Tag Archives: politics

Minnesota’s Umlautgate

The post comes from my Big Show pal David Leveille.

The Minnesota Gov. Mark Dayton issued a quirky executive order on Wednesday concerning the spelling of the name of the small Minnesota city of Lindström (population, 4,442).

Somehow, it seems when highway crews last updated the road signs leading into town, they removed those little twin dots that hover over the O. Lindström became Lindstrom. The transportation department defended the decision, citing federal policy that highway signs include only letters in a standard alphabet.

The omission wasn’t much noticed, though, until a Minneapolis Star-Tribune reporter spotted it. Soon enough, many of the town’s Swedish American residents were up in arms. They wanted the dots restored to reflect their heritage.

Keep in mind that the city of Lindström is nicknamed America’s Little Sweden. Many locals speak Swedish when buying Scandanavian donuts at the local Swedish bakery. A sign near the city center reads “Välkommen till Lindström.”

So on Wednesday, the governor predictably set things right by ordering the umlaut to be put back on the green highway signs that welcome tourists. “Nonsensical rules like this are exactly why people get frustrated with government,” Dayton said. “Even if I have to drive to Lindström, and paint the umlauts on the city limit signs myself, I’ll do it.”

“Underbar, and that means wonderful!” said local historian and tour guide Sally Barott reacting to the governor’s order. “We are ecstatic he’s making the umlauts come back.”

Barott says the dots affect the pronunciation and, more importantly, express the region’s cultural history and link to Swedish immigrants. “It’s important,” she says. “We have the old and the new. The blend is happening all over America, but I believe being able to retain our history and cultural ways, and to recognize and be traditional, honors the way we were taught and the way it was meant to me.”

Barott regularly escorts tourists around the city that was founded by Swedish immigrants back around 1850. One of her favorite stops is the Lindstrom Bakery where she orders Swedish glazed donuts and Swedish gingersnaps, called pepparkakor.

The Lindstrom Bakery does not use  an ö in its name. Go figure. (Photo courtesy of Lindstrom Bakery)

The Lindstrom Bakery does not use an ö in its name. Go figure. (Photo courtesy of Lindstrom Bakery)


Those gingersnaps have likely just come out of the oven, thanks to baker Bernie Coulombe, the woman behind the counter.

“This is a Swedish town. It has always been known for the Swedish settlers who first came here. So it is important to our customers and people who live here,” she explains. She says the town proudly shows off its heritage to tourists with a statue of Karl Oskar (a character in Vilhelm Moberg’s novels about Swedish emigration to the United States) that honors the early Swedish immigrants. There’s also an old water tower that’s in the shape of a coffee pot and a small Lutheran church that’s “strictly Swedish.”

But Lindstrom isn’t just hanging onto the past. “This is the way we were brought up, this is our Swedish inheritance, and you’ve got to keep your inheritance going,” says Coulombe.

This case of what might be called Lindstrom’s “umlautgate” is on the radar of The World’s language editor Patrick Cox. “Generally speaking English is thought of as the language where diacritics go to die.” All of the accents and the dots usually disappear, he says.

“America is the place where when you come to America, you sort of drop your clothes from the Old World and you embrace the New World. Names, surnames get changed, also the names of towns and cities get changed, and generally speaking the accents go.” But keep in mind, he says, “there are no rules in the English language right? I mean nobody’s going to stop the governor of Minnesota from saying ‘throw in some Cyrillic letters if you want to do that.’ He has every right to issue a decree like this.”

Strictly speaking, the Swedish ö does not use an umlaut. It is considered a separative letter in the Swedish alphabet. The umlauted o is a German thing.

But if you want to learn more about the linguistic difference between Lindstrom and Lindström, or the distinction between an umlaut (which has its origin in German) versus the happy twin dots that show up in Swedish words, and hear why rock bands ranging from Blue Öyster Cult to a Ukrainian band named Flëur like to play with umlauts, then you really must listen to Patrick’s podcast, The World in Wörds.


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A Canadian journalist escapes detention in Ukraine by speaking French

Photo: Ashok666/Flickr

Photo: Ashok666/Flickr

Here’s a guest post from my Big Show colleague, Nina Porzucki.

It may not be quite an epidemic, but pro-Russia insurgents in Ukraine are increasingly turning to an ominous new tactic: kidnapping.

Many people have been held hostage in the eastern town of Slovyansk — including journalists, pro-Ukraine activists and military observers from the Organization for Security and Cooperation in Europe.

One person not caught up in the sweep is the Toronto Star’s reporter in Slovyansk, Mitch Potter.

And that’s not for lack of trying on the part of pro-Russia activists.

Last week, Potter and his interpreter were pulled over by a group of angry insurgents. It was a tense situation and the one thing that Potter knew he shouldn’t do was speak English.

“It was known, well-known for days, that it was trouble to speak English on the streets,” said Potter. “There are pamphlets circulating in that city warning that anyone who speaks English is a spy and turn them in.”

So what did the English-speaking Canadian do?

“My lips started moving and the French language came out,” said Potter.

“I’m French Canadian,” Potter told the angry insurgents. “I have nothing to do with the English language.”

That’s not true. Potter is not French Canadian. Yet, somehow his improvised French worked and the Pro-Russian activists let him and his interpreter leave Slovyansk.

“This was after a week on the ground. And it was clear that we’re all Americans now, when we go to that place. They make no distinction between Americans and Canadians,” said Potter.

So why did speaking French pacify the insurgents in eastern Ukraine? Potter doubts that it has anything to do with an affinity for the French-Canadian separatist movement.

“People there tend not to travel. It’s a very insular place. They don’t even travel to western Ukraine, let alone pay attention to language politics in Canada,” said Potter.


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If you’re a political candidate in Colombia, forget about using your name

Santiago Ramírez at the Real Sound Studio in Bogota, where they compose jingles for political candidates. He says they once had a conservative client, a Colombian Mitt Romney-type, who asked for a raunchy reggaeton tune so he could connect with young vote (Real Sound/Flickr)

Santiago Ramírez at the Real Sound Studio in Bogota, where they compose jingles for political candidates.(Real Sound/Flickr)


Here’s a post from Bogota-based John Otis.

What do you do when you’re one among thousands of candidates on the ballot? In Colombia, you hire a jingle writer.

At a sound studio in Bogota, Juan Fonseca is composing a 15-second radio spot for a Colombian congressional candidate.

Radio reaches more people in Colombia than newspapers or TV, which is why a well-crafted jingle, played over and over on the radio, can help a campaign take off. But composing these ditties is a strange and tricky art form.

Santiago Ramirez of Bogota’s Real Sound studio recalls a button-down conservative — a sort-of Colombian Mitt Romney — who thought he could connect to younger voters by setting his jingle to raunchy, sexually explicit reggaeton.

“We were like ‘What? Do you really want a reggaeton?” Ramirez says.

Ramirez did ultimately produce the jingle, and the candidate lost.

Another challenge for jingle composers is politicians who have strange names that are hard to rhyme.

“We’re working with a guy whose name is very weird. It’s ‘Telesforo.’ It’s very similar to phone, you know, telefono,” he says.

When I ask him who names their kid Telesforo, he laughs and says, “I don’t know, man. A very crazy guy.”

Still, Ramirez says numbers are even more important than names. He plays me a song where there’s no name. The spot simply urges people to vote for candidate No.101. There’s a good reason for that.

Unlike US legislative races, which are mostly one-on-one contests, Colombia’s are a free-for-all. A whopping 2,300 candidates are running for 285 seats in the Colombian House and Senate.

As a result, the ballot for the March 9th election is the size of a newspaper. But it still isn’t big enough to hold so many names. Instead, each candidate is assigned a number and that’s what appears on the ballot.

“In Colombia when you go to vote, you have to mark with an “X” the number of the candidate. That’s super important,” says Miguel de Narvaez, who runs a recording studio called Sonido Comericial.

Narvaez says a good melody or chorus can implant the candidate’s number in the voter’s brain. Jingle writers prefer small numbers because they’re easier to rhyme.

So what about big numbers like 172?

“No! 172? That would make it very difficult,” Narvaez says. “Probably what we would do here would be to split the number.” He starts singing, “1-7-2” instead of “one-hundred-and-seventy-two.”

When we meet up again, Juan Fonseca, the piano man, has finished the jingle for his client, a congressional candidate named Monica Giraldo. Rather than reggaeton, Giraldo requested a more innocent sound, so Fonseca brought in a teenager to sing the vocal tracks.

Giraldo, of the Conservative Party, is listed as C-102 on the ballot, but Fonseca resists playing the numbers game. In the end politics is all about people, so Fonseca tried to make an emotional connection with voters by focusing on Giraldo’s human qualities.

“She is a person with leadership skills, who puts her heart into her work,” he says. “All of these attributes make her much more than just candidate number C-102.”


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Hiroshima, Nagasaki and self-censorship


(Updated) I originally wrote this post around the 65th anniversary of the Hiroshima and Nagasaki bombs. The recent earthquake in Japan seems to echo those incidents in certain ways: a calamitous event, followed by massive destruction and huge loss of life; entire communties wiped out; high levels of radiation in the atmosphere; unpredictability; fear.

Some foreign media organizations have made the comparisons (for example, here and here). Also implicitly making the connection was Prime Minister Naoto Kan, who has called the quake and its aftermath Japan’s worst crisis since World War Two. A further sign of the historical significance of the moment, and of the country’s plight: Japanese Emperor Akihito made the first television address of his reign.

That said, there are significant differences between the 1945 bombings and the earthquake. The most obvious is that the 1945 events were military attacks (though the vast majority of victims were civilians). The destruction of two cities and the radiation released was fully intended by Japan’s wartime enemy, the United States. Also, radiation levels today are nowhere near as high as in the aftermath of the bombings. Nor, so far, is the loss of life, as shockingly high as it is.

I checked in with a couple of  Japanese friends (one is a Hiroshima-based journalist; the other, a professor who has interviewed many A-bomb victims.) Their reponses were similar: for whatever reason, the Japanese media and public are not making a strong connection between Japan’s current crisis and the A-bombs. One connection, though,  has made, as reported in the New York Times: the earthquake and tsunami have rekindled memories of conventional World War Two air raids among elderly survivors of those bombing campaigns.

In the podcast I put together for the 65th anniversary of the dropping of the Atomic bombs, there are two takes on self-censorship. A child survivor of Hiroshima explains why she kept quiet about her experiences for so long, through the pain and guilt of survival. She was seven when the the bomb fell, killing her parents and siblings but inexplicably sparing her. Late in life, Sueko Hada tells her story, in the presence of her daughter and granddaughters. They’ve heard some of it before, but she includes many new details this time.  I snapped this picture of the family on the day I interviewed Mrs Hada in 2005. My report originally aired on The World as part of a series on the mental health of Atomic Bomb survivors, known in Japan as hibakusha.

Before I met Mrs Hada, I don’t think I fully understood why people with painful pasts remain silent, essentially censoring their own histories. But if you grew up in post-war Japan, surrounded by people who believed that radiation sickness was contagious and hereditary, you too might keep quiet about your past.

The legacy of Hiroshima and Nagasaki is hard to gauge. Japanese children still visit the Hiroshima Peace Memorial Museum (above). But these days, Tokyo Disneyland is a far more popular destination for school groups.

For many Americans, the use of the bomb remains a hugely sensitive issue.  Views both pro and con seem entrenched, dialogue virtually impossible. The debate — such as it is — hasn’t progressed much since the 1995 controversy over The Smithsonian’s Enola Gay exhibition.  But there has been new research about some of the earliest news reporting of the bombs. That began in 2005, when several dispatches written by Chicago Daily News reporter George Weller were published first time by the Tokyo newspaper Mainichi Shimbun.  That was followed by publication in English of those and other reports in First into Nagasaki, a book put together by Weller’s son, Anthony.

Weller blamed U.S. military censorship for the previous non-publication of his reports.  But Japanese freelance reporter Atsuko Shigesawa disputes that in a new book. (Japanese links here and here.) At the Library of Congress, she came across a statement from Gilbert Harrison, who was a sergeant in the US Army Air Forces and went to Nagasaki with Weller. Harrison went on to become editor of  the New Republic. In his statement, he describes how he delivered Weller’s reports to a Chicago Daily News employee in Tokyo. As far as he knows, he says, the reports were filed there and then and were not subject to military vetting. He says he “doesn’t know why”  the New York Times and the Arizona Republic reported in 2005 that “our reports were censored and not printed for 60 years.”

Atsuko Shigesawa believes that the true acts of censorship in reporting on the A-bombs were self-imposed, sometimes by reporters, sometimes by their editors. In Weller’s case, she believes his editors at the Chicago Daily News killed many of his stories. And when it came to other reporters filing stories from Hiroshima and Nagasaki, Shigesawa found that newspapers routinely cut the segments dealing with radiation sickness and other after-effects of the bombs on the human body.  (The photo above was taken at a hospital in Tokyo. The original caption reads: “The patient’s skin is burned in a pattern corresponding to the dark portions of a kimono worn at the time of the explosion.”) In addition to these editorial cuts, at least one correspondent chose not to report on his hospital visits, believing that they were part of a plot to hoodwink him. William Lawrence of the New York Times wrote that American reporters were being subjected to “a Japanese propaganda campaign calculated to shame Americans for using such a devastating weapon of war”. He continued: “I am convinced that, horrible as the bomb undoubtedly is, the Japanese are exaggerating its effects in an effort to win sympathy for themselves in an attempt to make the American people forget the long record of cold-blooded Japanese bestiality.” For those reasons, Lawrence did not write about his hospital visits and the cases of radiation sickness he witnessed until 1972, in his memoir.

We don’t — and probably never will — have the full story of what influenced those initial reports of Hiroshima and Nagasaki. But there’s enough to suggest that self-censorship played a prominent role.

For another take on the meaning of Hiroshima and memory, check out Rahna Reiko Rizzuto’s memoir Hiroshima in the Morning. It was a 2010 finalist in the autobiography category of the National Book Critics’ Circle Award.

Listen via iTunes or here.

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The staying power of English, and Shakespeare in Shona

Top five language stories this month with Patrick and cartoon queen Carol Hills:

5. Multi-lingual Shakespeare. All of Shakespeare’s 38 plays will be performed next year in London, each in a different language. Hosting this 6-week season — part of London’s 2012 Cultural Olympiad —  is the reconstructed Globe Theater. The environs may be authentically Elizabethan, but no-one back in the 16th century would have seen Titus Andronicus in Cantonese, The Tempest in Arabic, Love’s Labour’s Lost in British Sign Language, or The Taming of the Shrew in Urdu.

Given the diversity of languages and, presumably, styles of stagecraft, it’s surprising the Globe isn’t presenting these plays at a diversity of venues. Putting on plays at the Globe is all about conjuring up a specific time and place in English history. This season of plays seems designed to do the opposite. Think of all Shakespeare-inspired foreign language movies, like Akira Kurosawa’s Throne of Blood — based on Macbeth — that transport you worlds away. That’s when you get a sense of the universality of Shakespeare. I’m not sure if the setting of Globe for all these plays will convey that.

4. Texting surprises. Two new studies on texting are out. The first focusses on literacy acquisition, and the scond on the texting habits of Australians. In the first, a group of children in the UK were given mobile phones to text to their hearts’ content. Their literacy acquisition skills — reading and spelling — did not suffer as a result. In the second,  Austalians, and men in particular, expressed disatisfaction with texting shorthand (even the Aussie-specific stuff like totes (totally) and redic (ridiculous). Also — this is really surprising — more than 75% of  Australians age 65 years and older send at least one text a day. Those elderly Australians are totes techno. Redic!

3. Eliminating an unwanted language. In these times of language disappearance,  it’s not often you hear of an effort to willfully eliminate a language. That, though, it what’s happening in South African. The language in question is more like pidgin. It’s called Fanagalo, and it’s like a simplified version of Zulu, with some Xhosa, Afrikaans and English thrown in.  During colonial times, it was used as a language of instruction in the mines. Colonial bosses would issue orders to workers in Fanagalo. Over the years, it acquired quite a few technical mining phrases and so it is still used today. Now, there’s a debate in South Africa over its usefulness, even as there’s widely-held distaste for the way in which it came into being. The National Union of Mineworkers is pushing to have Fanagalo abolished — which has set South Africa’s Chamber of Mines thinking about how exactly to do that.

2. Keeping Russian and Chinese pure. Efforts are underway to keep Russian and Chinese free of English words and acronyms. Here are two languages that developed largely in isolation during large parts of the 20th century.  Now that Russia and China are more connected,  Russian and Chinese are having trouble incorporating (or resisting) Anglicisms. Some new Russian words include steyk-kholdery (stakeholders), autsorsing (outsourcing), riteyl (retail) and franchayz (franchise). New Chinese words often derive from English-language acronyms: NBA, CPI, WTO, GDP.

Both countries are taking ham-fisted approaches: Russia’s anti-monopoly service penalized a Japanese sushi chain which displayed a billboard saying Happy New Menu. It also took action against a sportswear store  using the expression new collection. China’s General Administration of Press and Publication issued an edict barring Chinese newspapers, books and websites from using English words and phrases. Neither approach seems likely to work.

1. New book sparks a debate about the staying power of English. Nicholas Ostler’s The Last Lingua Franca makes the argument that one day in the distant future English will cease to be a global language, that most English speakers will be native speakers (right now, an estimated 30% of English speakers are native speakers).  Not only that, but it won’t be replaced by any other lingua francas. The world won’t need a common tongue, says Ostler, because we’ll all be able to speak in our own native tongues, and communicate via translation devices. Not surprisingly, Ostler’s theory/prediction has been roundly criticized, by champions of English as well as by techno-skeptics. Still, one of Ostler’s main points, that history has not stopped, and that language evolution has not played itself out, is well taken. And just look at Aramaic, Greek and Latin, all in their days lingua francas.

Listen in iTunes or here.


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At the BBC, fewer languages and less influence

Like millions of others, I grew up with the BBC. Today I work for a BBC co-production. I’m not a BBC employee, but I’m close to this story. And, um, that’s not me in the picture. I use a smaller microphone.

The cuts:   five BBC language services will close (Serbian, Albanian, Macedonian, Portuguese for Africa and English for the Caribbean). Seven more language services, including Mandarin Chinese and Hindi, will be cut back from radio to internet only. A further six services will stop transmitting on short wave.

It means an estimated 30 million fewer BBC listeners worldwide. Will people migrate to the web and to English language news, or will the BBC – and its news values – become less influential?

There was a huge amount of coverage of this story. Most people were critical of the cuts with the British government — rather than the BBC —  receiving the blame (here and here for example). But in Britain there is a BBC-despising minority which offered its own spin.

For the pod, I picked some of the best pieces of the BBC’s own coverage: interviews with the director of BBC global news Peter Horrocks,  former World Service director John Tusa, and British foreign minister William Hague. Hague heads the Foreign Office, which has presided over the BBC World Service.

I also interviewed Debbie Ransome, head of the axed Caribbean Service. The Caribbean Service could be seen as some broadcast throwback to the days when the World Service was known as the BBC Empire Service. But Ransome says the service is unique in that it is regional, and so rises above  the interests of any single country. She says the other broadcast media in the region either take political sides, or play a lot of music and not much else.

So which global radio services will move in to replace the BBC?  The pod’s last interview is with journalism professor George Brock. He says that services run by the Chinese and Russian governments are likely to benefit, especially in Africa and Asia. And they don’t have the same news values as the BBC. Where the Beeb is remarkably successful at maintaining its editorial independence, Brock says the Russian and Chinese operations  are mainly mouthpieces of their respective governments.

Listen in iTunes or here.


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Beautiful code, ugly fonts, and the architecture of diplomacy

In this podcast, we have a story from California-based freelancer Corey Takahashi on a new exhibit in Silicon Valley that traces the history of computers and their languages.  When Corey and I talked about how to approach this story, we decided that language was the key. Computer programming languages are world-famous among computer programmers, but almost completely unknown to the rest of us. I mean, have you heard of Fortran? Have these languages developed the same way as other languages, acquiring grammatical rules, then  breaking them? Is there such a thing as beautiful code, worthy of our gaze in a museum?

Also, new research suggests that hard-to-read typographical fonts may help us remember the ideas they spell out. Jonah Lehrer spoke to the BBC about this. He writes a blog for Wired on neuroscience. Last September he wrote a post about using his kindle. He found the kindle-reading to be incredibly comfortable and easy — maybe too easy.  More recently he noted that new research appears to confim that hunch. It suggests that we are less likely retain information if it is written in a clear, easy-to-read typeface like Clearview:



Maybe we should all switch to a font like Lucinda Blackletter. OK, maybe not on the roads, but in classrooms:

Part 3 of the pod concerns the architectural grammar of the United Nations Security Council. The design layout of the Council’s chamber and adjourning rooms is considered so important that replicas have been constructed during refurbishment.


Our man in New York Alex Gallafent does a fantastic job of turning a tour of the temporary chambers into an audio history of how architecture and design have shaped the history of UN Security Council.

Listen in iTunes or here.


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Tuareg tales and the R word

The first pod story of 2011 comes from Mali, where a group of people are trying to use storytelling to preserve the Tamasheq language. The language is spoken by a dwindling number of the nomadic Tuareg people.

That’s followed by a conversation about the merits of the King James Bible, which turns 400 in 2011. In secular Britain, those merits aren’t strictly religious. In fact, people like former UK poet laureate Andrew Motion view the King James Bible as a literary giant, second only perhaps to Shakespeare. He argues that we are fast forgetting how it has shaped English-language poetry, fiction and rhetoric.

Then, the main event: the R word.  Or perhaps the R-rated word: rationing. For manyAmericans, the idea of rationing is, well, unAmerican. In Britain though, rationing is part of the national psyche: it got the country through two world wars, and its collectivist values are at the core of Britain’s government-run health service. Now though, the emergence of expensive, new end-of-life drugs are challenging Brits’ belief in rationing.

During World War II and for nine years after, the British government rationed most food items: meat, flour, eggs, sugar. The government also strictly controlled the supply of gasoline, soap, stockings—even the number of buttons on jackets.

Although there was wartime rationing elsewhere, including in the United States, it generally applied to fewer items over fewer years and was quickly forgotten. In Britain, however, rationing became a part of the national identity.

Many older Britons speak of rationing as a great legacy of those wartime and post-war years, when people sacrificed their own interests for the greater good.

After World War II, the British government extended this societal approach to health care. It created the National Health Service, the NHS.

Today, 95 percent of Britons get their care through the government-run program. In order to provide care to everyone, the government says it must place limits on the care it provides. It must ration.

Limits to Care

“We have a limited budget for health care, voted by Parliament every year, and we have to live within our means,” said Michael Rawlins, chairman of a government agency called the National Institute for Health and Clinical Excellence (NICE).

NICE decides which drugs and other treatments can be prescribed by NHS doctors.

NICE was created in 1999 to clarify the reasons why certain drugs are approved and others are rejected. “In the old days it used to be done in secret, behind closed doors, in smoke-filled rooms,” Rawlins said. “Now it’s explicit. Everybody knows what the rules are.”

NICE’s rationing decisions start with a basic premise: The government should spend its limited resources on treatments that do the most good for the money. NICE calculates cost-effectiveness with a widely used measure called a quality-adjusted life year (QALY).

In essence, NICE asks these questions: How much does a drug or procedure cost? How much does the treatment extend the average patient’s life? And what is the quality of that life gained?

The calculations are complicated, but imagine that a cancer treatment costs $100,000 and that it extends the life of the average patient by four years. That means the cost of the treatment per year gained is $25,000.

Now imagine that for part of those four years the patient will be in pain and bedridden. NICE might figure the quality of that life at 50 percent of perfect health. Under NICE’s formula, that would make the drug half as cost-effective. In other words, the result would be $50,000 per quality-adjusted year gained.

NICE has set a maximum that it will spend on a treatment: about $47,000 per quality-adjusted year gained.

NICE tends to assume, without always performing calculations, that most common treatments are cost effective—including insulin for diabetes, cholesterol-lowering drugs for heart disease, and kidney transplants.

Instead, NICE analyzes only selected therapies, such as expensive new drugs that may extend life at the end of life. It has calculated that some of the more expensive drugs meant to slow the progression of Alzheimer’s Disease and some cancers fall below the cost-effectiveness threshold. In such cases, NICE says, the NHS shouldn’t pay for the drugs.

NICE chairman Michael Rawlins acknowledged that his agency’s decisions deprive some patients of drugs that may extend their lives by several months or more.

“We do recognize that the end of life is a very special time,” Rawlins said. “[It] allows people to attend weddings, see a grandchild born, seek forgivenesses.”

But he argued that if Britain spends a lot of money at the end of life, “we’re going to have to deprive other people of cost-effective care.” Rawlins said that might mean spending less money at the beginning of life—and might result in a higher infant mortality rate.

A Cancer Patient Fights Back

“Imagine how I feel when I hear people saying that if they give me the drugs I need to stay alive, babies are dying,” said David Cook, one of a growing number of British cancer patients speaking out against NICE and its rationing formula.

While sipping strong English tea in his village farmhouse kitchen, Cook argued that NICE’s logic breaks down when you go from the abstract formula to specific patients—like him.

A senior government manager in his fifties, Cook was diagnosed with kidney cancer in 2004. Two years later his prognosis was bad.

Cook’s doctor said he would die within months unless he got a drug to slow the growth of his tumors. But the cost of the drug was high—too high for NICE in light of the advanced stage of Cook’s cancer—and the NHS refused to pay for it.

Cook fought back. He contended that NICE’s rationing formula calculates cost-effectiveness based on the average patient, but individual patients might do better on a given treatment, which would make the drug more cost effective than NICE suggests. Cook’s doctor believed that was true for him, so Cook pleaded his case before a panel of experts.

“I had to persuade a total of six people that were in the room” he said. “I had to talk for my life.” Cook won his appeal—he got the drug—but he resented that he had to fight for it, that he was treated as an exception.

Cook has other complaints about NICE.

He says the agency treats patients inequitably; it is more likely to reject drugs for rarer cancers like his because the treatments are more expensive than those, say, for breast cancer or lung cancer. “We’re being penalized for having…the ‘wrong’ type of cancer,” he said.

Cook contends that NICE overreaches by measuring the quality of a patient’s life. He said it should not be up to bureaucrats to decide that the life of a bedridden patient, for instance, is worth a quarter or a half that of someone in perfect health.

Cook further argues that NICE neglects an important fact—that by helping a patient live longer, a drug may improve not only that patient’s life but also the lives of loved ones. For his part, Cook remains active and working and has helped care for his wife, who has been diagnosed with breast cancer.

Public Backlash

Stories like David Cook’s—about the government restricting access to life-saving drugs—have become common in the British media.

Part of the reason is that many new cancer drugs have become available in the last few years, and some of these drugs are extremely expensive.

NICE’s rejection of such drugs has fueled a growing backlash against the agency. Patient groups and drug companies have called it heartless and indiscriminate.

NICE’s future now hangs in the balance.

In May 2010, Britain’s ruling Labour Party, which founded the agency, lost a general election. The new Conservative-led government has said it will establish a cancer fund, totaling more than $300 million a year, to pay for some cancer drugs turned down by NICE.

This comes at a time of economic crisis in Britain. The government is making large cuts in just about every other public service.

Health economist Alan Maynard of the University of York said it may seem compassionate to set up a cancer fund, but it undermines NICE at a time when the country needs to be reminded of the value of rationing.

These days in Britain, few speak favorably about an agency that was set up to ensure that the government could provide the best care to the most people.

“NICE is not very popular,” said writer Lionel Shriver. “I may be the only fan of NICE in the country. After all, it’s the organization that says ‘no.’”

Shriver is an American who lives in London. Her latest novel, So Much for That, is about the U.S. health care system and how, in her view, it failed a woman who was dying of cancer.  Shriver said her novel would have turned out “drastically differently” if she’d been writing about the British health care system.

The novel follows a character who has mesothelioma, a rare but deadly disease that is usually caused by exposure to asbestos. The character is partially based on a close friend of Shriver’s who lived 15 months after being diagnosed with mesothelioma. Shriver says her friend’s treatment cost $2 million.

“If she had been in the UK, that character would have been given palliative care alone,” said Shriver. “They would have tried to keep her comfortable and out of pain, but they would have skipped the major surgery. They would have skipped all that excruciating chemotherapy.”

“I think that my character and indeed my friend would have been better off in the United Kingdom,” Shriver said.

A Model for Other Countries?

Britain’s medical rationing has been noticed around the world. A steady stream of health officials from countries like Brazil, China, and Poland have visited NICE to see if setting up a rationing agency along similar lines makes sense for them.

Some American health care experts wanted to establish an agency like NICE as part of reforming the U.S. health care system. But after Sarah Palin cited Britain as the inspiration for what she claimed was an Obama Administration plan for “death panels,” that idea was dropped.

In fact, in this year’s health care reform law, Congress specifically prohibited British-style rationing. Medicare, for example, cannot apply quality-of-life tests in determining the cost-effectiveness of treatments.

Lionel Shiver is not pleased with that outcome. She said Americans still don’t seem ready to focus on some key end-of-life questions. “At least in the UK we’re having the conversation. How much is a life worth? And what kind of quality of life is that?”

But as other countries look to Britain as a model, it’s far from clear that the model itself will survive.

And that begs the question: Can explicit health care rationing work anywhere if it’s in trouble in the very country that may be best equipped to take it on?

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English sources, Italian renaissance, Spanish rebellion

The online version of the Oxford English Dictionary has just had a makeover. One of the new features is a list of 1,000 sources for English words and expressions. These tend to be authors  (Shakespeare, Dickens, Twain) or publications (Chambers’s Cyclopaedia, Geographical Journal, New York Times). This is a historical list; there is no room for, to name but one modern linguistic innovator, André 3000.

My favorite entries are for people or publications I haven’t heard of: Helkiah Crooke — what a name!– a 17th century physician and anatomist; Anne Baker, a 19th century philologist; the Dictionary of the Older Scottish Tongue.

With budgets tight at American schools and colleges, and with a growing interest in Chinese, what happens to a language like Italian?

Once a heritage language, Italian is now more of a lifestyle choice. At Eataly — a new food emporium in New York City — TV chef Lidia Bastianich offers cooking and language classes. A latte just tastes better when you can order it in the original language, or so the thinking goes. Meantime, Italian has been canceled at SUNY-Albany, and appears imperiled elsewhere, at colleges and grade schools. It’s only through the rearguard action of people like Margaret Cuomo of the Italian Language Foundation that the language is still studied in the United States.

Also in the pod this week: Latin America is livid with the Royal Spanish Academy. That’s nothing new — there’s always been tension over how Spanish should, if at all, be regulated. But now, the academy wants to reduce the alphabet from 29 to 27 letters. The victims are a couple of couples: ch and ll, both beloved in the Americas. These sounds — or spellings — aren’t disappearing. They just will no longer have their special place in the dictionary. Those dictionary publishers will no doubt put out new editions, which will help their bottom line: they must love the Royal Spanish Academy!

Venezuela’s Hugo Chávez must like the academy too: it’s given him something else to rail about. Now that ch is no longer recognized, he has proclaimed that he will henceforward be referred to Ávez. Sounds kind of cockney.

Helping us wade through the inter-Spanish linguistic warfare is Ilan Stavans, author of Spanglish, the Making of the New American Language. Listen to an interview with him on that subject here.

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The events of English and the future of Tibetan

Five language stories from the past month with Patrick, Carol and Rhitu

5.Tibetan in schools

Tibetans have been protesting over the potential loss of their language in schools.

It started after the Chinese Communist Party’s Qinghai province chief, Qiang Wei reportedly called for “a common language” in schools.  He went on to propose that Qinghai use Mandarin as the language of instruction in all schools. Now,  it already is the language of instruction in most schools in Qinghai, as in the rest of China. But the province is also home to a significant number of Tibetans, who typically learn at elementary level in their own language. Those who stay on in higher grades switch to Mandarin.

Estimates put the number of protesters between several hundred and several thousand. They spread beyond Tibetan speakers, with Uigher-speaking students also taking to the streets in sympathy. They know they could be next.

4. Spain re-orders its family names

The Spanish government has drafted a law that would change birth registration rules. That could result in a dramatic transformation of naming customs. Spaniards have two family names.  Right now, either of those names can come first, though it’s customary for the father’s name to assume priority. Under the proposed law, the two names would simply be listed alphabetically, unless otherwise instructed by the parents. This may well result in gender neutrality, but it would certainly discriminate against letters at the end of the alphabet. Zapatero? Forgetaboutit! Just think: had the law been around in 1892, Spanish dictator Francisco Franco might have been known as Generalísimo Bahamonde. Would he have won the Spanish Civil War with a name like that?

3. Events that shaped English

A non-profit group in Britain called The English Project is putting together a list of historical events and places that have shaped the development of the English language. It’s a thoroughly UK-centric list. Which is fair enough, until that time in history when Britain began exporting the English language. Here’s the list.  Post your ideas for a more expansive global list on English either there or on this site.

2.When can you say you speak a language? There’s no widely-accepted standard for speaking a second language, nor should there be: people use languages in so many different ways that there can never be  a single answer to this question.  But it’s instructive to try to come up with your own definition.

For the writer of this Economist blog, it’s a test of linguistic skills in journalism: “If my editor sent me to a country where I needed to report on a topic of general interest for The Economist, could I pull off interviews and research?  If yes, I speak it.”

The comments after the blog post are all over the map, as they should be:  “When you find yourself dreaming in a language, you can safely say that you can speak it.” (I disagree: I dream more fluently than I speak).  I prefer this one: “When you have mastered all, I emphasize all, the nuances contained in a given cuss word, and know when and when not, to deploy the word, so that you obtain the precise effect you want, not more, not less. This you do a native speaker of the language.”

1. We speak, therefore we think. New research out of Australia on how the languages we speak may determine how we think. Pormpuraawans — aboriginals living in a remote part of Australia — relate spatially to things according to the position of the sun. So while they think east and west, we English speakers often think left and right,  Arabic and Hebrew speaker right and left, and Chinese speakers up and down.  This plays in nicely to the recently renewed debate over language and thought: does language arise out of thought, or does it give shape to thought? Are we all prisoners of our native tongues?

Musings on this here and here. And more coverage of the research in a recent World Science podcast.

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