC archives online, as they have the most comprehensive information available to the English speaking population. 

Thread Bare: Cotton Subsidies and Progressive Inaction

Jason Campbell

More than ever, money has the capacity to influence political decisions. Their connections to the political elite allow the largest companies to reap undeserved profits through subsidies, tax breaks, and bailouts. Supporters of such methods have claimed that benefits to larger corporations will allow them to hire more workers, which will result in the flourishing of the economy. To the contrary, these methods have proven to be detrimental rather than beneficial to the economic recovery and do not truly represent a “free market” approach. Providing subsidies to smaller companies would allow them to be more competitive with well-established, larger corporations, which would force the market to innovate and optimize efficiency. Rather than foster competition, increased advantages are provided to the largest companies; smaller companies are unable to compete, which inevitably leads to the largest companies dominating the market. According to the Environmental Working Group, 10 percent of the US farms producing cotton have received 74 percent of the total cotton subsidies between 1995 and 2009. The United States federal government maintains the position that these cotton subsidies are used to protect the farmers—why then do 62 percent of farmers receive no subsidies at all? An analysis of the raw data shreds holes in any optimistic theories on subsidy use.

Subsidies are damaging to smaller companies in any economy, but also, and more dangerously, to the global market. Companies that receive subsidies are able to sell products at lower prices—when these cheaper products are sold in the international market, countries that can’t afford to subsidize suffer due to the price differential. Subsidies are provided to a realm of different industries; unfortunately, cotton subsidies have proven to have disastrous consequences on the markets of less developed nations. In particular, the C-4, consisting of Benin, Burkina Faso, Chad, and Mali, have issued numerous requests to have the unfair subsidy issue addressed—however, their call for change has fallen on deaf ears.

Who decides what’s fair in the world market, you ask? The World Trade Organization (WTO) is responsible for monitoring trade policies and implementing WTO trade agreements. There are three categories of subsidies as defined by the WTO: amber, blue, and green. “Green box” subsidies are those that don’t distort trade, are government-funded, and are not involved in price support—these are good subsidies. “Amber box” subsidies distort production and trade; these are the subsidies that are damaging to the world economy because they are used to lower prices or encourage high levels of production.  “Blue box” subsidies are similar to those in the amber box, with the key difference that these subsidies have conditions that limit production. There is a limit to the amount of amber box subsidies that any one country can implement due to their negative influence on world markets. Despite the clear limits established by the WTO, the United States and the EU have continued to fill up the amber box with money to “protect their farmers.”

Brazil, a member state of the WTO, has raised concerns that subsidies applied to the cotton industry in the United States are damaging the economies of lesser-developed countries involved in cotton exports, which would render such subsidies illegal. The WTO ruled in favour of Brazil and permitted them to levy 830 million dollars worth of tariffs against the US to compensate for their losses as a result of the subsidies. Rather than deal with international problems associated with the subsidies, Brazil now receives over 140 million dollars in subsidies from the United States, effectively solving the problem in Brazil, while countries elsewhere continue to suffer.  Although successive American administrations had promised to revoke the subsidies, the farm bill currently being debated by US legislators seeks to maintain the illegal cotton subsidies which could re-ignite the conflict between Brazil and the US. 

Despite the growing number of legitimate complaints from cotton-producing African countries, the subsidy issue has still not been addressed at the global scale. One might assume the ruling that resolved the issue for Brazil could be applied to other nations suffering from the exact same cotton subsidies. Rather than address the issue at the global level, which would seem like common logic for an organization known as the “world” trade organization, these resolutions are dealt with similar to individual court cases bilaterally. Since Brazil brought up the case, they are the ones to reap the benefits, while other member nations are left to fend for themselves. Is it even plausible to believe that only one country can be affected? The answer is no.

In the case of Brazil, the WTO ruled that Brazil could implement tariffs on trades with the United States due to the illegal subsidies, while these exact same subsidies continue to be a detriment to numerous other economies. The problem has been clearly identified, yet no international action is taken. Unlike Brazil, the C-4 nations often can’t afford the lengthy judicial process and don’t have as much economic leverage involved in obtaining a formal decision. Although the WTO has a Secretariat composed of experts in law, statistics, and economics, no case has been made for less developed nations suffering from the American cotton market. 

If you’ve ever watched a TV show about law, you’ll notice that if a defendant can’t afford a lawyer, one is provided for the person; in the World Trade Organization, if a member nation can’t afford the legal process they’re seemingly out of luck. The difference is that rather than a single individual suffering from a lack of representation, an entire country’s population suffers from it. Reality is antagonistic to the WTO’s claim that special provisions are provided for developing nations—if this were the case, why are these illegal subsidies still able to negatively affect the economies of these less affluent member states?   The American pacification of Brazil with subsidies is intended to prevent interfere with the illegality of their policies while the WTO watches. It’s as if the defendant got up after the court had ruled, handed some money to the prosecution, and said “let’s just forget about this court ruling for right now.”

No clear end to the subsidy problem is in sight; the World Trade Organization has been ineffectively addressing these issues since the Uruguay talks that begin in the ‘80s. These initial talks ineffectively dealt with the trade issues at hand and established a future agenda rather than take much direct action, which led to the absence of some member nations at the Seattle conference in 1999. A follow-up conference, the Doha round of talks, began in 2001 hoping to reduce subsidies that protect industries in more developed nations. Essentially, the countries with the largest economies are refusing to compromise on key agricultural issues and each agenda promise is delayed or extended another year.

Does the World Trade Organization have any influence on countries with the largest economies? Seemingly not. The trade promises that have been made over the past 20 years are still in the process of being implemented while the issues that aren’t addressed continue to decimate other nations’ industries. Where is the accountability? If the WTO took a stronger stance on implementing punishment for countries that refuse to abide by their trade agreements, we might see more results. However, it seems that they’d rather not ruffle the feathers of any of their more affluent members. Twenty years of inaction is enough. When is the world going to protest the cotton industry rather than Kony? It’s time to wake up and take action—the problem exists, it needs a solution.

http://agritrade.cta.int/Agriculture/Commodities/Cotton/Executive-Brief-Update-2011-Cotton-sector

http://www.wto.org/english/tratop_e/dispu_e/cases_e/ds267_e.htm

http://www.guardian.co.uk/global-development/poverty-matters/2011/may/24/american-cotton-subsidies-illegal-obama-must-act

http://www.wto.org/index.htm

http://farm.ewg.org/index.php

http://www.guardian.co.uk/business/2008/jul/21/globaleconomy.wto

http://www.guardian.co.uk/environment/2010/nov/15/cotton-subsidies-west-africa