So many white lies. .How easily we speak’em. So much so that they become an integral part of our life. The misery of the situation is that we don’t even feel that there is anything wrong with it. We want to ignore someone or his call we fake we never “got the message”. Better still, deny we ever had his number. He talks and we fake interest. That is particularly the time we are focused “on something more important in our lives”. Always verbally “willing” to help but when the time comes, “we were at an important meeting”. Constantly projecting and posing innocent or the ignorant one. Generally the “fake-all” kind think that they had their way. Nobody knew. Mind you, most of the times the other party knows. With the sheer pleasure of the fact that he is in the same boat, faking things. Or if he is the “genuine” kind (who does not indulge in anything wicked, by choice, to be a good human being), he still knows, because after all he has had the experience with so many of “your kind” earlier.

But never mind. There is always a tomorrow to begin things afresh. There will be another morning, another Spring, another tabula rasa to start things afresh. Well again, if not in this life, there might still be another, to give TRUTH a try. As long as things do not go wrong in our life we never think that living it fallaciously was even a big deal. Shockingly there are some, who continue the life of deceit even in bad times, thinking what worse could now happen.

As long as nothing seems at stake, it is all well.

The heart of the matter is that it is difficult to be truthful and untainted and it takes an effort to survive with that. Ultimately all the crap of seemingly harmless lies piles up, making us grotesque creatures—more heinous than you would ever imagine. Because when we deceive others, WE become deceitful. When we talk lies, WE become liars. The ultimate harm done is our own. It does not matter what we did to others or how successful we were in tricking someone. What matters is what we did to OURSELVES.

Well, it is the trap. An invisible one.

Seeking to be outside the trap,
Manjit

⁽⁰⁾

Used it the first time to create an artist book (nachtmusik) although the music tape that accompanied the book was made with a simple cassette recorder. In 1995 I got an internet connection and started to build a first web site and experimented with sound and image (no longer on-line). It felt like coming home, if you look at my background; music, visual arts and a “heavy reader”, this seems natural.

Always have been interested in the so called “gesamtkunstwerk”, like Scriabin. In exhibitions and in the series A Polyphonic Chronicle I tried to find ways to use music forms like the sonata, polyphony or the passacaglia to give structure. Although music forms deal with time, their inner structures like repeating and variation, helped me to think in a different way about visual works and exhibitions. And not to forget John Cage, I think of him as one of my dearest teachers. [never met him though :-( ]

Andrews
Do you see yourself as a net.artist? What does that term mean to you? Do you distinguish it from 'web.artist'?

Knaven
No not specificly, I consider netart as a form that suits my needs for the things I want to tell. Netart is just one of the new forms used in newmedia art. For me it makes no difference working in real or working for the net, it all depends on the subject and the appropriate form. But as a form it's fascinating. In my view it's the new way of creating artists' books, it has relations with that form of art like the way you view it: 1 to 1, intimately. New component is sound. Using the label netartist is a good way to promote the medium. So I don't mind if people call me netartist. (they also call me photographer, violinist, visualartist, soundartist..:-) what's in a name)

Andrews
Do you surf the work of other people much? If so, where do you get your links? What do you look for?

Knaven
Yes I do. I want to follow what's happening in netartland. And I want to share it, that's why I started MICHEL***, my netartguide. Now MICHEL is running quite well, I get a lot of links from visitors. But I also use resources like Rhizome and tips from friends.

Andrews
What media and arts do you see your work in relation to?

Knaven
visual arts like photography, film, installations, assemblage/collage, artist's books.

Andrews
What tools do you use?

Knaven
Macromedia director, photoshop, soundforge,hotdog, digitalcamera, minidiskrecorder, a pair of scissors and glue

Andrews
Do you consider yourself a competant programmer? Is that important to you?

Knaven
I manage now a days to get it programmed the way I want, but I don't consider it as an important skill. On the other hand it forces me to think about the things I want to make in a different way, your idea reduced to if-then statements which is sometimes very refreshing.

Andrews
What should a web.artist know? Apart from themselves and others. I am asking you how you see the role of technical knowledge in web.art. Is it necessary? What is necessary?

Knaven
Start blank and choose what technical knowledge you need depending on what you want to create. For me that's the only rule that counts!!! When I compare it with photography, you can start with learning everything about apertures, develop times etc etc. But then you still don't have a good picture because the quality of the image depends not on technical things but on your personal view and perception!

Andrews
Do you think you've grown as an artist over the last few years? Howso?

Knaven
Yes I think so. Difficult to see in your own work but I have the feeling that since the soundboxes and "Conversations with Fransesca" the form in relation to the content is getting more clear. I'm getting closer to the "images in my head"

About the Artist
Looking at Michiel Knaven's portfolio , one sees that he is involved in a wide range of arts and media, from the making of artists' books to photography, "boxes and assemblages," CD ROMs, and net art. And the net art and sound art he has online reflect that diversity as well.

Many artists who get involved in net art and were previously involved in other practices end up stopping all but the net practice. But Michiel hasn't. And much of his net.work continues to be informed by the "scissors and glue" he mentions in the interview below. It seems, then, that whether he ends up making something for the net or something for a gallery (or whatever) depends on the materials and the form. His approach to multimedia is quite broad.

His Soundboxes have an interesting way of treating sound as object. The first one, "comic", is a simple generative music piece. The sounds you hear are triggered by collisions of the moving objects. In particular, the collisions with the circle are key to the generative music. Whether the music is taken from cartoons or not, the resulting collision-music has a 'cartoon music' feel to it.
Perhaps that is part of the point of the piece: even if the music were not taken from cartoon music, there is probably bound to be an element of comedic mishap to music based on collision detection. And the collision, if not its algorithmic detection, seems to have an important place in cartoons; characters do not so much meet as collide, generally, like the plot lines in comedy.
Another of the Soundboxes called "watch me" develops that 'cartoon music' theme more. And a different one called "kartoffel dampf kanone 'schmidt'" further humorously develops the exploration of sonic generation via collision detection.

We also see other types of fruitful collisions in Michiel's work. In Conversations with FRANCESCA, high art collides with audio from TV soap operas.
But, more generally, we see in Michiel Knaven's work a fine sense of how idea emerges from material. As though he were a writer but with material objects instead of words. Perhaps this means he has an interesting sense of composition and the language of material objects and their relations. His broad sense of multimedia, through netart and beyond, is involved here.

It's interesting to compare the iconography of Knaven, Stanza, and Strasser. Knaven is more inclined to use cut-out art objects than either of the other two, for instance. But, more generally, there is a sense of the physicality of his practice, even in the digital, and the emergence of ideas from physical, animated things.

Michiel Knaven lives in Zwolle, Holland. His site is michaelmedia.org.

Originally Published in www.turbulence.org

⁽⁰⁾

⁽⁰⁾

What you are is what you have been, and what you will be is what you do now
The Buddha

You can not prevent the birds of sorrow from flying over your head, but you can prevent them from building a nest in your hair
Chinese Proverb

Reciting a small portion of the scriptures,
But putting it diligently into practice;
Letting go of passion, aggression, and confusion:
Revering the truth with a clear mind;
And not clinging to anything, here or hereafter;
Brings the harvest of the holy life.
Dhammapada

Direct your eye right inward, and you'll find
thousand regions of your mind
Yet undiscovered. Travel them and be
Expert in home-cosmography
Henry David Thoreau
Walden

⁽⁰⁾

I remember when you were born. As I looked at you closely for the first time, feeding eagerly at my breast and having no way of knowing the struggles ahead, I questioned my ability to guide you. The knowledge and structure I knew I must give to you would not come like the milk, which so voluntarily and miraculously came into my body to nourish you. How fine it would be to feed into you wisdom and compassion as easily as I was feeding into you milk.
The dreams and goals I had for you those many years ago have not really changed so very much: to find fulfillment in work and joy in play; to discover the fine line between independence and the need of a shoulder to lean on; to be aware of the rights of all people; to be gentle and full of humor. Some of those dreams are already coming true.

But who could have told me then of the things I would learn from you.
You offered me a chance to develop patience when I discovered you finger painting on the wall with the contents of a dirty diaper; when you cut off the dog's whiskers because, "Mom, she looked too much like a cat;" and when learning to read, you could never recognize the word "that" in your reading lesson (why couldn't the word have been something hard like "friendly" or "neighbor?"). I learned that spankings were usually a result of my own impatience and frayed nerves. I found other ways to guide, and I learned that preventive measures saved so many tears and worries.

You developed my communication skills and sense of reasoning when you asked, "Do people ever cry after they die and are put in the ground?" or "Do blind people know what red is like?" Sometimes answering your simple questions solidified my own insights. How glad I am that I took the time to look and think beyond the superficial simplicity of your questions - profound and touching on life itself is what they were.

I still remember how nervous I was when I hauled out the biology book to give you the facts of life. No, it wasn't nervousness related to embarrassment. It was just that I wanted so much to do it right, so that you would know about love - and responsibility - and the wrongness of a double standard - all this in addition to the necessary physical facts.

The book fell open and displayed a woman's breasts, and I explained that I had nursed both you and your brother in this way. You, in great seriousness, wanted to know which one was his and which one was yours - like his blue cup and your yellow one. A great question with a need for a great answer: "You used both and so did he." What a look of disgust crossed your face: "I thought you were suppose to be sanitary with babies."

You gave me the chance to mature by accepting responsibility, for you were probably the greatest responsibility I have ever have. Producing an emotionally, mentally and physically well child is a complex operation because so much of it simply cannot be delegated. The decisions were mine for better or worse, and some days there were so many decisions to make.

When I did delegate responsibility, there was responsibility of delegating the responsibility to responsible people. All the way from the dentist and the doctor to the people who would guide your mind (be it a care provider, a teacher or even a playmate - and the latter category, I have found, is a great mind-guider), I needed to use judgement.

Simple decisions (or are they so simple?) like which television programs you should watch or what books you should read needed to be made. Was the time right for a tricycle? Should you have a dog? Was a pogo stick too dangerous? Was it O.K. to ride your bike all the way across town? Should you have your own car? Maybe the decisions I made helped you grow. Certainly making those decisions helped me grow.

You have taught me humility. It is very had to look at a five-year old and say, "I'm sorry." I've had to learn I'm not perfect and even a big adult like me has had to eat words.

I remember the time the mother next door said you had bitten her child's stomach - and would I please look at that welt. I looked, and I saw the angry, red set of teeth marks. I launched into you - what a naughty thing you had done. In the midst of my tirade, the little voice directly above the wounded tummy informed us all that he meant the boy in the house next door on the other side - he didn't mean you. I had to look at you, with tears running down your cheeks, and tell you how very, very sorry I was.

You know more than me in a lot of ways now. I can't help you with your homework in at least two subjects because I either never did know anything about them or I have forgotten. I must be careful what I say or I eat my words. I could have sworn that Charleston was the capitol of South Carolina.
You constantly have and do keep alive in me the wonder of love. Never had I felt the melting inside of me that I experienced each time I touched your chest at night to reassure myself that you were breathing. How strongly my defense mechanisms swung into gear when anything threatened you. How agonizing it was to realize that defensive mothers must sometimes step aside.

When I was ill and had to stay in bed, how well I remember that hacked-up salad, drowning in Italian dressing, you carried in with pride and love. Or the day I was grumpy and yelled and ranted at you. I remember how you put your lips on my cheek and whispered in my ear, "It's been a bad day for you."
I remember the pride (and secret fear) I felt when you stood and recited your first part in an assembly, when you played your first trombone solo, when I drove you in our old station wagon to pick up your first date.

How I hurt for you when I recognized the badly disguised signs of a rejected first love. Most vividly I remember how we cried together in each other's arms when I had to tell you your dog Perky had been killed - all this was a part of the love that was the greatest blessing you brought to me.

I hope I've done right by you, my love. You've given me the world.

Originally published in www.cheewa.com

Cheewa James is a Professional Speaker and Author.

⁽⁰⁾

Well, this book was the answer for me, and as many times as I've overlooked this book, I finally broke down and bought it as an act of desperation under endlessly cloudy Michigan skies.

This book is actually an anthology of Scotty's articles from past S&T magazines. Cleverly assembled and edited by James O'Meara, the editing is largely transparent and does not eclipse Scotty's presence at all. If anything, O'Meara's contributions merely clarify the context of certain articles to make them more compelling to the contemporary astronomer without changing the "feel" of the articles.

In this compelling collection, Walter Scott Houston captures a unique approach to observing the deep sky that is very different from the current crop of excellent columnists that grace the pages of today's magazines. In fact, reading Scotty's book takes you back to the days when larger scopes were 6-inch and the concept of a nebula filter was still very new. Because of this, Scotty makes you feel like part of his network of observer/readers, asked to push the limits of their small scopes and overcome the barriers of visual small scope use. He offers observing challenges for a wide variety of objects from different catalogs…not only the Messier and NGC.

You will be surprised, as I was, how many spectacular objects are within reach of smaller scopes even though they do not necessarily appear in the Messier catalog. His description of various attempts (some were successful!) at observing the Horsehead Nebula, California Nebula, Barnard's Loop and other difficult objects with smaller equipment make you want to rush out and try it yourself. In this regard, I found it refreshing to realize that this gentleman had accomplished years ago with a 4-inch refractor what many "armchair astronomers" on so many internet newsgroups maintain cannot be done. Also, he challenges conventional thinking about observing southern constellations and targets by making a reasonable case for successfully chasing objects in Fornax from 40 degree latitudes.

Granted, the issue of increased light pollution over the last 50 years may greatly diminish your local capability, but with smaller scopes comes the option of packing your gear heading for darker sites and a fair simulation of the conditions that Scotty had in the 60's and 70's.

There is never any doubt in your mind as you read these chapters, that Scotty's prime observing tool is his eye, and the mention of different scope types and apertures is almost incidental and detached from the observing experience. Given today's endless (and in many cases pointless) internet debates over scope types and accessories, Scotty's approach is most refreshing and recharges your enthusiasm for just plain observing.

Amusingly, Scotty even tries a plain cardboard tube with a blackened inner surface in an effort to see the Pleiades better. He admits that the experiment didn't work, but this venture certainly shows you Scotty's philosophical purity when it comes to visual observing. I did have one bone to pick with him however. He states that star hopping with a right-angle finder is almost impossible because of the mirror-image view. I am glad I didn't pick this up sooner from either his articles (I missed many in those days) or from this book, since that's always been my choice method of star hopping… I had no idea it was almost impossible!

This book gave me pause to reconsider where to direct my efforts as a visual observer after completing various deep sky observing projects. It gave me a new challenge to see if I could "expertly" revisit with smaller apertures the objects that, in many cases, had cost me several hours and even entire evenings of searching with larger scopes. Indeed, the chase is sweet, but never so sweet as to find objects by depending primarily on the eye's acuity and one's observing skills rather than on brute force aperture.

I am very pleased with the book and would recommend it as one that you will likely read over and over again. It is certainly a fantastic gift idea for your favorite astronomer, regardless of their specific interest or pursuits.

Deep Sky Wonders by Walter Scott Houston
Hardcover: 309 pages
Publisher: Sky Pub Corp (December 1998)
Language: English
ISBN: 093334693X

⁽⁰⁾

There is an apparently limitless amount of money to be made from marketing pharmaceutical remedies for diseases and even more from remedies to reduce risk factors for disease. An emphasis on the treatment of disease minimises political responsibility for those fundamental causes of disease that are located within the structure of society, and substantial and lucrative professional careers have been built on the endless pursuit of new diseases or risk factors for disease.

More fundamentally, disease mongering exploits the deepest atavistic fears of suffering and death. Throughout history, humanity has kept such fears at bay by accepting burdens and sacrifices in the present in the hope of future salvation. In earlier times, the mediator was religion and the salvation was to come after death. Now, for those without religious belief, death has become more final, and salvation must be sought before death in an ever-expanding longevity. An adequate response to the false hopes raised by disease mongering will demand, from those in positions of power and influence, an ability to acknowledge, accommodate, and move beyond these profound existential fears [1]. Such ability is rare.

The way forward will rely on a capacity to rediscover courage and stoicism as both private and civic virtues, alongside seeking a radical realignment of the relationship between economic, political, and professional interests. Doctors and biomedical scientists, in particular, have a responsibility not only to put their own house in order but to provide much better advice to politicians and to the public, both as patients and as citizens.

The Challenge to Professionals
The first step has to be a genuine disentanglement of the medical profession from the pharmaceutical industry—there really is no such thing as a free lunch [2]. The pharmaceutical industry spends millions of dollars supporting the “education” of doctors because it is in its economic interest to do so (Figure 1). If prescribing activities and industry profits were not affected by this support, it would not be offered. Doctors can only provide appropriately independent and authentic advice to patients and, indeed, to politicians if they are seen to be completely independent of other powerful interests. Politicians genuinely interested in the welfare of patients and the health of citizens should actively promote such independence [4].

Figure 1. Percentage of Doctors That Use Information Provided by Drug Company Representatives in Their Clinical Practice [Click to Enlarge image]

Data derived from [3]
(Image: Adapted from a slide presentation created by No Free Lunch, http://www.nofreelunch.org/downloads/Nofreelunch%20Presentation.ppt)

Disease mongering exploits the deepest atavistic fears of suffering and death.
Beyond this, there is a need for better science that has the integrity to demand more explicit acknowledgment of the limits of medical knowledge, less extrapolation beyond research findings, and much more responsible use of statistics, so that the true extent of the benefits and harms of proposed treatments can be properly understood.

The rhetoric surrounding disease mongering suggests that it will promote health, but the effect is in fact the opposite. Much disease mongering relies on the pathologising of normal biological or social variation and on the portrayal of the presence of risk factors for disease as a disease state in itself. When pharmaceuticals are used to treat risk factors, the vicious circle is completed because “anyone who takes medicines is by definition a patient” [5].

Most variables are distributed across a continuum, but despite this, the medical tradition has been to dichotomise the continuum into normal and abnormal [6]. Within a continuum, there can never be a clear boundary, so the definition of disease is inevitably both arbitrary and fluid. It is in the interests of pharmaceutical companies to extend the range of the abnormal so that the market for treatments is proportionately enlarged. We have seen this process operating, for example, in the continual lowering of thresholds for treatment of blood pressure and lipids—the most recent guidelines from the European Society of Cardiology can be used to identify 76% of the total adult population of a county of Norway as being at “increased risk” [7].

We need to reverse this situation so that instead of defining an arbitrary threshold of abnormality, governments would make a judgement about the appropriate level of investment in preventive technologies for currently healthy populations, and set the thresholds for intervention accordingly. For example, a government might decide to treat the 10% of the population most at risk of ischaemic heart disease, and could then calculate the thresholds of blood pressure and cholesterol, which would identify this most vulnerable 10% of the population. Clearly, these thresholds would be much higher than those recommended today.

Preventing Disease through Population-Based Measures
The seeds of the current situation were already present 21 years ago, when Geoffrey Rose wrote his seminal paper entitled “Sick individuals and sick populations” [4]. In this paper, he showed that risk factors for health are almost always distributed across a bell curve and argued that more could be achieved by attempting to shift the whole of the bell curve than by targeting those at highest risk (Figure 2). His rationale was that the large number of people at low risk may give rise to more cases of disease than the small number who are at high risk. There has been general acceptance of this argument, but Rose's own warnings seem to have been lost.

Figure 2. Risk Factors for Health Are Almost Always Distributed across a Bell Curve

Geoffrey Rose argued that more could be achieved by attempting to shift the whole of the bell curve (the “population approach” to prevention) than by targeting those at highest risk (the “high-risk” approach). (Image: Adapted from a figure by John Emberson from [8])

Rose was careful to list the disadvantages of attempting to shift the whole bell curve, which included (1) a “worrisome” benefit–risk ratio (there is only a small possibility of benefit for any one individual, but everyone is exposed to the intervention and thereby to any adverse effects, such as medicalisation, anxiety, and side effects of treatments) and (2) poor motivation on the part of individual patients, each of whom had a very small chance of benefit. These predicted disadvantages have become more and more apparent, so there has been a systematic attempt to improve motivation through the explicit use of fear, which in itself erodes and undermines health. “If you don't take more exercise, improve your diet or take this medication, you actively put yourself at risk of an untimely death.”

Rose was also very careful to distinguish between two approaches to shifting the bell curve. The first restores biological normality by preventing exposure to hazards such as tobacco smoke or industrial air pollution. The second approach is to interpose some new, supposedly protective intervention, but this is much less robust because it leaves the underlying causes intact. The current use of pharmaceuticals for public health policy falls into this category. As more and more risk factors are identified, closely followed by a pharmaceutical treatment for each, the ambition to shift the whole bell curve legitimises the wholesale drug treatment of healthy populations at vast expense and with huge pharmaceutical profits. There is a clear need to reiterate Rose's distinction and prioritise the reduction of exposure to biological hazards above the application of pharmaceutical prophylaxis.

Current trends raise the prospect of exponential spending on preventive pharmaceuticals, justified by potential long-term benefits to an unidentifiable, but statistically significant, number of people in the population. When doctors treat patients with diseases, progress can be assessed and the outcome is measurable. This means that if the patient responds to treatment, it can be continued; if not, the treatment can be stopped. When doctors treat people who are merely at risk of disease, the outcome is probabilistic, so whether disease is prevented or was never going to develop, the treatment continues indefinitely [9].

Shifting the bell curve through population-based interventions aimed at protecting health is part of a long and magnificent tradition which began when John Snow capped the Broad Street pump; shifting the bell curve through the mass pharmaceutical treatment of individuals turns out to be something quite different. Further, where individualised solutions become prevalent, societal, population-based interventions tend to fall away, and the result is worsening health inequalities.

The medical profession needs to do much more to define sensible limits to medical intervention. There is a clear and urgent need for more research into the psychological impact and the wider health consequences of being labelled “at risk” [10]. Doctors, and society as a whole, need to stop confusing health with happiness [11]. This confusion is at the root of much of the medicalisation of normal human variation that we are witnessing. Male pattern baldness and shyness, to take just two examples, are not diseases but normal parts of the range of human experience. We are witnessing diagnostic drift in a whole range of conditions, from depression [12] to hypertension [13], with pressure for more and more people to be included within the range of abnormal and offered treatment. The justification for these treatments is often based on short-term studies, which are then extrapolated over much longer time periods. There is insufficient recognition of the fact that the less the need for treatment, the higher the number needed to treat for given outcomes and the higher the risk to patients, since the rate of adverse effects remains constant.

The Challenge to Politicians
Politicians are charged with overseeing the organisation of society for the benefit of all. A major political achievement of Western societies, with the very notable exception of the United States, has been the provision of universal health-care systems available and accessible to all. There is now a pressing need for politicians to recognise the threat to these systems, and to the social solidarity that they embody, posed by exponential increases in pharmaceutical expenditure. No universal health-care system funded by taxation can pay for the pharmaceutical treatment of all risks to health. There are very difficult decisions to be made, but politicians must balance the wish to support a vibrant and innovative pharmaceutical industry—and the undoubted economic, employment, and therapeutic benefits that drug companies bring—against the increasing capacity of this industry to bankrupt universal health-care systems.

Part of the rationale for expenditure on the treatment of health risks is that it will reduce health costs in the long run, but such arguments do not stand up to close scrutiny. The costs of health care are highest during the year before death, regardless of the age at which death occurs. Everyone must die and be cared for while dying, and no amount of preventive pharmaceuticals can reduce the cost of providing this crucial end-of-life care [14]. The aim of preventive health care should be the reduction of untimely deaths in relatively young people, but the fear of accusations of ageism in health care means that doctors are encouraged to go on prescribing preventive pharmaceuticals to people well into their late eighties and nineties [15].

In any system of health care predicated on social solidarity, the rights of individuals to treatment have to be balanced against the duties of citizens to provide the appropriate level of funding. Citizens agree to pay tax for the care of those who are sick, with the understanding that they, too, will be cared for should they, in turn, become sick. It remains unclear how far this pact of social solidarity extends to paying for the treatment of risk factors and marginal “diseases”, where the benefits in terms of reducing suffering are much less clear. Publicly funded preventive treatment of risk factors for those who have already exceeded the average life expectancy seems particularly hard to justify.

Socioeconomic deprivation has been described as a “fundamental cause” of disease, which works through a multiplicity of risk factors and pathophysiological pathways to produce multiple disease states [16]. Even if one of these pathways is interrupted by the application of a preventive technology, an association between a fundamental cause and disease will reappear in a different form. The closer to the individual the intervention is situated, the less likely the improvement in health status is to be maintained.

In mental health problems, we see this process operating when people are helped to cope with poor housing and lack of rewarding employment through the provision of counselling, rather than better social conditions. Population-based interventions favour the poor because such interventions are applied universally and the poor are the most at-risk; individually based interventions favour the rich because they are more likely to make use of what is offered. For this reason, population approaches to tackling the fundamental causes of socioeconomic deprivation must remain the most effective way of tackling health inequalities [17]. However, there is also a continuing role for individually based treatment of those at the highest risk of particular diseases, but this must be effectively targeted if inequalities are not to be exacerbated.

Age is another fundamental cause of disease, less remediable than poverty but again generating multiple risk factors and multiple disease outcomes. All clinicians are familiar with the processes by which treating one disease in a frail, older person will often mean that symptoms reappear through another pathway. Authentic health care for the old and frail has much more to do with helping to preserve their dignity, treating them with affection, and supporting their continued involvement in social activities, rather than the pursuit of ever-more elusive cures. Politicians have a responsibility, alongside doctors and many others, to make such care available, and this in itself will be an important part of the way forward.

The huge amount of money that can be made from preventive technologies has diminished the economic importance of treatment technologies, particularly for those illnesses that primarily affect poorer people in poorer countries [18]. This has meant a shift of attention from the sick to the well and from the poor to the rich [19]. This effect of global markets requires a response in the form of an assertion of global human solidarity. Health inequalities matter globally as well as locally. A way forward might be through taxation or other means, to make the sale of preventive technologies in countries with above-average expectation of life conditional on the availability of treatment for those diseases that cause the most catastrophic shortening of life in poor countries.

Conclusion
Human societies are riven by the effects of greed and fear. The rise of preventive health technologies has opened up a new arena of human greed, which responds to an enduring fear. The greed is for ever-greater longevity; the fear is that of dying. The irony and the tragedy is that the greed inflates the fear and poisons the present in the name of a better, or at least a longer, future. Ultimately, the only way of combating disease mongering is to value the manner of our living above the timing of our dying.

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17. McAlister A, Puska P, Salonen JT, Tuomilehto J, Koskela K (1982) Theory and action for health promotion: Illustrations from the North Karelia Project. Am J Public Health 72: 43–50.
18. Freemantle N, Hill S (2002) Medicalisation, limits to medicine, or never enough money to go around? BMJ 324: 864–865.
19. Heath I (2005) Who needs health care—The well or the sick? BMJ 330: 954–956.

Originally Published in Public Library of Science. Heath I (2006) Combating Disease Mongering: Daunting but Nonetheless Essential. PLoS Med 3(4): e146

Iona Heath is a general practitioner at the Caversham Practice, London, United Kingdom. E-mail: iona.heath@dsl.pipex.com

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Once, the Aral Sea was the world's fourth-largest inland body of water, teeming with fish and popular for recreation. But in the 1950s, the Soviet Union decided that the great plains around the sea were ideal for growing cotton on a massive scale, so it constructed a number of dams along the two main rivers feeding the sea - the Amu Darya and the Syr Darya. Water from those dams was diverted into a vast series of canals and used to irrigate crops.

Cut off from its water supply, the sea began to die. By the time of my visit, waters had receded so much that some fishing towns were more than 100 kilometres from the sea. In between was a scorched seabed, littered with the rusting hulks of ships. The sea itself had become saturated with poisonous runoff from the cotton fields and most of its fish species had died off.

Human health suffered the most, as dust storms whipped up pesticides and other toxins from the dry seabed. Tens of thousands of people fled the region. Those that stayed suffered from the world's highest incidence of tuberculosis and a host of other chronic illnesses. One pediatrician told me that nearly 90 per cent of the area's children suffered from serious ailments, including chronic bronchitis, infections and skin lesions.

But there is hope. Recently, the North Aral Sea has been showing signs of improvement, thanks to a rescue mission funded through the World Bank. After years of rehabilitation, including the construction of new dams, dykes and sluices to repair previous damage, the Syr Darya River now flows freely and the amount of water reaching the sea has doubled.

For the North Aral's main port city, Aralsk, the project has been a lifesaver. When sea levels started to fall decades ago, more than half of the population left and residents found eventually themselves 80 kilometres from the water's edge. Today, the water has risen to within 15 kilometres of the city and fish have even started to return, providing a source of food and income once more.

Although it will be a long time before we can say the Aral has truly returned to its former glory, the recent improvements show that if we make an effort to change our ways, the planet is capable of healing itself. With enough political will, we can move mountains.

But does this mean we don't really have to worry about environmental problems since we can just fix them later? Not at all. In addition to the direct human health impacts of poor environmental planning, some of the changes we're making to the planet will affect us for centuries. Greenhouse gases like carbon dioxide, for example, can stay in the atmosphere for hundreds of years.

Even if we stop churning them out today, the climate will continue to heat up.
With some issues, like climate change, we simply cannot afford to take a wait-and-see approach. That's why former Prime Minister Brian Mulroney recently urged Prime Minister Harper to start making serious cuts to greenhouse gas emissions. We simply cannot afford to experiment with the only atmosphere we have.

Our planet may have a remarkable capacity to heal, but there's only so much she can take.

Originally published on April 28, 2006.

Dr. David Takayoshi Suzuki is distinguished Canadian geneticist who has attained prominence as a science broadcaster and an environmental activist. He is also a co-founder of the David Suzuki Foundation.

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2. Catty
a) Malicious
b) Cute
c) Docile cat
d) None of the above

3. Cottonwool
a) Mix of cotton and wool
b) A fabric
c) Unprocessed cotton
d) None of the above

4. Dud
a) A kind of crude weapon
b) A Device or person proving to be failure
c) A young lad
d) None of the above

5. Forgettery
a) Related to forgetting
b) Faulty memory
c) An ideology
d) Both a & b

6. Gooseflesh
a) Rough skin
b) Induced by fear or cold
c) Related to goose
d) Both a & b

7. Meek
a) Timid
b) Humbly patient
c) Powerful
d) Both a & b

8. Parkade
a) Space above parking
b) Space for parking
c) Space below parking
d) None of the above

9. Scotch (v.t.)
a) To put an end to
b) A type of liquor
c) Related to Scotland
d) None of the above

10. Tenderable
a) Brittle
b) Pliable
c) Capable of offering in payment
d) None of the above

Answers:
1. (b) 2. (b) 3. (c) 4. (b) 5 (d) 6 (d) 7 (a) 8 (b) 9. (a) 10 (c)

Your Score:
8-10 Excellent
5-7 Good
1-4 Need improvement

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