‘Anti-malarial mosquitoes’ created using controversial genetic technology

Scientists aim to tackle malaria by creating bugs unable to spread the parasite, but caution recommended over unpredictable ecological consequences

Hundreds of genetically modified mosquitoes that are incapable of spreading the malaria parasite to humen have been created in a laboratory as part of a revolutionary approach to combating the disease.

The move marks a major step towards the development of a powerful and controversial technology called a gene drive that aims to tackle the disease by forcing anti-malarial genes into swarms of wild mosquitoes.

The procedure can quickly transform the genetic makeup of natural insect populations, making it a dramatic new tool in the fight against an infection that still claims over 400,000 lives a year. The same technology is being considered for other human diseases and infections that devastate crops.

This is a significant first step, said Prof Anthony James at the University of California, Irvine. The mosquitoes we created are not the final brand, but we know this technology allows us to efficiently generate large populations.

But gene drive technology is so powerful that resulting researchers have recommended scientists in the field to be cautious. A warning published in August in the prestigious publication Science, by squads in the UK, US, Australia and Japan, said that while gene drives have the potential to save lives and bring other benefits, the accidental release of modified organisms could have unpredictable ecological consequences.

They call on scientists to ensure that experimental organisms cannot escape from their labs, be released on purpose, or even find their way out accidentally in the event of a natural disaster. Researchers should also be open about the precautions they take to prevent an unintended release, they said.

In the latest study, mosquitoes were engineered to carry genes for antibodies that target the human malaria parasite, Plasmodium falciparum . When released into the wild, researchers believe the modified insects will breed with normal mosquitoes and pass the anti-malarial genes on to their young, making an ever-increasing proportion of future generations resistant to the malaria parasite.

James and his squad employed a genome editing procedure called Crispr-Cas9 to write anti-malarial genes into the Dna of eggs belonging Anopheles stephensi mosquitoes. A major carrier of the malaria parasite in Asia, the strain is responsible for more than 10% of malaria cases in India.

In lab tests, the modified mosquitoes passed on their anti-malarial genes to 99.5% of their offspring, is recommended that the procedure was incredibly effective and efficient. To track which bugs inherited the antibody genes, the scientists added a tracer gene that devoted carriers red fluorescent eyes.

James, who signed the warn in Science, said more run was needed to perfect the gene drive before modified insects can be tested in field trials. But describing the experimentations in Proceedings of the National Academy of Science, he wrote: Strains based on this technology could have a major role in sustaining malaria control and elimination as part of the eradication agenda.

Dr Simon Bullock, a geneticist at the MRCs Laboratory of Molecular Biology in Cambridge, helped to perfect the use of Crispr genome editing in flies, and also signed the call for precautions over gene drive research. Gene drive technology has great potential to help tackle malaria and other global problems in public health. But the capacities of genetic changes to spread rapidly in the wild population means that great caution should be taken when building gene drive systems in the laboratory.

Accidental or malicious release of a gene drive system into the wild could have unpredictable ecological consequences and thus researchers must use multiple safeguards the hell is robust to human error and nefarious actions. Fortunately, several safeguarding strategies are already available, he said.

But Bullock, who was not involved in the research, was surprised that the California group had not described the safeguards they put in place to ensure the mosquitoes did not escape. Devoted the highly sensitive nature of this technology and their call for transparency in this area of research, Im flabbergasted that the authors have not are set out in the publication detailed information on the containment procedures used in this study and how they were evaluated, he added.

Prof Anthony Shelton who studies pest management at Cornell University in New York said the California-based team was justified in its optimism over the procedure. Before open field test, they need to test their bugs in small arenas and field cages to decide the potential for it to work on a larger scale, he told. In theory this technology should work in the field, but farther exams are needed and only then will the full potential of this breakthrough be realized for the benefit of humanity.

Prof Gregory Lanzaro at University of California, Davis added: Concern that narcotic and insecticide resistance are eroding recent successes in managing malaria has drawn attention to alternative approaches, including the use of genetically modified mosquitoes. This new study marks a significant advance toward the development of this strategy.

Read more: www.theguardian.com

Hippy dream now a billion-dollar industry with California set to legalise cannabis

The state that is the worlds sixth biggest economy will legalise cannabis on New Years Day and expects a boom hour for jobs and investment

While Arctic conditions gripped America’s north-east, balmy sunshine bathed Los Angeles last week- but that was not the only reason denizens of the Venice boardwalk were feeling mellow. An astringent, earthy fragrance infused the Pacific zephyrs wafting through the buskers, joggers, skateboarders, tourists and panhandlers.

” Weed is part of the culture here ,” said Oni Farley, 30, perched on a sandy knoll, watching life go by.” It’s part of the LA/ California scene, the laid-back vibe .” He ignored a police patrol car that inched through the throng.” I’ve blazed in front of cops and they don’t said so. To be honest, the majority of members of the time I’m so high I don’t notice them .”

Pot wasn’t hiding. In multiple different ways it was on display.

” Addicted to weed, anything green helps ,” told a scrawled sign tilted against the knapsack of Alexander Harth, 36, a dusty is part of the boardwalk’s homeless population.

On the pavement, Marc Patsiner hawked wooden decorations etched with Californian symbols: sunglasses, palm trees and marijuana leaves.” It’s pretty bohemian out here. People associate us with the foliage .”

A vape shop offered glass tubes and other pot paraphernalia. T-shirt stores peddled images of Barack Obama smoking a joint alongside other herb-themed garments telling ” best buds” and” just hit it “.

On Monday, California, the US’s most populous state, and the world’s sixth biggest economy, was formally” reach it” by legalising cannabis.

Think Amsterdam, but sunnier and vaster- a watershed event for the legalisation movement. Overnight a darknes industry worth billions of dollars annually will emerge into the light, taking its place alongside agriculture, pharmaceuticals, aerospace and other sectors that are regulated and taxed.

It will answer to the newly created Bureau of Cannabis Control- bureaucratic confirmation that a day many activists did not dare dream of has indeed come to pass.

A product pilloried in the 1936 film Reefer Madness will become culturally normalised and economically integrated, said Philip Wolf, an entrepreneur who runs a cannabis marriage company and a firm that pairs pot with gourmet food.” It’s going to help destigmatise the plant. There’s going to be a lot of people making money and people will want to tax those dollars. This is going to spread. California is a trend-setting country .”

California legalised pot for medicinal purposes in 1996, ushering in a web of dispensaries, spin-off businesses and sneaking mainstream acceptance. That culminated in voters last year approving proposition 64 ,~ ATAGEND a ballot initiative which legalised pot sales for recreation. History will mark the date it came into effect: 1 January 2018.

It is expected to unleash profound changes across the nation. The Salinas Valley, an agricultural zone south of San Francisco nicknamed America’s salad bowl, has already earned a new moniker: America’s cannabis bucket. Silicon Valley investors and other moneyed folk are hoping to mint fortunes by developing technology to cultivate, transport, store and sell weed. Entrepreneurs are devising pot-related products and services. Financiers are exploring ways to fold the revenue- estimated at$ 7bn per annum by 2020- into corporate banking.

Customers
Customers at MedMen, a medical marijuana dispensary in Los Angeles. Use of the drug to ease ache and cancer has already been decriminalised in California. Photograph: Richard Vogel/ AP

California is not the trailblazer. Colorado grabbed that mantle in January 2014 when it became the first jurisdiction in the world- beating Washington state and Uruguay by months- to legalise recreational cannabis marketings. California is one of 29 US countries where pot is legal for medical or recreational use. With medical certificates you can criss-cross the country getting legally stoned.

But cultural, political and economic heft constructs California a landmark in the global legalisation campaign. This is the state that incubated the political careers of Richard Nixon, who launched the war against narcotics in 1971, and Ronald Reagan, who continued hardline prohibition policies under his wife Nancy’s slogan ” just say no “.

California’s path to yes meander through Venice, a gritty beachside haven for beat poets, artists and musicians long before hippies wore blooms on their way to San Francisco. The Doors, among others, kept the counterculture torch light in Venice: here they wrote Light My Fire, Moonlight Drive and Break on Through. A giant mural of a shirtless Jim Morrison still peers down from a wall. It was in Venice that generations of Angelenos and tourists toked illicit spliffs. They still do, though it is now a gentrifying tech enclave.

When California legalised pot for medicinal intents many cities and neighborhoods refused to issue licenses for pot dispensaries. In Venice they popped up like toast, as did “clinics” where for a fee ranging from around $20 to $40 physicians issued pot recommendation letters to ostensible patients. Some were genuine, with ailments and pain alleviated by the herb. Many just wanted to get high.” Feigning you have an adversity merely to smoke, that’s ridiculous ,” told Farley, the boardwalk commentator. Having had participated in the navy, he claimed to have post-traumatic stress disorder.” I don’t, but that’s what I said .”

The California Alternative Caregivers‘ dispensary put in store in 2005 on Lincoln Boulevard, on the second floor of a maze of little shops and offices.” It was by design, upstairs, all the way to the back. We didn’t advertise ,” said the manager, Jim Harrison, 46. Pot, medicinal or not, still needed to be discreet. If requested information about his profession Harrison would say he was a healthcare professional.

The sky failed to fall in on Venice, or other areas with dispensaries, and little by little pot became more mainstream, even respectable. Harrison, who wears a white coat and calls his patrons patients, is proud that his dispensary’s protocols, such as sealing and labelling containers and containers, have been replicated in the new country regulations for recreational pot.

Full legalisation feelings historic, he said.” It’s pretty amazing. The cat’s out of the pouch .” His dispensary will create a new space for recreation customers and keep a separate room for patients. Tax on medicinal pot is lower so dispensaries expect that marketplace segment to dwindle but not disappear.

The new epoch may begin with a whimper. State authorities have given counties and cities authority and responsibility to govern the new industry. The result is a patchwork. Some places, such as Kern county, are still banning all commercial pot activity. LA and San Francisco only recently approved local regulations so it could be weeks or month ago freshly licensed pot shops start budding. Oakland, Santa Cruz and San Diego have licensed operators ready to open on Monday.

Golden
Golden state Greens’ budtender’ Olivia Vugrin( right ), serves a client in San Diego, California. Dozens of stores in the country is likely to be selling marijuana for recreational use from tomorrow. Photo: Elliot Spagat/ AP

Donald Trump’s administration casts a shadow because pot remains illegal under federal law. The us attorney general, Jeff Sessions, has compared the herb to heroin and threatened a crackdown. Fearful of federal prosecution, banks are shunning pot industries, leaving the industry stuck with mounds of money which must be transported under armed guard.

Venice’s bohemians helped pave the way to California’s big experiment but it is another California, that of boardrooms and city hall, which stands to gain.

Based on Colorado’s experience legislators across the Golden state are expecting tax windfalls. Labour unions are hoping to recruit thousands and thousands of workers to cultivate and sell pot.

Wealthy investors are snapping up land in Salinas and other cultivation areas with a view to mass production. Others are forming pot-focused business accelerators and management firms. Start-ups are devising new apps, products and services.

Corporate expansion felt a world away from the patch of sand that Harth, the Venice panhandler, called home. Despite the sunshine describing big crowds to the boardwalk he stuffed his sign-” Addicted to weed, anything green helps”- into his backpack. The dollars weren’t coming.

Read more: www.theguardian.com

Hippy dreaming now a billion-dollar industry with California set to legalise cannabis

The state that is the worlds sixth biggest economy will legalise cannabis on New Years Day and expects a boom hour for jobs and investment

While Arctic conditions gripped America’s north-east, balmy sunshine bathed Los Angeles last week- but that was not the only reason denizens of the Venice boardwalk were feeling mellow. An astringent, earthy fragrance infused the Pacific zephyrs wafting through the buskers, joggers, skateboarders, tourists and panhandlers.

” Weed is part of the culture here ,” said Oni Farley, 30, perched on a sandy mound, watching life go by.” It’s part of the LA/ California scene, the laid-back vibe .” He dismissed a police patrol car that inched through the multitude.” I’ve blazed in front of policemen and they don’t say anything. To be honest, the majority of members of the time I’m so high I don’t notice them .”

Pot wasn’t hiding. In multiple different ways it was on display.

” Addicted to weed, anything green helps ,” told a scrawled sign tilted against the knapsack of Alexander Harth, 36, a dusty is part of the boardwalk’s homeless population.

On the pavement, Marc Patsiner hawked wooden ornaments etched with Californian symbols: sunglasses, palm trees and marijuana leaves.” It’s pretty bohemian out here. People associate us with the foliage .”

A vape shop offered glass tubes and other pot paraphernalia. T-shirt stores peddled images of Barack Obama smoking a joint alongside other herb-themed garments telling ” best buds” and” merely hit it “.

On Monday, California, the US’s most populous state, and the world’s sixth biggest economy, was formally” hit it” by legalising cannabis.

Think Amsterdam, but sunnier and vaster- a watershed event for the legalisation motion. Overnight a darknes industry worth billions of dollars annually will emerge into the sunlight, taking its place alongside agriculture, pharmaceuticals, aerospace and other sectors that are regulated and taxed.

It will answer to the newly created Bureau of Cannabis Control- bureaucratic confirmation that a day many activists did not dare dream of has indeed come to pass.

A product pilloried in the 1936 cinema Reefer Madness will become culturally normalised and economically integrated, told Philip Wolf, an entrepreneur who runs a cannabis wedding company and a firm that pairs pot with gourmet food.” It’s going to help destigmatise the plant. There’s going to be a lot of people making money and people will want to taxation those dollars. This is going to spread. California is a trend-setting country .”

California legalised pot for medicinal purposes in 1996, ushering in a web of dispensaries, spin-off businesses and creeping mainstream adoption. That culminated in voters last year approving proposition 64 ,~ ATAGEND a ballot initiative which legalised pot sales for recreation. History will mark the date it came into effect: 1 January 2018.

It is expected to unleash profound changes across the country. The Salinas Valley, an agricultural zone south of San Francisco nicknamed America’s salad bowl, has already earned a new moniker: America’s cannabis bucket. Silicon Valley investors and other moneyed folk are hoping to mint lucks by developing technology to cultivate, transport, store and sell weed. Entrepreneurs are devising pot-related products and services. Financiers are exploring ways to fold non-respendable revenues- estimated at$ 7bn per annum by 2020- into corporate banking.

Customers
Customers at MedMen, a medical marijuana dispensary in Los Angeles. Use of the medication to ease pain and cancer “ve already” decriminalised in California. Photograph: Richard Vogel/ AP

California is not the trailblazer. Colorado grabbed that mantle in January 2014 when it became the first jurisdiction in the world- beating Washington state and Uruguay by months- to legalise recreational cannabis sales. California is one of 29 US countries where pot is legal for medical or recreational use. With medical certifications you can criss-cross the country getting legally stoned.

But cultural, political and economic heft makes California a landmark in the global legalisation campaign. This is the state that incubated the political careers of Richard Nixon, who launched the war on drugs in 1971, and Ronald Reagan, who continued hardline proscription policies under his wife Nancy’s slogan ” just say no “.

California’s path to yes meander through Venice, a gritty beachside haven for beat poets, artists and musicians long before hippies wore flowers on their way to San Francisco. The Door, among others, kept the counterculture torch illuminated in Venice: here they wrote Light My Fire, Moonlight Drive and Break on Through. A giant mural of a shirtless Jim Morrison still peers down from a wall. It was in Venice that generations of Angelenos and tourists toked illicit spliffs. They still do, though it is now a gentrifying tech enclave.

When California legalised pot for medicinal purposes many cities and neighbourhoods refused to issue licenses for pot dispensaries. In Venice they popped up like toast, as did “clinics” where for a fee ranging from around $20 to $40 physicians issued pot recommendation letters to ostensible patients. Some were genuine, with ailments and pain alleviated by the herb. Many just wanted to get high.” Feigning you have an adversity merely to smoke, that’s ridiculous ,” said Farley, the boardwalk commentator. Having served in the navy, he claimed to have post-traumatic stress ailment.” I don’t, but that’s what I said .”

The California Alternative Caregivers‘ dispensary set up shop in 2005 on Lincoln Boulevard, on the second floor of a maze of little stores and offices.” It was by design, upstairs, all the way to the back. We didn’t advertise ,” said the manager, Jim Harrison, 46. Pot, medicinal or not, still needed to be discreet. If asked about his profession Harrison would say he was a healthcare professional.

The sky failed to fall in on Venice, or other areas with dispensaries, and little by little pot became more mainstream, even respectable. Harrison, who wears a white coat and calls his patrons patients, is proud that his dispensary’s protocols, such as sealing and labelling purses and receptacles, have been replicated in the new state regulations for recreational pot.

Full legalisation feels historic, he told.” It’s pretty amazing. The cat’s out of the container .” His dispensary will create a new space for recreation customers and maintain a separate room for patients. Tax on medicinal pot is lower so dispensaries expect that marketplace segment to dwindle but not disappear.

The new era may begin with a whimper. State authorities have given districts and cities authority and responsibility to govern the new industry. The result is a patchwork. Some places, such as Kern county, are still banning all commercial pot activity. LA and San Francisco only recently approved local regulations so it could be weeks or months before freshly licensed pot shops start budding. Oakland, Santa Cruz and San Diego have licensed operators ready to open on Monday.

Golden
Golden State Greens’ budtender’ Olivia Vugrin( right ), serves a customer in San Diego, California. Dozens of shops in the nation will be selling marijuana for recreational use from tomorrow. Photo: Elliot Spagat/ AP

Donald Trump’s administration casts a darknes because pot remains illegal under federal statute. The us attorney general, Jeff Sessions, has compared the herb to heroin and threatened a crackdown. Fearful of federal prosecution, banks are shunning pot industries, leaving the industry stuck with mounds of cash which must be transported under armed guard.

Venice’s bohemians helped pave the way to California’s big experiment but it is another California, that of boardrooms and city hall, which stands to gain.

Based on Colorado’s experience legislators across the Golden State are expecting tax windfalls. Labour unions are hoping to recruit thousands and thousands of employees to cultivate and sell pot.

Wealthy investors are snapping up land in Salinas and other farming areas with a view to mass production. Others are forming pot-focused business accelerators and management firms. Start-ups are devising new apps, products and services.

Corporate expansion felt a world away from the patch of sand that Harth, the Venice panhandler, called home. Despite the sunshine depicting big crowds to the boardwalk he stuffed his sign-” Addicted to weed, anything green helps”- into his backpack. The dollars weren’t coming.

Read more: www.theguardian.com

Sexuality a key part of life for people over 65, analyse says

US survey receives two-fifths of people between 65 and 80 report being sexually active, but topic is rarely discussed

Sex is not only a pursuit of the young and carefree but also a key part of life for adults in their later years, a new poll has disclosed- putting paid to the trope that action stops as pensions loom.

A US survey has found that 40% of those aged between 65 and 80 report being sexually active, with more than half of those who have a partner saying they still engage in steamy moments.

” We recognise that sexuality and sexual health is something that is very important to the health and wellbeing of older people but is not something that gets a lot of attention ,” told Dr Erica Solway from the University of Michigan, who was involved in the research. That, she says, could be because either individuals or medical professionals don’t raise the issue.” We guessed this was a unique way to better understand this issue from the perspective of older people ,” she said.

The findings, part of the university’s National Poll on Healthy Aging, are based on online answers from around 1,000 participants aged between 65 and 80, and are nationally representative. The study was funded by Michigan Medicine- part of the university- and AARP, an interest group for ageing.

The results reveal that 84% of men and 69% of women between 65 and 80 believe sex is important to a relationship at any age, with just over half of men and only under a third of women reporting that the latter are sexually active- although the researchers did not define quite what that involved.” We wanted it to be how that person defined it ,” told Solway.

While 12% of women reported having a strong interest in sexuality, more than 50% of men said the same. Fewer humen were” exceedingly or very” happy with their sex life compared with women.

Age was another key factor. Only a quarter of those aged between 76 and 80 reported being sexually active, compared with 46% of those aged 65 -7 0.

The writers say the report shows that while sexuality is important for many older adults, the topic is rarely discussed with either partners or healthcare professionals- only 17% of participants said they had “was talkin about a” it with a health provider in the past two years, despite almost two-thirds saying they’d be happy to do so.

” Some of these dialogues are not happening ,” told Solway.” It is possible it is because people don’t have problems, but more likely what might be happening is that healthcare providers may be more likely to wait for the older adults themselves to initiate a conversation .”

Solway said the lack of discussion was important , not least because such dialogues could help increase testing and awareness of sexually transmitted infections. According to UK figures, diagnoses of infections such as chlamydia are soaring among older adults.

What’s more, 18% of men and 3 % of women in the 65 -8 0 age group reported taking medications or supplements in the last two years to improve their sexual function.” It is possible that there could be interactions with other drugs that they are taking ,” said Solway.

And there might be other benefits from talking to doctors: recent research has detectedthat while sexuality in older age appeared to protect women from cardiovascular problems, the opposite was true for men.

Lesley Carter of Age UK said the report chimed with findings from England, and that it was time to get rid of stereotypes and misconceptions about sexuality in older age. She added that it was important medical professionals broached the topic with patients:” We know as younger people if you don’t get[ sex] enough then you are quite miserable, but that is the same thing in older people. I think we as a society have to agree that older people have a right to good sex health too, because every message is always about younger people .”

Prof Josie Tetley of Manchester Metropolitan University, who has worked on English analyzes into the issue but was not to participate in the most recent survey, agreed.” Evidenced-based data regarding the English Longitudinal Study of Ageing has identified that sex and intimacy are important issues of ageing ,” she said.

” However, our research recognises that sex and intimacy is not all about penetrative sexuality, and we are looking at how sex and intimacy can be supported in afterwards life through health and relationship supporting .”

Read more: www.theguardian.com

I shouldn’t be criminalised for using cannabis to ease my constant pain | James Coke

A new bill could give hope to millions of people suffering in the UK, argues the writer James Coke

For much of my adult life I’ve had to rise each morning and combat multiple sclerosis. Sometimes it’s a thankless task- my legs scissored together, locked in cramp as I fight to break free of its stranglehold.

I’m convinced cannabis has allowed me to live more of a normal life than would have been possible with the constant ache. I’ve always smoked it. But in recent years I’ve been building cannabis oil and turning it into tinctures. A few drops of my special brew numbs any niggling aches, clear my mind and help me get a good night’s sleep, spasm-free.

But smoking a joint or stimulating cannabis tinctures could land me in jail for five years under our current drug laws. For someone living with MS or any other affliction that can be soothed by cannabis- including “Parkinsons disease”, post-traumatic stress ailment or cancer- the stigma of a criminal record is not ethical or fair.

Since the” war on medications” was launched in the early 1970 s millions of people with medical problems have been getting a bum deal. Cannabis, for centuries lauded for its therapeutic benefits, was unjustly demonised, flung in with the likes of heroin and cocaine, to be expunged from the reach of society. However, the war was lost long ago. It is estimated that the illegal global drug market is worth about $400 bn a year. The figure represents the total failure of the policy and excludes the billions wasted fighting it.

Several UK police forces, including Durham, effectively decriminalised the personal employ of cannabis to prioritise resources. And public opinion supports a change in the law, especially when it comes to medical cannabis. That is only likely to increase after the fight by the mother of a six-year-old boy with a rare form of epilepsy who has been refused a licence to be treated with cannabis petroleum.

Changes in the law in parts of the US, Canada and Germany mean that the use of medical cannabis is now legal there. The shifting in policy has given people the opportunity to choose their medical route, allowing many to escape addiction to prescription opioids.

The UK government appears reluctant to follow suit. Yet since 1998 it has licensed GW Pharmaceuticals to make Sativex. The medicine, for people with MS, are from cannabis plants, mostly grown by British Sugar. It is a step, but ultimately it has ringfenced the developing and sale of medical cannabis at a massively inflated cost. Only a handful of those with MS receive it: the National Institute for Health and Care Excellence( Nice ), which authorises the use of drugs by the NHS deems it too expensive( a year’s supply can cost upwards of PS5, 000 ). You either have to live in parts of Wales or be able to afford a private prescription to benefit.

The formula in each 10 ml Sativex bottle includes the chief components in cannabis- THC and CBD( 2.5 mg of each ). It costs PS125 a bottle and lasts on average 10 days. In comparing an ounce of medical cannabis will cost me PS250 and hold upwards of 900 mg of each component. Once extracted into cannabis oil and dosed accordingly, it can produce about 350 bottles of a product that does the same task, at a fraction of the cost.

Obviously by making the spraying I am transgressing the law- but it helps indicate the hypocrisy of the government’s posture and its inertia in facilitating real reform. The production process is certainly not rocket science, and cannabis is a common herb in many countries, and should not cost an arm and a leg. People are just being held to ransom by an outdated law.

Much remainders on the second reading of Paul Flynn’s private member’s bill on Friday advocating cannabis be made legal for medical utilize. If it eventually passed into law, it would be a landmark day for people living with a chronic illness or in constant pain.

Big pharma and major corporations involved in the industry such as British Sugar may balk at a regulated free market in medical cannabis, seeking to protect their interests. The narcotics pastor, Victoria Atkins, has shown antipathy for any kind of reform to the laws on medical cannabis.( Incidentally her husband Paul Kenward, is the managing director at British Sugar .)

Flynn has got a lot of backers in his corner, though. Legalising medical cannabis might be personal to me, but it should be personal to us all. There are more than 11 million people living with a disability in the UK, and an ageing population means few will be immune from the pain that lies ahead. The benefits seen from the US and across the world offer us a template to build upon.

* James Coke is a novelist. He blogs at thedisabledchef.com

Read more: www.theguardian.com

Alzheimer’s link to herpes virus in brain, say scientists

Research exposes strains of virus more abundant in brains with early stage of disease, though uncertainly whether virus is a trigger or a symptom

The presence of viruses in the brain has been linked to Alzheimer’s disease in research that challenges conventional theories about the onset of dementia.

The outcomes, based on tests of brain tissue from virtually 1,000 people, found that two strains of herpes virus were far more abundant in the brains of those with early-stage Alzheimer’s than in healthy controls. However, scientists are divided on whether viruses are likely to be an active trigger, or whether the mind of people already on the path towards Alzheimer’s are simply more vulnerable to infection.

” The viral genomes were detectable in about 30% of Alzheimer’s brains and virtually undetectable in the control group ,” told Sam Gandy, professor of neurology at the Icahn School of Medicine at Mount Sinai, New York and a co-author of the study.

The survey also suggested that the presence of the herpes viruses in the brain could influence or control the activity of various types of genes linked to an increased risk of Alzheimer’s.

The scientists did not set out to look for a is connected with viruses and dementia. Instead they were hoping to pinpoint genes that were unusually active in the brains of people with the earliest stage of Alzheimer’s. But when they analyse brain tissue, comparing people with early-stage Alzheimer’s and healthy controls, the most striking differences in gene activity were not found in human genes, but in genes belonging to two herpes virus strains, HHV6A and HHV7. And the abundance of the viruses correlated with clinical dementia ratings of the donors.

” We didn’t go looking for viruses, but viruses kind of screamed out at us ,” said Ben Readhead, deputy professor at Arizona State University-Banner Neurodegenerative Disease Research Center and lead author.

Gandy said the team were initially” surprised and sceptical” about the results, based on brain tissue from the Mount Sinai Brain bank, and so recurred such studies use two further brain banks- in total 622 brains with signs of Alzheimer’s and 322 healthy control brains- and saw the very same genes.” We’ve tried to be conservative in our interpretation and replicated research results in three different brain banks, but we have to at the least recognise that these diseased brains are carrying these viral genomes ,” he added.

The scientists could not prove whether viruses actively contribute to the onset of illnes, but they discovered a plausible mechanism for how this could happen. Some of the herpes genes were found to be boosting the activity of several known Alzheimer’s genes.

David Reynolds, chief scientific police officers of Alzheimer’s Research UK, said this element was significant.” Previous studies have suggested that viruses might be linked with Alzheimer’s, but this detailed analysis of human brain tissue takes this research further, indicating a relationship between the viruses and the activity of genes involved in Alzheimer’s, as well as brain changes, molecular signals, and symptoms associated with the disease ,” he said.

However, others were more sceptical. Prof John Hardy, a geneticist at University College London, said:” There are some families with mutants in specific genes who always get this illnes. It’s difficult to square that with a viral aetiology. I’d urge an extremely cautious interpreting of these results .”

The viruses highlighted are not the same as those that cause cold sores, but much more common forms of herpes that nearly everyone carries and which don’t typically cause any problems. The examine in no way been shown that Alzheimer’s disease is contagious or can be passed from person to person like a virus- or that having cold sore increases a person’s risk of dementia.

There are currently 850,000 people living with dementia in Britain, and the number is projected to rise to a million by 2025 and 2 million by 2050. But despite hundreds of medication trials during the past decade, an effective therapy has not yet emerged.

” While these findings do potentially open the door for new therapy alternatives to explore in a disease where we’ve had hundreds of failed trials, they don’t change anything that we are all familiar with the risk and susceptibility of “Alzheimers disease” or our ability to treat it today ,” said Gandy.

Read more: www.theguardian.com

The spectacular power of Big Lens | The long read

The long read: How one giant company will predominate the route the whole world sees

If you have been wearing glass for years, like me, it can be surprising to discover that you perceive the world thanks to a few giant companies that you have never heard of. Fretting about the fraying edge of motorway lightings at night, or words that slide on the page, and occasionally spending a fortune at the opticians is, for many of us, enough to think about. And sights are unusual things. It is hard to think of another object in national societies which is both a medical device that you don’t want and a fashion accessory which you do.

Buying them, in my experience anyway, is a fraught, somewhat exciting exert that starts in a darkened room, where you contemplate the blurred letters and the degeneration of your visual cortex, and ends in a bright, gallery-like space where you enjoy the spry feeling of acetate in your thumbs, listen to what you are told, pay more than you were expecting to, and look forward to inhabiting a new, somewhat sharper version of your existing self.

The $100 bn( PS74bn) eyewear industry is built on impressions such as this. In the trade, the choreography that takes you from the consulting room to the enticing, bare-brick display of PS200 frames is known as” romancing the product “. The number of eye exams that turn into sales is the” capture rate”, which most opticians in Britain( or optometrists, as they are known in the rest of the world) set at around 60%. During the 20 th century, the eyewear business worked hard to transform a physical deficiency into a statement issued style. In the process, optical retailers learned the strange fact that for something that costs only a few pounds to build( even top-of-the-range frames and lenses cost, blended , no more than about PS30 to produce ), we are happy, happier in fact, when paying 10 or 20 hours that sum.” The margins ,” as one veteran of the sector told me carefully,” are outrageous .” The co-founder of Specsavers, Mary Perkins, is Britain’s first self-made female billionaire.

Almost everyone wears glasses at some phase in “peoples lives”. In developed countries, the rule of thumb is that around 70% of adults require corrective lenses to watch well. In Britain, that translates to some 35 million people. But it’s hardly a topic of national dialogue. To the casual commentator, the optical market also presents a busy and confusing sight. In Britain, thousands of independent opticians rub alongside a few big retail chains such as Specsavers, Vision Express and Boots. The wall displays in even a small, local optician hold several hundred frames, metal, acetate and rimless, while posters advertise a range of lenses with sciencey-sounding properties- “freeform”, ” photo-fusion”,” reflex vision”- and names so bland they are hard to remember even when you are looking straight at them.

But what we watch masks the underlying structure of the global eyewear business. Over the last generation, merely two companies have risen above all the remainder to dominate the industry. The lenses in my glasses- and yours too, most likely- are made by Essilor, a French multinational that controls almost half of the world’s prescription lens business and has acquired more than 250 other companies in the past 20 years.

There is a good chance, meanwhile, that your frames are made by Luxottica, an Italian company with an unparalleled combination of factories, designer labels and retail outlets. Luxottica pioneered the use of luxury brands in the optical business, and one of the many powerful functions of names such as Ray-Ban( which is owned by Luxottica) or Vogue( which is owned by Luxottica) or Prada( whose glass are made by Luxottica) or Oliver Peoples( which is owned by Luxottica) or high-street outlets such as LensCrafters, the largest optical retailer in the US( which is owned by Luxottica ), or John Lewis Opticians in the UK( which is run by Luxottica ), or Sunglass Hut( which is owned by Luxottica) is to build the marketplace feel more varied than it actually is.

Between them, Essilor and Luxottica play a central, intimate role in the lives of a remarkable number of people. Around 1.4 billion of usrely on their products to drive to run, read on the beach, follow the whiteboard in biology lessons, type text messages to our grandchildren, land aircraft, watch old movies, write dissertations and glance across eateries, hoping to look slightly more intelligent and interesting than we actually are. Last year, the two companies had a combined customer base that is somewhere between Apple’s and Facebook’s, but with none of the hassle and scrutiny of being as well known.

Now they are becoming one. On 1 March, regulators in the EU and the US gave permission for the world’s largest optical companies to sort a single firm, which will be known as EssilorLuxottica. The new firm will not technically be a monopoly: Essilor currently has around 45% of the prescription lenses market, and Luxottica 25% of the frames. But in seven centuries of sights, there has never been anything like it. The new entity will be worth around $50 bn( PS37bn ), sell close to a billion pairs of lenses and frames every year, and have a workforce of more than 140,000 people. EssilorLuxottica intends to dominate what its executives call” the visual experience” for decades to come.

The creation of EssilorLuxottica is a big deal. It will have knock-on repercussions for opticians and eyewear manufacturers from Hong Kong to Peru. But it is also a response to an unprecedented moment in the story of human vision – namely, the accelerating degradation of our eyes. For several thousand years, human being have lived in more or less advanced societies, read, writing and doing business with one another, mostly without the aid of glasses. But that is coming to an end. No one is exactly sure what it is about early 21 st-century urban living- the time we spend indoors, the screens, the colour spectrum in LED lighting, or the needs of ageing populations- but the net outcome is that across the world, we are becoming a species wearing lenses. The require varies depending where you go, because different populations have differing genetic predilections to poor eyesight, but it is there, and growing, and likely greater than you think. In Nigeria, around 90 million people, or half the population, are now thought to need corrective eyewear.

There are actually two things going on. The first is a largely unreported global epidemic of myopia, or shortsightedness, which has doubled among children and young people within a single generation. For a long time, scientists believed myopia was primarily determined by our genes. But about 10 years ago, it became clear that the way infants were growing up was harming their eyesight, too. The consequence is starkest in east Asia, where myopia has always been more common, but the rate of increase has been uniform, more or less, across the world. In the 1950 s, between 10% and 20% of Chinese people were shortsighted. Now, among teenagers and young adults, the proportion is more like 90%. In Seoul, 95% of 19 -year-old men are myopic, many of them severely, and at risk of blindness later in life.

At the same time, across the developing world, a slower and more complex process is underway, as populations age and urbanise and move indoors to work. The history of eyewear am saying that people do not, as a rule, start wearing glasses because they notice everything has run a little out of focus. It is in order to take part in new different forms of entertainment and labour. The mass market in sights did not emerge when they were invented, in 13 th-century Italy, but 200 year later, alongside the printed term in Germany, because people wanted to read.

In 2018, an estimated 2.5 billion people, mostly in India, Africa and China, are thought to need spectacles, but have no means to have their eyes tested or to buy them.” The visual divide”, as NGOs call it, is one of those vast global shortcomings that abruptly makes sense when you think about it. Across the developing world, straightforward myopia and presbyopia, the medical name for longsightedness, have been linked with everything from high road deaths to low educational achievement and poor productivity in factories. Eye-health campaigners call it the largest untreated disability in the world.

It is also a staggering business opportunity. Essilor and Luxottica know this. It was Essilor that worked out and first publicised the 2.5 billion statistic, in 2012.” For 2,000 years people were living mainly outside ,” said Hubert Sagnieres, Essilor’s chairman and chief executive, when we gratified lately in Paris.” Abruptly, we live inside, and we use this .” He tapped his mobile phone on the table. The legal and technical details of the EssilorLuxottica merger will take a few years to iron out, but Sagnieres was transparent about its mission: to equip the planet with eyewear over the coming decades.” I am driving a very profitable company ,” Sagnieres told me.” You know, between 2020 and 2050, governments will not solve all the problems of the world .”

The looming power of EssilorLuxottica is the subject of morbid obsession within the eyewear world. Everyone knows the new company is poised to have a profound impact on the way that we are going to see. “Forgive me,” said one longtime entrepreneur in key sectors.” But it is nothing short of control of the industry .” One investor described the new firm as a” category murderer “. In many dialogues, people described its arrival, which would have been genuinely unthinkable a generation ago, as both extraordinary and somehow inevitable at the same period. That struck me as the kind of contradiction you come across more often in a person than in a business. And it is true of EssilorLuxottica and, to some extent, the business of vision itself, because it is- to an amazing degree- the legacy of a single man.


Leonardo Del Vecchio is the patron, legend and haunting spirit of the global eyewear business. He is its Citizen Kane and its Captain Ahab. His father died before he was born; his mother was poor; and he was raised in an orphanage in wartime Milan, where he went out to work as a metal engraver at persons under the age of 14. In 1961, Del Vecchio opened a workshop in the town of Agordo, in the Dolomite mountains. He was 25, and starting out on his own. The valley around Agordo was emptying out because of the closure of a mine, and the town was giving away land to companies that were willing to move there. Del Vecchio asked for 3,000 sq metres on the riverbank to build a factory to induce components for sights. He had a young household, and in time, he constructed a home next door to the workshop so he could step from one to the other, starting his day at 3am.

Over the next half century, Del Vecchio grew his company, which was called Luxottica, into the world’s greatest maker of glasses frames. In an industry that was traditionally fragmented and small-scale, the totality of Del Vecchio’s ambition took his competitors by surprise. He sought to control every part in the business, from the metal alloy of the hinges to the stores where eyewear is sold.” Never assume that you have arrived, or look at the world as your only point of reference ,” he liked to say. In a series of audacious takeovers, Del Vecchio acquired brands such as Ray-Ban and Oakley and Persol, and signed contracts with fashion houses such as Armani, Ralph Lauren and Chanel. He constructed factories in China, acquired vision insurance schemes in the US and retail chains on four continents.

Since 1994, Del Vecchio has been Italy’s highest individual taxpayer and the country’s second-richest man. A few years ago, people supposed his career had run its course. But in January 2017, at the age of 81, Del Vecchio announced the greatest deal of his life, in which he also secured the final missing part for his frames- the lenses- when Luxottica agreed to merge with Essilor.” He wants to do this consolidation ,” a former colleague told,” thinking he will leave behind this great company that will last for 100 years .”

When I arrived in Agordo one recent afternoon, it was thinking about starting to snow. The township rests among steep wooded mounds and the bare gray sides of mountains. The blue houses of the Luxottica factory, with Del Vecchio’s house still standing by the entrance, glowed across the river. Although the plant is now merely one of the company’s 12 frame manufacturing facilities, which stretch from Sao Paulo in Brazil to Dongguan in southern China, the founding in Agordo remains Luxottica’s organising myth. Every year, Del Vecchio hosts a Christmas dinner for the plant’s 4,500 employees( the town of Agordo has a population of 4,000 ), which is entertained by an Italian pop star of his choose.” People are screaming and screaming when he comes in ,” said Giorgio Striano, Luxottica’s chief operating officer. In Agordo, Del Vecchio is referred to as simply, “ Il Presidente “.

Leonardo
Leonardo Del Vecchio( right) with Giorgio Armani in Milan, 2013. Photograph: Stefania D’Alessandro/ Getty Images

For the company’s 30 th anniversary, in 1991, Del Vecchio renovated some 15 th-century stables in the middle of Agordo and opened a private glass museum. The curator, Caterina Francavilla, who is the daughter of Del Vecchio’s longtime deputy, showed me round before she closed up for the day. The first glasses were almost certainly induced in northern Italy in the past several decades of the 13 th century.( Lenses are called lenses because they looked like lentils .) But for centuries after their invention, sights and other magnifying lenses were mostly rejected by medical men, who warned of their unnaturalness and recommended potions to correct people’s eyesight instead. In The Perfect Oculist, of 1666, Robert Turner, a London doctor, recommended turtle’s blood and the pulverized head of a bat for the therapy of squints. For weak eyesight, you might try wearing cow’s eyes around your neck.

The cabinets in Del Vecchio’s museum traced the evolution from the leather frames and hinged bridges of the middle ages to the gold rims of the 19 th century. There were opera glasses designed by Napoleon for his Polish mistress, Maria Walewska; a pair of Emperor Franz Joseph’s sights; and some pink “ occhiali appartenenti a Elton John .” No one knows why it took 400 years to put the arms on glasses- which are known as temples, and were pioneered in London in the early 18 th century- so they eventually sat comfortably on people’s ears. To mark another historic milestone, one cabinet also held a copy of Luxottica’s slender debut catalogue, from 1971, when the company induced its first complete frames.

On a shelf near the door of the museum, I spotted A Man Who Sees Far, an official Luxottica biography of Del Vecchio, which was published in 1991. I expected the optical world to be genteel and polite, and was taken aback whenever dialogues turned to the personal charisma, and menace, of Del Vecchio.” He’s the godfather ,” told Dean Butler, who founded LensCrafters in 1983.( Del Vecchio bought it in 1995.)” The godfather, to me, is the guy . He runs it .” One former senior Luxottica executive told me:” Honestly, he kind of rules by dread .” Very few opticians would even mention Del Vecchio’s name- lending him a Voldemort-like aura- for anxiety of offending him, however unlikely that are likely to. One talked about” getting a horse’s head in the bed “. Another concluded our interview by saying:” You can quote me as long as it sounds like I am sucking Del Vecchio’s dick .”

I took A Man Who Sees Far back to my hotel. Even in the company’s hagiography, Del Vecchio goes across as improbably driven and unfeeling. The biographer fights to get a few words with Il Presidente as he traverses the tarmac to his private plane.( Del Vecchio rarely gives interviews; he declined to speak to me .)” There were no kisses , no snuggles ,” his eldest daughter, Marisa, recalls in the book.” Frankly, we were scared of him .”


Del Vecchio built the empire of Luxottica on two ideas. The first was to do everything itself. After the company’s initial progression from components to frames in the early 1970 s, it set out, step by step, to control the entire process of making and selling glass, from acquiring the raw materials to selling its own products “in ones own” stores. No one had done this before Del Vecchio.” There is a simplicity to him ,” one former colleague told me.” To him it is a very simple equation: I build the best stuff, why doesn’t everybody buy it ?”

For the first 25 years, Luxottica remained on the wholesale side of the industry- “behind the curtain”, as it is known- selling its glass through opticians to the public. In the 1990 s, however, Del Vecchio chose he wanted a retail network too. First, he got Luxottica listed on the New York stock exchange, an almost-unheard of move for a mid-sized Italian business.” A plenty of big experts said it was impossible ,” told Roberto Chemello, the chief executive at the time. Luxottica afterward estimated the listing to have been worth around $100 m in advertising in the US- and it laid the ground for Del Vecchio’s hostile takeover of US Shoe, a conglomerate that owned LensCrafters, the country’s largest optical chain, in 1995. On paper, the deal seemed outlandish. US Shoe was five times larger than Luxottica, and its board did not want to sell. Having its own stores would also set Luxottica in direct competition with the thousands of optometrists it had been supplying for decades.” You have to be not only courageous ,” said Chemello, of the transaction,” but a little bit crazy .” Luxottica bought US Shoe for $1.4 bn.

Once the bargain was done, Del Vecchio promptly broke up US Shoe, whose roots went back to 1879, until all that was left were the LensCrafters stores that he wanted in the first place, which he proceeded to fill with Luxottica frames.” That is precisely the formula they have utilized ever since ,” said Jeff Cole, the former chief executive of Cole National Corporation, an even larger optical retailer that sold out to Luxottica in 2004.” When they buy a company, they spend a little time figuring it out and kick out all the other suppliers .”

The formula means that when you or I walk into a LensCrafters, or a Sunglass Hut, or a David Clulow, or an Oticas Carol( which has 950 branches in Brazil) or a Xueliang Glasses in Shanghai, or a Ming Long store in Hong Kong, around 80% of the frames on display will be made by Luxottica. Having its own designers, technologists, factories, render depots and retail outlets- Luxottica currently has almost 9,000 stores and contracts with a further 100,000 opticians around the world- means it can bring products to market faster and in greater quantities than any of its competitors. It also maintains a larger proportion of its earnings as a result.

In the factory in Agordo, I insured dual-armed robots pinning together the front and temples of Ray-Ban Wayfarers, and basket after basket of metal frames being dunked in a series of chemical baths to coat and colour them. Glasses may appear to be relatively simple objects, but they involve between 180 and 230 manufacturing stages to produce. With its own designers, lasers and massive, softly humming machines, Luxottica can take a pencil sketch to global production in about three weeks.” We are in a closed loop ,” told Striano, the operations chief. Taking into account all the different colourings and face shapes( Japanese noses are not the same as Latino noses ), Luxottica has around 27,000 models in production at any one time. Its plants turned off 400,000 pairs of frames per day. I asked Striano if any other company came close.” I suppose nobody ,” he said.

Del Vecchio’s second great insight is the one that changed the nature of the optical business- and that was to combine it with the fashion industry. Although designers such as Pierre Cardin and Christian Dior had been experimenting with frames since the 1960 s, Del Vecchio find a way to take their notions, and more importantly, their labels, to a mass marketplace. In 1988, he signed a licensing enter into negotiations with Giorgio Armani, another self-made tycoon, who had started out as a window-dresser at a department store in Milan. The deal transformed the glasses game. Until then, customers in Europe and America who wanted fancy sights had to rely on staid, industry names such as Zeiss, Rodenstock or Silhouette. After the Armani deal, they could buy Prada, Gucci and Chanel, and they were willing to pay for it.” It generated something ,” as one Luxottica manager artfully told me,” to build the needs where probably they are not .”

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A store selling Luxottica brands Oakley and Ray-Ban in New York. Photograph: Alamy Stock Photo

By the early 1990 s, Luxottica salesmen furnishing opticians in the City of London were attaining so much money that the latter are use chauffeurs to get around.( Armani himself has sat on the board of Luxottica, and owns a 5% stake in it .) In early 2018, Luxottica has around 30 brands, including some that it owns outright, such as Ray-Ban and Persol, or that it makes under licence( Michael Kors, Paul Smith, DKNY, Burberry and so on ).

People in the industry observe that taste in frames follows a approximately 30 -year cycle, from metal, to rimless, to acetate and back again, in which familiar spectacle shapes recur and then disappear. The trend right now is towards metal, and designs that last flowered in Ronald Reagan’s America. In the “Style Area” in Agordo, on the factory’s first floor, I gratified Mario Mollo, a senior product director.” You see now the 80 s is becoming very popular ,” he told.” You ensure shallow, very wide .”

Mollo was poring over a desk of large-scale drawings of a new acetate frame for Oliver Peoples, named “Leonardo”. Spectacle frames require a thousand barely noticeable design decisions, around the shape of the bridge, the thickness below the eyes, or the pantoscopic tilt( how the slant of the lens fulfils the front of your cornea ). The Leonardo had an unusual temple, in which a curving piece of wire “mustve been” sandwiched between two pieces of acetate.” Sometimes this one is not easy to find the right bending ,” told Mollo, tracing his finger along the drawing. Like every other senior Luxottica figure I met in Agordo, Mollo was Italian, male, dressed in cashmere, and wearing a pair of the company’s frames. On a workbench a few feet away, there was a pair of EUR4, 000( PS3, 500) Dolce& Gabbana sunglasses that were hand-painted in Sicily, made out of wood and looked like a carnival float.” With sunshine, you can go totally crazy ,” told Mollo. Luxottica had stimulated only 100 for the entire world. “Crazy,” told Mollo,” but sold out .”

The transformation of glasses from a medical device to a means of self-expression, like clothes or sneakers, has been a source of pleasure for millions of people. But it has furthermore obscured their original intent, and complicated efforts to distribute them as easily as, say, mosquito nets or aspirin. When I mentioned this to Mollo, he recalled a recent trip-up he had taken with Luxottica’s corporate social responsibility program, conducting eye tests and distributing glass in rural China.” They were so happy having the possibility to see. They were hugging us. It was actually not for fashion ,” he said.” Then they started, you know, looking at themselves ,”- Mollo paused for a second-” and the style moment arrived .”

The fusion of the fashion industry and the optical business is now regarded as complete. Until recently, eye-health charities and campaigners used to distribute thousands of pairs of secondhand glasses from richer countries to poorer populations that lacked them. In 2011, the World Health Organization advised them to stop- in part because people were refusing to wear outdated styles.” Being poor doesn’t mean we want to look stupid, you know ,” Prof Kovin Naidoo, who runs the Brien Holden Institute, one of the world’s resulting eye-health NGOs, told me.

My last stop in Agordo was Luxottica’s sample room, a broad, quiet, carpeted space looking out over the river. The room contains every current Luxottica design, arranged on various tables and ranked in order of marketings. The system has been in place since the plant was built in 1972, and during that time, it has been the domain of Luigi Francavilla, Luxottica’s deputy chairman, who is now in his early 80 s.” Glasses are beautiful ,” he told, pausing among the hierarchies of Ralph Lauren, Valentino and Bulgari models.” Especially the ones that sell the most .”

It was snowing outside and Francavilla was wearing a thick blue cardigan. One of the first things he did was to take my glass off my face to identify the tortoiseshell acetate, which is known as Havana. His own glass were a pair of rimless Ray-Bans with pink carbon-fibre temples. Luxottica bought Ray-Ban from Bausch& Lomb, one of the 20 th century’s great optical companies, in 1999. At the time, the label was washed up. You could buy a pair of Aviators at a petrol station for $19( PS14 ).” It was a train smash ,” a former senior Luxottica executive told me.” They were selling Wayfarers at Walmart .”

Del Vecchio paid $645 m( PS476m) for Ray-Ban. During the negotiations, he promised to protect thousands of jobs at four mills in the US and Ireland. 3 months later, he shut the plants and shifted production to China and Italy. Over the next year and a half, Luxottica withdrew Ray-Ban from 13,000 retail outlets, hiked their costs and radically improved the quality: increasing the layers of lacquer on a pair of Wayfarers from two to 31. In 2004, to the incredulity of many of his subordinates, del Vecchio decided that Ray-Ban, which had been invented for American pilots in the 1930 s, should branch out from sunglasses into optical lenses, too.” A lot of us were sceptical. Genuinely? Ray. Ban. Banning rays from the sunshine ?” the former director told.” But he was right .”

Ray-Ban is now the most valuable optical brand in the world. It produces more than$ 2bn( PS1. 5bn) in marketings for Luxottica each year, and is thought to account for as much as 40% of its gains. Francavilla joined the company in 1968. I asked him how a human with a small sights workshop in the Dolomites had come to bestride the global eyewear industry. “ L’appetito cresce con il mangiare ,” said Francavilla. The appetite grows with eating.


How did just two companies- one in frames, and one in lenses- come to predominate something as generic, as obvious, as glass? It’s almost as if the world had one producer for pens, and the other for ink. The conditions that have allowed for the rise of Essilor and Luxottica are rooted, deep down, in the way sights are sold. Until the end of the 19 th century, you could buy a inexpensive pair of glasses- for read or for distance- out of a rack in Woolworth’s, or from a jewellery shop, or a guy in the street. Eyewear was a craft of tinkerers and discoverers.” I this evening did buy me a pair of green spectacles ,” Samuel Pepys wrote in his diary on Christmas Eve 1666,” to see whether they will help my eyes or no .”( They didn’t; Pepys’ failing eyesight forced him to give up his publication three years later .)

It was the birth of the optometry profession, around 1900, that changed things. This was a new breed of sober, respectable spectacle-sellers- not unlike pharmacists- who are seeking to standardise eye testing and to restrict the sale of glass to licensed professionals. Their aim, for the most component, was to raise standards. Eyeglass pedlars in the 18 th and 19 th centuries were notorious for swindles and faulty lenses. But there was also another compelling reason to take a cheap, widely available product and set it in the hands of a few authorised dealers- and that was to make money.

The first opticians had a tough time of it. They were disdained by ophthalmologists- proper eye doctors, who had trained in hospitals and considered themselves above the tawdry trade in glass. The first optometry course in the US was taught at Columbia University’s physics department because it was not allowed inside the medical school.( A remnant of this racism still holds: within the optical industry, optometrists are always being taunted for their chippiness and self-importance.” One step above dermatology ,” a former Luxottica executive sniped to me ).

But the new professionals persevered and, in a way, the story of optometry for much of the 20 th century was of receiving new ways to protect their patch. Across Europe and in the US, optometry laws and regulations were passed to control the prescription and selling of eyewear. Many of these had a “doctorly” aspect, but they also had the effect of creating a highly opaque marketplace. For a long time, opticians fought all manner of advertising, for example, which might force-out them to spell out their costs and allow customers to store around. In some places, this reached ridiculous extremes: in Kentucky, for a time, optometrists’ signs could not be more than four inches high. Under Britain’s Opticians Act of 1958, the display of costs was banned wholly, which meant that opticians were more or less free to build them up on the spot.” The cost would come from a little black book ,” one veteran practitioner told me.” There was a lot of sharp practice around .”

Limiting the number of glass sellers dedicated the largest optical producers opportunities to try and corner the market. As early as 1923, the American government was investigating a scam to fix prices of the nation’s best-selling Kryptok bifocal lenses. After the second world war, researchers at the US Department of Justice uncovered a vast bribe strategy- thought to amount to $35 m a year, and to involve some 3,000 eye doctor- in which the American Optical Company and Bausch& Lomb effectively bribed practitioners to prescribe their lenses. In 1966, after another scandal, the two companies, which at a time fabricated around 60% of the glass sold in the US, were banned from opening new retail and wholesale outlets for 20 years.

This was when Essilor went on the scene. In 1972, Essel and Silor, two French optical companies, merged and began sell aggressively into the US market. Essilor specialised in plastic lenses, which were replacing glass, and it also had a magical product: “Varilux”, the world’s first progressive lens, invented by an Essel engineer named Bernard Maitenaz in 1959. Progressive lenses allow people who are both long- and shortsighted- typically older customers- to combine their prescriptions into a single, graduated lens. The early Varilux models were experimental and not everyone could adapt to them, but they were probably the most important point invention in eyewear since the invention of bifocals around the time of the French revolution. The company set out to make sure that Varilux and the rest of its products( Essilor’s current sales manual operates to around 400 pages) were sold in every optometrist in the world.

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The Essilor department of the Vision Institute research centre at the Quinze-Vingts National Ophthalmology Hospital, Paris. Photo: BSIP/ UIG via Getty Images

Lenses are the pixie dust of the optical business. Barely anyone knows what they are made of, how the objective is constructed and, especially at the high end, exactly how they work. For the last half century, persuading opticians to prescribe Essilor, as opposed to Hoya or Zeiss, the company’s main rivals, has been painstaking, face-to-face work. One British optician, who stocks Essilor, describing him to me this way:” Is there a difference between an Audi, a BMW or a Mercedes? Probably not. But you prefer that badge to that badge, or the route they win hearts and minds .” For years, the company has brought opticians to Paris and its Essilor Academy, where they are wined and dined and taught about its latest products.” It’s not really bribes; it’s the way it works ,” one industry veteran told me.

And when all else fails, Essilor- like its rivals, and like all wholesalers- use financial incentives to keep its customers satisfied. Opticians and industry analysts that I spoke to for this article described how Essilor employs so-called ” spiff money”- offering stores large, multi-year discounts and money bonuses for selling its products- in order to squeeze out the competitor.” Essilor wants to dominate this industry worldwide ,” one retailer told me.” They are actually a well run company. They are not a ruthless company. But they get away with all this crap which in any other industry would be anti-consumer .”

The arrangement suits Essilor and its clients pretty well. The profit margins within the optical business are a closely guarded secret, but insiders explained to me that while opticians might sell frames for two, or two and a half hours, their wholesale price, it is the lenses where they induce the most money, charging markups of 700% or 800% to their clients. The largest margins of all are on complex progressive lenses and protective coatings- for scratch resistance, or to cut out blue light- features that expense Essilor a few cents to build, and which opticians sell for between PS25 and PS50 a pop. Even Luxottica executives are awed by this.” Ray-Ban did a good job of saying Ray-Ban would cost $150, PS150, EUR1 50 and the equivalent across the world. A little bit like the Big Mac, right ?” one former marketing manager told me.” But lenses? Nobody knows how much lenses expense. The customers don’t know. Nobody knows .”

Some opticians call Essilor” The Big E “. The company boasts of rendering between 300,000 and 400,000 stores around the world- three or four times as many as Luxottica.” The strategy has to be absolutely global ,” Sagnieres, the chief executive, told me.” Not just for the rich or poor .” The company has not limited itself to lenses by any means. If Luxottica has expended the last quarter of a century buying up the most conspicuous the components of the optical business( the frames, the brands and the high-street chains) then Essilor has busied itself in the invisible portions, acquiring lens producers, instrument makers, prescription laboratory( where glasses are put together) and the social sciences of sight itself.

The company holds more than 8,000 patents and funds university ophthalmology chairs around the world. In deals that rarely induce the business pages, Essilor buys up Belgian optical laboratories, Chinese resin manufacturers, Israeli tool makers and British e-commerce websites. You can find threads on optometrist message committees with headings like” Essilor Has Bought and Now Owns( Insert Company Name Here )”, which attempt to record all the independent lens makers and laboratories that used to exist. Within the industry, the Big E is generally considered less rapacious than Del Vecchio’s Luxottica; people consider it instead as a kind of unstoppable, enveloping tide.


The first rumour, imagines really, of the two companies joining forces-out began more than a decade ago. The notion has an intuitive appeal- the fulfilling click of lenses with frames- but there were considerable obstacles. The first was culture. Essilor might be huge, but it has retained the feel of a traditional, French industrial enterprise: 55% of its employees are shareholders of the company. Luxottica, on the other hand, functioned more or less like a autocracy, with none of the management structures of most multibillion-dollar companies.” The corporate governance and headquarters of Luxottica were Mr Del Vecchio’s dining-room table ,” one former administrator in the US business recollected of the early 2000 s.” We would fly to Italy, go to his home, show him our annual scheme … He was like,’ Go do that again .'”

The companies watched themselves differently too.” I guess Essilor, while not a model company by any means, has a moral intent ,” the former manager told.” With Luxottica, it’s just lip service. It is all about dominance .” The most infamous Luxottica bargains carried an edge of brutality. In 2001, the company clashed with Oakley, the world’s hottest stimulate of sunglasses at the time. Luxottica had just bought Sunglass Hut, which sold a third of the US’s sunglasses, and Del Vecchio demanded that all its suppliers drop their prices. Oakley refused. In the summer of 2001, the company’s founder Jim Jannard flew to Milan to fulfill Del Vecchio and strike a deal. Jannard had founded Oakley out of the back of his auto in 1975. According to Forbes magazine, at the end of their conversation, he said he hoped the two men would one day be friends.” We will never be friends ,” Del Vecchio reportedly replied.

A few months later, Il Presidente swung into action. In November, Sunglass Hut stopped selling Oakleys. The chain made up around a quarter of Oakley’s business and the market share cost fell by 37%. Then Luxottica began to produce Ray-Bans with bright blue and green lenses that were eerily similar to Oakley’s trademark ” Ice” and “Emerald” coloured shades.” We were doing stuff like generating fake Oakleys ,” a former Luxottica executive who was involved in the strategy told me.” There was a kind of war going on .”

After Oakley sued in 2001, Luxottica issued a statement” denying the allegations in Oakley’s complaint in all material respects” and the case was resolved out of tribunal. But Luxottica won the war, buying Jannard’s company for $2.1 bn( PS1. 5bn) in 2007.

By that time, Del Vecchio appeared ready to retire. In the summer of 2004, as he approached his 70 th birthday, Luxottica’s founder handed over day-to-day control of the company to Andrea Guerra, a young chief executive he hired from Indesit, the Italian white goods company. Under Guerra, Luxottica rationalised its manufacturing, changing more production to China. It also became more stable and predictable. The share price trebled. But according to several former executives who were close to Guerra, he was opposed to any enter into negotiations with Essilor, considering the company as a long-term rival.( Guerra declined to speak with me ).” He did not want to merge with Essilor ,” a colleague said.” He wanted to protect us in a different way .”

In 2014, however, Del Vecchio came back to work. He was 79.” We were all pretty shocked ,” a former senior Italian executive told me. But it became clear that Del Vecchio cares about what would happen to Luxottica where reference is dies.” His most precious infant is this company ,” the US manager told me. Del Vecchio has six children around four matrimonies to three women( he remarried his second spouse, Nicoletta Zampillo, in 2010) but he has always insisted they will never succeed him. According to several senior figures at Luxottica, Del Vecchio came to believe that folding Luxottica into Essilor was the best style for his work to endure, and informal talks between the two companies began.

In many routes, the final chapter of Del Vecchio’s rule at Luxottica has been chaotic and disorienting. Guerra was soon forced out. After that, Del Vecchio went through four chief executive in three years. In his early 80 s, he is no longer the force that he once was. Subordinates told him that Del Vecchio can no longer work a full week and sometimes loses his place in meetings, while demanding to sign off on decisions as small as the floor-plans of new Luxottica stores. Dozens of senior managers have left.” He truly doesn’t trust anyone ,” one told me.

But throughout his shaky return, Del Vecchio maintained his eyes on the award, meeting in secret with Sagnieres, the CEO and chairman of Essilor, until, by the summer of 2016, Sagnieres told, “it was obvious” that the deal would go ahead. When the two men announced the formation of the blended company on 16 January last year in a call to investors, Del Vecchio’s voice came on the line.” I’m very pleased to be here with you today ,” he told,” to present the achievement of a lifetime dreaming .”


Over the coming decades, EssilorLuxottica will have the power to decide how billions of people will see, and what they can expect to pay for it. Public health systems are always likely to have more urgent problems than poor eyesight: until 2008, the World Health Organization did not measure rates of myopia and presbyopia at all. The combined company is able to interpret its mission more or less however it wants. It could share new technologies, screen populations for eye both problems and flood the world with good-quality, affordable eyewear; or it could use its commercial dominance to choke furnish, jack up prices and induce billions. It could go either way.

Right now it is EssilorLuxottica’s putative rivals in developed markets, such as the US and Europe, that are most anxious about the power of the new company. In January, Doug Perkins, the other co-founder of Specsavers, warned that EssilorLuxottica was ” hurling millions of pounds” at new technologies, such as automated optometry kiosks and online retailing, that threatens the future of Britain’s high-street opticians wholly.” That is 100% certain to happen ,” said Perkins.

The bigger scene takes a moment to discern. Late last year, I visited Britain’s most important optical collect, which is kept in the cellar of the College of Optometrists, a townhouse around the corner from Charing Cross Station. For the last 19 years, Neil Handley, the college’s historian, has been cataloguing 27,000 items donated by opticians and eyewear producers, detecting the story of the industry as he goes along.” It’s under the radar ,” he told.” It’s not something that is talked about .” When I asked Handley about the creation of EssilorLuxottica, he pointed to an old display of British sight components, made by a firm called Hadley in Surrey in the 1930 s. Until the 1970 s, and the rise of inexpensive manufacturing in China, Britain used to have hundreds of frame-makers up and down the country.Today it has four.

” What you are seeing is a potential monopoly, and health risks that brings ,” told Handley. While it’s easy to fixate on the brands and the profits of the giants of the optical sector, the industry as a whole must expand dramatically in order to serve the world’s growing, ageing populations and increasing myopia among the young.” The peril is if their proposed answer to these problems turns out not to be the answer ,” said Handley.” They have stifled all opponent, and so nobody else has the chance to come up with the answers .” The stakes are highest in parts of the world that currently do not have anything like enough access to eyewear- what the industry calls the” white spaces” of Africa and parts of Latin America and Asia.

” It is always better if there is more diversity in the market, and less predominance ,” said Prof Naidoo, of the Brien Holden Institute, about the impact of the merger.” I don’t think everyone can argue with that .” In 2013, Naidoo was one of the authors on a groundbreaking newspaper that forecast that half the world’s population will be shortsighted by 2050- virtually 5 billion people. In the course of a single generation, across the world, from Inuit communities in Alaska to secondary-school students in Northern Ireland, researchers have recorded a rough doubling in the number of people who become short-sighted as children.

What’s the world’s loneliest city?

In Tokyo, you can rent a snuggle. Loneliness is a health issue in Manchester. And perhaps nobody is as isolated as a migrant worker in Shenzhen. But can we really know what makes a city lonely?

New York has a trip-hammer vitality which drives you insane with restlessness, if you have no inner stabiliser, wrote Henry Miller after moving back to the city following almost a decade in Paris. It could be expected that the Brooklyn-born novelist would have been happy to return, yet something didnt sit right:

In New York I have always felt lonely, the loneliness of the caged animal, which brings on crime, sex, alcohol and other madnesses. Miller didnt hurt for friends or charm he was married five times but he saw himself as an outsider, forever and ever the ridiculous human, the lonely soul, and it was his hometown that brings with it this fever of loneliness.

Could Millers terms be evidence that New York where countless people have gone to find fame, work, love and even themselves is the loneliest city in the world? Or is it possible that the person or persons , not the place, is the root cause of Millers discontent? And if so, whatisthe loneliest city?

Urban life is more stressful than rural life, but whether its lonelier is a point of debate among social scientists. A 2016 report by Age UK noted there are higher incidences of loneliness in cities, but precisely what brings it on is surprising. The same report found that gender and education are largely irrelevant except for those with the highest level of education, who are often lonelier and that household income and caring for a pet also have little effect.

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Isolation is one of the biggest problems faced by Vancouver residents. Photograph: Ben Nelms/ Reuters

So what impacts loneliness, and how does that play out in cities? The sizing of a household inversely affects how “youre feeling”: the smaller the household, the more lonely it tends to be. And people who rent or own a home are lonelier than those with a mortgage, perhaps because cities with lots of renters such as London, which is expected to have 60% of residents renting by 2025 have greater transience, and potentially lower community involvement. New York, Los Angeles and San Francisco have rental figures hovering in the mid-5 0s. Renters predominate in German cities, too a long-term trend attributed to low rents and housing policies, but one that may end up influencing neighbourhood engagement.

One thing is certain: percentages per of those who live alone has increased dramatically. In the US, 27% of people live alone, up from 5% in 1920, and in New York City its roughly one third. The same trend is evident in Canada, and even more pronounced in Europe 58% of people in Stockholm live alone, a figure that is considered the highest in Europe. In many cities, the trend is here to stay. The Australian Bureau of Statistics estimated that there will be 1.3 m more single-occupancy households by 2025, a jump of roughly 60%, and one that could mob major cities and affect access to affordable housing.

Obscured by those figures, however, is the assumption that living alone leads to loneliness two things the sociologist Eric Klinenberg, author of Going Solo, says are often conflated. In fact, theres little evidence that the rise of living alone is responsible for attaining us lonely, he wrote in 2012. Research shows that its the quality , not the quantity of social interactions that best predicts loneliness. What matters is not whether we live alone, but whether we feel alone.

The demographic that most reports feeling lonely are older people, and they do often live alone. In Stockholm, 35% of people over the age of 75 experienced loneliness, while in Bristol 10 -1 5% reported the same.( Hence the slogan Bristol: a brilliant place to grow old .) Older people are likely to be more lonely in cities, especially if they are poorer, have physical or mental health the questions or live in underprivileged areas.

Campaign to End Loneliness suggested that 7% of older people in the UK are lonely, while age researcher Thomas Scharf determined that 16% of older people in deprived neighborhoods in English cities were severely lonely. Manchester fared worse than Liverpool or London, which may explain why it is treating loneliness as an urban health issue: it made the Valuing Older People programme in 2003 to address, among other issues, loneliness and isolation. Similar projects have leapt up in other cities which recognise that loneliness runs tandem to issues such as segregation, housing, healthcare, and isolation among seniors and others vulnerable citizens.

Migrant
The networks of migrant workers in China might help to stifle isolation, but living and working conditions can be difficult. Photo: Andy Wong/ AP

But its not only older people who suffer from isolation. In Australia, city dwellers have fewer friends than they did two decades ago. In the US, a troubling one in five people said they had only one close friend. Or consider idyllic-looking Vancouver, on the shores of the Pacific Ocean, which struggles not only with affordability( it was recently crowned the most expensive city in Northern america ), but also with friendliness.

The Vancouver Foundation thinktank asked community leaders and charities to identify the biggest issues facing Vancouverites and were told it wasnt homelessness or poverty; it was isolation. Of 4,000 people from 80 -odd ethnic groups who were polled, one third of respondents find it hard to make friends something I discovered firsthand when I expended a rainy, grey winter working in Vancouver, straying Stanley Park alone with my dog at weekends and sitting in crowded cafe by myself. In this young, diverse city, the newly arrived conflict most: among people who had been in Canada for five years or less, nearly half( 42%) had just two close friends.

A dearth of friendship doesnt afflict merely recent immigrants. Many Tokyoites long for friends so dearly that theyre willing to hire them. American writer Chris Colin, intrigued by Japanese affection for hire industries such as cuddle cafes and cat rentals, spent time with a service that offer temporary friends. The clientele was differed, he wrote: widowers, shy single kinds, that one dude who just wanted a friend whod do him the solid of waiting seven hours outside Nike to snag these fresh sneakers for him when they went on sale. The largest of the rent-a-friend bureaux, Client Partner, has eight branches in Tokyo alone.

Cat
Japanese cat cafe have become popular with people living in urban areas, as has the idea of affection for hire. Photo: Junko Kimura/ Getty Images

Across the Sea of Japan, theres a different problem: large-scale migration. As rural Chinese move to big cities such as Shanghai and Beijing, they encounter isolation on an epic level. As of 2012, a staggering 230 million people had migrated from the countryside to cities.( More than half the countrys population now live in cities, up from one one-third in 1990.) Known as the floating population, they can find themselves in low-quality, high-density housing, subject to discrimination and at risk of low social participation, especially if they move frequently.

Researchers surveyed Chinese reports on community social networks, neighborhood attachments and marginality and determined that migrants were more neighbourly which may help them counteract isolation but faced discrimination and, in some cases, grim living conditions: one corporation in the factory city Shenzhen homes more than 200,000 employees in dormitories, which theres been an epidemic of suicides. The report noted: The neighborhood for them is likely to be the factory. Yet in Beijing migrants had greater neighbouring intensity in other words, theyre better at connecting with their community suggesting that migrants may bring much-needed village values to the lonely urban jungle.

If life in Chinas megacities shows anything, it might be that loneliness is often due to situation. This wouldnt surprise Olivia Laing whose new volume, The Lonely City, chronicles a post-breakup stint in New York.The thing with cities is we are absolutely surrounded by people, Laing lately told the Globe and Mail. We can see other people living richer, more populated lives than our own. At the same hour, we can feel very exposed there are lots of eyes on everyone. That is why the loneliness of the city has a particularly distinct tang to it. Loneliness, however, is often like bad weather, it passes through our lives.

So are people in Shanghai or Berlin more solitary than those in Stockholm or Vancouver? I put the question to one of the fields resulting researchers, the University of Chicagos John Cacioppo, who wrote the book, Loneliness. His research disputes the idea that urban life is inherently lonelier than rural life, and he declined to play favourites and picking simply one city. You create an interesting question, he says. Unfortunately, we have no data with which to address it. Perhaps Laing is right that urban loneliness is ephemeral. Or perhaps we can learn from Henry Millers struggle with New York; in 1944, he packed his suitcases and moved to sunny Big Sur, California.

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Does a nose job hurt? You asked Google- here’s the answer | Virginia Blum

Every day millions of internet users ask Google some of lifes most difficult questions, big and small. Our novelists answer some of the more common queries

The nose job. Such an inoffensive, even cheerful, euphemism. An unwanted bump is straightened or the long nose sweetly bobbed.

The nose is simply fixed. Matter-of-factly, we tell friends and family: I dont like my snout, so Im having it done. Once the province of celebrities and the affluent, the nose job has become one of the most popular and accessible procedures. Theres something nearly coy about the term, playing conceal and seek as it does with its stern medical equivalent rhinoplasty, the word the plastic surgeon will use during the consultation.

While rhinoplasty remains a popular cosmetic surgery in both the USand the UK, plastic surgeons admit that it has low patient gratification rates compared to other aesthetic procedures. Many surgeons blame poor patient selection by which they entail patients with unrealistic expectations. Others acknowledge that rhinoplasty is one of the most technically challenging cosmetic surgeries and thus prone to more botched results.

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Advertisement from the 1930 s for the Trilety nose shaper, a nose-shaping device. Photograph: Flickr

As a teenager, I had a nose job that went seriously awry and required revision, a journey that was emotionally and financially draining. For Jewish Americans like me in the 1970 s , nose jobs were fairly common, especially on the two coasts. My parents fostered me to narrow the broad tip-off and, although initially hesitant, I was open to what seemed at the time like a minor intervention. But my surgical outcome was anything but. I was left with a lump on one side of what had been a straight bridge and a flat columnella( the piece between the nostrils ). In chiselling the tip, the surgeon had removed too much of the lower snout, which left me feeling as though part of my face was missing. As period went on, the tip was beginning to sag due to lack of support. After two revise surgeries, I resigned myself given the fact that there existed mistakes that could not be reversed, even by a very talented surgeon.

Still, most patients are very pleased with their outcomes. If you go online to discussion boards that focus on rhinoplasty, you will find abundant accounts by delighted patients extolling their surgeries as life-changing. Some acknowledge that the new nose isnt identical to the perfect nose they anticipated, but are pleased nonetheless.

Patients considering a nose job necessarily have a range of fears, and its indisputable that surgery will cause physical discomfort. With rhinoplasty, the most unpleasant part tends to be during the course of its initial aftermath. Patients are bruised and swollen and their snouts are packed with gauze, but it looks much worse than it feels. Once the initial post-op edema subsides( relatively quickly ), some swell may persist for many months. The degree of pain and post-op swelling and bruising depend on the individuals own threshold for pain as well as the extensiveness of the surgery( rhinoplasties differ from minor to major interventions. Typically, when individuals try plastic surgery, they are so invested in the transformation that the relatively short period of discomfort seems worth it. When I was first considering surgery, I was apprehensive about both the pain and the recovery period( how long before I could re-enter the world looking normal ?), yet I discovered both easily manageable.

What can be truly distressing, however, is the discrepancy between expectation and outcome. Most patients eagerly await the resolution of the swelling as a kind of final unveiling of their beautiful new nose; but sometimes the objective is stunned, as I was, by the revelation of all that went wrong. What was indiscernible in the swollen tip is now exposed as lopsided or dented. The broad bridge of the swollen nose resolves into a twist, the opposite of the smooth straight line the patient was after. Post-operatively, the patient may not exhale as well as they once did.

Other changes can manifest themselves decades after the original surgery. Thinning skin can expose hitherto concealed cartilage grafts, while contracting scars might compromise the nasal structure.

Even though plastic surgeons concede that the operation is complex, much of the popular literature enthusiastically suggests the inevitability of a positive result and minimises, omits or misrepresents the risks. While minor primary surgeries to the nose( say, shaving off a bump) mainly have successful outcomes, more extensive interventions necessitate commensurately more surgical skill.

Surgeons Ive interviewed explain that for young and less experienced surgeons, rhinoplasty has an remarkably steep learning curve due to the lag time between the surgery and its final result a year later; only then can surgeons assess what they should do differently. A recent issue of Annals of Plastic Surgery, published this month, is wholly to be given to rhinoplasty, and its sobering reading. Most articles make clear what the general public doesnt know about the procedure that the technique( as well as outcome) of the nose job remains heavily disputed among surgeons. And there are many things that affect the outcome, from the inherent structure of the individuals snout to the surgeons experience, planning and skill.

Patients who experience poor outcomes often have to resort to expensive revise surgeries. Ones fixed nose, the nose that was intended to increase ones confidence, instead leaves one impression damaged.

For a long time after the initial surgery, my nose was all I insured when I appeared in the mirror. The very idea of cosmetic surgery stirs up fictions of miraculous transformation. Most of us like to believe we are realistic about what surgery can accomplish, but cosmetic surgery comes with implicit promises of the largest physical perfection that can be psychically distorting. When the result is not only less than the patient expected but also worse than the original, it can feel devastating.

Nevertheless, because the healing process is protracted, one tells oneself that what seems bad in the short term is wholly attributable to swelling( at least, thats what my surgeon assured me ). Dont obsess, in other words everything will turn out right in the end. So many “girls ” have been raised on fairytales about ugly ducklings becoming swans “that weve” pre-programmed to be patient in anticipation of beauty. Every day, we look in the mirror, waiting.

Surgical error isnt the only problem. Patient dissatisfaction also ensues from significant disconnections between the surgeons aesthetic goal and the patients. Surgeons might be exhaustively pleased to see results that leave patients distressed. The nose seems strangely short, for example, or the altered tip the surgeon deemed too narrow, the patient now sees as bulbous. The dorsal hump the patient hated before surgery is still in plain view. In these cases, there was a bad match between surgeon and patient.

My first revise surgery was just such a bad match. Because the surgeon agreed that my first surgery was disastrous, I didnt seem any further. Before I went under, I heard him tell a nurse: Seem what some joker did to this poor girls nose. He harvested cartilage from behind my ear in order to replace those bits excised during the original surgery. The surgery on my ear was more painful than my nose and took considerably longer to resolve. Some patients are advised that so much cartilage is required for graftings that the surgeon will need to invaded the ribs for a bountiful furnish. There are associated hazards; although rare, pneumothorax( collapsed lung) is one, and surgeons describe in chilling detail how to assess its severity and remedy it on the operating table. Pain( perhaps prolonged) always results from such intercostal harvesting.

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Advertisement for a nose-shaping device, 1923. Photograph: Alamy

This second nose was very small and didnt suit my face or my notion of what real noses should look like. Put differently, it was a great nose on someone elses face. If I had been paying more attention, if I had even momentarily put aside my driving fantasy about being fixed, I should have recognised that every woman in its term of office, from nurses to receptionists, was branded by his signature style the tiny up-tilted nose.

For my third, and final, surgery I went to a surgeon whose practice was largely devoted to rewriting other surgeons bad rhinoplasties. He not only improved function( the second surgery had partially blocked my airway with bone ), he expanded the bridge and supplemented the supporting structure of the lower third of my snout. This last surgery took place 20 years after the initial operation.

Whatever picture they may bring to the surgeon, patients should be aware that surgeons remake noses in line with their own aesthetic vision. And like any manner tendency, esthetics in noses differ over day. Indeed, they can go out of style. The history of the nose job in the United States is deeply linked to the pursuit of ethnic assimilation to an ostensibly generic American appearance. The paradigm of the perfect snout, unmoored from any particular face, is what resulted in the proliferation of cookie cutter 1960 s and 70 s nose jobs among certain affluent populations in the United States. The ski-slope nose coveted by so many Americans whose ethnic appearance diverged from the persisting white Anglo-Saxon Protestant esthetic, was often tried with little regard to facial context. These surgical noses tended to exaggerate aspects of the Wasp ideal too small, too turned-up, pinched and over-sculpted nasal tips-off. Patients who were initially pleased with their results became less so as fashions in beauty shifted. By the 1980 s, surgeons began to identify the various deformities( such as alar retraction, by which they mean flared nostrils ), links with what for years had been the quintessential fixed nose.

Some surgeons specialised in revising snouts that were now deemed overdone. In the 1990 s, there was widespread criticism of the operate and maintain nose and, in its place, surgeons claimed to build a natural-looking nose tailored to enhance the individual face. Since that time, there has been a growing body of surgical literature exhorting surgeons to attend to racial and ethnic changes, both anatomically and in the service of culturally appropriate aesthetic outcomes. Still, many plastic surgeons persist in aesthetic homogeneity and rely on what they consider the ideal( white) proportions for their surgical templates. Just last year, for example, a study claimed to have confirmed the most attractive measurings for nasal tip projection and rotation among young white girls. Despite increased consciousness among surgeons of aesthetic relativism, “were not receiving” avoiding the obduracy of each surgeons perspective. The plastic surgeon isnt simply a technician; instead, she or he is an individual guided by personal savor. Yet, in a mass culture dominated by celebrity images of beauty, we can feel as though beauty is altogether objective and its criteria universally shared. The presumption of a shared aesthetic can misinform both patients and surgeons.

This is not intended to dissuade people from having surgery. Rather, I am urging prospective patients to be as informed as possible about how experienced their surgeon is, about the varying approaches( eg closed rhinoplasty, where the surgeon works within a limited visual field, v open, where the surgeon unmoors the nose from the face) as well as the real physical the limit of the body itself.

As members of a culture deep invested in physical appearances, we are all at some risk when we visit plastic surgeons, those self-styled architects of beauty. We may be overly vulnerable to their assessment of our flaws because, after all, they are the experts, arent they? There are surgeons who will sweet-talk you. My first surgeon reeled me in with a photo of a model he had operate and maintain, all the while promising an enormous( and candidly impossible) improvement to my appearance.

Make sure you schedule consultations with several surgeons. Ironically, although we commonsensically tend to seek multiple bids on a new roof for our home, when it comes to our own bodies we can be easily swayed by the first magical surgeon we visit. If the surgery have started to audio extensive( if it involves grafts, for example ), you should be doubly cautious because more can go amiss.

If you are looking for an outcome congruent with your race and ethnicity, go to a surgeon who is both surgically experienced with and aesthetically sensitive to a diverse patient population. Different surgeons may present different operative schemes and objectives to you, and you will need to decide among them. One important factor is whose work you like best insist on watching a lot of before and after photos. Of course, photographs can misinform through carefully staged angles and lighting, but at least you will know if you and the surgeon are on the same page regarding appearance.

Imaging software both 2D and 3D are applied to simulate what the change will look like on your own face, is a marketing tool that can be simultaneously informative, seductive, and beside the point. Real flesh and bone will not yield to the scalpel like a two-dimensional image.

The clairvoyant danger posed by such technology comes with the implicit temptation to imagine ourselves as infinitely mutable; this morphed version of our face beckons us into a future of potentially unsatisfying surgeries that dont measure up to the screen image.

Failed nose jobs can become lifelong preoccupations, as patients wander from one expensive surgeon to another. It is not simply the search for the perfect snout that compels us. Many of us yearn for our pre-operated, intact nose so we can go back to the beginning, before the physical and emotional damage caused to our appearance from which we cannot recover. The real risk of rhinoplasty is not inevitably physical at all. It is about becoming more preoccupied with ones appearance after the surgery than before.

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Time 100: FGM campaigner Jaha Dukureh constructs prestigious list

US campaigner induced Obama take action on female genital mutilation, and get practice banned in the Gambia

Anti-FGM campaigner Jaha Dukureh has been named one of the worlds more influential leaders by Time magazine alongside John Kerry, Angela Merkel, Aung San Suu Kyi, Bernie Sanders and Christine Lagarde.

Dukureh, the lead campaigner in the Guardians global information campaign to end female genital mutilation, was honoured in particular for her work in the US and the Gambia but is now campaigning to end the practice worldwide in a generation, employing her experiences as a survivor to build public supporting.

She first came to prominence with the success of her change.org petition, which received more than 220,000 signatures, asking the Obama administration to conduct a new prevalence survey into the current scope of FGM in the United States.

The
The Guardians editor-in-chief, Katharine Viner, with Jaha Dukureh. Photograph: Alicia Canter for the Guardian

Now based in Atlanta, Dukureh has become the leading campaigner against FGM in the Gambia. She is of a new generation of young women in the country who are working through the media to make sure that the mutilation they have suffered is not recurred on their daughters.

In 2015 her campaign led to the Gambia announcing a ban on FGM.

Maggie OKane, coordinator of the Guardian campaign to end FGM, told: The Time 100 award for Jaha Dukureh puts FGM out there slap bang in the middle of human rights agenda, where it should be when 200 million girls and women are mutilated around the world today.

Last year FGM was banned in Nigeria, which joined 18 other African countries that have proscribed the practice, including Central African Republic, Egypt and South Africa.

The Guardian has been working with activists like Dukureh in the UK, US, Kenya the Gambia and Nigeria. The information campaign, supported by the Human Dignity Foundation, begins work in June in Sierra Leone, where 88% of daughters are subjected to FGM which means the forcible removal, usually with a razor blade, of the clitoris and the labia and the sewing up of the vagina.

Somalia, which has the highest prevalence of FGM in the world, has indicated it would like to end the practice, despite significant resistance in the country. Currently, 98% of daughters aged between four and 11 being submitted to FGM in Somalia.

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