TIME health

Changing the Face of Medical Education in the U.S.

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Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

We have a focus on wellness, prevention, chronic disease management, and finding ways to deliver health care in the most cost-effective setting

The United States spends more money on health care than any other country in the world. So how does Costa Rica outperform the United States in every measure of health of its population?

Costa Rica is healthier because its government spends more money than ours does on prevention and wellness.

In our country, we have left vast segments of the population without affordable care and we do not focus on wellness or chronic disease management. We don’t consistently control the glucose levels in diabetics and, consequently, too many go blind or lose a limb. Too often, hypertension goes untreated until the patient has a stroke or kidney disease. Then, all too often, these individuals go on medical disability with far more societal expense than the cost of the original health management.

Sadly, it has become the American way to leave many chronic diseases untreated until they become emergency situations at exorbitant cost to the U.S. healthcare system. For many patients, this care is too late to prevent life-changing disabilities and an early death.

When people ask me why we started the UC Riverside School of Medicine last year – the first new public medical school on the West Coast in more than four decades – I talk about the need for well-trained doctors here in inland Southern California. But we also wanted to demonstrate that a health care system that rewards keeping people healthy is better than one which rewards not treating people until they become terribly ill.

As we build this school, we have a focus on wellness, prevention, chronic disease management, and finding ways to deliver health care in the most cost-effective setting, which is what American health care needs.

We also teach a team approach to medicine—another necessary direction for our health care system. If you have a relatively minor problem, your doctor might refer you to a nurse practitioner or physician assistant for follow-up. This kind of team care makes financial and clinical sense, particularly since we have such a national shortage of primary care doctors. The good news: Even among physicians, the team approach, or medical home model, is gaining ground, with the Affordable Care Act accelerating change.

For all the talk about the lack of health insurance in this country, we don’t often discuss the other side of the problem – the fact that many Americans get more care than they need. You may have heard advertisements that you should have your wife or mother get a total body scan for Mother’s Day, because it will find cancer or heart disease. There is no evidence that this screening is a good idea. But in the U.S., we often encourage people to do things that have no proven benefit, and our churches or community centers sponsor these activities.

For all these reasons, we must shift the focus of health care to prevention. Two of the most profitable prescription drugs in the U.S., according to some sources, are those that reduce blood cholesterol and prevent blood clots—both symptoms of coronary heart disease, a largely preventable condition. Shouldn’t we be spending at least as much on prevention as we do on prescriptions? Closely connected to prevention is wellness. So many of our health problems in the United States are self-inflicted, because we smoke, eat too much, and don’t exercise. Doctors need to “prescribe” effective smoking cessation programs, proper diets and exercise as an integral part of care.

One way to accomplish this shift is to teach it to future doctors. At UC Riverside, we are supplementing the traditional medical school curriculum with training in the delivery of preventive care and in outpatient settings. Our approach is three-pronged..

First, we work with local schools and students to increase access to medical school through programs that stimulate an interest in medicine and help disadvantaged students become competitive applicants for admission to medical school or other professional health education programs. These activities start with students at even younger than middle school age, because that is when students begin to formulate ideas about what they want to be when they grow up. We focus on students from Inland Southern California because students who live here now will be among those best equipped to provide medical care to our increasingly diverse patient population. Doctors who share their patients’ cultural and economic backgrounds are better at influencing their health behaviors.

Second, we recruit our medical students specifically with a focus on increasing the number of physicians in Inland Southern California in primary care and short-supply specialties. Our region has just 40 primary care physicians per 100,000 people—far below the 60 to 80 recommended—and a shortage in nearly every kind of medical specialty. Students who have been heavily involved in service such as the Peace Corps, or who are engaged in community-based causes, are more likely to go into primary care specialties and practice in their hometowns.

Then, we teach our medical students an innovative curriculum. For instance, the Longitudinal Ambulatory Care Experience, called LACE for short, replaces the traditional “shadowing” preceptorship, where students follow around different physicians. Instead, our students participate in an a three-year continuity-of-care primary care experience that includes a sustained mentor-mentee relationship with a single community-based primary care physician. In this experience, they “follow” a panel of patients and gain an in-depth understanding of the importance of primary care, prevention and wellness. Our approach also includes community-based research that grounds medical students in public health issues such as the social determinants of health, smoking cessation, early identification of pre-diabetic patients, weight loss management and the use of mammograms to detect breast cancer.

We try to remove the powerful financial incentive for medical students to choose the highest paying specialties in order to pay off educational loans. We do this with “mission” scholarships that cover tuition in all four years of our medical school. This type of scholarship provides an incentive for students to go into primary care and the shortest-supply specialties and to remain in Inland Southern California for at least five years following medical school education and residency training. If the recipients practice outside of the region or go into another field of practice before the end of those five years, the scholarships become repayable loans.

Third, we are creating new residency training opportunities in our region to capitalize on the strong propensity for physicians to practice in the geographic location where they finish their post-M.D. training. Responding to our region’s most critical shortages, we are concentrating the programs on primary care specialties like family medicine, general internal medicine, and general pediatrics, as well as the short-supply specialties of general surgery, psychiatry, and OB/GYN. We are also developing a loan-repayment program for residents linked to practice in our region.

Ultimately, we hope our ideas for how to change health care will succeed and be adopted by others. It might take 30 years, but we believe what we are doing at the UC Riverside School of Medicine will change the face of medical education in the U.S.

G. Richard Olds is vice chancellor of health affairs and the founding dean of the UC Riverside School of Medicine. He wrote this for Zocalo Public Square. Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Transportation

No, Carmaggedon is Not Inevitable

Los Angeles Traffic
Heavy traffic clogs the 101 Freeway as people leave work for the Labor Day holiday in Los Angeles on August 29, 2014. Mark Ralston—AFP/Getty Images

Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

From peak time tolls to smarter parking meters, some ideas that could get Angelenos moving

It makes sense now that the first movie ever filmed in Los Angeles was of nothing but traffic. The 30 seconds of shaky film, shot downtown on Spring Street in 1898, reveal the origin of an enduring issue for the city. L.A. is defined by its traffic, which is universally understood to move very, very slowly.

Today, drivers armed with smartphones use apps like Waze, darting on and off freeways to cut commute times by minutes. And this year, L.A. became the world’s first major city to synchronize all of its traffic lights. Yet in 2013, Angelenos still spent an average of 90 hours stuck in traffic. Could a recent infusion of $32 million for transit improvements in the city help recover this lost time? In advance of the Zócalo/Metro event “What Could Speed Up L.A. Traffic?” we asked transportation experts the following question: What innovations have other cities implemented that could teach L.A. how to speed up traffic?

Matthew Turner: The price of fixing congestion

When a bakery in the former Soviet Union opened in the morning, it gave bread to the first person in line, and then the next, until all the bread was gone. Everyone still in line had to wait for the next batch. This meant that if you were going to get your bread for breakfast, you had to get there early. So there were long lines for bread (like this one).

We do something similar to allocate access to roads. The government builds roads and every morning, the people who want to use them line up. If you are early, there is lots of capacity for you, and you have a speedy trip. If you come a bit later, the capacity is all used up, and you need to wait for road capacity to become available (like cars on this on-ramp).

The Soviet bakery had a line-up problem because bread was handed out free to the first in line. But what if we could price access to roads, just like we price access to bread today? If that were the case, queuing would no longer occur.

In a number of cities around the world—London, Singapore, Stockholm, and even a few highways in L.A.—local authorities make drivers pay to access roads at peak times (but not at other times). In response to a peak hour toll, drivers rearrange their travel schedules. As a result, driving speeds increase and travel times decrease. By constructing a system of tolls, or prices, that are higher for congested roads and times than for uncongested roads and times, we can fix the traffic congestion problem.

The price of reducing traffic congestion is pricing access to roads.

Matthew Turner is professor in the department of economics at Brown University. His research focuses on the economics of land use and transportation. Current projects investigate the relationship between public transit and the growth of cities, whether and how smart growth type development affects individual driving behavior.

Francie Stefan: Streets are a limited resource

Our streets are a limited resource, like water or energy. We can use this resource more efficiently by reducing the need for car trips or by making trips on modes that take up less space. To find a few tools that boost streets’ efficiency, Angelenos can follow the lead of the city of Santa Monica.

Since 40 percent of trips in L.A. County are less than two miles, we know that there are opportunities to convert some vehicle trips to walking, biking, and active transportation. In Santa Monica, basic street restriping was able to convert excess lane width (without reducing car lanes) into over 40 miles of new bike facilities. In only two years, biking increased by over 50 percent.

The best transportation plan is a good land use plan. Santa Monica is focusing housing and jobs near bus and rail networks, taking advantage of L.A. County’s historic streetcar routes and the walkable streets that grew from them. And Santa Monica is building strong first-mile/last-mile walking, biking, and transit connections to future Expo Light Rail stops.

Private industry plays an important role too. New businesses, employers, and residential buildings can help sustain trip reduction strategies by providing commuter incentives, facilities for active commuters (like bicycle stations featuring showers and racks), transit pass subsidies, shared parking, and telecommuting options. These amenities reduce household transportation costs as well as demand on the transportation network.

These strategies will provide a more holistic management of our street resources and “speed up traffic” by moving people in more ways, reducing the bottlenecks for everyone.

Francie Stefan is the transportation & strategic planning manager for the city of Santa Monica, which has set a target of no net new trips for evening peak periods to support more sustainable street function, encourage wellness through active living, and reduce GHG emissions.

Donald Shoup: Tax foreigners living abroad

Most people view parking meters as a necessary evil, or perhaps just evil. Meters can manage curb parking efficiently and provide public revenue, but they are a tough sell to voters. A new kind of meter, however, can change the politics of parking–and reduce traffic–by allowing cities to give price discounts for residents.

In Miami Beach, residents pay only $1 an hour at meters in areas where nonresidents pay $1.75 an hour. Some British cities give the first half hour at meters free to residents. Annapolis, Maryland, and Monterey, California, give residents the first two hours free in municipal parking lots and garages.

Pay-by-license-plate technology can automatically give discounts to all cars with license plates registered in a city. Cities link payment information to license plate numbers to show enforcement officers which cars have paid or not paid. Pay-by-plate meters are common in Europe, and several U.S. cities, including Pittsburgh, now use them.

Like hotel taxes, parking meters with resident discounts can generate substantial local revenue without unduly burdening local voters. The price break for city plates should please merchants because it will give residents a new incentive to shop locally. In big cities, the discounts can be limited to each neighborhood’s residents. More shopping closer to home might then reduce total vehicle travel in the region.

Parking meters with resident discounts come close to the most popular way to raise public revenue: tax foreigners living abroad. More money and less traffic will help any city.

Donald Shoup is distinguished professor of urban planning at UCLA, where he has served as chair of the department of urban planning and director of the Institute of Transportation Studies. His book, The High Cost of Free Parking, explains how better parking policies can improve cities, the economy, and the environment.

Doris Tarchópulos: Reimagining the suburbs

Each city has its own urban characteristics. The dimensions of the streets, the block size, the shapes of the lots, and the type of housing all differ depending on the city and its origins. North American cities are very different from Latin American cities, but they also have common features. From the mid-20th century, Americans in both the Northern and Southern hemispheres have left the core of the city and gone to the suburbs, which has caused car dependency and a crisis of mobility.

In Bogotá, Colombia, we are working on research to create a mix between the current suburbs and human-scale neighborhoods that can be traversed by walking and bicycling. We are thinking of repurposing suburbs gradually, introducing commercial strips along the main roads within neighborhoods, using parking lots or streets to foster vibrant community life, and at the same time, moving people back to the old quarters of the city center.

These ideas are easy to write about but difficult to implement. Reshaping cities demands political will and public conscience. But we also need new definitions of a city model based on a reimagined mobility system. Los Angeles has long been a traffic-clogged city, but given enough time and public support, the way people get around it could be transformed.

Doris Tarchópulos is an architect, associate professor, and director of the master in urban and regional planning at the architecture school of Javeriana University. She has published several award-winning books and scientific articles on housing and urban planning.

This discussion originally appeared on Zócalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.


Will We Have Any Privacy After the Big Data Revolution?

Operations Inside The Facebook Data Center
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Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

Corporations know more about their customer’s lives than ever before. But the information economy doesn't have to leave us exposed

Does the rise of big data mean the downfall of privacy? Mobile technologies now allow companies to map our every physical move, while our online activity is tracked click by click. Throughout 2014, BuzzFeed’s quizzes convinced millions of users to divulge seemingly private responses to a host of deeply personal questions. Although BuzzFeed claimed to mine only the larger trends of aggregate data, identifiable, personalized information could still be passed on to data brokers for a profit.

But the big data revolution also benefits individuals who give up some of their privacy. In January of this year, President Obama formed a Big Data and Privacy Working Group that decided big data was saving lives and saving taxpayer dollars, while also recommending new policies to govern big data practices. How much privacy do we really need? In advance of the Zócalo event “Does Corporate America Know Too Much About You?, we asked experts the following question: How can we best balance the corporate desire for big data and the need for individual privacy?

Corporations need to protect vulnerable data

Last week, the government of Singapore announced an increase in the cost of a toll at Bangunan Sultan Iskandar, the customs point for travelers entering and exiting between Singapore and Malaysia. Motorists, who will have to pay over five times more than they previous paid, are furious. In protest, a group of hackers, known simply as “The Knowns,” have decided to use their skills to hack into and release corporate data on customers. The group released the mobile numbers, identification, and addresses of more than 317,000 customers of Singapore-based karaoke company K Box.

In an era of “hacktivism,” data is necessarily vulnerable. So how do we negotiate between companies’ increasing needs to collect and store our personal digital data, individuals’ privacy and ethical needs, and governments that are often slow to gain an understanding of these needs and how to address changes in this area?

If we borrow from recent work by psychologists and ethicists, we can agree upon a few preliminary guidelines: 1) Before collecting private and personal data, consumers should be informed of what data a company intends to collect, how it will be stored and used, and what precautions are being made to protect their information from data attacks. 2) Consumers should be given the ability to consent and opt-out from collection of personal data. 3) Companies that are collecting and storing personal data should periodically remind their customers about their data storing policies.

Although companies should have the freedom to be innovative in their business models (such as by collecting new types of consumer data), these methods should not compromise the individuals on whom companies ultimately depend.

Sean D. Young is the Director of the UCLA Center for Digital Behavior and a medical school professor in the Department of Family Medicine. He writes and teaches about topics at the intersection of psychology, technologies, medicine, and business, at seanyoungphd.com.

Big data isn’t magic

A big data society seems to be inevitable, and promises much, but privacy (properly understood) must be an important part of any such society. To have both privacy and the benefits of big data, we need to keep four principles in mind:

First, we need to think broadly about privacy as more than just the keeping of a secret, but as the rules that must govern personal information. Privacy rules are information rules. We have rules now protecting trade secrets, financial and medical data, library records, and computer security. We have to accept the inevitability that more rules (legal, social, and technological) will be needed to govern the creation of large data sets and the use of big data analytics.

Second, we need to realize that information does not lose legal protection just because it is held by another person. Most information has always existed in intermediate states. If I tell you (or my lawyer) a secret, it is still a secret; in fact, that’s the definition of a secret, or as we lawyers call it, a confidence. We must ensure that big data sets are held confidentially and in trust for the benefit of the people whose data is contained in them. Confidentiality rules will be essential in any big data future.

Third, we need to realize that big data isn’t magic, and it will not inevitably make our society better. We must insist that any solutions to social problems based on big data actually work. We must also insist that they will produce outputs and outcomes that support human values like privacy, freedom of speech, our right to define our own identities, and political, social, economic, and other forms of equality. In other words, we need to develop some big data ethics as a society.

Finally, it’s important to recognize that privacy and big data aren’t always in tension. Judicious privacy rules can promote social trust and make big data predictions better and fairer for all.

Neil Richards (@neilmrichards) is a Professor of Law at Washington University in St. Louis and an internationally-recognized expert in privacy and information law. His book, Intellectual Privacy, will be published in January 2015 by Oxford University Press.

Corporate research is always an unequal exchange

When asking “how can we best balance” the desires of corporations and the needs of individuals, we need to recognize that there are different “we”s involved here. Executives at Google and Facebook are interested in learning from big data, but they are, naturally, more concerned about their own individual privacy than the privacy of their users.

As a political scientist, I’m interested in what I can learn from moderately sized data such as opinion polls and big data such as voter files. And I naively act as if privacy is not a concern, since I’m not personally snooping through anyone’s particular data.

Survey organizations also profit from individuals’ data: They typically do not pay respondents, but rather rely on people’s goodwill and public-spiritedness to motivate them to participate voluntarily in helping researchers and answering surveys. In that sense, the issue of privacy is just part of the traditional one-way approach to research in which researchers, corporate and otherwise, profit from uncompensated contributions of the public. It is not clear how to balance this unequal exchange.

Andrew Gelman is a professor of statistics and political science at Columbia University. His books include Bayesian Data Analysis and Red State, Blue State, Rich State, Poor State: Why Americans Vote the Way They Do.

This discussion originally appeared on Zócalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Science

If Synthetic Biology Lets Us Play God, We Need Rules

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Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

How can we prevent these technologies from falling into the wrong hands?

Synthetic biology has been called “genetic engineering on steroids.” It’s also been described as so difficult to pin down that five scientists would give you six different definitions. No matter how this emerging field is characterized, one thing is clear: the ability to synthesize and sequence DNA is driving scientific research in brand-new and exciting directions.

In California, scientists have created a breakthrough antimalarial drug—baker’s yeast made in a lab that contains the genetic material of the opium poppy. The drug has the potential to save millions of lives—and to ensure drug production that independent of poppy flowers. At MIT, researchers are working on a way for plants to “fix” their own nitrogen, so farmers will no longer need to use artificial fertilizers. And, in the far future, scientists and NASA researchers are looking to create a “digital biological teleporter” to bring to Earth life forms detected on Mars via a sort of biological fax.

What should we worrying about in this moment of tremendous, and potentially cataclysmic, scientific discovery? In advance of the Zócalo/Arizona State University event “How Will Synthetic Biology Change the Way We Live?, we asked experts the following question: Soon we’ll be able to program DNA with the same ease we program computers. What new responsibilities will be imposed on us?

1) Stepping ahead of technology to imagine the world we want to live in

Synthetic biology sees life as an engineering project— a repertoire of processes that can be reprogrammed to produce technologies and products. It envisions powerful new tools for constructing biological parts. Many in synthetic biology celebrate technologies like automated DNA synthesis as agents of “democratization,” potentially allowing easy and widespread access to custom-made DNA. According to their vision, these technologies will enable bioengineers to freely experiment with living systems, accelerating progress in innovation and producing enormous benefits for society.

But there are risks. The question is often raised: How can we prevent these technologies from falling into the wrong hands? DNA synthesis machines cannot distinguish between tinkerers and terrorists. Though this question is crucially important, it is revealing for what it leaves unasked. Why are synthetic biology’s tinkerers presumed to be the safe hands for shaping the technological future? Why do we defer to their visions and judgments over those that we collectively develop?

We tend to focus governance not on projects of innovation, but on how resulting technologies might be used in society. By attending primarily to technology’s “misuses,” “impacts,” and “consequences,” we confine ourselves to waiting until new problems—and responsibilities—are imposed upon us. Science is empowered to act, but society only to react. This leaves unexamined the question of who gets to imagine the future and, therefore, who has the authority to declare what benefits lie ahead, what risks are realistic, and what worries are reasonable and warrant public deliberation?

Our imaginations of the future shape our priorities in the present. It is a task of democracy, not science, to imagine the world we want to live in. Genuine democratization demands that we embrace this difficult task as our own, rather than wait to react to the responsibilities that emerging technologies impose upon us.

Benjamin Hurlbut is an assistant professor of biology and society in the School of Life Sciences at Arizona State University. Trained as a historian of science, he studies the intersection of science, politics, and ethics, with a particular focus on governance of emerging biotechnologies in the United States.

2) Addressing the gap between scientific innovation and human need

When it comes to programming DNA, the greatest challenge we face isn’t how to do it but rather for what purpose. How will we use the molecular tools we develop? The much-heralded promise is that genetic technologies will reveal clues to more effective treatment of disease. A serious challenge to making good on this promise is recognizing the social context—the values, beliefs, and structure in which these tools are called into being— that informs how scientists, policymakers, and the public prioritize their use.

We can start by asking why cutting edge biotechnologies have yet to solve our most intractable and dire global health problems. We assume that these new tools can be used to identify molecular targets to develop vaccines for neglected diseases disproportionately affecting low resource countries. And yet, a 10/90 gap persists in which a mere 10 percent of research is devoted to 90 percent of disease burden worldwide. In a market where male baldness and cellulite reduction take precedence over diarrheal diseases, malaria, and tuberculosis, we need to creative economic solutions to bridge the widening expanse between scientific innovation and human need.

Our social agenda will inform not only what is programmed into DNA, but also who will ultimately benefit from this new technology. Will our efforts bolster advantage among the select few or alleviate the suffering of the invisible many? The answer to that question depends upon whether we decide to leverage our shiny, new tools to address head-on the very old and obstinate problem of inequity.

Sandra Soo-Jin Lee, Ph.D., is a medical anthropologist and senior research scholar at the Center for Biomedical Ethics at Stanford University School of Medicine. Her current book project is entitled American DNA: Race, Justice and the New Genetic Sciences.

3) Rethinking DNA as a building tool

For much of the late 20th century, scientists, writers, and the general public imagined DNA as information. It was code in the form of a chemical, a molecule that directed our development and determined our destiny. This discourse served to organize, guide, and inform the research agenda of scientists for decades.

DNA, as any high school science student knows, exists as a double helix. Its structure is made of four different types of nucleotide subunits—adenine, cytosine, guanine, and thymine. The exact sequence of an organism’s DNA is determined by what scientists call complementary base pairing: adenine always pairs with thymine; guanine connects with cytosine. This predictability allows scientists to synthesize strands of artificial DNA—a technique perfected in the 1980s—which, when properly treated in the lab, can link up to form the desired structure.

Today, a community of scientists has adopted a different way of thinking about DNA. No longer just an information-containing biomolecule, DNA is now used as a building material by chemists, computer scientists, and molecular biologists. Starting with simple two-dimensional geometric shapes, DNA nanotechnologies can now fabricate complex three-dimensional objects capable of performing elementary mechanical functions and computations.

DNA nanotechnology is one part of the growing field of synthetic biology. What scientists will be able to do with the rapidly increasing capabilities is hard to project. To date, successes with DNA nanotechnology have included the construction of increasingly complex three-dimensional shapes, carrying out massively parallel computations, and building “DNA walkers” that can traverse a substrate and deliver “cargoes” of nanoscale particles.

For a historian of science, what is fascinating about this evolving field is this new perspective of DNA. We can no longer see it as just a blueprint for life … we now must also think of it as a building material. What kind of future will we build?

Patrick McCray is a professor in the history department at the University of California, Santa Barbara and the author, most recently, of The Visioneers: How a Group of Elite Scientists Pursued Space Colonies, Nanotechnologies, and a Limitless Future.

4) Ensuring careful consideration of potential impacts

In the decades just before the turn of the 20th century, there was great hope among researchers, lawmakers, and the public that our (then) new understanding of genetics could help to alleviate disease. It was from this promise that the world witnessed the emergence of—and later the horrors of—institutionalized eugenics. Synthetic biology offers similar promise and requires vigilance on the part of those developing the technology to ensure its careful implementation.

Scientists and policymakers have a responsibility to think holistically about how synthetic biology could affect individuals as well as populations, societies, and the human species as a whole. If synthetic biology is carelessly used to create genetic homogeneity as a means to cure genetic disorders, it could be detrimental. From an evolutionary perspective, genetic diversity has been key to the success of our species as it offers alternate solutions to environmental stressors. Alternatively, synthetic biology could also be used as a tool to create new types of genetic variations that, in the right environment, could ensure the survival of our species.

The development of this technology should be driven by the same ethical tenets that drive all current scientific research: respect, beneficence, and justice. The promise of synthetic biology rekindles hope in the discovery of a kind of genetic panacea. But the advent of this technology should, at the very least, solidify our resolve not to repeat the errors of the eugenicists of the past.

Jada Benn Torres is an assistant professor of anthropology at the University of Notre Dame. As a genetic anthropologist, her research interests include genetic ancestry, human variation, and women’s health.

5) Developing governance as innovative as our science and technology

Synthetic biology will present us with an ever-growing number of choices. Choices about what we eat. Medicines we take. Fuels we use. Products we buy. Clothes we wear. Pets we own. Enhancements to our bodies and minds. These new choices will provide us with many important benefits—but they will also confront us with challenging dilemmas.

Some choices made possible by synthetic biology will affect only individuals and their families, while others will have a much wider reach. For example, buying goods made by synthetic biology may displace workers in other nations who make the same products using older technologies or raw materials. When we enhance our own capabilities using synthetic biology, we put pressure on others to make similar enhancements or risk being left behind.

There may also be safety and health risks from the individual choices we make. If people create new organisms in their garage or basement using DIY biology, they may inadvertently create pathogens that put others at risk in their neighborhoods, cities, or even beyond.

Individual choices empowered by synthetic biology with the potential to adversely affect others will put additional burdens and pressures on our societal institutions to make more (and better) governance decisions.

And that is where the problem and danger really lies: At the very moment that new technologies like synthetic biology require us to make more complex decisions, our societal decision-making institutions have never been more broken. Our regulatory agencies are overwhelmed, under-funded, and ossified, our legislatures are gridlocked by partisan bickering and too much information and issues, and our courts are glacial and lacking scientific competency. We urgently need new innovations in institutions and governance to match the rapid new innovations in the science and technology of synthetic biology.

Gary Marchant is Lincoln Professor of Emerging Technologies, Law and Ethics and faculty director of the Center for Law, Science & Innovation at Arizona State University. He teaches and researches governance of emerging technologies.

This originally appeared on Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME policy

5 Ways California Can Imprison Fewer People

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Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

Lessons from Texas, Illinois, Washington state and more

In 2009, overcrowding in California’s prisons had gotten so bad—140,000 inmates crammed into prisons built to house just 80,000—that federal judges ruled it violated prisoners’ civil rights. Under order to reduce the state’s prison population, Governor Brown introduced realignment in 2011, a plan to send nonviolent inmates to county jails and probation departments rather than prison.

This year, a federal court gave California two more years to reduce the inmate population of its 33 prisons to 112,100. Along with shifting responsibilities to the county, the state is looking at other measures to move people out of prison, including good-behavior credits to shorten sentences and quicker parole for people deemed suitable for release.

And this fall, Californians will vote on Proposition 47, which proposes to reduce felonies for crimes like petty theft to misdemeanors and thereby keep greater numbers of low-risk, nonviolent offenders out of prison.

What has worked in other places to address prison overcrowding without compromising public safety? How can we address recidivism and the fact that 60 percent of former prisoners commit a new crime within three years of release?

In advance of the Zócalo/California Endowment event “Why Are There So Many People in Prison?”, we asked criminal justice experts the following question: What state has lessons to teach California about reducing its prison population?

1) Texas and its investment in health solutions

I have to hand it to the Lone Star State; they do indeed do everything big. That includes reductions in its incarceration rates and costs, as well as in its crime rates, providing lessons for other states—including California.

In California we like to think we’re first in everything, but Texas began addressing over-incarceration in 2003. They passed laws that strengthened and encouraged alternatives to incarceration for certain nonviolent offenses, and increased the use of assessment tools to identify who received which forms of accountability based on their individual risks and needs.

As a result, not only did incarceration rates go down, but so too did serious and violent crime: a 12.8 percent drop since 2003. These successes allowed lawmakers to close a prison and scrap plans to build 17,000 more prison beds (saving taxpayers $2 billion).

One key lesson to learn from Texas’ success is their investment in health solutions for the health problems that many incarcerated people share: substance abuse disorders and mental illness. The state allocated hundreds of millions of dollars to residential and non-residential treatment options for people convicted of nonviolent offenses, and on enhancing in-prison treatment programs.

This included expanding drug courts to deal specifically with drug offenses—and the accountability steps needed to end cycles of addiction and crime. By 2009, the recidivism rate for people who participated in the Texas Specialized Drug Court was nearly eight times lower than defendants who had not.

Substance abuse disorders and mental illness are pervasive in California jails and prisons, which is part of the reason for our stubbornly high recidivism rate of 60 percent. The good news is that we are making strides, including increasing investments in community-based health approaches.

If we do that, California will not just have lessons to share but also healthier, safer communities.

Lenore Anderson is Executive Director of Californians for Safety and Justice, a nonprofit working to reducing over-incarceration with common sense solutions that improve public safety and reduce taxpayer costs.

2) 45 other states where parole board decisions are not reviewed by the governor

To help achieve sustained reductions in incarceration, California should end the practice of allowing governors to review parole board decisions. In doing so, it would join 45 states that allow parole boards to independently determine when a prisoner is ready for community supervision.

One in four California prisoners are “lifers” sentenced to life with the possibility of parole. The national rate is only 7 percent. California gained this dubious distinction because of its sentencing and parole policies, not its crime rates.

In 1988, Proposition 89 authorized the governor to reverse parole decisions in cases involving murder, and to require additional review for non-murder convictions. Parole rates plummeted as governors overturned most of the parole board’s release grants, thus warehousing hundreds of prisoners who had been deemed low-risk and ready for community supervision.

Under Governor Brown, there has been a sharp change. The parole board has found lifers eligible for parole in 15 percent of its hearings—a low figure that nonetheless exceeds the 4 percent average from the previous three decades. And Gov. Brown has approved over 80 percent of these decisions.

But why should the governor reverse even 20 percent of a governor-appointed board’s decisions? And why should the state allow any future governor to revert to virtually ending parole for lifers?

These prisoners have often committed serious violent crimes. But decades-long sentences are excessive and expensive. A Stanford University study found that former lifers with murder convictions had a “minuscule” recidivism rate—less than 1 percent. That’s much lower than the nearly 50 percent re-imprisonment rate of all California prisoners. Yet it’s achieved at the cost of $47,000 per prisoner annually. Those funds should be redirected to prevent the violence that leads to calls for severe punishment.

Twenty years ago, Texas amended its constitution to end gubernatorial parole review. It’s well past time for California to depoliticize parole.

Nazgol Ghandnoosh, Ph.D., is a research analyst at The Sentencing Project, a national non-profit organization engaged in research and advocacy on criminal justice issues. Her recent publications include “Fewer Prisoners, Less Crime: A Tale of Three States” and “Race and Punishment: Racial Perceptions of Crime and Support for Punitive Policies.”

3) The state of Washington and its focus on rehabilitation

California’s experiment in Public Safety Realignment is being credited with closing the revolving door that keeps low-level offenders cycling through the state prison system by housing them instead in county jails and providing counties funding and flexibility to provide for these inmates. Currently the state’s 58 counties are doing their own experiments to determine how much of the realignment resources should be devoted to rehabilitative programs. But reducing California’s prison population over the long term will require the state to provide rehabilitative services like education that reduce recidivism and help to turn individuals’ lives around once they return to communities.

California can learn a great deal from the state of Washington, which has implemented a series of reforms focused on rehabilitation—on diverting offenders to treatment and other options and making serving time in prison the last option. The logic for this is clear: Analyses by the Washington State Institute for Public Policy show that cognitive-behavioral programs for adult offenders in prison and community settings can be expected to reduce recidivism rates by 6.3 percent, on average.

RAND’s recent national study on correctional education shows that adult offenders who participated in prison education programs reduced their risk of recidivating by 43 percent and that every $1 invested in these programs resulted in about $4–$5 in savings in re-incarceration costs. Beyond the stark economic benefits is the broader incentive that such rehabilitation is good for society as a whole. As a recent report by the National Academy of Sciences indicated, mass incarceration is associated with negative social and economic outcomes, which make it very difficult for ex-offenders to turn their lives around when they return, disproportionately, to disadvantaged communities.

California took a bold step in implementing the Public Safety Realignment Act. Now it should move beyond realignment to focus on rehabilitation.

Lois M. Davis is a senior policy researcher at the nonprofit, nonpartisan RAND Corporation.

4) California’s own efforts at “success-oriented funding”

As California officials search for solutions to the state’s overcrowded prison system, they should consider using funding to shape a better system.

A “Success-Oriented Funding” model is a simple, yet effective approach: Lay out clear priorities for what taxpayer dollars should accomplish, then tie funding directly to achievement of those priorities. The concept is simple: Fund what works to reduce crime and incarceration, and dump what doesn’t.

Some states and cities—like Illinois and New York City—have already implemented Success-Oriented Funding programs, but California need not look outside its own borders for a model to reduce unnecessary incarceration.

Passed into law in 2009, the California Community Corrections Performance Incentive Act encourages probation offices to keep violators in the program rather than sending them back to prison by awarding counties up to 45 percent of what the state saves in prison costs. In its first year, California probation officers reduced the number of felony offenders sent back to prison by 23 percent, which saved the state nearly $180 million; of those savings, the counties received $88 million. This program promotes alternatives to incarceration that do not appear to significantly increase crime, according to the Public Policy Institute of California.

The state should implement Success-Oriented Funding to criminal justice budgets across the board. For example, the legislature could provide additional funding—found within prison cost savings—to prosecutors’ offices that recommend alternatives to incarceration or to law enforcement agencies that issue citations in lieu of arrests. This could move California toward a smaller prison population and a more effective, socially beneficial, and efficient criminal justice system.

Nicole Fortier is Counsel in the Justice Program at the Brennan Center for Justice at NYU School of Law and co-author of a policy proposal to reform funding streams to reduce incarceration levels across the country.

5) Mississippi and its focus on alternatives to incarceration for low-level offenders

A growing number of states are recognizing that our “lock ‘em up” approach to criminal justice is breaking the bank—and the spirit of communities.

From New York to Kentucky to Georgia, states are saving resources and safely reducing the number of people behind bars. One of the latest is Mississippi, which has the nation’s second highest incarceration rate—and a history of racial injustice. This year, Mississippi passed comprehensive reform that focuses on alternatives to incarceration for low-level offenders and strengthens interventions to reduce recidivism.

This moment shows us that it is possible to push forth brave initiatives and policies that preserve resources while keeping our communities safe. Here are three steps we can take to ensure that public safety is a true civil and human right for all of us.

We can shift our “incarceration only” approach; instead of building more jails and prisons designed to warehouse, we can invest in evidence-based alternatives that can reduce crime and racial injustice in our system.

We can make reentry a priority, not an afterthought. Every day in California, people who have served their time are sent back to communities with little more than $50 and a bus pass. Without the opportunities they need to get their lives back on track, nearly 65 percent end up behind bars in just three years. We can stop recidivism by eliminating barriers to reentry and investing in rehabilitation and critical support needed to help formerly incarcerated people live meaningful, productive lives—and to keep them out of prison in the first place.

We can also build a broad-based coalition to collectively champion change. This is an issue that has deep implications across many sectors, including education, health, and the economy. From businesses and law enforcement leaders to advocates for families and communities, we need all voices calling for an end to business as usual.

Cages can’t create safe and healthy communities. Criminal justice reform is one of the leading civil rights issues of our time, and we must turn around the legacy of failed policies that are costing us not just dollars but also precious human potential.

Lateefah Simon is the Program Director for the Rosenberg Foundation and a long-time advocate for criminal justice reform.

This story originally appeared on Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

6 Ideas From Science Fiction That Should Become Reality

Coneyl Jay—Getty Images

Zocalo Public Square is a not-for-profit Ideas Exchange that blends live events and humanities journalism.

Let’s violate the laws of physics

Science fiction writers can be eerily prescient. Consider what John Brunner got right about our world in 2010, as described in his 1968 novel Stand on Zanzibar: a world shaken up by terrorist attacks and school shootings, the near-abandonment of Detroit, a zeal for upgrading everything, including our bodies. When Isaac Asimov envisioned in 1964 what 2014 would be like, he described what we’ve come to know as satellite phones, Skype calls, and driverless cars. Of course, with all hits, there have been some misses: we don’t have Brunner’s single super computer that powers the world, but the rhizome of the Internet with servers all over the globe; we don’t have the moon colonies that Asimov assumed we’d already have. Still, the power of science fiction comes from the license to dream – and in many case to have nightmares. In advance of the Zócalo/ASU Center for Science and the Imagination Event “Can Science Fiction Revolutionize Science?”, we asked experts: What idea from science fiction would you most like to see become reality?

1. Instant messaging – across galaxies

By Seth Shostak

There are many concepts in science fiction that would be truly revolutionary if they were to change from fantasy to fact. Strong artificial intelligence, for example, would demote us as the rulers of the planet. Our species might take on a new status – as pets.

Building orbiting space colonies is another staple of sci-fi that would have major effect. Getting some of the population away from Earth and mining natural resources from asteroids or other bodies would permanently relieve many of the environmental pressures on our world.

These are examples of developments that would shift Homo sapiens into another gear. But they’re not truly spectacular because, frankly, they’re too plausible. They’re almost certain to happen, and perhaps quite soon. They don’t violate physics.

However, here’s something that’s in a different camp altogether: instantaneous communication. It does violate physics, at least the physics that we know. We’re not talking warp drive, but warp communication: the ability to exchange bits of information between any two locations, no matter how great the separation, without delay.

Consider what happened when the alien planet Alderaan is destroyed in the Star Wars film A New Hope. Millions of people are killed, but thanks to the instant messaging capability of The Force (whatever that is) Obi-Wan Kenobi feels their pain immediately.

That capability would change everything, and forever. Face it, there can never be a galactic empire in which biological beings cooperate or compete as long the delivery time for messages (“Help, Klingon attack!” or “Join the Vulcan book club”) is tens of thousands of years.

Searching for extraterrestrial intelligence would become trivial and gratifying. All that’s necessary is to systematically ping every star system in the galaxy, and – without delay – check for a response.

Instant communication would put everyone everywhere on-line. It would unite the cosmos intellectually and culturally. Goodbye isolation; hello socialization.

Seth Shostak is the senior astronomer and director of the Center for SETI Research at the SETI Institute, a Mountain View, California-based organization that aims to explore, understand, and explain the origin and nature of life in the universe. Shostak is also the author of the book, Confessions of an Alien Hunter and host of the radio show, Big Picture Science.

2. Pushing past culture clashes

By Bobak Ferdowsi

I’d pick the thing I recognized when I first started watching reruns of Star Trek and reading the works of Arthur C. Clarke – international cooperation.

I grew up in a multicultural family where, since my birth, there has been animosity between the nations my parents come from – Iran and the United States. The idea that one day humanity would push past the clashes between nations and cultures to pursue the human endeavor of exploration is immensely appealing. Even more wonderful in this science-fiction universe, cultures are not lost, but instead preserved and appreciated. Even today, we face so many challenges on our own planet that stem from cultural misunderstandings and perceived differences in interests.

If I’m forced to suggest a single technical fantasy to become reality, I suppose it would be the replicators from the later generations of Star Trek. The ability to readily convert energy into matter opens up the possibility of providing supplies to remote and underserved locations. While our present has yet to solve the issue of clean, renewable energy, I feel that is within our ability in the next generations. Ultimately I’d like to believe this technology would minimize many of the conflicts over supplies, which I think could be worsened by climate change, growing populations, and shrinking resources.

I’m optimistic about our future – in large part because so many of the engineers and inventors of today are ­inspired by science fiction. Flip-phones and tablets are a reality. Xprize has a competition to build a medical tricorder, and already our cell phones are being leveraged as platforms for new growth. It may not happen at once, but the good news is we’re making progress – and have the imagination of science fiction chroniclers to help us.

Bobak Ferdowsi is a systems engineer at NASA’s Jet Propulsion Laboratory. He is a member of the Europa Clipper study team, and previously worked on the Mars Curiosity rover and Cassini Saturn orbiter. He plays softball at JPL and often rides his bike to work.

3. My own personal spacecraft

By Leroy Chiao

I want more than just the flying car that we were promised when I was young. I want a personal spacecraft! The personal spacecraft would not launch on rockets, or need parachutes or a runway to land. It would not be a vehicle that just propels you into orbit around a body (like Earth), but would instead be capable of travel far beyond.

Inspired by a combination of the flying cars in Blade Runner and the fighter spacecraft in Star Wars that can land on and depart from planets easily, my vehicle would take off and land vertically. The versions of those kinds of jump jets in existence (like the military’s Harrier) are VERY loud, but mine would not make a lot of noise. And mine would fly both through the atmosphere, as well as into space. It would not need any refurbishment to fly again. It would be practical for everyday use, just like your car today.

Would this ever be possible? Yes, but several things need to be invented and solved first:

  1. A nearly infinite, compact, lightweight power source. This would be absolutely necessary to power the engines and run the systems (including active shielding from radiation that could fry the pilot and passengers once they left the Earth’s protective magnetic force field).
  2. Quiet, small, lightweight, powerful, and clean engines. These would run off of the power supply described above. They would have to be quiet, otherwise the roar from everyone operating these vehicles would be deafening. They would have to be clean. Otherwise, if everyone had one, the environment would quickly become polluted or contaminated.
  3. Automated collision avoidance and navigation. This is easier than you might think. With transponders and sensors that are just a bit more advanced than those today, coupled with high-speed connection to data and computing power in the cloud, this could actually become a reality sooner rather than later.
  4. Oh, and all of this stuff would have to be inexpensive.

Why not go directly to teleportation? Call me old-fashioned, but I am squeamish about the idea of having my molecules disassembled and reassembled at another location. Would I still be me, even if it all worked physically? Consciousness and the idea of a soul are still pretty darned intangible.

Leroy Chiao served as a NASA astronaut from 1990-2005. During his 15-year career, he flew four missions into space, three times on Space Shuttles and once as the co-pilot of a Russian Soyuz spacecraft to the International Space Station. On that flight, he served as the commander of Expedition 10, a six-and-a-half month mission. Among other positions, he serves as a Special Advisor to the Space Foundation, and also to the Houston Association for Space and Science Education.

  1. Beyond the big things, an improvement in nail polish

By Amy Mainzer

Obviously I’d love a transporter for every time I’m stuck in traffic, or the unlimited clean energy derived from banana peels by the Mr. Fusion generator from Back to the Future. But forgetting about civilization-changing technologies for a second, one idea that I have always really liked is a much, much smaller one: the futuristic manicure from Total Recall.

In the movie, someone figured out how to make nail polish that changes colors with the touch of some kind of pen. It’s just a short moment, but this small detail helps to establish a world that truly is futuristic. It also struck me as something that someone might actually invent one day. Although it’s fun to think of big stuff like warp drive and time travel, I’ve always particularly enjoyed thinking about the smaller ways that technology changes our lives. What will day-to-day life be like in the future?

I really wish someone would make nail polish that changes colors by tapping a pen – because I hate the smell of acetone.

Amy Mainzer is an astronomer at NASA’s Jet Propulsion Laboratory. She’s the principal investigator of the NEOWISE mission, a space telescope that searches for asteroids and comets using infrared light.

5. Truly clean energy sources

By Steven Gould

I’d like to see cheap, safe, clean energy production come into being, whether in the form of orbiting satellites that can beam solar energy down to the Earth in microwaves (à la Isaac Asimov’s 1941 short story “Reason”) or super efficient photo-electric panels (as in Robert Heinlein’s 1940 short story “Let There Be Light”). But something that replaces the burning of fossil fuel and drastically cuts our pumping of carbon dioxide into earth’s atmosphere. The likeliest technology on the horizon is nuclear fusion, (clean energy released by the controlled fusing of atoms) but, sadly, we’re talking a distant horizon. I’d also like to see technology that lets us capture and sequester carbon in high volumes. If these “science-fictional” technologies aren’t forthcoming, I’d like to see the most far-fetched, science fictional thing yet: that governments of the world start making decisions based on our best scientific consensus and in the best interest of our species and biosphere, rather than unduly considering the vested interests of corporations.

Otherwise we’re going see a lot of science fiction ideas coming true–things like:

- John Barnes’ Mother of Storms, in which the clathrate gun hypothesis (where a rise in sea temperature triggers a runaway release of methane that leads to even higher temperatures) causes a devastating superstorm.

- Kim Stanley Robinson’s Science in the Capital trilogy, in which the disruption of ocean circulation patterns halts the Gulf Stream with catastrophic results.

- And even J.G. Ballard’s The Drowned World from 1962, in which melting ice caps have raised world sea levels.

Much as I love the positive futures of science fiction — the spread of humanity out into our solar system or farther, the creation of artificial intelligences that will help us to solve our many problems, a resource-abundant future in which the vast economic disparity of our current times is eliminated — it is the “If this goes on” kinds of science fiction that I am most worried will come true.

But don’t count us out yet. We’re clever monkeys.

Steven Gould is the award-winning and New York Times best-selling author of the Jumper books (which inspired the 2008 movie of the same name) as well as standalone novels Wildside, Helm, Blind Waves, 7th Sigma, and Greenwar (written with Laura J. Mixon.) He is the current president of the Science Fiction and Fantasy Writers of America and his latest book is Exo (Jumper IV.)

6. These toys should come with warning labels

By Devon Maloney

From touch screens to psychokinesis, there seems to be little left for science to pluck from the pages of revered sci-fi visionaries like Isaac Asimov or Gene Roddenberry and place in the hands the consumer. For authors, it’s made predicting the future feel a little like determining the future, which is a pretty cool system. We’re quite literally getting almost everything we’ve ever dreamed of, and very quickly, to boot.

But one thing that I think often, if not most of the time, gets lost in translation from page to life is perhaps the most vital piece of science fiction’s offerings: the instruction manual. While any inventor can develop a device and bring it into existence, sci-fi authors can pair their imaginings with philosophical and ethical explorations of what tech like this might mean, for individuals, groups, and the future of humanity. The way in which we use the tools we create—and in which those tools might use us—is perhaps even more important than their simple existence. Philip K. Dick’s Do Androids Dream of Electric Sheep? deftly draws parallels between the proliferation of android servants and our present dehumanization of the poor; the protagonist of Octavia Butler’s Wild Seed has superhuman abilities but instead of giving her power, they open her to subjugation, directly trouncing the utopian idea that technology will unquestionably be a great equalizer. Roddenberry gave us the pro-diversity IDIC and the anti-imperialist Prime Directive — two of the most deeply humanist philosophies in fiction, period. And Asimov, with his laws of robotics and the subsequent roboethics conversations they inspired (see: Arthur C. Clarke’s HAL 9000 and The Terminator‘s Skynet), gave us some of, if not the most widely disregarded warnings in the rapidly evolving production of artificially intelligent tech.

Too often we are like children at Christmas, ripping open boxes of sophisticated electronic toys—and ignoring their bright DO NOT GET WET warning labels as we bring them into the swimming pool with us. What a deeply tragic irony that the entirety of science fiction and dystopian fiction might come to fruition: both the miraculous, utopian tech and our inability to see how, if mindlessly utilized, it will most certainly destroy us.

Devon Maloney is an L.A.-based culture journalist and critic. She writes about science fiction and dystopia for Wired; her writing also appears in publications like Grantland, Billboard, SPIN, T magazine, Rolling Stone, Pitchfork, GQ, and Vulture.

This piece originally appeared on Zocalo Public Square.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Public Space, Meet Cyberspace

Social Media Life
Lucia Lambriex—flickr Editorial/Getty Images

The rise of digital technology has changed the way we use public squares, parks and the streets

Public squares and parks are the sites of some of history’s most memorable moments: the beheading of Marie Antoinette during the French Revolution at the Place de la Concorde (then known as the Place de la Révolution) in Paris in 1793; the March on Washington in 1963, where a crowd filling the National Mall heard Martin Luther King, Jr.’s “I Have a Dream” speech; the pro-democracy protests in 1989 in Beijing’s Tiananmen Square, bringing us the indelible vision of the single man standing in front of a line of tanks. These public spaces have also traditionally hosted markets, outdoor concerts, and cafés.

Enter the Digital Age, where every kind of information can be translated into bits and transmitted to mobile phones, computers, and TV screens. We can catch up on the news, buy goods, listen to music, watch webcams, and sign petitions – all without meeting in person. What is to become of these storied public spaces? In advance of the Zócalo/Getty “Open Art” event, “Is the Digital Age Killing Public Space?”, Zócalo asked experts: How has the rise of digital technology changed the way we use public space?

1. Losing One Kind of Entertainment, But Gaining Another

Yi-Fu Tuan

I was drinking tea at a sidewalk café when three young women, no doubt University of Wisconsin-Madison students, walked in. I immediately looked forward to eavesdropping on them when they sat down, for that’s how I learn about student interests and life. But no such luck, for the three women immediately took out their iPhones and started texting. How curious, I thought. On the one hand, there was physical intimacy, for I could see that their kneecaps touched under the table. On the other, they ignored one another in favor of someone in another part of town or out of town altogether.

Were the three women philosophy students, I wondered? After all, Jean-Paul Sartre said that real conversation is impossible in a group of three and can only occur between two individuals in private space. But weren’t the women conversing one-on-one in private space when they texted? My answer is no, if only because text messages are more likely to be factual than discursive, and yet texting does have a moral plus in its favor: it encourages people to be honest—honest as machines are honest. If the three women chatted instead, the content of their chatting might still contain facts, but the facts will be qualified and even undermined by the tone with which they are delivered—that is, by body language.

Public space is body-language space, and as such provides endless entertainment. People watching, we say. Everyone is part of the show—the baby soundly asleep in her stroller no less than the mother feeding the pigeons, and as supporting extras the pedestrians parading back and forth. If more and more people are locked into the private worlds of their earphones and iPhones, will that not diminish—or kill—public space, which is space that justifies itself by, among other things, its power to entertain?

But the digital age can enliven and promote public space and do so without radical change in social habits and tradition. Think of Chicago’s Millennial Park, which draws a large crowd by means of the projection of the faces of ordinary citizens on giant screens. Or think of how this essay, so ineffectual when read in the private space of the library carrel, can woo an audience in an auditorium when it is supplemented by electronically projected images, even one of me—a feeble-voiced, octogenarian American-Chinese.

Yi-Fu Tuan is a philosopher, author, and emeritus professor of geography at the University of Wisconsin-Madison

2. Public Squares Are More Vital Than Ever as Our Public Conversation Expands

Setha Low

Many social scientists predicted that, with the Internet, public spaces would stop being used. Instead, we are finding that the Internet (and especially Twitter and Facebook, which allows for rapid communication) can produce very large audiences involved and concerned about an issue, and they are showing up in public spaces. The Internet has expanded the public sphere—the political realm of ideas and conversation that is outside of the control of the domestic and “private” spheres of home and business. Many more people than ever before are included in the public sphere because they can comment on and even direct political conversations in ways that previous generations were not able to do except through newsprint, television, and book writing. It’s hard to keep this kind of energy constrained only to the virtual sphere of cyberspace.

Social movements and political uprisings belie arguments that public space and the public sphere have ever been separated. The centrality of a public square, park, or street as a place to come together to struggle, celebrate, grieve, and collaborate remains as vital as ever. Think of how people take to the streets or a square to express their rights to participate and be represented in the public sphere. The Arab Spring and the global Occupy movements drew inspiration from the jubilant atmosphere and contagious energy emanating from the crowds, from the urban design and siting of the public spaces where they occurred, and from the digital technologies that connected people through mobile phones and websites that alerted people to what was happening and where.

The end result is that digital technologies and the Internet are making dissent particularly visible and widening the political realm of ideas to include diverse publics and counter-publics.

Setha Low is director of the Public Space Research Group at The Graduate Center, City University of New York. Recent books include Politics of Public Space; Rethinking Urban Parks: Public Space and Cultural Diversity; On the Plaza: The Politics of Public Space and Culture; and Behind the Gates: Life, Security and the Pursuit of Happiness in Fortress America.

3. If Cyberspace Were Enough, Why Would I See People Fishing, Picnicking, and Stealing Kisses at the Park?

Steve Hymon

A few days ago, I rode the Metro Gold Line to the park next to the East L.A. Civic Center.

The park is one of those L.A. places most people probably have never visited unless their car broke down nearby or they served jury duty in the adjacent courthouse. It’s a neighborhood place, featuring a nice (albeit manmade) fishing lake, a small amphitheater and inviting green lawns and shade trees.

On this beautiful August evening — I was at the park for work purposes — there was no shortage of people. Sure, some stared blankly into Vader-black rectangles glued to their palms. But most park-goers, to my eye, were doing the kind of things people have always been doing in parks: picnicking, playing games, snoozing under a tree, stealing a kiss from the girlfriend. A young guy caught a smallmouth bass, then made his buddy remove the hook. The height of masculinity it was not. But it wasn’t a video game. It was man versus beast.

The so-called Digital Age may be in the process of unrepentantly swallowing whole newspapers, bookstores, libraries, and attention spans. But public space and all that goes with it seems quite immune to digital’s charms. On any given day, I can take a bus or train to a variety of plazas, squares, parks, beaches, piers, esplanades, walking paths — whatever you want to call them — and find plenty of people using public space as they always have.

If anything, the existence of cyberspace, which isn’t really space at all, makes most of us eager to see, touch, and feel anything that isn’t a 1 or 0. I don’t see that changing except for one thing: smartphones guarantee a future with more pics of people using public space.

Steve Hymon is a former journalist and the editor of Metro’s blog, The Source.


How Watching Every Single World Cup Game Changed My Life

FBL - WC - 2014 - FRA - FANS
Football fans react during the FIFA World Cup 2014 football match between France and Ecuador on June 25, 2014 at a bar in Paris. STEPHANE DE SAKUTIN—AFP/Getty Images

Vieiwing all 64 matches in 2010 showed me true, unadulterated passion, and led me to quit my job.

Maybe I did expect to be in a New York City bar below 14th Street at 7 in the morning at some point. Doesn’t every newly minted college graduate hoping to make it in the Big Apple’s art and greed industries have that expectation? I didn’t, however, expect it to be mid-week, on my way to work, and involving zero women.

Nonetheless, I found myself at Dempsey’s in the East Village at dawn, watching the least anticipated game of the 2010 World Cup: New Zealand vs. Slovakia. I had embarked on a self-appointed quest to watch all 64 games taking place in South Africa over the course of a month. I had done this for the 1998 France Cup, but back then I was in high school, on summer vacation. Now I held a 9-5 job in corporate publishing.

I bounced around New York watching games before work and taking long lunches in the middle of the day in dark bars. I watched games surrounded by foreign nationals and the ever-growing USMNT fan base (that’s the U.S. Men’s National Team, for the uninitiated). I watched games on a bus to Boston and at my niece’s second birthday party. I kept a blog that I treated as a personal journal, and to my surprise about 150 people seemed to follow it. I even got some fairly technical questions sent in to me by readers, including “If Carlos Tevez is the second ugliest man in the tournament, who is the ugliest?” Some other smalltime blogs linked to my own, lauding my ethnic ribbing of the gelled hair, headband-wearing Italian national team. A Greek chap got angry at me for scorning his team’s goading tactics against an undisciplined Nigerian squad. I was having fun.

Drinking breakfast pints and waving the flag of nations I’d adopt for 90 minutes at a time was great, but of course I couldn’t sneak away from my job for every game. There were many I had to watch under fluorescents in my cubicle. This, though not ideal, greatly improved my workday. But when my boss interrupted the Ivory Coast match I was watching at my desk and she apologized sincerely, I began to realize the low stakes of my work. It crossed into the absurd when a vice president from our corporate headquarters in Germany came into my cubicle to watch Die Mannschaft. She didn’t know my name, but she did know that my job was unimportant enough not to care.

I hated my career. This was not a big reveal. It wasn’t Portugal’s trashing of North Korea or being cramped on a bus trying to watch two semi-tedious games at the same time that made me realize that punching in numbers on a spreadsheet and passing along UPS orders was not the ultimate career for me. I had half-heartedly searched for new jobs, but I was comfortable where I was. I liked my colleagues, had a lot of friends at the company and captained the softball team. No, the 2010 World Cup did not shine a light on the fact that I didn’t care much about my job. But it did illuminate that no one else cared about it either.

Seven months later, I quit that job. Before the end of the next year, I’d left New York City for the Bay Area. As the World Cup in Brazil opens, I’m finishing my first semester of medical school in Australia (where I will be watching games in the middle of the night) and am set to have a wedding stateside in January. Watch all 64 games, learn about life, become a doctor, get married. FIFA should hire me for an ad campaign.

I love being an American fan of international soccer. There are very few times we as Americans get to be the clear underdog, and the World Cup is one of them. “300 million people,” a Scottish bartender at Luca Lounge in Alphabet City said to me with pity during the thrilling third-place match between Uruguay and Germany, “and you can’t find 11 who can beat Ghana at a football match.”

It took four years, but we proved him wrong. And even in 2010, the USMNT’s 0-2 comebacks, last second game-winners, and a final gut-wrenching defeat in extra time made it clear that the U.S. could compete on the world stage. While I was standing on a chair tossing piles of napkins in the air, celebrating Landon Donovan’s dramatic goal against Algeria, Brooklyn’s Black Horse Pub burst into “The Star-Spangled Banner.” On the pub’s giant LCD screens, bars around the country were being broadcast, doing the same.

Anyone who has ever identified with Joan Didion’s “Goodbye to All That” or The Onion’s oft-shared article on realizing that New York is a horrible place to live—and perhaps anyone who’s thought to themselves that New York’s a nice place to visit but not to stay—should try to bounce around the city for the 2014 World Cup. I’ll never forget leaving the orange-clad Dutch fans at a Midtown bar blaring their euro-techno to celebrate a win over Brazil to join the African nationals rallying around Ghana at a South African restaurant in Fort Greene. They watched their continent’s last hope in the tournament dissolve twice: once when Luis Suarez’s handball denied them a victory, and again when the ensuing penalty kick rattled the crossbar. The crowd that had drummed and danced in the street at halftime fell silent, with tears in their eyes, until the quiet was punctuated by Ghanaians wailing in agony.

The 2010 World Cup showed me a city that forces you to interact with the rest of the world’s population. When I think back to the Chileans wrapped in flags and caked in face paint or the Korean grocer who left his shop to sneak a peek at the neighboring sports bar, there is no doubt I miss New York. The 2010 World Cup also brought me face to face with true, unadulterated passion and when it was over, the void was intolerable. Unfortunately I had to leave a place I loved in order to do something I loved. But when the 2018 World Cup rolls around, I’m counting on returning to a bar below 14th Street—even if it’s at 5 a.m. to watch the match from Moscow. There are many reasons to call New York the city that never sleeps. My favorite is that somewhere around the world, a soccer match is being played.

Saba Afshar is a medical student at the University of Queensland Ocshner School of Medicine in Queensland, Australia. A version of this piece originally appeared at Zocalo Public Square.

TIME Media

The F-Word: Let’s Just Call It What It Is… [Bleep!]

Los Angeles Kings Victory Parade And Rally
Los Angeles Kings Mayor Eric Garcetti raises a beer and swears during the Los Angeles Kings Victory Parade and Rally on June 16, 2014 in Los Angeles, California. Harry How—Getty Images

(But if you don't like hearing it, or saying it, or reading it, you should probably stop right here.)

In making headlines after declaring at a hockey rally, “This is a big fuckin’ day,” was Los Angeles Mayor Eric Garcetti having a big fuckin’ day himself? Or rather, one for the f-word?

There are real data now to help answer such a question. Relatively recent technologies — cable television, satellite radio, and social network media — provide us with a not-too-unrealistic picture of how often people swear in public and what they say when they do. Before these new forms of reporting, the media provided a fairly sanitized view of spoken English. Newspapers today still swerve to avoid swearing, opting for euphemisms like “_____,” “PG-rated expletive,” or “an eight-letter word for animal excrement,” instead of telling us what was really said. Fortunately, YouTube now offers people like me, who study language and profanity, a more accurate picture.

Are widely reported acts of swearing by public figures like Garcetti’s typical or not? And are the rest of us any different? How frequently do regular people swear and what do we say?

We language scientists attempt to answer these questions. In one study reported in the journal Science, less than one percent of the words used by participants (who were outfitted with voice recorders over a period of time) were swear words. That doesn’t sound like very much, but if a person says 15,000 words per day, that’s about 80 to 90 “fucks” and such during that time. (Of course, there’s variability–some people don’t say any swear words while other people rival David Mamet). More recently, my research team reported in The American Journal of Psychology that “fuck” and “shit” appeared consistently in the vocabularies of children between 1 to 12 years of age. And you shouldn’t worry — there is no evidence to suggest a swear word would harm a youngster physically or psychologically.

So please, let’s not be shocked by swear word statistics, or by politicians swearing in public. Politicians get caught swearing all the time. In 2000, George W. Bush referred to a New York Times reporter as a “major league a–hole.” In 2004, Vice President Dick Cheney told Vermont Senator Pat Leahy to go [bleep!] himself on the floor of the U.S. Senate. In 2010, Vice President Joe Biden called the passage of President Obama’s health care legislation “a big fucking deal.” (Granted, it was meant to be said more privately than the mic conveyed.) I place Mayor Garcetti’s profane celebration of the Kings’ Stanley Cup in the Biden category of Happiness-Induced Cussing.

But what happens when the viewer at home encounters these expletive-laced speeches on their TVs or the Internet? Some viewers take it personally, taking it as classless, or moral degradation; I would argue they’re only thinking of the historically sexual meaning of the word “fuck.” But both Garcetti and Biden (along with Bono at the Golden Globes) used “fucking” as an intensifier, not as a sexual obscenity. Yet most swear words are used connotatively (to convey emotion).

The Federal Communications Commission waffles on what to do about Garcetti-style “fleeting expletives.” Fox Sports apologized for Garcetti’s “inappropriate” speech but it’s not clear if Fox will be fined by the FCC. (My best guess: probably not, since Obama’s commissioners are dovish on profanity.) The FCC ruled less liberally during the Bush years when conservatives had more sway. It’s interesting that people don’t complain as much about alcohol ads in professional sports. Alcohol can kill you, but swearing won’t; swearing might even help you cope with life’s stressors, according to recent research.

Older generations who are less understanding of technology may perceive that profanity represents a change in language or societal habits, even when that is not the case. Swearing by people in positions of power has always been there; it just used to be better hidden. We have to learn to accept that we are now going to hear more Garcettis.

And there’s something else you might have noticed. The day after any swearing incident nothing happens. No one has to be hospitalized or medicated. Yes, sensibilities may get jangled, but coping with slight deviations from the expected is part of life. No one, not even your mother, dies from hearing “fuck.”

Timothy Jay is a professor of psychology at the Massachusetts College of Liberal Arts. He has published numerous books and chapters on cursing, and a textbook for Prentice Hall on The Psychology of Language. This piece originally appeared at Zocalo Public Square.


How to Deal With Doctors Who Get Drunk and High on the Job

A group of surgeons work in an operating theatre.
A group of surgeons work in an operating theatre. Jochen Sands—Getty Images

Doctors might be under the influence more often than you think. A California physican explains why mandatory drug and alcohol testing could be the solution

Larry was a doctor trainee at a hospital where I taught in Burbank. I recommended that he not passdue to his poor preparation and work habits. But he did, and set up a general practice nearby. He had trouble with it, though, and drifted into addictionmedicine over time, helping patients overcome their problems (he was said to have had a cocaine problem in his past). He later moved outside the immediate area, and word got around that he was a go-to localfor scoring prescription narcotics. People who encountered him thought he might be high. Eventually, the DEA entered his life, and he put a gun into his mouth and pulled the trigger.

An upcoming ballot initiative on malpractice caps in California includes a provision that would require physicians to be drug- and alohol-tested prior to practicing at any hospital, and require other health care practitioners to report any suspected abusers. This is packaged with other measures that appear punitive towards all physicians. But the drug-testing provision deserves scrutiny because, while drug testing is widespread in American business, and required of nurses and many medical workers, private doctors have not been routinely tested.

I’d like to tell you substance abuse isn’t a problem for doctors, but unfortunately, I’ve seen firsthand that there are physicians who practice while they are under the influence. And we physicians often find it hard to speak up when we see something. The attitude is all too often, If it isn’t my patient, it isn’t my problem.

I personally made it my practice never to have a drink at lunch or in the evening when I was on call. And because I was on call for most weekdays for 30 years, I never felt free to drink during my career. Sadly, that was not always what I encountered from my fellow physicians.

When I was a young ER physician new to a small community hospital in California, I called in a prominent surgeon to perform an emergency appendectomy. He arrived, reeking of alcohol. There was no other availablesurgeon, and a delay exposed the patient to significant risk. The surgery went ahead, and the patient did fine. But I asked around, and the surgeon turned out to be known as a boozer, frequently coming to the hospital drunk. This still haunts me, and I left that hospital rather quickly.

That was my first experience with the difficulty of dealing with physicians who abuse mind-altering substances. I didn’t make any sort of formal report on the surgeon; I would have felt intimidated. I passed the word along to colleagues, but that was all I did. Today, as a senior physician in the latter part of my career, I would hope that I’d do more.

But that was a case when I recognized a problem. It can be hard to recognize that a colleague has a substance abuse problem, even if you’re a trained observer of addicts. Among my professional pursuits, I was the director of a drug/alcohol program for a large medical group, and personally saw every patient who entered the program for several years.

In 1994, I hired an associate, Cindy, a graduate of a famous cancer center, looking for temp work. She was young, attractive, and very smart. But I was surprised by her poor work habits, and my staff reported strange behavior. Drugs from the office started disappearing. I just couldn’t believe Cindy was abusing drugs, until it became undeniable. (Although she denied it.) A year later she had her license revoked for drug use, unrelated to my experience with her.

Until a few years ago, the licensing board for physicians in California had a diversion program for those who were identified as having an abuse problem, which allowed such physicians to keep their licenses if they sought adequate rehabilitation. It had a 75 percent long-term success rate and allowed for anonymous reporting of suspected abuse. However, the licensing board, in its wisdom, recently discontinued this program as they felt that the board’s primary mission was patient protection, not physician rehabilitation. Funding should not have been an issue: the program was paid for by physician licensing fees, not by taxpayers. Nothing has appeared to take its place, and so California is without a confidential reporting system for doctors.

I’ve spoken with a number of practicing physicians recently, and surprisingly, I hear a lot of support for mandatory testing. This support may have less to do with protecting patients than with a feeling of impotence in dealing with colleagues who abuse drugs and alcohol.

Mandatory testing will cost a lot of money, and it is intrusive to the daily practice of medicine. But patient safety concerns justify such testing for physicians, just as air safety concerns justify testing for pilots. And even with testing in place, doctors should not be excused from their obligation to report colleagues, and the government should provide a way to make such reports confidentially.

None of this should be done by a deeply flawed ballot initiative; instead, the Legislature should craft a careful law that will work in practice.

Ken Murray MD is a retired Clinical Assistant Professor of Medicine from USC, and is a frequent contributor to the Southern California Bioethics Commitee Consortium. He writes on topics of end-of-life, ethics, and water. His writings have been published in media world wide in virtually all languages, and he speaks frequently on these subjects.


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