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The headlines like, Doctors Strike May Be Good For Your Health (as reported in British Medical Journal, 2000)* or "Mortality Rate Goes Down When Doctors Go On Strike" (as reported in Oxford Journal, 2001)* feature frequently in the Medical Journals. K and Israel or the hospital in India (try recalling the strike in Kanpur in the beginning of 2014), it was seen that the death rate decreased dramatically by 40%. The contribution of Modern Medical Industry in human care can be more clearly understood by the report published in Economic Times (Aug 3, 2013). According to the report the state with lowest patient doctor ratio is Kerala with 0. So when it comes to caring for this life especially the medical care, you cannot take chances. If you agree with me then read on with an open mind, this first chapter at least and be prepared to see how Mortality Rate Drops When Doctors Go On Strike; 17 your long-held belief about the health care system, shatters in just few minutes. Throughout the book you will find the video reference* which you can access so that you are more sure about what I am saying. If you want, you can reinvestigate the facts which I am going to present, ask question (hound of the doctors around) and then come to your own conclusion. Life and death of the people around you and even you may already be the victim of the conspiracy of the medical industry. But the disturbing part was that inspite of the best efforts, the health of the patient was undetermining and inconsistent. But there were few unwanted parameters, which were highly consistent: 1) Ever increasing amount of discomfort:* Year 1965 1968 1972 1974 Discomfort Septicemia, Allergy Skin Allergy Skin Allergy, High Blood Sugar Skin Allergy, Diabetes Diagnosed 18: Why Mortality Rate Drops when Doctors Go on Strike Year Discomfort 1980 1992 1995 1999 2000 2003 2006 2010 2014 Skin Allergy, Diabetes, Body Ache Skin Allergy, Diabetes, Body Ache, Cholesterol Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid, High Blood Pressure Diagnosis Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation,Acidity, Thyroid, High Blood Pressure, Obesity Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid, High Blood Pressure, Obesity, Joint Pains, Rheumatoid Arthritis Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid High Blood Pressure, Obesity, Joint Pains, Rheumatoid Arthritis, Palpitation Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid High Blood Pressure, Obesity, Joint Pains, Rheumatoid Arthritis Palpitation Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid High Blood Pressure, Obesity, Joint Pains, Rheumatoid Arthritis Palpitation. List of diseases: Skin Allergy, Diabetes, Body Ache, Cholesterol, Constipation, Acidity, Thyroid High Blood Pressure, Obesity, Joint Pains, Rheumatoid Arthritis Palpitation. List of symptoms/discomforts: Body Aches, Knee pain, Palpitations, Acidity, Constipation. List of drugs with dosage: Huminsullin -30/70, Diamicron 30mg, Loscar 50mg, Ellixca-125,Nebistar-10mg, Ivabrad-5mg, Detemir Insullin 10 unit, Levorid-5mg, Mixtard 30/70, Jalra (50gm),Glimiastar-1mg 4. Monthly medical bills (including doctors fee, Emergency handling, diagnostic, drugs): (approx Rs 9375 to Rs 10,000) At this point I must mention that Mr. Today, while I am writing this book, its 2nd June 2015, roughly little more than 1 year from the day when Mr. This is what he did: He did nearly opposite of what doctors had been recommending for the last 50 years during the treatment of the patient. He reduced the dairy consumption of the patient to nil (doctors have been suggesting ample milk intake for the bone health). Patient started drinking 2 glasses of coconut water a day (doctor prohibited the patient from drinking coconut water fearing that high potassium level in coconut water may damage otherwise already compromised kidney). Within few weeks of following the seemingly suicidal approach for cure, something unusual happened. Diabetes for past 10 yrs High Cholesterol for past 8 yrs 22 Why Mortality Rate Drops when Doctors Go on Strike 5. Knee Pain for past 6 yrs Medication: Amitiza (50gm), lisinopril oral (25 mg), Glumetza (25mg), lipitor (25mg), Levodopa(50 mg), home remedies for knee pain. Although both the patients recovered but you may be confused about the irresponsible behavior of Mr. He tried this approach on himself and could get rid of diabetes and also skipped the much recommended dental surgery. This Accidental Doctor is Mr Yogeshh Mittal and the 2 patients (whose information I just shared) are his mother Mrs. She wanted to discuss with me if there was any possibility of skipping the otherwise recommended dental surgery. Indupreet) decided a set of protocol based on the new medical research, "The China Study" (you will get to know more about it later in the book). Mortality Rate Drops When Doctors Go On Strike; 23 Since then healing people became a full time passion for Mr. In the past also many intellectually evolved people have bypassed the conventional protocol of medical treatment and did something radically opposite and could quickly recover from the disease. End Note: Here it is important for me to mention that being qualified in lifestyle disease & nutrition and also in emergency medicine, I can tell you with authority that although modern medicine has failed miserably in the care & cure of life style diseases but has done a commendable job in handling the medical emergencies.
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The opioid epidemic has devastated American communities, and the Trump Administration has completely failed in its response, leaving millions of families desperate for help. Democrats will make medication-assisted treatment available to all who need it, and will require publicly supported health clinics to offer medication-assisted treatment for opioid addiction. Democrats recognize that incarcerated people suffer from serious mental health and substance use disorders at higher rates than the general population, which is why we will support expanded access to 33 mental health care in prisons and for returning citizens. We will ensure no one is incarcerated solely for drug use, and support increased use of drug courts, harm reduction interventions, and treatment diversion programs for those struggling with substance use disorders. Democrats support measures to eliminate state waiting lists for home and community based care, including through a significant expansion of the home care workforce, and will work to develop a broader approach to eliminate the institutional bias within Medicaid. Democrats will also pursue policies to improve nursing home staffing and quality standards, strengthen accreditation processes, and combat corporate abuses in nursing homes. And Democrats are strongly committed to protecting and enforcing the Americans with Disabilities Act and fulfilling the promise of the Olmstead v. Eliminate Racial, Gender, and Geographic Health Inequities the national statistics on American health care mask profound disparities in insurance rates, access to primary and specialized care, and health outcomes. Black children are more than twice as likely as white children to suffer from asthma. Latinos, Native Americans, Asian-Americans and Pacific Islanders, and Black Americans are diagnosed with diabetes at higher rates than whites. And average life expectancy is almost three years lower for rural Americans compared to those who live in metropolitan areas. Democrats are committed to eliminating health disparities by race, ethnicity, gender, and geography. That is why Democrats will launch a sustained, government-wide effort, with leadership at the highest levels, to eliminate racial, ethnic, gender, and geographic gaps in insurance rates, access to quality care, and health outcomes. That includes tackling the social, economic, and environmental inequities-the social determinants of health like poor housing, hunger, inadequate transportation, mass incarceration, air and water pollution, and gun violence-that contribute to worse health outcomes for low-income Americans and communities of color. People of color-and particularly Black people and Latinos-are more likely than average to live near heavy polluters, including ports, power plants, and industrial sites. Air pollution contributes to higher rates of asthma, heart disease, premature birth, and low birth weights, among other serious health issues. Democrats will put environmental justice at the center of our climate change and energy policies, and take steps to remedy the legacy of decades of cumulative pollution impacts on frontline communities by creating a new environmental justice fund. Black men are significantly more likely to die from heart disease and stroke than white men. Among Latinos and Asian-American and Pacific Islanders, health disparities vary considerably depending on income and country of origin, particularly for first-generation Americans. We can and must fix these inequities by expanding coverage, making health care more affordable, and tackling implicit bias in our health care system. Democrats will ensure federal data collection and analysis is adequately funded and designed to allow for disaggregation by race, gender, geography, disability status, and other important variables, so that disparities in health coverage, access, and outcomes can be better understood and addressed. Native American tribes have for too long been forced to cope with insufficient access to health care and mental health services, nutrition services, and modern infrastructure. Democrats are committed to pursuing environmental justice and climate justice, including for indigenous peoples and communities, and will invest significant new resources in clean water and wastewater infrastructure, clean energy generation and distribution, and sustainable and regenerative agriculture. Like the majority of Americans, Democrats believe that every woman should be able to access high-quality reproductive health care services, including safe and legal abortion. We are proud to be the party of the Affordable Care Act, which made prescription contraceptives available free of charge to all women and has helped significantly reduce teen pregnancy rates. Democrats are committed to ending sexual assault and domestic abuse, and will act swiftly to overcome Republican obstructionism and reauthorize the Violence Against Women Act. And Democrats will increase resources to eliminate the national backlog of untested rape kits so that more survivors can see justice be served. We believe that expanding access to mental health care is key to confronting the epidemic of suicides-by-firearm, including among veterans. Democrats will ensure the Centers for Disease Control and Prevention have sufficient resources to study gun violence as a public health issue and support evidence-based programs for preventing gun violence. Far too many of them have lost their lives to this terrible disease, and untold thousands are suffering the mental and emotional strain of losing far too many patients. And yet, despite the critical role they play in our society and our economy, these frontline workers are often underpaid and lack access to paid sick days, health insurance, and other benefits critical for their own health and the health of patients. Democrats believe that all jobs in the caring economy must come with family-sustaining wages, good benefits, access to training and professional development, and the ability to join a union and collectively bargain.
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Change the tax code to further help working families: Reform the tax code to be more progressive and equitable, while also reducing barriers for families who are eligible for benefits from receiving targeted tax breaks. Provide more generous refundable tax credits to benefit lowand middle-income families, including more equitable access to tax provisions that build wealth and support working families. Labor Unions and Worker Rights Strong unions defined what it means to live a good life and know you can take care of your family. The following proposals will build a stronger, more inclusive nation by strengthening public, private, and federal sector unions and helping all workers bargain successfully for what they deserve. In addition, ban captive audience meetings, and penalize companies that bargain in bad faith. Appoint members to the National Labor Relations Board and National Mediation Board who will protect, rather than sabotage, worker organizing, collective bargaining, and legal rights to concerted action including strikes. Ensure federal dollars do not flow to employers who engage in union-busting activities, participate in wage theft, or violate labor law. Ensure workers can bargain with the employer that actually holds the power, including franchisors, and ensure those employers are accountable for guaranteeing workplace protections. Embrace labor market competition by eliminating barriers to mobility and addressing harmful labor market practices that distort the balance of power and create monopsonylike conditions. This includes outlawing unnecessary non-compete clauses, no-poaching agreements, inadequate wage transparency, mandatory arbitration, burdensome occupational licensing restrictions, and excessive concentration of employers in local labor markets. Ban individual forced arbitration agreements where workers waive their rights to civil action. And, mandate that contractors publicly disclose plans to recruit and advance people of color, women, people with disabilities, and covered veterans and will increase enforcement efforts, including pursuing debarment where contractors refuse to end discriminatory practices. When undocumented immigrants are victims of serious crimes and help in the investigation of those crimes, they become eligible for U Visas. Ensure that workers on temporary visas, including guest teachers, are protected so that they are able to exercise the labor rights to which they are entitled. We need to take bold action to rebuild and strengthen our economy and restore jobs for all. In order to ensure that everyone who wants to work has a pathway to employment, the government must enact measures to create jobs and jobs programs like those effectively used during the New Deal, and ensure such programs are inclusive for women and people of color. These programs should focus on lifting wages, expanding public services, strengthening bonds with communities, protecting workers, and building our public, physical, and human infrastructure so the United States is more resilient to future pandemics, climate change-fueled catastrophes, and economic downturns. Transformational federal investment is needed in initiatives such as a clean energy revolution in all sectors of the economy (power, transportation, buildings, agriculture, industry), growing employment and raising wages in the care economy, and American manufacturing and physical infrastructure. We must also support training models, such as registered union apprenticeships, that both provide earnings and directly connect to a job. Infrastructure: In all federal investments in infrastructure, including those undertaken both as stimulus and in periods of a growing economy, undertake productive infrastructure projects which prioritize community cohesion, local hiring, and equal access to public benefits. At the same time, develop a procurement system which embraces equal access to federal contracts for minority- and women-owned businesses. Support new jobs through an unprecedented investment in public infrastructure, including roads, bridges, transit, rail, ports, airports, waterways, freight, energy, and broadband, and increasing the number of sustainable homes. Support investing in the education and training of underrepresented groups in the construction trades, including people of color, low-income individuals, women, veterans, and people with disabilities. Provide economic empowerment through retrofitting public housing infrastructure to create safe and healthy homes and union jobs. Substantially expand investment in the National Housing Trust Fund and repair and rehabilitate public housing. Support a workforce to retrofit America through public programs that revitalize not only publicly owned buildings, homes and businesses. Mobilize the next generation of workers-a new corps and cohort challenged to conserve our public lands, deliver new clean energy, and address the changing climate. In the 21st century, the Internet is not optional: It is a vital tool for participating in the economy, and all Americans need access to high-speed, affordable broadband service. Prevent states from blocking municipalities and rural co-ops from building publicly-owned broadband networks, and increase federal support for municipal broadband.
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Many of these disorders are identified only after a significant medical odyssey involving multiple medical evaluations over several years. In 2001, the Institute of Medicine identified the lack of good symptom control, failure of care coordination, and absence of decision-making support for children at the end of life as a national crisis. At the time, the majority of children with complex medical illness died with poor pain control and without access to quality home hospice care, and families had no provision for bereavement care. In response, the field of pediatric palliative medicine was created to address these gaps while still promoting a dedication to discovery for rare diseases. This is accomplished by helping physicians, parents and patients come to a common understanding of the available prognostic information, set reasonable goals for care, and then make medical decisions within the context of those goals. They may be offered a myriad of confusing and complicated medical treatments and face difficult medical decisions with no clear right or wrong answers. Inborn errors of metabolism often are more treatable, but still can lead to significant morbidity and mortality. Created in 2003, the Supportive Care Team provides high-quality, family-centered palliative care to children with life-limiting and life-threatening illnesses. The team is comprised of a board-certified pediatric hospice and palliative medicine physician, a nursing manager with years of hospice training and experience, an advanced practice provider, and a full-time bereavement coordinator. Together with the genetics team, they provide expert management of symptoms including pain, anxiety, depression and airway management. When medical interventions become solely comfort-based, the supportive care team is able to provide direct management of in-home hospice, or end-of-life care in the hospital. After the death of the child, parents, siblings and extended family suffer tremendously, and via the bereavement coordinator, the supportive care team provides grief resources, events and individualized follow-up care to those in need. Importantly, the involvement of a palliative medicine team does not preclude those fighting disease from making new discoveries. Whenever appropriate, patients may be offered experimental treatments aimed at either slowing down or reversing the effects of a metabolic error. Even in situations where a cure is sought, the early involvement of palliative medicine specialists can ensure that the quality of life for a patient is preserved and enhanced. Geneticists and palliative medicine specialists have even worked together to help patients comply with novel treatments such as enzyme replacement therapy. As we learn more about rare metabolic and other congenital disorders, the treatment of these conditions becomes more and more complex. Parents and children who find themselves in these impossible circumstances deserve care that provides hope for the future and comfort and compassion now. Working together, families, genetics specialists and palliative care providers can provide care which pushes the frontiers of medicine further, while still providing these patients a chance to be children. Mauer is medical director, Supportive Care Program, and assis- tant professor of Pediatrics, Division of Hematology/Oncology at University of Pittsburgh School of Medicine. Patients diagnosed with an end-stage disease or who are suffering from multiple chronic illnesses need to be identified, engaged by their health care providers and counseled on disease management and symptoms management. Doing so should provide the patient and his/her family ample time to ask all the right questions and then decide collectively on the best treatment plans. Lately, many outpatient services have been developed to assist those patients and their caregivers in managing terminal or chronic diseases primarily outside of the hospital walls. Those services need to be further developed and supported to achieve favorable results. Oftentimes when those services are not adequately provided, patients are admitted to the hospital in order to address any unmet needs. In many hospitals, Palliative Care Teams are asked to provide their recommendations and expertise. According to a recent report by the Center to Advance Palliative Care, "Hospital palliative care teams are often overstretched and unable to see every hospitalized hen faced with the hard task of engaging a patient and his family in a conversation about endof-life care, hospitalists occasionally are unprepared, but mostly they are facing unfavorable circumstances. One needs to establish trust and rapport with the patient and his family even prior to initiating the "talk. Often when those conversations are conducted in an acute-care setting without adequate preparation, the most common conclusion is the physician or the staff declaring, "They (meaning the family or the patient) are not ready. If we are serious about avoiding unnecessary, lengthy and potentially harmful hospitalizations for the most vulnerable patients, the right process should lead to a better outcome every time. Hospitals generally are the costliest Hospitals need to ensure that empathy training is available and encouraged. The Institute for Healthcare Improvement did publish a detailed framework built on five core principles to help hospitals and other health care organizations improve end-of-life care.
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From a young sailor who had deserted his ship at Rendang-Lobo and somehow made his way across the Strait, the Raja had learned to speak English with remarkable fluency, but, also, in faithful imitation of his teacher, with a strong Cockney accent. There was something, to him, inexpressibly improper about a king who spoke like Sam Weller. Besides being a king, the Raja was a man of intellect and the most exquisite refinement; a man, not only of deep religious convictions (any crude 149 oaf can have deep religious convictions), but also of deep religious experience and spiritual insight. That such a man should express himself in Cockney was something that an Early Victorian Scotsman who had read the Pickwick Papers could never get over. At their first tragic meeting, that shocking, lower-class accent seemed strangely touching. Laying the palms of his hands together in a gesture of supplication, the sick man whispered, Elp me, Dr. Then, turning to the attendants who had been hovering all this time in the background, he ordered them out of the room. They did not understand the words; but his tone and accompanying gestures were unmistakably clear. Andrew took off his coat, rolled up his shirt sleeves and started to make those famous magnetic passes, about which he had read with so much skeptical amusement in the Lancet. It was all fraud and humbug; but all the same he was determined to make this poor devil go to sleep, even if it took him the whole day to do it. He mopped his face, then rose, stretched his arms and took a couple of turns up and down the room. An hour before it had been running at almost a hundred; now the rate had fallen to seventy. He let go, and the arm dropped by its own weight and lay, inert and unmoving, where it had fallen. It was all quack-ery, humbug and fraud, but all the same it worked, it obviously worked. Andrew began by telling his patient that henceforward he would be able to swallow without pain. And between meals he put him into trance and kept him asleep until it was time for another feeding. But this unshakable confidence did not prevent him from doing everything that might contribute to its success. The trance, he kept telling his patient, was becoming deeper every day, and on the day of the operation it would be much deeper than it had ever been before. Andrew made these affirmations with a mixture of total skepticism and complete confidence. But in the present context past experience had 152 Island proved to be irrelevant. The important thing was to say that it would happen-so he said it, again and again. You just lie there, comfortably asleep, while I dissect the cheek back to the nose. It has its roots there in the antrum and it has grown upwards, under the cheekbone, into the eye socket, and downwards into the gullet. And as I cut it loose, you lie there as before, feeling nothing, perfectly comfortable, completely relaxed. Ten minutes later, after making some more passes and telling his patient to sleep still more deeply, Dr. He stretched the skin, he made the incision, he dissected the cheek, he cut the tumor away from its roots in the antrum. The Raja lay there perfectly relaxed, his pulse firm and steady at seventyfive, feeling no more pain than he had felt during the make-believe of the rehearsal. Four hours after the operation was over, he was still sleeping; then, punctual to the minute, he opened his eyes, smiled at Dr. Andrew between his bandages and asked, in his singsong Cockney, when the operation was to start. After a feeding and a sponging, he was given some more passes and told to sleep for four more hours and to get well quickly. The Raja suffered almost no pain and, in spite of the thoroughly septic conditions under which the operation had been performed and the dressings renewed, the wounds healed without suppuration.
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Leaders must also be able to maintain smaller coalitions that will have the consensus necessary to target specific issues, even if that same coalition could not be held together to pursue other endeavors falling under the umbrella of the Campaign. Effective leadership must facilitate and maintain collaboration where there is common ground, and partition the effort so that people who cannot agree on certain issues can still be involved and contribute without having other areas of disagreement make them abandon the Campaign altogether. As a working assumption in the formative stage of the Campaign, Hunt Alternatives Fund has stipulated that the Campaign should be designed to last for 10 years. A substantial timeframe conveys the message that the Campaign is serious and substantial, and intends to see things through until its objectives are achieved or substantial progress is evident. In addition, the key advantage of the decade timeframe is that it will facilitate planning, and allow for a sequential rollout of initiatives and the establishing of information Abt Associates Inc. Chapter 2: Strategic Frameworks for the National Campaign 2-43 feedback loops and refinement. For example, if the Campaign is of the scope that is anticipated, there will be a core staff of leaders and support personnel. People will make career decisions and take positions as leadership or staff tasked to pursue the National Campaign, and it will be much easier to attract staff if they know that the Campaign is designed to last, rather than push for a few years and then dissolve-much like many grant-driven programs do. In addition, the Campaign will be comprised of a variety of targeted and sometimes localized initiatives, and for people to prioritize the work of the Campaign and fit it into already busy schedules and already stretched resources, it will be important to know that the Campaign intends to operate for more than a very short timeframe. While there are advantages to the 10-year timeframe, there is the potential for one disadvantage: it could convey the message that substantial accomplishments cannot be expected soon. The way social movements often work is that there are long periods of plodding work and plateauing, where progress is slow and incremental, but that tipping points can be reached or opportunities emerge that allow for quite sudden breakthroughs and monumental shifts to entirely different levels of achievement. Hopefully, this Campaign will be a driving force behind a substantial and swift shift, and it should not be assumed that 10 years will be needed to see results. Given the amount of attention that human trafficking currently receives and the apparent readiness of the field to be mobilized, there is no reason to believe that significant accomplishments cannot occur within the first year or two of the Campaign. Even if breakthroughs occur relatively quickly, commitment to a longer timeframe will still be necessary. Breakthroughs do not mean that the problem is solved, and it is likely that there will be evident, tangible needs for the Campaign to work for the entire decade and beyond to ensure that early gains are maintained, and to implement programs and practices that may be authorized or funded early in the Campaign-but not yet executed. That said, it is important to proceed aggressively and to approach the first year with a sense of urgency, fully expecting to achieve significant successes in mobilizing action that will lead to a paradigm shift that is the ultimate goal of the Campaign. We also believe that it would be a fatal mistake to proceed so deliberately that the Campaign is not expected to be at full strength until three or five years out. While many initiatives cannot be launched immediately, and the knowledge necessary to launch them will take years to assemble, those longer-term initiatives should be running parallel while the most visible major efforts move quickly to push public opinion and political will over tipping points immobilizing action. Framing the National Campaign and the Issues it Pursues How the issues are framed and presented will have important consequences for many aspects of the National Campaign. Part of the framing issue is addressed when the Campaign decides upon its priorities and actions. What the Campaign will be about and how it will proceed sets the boundaries of how its core issues can be framed. However, given a set of clearly defined issues, priorities, and a course of action, there is a great deal of flexibility in how they can be presented, and choices made about emphasis and communication strategy can affect how successful the Campaign will be in forming and holding its coalition, attracting donors, influencing the public, and generating the political will necessary to support effective interventions. For the moment, let us assume that the Campaign will focus on the set of core objectives outlined earlier: impacting buyers and potential buyers of commercial sex by engaging in a number of efforts reaching them directly, such as education and law enforcement operations. The Campaign will also pursue objectives to make those direct interventions possible and effective: producing a paradigm shift in public awareness and political will, which will give practitioners the resources and the mandate to take effective action. Within that framework, there will be a focus on particular targets, and on strategies and tactics that are concrete and can be described in ways that are easily understood. Once finalized, the values, principles, and assumptions driving the Campaign can be clearly understood among donors, the coalition, and partners. The emphasis placed on certain initiatives and how they are described will be important. For example, the Campaign may work to combat all forms of sexual exploitation, but may "brand" the Campaign by presenting is as an anti-slavery effort. Obviously, the priorities and activities of the Campaign should be closely aligned with how the Campaign is publicly presented, but there are many choices in how to present an endeavourer that is comprehensive and complex. These choices will be important for branding the Campaign and aligning its nuts and bolts activity with its higher-profile media work, social marketing, training, and public education campaigns. There should be consistency across the elements of the Campaign so that the larger effort and the organization providing its underpinnings do not become muddled or seen as disorganized or working at cross-purposes.
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An ancestor species that had inadequate fitness would have died out and left no progeny. An ancestor that had inadequate evolvability would also have died out because it was unable to adapt. The inheritance system and existence of a complex, obviously evolved, genomic design in sexually reproducing organisms generally represents a conflict with the idea that natural selection, selecting between phenotypic differences in individual organisms, completely explains evolution. To illustrate, a text document (also digital data) could be written completely defining the design of some complex structure. The document could then be copied and 123 the Evolution of Aging distributed to multiple builders for execution. The methods and systems used to copy and transmit the data do not affect the design of the structure; (the designer could even have written in a different language). In the same way genomic design, which also involves a language, decoding, interpreting, merging, copying, and other complex processes does not affect the phenotypic design of organisms defined by the data it carries. Therefore, individual benefit cannot explain the development, evolution, and retention of the sexual inheritance system. A species that, for whatever reason, did not encounter many changes in its external world would not need much evolvability. However, higher animals would have a great need for evolvability because, if for no other reason, other organisms were evolving. An animal whose predators or prey were evolving would have great need for evolution itself. Regardless of how one defines "species" in a time-sequential context, it is obvious that very many species occupy the chain of descendancy between the original single-cell primordial life form and any current animal. As you will see, there are many other characteristics of an animal that could contribute to evolvability. Evolvability, like the selfish gene theory, is based on discoveries in genetics that were made subsequent to Darwin. Like the selfish gene theory and group selection theory, evolvability is an extension or adjustment to orthodox Darwinism. Like selfish gene theory, we could presume that, if Darwin were here today and knew what we do about genetics, he would "embrace" the evolvability theory. Finally, evolvability, group selection, and selfish gene theory appear to be compatible and are not mutually exclusive. Death Rate and Evolvability A requirement of the theory of natural selection is that evolution requires deaths. Evolution results from the differences in average lifespan between more fit and less fit organisms. In effect each life of an organism is a trial of and a "vote" for the combination of traits possessed by that organism. A longer than average life and thereby production of more progeny represents a vote in favor of the combination of traits exhibited by that organism. A higher death rate will accumulate more votes and test more combinations more rapidly. As larger, more complex, animals evolved, they encountered reductions in evolvability for several reasons: First, larger animals consume more resources and their populations therefore tend to be smaller (how many elephants are there in the world compared to ants). A smaller population represents a smaller number of simultaneous combinations of traits and a lower rate at which trials are being conducted. Second, larger and more complex animals tend to require more time to develop into mature adults. As we shall see, deaths of animals prior to becoming mature do not contribute to evolution in the same way as deaths of mature organisms. Therefore, even for the same size population, longer living animals will have lower death rates and therefore have an evolutionary disadvantage. Are longer claws and shorter feet better, or are longer feet and shorter claws better, or are longer feet and longer claws but a larger, heavier, and therefore slower, animal better, and so forth for thousands of parameters. In effect, the larger and more complex an animal becomes, the more difficult further evolution tends to become unless compensating factors are present. Evolvability theory proposes that more complex organisms have evolved many ways to increase their evolvability and that evolvability in such organisms would be negligible without these enhancements.
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Darwin concluded for reasons described above that evolution took place by means of tiny increments. When Darwin referred to "my theory", he was referring most specifically to these features in addition to the idea that species evolved from other species in the same manner. In addition to physical characteristics, Darwin included instincts and inherited behavior patterns in traits that evolved through natural selection. Flying and seeing would need to be supported by the appropriate brain and nervous system characteristics including inherited behaviors that lead to learning to fly and learning to see. Even a light sensitive spot on a worm would have no added survival value unless it somehow altered the behavior of the worm. In connection with evolution we need to discuss some aspects of probability theory because whether an individual organism lives longer or breeds more is a matter of chance. When "flipped" one type has a 50 percent probability of landing "heads" (and 50 percent probability of landing "tails. Suppose the coins are otherwise indistinguishable and we desired to separate the two types. We could run a number of flipping trials on each coin and note the results (heads or tails). However by making a number of trials on each coin we could definitively distinguish between the types. We could still definitively distinguish between the two types but it would require a much larger number of trials on each coin. The number of trials required is inversely proportional to the size of the probability difference. In the evolution process, the life of an organism is essentially a trial of the particular combination of design properties possessed by that organism. Another observation is that in complex organisms such as mammals the inheritance system is generally capable of independently specifying and evolving the characteristics of a very large number of design elements. Even if we consider only mammals, there are examples of essentially any possible combination of foot parameters. This observation is important in evaluating the plausibility of some theories of aging (to be described) that hold that aging is an unavoidable side effect of a beneficial property. Some important implicit requirements of the theory of natural selection should be mentioned. First, the natural variations in characteristics in a population of animals must be genetically programmed and thereby inheritable. Variations that were not genetically recorded could not participate in evolution because they would not affect the genetic content and therefore the design of subsequent generations. It is irrelevant if the squirrels on the other side of the planet are faster or smarter than those on this side. The variation must exist between individuals that could plausibly be in competition. Evolution results from the difference in statistical lifespans between animals that have a beneficial trait and those that do not. Third, in order to evolve, a trait must be expressed or displayed by the organism in such a way that it affects the differential in lifespan or reproduction. The death of that animal therefore could not have contributed to evolution of that characteristic. Finally, and very important, the probability that an individual animal would live longer and/or breed more is determined by the combined effect of all its characteristics. As you will see later in this book, these requirements are central to discriminating between various theories of aging. Few scientists of the time would have argued against the idea that natural selection could cause a species to evolve. After all, humans had for thousands of years been causing domesticated species to change by selective breeding. If small dogs were bred with small dogs for a long time, men could produce a Chihuahua. If you go back far enough, Chihuahua and Greyhound are descended from the same dog. Selective breeding could produce an organism design that did not previously exist. The argument was whether all the species that now exist could have evolved from a single original primordial species (probably a single-cell organism on the order of pond scum) simply by the effects of natural selection acting in slow small increments on individual variation caused by random mutation.