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Being robbed is a horrible experience under any circumstances. But being robbed by your employer involves a unique betrayal of trust.

So it was a sign of real progress when “wage theft” finally became a crime in New Zealand earlier this month with the passage of the Crimes (Theft by Employer) Amendment Act.

Heralded by trade unions and the Labour Party as a victory for workers, the new law makes it a criminal offence under the Crimes Act for an employer to intentionally (and without reasonable excuse) fail to pay workers what they’re entitled to.

Wage theft can include deliberately underpaying wages or holiday pay, or making unlawful deductions from pay packets. The question now is how well the new law will be enforced.

While there is little research on how widespread wage theft in New Zealand is, we do know it all too often affects temporary migrant workers and those in labour-intensive industries such as hospitality, construction and horticulture.

But if, as seems likely, the police are tasked with investigating allegations of wage theft, the new law may struggle to be enforced effectively.

Who investigates wage theft?

Until the law change, wage theft was only addressed through the civil system, not the criminal courts. Underpaid employees could take an employer to court to recover what was owed – if they had the means to navigate what could be a complex process.

It took an initiative by former Labour MP Ibrahim Omer – who as a refugee in New Zealand had experienced wage theft – to begin the reform process. He introduced a members’ bill to parliament in 2023 seeking to make wage theft a criminal offence.

Under the new law, the maximum penalties for wage theft are the same as for general theft. For serious offences, this means employers can be imprisoned for stealing their workers’ pay.

The trouble is, the law doesn’t state which government agency will be responsible for investigating such crimes. This is important because adequately enforcing the law is the whole point.

A 2024 report by the Ministry of Justice had suggested investigative responsibility might sit with New Zealand’s workplace regulator, the Labour Inspectorate. This seemed a logical move.

But when the legislation was being debated in parliament, it became clear MPs assumed enforcement responsibility would lie with police. Confirming the law change this month, Labour MP Camilla Bellich said:

Theft is theft, and before this bill was law workers had to take up a civil case. Civil wage claims are difficult for any employee to initiate and often time consuming and expensive. Now workers can go to the police and report wage theft as a crime.

Former Labour MP Ibrahim Omer’s experience of wage theft as a refugee inspired him to change the law.
Getty Images

How Australia does it

On the face of it, the police might seem like the logical enforcement agency. They investigate crimes and play an important role in crime prevention. But wage theft isn’t an area they have dealt with before. And uncovering wage theft in practice is very difficult.

First, those most at risk – such as migrant workers and young employees – are the least likely to report it, often for fear of the consequences or because they simply don’t know how to make a formal complaint.

Secondly, bad employers are good at covering their tracks, leaving no paper trail or fudging the books.

Without specialised knowledge or experience in these areas – as well as dealing with their existing resourcing challenges – the police will potentially struggle to uncover wage theft offending.

A better model might be Australia’s criminal wage theft regime, which came into effect at the start of this year. Overall, it is tougher and more targeted than New Zealand’s.

The Australian law applies hefty maximum penalties for wage theft offences – up to ten years’ imprisonment and monetary fines in the millions. Investigations are the responsibility of the national workplace regulator, the Fair Work Ombudsman.

This makes sense, because it’s the Fair Work Ombudsman which has significant experience in uncovering breaches of national employment laws, not the police.

Put the Labour Inspectorate in charge

The equivalent enforcement agency in New Zealand is the Labour Inspectorate, whose entire remit is to uncover breaches of employment standards.

The Labour Inspectorate, far more than the police, will understand the intricacies of wage theft, including which workers and industries are most vulnerable, and what methods dodgy employers use to hide wage theft.

If necessary, the inspectorate’s powers and resources could be reviewed and modified to ensure it has the tools to conduct criminal investigations, including the ability to search and seize evidence.

Finally, empowering an agency with the right tools, knowledge and experience to investigate wage theft would leave the police to deal with the other serious crimes already demanding their attention. Läs mer…

Only five days after the arrest warrant against former Philippines President Rodrigo Duterte was issued, he was apprehended and immediately put on a plane to The Hague to face charges before the International Criminal Court (ICC).

The prompt action – and the fact he is the first former Asian head of state before the ICC – have been heralded as “a pivotal moment for the court”.

While this is a rare success story in the court’s tumultuous history, many challenges remain. The successful arrest of one defendant will unfortunately do little to change negative perceptions of the court or remove the many obstacles it faces in prosecuting cases.

A long history of criticism

The ICC was conceived as a “court of last resort” in 1998 under the Rome Statute, the treaty that established it. The aim was to try individuals accused of war crimes, crimes against humanity, genocide and aggression in cases where a state’s domestic courts refuse or are unable to do so.

Shortly after it began its work in 2002, however, the ICC faced criticism for its perceived focus on Africa.

In more recent years, it has also been criticised for its limited effectiveness, its perceived hypocrisy, and a lack of support from major powers, such as the US, China and Russia, which are not members.

The court has long faced a public relations crisis it may never be able to resolve. When it does not investigate a potential case, it is said to be ineffective. And when it does initiate investigations, it is often said to be biased or acting beyond its capabilities.

The ICC has had many detractors in its short history.
Omar Havana/AP

Putin and Netanyahu

Currently, the ICC has 12 ongoing investigations, mostly in Africa and Asia. It has issued 56 arrest warrants, half of which have yet to be executed.

As the focus of the court is limited to those who bear the greatest responsibility for international crimes, the cases frequently involve high-profile individuals.

Current arrest warrants, for example, have been issued against Russian President Vladimir Putin on charges of allegedly deporting Ukrainian children to Russia and Israeli Prime Minister Benjamin Netanyahu for alleged war crimes committed in Gaza.

These two cases have been among the court’s most controversial. Critics say the ICC lacks jurisdiction because:

the alleged crimes did not occur in their own states
their states are not parties to the Rome Statute
the UN Security Council did not refer these cases to the ICC for investigation.

Others have accused the court of selective prosecution and bias for pursuing a case against Netanyahu, specifically, instead of prioritising cases in states run by dictators, such as Syria.

Arrest warrants were issued last year for both Israeli Prime Minister Benjamin Netanyahu, left, and Defence Minister Yoav Gallant.
Abir Sultan/Pool European Pressphoto Agency/AP

And some complain the court should be focusing on crimes allegedly committed by Western leaders in places like Iraq.

Indicting leaders of states raises additional legal challenges. International law dictates that heads of state enjoy immunity in other states’ courts – unless this immunity is expressly waived by their own governments.

The ICC defends its actions as fair. It argues it does have jurisdiction in the cases against Putin and Netanyahu because the alleged crimes took place in Ukraine and Palestine, two states who have explicitly accepted its jurisdiction.

And Article 27 of the Rome Statute says the ICC can exercise jurisdiction over people with state immunity, although it’s debatable whether this must be first waived for leaders of states not party to the Rome Statute.

Cooperation remains key

The ICC is not only constrained by these complex legal questions, but also by the limited cooperation of states around the world.

It relies on close cooperation with its 125 state parties, among others. But some states have been reluctant or even refused to cooperate with the court in executing the arrest warrants of controversial figures.

For example, Putin was not arrested when he visited Mongolia, an ICC member, last year, in part, because Mongolia relies heavily on Russian energy. South Africa similarly refused to arrest Sudanese dictator Omar al-Bashir when he visited in 2015.

Even when state parties do cooperate, the political fallout can impact the court’s reputation.

Following Duterte’s arrest last week, a Filipino senator (the sister of the current president) launched an urgent investigation to ensure due process was followed and Duterte’s legal rights were upheld and protected. She acknowledged the arrest has “has deeply divided the nation”.

The lack of support from the US – arguably, still the world’s most powerful democracy – remains a perennial problem, as well.

While the US has generally supported the court’s mandate over the years, it has been wary of its jurisdiction over American citizens and those of its allies accused of crimes. Last month, President Donald Trump authorised new sanctions against ICC officials in an attempt to paralyse the international organisation.

Although 79 states did declare their support for the ICC following the sanctions, the Trump adminstration’s rejection of the court’s jurisdiction, legitimacy and authority has had significant consequences for its operations.

It remains to be seen how the case against Duterte will play out. Securing a conviction is not assured.

However, his arrest demonstrates the court can fulfil its mandate and remain a relevant force in the fight against the gravest of crimes. It is also a significant moment for the families of those killed during Duterte’s rule, who have long sought justice for their loved ones. Läs mer…

If you’ve ever picked up your child from childcare and wondered if they’re living a double life, you’re not alone.

Parents often receive rave reports from educators about kids’ adventurous eating habits, only to face a different reality at home, when the child who devoured a veggie-packed curry at lunchtime morphs into a fussy eater refusing anything but dinosaur-shaped chicken nuggets.

While this confusing behaviour is frustrating, it’s completely normal.

Here’s why it happens and what you can do.

How kids’ tastes and eating behaviour develops

To understand why kids eat differently in different settings, we need first to understand two factors that shape their tastes and food preferences:

Genetics. Our hunter-gatherer ancestors developed physiological responses for survival that are embedded in our genes and influence taste preferences from birth. These include developing “food fussiness” – a natural aversion to unfamiliar foods and bitter flavours to avoid ingesting toxins – and learning to seek palatable foods rich in natural sugars, fat and protein to avoid starvation.

Eating environment. As kids grow, their surroundings at mealtimes – namely carers’ eating habits, feeding practices, routines and social cues conveyed – shape what they actually eat and enjoy.

The interaction between these two factors drives how fussy kids will be, their likes and dislikes and how open they are to new foods.

Why eating behaviour differs between childcare and home

The simple reason kids may eat differently at childcare comes down to the eating environment. Here’s what typically makes childcare different to home:

1. Childcare has strict routines

Childcare runs to a strict schedule, teaching kids to expect meals and snacks at set times and places. Meals are also planned to ensure kids sit down to eat when they’re hungry, and food is offered for a limited time – factors that help kids focus on eating.

When mealtimes are less structured at home, it often leads to kids snacking, reducing their appetite at dinnertime. Distractions, like screens, also take kids’ attention away from eating.

2. Kids are exposed to peer influence and different role models

Kids are natural copycats, so seeing friends enjoying healthy food makes them more willing to try it. This behaviour is supported by a study showing that seating a preschooler who dislikes a vegetable next to a peer who enjoys it can gradually shift their preference, leading them to eat the previously disliked vegetable.

Additionally, the social nature of eating in a group setting encourages kids to try new foods and eat more.

Research also shows carers – who are trained to model enthusiasm for nutritious foods – shape healthy eating habits and help kids learn other valuable behaviours like table manners.

At home, time constraints and limited knowledge can make it harder for parents to model these same behaviours.

3. Childcare regularly exposes kids to new foods

At childcare, meals are carefully planned according to Australian Dietary Guidelines and are focused on exposing kids to new foods regularly and repeatedly to get them comfortable with different tastes and textures.

At home, busy family lives often lead to repetitive meal routines.

4. Kids are offered limited choices

At childcare, meals are planned with military precision and served without negotiation, teaching kids to try to eat what’s provided.

At home, mealtimes can involve high-stakes negotiations when kids refuse certain foods, leading parents to surrender and offer alternatives – a tactic that only reinforces fussy eating and teaches kids to hold out for favourite foods.

5. Kids are given some control over what they eat

Kids have very little control over their daily lives – we’re constantly telling them what to do and when they’ll do it.

However, one way kids assert control is by refusing to eat certain foods at home.

Childcare cleverly gives kids the control they seek, encouraging them to serve themselves from shared platters, making them more willing to try new foods.

6. Kids experience less attention and pressure

At home, we naturally focus on what our child is eating (and not eating) which makes mealtimes stressful for kids.

At childcare, kids don’t have an audience watching their every bite, so they feel less pressure, eat more freely and are more willing to try different foods.

Read more:
5 picky eating habits – and how to help your child overcome them

Six ways to bring childcare eating habits home

1. Stick to a strict routine

Serve meals around the same time each day and establish snack times, ensuring they’re two hours before mealtimes so your child sits down hungry and ready to eat. Your routine should include putting devices away so your child’s full attention is on eating.

2. Be a positive role model

Because kids observe and mimic what they see, if you show enthusiasm for trying new foods and healthy eating your child will do the same.

3. Get creative

Take a leaf out of childcare’s book and ensure your child’s plate features different colours, textures and flavours presented in fun ways to capture and hold their interest in new foods.

And just like childcare, do this regularly, as repeated exposure is key – it can take eight to ten exposures before your child will accept eating a new food.

4. Limit food choices (but in a fun way)

Offer limited choices but in a way that gives your child some control, like serving platter-style meals where they can choose what they want.

Don’t give into food demands. While it’s tempting to offer alternatives when meals are refused, this creates more problems than it solves, reinforcing food fussiness and narrowing their diet.

5. Encourage independence

Actively involve your child in meal preparation, asking them to pick healthy recipes, help you shop and complete simple tasks like washing veggies and mixing ingredients. This can make them curious to taste the meal they’ve helped prepare.

6. Make mealtimes stress-free

Prioritise sitting down to eat as a family and ensure mealtimes are relaxed and fun – especially when you’re introducing new foods – to create positive associations with healthy eating.

Nick Fuller is the author of Healthy Parents, Healthy Kids – a clinically proven blueprint to overcoming food fussiness. Läs mer…

This year’s Alliance Française French Film Festival showcases a diverse selection of films from blockbusters and biopics to comedies and gripping thrillers for Australian audiences.

I’ve written before about how this annual event, now in its 36th edition, is, in terms of tickets sold and films screened, the largest film festival dedicated to contemporary French cinema outside of France.

The 2025 program once more shines a spotlight on the established icons and rising stars of French cinema.

In the this year’s festival, 30% of the films are directed by women and thorny issues such as slavery, consent and caregiving are presented sensitively and provocatively.

But from a competitive bunch, here are the best five films I saw this year.

How To Make A Killing

It’s Christmas in the Jura, France’s picturesque eastern region full of mountains, snow and pine trees. When Michel (Frank Dubosc) accidentally crashes his truck into a car, killing its driver and passenger, his wife Cathy (Laure Calamy) tells him he may have left fingerprints at the crime scene.

They return – and discover two million euros in the car boot, and a loaded gun in the glove box.

From this point on, How To Make A Killing features one improbable but amusingly nerve-wracking twist after another. There’s a local policeman in over his head and drug lords and contract killers who want their money back.

Oh, and a black bear is on the loose.

Writer-director Dubosc pays homage to the Coen brothers and sprinkles in a typically Gallic dose of black humour. What really gives the film zip and pizzazz is the fabulous Calamy. She has risen to the apex of contemporary French stardom and her performance is a delight.

The Divine Sarah Bernhardt

Sarah Bernhardt can lay claim to being the first film celebrity. Born in Paris in 1844, Bernhardt was first a legendary stage actress, performing Shakespeare and Racine across the world (including Melbourne and Sydney in 1891) before gravitating to silent cinema.

Known for her extraordinary talent and intense stage presence (hence “divine”), she refused to play just female roles, famously playing Hamlet. Her eccentricity was equally renowned: she often travelled with an extensive menagerie of exotic pets.

Guillaume Nicloux’s sumptuous biopic unfolds in a radical way. Rather than tracing Bernhardt’s career in the fairly bog-standard biopic way, Nicloux jumps around, focusing on key events from her life – the amputation of a leg, her death, her bisexuality, her hedonistic lifestyle.

Through this bold achronological prism comes another daring choice: we never see Bernhardt act on stage or film. Her stardom emerges through the extraordinary effect she has on people who enter her orbit.

At the centre is a remarkable performance by Sandrine Kiberlain. She captures Bernhardt’s glamour and narcissism but also taps into her vulnerability to reveal her gradual hollowing out as the vagaries of fame take their toll.

It’s a cautionary tale that speaks to our current ambivalence towards stage-managed celebrity and “stardom at all costs”.

My Brother’s Band

Ever since its Cannes debut last May, Emmanuel Courcol’s My Brother’s Band has received rave reviews. It is sure to be an instant classic.

Two brothers are separated at birth and are only reunited decades later when Thibaut (Benjamin Lavernhe) needs a bone marrow transplant. The only suitable donor is long-lost Jimmy (rising star Pierre Lottin).

All that bonds the two is a shared love of music. Thibaut is an esteemed orchestra conductor while Jimmy plays the trombone in a local brass band.

Lavernhe’s and Lottin’s scenes together are wonderfully wry and tender as the two brothers learn to appreciate each other’s lifestyles and ways of seeing the world. We also see how music can bind communities together during times of personal and collective crisis.

Courcol shuttles between the stuffy, cathedral-like spaces of a Paris conservatorium and the cramped parish halls of northern France. Think Brassed Off meets Tár. My Brother’s Band brings the feel-good to the festival.

When Fall is Coming

When Fall is Coming, the latest work by prolific auteur François Ozon, is a broody family drama set in Burgundy.

Behind the autumnal landscapes and off-the-beaten-track villages lies hidden trauma. Michelle (the outstanding Hélène Vincent, now 81) nervously awaits the arrival of her grandson and the daughter from whom she is long estranged (for reasons we don’t understand until much later).

An innocuous first night meal turns to tragedy, and kickstarts a deeply engrossing, often menacing film. Pierre Lottin features again, this time as an ex-con slowly drawn into this unsettling web of secrets and lies.

The “fall” in the title can be read any number of ways. Suffice to say, this slow-burner reminds us of Ozon’s knack in withholding plot points and revealing them gradually. With its blend of spiteful intimacy and startling revelations, When Fall is Coming quietly chills. You’ll not look at mushrooms in the same way again.

Lucky Winners

French filmgoers love to laugh. The top ten grossing French films in history are all comedies.

Lucky Winners is a jet-black comedy about four different winners of France’s national lottery. Each becomes a millionaire overnight – but that’s when their troubles begin. Romain Choay and Maxime Govare’s witty film features a fine ensemble cast and a healthy dose of cruelty and squabbling.

The dream sours. Money does not bring happiness, only guilt, revenge and greed. Feel-good quickly descends into feel-bad. I imagine Hollywood will be remaking this very soon.

The Alliance Française French Film Festival is in cinemas around Australia on various dates until April 27. Läs mer…

Ironically, Mark Zuckerberg’s attempts to muzzle his former employee, Sarah Wynn-Williams, once director of global public policy at Meta, seem to have created a bestseller.

While Meta’s legal action successfully prevented Wynn-Williams (who worked there from 2011–17) from promoting her memoir, Careless People, her publisher has continued to promote it without her.

In the week of its release, the book sold 60,000 copies in the United States. In the United Kingdom, it sold 1,000 copies a day for the first three days.

“This early success is a triumph against Meta’s attempt to stop the publication of this book,” Joanna Prior, CEO of publisher Pan Macmillan, told the Guardian last week.

The court order that prevents Wynn-Williams from promoting her memoir may also prevent her from responding to requests from lawmakers in several countries to discuss her time at the company, formerly known as Facebook, and “issues of public concern”, her lawyers believe.

Requests have come from members of the US Congress, the parliament of the UK, the parliament of the European Union and other sources, reports CNN.

This comes as Zuckerberg, the founder, chairman and CEO of Meta, has committed the company, as Trump’s second term begins, to “free expression”. “Too much harmless content” is being censored, he says. In practice, this means getting rid of fact-checkers, in favour of a Community Notes program like the one on X, which Zuckerberg cites as a model.

Tech titans Mark Zuckerberg, Jeff Bezos, Sundar Pichai and Elon Musk at the second inauguration of US president Donald Trump.
Julia Demaree Nikhinson/Pool/AAP

Meta claims Wynn-Williams, a former diplomat born in New Zealand who convinced the company to create her global position, has broken a non-disparagement agreement: signed, it says, after she was dismissed for poor performance. Last week, it called the book

a mix of out-of-date and previously reported claims about the company and false accusations about our executives.

A true insider account

Last year, tech journalist Kara Swisher, in her memoir Burn Book, summed up Zuckerberg as “one of the most carelessly dangerous men in the history of technology” – interestingly, given this memoir’s title. She also referred to Facebook as “anti-social media”.

There have been other books about the company too, such as Facebook: the Inside Story by tech journalist Steven Levy in 2020 and An Ugly Truth: Inside Facebook’s Battle for Domination by journalists Sheera Frenkel and Cecilia Kang in 2021.

Some of the company’s misdeeds were discussed in these books. But whereas they are based on interviews with unnamed sources, Wynn-Williams, a senior insider, has put her name to them. She refers to the protagonists by their first names, reflecting the rapport they once shared.

Sarah Wynn-Williams’ book is unique in referring to protagonists like Sheryl Sandberg and Mark Zuckerberg by their first name, reflecting their one-time rapport.
Facebook/AAP

From shark attack to Facebook

Careless People starts with Wynn-Williams’ story of narrowly surviving a shark attack as a child, despite the complacency of her family and the local doctor. This may be to indicate her strength and resolve. Or perhaps it is a metaphor for the viciousness and indifference she would later encounter at Facebook.

She was initially a big fan of the company, which she saw as a potential force for good. An example of the good work of Facebook in its early days was a randomised control experiment before the 2010 US midterm elections. Some subscribers were sent a message at the top of their newsfeed encouraging them to vote, with a link to polling places and an “I voted” button they could click. This led to an additional 340,000 voters.

Every employee joining Facebook was given a Little Red Book written by Zuckerberg. As Wynn-Williams comments, the book represents “core principles from the supreme leader” who she calls “another MZ channeling his own peculiar form of Maoist zeal”.

Over time, Wynn-Williams’ admiration for Zuckerberg would wane. Her book is also rather unflattering about Sheryl Sandberg, Zuckerberg’s then deputy. The Lean In author is described as drawing people in “like moths to a flame” and expecting female staff to spend evenings helping to promote her book. This was particularly galling, as her book was about empowering women in the workplace.

Sandberg was such a demanding boss, Wynn-Williams was sending her talking points for a meeting at Davos while giving birth. Her doctor was saying: “you should be pushing – but not pushing ‘send’!”

Sheryl Sandberg was such a demanding boss, Wynn-Williams was sending her talking points for a Davos meeting while giving birth.
Jean Christophe Bott/AAP

Losing faith and breaking things

Wynn-Williams started to question her faith in Facebook (which changed its name to Meta in 2021) when she realised parents working there did not allow their own teens to have mobile phones. “These executives understand the real damage their product inflicts on young minds,” she writes.

In 2017, an internal memo revealed Facebook was offering advertisers the opportunity to target teenagers when their posts revealed low self esteem. For example, beauty products could be targeted to young women when they deleted a selfie. The company was increasingly adding features that were “addictive by design”, as they sought to maximise engagement at all costs.

The company was adopting an aggressive stance towards traditional media. Zuckerberg attacked one of his staff for “compromising with a dying industry rather than dominating it, crushing it”.

In its drive for global domination, Facebook thought, in the words of one senior colleague, that “the first billion users are the easy billion”. Beyond that, there were the technical problems of expanding into countries with low or poor internet coverage. There were also ethical questions about collaborating with autocratic governments.

Wynn-Williams was perturbed when Facebook told China it could help “promote safe and secure social order”.

A United Nations investigator described how Facebook played a critical role in spreading hatred of Rohingya and Muslims within Myanmar. In 2018, the chairman of the UN Independent International Fact-Finding Mission on Myanmar told reporters that Facebook “substantively contributed to the level of acrimony and dissension and conflict” in the public, including “hate speech”.

Chinese President Xi Jinping, centre, talks with Facebook Chief Executive Mark Zuckerberg, right.
Ted S. Warren/AAP

She also worried about the role Facebook played in the first election of Donald Trump, in 2016. It allowed the Trump campaign to target misinformation to people it would most likely influence, she writes. The campaign also used it to discourage groups less attracted to Trump from voting. She was disgusted when Zuckerberg, rather than being upset about this, admired “the ingenuity” of Trump’s campaign.

After a meeting with President Barack Obama, Zuckerberg was furious at being accused, accurately, of not taking seriously the problem of untrue stories being widely promoted.

The author warns that, unlike the global leaders he increasingly mixed with, Zuckerberg (now aged 40) could stay in his current position “for another fifty years”. His potential longevity is compared to Queen Elizabeth II.

At one stage, Zuckerberg seemed to be musing about a presidential run. Unlike Elon Musk, Zuckerberg was born in the US, so is eligible. But as Levy put it in his book, “no country on Earth has a population as big as Facebook; the presidency would be a step down”.

Unanswered questions

Wynn-Williams feels this emphasis on maximising profits at all costs is unnecessary. Had they wished, the senior people at the company could have been incredibly rich while still displaying some basic human decency.

Meta’s famous slogan is “move fast and break things”. But increasingly, Wynn-Williams concluded one of the things being broken was community health.

The book is easy to read and the author writes engagingly. But unanswered questions remain. Readers may wonder why the author stayed at Meta as long as she did once she developed misgivings about its impact.

She mentions her serious health issues: she feared losing her health insurance. But surely she had been on a large salary package and could afford to look after herself. She may have been in denial, unwilling to admit her initial admiration for Zuckerberg had been misplaced. Her husband’s explanation was she suffered from Stockholm syndrome.

The book would be a more useful reference if it had a bibliography and an index. But it does reveal some important insights about the attitudes of some careless –but very powerful – people. Läs mer…

You’ve got a new brown spot on your face, but is it a freckle or a sunspot? Or perhaps you’ve found a spot on your back that looks like a mole but is flatter than your other ones – is it a mole or a dark freckle?

Here’s how to tell the difference between freckles, sunspots and moles – and when you need to get a spot checked to see if it’s skin cancer.

Freckles

Freckles, known as ephelides, are small, flat, light brown spots that appear on people with fair skin, or red or light-coloured hair.

These people are more likely to have the MC1R gene, which leads to freckles forming.

Freckles are caused by sun exposure and are more noticeable in summer. When sunlight hits the skin, cells called melanocytes produce melanin, the pigment that gives skin its colour.

In people prone to freckles, the melanin doesn’t spread evenly. Instead, it clumps together, creating freckles.

Melanin doesn’t spread evenly in people prone to freckles.
Chermiti Mohamed/Unsplash

Freckles generally appear in childhood and may fade with age, especially if sun exposure reduces. As we age we produce less melanin, or it can break down or disperse, resulting in lighter or fewer freckles.

Using sunscreen and wearing protective clothing can help prevent new freckles from developing, especially on the face and arms.

While freckles are completely harmless, they are a sign that someone is genetically at higher risk of developing skin cancer.

Sunspots

Sunspots are also called age spots or actinic keratoses (or liver spots, but they have nothing to do with the liver). They are larger than freckles: sometimes the size of a small coin, and appear as flat brown spots.

Sunspots develop over time due to long-term sun exposure, which leads to excessive melanin production. They tend to appear on skin with greater sun exposure, such as the face, hands, shoulders and arms.

Sunspots develop after years of sun exposure.
Zay Nyi Nyi/Shutterstock

Unlike freckles, which tend to get lighter with less sun exposure, sunspots will not fade with time, and may further darken with continued sun exposure.

However, some people try to remove their sunspots for cosmetic reasons using either a laser, chemical peel or a prescription topical cream.

While sunspots are not dangerous, they do increase your risk of other skin cancers in that area.

It’s also important to monitor them, as slow-growing melanomas may initially look like sunspots. If you see the spot changes in size, shape or colour, see your doctor to rule out skin cancer.

Moles

Moles are often dark, raised or flat skin growths that can appear anywhere on your body.

Although moles can exist from birth, they typically grow during childhood, adolescence and early adulthood (including during pregnancy, when hormones are changing), until around the age of around 40. Moles can increase in size, and new ones can also appear.

Most adults have between ten and 40 moles on their body. A person with a high mole count has 50 or more, while someone with a very high mole count has 100 or more.

Some moles are raised while others are flat.
Pixel-Shot/Shutterstock

Moles form when melanocytes grow in clusters instead of spreading evenly throughout the skin.

Moles can either be raised or flat, depending upon their type, depth and age.

Raised moles, referred to as compound nevi, have both flat and raised portions and typically have pigment that is deeper in the skin.

Dermal nevi are skin-coloured or light brown moles that are also raised.

Most moles are harmless. Some may have hair growing from them and some may disappear, whereas other moles may darken or alter with age or hormonal changes.

However, some moles can develop into melanoma, a dangerous form of skin cancer.

When to see your doctor

While freckles and sunspots are completely harmless, moles do require more attention, especially if they change in size, shape, colour or texture.

If a mole shows any of the following warning signs, see your doctor, who will use the ABCDE rule to detect if a lesion is a skin cancer:

asymmetry: if one half of the mole looks different from the other half
border: if your mole is shaped irregularly, jagged or has poorly defined edges
colour: varied shades or sudden changes in colour of the mole
diameter: if it is larger than 6 millimeters (about the size of a pencil eraser)
evolving: if your mole has any changes in its size, shape, colour, or sensation such as itching or bleeding for more than a few weeks.

Our research shows only 21.7% of people can correctly identify melanoma on their own, so professional checks are essential.

How to prevent skin damage

Since freckles, sunspots and some moles are influenced by exposure to the sun, you can protect your skin by:

avoiding the sun when ultraviolet rays are strongest
wearing sunscreen with SPF 50 every day, even when it’s cloudy. Apply it 20 minutes before going outside and reapply every two hours
wearing protective clothing, including a wide-brimmed hat to cover your face, neck and ears, and long-sleeved shirts and pants to protect your arms and legs. Läs mer…

The Anatomy of Melancholy was written more than 400 years ago, but Robert Burton’s masterpiece is strangely modern. Although it brims with quaint language and Latin quotes, it also resembles a medical textbook: a compendium of the symptoms, causes, prognoses and treatments of human misery.

Take Burton’s discussion of “love-melancholy”. Its symptoms include leanness, loss of appetite, hollow eyes, fear, sorrow, disturbed sleep, suspicion, sighing, moaning, peevishness and pallor, “as one who trod with naked foot upon a snake”. It has dietary, climatic and astrological causes. Burton is not optimistic about recovery, but suggests “good counsel and persuasion” may help.

Love-melancholy is no longer recognised as an illness, but Burton showed how it could be diagnosed. From Greek roots meaning “to know apart” or distinguish, diagnosis takes place in countless consulting rooms around the globe. In essence, this process of discerning illness from symptoms is no different from any other kind of categorisation, like identifying birds or car models.

Review: Age of Diagnosis – Suzanne O’Sullivan (Hachette)

Diagnosis may be an everyday activity, but it is a contentious one. There has been a staggering rise in the prevalence of many medical conditions and the cultural attention we pay them. Diagnostic labels saturate our language, firehosed by social media. The stigma attached to some diagnoses, such as depression and attention deficit hyperactivity disorder, has waned to the point where many people actively seek and embrace them.

But as diagnosis has risen in prominence, it has become a magnet for criticism. New diagnostic manuals are lashed for turning ordinary life problems into pathologies. Mental health professionals argue we should abandon diagnosis altogether, or replace its categories with spectra. Countless video clips on social media channels like TikTok peddle expansive and inaccurate definitions of illness, while others push back against self-diagnosis.

Suzanne O’Sullivan.
Penguin Random House

British neurologist Suzanne O’Sullivan enters this battlefield with her timely new book, The Age of Diagnosis. O’Sullivan is a seasoned clinician and science writer who has seen firsthand how the diagnostic landscape has changed. We have taken diagnosis too far, she argues, and our cultures, health systems and selves are suffering the consequences.

Her perspective is a necessary one, complementing the concerns about overdiagnosis and “concept creep” raised by writers whose backgrounds are primarily in research and theory. As someone who works at the clinical frontline, and whose compassion for her patients is clear, O’Sullivan’s views cannot be written off as out of touch or uncaring.

Overdiagnosis and medicalisation

O’Sullivan’s case rests on two pivotal concepts: overdiagnosis and medicalisation. We might imagine that overdiagnosis occurs when diagnoses are made in the absence of illness, but O’Sullivan’s definition is more subtle. A condition is overdiagnosed, she writes, when the costs of the diagnosis outweigh its benefits.

This definition draws attention away from knotty ontological questions about the boundaries of illness and towards the pragmatic question of whether diagnosis is helpful. “A diagnosis is supposed to lead to something,” O’Sullivan writes, and if it doesn’t lead to something good, it is unwarranted.

Ideally, a diagnosis should deliver the benefits of effective treatment while doing no harm. In practice, many diagnoses carry stigma, undermine our sense of self and future, and have self-fulfilling negative (“nocebo”) effects. O’Sullivan argues we systematically underestimate the costs of diagnosis and overestimate its benefits. This is especially so for milder forms of illness, where the benefits of treatment are often minimal.

Medicalisation is the tendency for concepts of illness to expand to encompass a widening range of human experience. New conditions can be invented and old ones stretched to include milder phenomena. Ordinary variations in human biology can be defined as disease risks, as in “predictive diagnosis”, when the likelihood of developing a condition is calculated based on genetic tests or other health information.

Medicalisation leads us to see the world through the lens of pathology. By expanding concepts of illness into the zone of ordinary unhappiness, O’Sullivan argues, it fosters overdiagnosis.

Attributing more to sickness

O’Sullivan believes overdiagnosis and medicalisation are rife. Rates of some diagnoses are rising, not due to declining population health or enhanced detection, she suggests. Instead, “borderline medical problems are becoming ironclad diagnoses”. “We are not getting sicker,” she writes, “we are attributing more to sickness.”

This trend has several adverse consequences. Overdiagnosis leads to overtreatment. Because diagnoses are not inert labels, it can actively create illness and distress. It can waste resources and divert them from areas of greater need.

Chapters of the book explore these themes in a range of health conditions, many psychiatric or neurological. They offer an informative combination of clinical case study, clearly articulated science, and sober reflection on social implications.

A chapter on autism chronicles the steady expansion of this condition. Originally a severely disabling and vanishingly rare condition of childhood that disproportionately affected boys, it has become one that encompasses people with relatively benign challenges, she writes. Increasingly, it is diagnosed in adults and the sex ratio is gradually becoming more balanced.

For O’Sullivan, these developments reflect “diagnostic creep” and questionable theorising. The autism phenotype has become overstretched, she argues: concepts such as “masking” allow people with relatively mild visible social impairments to be included. Many people find autism diagnoses validating, she argues, but evidence they produce benefits for everyday functioning is scarce. She also warns autistic identities may be stigmatised and self-limiting.

Concepts such as ‘masking’ allow people with relatively mild visible social impairments to be included in autism diagnoses.
Ian Talmacs/Unsplash

Meanwhile, heterogeneous samples and shifting diagnostic sands make it well-nigh impossible for researchers to develop reliable, cumulative knowledge about autism. It has become a moving target: a paradigm case of philosopher Ian Hacking’s “looping effects”, by which our classifications influence the people they classify – and are then influenced by them.

Critical of neurodiversity

Similar concerns are raised about attention deficit hyperactivity disorder (ADHD). Like autism, the diagnosis has increased rapidly and received many more adult and female cases. O’Sullivan notes the unavoidable subjective elements involved. All 18 “symptoms” must be judged to occur “often” to be considered present, a judgement known to vary between people. These symptoms must be appraised as “negatively impacting” social, academic or occupational activities, another intrinsically vague benchmark.

Autistic and ADHD actor Chloe Hayden.
Bianca De Marchi/AAP

O’Sullivan is critical of the “neurodiversity” view of ADHD, which holds that the condition is a form of difference to be celebrated rather than a disorder to be fixed. She denies that its essence is neurological and challenges the “biologising” focus on brain processes. That focus oversimplifies ADHD, overlooking its social and environmental determinants. “I am a psychologiser,” she announces, sceptical of biological reductionism.

The recent trend for ADHD to be adopted as an identity also comes in for criticism. O’Sullivan sees this identity as more constraining than liberating. Viewing ADHD as an enduring and inbuilt aspect of one’s brain promotes passivity, and the bogus binary between the neurodivergent and the neurotypical creates an unhelpful “us versus them”, she writes.

O’Sullivan acknowledges that many people find self-acceptance in the diagnosis. However, its additional benefits are unclear, she suggests, especially among relatively mild cases. For example, stimulant medication may not compensate for the adverse impacts of diagnostic labelling for children with less severe ADHD. Similarly, study accommodations such as extra time on tests have little effect on performance. In the absence of tangible benefits and the presence of potential costs, she argues, ADHD is likely to be overdiagnosed.

Overscreening cancer

Although many of the book’s examples scrutinise mental health, The Age of Diagnosis roams wider. O’Sullivan gives equal weight to Huntington’s disease, Lyme disease, long COVID and rare genetic conditions, among others. In these conditions, tensions often arise between advocacy groups and medical scientists. The former typically agitate for broader and sometimes questionable diagnoses. O’Sullivan makes no secret of where she stands:

Scientific answers aren’t at the convenience of the majority opinion. Understanding patient experience is fundamental in setting research priorities, but scientific process must still be systematic, methodical, rigorous and open to any answer.

In a powerful chapter on genetic screening for cancer, Sullivan finds it often fails to deliver health benefits but succeeds in pathologising normal biological variations. All screening tests have false positives, but these can be significantly more common than true positives. False positives are not cost-free and the benefits of accurate early detection are not straightforward.

Breast cancer screening.
Torin Halsey/Times Record News/AAP

Positive tests can have damaging psychological and sometimes physical consequences, she writes. These include dread-filled time waiting for disease to manifest and unnecessary interventions. Some screening tests massively overestimate the likelihood that positive tests will develop into illness requiring treatment.

Even if screening reduces progression to a particular fatal disease, it may not reduce deaths by all causes combined. O’Sullivan cites one meta-analysis showing that with the exception of large bowel cancer, cancer screening did not extend the lifespan at all. It is instructive that people who are properly apprised of the potential risks and benefits of screening often forego it, even when the benefits are relatively unambiguous.

Fixing the diagnosis problem

What to do? O’Sullivan is not one to wring hands. She offers a range of remedies, some directed at medical practice and some to the culture at large.

From the standpoint of medicine, O’Sullivan’s key recommendation is to take overdiagnosis much more seriously. Greater scrutiny is required whenever definitions of disorders are loosened or new screening tests are developed. Deeper scepticism about the aggregate benefit for patients’ quality of life is also needed. More attention must be paid to the potential downsides of diagnosis.

A more nuanced understanding of diagnosis itself is required. Often the problem is not diagnosis itself, but doing it too mechanically and taking it too literally. Diagnosis is a clinical art, not something decided by a superficial checklist or lab test.

O’Sullivan makes an evidence-based case for the importance of clinical judgement, informed by intimate and holistic awareness of the patient’s life circumstances. That kind of awareness is the best done by generalists, endangered as they are in our age of specialists.

Humanistic care is essential, but it is not enough. There is an urgent need to arrest the proliferation of diagnoses. O’Sullivan observes that patients increasingly present with multiple diagnostic labels, and discusses the poignant case of a young woman with nine.

The problems this trend poses should be obvious. Multiple diagnoses draw in multiple specialists, call for different treatments, make the coordination of care a major challenge, and become all-absorbing for the patient. The stickiness of diagnostic labels means that conditions are added but rarely subtracted.

Frequently the multiple diagnoses are not meaningfully distinct “co-morbid” ailments, but different expressions of a single underlying emotional disturbance, O’Sullivan suggests. Splintering this disturbance into a motley assortment of diagnoses fragments treatment. Like the fabled blind men who palpated different parts of an elephant, identifying it as a snake, spear, tree trunk, rope and wall, it also gets the ontology of the illness wrong.

Changing the culture of diagnosis

Responsibility for solving this problem should not fall on health professionals alone, however. It requires cultural change as well. Once upon a time we could blame the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) for medicalising experience and shrinking normality. But now inflationary trends in diagnosis are driven more by social media and well-meaning efforts to boost awareness.

The DSM may have helped to create a diagnostic culture, but it is laypeople who are now stretching its concepts and bandying about illness labels to diagnose themselves and others. This change is often seen as a welcome democratisation of mental health, a belated recognition of the value of “lived experience”, and a form of resistance to the biomedical model. However, its effect has been to pathologise everyday life as much as to normalise mental ill health.

Inflationary trends in diagnosis are based less on the DSM than social media and well-meaning awareness raising.

The pitfalls of these expansive concepts are now well documented in the research literature. People who apply diagnostic labels to their depressed mood tend to deal with it ineffectively. Making anxiety central to one’s identity is linked to coping poorly with it. Those who define adversities as traumas are more likely to respond in post-traumatic ways to unpleasant experiences.

Holding expansive concepts of mental illness leads people to self-diagnose at relatively low levels of distress. Applying diagnostic labels to mild or marginal cases of suffering leads people to think recovery is less likely and troubles less controllable. Findings such as these indicate that whatever benefits baggy diagnostic concepts may have, they also have a significant downside.

A growing ‘dediagnosis’ movement

The realisation that rising awareness of and attention to mental illness may be backfiring is beginning to dawn. There is little evidence it is improving our mental health – which continues to decline globally as awareness grows, especially among the young. However, there is reason to worry it may be doing the opposite.

A similar story might be told about other forms of illness. It is not hard to believe elevated concerns about risk and the medicalisation of normal losses of physical function can drive a joyless pursuit of perfect health and happiness.

O’Sullivan is correct in diagnosing our “age of diagnosis” and she makes a strong case for moving beyond it. It is hard to say what a post-diagnostic age might look like and how the pendulum might be wrestled back. It will surely require significant reform on the part of health systems and a serious reckoning with the rise of screening tools.

In this connection, it is gratifying to see an emerging movement for “dediagnosis” within medicine. It will have to be accompanied by a transformation in how the public thinks about diagnosis. O’Sullivan’s masterful book could help bring such an alliance into being.

The Age of Diagnosis shows us how we got into our pathological predicament – and indicates how we might get out. Läs mer…

The Australian Music Venue Foundation launched this month to advocate for and potentially administer an arena ticket levy to support grassroots live music venues. Funds would be raised through a small levy, approximately A$1 per ticket, on the price of tickets to large music events, over 5,000 capacity.

The foundation is partly modelled on the United Kingdom’s Music Venue Trust, a charity and advocacy body founded in 2014 that has advocated for a big ticket levy.

While the proposed levy would certainly help to level the playing field between grassroots music venues and the big end of touring, the Music Venue Trust was founded on much more radical principles and ambitions than simple redistribution.

Socialising live music

Although the Music Venue Trust has moved into advocacy and policy work, such as vocal support for the big ticket levy, the trust’s original and continuing mission is to socialise grassroots music venues. This means they work to help venues transition away from for-profit models and towards alternative ownership structures.

The trust’s “Own Our Venues” campaign spawned Music Venue Properties, a charitable landlord funded by the broader music community. The scheme has now purchased five grassroots venues around the UK, leased on the condition they continue to run as live music venues.

The goal is to take the profit motive out of running a venue. Surplus is reinvested into venue spaces, ensuring their long-term sustainability.

As the trust’s founder and CEO Mark Davyd states, “[the community] is the best person to own a venue”.

We don’t want money going to private landlords, we want it in the cultural economy because that’s the way we generate more great artists and give more people the opportunity to be involved in music.

Acknowledging that such radical ambitions require funding, the trust have been long term advocates for a big ticket levy. However, this advocacy has always accompanied their greater goal of socialising live music venues.

The trust have helped to change the broader cultural understanding of grassroots venues in the UK. Between 2014 and 2022, the proportion of music venues in the country run as not-for-profit ventures increased from 3% to 26%.

The Australian context

Melbourne’s Gasometer Hotel and Brisbane’s The Bearded Lady are the latest small, but culturally significant, live music venues to face closure. The number of venues licensed for live music in Australia is falling, with the greatest reductions in the small-to-medium range.

The recent parliamentary inquiry into the live music industry found costs like insurance and rent have risen sharply in the last five years. Meanwhile, income from alcohol sales – a core revenue source for smaller venues – has dropped in connection with changing youth culture, the cost-of-living crisis, and excises hitched to inflation.

Costs to run music venues have increased, while income from avenues like alcohol sales have fallen.
Frankie Cordoba/Unsplash

Surveys of young people and other groups affirm that Australians value live music, and most people would like to attend more. The most commonly cited barrier is cost, followed by distance from appropriate venues, especially in regional areas.

An arena ticket levy was a key recommendation of the inquiry, with the committee recommending government agency Music Australia should manage the funds.

The committee proposed a levy could enable Music Australia to fund:

performances with minimum pay rates for musicians
capital improvements to venues, such as sound-proofing or disability access
festivals promoting regional, all-ages, First Nations and community participation.

Neither the Labor government nor the opposition have indicated a position on this recommendation, which would require legislation.

The industry proposal

The Australian Music Venue Foundation is asking big music businesses to opt in to an industry-managed ticket levy to fund grassroots live music.

While there has been advocacy for such a voluntary arrangement in the UK, this is yet to come to fruition. The UK government’s deadline for the arrangement of a voluntary scheme by the end of March is approaching, opening up the alternative scenario of a legislated mandatory levy.

Australian advocates believe they may have the relationships to create a different outcome, arguing all industry players have a stake in a healthy music ecosystem.

In the proposed Australian scheme, the recipients and use of funding would be decided by a board of industry professionals. This raises questions around potential conflicts of interest. The foundation has applied for charity status, which requires transparency around operations and finances. However, there are broader questions about priorities.

The foundation argues all levels of the industry have a stake in their being a healthy ecosystem of venues.
Austin/Unsplash

If the scheme gets up, the foundation will need to consider whether to restrict its support to Australian-owned, independent venues of a certain size. Alternatively, funds may be available to venues that are part-owned by the same major, for-profit, international companies paying into the scheme.

To replace the proposed government levy, the foundation would also need to find ways of supporting access to live music for regional, all-ages, First Nations, and other disadvantaged communities, as recommended by the inquiry’s report.

To ensure benefits flow to artists, venue support could also be made conditional on paying a minimum performer’s fee, something venue’s have previously opposed.

The foundation could promote social objectives such as performer diversity, patron safety, and environmental sustainability, but there are no guarantees of this under an industry-led scheme.

These examples demonstrate the issues that can arise when economic redistribution is managed within an industry, rather than by government.

Lofty ambitions

The Music Venue Trust has successfully argued for grassroots music venues as a public good, worthy of longterm community and public investment as well as a structural approach to support.

Through their work, they have provided a new narrative for live music in the UK, supporting innovative ownership and operating models that go beyond the default of a commercially-leased space run as a for-profit small business.

Ambition and innovation has made the trust much more than another industry association advocating for the interests of a particular group of businesses. The Australian Music Venue Foundation should aspire to similar heights if it is to have the same level of influence and impact. Läs mer…

Plant behaviour may seem rather boring compared with the frenetic excesses of animals. Yet the lives of our vegetable friends, who tirelessly feed the entire biosphere (including us), are full of exciting action. It just requires a little more effort to appreciate.

One such behaviour is the dynamic opening and closing of millions of tiny mouths (called stomata) located on each leaf, through which plants “breathe”. In this process they let out water extracted from the soil in exchange for precious carbon dioxide from the air, which they need to produce sugar in the sunlight-powered process of photosynthesis.

Opening the stomata at the wrong time can waste valuable water and risk a catastrophic drying-out of the plant’s vascular system. Almost all land plants control their stomata very precisely in response to light and humidity to optimise growth while minimising the damage risk.

How plants evolved this extraordinary balancing act has been the subject of considerable debate among scientists. In a new paper published in PNAS we used lasers to find out how the earliest stomata may have operated.

Tiny valves, global consequences

Much depends on the way stomata behave: plant productivity, sensitivity to drought, and indeed the pace of the global carbon and water cycles.

However, they are difficult to observe in action. Each stomata is like a tiny, pressure-operated valve. They have “guard cells” surrounding an opening or pore which lets water vapour out and carbon dioxide in.

When pressure increases in stomata guard cells, the pore opens – and vice versa.
Artemide / Shutterstock

When fluid pressure increases inside the stomata’s guard cells, they swell up to open the pore. When pressure drops, the cells deflate and the pore closes. To understand stomata behaviour, we wanted to be able to measure the pressure in the guard cells – but it’s not easy.

Lasers, bubbles and evolution

Enter Craig Brodersen of Yale University with a newly developed microscope-guided laser. It can create microscopic bubbles inside the individual cells that operate the stomatal pore.

When Brodersen spent a sabbatical at the University of Tasmania (where I am based), we found we could determine the pressure inside stomatal cells by tracking the size of these bubbles and how quickly they collapsed. This involved theoretical calculations guided by bubble expert Philippe Marmottant, of the French National Centre for Scientific Research (CNRS) in Grenoble.

This new tool gave us the perfect opportunity to explore how the behaviour of stomata is different among major plant groups. The aim was to test our hypothesis that the evolution of stomatal behaviour follows a predictable trajectory through the history of plant evolution.

We argue it began with a relatively simple ancestral passive control state, currently represented in living ferns and lycophytes, and developed to a more active hormonal control mechanism seen in modern conifers and flowering plants.

Against this hypothesis, some researchers have previously reported complex behaviours in some of the most ancient of stomata-bearing plants, the bryophytes. We wanted to test this finding using our newly developed laser instrument.

400 million years of development

What we found was firstly that our laser pressure probe technique worked extremely well. We made nearly 500 measurements of stomatal pressure dynamics in the space of a few months. This was a marked improvement on the past 45 years, in which fewer than 30 similar measurements had been made.

Secondly, we found that the stomata of our representative bryophytes (hornworts and mosses) lacked even the most basic responses to light found in all other land plants.

The stomata of hornworts and mosses showed no response to changes in light.
Gondronx Studio / Shutterstock

This result supported our earlier hypothesis that the first stomata found in ancestors of the modern bryophytes 450 million years ago should have been very simple valves. They would have lacked the complex behaviours seen in modern flowering plants.

Our results suggest that stomatal behaviour has changed substantially through the process of evolution, highlighting critical changes in functionality that are preserved in the different major land plant groups that currently inhabit the Earth.

How plants will survive the future

We can now say with confidence that stomata in mosses, ferns, conifers and flowering plants all behave in very different ways. This has an important corollary: they will all respond differently to the heaving changes in atmospheric temperature and water availability that they face now and into the near future. Predicting stomatal behaviour in the future will help us to predict these impacts and highlight plant vulnerability.

In terms of agricultural benefit, our new laser method should be fast and sensitive enough to reveal even small differences in the the behaviour of closely related plants. This may help to identify crop variants that use water in a more efficient or productive way, which will assist plant breeders to find varieties that better translate increasingly unpredictable soil water supplies into food.

So next time you look upon a leaf, consider the frantic pace of dynamic calculation and adjustment of millions of little mouths, reacting as your breath falls upon them. Realise that our own fate, tied to the performance of forests and crops in future climates, hangs on the behaviour of the stomata of different species. A good reason for us to understand these unassuming little valves. Läs mer…

Australia’s BreastScreen program offers women regular mammograms (breast X-rays) based on their age. And this screening for breast cancer saves lives.

But much has changed since the program was introduced in the early 90s. Technology has developed, as has our knowledge of which groups of women might be at higher risk of breast cancer. So how we screen women for breast cancer needs to adapt.

In a recent paper, we’ve proposed a fundamental shift away from an age-based approach to a screening program that takes into account women’s risk of breast cancer.

We argue we could save more lives if screening tests and schedules were personalised based on someone’s risk.

We don’t yet know exactly how this might work in practice. We need to consult with all parties involved, including health professionals, government and women, and we need to begin Australian trials.

But here’s why we need to rethink how we screen for breast cancer in Australia.

Why does breast screening need to change?

Australia’s BreastScreen program was introduced in 1991 and offers women regular mammograms based on their age. Women aged 50–74 are targeted, but screening is available from the age of 40.

The program is key to Australia’s efforts to reduce the burden of breast cancer, providing more than a million screens each year.

Women who attend BreastScreen reduce their risk of dying from breast cancer by 49% on average.

Breast screening saves lives because it makes a big difference to find breast cancers early, before they spread to other parts of the body.

Despite this, around 75,000 Australian women are expected to die from breast cancer over the next 20 years if we continue with current approaches to breast cancer screening and management.

Who’s at high risk, and how best to target them?

International evidence confirms it is possible to identify groups of women at higher risk of breast cancer. These include:

women with denser breasts (where there’s more glandular and fibrous tissue than fatty tissue in the breasts) are more likely to develop breast cancer, and their cancers are harder to find on standard mammograms
women whose mother, sisters, grandmother or aunts have had breast or ovarian cancer, especially if there are multiple relatives and the cancers occurred at young ages
women who have been found to carry genetic mutations that lead to a higher risk of breast cancer (including women with multiple moderate risk mutations, as indicated by what’s known as a polygenic risk score).

For some higher-risk women, could MRI be an option?
VesnaArt/Shutterstock

Women in these and other high-risk groups might warrant a different form of screening. This could include screening from a younger age, screening more frequently, and offering more sensitive tests such as digital breast tomosynthesis (a 3D version of mammography), MRI or contrast-enhanced mammography (a type of mammography that uses a dye to highlight cancerous lesions).

But we don’t yet know:

how to best identify women at higher risk
which screening tests should be offered, how often and to whom
how to staff and run a risk-based screening program
how to deliver this in a cost-effective and equitable way.

The road ahead

This is what we have been working on, for Cancer Council Australia, as part of the ROSA Breast project.

This federally funded project has estimated and compared the expected outcomes and costs for a range of screening scenarios.

For each scenario we estimated the benefits (saving lives or less intense treatment) and harms (overdiagnosis and rates of investigations in women recalled for further investigation after a screening test who are found to not have breast cancer).

Of 160 potential screening scenarios we modelled, we shortlisted 19 which produced the best outcomes for women and were the most cost effective. The shortlisted scenarios tended to involve either targeted screening technologies for higher-risk women or screening technologies other than mammography for all screened women.

For example, in our estimates, making no change to the target age range or screening intervals but offering a more sensitive screening test to the 20% of women deemed to be at highest risk would save 113 lives over ten years.

Alternatively, commencing targeted screening from age 40 and offering a more sensitive screening test annually to the 20% of women at highest risk, and three-yearly screening (of the current kind) to the 30% of women at lowest risk, would save 849 lives over ten years.

However, less frequent screening of the lower risk group was expected to lead to small increases in breast cancer deaths in that group.

How do we best assess women for their risk of breast cancer? At this stage, there’s no one answer.
Tint Media/Shutterstock

We also outlined 25 recommendations to put into action, and set out a five-year roadmap of how to get there. This includes:

a large scale trial to find out what is feasible, effective and affordable in Australia
making sure women at higher risk in different parts of Australia are offered suitable options regardless of where they live and who they see
better data collection and reporting to support risk-based screening
testing how we assess women for their risk of breast cancer, including whether these assessments work as intended and make sense to women from a range of backgrounds
clinical studies of screening technologies to determine the best delivery models and associated costs
ongoing engagement with groups including women, health professionals and government.

Breast cancer screening review out soon

Federal health minister Mark Butler said a review of the BreastScreen program would consider our recommendations. The results of this review are expected soon.

We’re not alone in calling for a move towards risk-based breast cancer screening. This is backed by national and international submissions to government, policy briefing documents and the Breast Cancer Network Australia.

We’ve provided an evidence-based roadmap towards better screening for breast cancer. Now is the time to commit to this journey.

We acknowledge Louiza Velentzis from the Daffodil Centre, and Paul Grogan and Deborah Bateson from the University of Sydney, who co-authored the paper mentioned in this article. Läs mer…