• #Travail des #enfants : « Il est difficile de concevoir qu’un pays aussi riche que les Etats-Unis s’attaque aux droits des enfants »

    Ce ne sont pas des boulots pour des gamins. Ce sont des environnements très dangereux. Ils n’y apprendront pas un métier de manière encadrée dans le cadre d’un programme d’étude, ils vont juste faire le sale boulot, du nettoyage, de la manutention dans un environnement non sécurisé. Et puis c’est un comble de vouloir les faire travailler dans les secteurs comme les abattoirs et les entreprises de nettoyage. C’est justement là qu’il y a eu des accidents, des brûlures graves qui ont déclenché les enquêtes du ministère du Travail, parce que les enfants avaient été en contact avec des substances chimiques.

    La proposition de l’Iowa prévoit également d’augmenter le nombre d’heures de travail que les adolescents sont autorisés à faire, jusqu’à six heures par jour pendant l’année scolaire. Imaginez la journée d’un gamin de 15 ans qui rentre de cours à 15 heures, part dans la foulée travailler, n’est pas de retour chez lui avant 22 heures, doit ensuite dîner et faire ses devoirs ! Le seul fait d’étendre les plages horaires de travail revient à diminuer la disponibilité des enfants pour l’école et les conduire à l’échec scolaire. Ces lois sont contraires à leur bien-être. Le texte de l’Iowa prévoit en plus d’exempter les employeurs de toute responsabilité civile en cas d’accident, et même de décès, d’un mineur sur son lieu de travail. C’est particulièrement cynique : cela signifie qu’ils savent que des gamins vont être blessés. Sinon, pourquoi auraient-il pris la peine d’en parler ? Résultat, les employeurs ne vont pas se soucier plus que ça de la sécurité des adolescents qu’ils emploient, puisqu’ils ne craindront pas d’être poursuivis.

  • A Fraught New Frontier in Telehealth : Ketamine - The New York Times

    Un (long) article passionnant. On retrouve un processus qui a créé la crise des opioides. Même si le danger de la kétamine n’est pas comparable, le pattern de comportement des autorités, comme des fabricants, des médecins et des patients est similaire. Et on retrouve toujours « l’excuse » des mauvais comportement avec un « bon » produit que les fabricants d’opioides, notamment les Sackler, ont utilisé très longtemps (avant qu’ils ne se mettent à fabriquer des produits pour sauver des overdoses, puis se déclarent en faillite pour ne pas payer d’amendes).

    Covid-19 exacerbated the nation’s mental health crisis and underscored the inadequacy of many existing treatments, accelerating a reconsideration of once-stigmatized psychedelics. Because the Food and Drug Administration approved ketamine as an anesthetic more than 50 years ago, federal rules allow doctors to prescribe it for other conditions as well, and its use for depression, anxiety and post-traumatic stress disorder was growing before the pandemic.

    With the rule changes in 2020, the at-home ketamine industry appeared practically overnight.

    Tech start-ups and individual doctors began offering medical services online, and so-called compounding pharmacies, which can make variations of approved drugs, found a market for tablet and lozenge versions of ketamine, normally manufactured as a liquid and distributed in vials.

    Primed by glowing media coverage and aggressive advertising, many patients interviewed by The Times came to regard the drug — and its remote availability — as akin to a miracle cure with few risks.

    Studies of recreational users have documented that ketamine — popularly known as K or Special K, with a reputation as a club drug — can be addictive and, when taken chronically in high doses, can cause severe bladder damage that in the worst cases requires surgical reconstruction of the organ. There are indications that abuse may also lead to cognitive impairment.

    Advocates of increased therapeutic use say those issues are exceedingly rare or nonexistent at the doses and frequencies commonly prescribed. But because treatment is remote and there is little mandatory reporting of side effects, it is nearly impossible to accurately gauge their prevalence.

    Many ketamine patients described the drug as a reset button for the brain. During treatment sessions, they experienced pleasant visualizations, sometimes accompanied by a sense of existing outside themselves and melding with the universe. Afterward, their daily problems seemed less weighty.

    The considerable hype surrounding ketamine stems in part from the drug’s ability to affect brain receptors that traditional antidepressants do not target. The psychedelic-like trip, many believe, is integral to the drug’s therapeutic effect.

    But for some patients who spoke to The Times, including a Tennessee cybersecurity manager and a former Pennsylvania factory worker, the profound experiences of their early sessions faded. Chasing the lost high, they sought increased doses, took multiple days’ worth at once or altered the medicine to release more of its payload.

    For others — a Utah data analyst, a California bartender and a Pennsylvania internet entrepreneur — ketamine treatment eventually meant dealing with a constant urge to urinate, often painfully, as well as other bladder ailments.

    The experiences of the dozens of patients who shared their stories with The Times encapsulate both the well-publicized promise of ketamine and the lesser-discussed risks.

    “We know at a certain point you will get both the neurotoxic and the bladder-toxic effects — we just don’t know at what level,” said Dr. Gerard Sanacora, a psychiatrist and leading ketamine researcher at Yale University.

    In the absence of data, some medical professionals said they were becoming more conservative in their prescribing because of anecdotes in published case reports or online forums.

    Professional groups have developed informal guidelines that emphasize catching symptoms early, reducing the dose and spacing out treatments. But some at-home providers are pushing in the opposite direction, viewing ketamine as just another medicine to be taken regularly.

    “I would be worried about chronic usage,” said Dr. Adam Howe, a urologist at Albany Medical Center who advises a group developing treatment guidance. Damage is avoidable with proper safeguards, he said, but “common sense would tell you, if you’re to use this every day for years on end, then at a certain point, you’re going to be damaging your bladder probably.”

    The literature on addiction and abuse among medical users is also thin and inconclusive. Supporters point to studies indicating that patients on ketamine rarely, if ever, have those issues. Others note a pattern common in drug development: an initial overestimation of benefit, followed by more tempered results and recognition of previously undetected harm.

    Production Is Booming

    For years, mental health clinics have administered the F.D.A.-approved liquid form of ketamine that doctors also use to sedate patients in surgery. But at-home treatment created demand for a version that was less potent and easier to take — something not available from drugmakers.

    Enter a uniquely positioned industry: compounding pharmacies.

    These specialized companies operate in a murky regulatory space somewhere between a corner drugstore and a pharmaceutical manufacturer. They can produce variations of approved drugs but do not have to follow the same quality-control rules as drugmakers.

    Most compounding pharmacies do not have to notify federal regulators when they learn of a patient experiencing a problem, and they are rarely, if ever, inspected by the F.D.A. In many cases, the agency may not even know they exist.

    Companies that once served primarily local customers now ship their products across the country as the ketamine boom has presented an alluring opportunity.

    “It’s become the new buzz in this space,” said Jeanine Sinanan-Singh, chief executive of Vitae Industries, which sells a machine that compounding pharmacies can use to produce doses at a faster clip than with other methods.

    Joyous is the new kid on the at-home ketamine block, a reflection of where market forces and scant regulation have taken the fledgling industry. The company has sought to distinguish itself by promoting its tech-driven, customizable treatment plans, but the real draw for many patients is its pricing.

    “I signed up for Joyous, if we’re being honest, just because of the price,” said Francisco Llauger, who, like Mr. Curl, found in-clinic treatments effective but too expensive.

    Joyous illustrates a reality of how at-home ketamine has evolved: Patients with some of the most serious and complicated mental health challenges are turning to some of the most hands-off treatment, according to The Times’s interviews.

    The company has carved out its place with a novel approach: Instead of prescribing higher doses to be taken once or twice a week, Joyous offers lower doses to be taken daily.

    Melding the argots of Silicon Valley and self-care, Joyous delivers treatment primarily by text message, replete with exclamation points and emojis. Each morning, patients receive a questionnaire on their phones asking about symptoms and side effects, and each evening, they get a text with the next day’s recommended dose.

    “Our algorithms use all of this information to tailor the protocol exactly to your brain and body’s needs,” Sharon Niv, co-founder and chief of customer experience, says in a video. In written responses to questions from The Times, the company said its general treatment approach “has been adapted and used by providers nationally and internationally” for more than five years and its internal data indicated that “this medicine is highly effective for both anxiety and depression.” It declined to provide details about how its technology works.

    The company says lower doses translate to lower risk. Yet most of the eight Joyous patients who spoke with The Times said their doses reached the maximum the company would prescribe within weeks. Some providers who generally support at-home treatment expressed concern that taking ketamine every day, even at lower doses, could heighten the risk of tolerance, addiction and bladder problems.

    “We believe that the patients who choose Joyous understand the risks and feel that the benefits outweigh the potential risks,” the company said, adding that nine out of every 10 patients “report feeling better overall.”

    “We want to emphasize that Joyous is a public benefits corporation,” the company said, “meaning that we prioritize public goods over profits.”

    The future of the ketamine boom depends largely on the actions of the federal government in the coming months. While states have some authority, the most important policy decision rests with the D.E.A. If the agency doesn’t take action before the Covid-19 public health emergency is scheduled to end in May, patients may be required to have at least one in-person visit before they can be prescribed ketamine. The D.E.A. declined to comment on its plans.

    Many patients who spoke with The Times expressed hope for a middle ground: something more stringent than the current laissez-faire approach but not so restrictive that a potentially lifesaving treatment became inaccessible.

    Mr. Curl said he hoped that his and other patients’ negative experiences would not ruin the at-home ketamine experiment more broadly.

    “I’m not on a mission to get them shut down or anything,” he said, “because that’s not going to solve any problems for people like me.”

    #Kétamine #Psychédéliques #Dépression #Abus #Pharmacie #Déontologie #Santé_publique

  • Inside the Hunt for U.F.O.s at the End of the World - The New York Times

    L’article est tout en anglais, très long et avec de splendides photos, mais je vous fait un brief : Ces derniers jours l’armée US a abattu 1 ballon chinois en Alaska puis 3 autres « objets volants » à divers points de l’Artique. La Maison Blanche dit qu’elle ne sait pas ce que c’était mais que c’était sans doute des ballons civils perdus. Les pilotes disent que les objets se sont brisés en morceaux quand ils ont été abattus. La région est survolée par beaucoup de ballons perdus.
    Et du coup c’est le bordel. Les politiciens d’Alaska râlent sur le manque de sécurité du territoire, la Chine râle en disant qu’abattre un ballon météo perdu à coup de missile, c’est peut-être un peu exagéré comme réaction, du coup les infos s’entrechoquent : Biden essaie de calmer le jeu avec la Chine (le pourquoi de la déclaration sur les « ballons civils perdus ») mais ça rend les démocrates dingues. Ils disent qu’utiliser des missiles qui valent 1/2 million de dollars pour abattre ces ballons c’est un peu lourd pour le budget national et un peu irresponsable comme réaction.
    Du coup les ufologues pensent tout pareil mais se demandent certainement comme moi comment des ballons peuvent se briser en morceaux quand un missile les touche.

    Robert Powell, a board member of the Scientific Coalition for U.A.P. Studies — the abbreviation that has replaced U.F.O. and means “unidentified aerial phenomena” — has been pushing for Congress to fund formalized research of the craft. In January, the Office of the Director of National Intelligence released a report that documented 366 recent unidentified sightings, many of which were drones, birds or trash.

    People like Mr. Powell are focused on getting answers about the many sightings that do not have an explanation. He does not consider the three downed objects to be in that category. In this case, he said, the government had released just enough information without offering a fulsome explanation.

    Even though he is a stickler for answers, he can see why.

    “If it turns out that the second, third and fourth object were a hobbyist balloon or some university’s research balloon or what have you,” Mr. Powell said, “it would not look good that we shot those down with a half-million-dollar missile.”

  • How #Climate_Change Is Making Tampons (and Lots of Other Stuff) More Expensive - The #New_York_Times

    “Climate change is a secret driver of inflation,” said Nicole Corbett, a vice president at NielsenIQ. “As extreme weather continues to impact crops and production capacity, the cost of necessities will continue to rise.”

  • Opinion | How the $500 Billion Attention Industry Really Works - The New York Times

    Un podcast du New York Times avec Tim Hwang.
    Tim parle très (très) vite, heureusement, il y a un transcript, et aussi la version française de son livre "Le grand Krach de l’attention’

    Tim Hwang is the former global public policy lead for A.I. and machine learning at Google and the author of the book “Subprime Attention Crisis: Advertising and the Time Bomb at the Heart of the Internet.” Hwang’s central argument is that everything about the internet — from the emphasis data collection to the use of the “like” button to the fact that services like Google Search and Facebook are free — flows from its core business model. But that business model is also in crisis. The internet is degrading the very resource — our collective attention — on which its financial survival depends. The resulting “subprime attention crisis” threatens to upend the internet as we know it.

    So this conversation is about the economic logic that undergirds our entire experience of the internet, and how that logic is constantly warping, manipulating and shaping the most important resource we have — our attention. But it’s also about whether a very different kind of internet, built on a very different economic logic, is possible.

    #Tim_Hwang #Podcast

  • How Teens Recovered From the ‘TikTok Tics’ - The New York Times

    Over the next year, doctors across the world treated thousands of young people for sudden, explosive tics. Many of the patients had watched popular TikTok videos of teenagers claiming to have Tourette’s syndrome. A spate of alarming headlines about “TikTok tics” followed.

    But similar outbreaks have happened for centuries. Mysterious symptoms can spread rapidly in a close-knit community, especially one that has endured a shared stress. The TikTok tics are one of the largest modern examples of this phenomenon. They arrived at a unique moment in history, when a once-in-a-century pandemic spurred pervasive anxiety and isolation, and social media was at times the only way to connect and commiserate.

    Now, experts are trying to tease apart the many possible factors — internal and external — that made these teenagers so sensitive to what they watched online.

    Four out of five of the adolescents were diagnosed with a psychiatric disorder, and one-third reported past traumatic experiences, according to a study from the University of Calgary that analyzed nearly 300 cases from eight countries. In new research that has not yet been published, the Canadian team has also found a link to gender: The adolescents were overwhelmingly girls, or were transgender or nonbinary — though no one knows why.

    Perhaps as striking as the wave of TikTok tics is how quickly it has receded. As teenagers have resumed their prepandemic social lives, new cases of the tics have petered out. And doctors said that most of their tic patients had now recovered, illustrating the expansive potential for adolescent resilience.

    Historians looking back thousands of years have come across stories of patients — most often women — with tremors, seizures, paralysis and even blindness that could not be explained. The ancient Greeks called it “hysteria” and blamed a wandering uterus. Sigmund Freud deemed the condition “conversion” and theorized that it was caused by suppressed traumatic experiences.

    In more recent decades, scientists have gained a greater understanding of how anxiety, trauma and social stress can spur the brain to produce very real physical symptoms, even if body scans or blood tests show no trace of them. When these illnesses interfere with day-to-day life, they are now called “functional disorders.”

    “We all recognize that the mind can make the body do things,” said Dr. Isobel Heyman, a child and adolescent psychiatrist at the UCL Great Ormond Street Institute of Child Health in London, who published the first report on the pandemic tics. Most people, after all, have experienced fear that makes their heart race or anxiety that ties their stomach in knots.

    “But when the symptoms are quite bizarre and quite intense — like a seizure, or not being able to walk, or ticlike movements — we think, ‘How on earth can the brain generate symptoms like this?’” Dr. Heyman said. “It just can.”

    Around the time Aidan started to tic, Dr. Pringsheim and Dr. Davide Martino, movement specialists at the University of Calgary, saw a message in an online forum for the American Academy of Neurology.

    “My practice has seen an unprecedented increase in young adolescent women with what appears to be acute explosive motor and vocal tics,” wrote a doctor in Kansas City, Mo.

    The Canadian neurologists had seen the same thing. Most of these new patients did not fit the mold of a typical case of Tourette’s, which generally affects boys and begins in early childhood. Tourette’s tics tend to be simple movements — like blinking or coughing — and they wax and wane over time. In contrast, the new patients were often rushed to the emergency room with tics that had appeared seemingly overnight. They were relentless, elaborate movements, often accompanied by emotionally charged insults or funny phrases.

    The matching accounts from physicians across the world made the neurologists suspect a shared source. They searched on YouTube but found little. Dr. Pringsheim’s teenage daughter suggested that they look at TikTok, an app used by more than two-thirds of American teenagers.

    When they searched for the word “tic” and hundreds of videos popped up, Dr. Pringsheim was stunned.

    “This is the person that I saw in my clinic today,” she recalled thinking.

    The TikTok influencers were saying the same words — like “beans” and “beetroot” — and making the same motions, like thumping their fists on their chests.

    Over the next few months, the influx of patients made the pediatric movement disorder clinic’s waiting list swell from three months to a year. “It was an avalanche,” Dr. Pringsheim said.

    TikTok videos labeled #Tourettes have been viewed 7.7 billion times.

    By last summer, Dr. Martino and Dr. Pringsheim had compiled a detailed registry of 294 tic cases from clinics in Australia, Britain, Canada, France, Germany, Hungary, Italy and the United States. They wanted to know: What made these adolescents so vulnerable to the tic videos, while others scrolled past?

    An overwhelming number of patients had a history of mental health conditions. Two-thirds were diagnosed with anxiety and one-quarter had depression. One-quarter had autism or attention deficit hyperactivity disorder. Roughly one in five had a prior history of tics.

    Eighty-seven percent of the patients were female, a sex skew that was also found in previous outbreaks of mass psychogenic illness. No one knows why girls are more susceptible to this kind of social influence. One theory is that women may seek out belonging more than men do, and may empathize more strongly with others’ suffering. Women also experience higher rates of depression, anxiety and sexual trauma than men.

    At a conference on tic disorders last summer in Lausanne, Switzerland, doctors from several countries shared another observation: A surprising percentage of their patients with the TikTok tics identified as transgender or nonbinary. But without hard data in hand, multiple attendees said, the doctors worried about publicly linking transgender identity and mental illness.

    “These kids have a tough enough life already, and we don’t want to inadvertently somehow make things even worse for them,” said Dr. Donald Gilbert, a neurologist at Cincinnati Children’s Hospital, whose adult daughter is transgender.

    Though the data is limited, some studies have suggested that transgender people have higher rates of functional disorders, which may be related to experiencing higher rates of discrimination, stigma and bias, said Dr. Z Paige L’Erario, a neurologist in New York City who collaborated on the unpublished study.

    These adolescents were “at an already difficult time of their life, going through this pandemic,” said Dr. L’Erario, who is nonbinary. The tics were “a manifestation of their hardship.”

    Other doctors suspect that a small subset of adolescents with serious mental health issues may be more susceptible to social influences. And during the pandemic, adolescents spent more time online, engaging with increasingly popular content related to mental health and gender, Dr. Hnatowich said.

    Shortly after finishing the rehab program, Aidan returned to school. They wrote and directed their first play, and graduated on time, with honors.

    Aidan hasn’t had a tic in a year. They no longer use TikTok — not because they’re afraid of getting sick, but because they find it boring. They still go on Instagram.

    Aidan has learned to better identify and manage their anxiety. With the support of their psychiatrist, the teenager is planning to wean themselves off antidepressants early next year. Their stress about gender has also faded. They now believe that the tics were an unfortunate byproduct of an earnest, if futile search for definitive answers about their mental health and identity.

    “After a year of therapy, I came to the conclusion that labels are stupid,” Aidan said. “I’m just out here.”

    Neurologists said that a majority of the adolescents who developed tics during the pandemic — even those who did not have intensive treatment like Aidan — have stopped twitching. Those who did not get better have often refused to accept the functional diagnosis. Others have struggled to resolve the stressors underlying the tics. Some have developed other symptoms, like seizures or paralysis.

    #Santé_publique #Tourette #Adolescents

  • Record Levels of Sadness in Teen Girls, CDC Reports - The New York Times

    Adolescent girls reported high rates of sadness, suicidal thoughts and sexual violence, as did teenagers who identified as gay or bisexual.

    Nearly three in five teenage girls felt persistent sadness in 2021, double the rate of boys, and one in three girls seriously considered attempting suicide, according to data released on Monday by the Centers for Disease Control and Prevention.

    The findings, based on surveys given to teenagers across the country, also showed high levels of violence, depression and suicidal thoughts among lesbian, gay and bisexual youth. More than one in five of these students reported attempting suicide in the year before the survey, the agency found.

    The rates of sadness are the highest reported in a decade, reflecting a long-brewing national tragedy only made worse by the isolation and stress of the pandemic.

    But about 57 percent of girls and 69 percent of gay, lesbian or bisexual teenagers reported feeling sadness every day for at least two weeks during the previous year. And 14 percent of girls, up from 12 percent in 2011, said they had been forced to have sex at some point in their lives, as did 20 percent of gay, lesbian or bisexual adolescents.

    “When we’re looking at experiences of violence, girls are experiencing almost every type of violence more than boys,” said Dr. Ethier of the C.D.C. Researchers should be studying not only the increase in reports of violence, she said, but its causes: “We need to talk about what’s happening with teenage boys that might be leading them to perpetrate sexual violence.”

    Although the technology’s full impact on adolescents’ mental health is still unknown, he said, there is “no question” of an association between the use of social media and the dramatic increase in suicidal behavior and depressive mood.

    “Kids are now vulnerable to cyberbullying and critical comments, like ‘I hate you’, ‘Nobody likes you,’” he said. “It’s like harpoons to their heart every time.”

    More girls than boys reported being cyber-bullied, according to the C.D.C. report, which found one in five girls said they had been the target of electronic bullying, almost double the 11 percent of boys.

    Dr. Fornari added that the number of adolescents coming to the emergency room at Long Island Jewish Medical Center in New Hyde Park, where he practices, for suicidal thoughts or attempts has increased dramatically in recent decades. In 1982, there were 250 emergency room visits by suicidal adolescents. By 2010, the number had increased to 3,000. By 2022, it was 8,000.

    “We don’t have enough therapists to care for all these kids,” Dr. Fornari said.

    #Suicide #Santé_publique #Etats-Unis #Adolesents

  • Following a Two-Year Decline, Suicide Rates Rose Again in 2021 - The New York Times

    A two-year decline in yearly suicides ended in 2021, as suicide rates rose among younger Americans and people of color, according to a new report from the Centers for Disease Control and Prevention.

    For decades, suicide rates among Black and Hispanic Americans were comparatively low, around a third the rate recorded among white Americans. But a gradual shift is underway, as suicide rates rise in populations most affected by the pandemic.

    Between 2018 and 2021, the suicide rate among Black people increased by 19.2 percent, from 7.3 to 8.7 per 100,000. The swiftest rise took place among some of the youngest Black people, those ages 10 to 24. The suicide rate in that group rose by 36.6 percent, from 8.2 to 11.2 per 100,000.

    Among people ages 25 to 44, suicide rates rose 5 percent overall, and even more significantly among Black, Hispanic, multiracial and American Indian or Alaska Native people. The suicide rate remained highest among Native American and Alaska Native people, increasing by 26 percent, from 22.3 to 28.1 per 100,000, in that period.

    The only racial group that saw a decrease in suicide rates across age cohorts was non-Hispanic white people. That population saw a decline of 3.9 percent, from 18.1 to 17.4 per 100,000. Suicide deaths in the white population numbered 36,681, more than three-quarters of the total number.

    The study did not examine reasons for the divergence in suicide rates among racial groups, but suicide may be influenced by financial stress, social isolation, substance use, barriers to health care and access to lethal means like firearms, among other factors, said Deborah Stone, lead behavioral scientist at the C.D.C.
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    The number of suicides has been climbing for decades and reached its highest point, 48,344, in 2018. Many expected the pandemic to cause a spike in suicides, but in 2020 the numbers dropped for the second year in a row, to 45,979.

    That dip seemed to come to an end in 2021, with a total of 48,183 suicides.

    Previous pandemics, wars and natural disasters have also seen a temporary drop in suicide rates, as communities mobilize to weather a crisis, said Dr. Christine Moutier, the chief medical officer of the American Foundation for Suicide Prevention.

    Collective emergencies bring a “retrenching, with psychological girding and resilience and working against a common enemy,” Dr. Moutier said. “That will wane, and then you will see rebounding in suicide rates. That is, in fact, what we feared would happen. And it has happened, at least in 2021.”

    One factor in rising suicide rates in younger age groups is the “remarkable weakening of our mental health response system,” which has made it extraordinarily challenging to get care for children and adolescents in crisis, said Mitch Prinstein, the chief science officer of the American Psychological Association.

    He offered the example of a friend, who, alarmed when their child expressed suicidal thoughts, waited 36 hours in an emergency room, was sent home after a ten-minute examination “with no resources whatsoever,” and then waited weeks for admission to an outpatient program.

    “It’s just become completely untenable,” he said. “We shouldn’t be surprised that some kids are experiencing a worsening of their symptoms to the point where suicide is more common.”

    #Suicide #Etats-Unis #Jeunesse #Santé_publique

  • H5N1 Bird Flu is Causing Alarm. Here’s Why We Must Act. - Zeynep Tufekci

    Bird flu — known more formally as avian influenza — has long hovered on the horizons of scientists’ fears. (...) things are changing. The virus, which has long caused outbreaks among poultry, is infecting more and more migratory birds, allowing it to spread more widely, even to various mammals, raising the risk that a new variant could spread to and among people.