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Alexander McCall Smith: Humankind by Rutger Bregman makes the case that humans are altruistic, not selfish

Rutger Bregman’s new book Humankind contains a real-life version of the ‘Lord of the Flies’ scenario that turned out very differently to William Golding’s novel, writes Alexander McCall Smith

Rutger Bregman's book Humankind could join the works of people like Sigmund Freud, pictured, in changing the way we think about human nature (Picture: AFP/Getty Images) Copyright: Getty Images

There are some books that you read, utterly rapt, in very few sittings, close with a sigh, and think, or even say, “Yes, precisely”. Sometimes such books make you want to write to the author and say thank you. So you get out your pen and you begin: “I do not make a habit of writing to authors...” (It’s remarkable how many letters to authors actually do begin that way.)

I am thinking of writing to Rutger Bregman to thank him for writing his new book Humankind. I shall probably not do so, because we all think of writing far more letters than we actually write. Indeed, there should be a special category of books: The Collected Intended Letters of... or The Unwritten Letters of...

This book has just been published and is beginning to be widely discussed. It is not entirely novel: the main issue it deals with has long been the stuff of debate in fields as diverse as biology, anthropology, and philosophy. The issue revolves around the question: is homo sapiens really red in tooth and claw? Hobbes and Rousseau are the poles there, and Bregman goes back to that old intellectual tussle, but with new insights, new evidence, and, in some cases, a fresh take on old evidence. This book, which is far from being a dry academic tome, could well be a much needed reminder of the traditional virtues of modesty and the like, of sharing, and of co-operation rather than vicious competition.

There are, of course, moments when the way in which we look at the world is changed by a single work. Darwin and Freud both produced books that changed the way we saw the world. In Darwin’s case, the publication of The Origin of Species was Copernican in the challenge it posed to our view of ourselves and of our place in the world. Later on, when genetics showed us how much of our DNA we shared with vegetables and pigs, let alone with other primates, notions of human exceptionalism were further weakened.

Freud’s writings similarly unsettled our view of ourselves, this time in the way in which we understood why we do what we do. Freud’s theories may not have survived scientific scrutiny, but the change that he brought about changed our fundamental intellectual framework and ideas of human motivation. Certainly, that was how Auden saw him in his poem In Memory of Sigmund Freud, where he wrote “to us he is no more a person/ now but a whole climate of opinion”.

The Selfish Gene

There have been others who have made people think very differently about the world, although few to the extent to which Darwin and Freud did. Scientific books may catch the popular imagination, as happened with Richard Dawkins’ The Selfish Gene, a widely read and highly influential work in its time. Then there was Stephen Hawking’s Brief History of Time that made the author a household name even in those households where cosmology may not be an everyday topic of conversation. That book sold in its millions, but has actually been read by a very small proportion of those who bought it – so obscure are the matters it sets out to elucidate. Even the duffers’ guide to A Brief History of Time has flummoxed most of those who have a copy. And yet for many, Professor Hawking did change their understanding of the world.

Bregman’s book may not change academic opinion to any great extent, but it stands a very good chance of having a real impact on the feelings of the general public. Having been written for ordinary readers, as opposed to specialists, it will no doubt be greeted with the academic sniffiness that is often displayed when a generalist presumes to write on subjects reserved for the Academy. Rutger Bregman, of course, does not pretend to be a professional evolutionary anthropologist or anything of the kind: he is an historian and journalist, described by the book’s publishers as one of “Europe’s most prominent young thinkers”. As a general rule, old thinkers are to be preferred to young thinkers – on the grounds that old thinkers have usually done a bit more thinking, have seen a bit more of the world, and have probably changed their ideas as they go along. But Bregman is a very good advertisement for those young thinkers who range freely over a variety of academic disciplines, are well-read, have open minds and are prepared to challenge philosophical orthodoxy.

The glove he throws to the ground in this invigorating book is a challenge to the received view that people are inherently selfish and violent. That is a view that has enjoyed widespread support, and has always been used as a justification for state coercion and control. It is also music to the ears of those who would regard human life as a matter of ruthless competition rather one of sharing and co-operation. That, Bregman argues, is simply wrong: we are an altruistic, co-operative species, and we flourish best when our institutions – and even business practices – stress trust and sharing. If that message rings true at this particular moment of crisis, then perhaps we should not be surprised. If books require the right zeitgeist to have a major impact, then Bregman’s timing may prove brilliant.

Humankind is kind

The book is crammed full of fascinating examples, including a real-life Lord of the Flies. William Golding, we are told, was something of a misanthrope, and in imagining the story of how badly a group of boys would behave if marooned on a desert island, he extrapolated from the way he would behave. We believed him. But in fact when a group of real Tongan boys were stranded on a small island for 15 months in 1965, they actually behaved extremely well. They co-operated, kept their fire going, and did not fight. All the things we need to do in our own crisis.

Reading Bregman on desert island behaviour sent me straight off to my own shelves, where I happen to have a book called The Robbers Cave Experiment, which gives an account of an important sociological experiment carried out on a group of American boys in 1954. They were not placed on an island, but were observed in camp conditions to see how they co-operated and related socially. They did not emerge as angels, but different sub-groups did co-operate to achieve common goals. That is not good news for the Golding hypothesis. The American boys, of course, were the product of American society, and would have been influenced by its individualistic ethos. The Tongan boys came from a very different society.

Bregman’s book is something of a beacon at the moment, when many are looking for values to profess in our traumatised and altered society.

Essentially he is reminding us that human nature is not inherently vicious; that we should celebrate kindness; and that conflict and confrontation are not what we are somehow programmed to perpetuate. People have started to talk about this book: perhaps the moment of this entirely positive, heartening message is about to come. Humankind is kind: we have seen that, we want it to be true, and there’s no real reason why we should not act accordingly.

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The Kessel Gambit

With a final clunk, the noises of hard-dock abate, leaving just the hum of air conditioning units and electrical systems. It seems unnaturally quiet after all the alarms, high thrust manoeuvring and main armament activity, intermixed with the occasional thump and bang as shields took hits from the enemy. A total engagement time for this phase of the operation: 6 minutes 23 seconds. Seemed like longer, but then things do when you're having fun. It gets trickier from here on in. The run to Kessel was made exactly to schedule and, with small adjustments here and there, exactly to the planned course. A total of six hyperspace jumps with one placed close enough to a known deep space monitoring probe to provide just a hint of our incoming trajectory, giving the star-destroyer Armoured Evangelist just enough time to get wind of our arrival and intercept us as we came out of hyperspace, 0.2 AU from Kessel itself. Just another hunk of junk, making the spice run in the hope of turning a tidy profit and not getting blasted while trying. Or so it seems. But now the real mission begins. Noises in the access way beyond my hiding space signal the imminent arrival of stormtroopers. Sure enough, a second later, the airlock door is blasted open and a unit of white suited 'troopers enter the ship. The stormtroopers run past me and down the corridor towards the bridge and cargo space. I can sense that two remain stationed outside the airlock. There's some encrypted chatter back and forth between the troopers. Probably wondering where the crew are hiding (good luck with that - just little old me here!), and why the cargo hold is empty - except, that is, for the bomb on the cargo bay door. I send a signal to the bomb to blow the device. The cargo bay has a big door, and there is pure vacuum outside, so the resultant explosive decompression is pretty impressive. Air screams through the airlock as that which is lost from the freighter is replaced by air from the star destroyer's dock-space. Within half a second the pressure loss condenses the moisture out of the air and visibility becomes a greyed-out zero. Normally the dock's blast doors would automatically close to seal the breach, but I'm holding the nearest one open by an extension of Force. Time to move. I come out of my hiding place and float out of the airlock against the raging current of air, stopping just inside the blast door to link to the Armoured Evangelist's network using a droid interface. At the moment I have all the advantages - the element of surprise, and a full set of schematics and illicit access override codes uploaded into my processor. It takes me a fraction of a second to countermand the order the panicked ship sends to close all the blast doors​ on the dock level, and another couple of seconds to upload a hijacking routine to the destroyer's internal comms network that allows me to remain linked to the ship without a physical connection. As soon as it's done, I'm off. The fog clears as the remaining atmosphere in the dock space fades to vacuum. The blast doors are still open in the dock but air has stopped escaping, so someone with their wits about them must have manually activated the blast door beyond dock space. A few stormtroopers are revealed, scrabbling around, clutching their throats and generally suffocating. Threat risk is low. As I move down the access way, I transmit one of my purloined codes that gives me access to the Armoured Evangelist's core AI and begin uploading a set of instructions that are so large, it will take a full 10.68 seconds to complete. There are things to do before the upload is finished. The best kind of plans have plenty of resilience built in. If something goes wrong - an objective not possible to achieve, say, or an attack beaten off - then you need to switch seamlessly to the next priority, or attempt an already thought-out alternative tactic to achieve your primary aims. This plan - the one I'm following now - doesn't have that. This is a one chance only, blink and it's gone dash-for-glory attempt that the highly annoying C3 unit back at Polis Massa kept telling everyone who would listen had only a three-point-two percent chance of success. Cretin. What does it matter when your mission is almost certainly going to end in your death, even if it succeeds? Anyway - back to business. I'm at the closed blast doors between dock space and ship interior. No application of the Force will open these now they are locked shut. Brute force is what's required. Blasters are no good ('blast' doors, remember?) and so I rely on my other particular weapon - a light sabre. Not your normal, Jedi issued sabre though. Being a droid means I have certain, ahem, advantages over my biological brethren. Massive parallel processors in a really tiny space mean I have the ability to build three dimensional shapes in real time out of my sabre-generator ports - from lance like projections to a fully-enclosing (but sensor-blinding) sphere out to two meters from case exterior. In training there was no way a single sabre-wielding Jedi could best me in one-on-one combat. And as for stormtroopers... Lighting up a lance from a 'sabre port I push through the blast door; globs of molten metal and carbon-diamond composites bounce and fizzle all over the floor, then I extend the sabre's circumferential dimensions outwards to form a hollow cylinder through which I can fit. Another vortex blasts through the hole as air rushes in to fill the void in the dock space. Strangely enough, resistance on the other side is more concerned with breathing than taking careful aim. I'm through and away and off down the Armoured Evangelist's keel lateral access way that leads directly to engineering space. When I'd reviewed the stolen designs for this class of star-destroyer, it had been with a sense of awe and incredulity that I'd seen the keel lateral access way. Just over two thousand meters long from where I'd entered it, and a dead straight line from docks to just one bulkhead away from engineering, it offered an almost laughably easy route to the decks directly beneath operations, weapons control, communications and command. A pulsed laser-ranging shot down to the far end of the access way confirms a distance of 2032.56 meters from my position to the far end, and no obstructions in my path. All blast doors are open (no one has thought to manually close any - yet), and I make sure ship keeps it that way. I push up to maximum speed, passing through the sound barrier less than a second later, at which point the balance of available Force vs. resistance is achieved. A small object travelling at at 343.2 meters per second through a corridor makes for a hard target, but a few plucky 'troopers have a go. They all miss. Stormtroopers and droids scatter and tumble in the shock wave behind me. A few fall from the access way into the keel space beneath. I can't resist taking a look through one of the Armoured Evangelist's security cameras as I pass ... pretty awesome, if I say so myself. Exactly 4.98 seconds after setting off I begin braking, at the same time sending a spread of stuttered x-ray laser pulses a nanometer wide at the bulkhead wall. The bulkhead gives way in a shower of sparks, heat and light, and with a shrewd nudge with my shields, a diamond shaped section gives way and tumbles to the floor leaving a space just large enough for me to fit through. As I come to a stop inside the bulkhead wall and begin to make my way upwards, the upload of illicit code I started earlier completes. I execute the code, sending all access overrides I possess to make the Armoured Evangelist think it's being given commands by a Grand Admiral, and hope that by the time I reach the top the instructions have done their work. Things might get a little hot otherwise. As I negotiate through a maze of ducting, pipework, power conduits and thick, glowing bundles of optic waveguide cables, I hear alarms through the bulkhead wall. That can only mean the Captain has authorised the activation of the secondary internal defence system (thoroughly independent of the Armoured Evangelist's own systems, and therefore immune to my fiddling). Enforcer droids will now be let loose on a shoot-to-kill engagement protocol. I tangled with a K series some years ago and they make for pretty tricky opponents, with lightning fast target-and-fire routines. Far more accurate than your average biological stormtrooper. Better be careful. By the time I reach the level of the weapons control deck, space is getting tight. I'm having to move things around to keep heading upwards. Progress is slow. It's 36 seconds since I left the airlock. I'm behind schedule. Like a Siche-Tick bite making its host Worrt subservient to its parasitic whim, the illicit code has the Evangelist's AI under my command - at least for the next several minutes or so, until someone realises what's happened and reboots the ship's dyanamid quantum-core processors. I hope the courier makes it on time... *** "How's it looking Chewie?" The big wookie takes his eyes off the navigation screen for a moment, cocks his head to one side and let out a wavering howl that leaves Han in no doubt that his co-pilot is unconvinced by their chosen course. A lopsided smile spreads across Han's face as he stares out at the blue hyper-spacial star-scape through which the Millennium Falcon spears towards Kessel. "I know Pal, but just the bonus alone for this trip will easily pay off all our debts with the Hutts. It's worth a little risk don't you think?" Chewbacca looks again at the crazy human, and wonders once more if his decision to take up the offer of business partner and co-pilot had been a good one. His own race was renown for its fierceness in battle, and no-one would dare question his bravery if they wished to retain their motile appendages. Humans in general were a strange lot, too much concerned with messy, distracting emotions and often shy when it came to battle. Not this one though. Behind the innocent and friendly demeanour was a being with genuine fight and a streak of loyalty that rivalled even that of his own clan members. This particular human, however, was reckless. Very, very reckless. According to the nav computer, the course they’re taking will get them from Forrnos to Kessel in only four jumps, a total distance of just under 12 parsecs. The straight line course (at current orbital alignments) measures only 10.67 parsecs. Normally, to avoid crashing into one of the various debris fields, asteroid belts and black holes that litter space between the two worlds, a ship would have to make numerous jumps, changing course wildly each time to avoid running into something. A typical run to Kessel covered a distance of 16 to 18 parsecs. Twelve was practically a straight line. They were probably going to die. Chewbacca lets out another howl and looks questioningly at Han. "Well," says Han, "He was very certain that this course would work. He told me a ship left months ago to map out the asteroid belts and this course was perfectly safe. Besides, why give me bad information if it means he'd lose the cargo?" Han gave Chewbacca another of his winning smiles. "We'll be making the last jump in a short while. Why don't you check our package is ready for delivery?" Chewbacca leaves the flight deck and makes his way back to the cargo hold, murmuring his displeasure and concern all the way. In the hold, nestled amongst the machine parts they would trade on Kessel for spice, was the thing the man who'd chartered their services back in a bar in Spicant had given them to transport. Chewbacca pulls off a dirty cargo cover to reveal a battered, deactivated R2 astromech unit. Bending down to release the retaining straps, Chewbacca reads the model designation near the edge of the rounded top of the droid, 'R2-D2' it said. Well, R2-D2 is destined for a bizarre journey, thinks Chewbacca as he pulls it over to the starboard escape airlock, pushes the droid inside, and readies the lock for release. *** A sound below draws my attention. Hmm. Something is coming up after me. By the sound of it, it's an Enforcer droid. The Enforcer is much larger than me, so it's having to move a lot more stuff out of the way. While I can easily stop it, it's probably broadcast my position to its comrades, and right now they will be making their way to the weapons control deck and command deck above to meet me. It looks certain a firefight will have to be fought soon if I'm to achieve my goal. I eject an antimatter mine one millimetre in diameter out of my casing and direct it down the route I came from, timing it to reach the climbing droid and detonate a fraction of a second after I laser my way out of the bulkhead into the weapons control deck. Emerging from the wall in a shower of sparks, there is a moment of immobility on the part of the black suited men on watch, one lieutenant in particular open mouthed and staring in amazement at my sudden appearance. This comical tableau is shattered as the mine reaches the climbing droid and detonates, sending a shock-wave through the fabric of the ship and a blinding flash of pure white light through the hole behind me. The lieutenant drops to the floor blinded, but the weapons officers in their anti-flash helmets are not so afflicted. Side arms are drawn and fired with surprising rapidity. I'm already moving through the room, using both my shields and 'sabre to deflect the incoming plasma bolts. Those I deflect using the sabre I send back in the direction it comes from. Others bounce off my shields and ricochet off the walls, floor and ceiling. Shouts of alarm, grunts of pain, bright flashes, smoke and the familiar chemical markers of ozone and burnt flesh begin to fill the space as I head towards the exit. An Enforcer droid appears in the doorway, levelling its weapon at me, but I throw it aside using the Force and tumble out into the access-way. There is open space beyond, and it is a simple matter of clearing the anti-fall field barrier and head upwards to the deck above, where closed armoured doors prevent access to the command deck. Movement to the right and left give away the presence of several Enforcers, backed up by white suited stormtroopers heading in my direction. It is now 62 seconds since commencement of hostilities in the dock. According to my chronometers, there are 306 seconds remaining until the earliest arrival of the courier. Once I'm inside the command deck, the final phase can begin. Before I do that, I need to even the odds. I send an instruction to the Armoured Evangelist, then shunt my cognitive processing routines from a quantum state matrix to a biomechanical substrate. I can access solid state memory still, but my processing speed will be way slower. However - needs must... The Armoured Evangelist carries out my orders, over-rides the safeties on sixty high-capacity EMP ordnance pods in the fighter bay arsenal and detonates them. The resultant EMP blasts take out all droids on board, effectively knocking them unconscious until their systems reboot. Across the ship, all Enforcers, astromechs and service droids go still, offline. It will take several minutes for them to come up to full system readiness. Even if they do, I could tell the Evangelist to detonate another batch of EMPs. Because I'm in biological processing, things are ... slow. I'm protected from the EMP, but my thinking speed is now that of a human. That puts them at less of a disadvantage, but unless I run into Darth Vader himself, I reckon I'm the one with all the aces. Anyway, onward and upward. Admiral Graad awaits... *** "What do you mean, they're all disabled!" Admiral Graad looks down his long nose at Captain D'Horza, whose face turns an even paler shade of grey than normal as he stares up at the imposing visage of his superior. "It seems... It seems that our own ship set off an EMP charge that took down all the droids on board, sir." Captain D'Horza pulls at his collar and glances at the chaos around him as his officers try to make sense of what was going on and what had become of their ship's AI. "I fear that the attacking force has, somehow, taken over the ship and is using it against us!" "Fate's end, how is that possible?" Admiral Graad didn't expect Captain D'Horza to answer. He knew himself that such a thing was unheard of in the history of the Empire. Bangs and thumps on the command deck's blast doors heralded the arrival of their foe. How had they got here from the docks so quickly? Chatter from the radios and officers around him seemed to imply that a single assailant - possibly a droid of some kind - had been the cause of all this. One lieutenant nearby was questioning a subordinate on a comms link, asking them repeatedly if they were sure of what they had seen. The word 'light sabre' was used several times. Admiral Graad began to get that cold, sinking feeling he always had when in the presence of Lord Vader. Surely not, he thought. They were all destroyed decades ago, weren't they? With a shuddering groan the blast doors twist inwards and open slightly, just enough to let a roughly diamond shaped device the size of a disembodied head into the command deck, whereupon it floats along the deck directly toward him. For a moment, a vivid fiery-red glow is visible beyond the blast doors before they slam shut, cutting off the carnage beyond. Everyone in the room is frozen, seemingly unable to act. Faces peer up from the stations below as the invader-droid beelines towards their Admiral. "Greeting, Admiral Graad," the droid says in clear, Imperial Basic, coming to a halt a few meters away. Admiral Graad raises a quivering hand and points at the droid. "I know what you are! An Abomination!" "Touche, Admiral. Although it pleases me that you recognise me for what I am." "It's impossible! Your kind were all destroyed, years ago!" "It's true. Most of us were. In fact, I am the last, and, I'm sure you'll be glad to hear, soon to be no more." Admiral Graad lowers his arm and looks quizzically at the droid. "Vader was most persistent in his pursuit of the droid-Jedi,” it says. “As an experiment, we were rather good at what we did. But he needn't have bothered. We were all getting far too old for this sort of thing, even then. The melding of midichlorians and machine was not a happy experiment. Much of the time it is torment to us. Most of my kin long ago took death as a welcome release. I will soon follow them. But first, I have a task to complete." Admiral Graad looks askance, wondering what this strange abhorrent mix of machine and biology could want from him. Then, unbidden, the thing he least wanted to divulge, the secret he'd buried deep within him came clear in his mind, even as he struggled to resist the growing pressure around his neck. "No, not that! You can't have that!" he croaks, as he is lifted bodily from the ground. But those possessed of the Force were always very persuasive, and in the end, Admiral Graad can’t resist. He tells the droid everything it wants to know. *** The Armoured Evangelist tells me it has detected the signature of a ship's hyperdrive collapsing its singularity field. It's time. I drop the Admiral’s unconscious body to the deck, then give the Armoured Evangelist its last instructions and heave an inward sigh of relief. Death will be a blessing. *** "Hold on, Chewie! Twenty seconds until we drop out of hyperspace. Is the package ready?" Chewbacca howls a brief acknowledgement and readies the airlock release. "As soon as it's on it's way, we make for the rendezvous. Wouldn't want to run into any trouble this close to the mines, not with all the Imperial activity round here lately." Han gives Chewbacca one of his sly grins and slaps his co-pilot on the shoulder. "Ok, here we go..." The Millennium Falcon's nav computer dis-engages the hyperdrive and the star field collapses to a real-space view. Immediately a target alert begins blaring. Chewbacca roars his surprise and alarm. "I know, I see it!" Han begins powering up deflector shields and puts the Falcon into a hard turn. Close by their exit point is a vast glowing cloud of debris, expanding rapidly outwards in a blossoming petal shape. Bits of twisted metal and ceramic shoot past the hull and impact the shields, but fortunately the largest parts miss by several kilometres. Chewbacca hits the airlock release, and the old, battered astromech inside joins the expanding nebula of wreckage. "From the size of it, I'd say that until a few moments ago, that was a star-destroyer. What the hell happened to it?" Han looks at Chewbacca, who shrugs in reply. "You know what, never mind," says Han. "Let's get out of here." Han pushes the throttles to maximum, heading directly away from the last resting place of the Armoured Evangelist toward the relative safety of Kessel itself. *** Signal received from Outer Rim Sector - source location triangulated to near Kessel orbit. Decoded by Alliance milcom at station Polis Massa [Note: Encrypted code stream from high gain directional transmitter - likely source: Imperial Class Star-Destroyer] Begins: Mission codename 'Kessel Gambit' objective achieved. Information extracted from primary target. Auto-destruct of Star Destroyer 'Armoured Evangelist' made at courier arrival. Transfer of Death Star plans to infiltrator-spec astromech 'R2-D2' achieved using low power blast-hardened transmitter following auto-destruct; thereby preventing signal interception by Imperial monitoring station 'Jorrudor'. R2-D2 astromech will broadcast a low power distress signal on 121.5Mhz for Rebel Alliance pick-up in debris field. If Imperial or non-Alliance intercept results, R2-D2 will await further instruction from Alliance milcom. ENDS. Comments

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Fully Automated Luxury Communism *IS* Our Future

I have been planning to write on this topic, but a recently featured article in OneZero inspired me to kick it off now. This is my rebuttal.

  In his analysis of the book Fully Automated Luxury Communism by Aaron Bastani, Robin Whitlock wrote an article that he felt outlined the reasons why Bastani is incorrect in his belief that one day (perhaps sooner than we may realize), the world will transition to a one-world, communist-style form of government. I haven’t read Bastani’s book, but, I have been an avid supporter of this concept for nearly a decade after watching the movie Zeitgiest: Moving Forward.

Over the years, I have also engaged in conversations about this topic with literally thousands of people, and most of them repeat the same fallacies over and over in their denial that such a thing could ever possibly happen. I have found that many people have several cognitive biases that hinder their ability to look forward into the future and see what it could potentially look like.

Often, they believe it will look and behave very similarly (if not worse) than what we have today, maybe just with a few more gadgets to play with. In fact, most people are completely unaware of their own biases, let alone that there are 175 known biases that influence our rationale.

Of course, the most obvious is the negative connotation that the word “communism" brings to mind. Immediately, the thought of walking skeletons forced into labor camps spurs a knee-jerk reaction to immediately stop listening to any argument that can even remotely be deemed “pro-communist". But, just to touch on some of the other common biases that influence this conversation (and most people’s daily lives) are:

Declinism- when we remember the past as better ��   than it was, while simultaneously believing the future will be worse than     it likely will be.

Just-World- Many of us who live in developed     nations like to believe the world is a just place. It makes us feel     secure. To think that somewhere in the world someone is dying of hunger,     can overwhelm us with guilt if we think about it while we enjoy an     expensive meal at a nice restaurant. So, we chase away the guilt by     reminding ourselves that we work hard and we’re good people, so we deserve     this nice meal. Anyone who doesn’t have access to such things is just not     trying hard enough, so they get what they deserve. Of course, this bias     can cloud our judgment of other people and their situations. It helps to     cloak the madness of the system we have built. It’s also a bias that     politicians tend to exploit to get you to vote for them, and one that     makes people believe the world in the future will be pretty much the same     place it is today.

Belief & Confirmation Bias: Our beliefs shape     our perception. After all, the human condition requires we believe in     something for it to be real. When one believes in something, they will     find or fabricate as much evidence as necessary to support that belief;     likewise for something one does not believe in. Our brains automatically     default to our belief structures when analyzing nearly any subject. And,     it can sometimes be difficult to examine the evidence with an open mind     that may challenge those beliefs.

Dunning-Kruger: The more you know, the less     confident you are. Fools rush in without understanding. The wise     understand how little they know and pause for consideration.

Framing: It is amazing what a frame can do for a     portrait or painting. The right frame really makes the piece pop and     increase the appreciation of those beholding the piece of art. The same     goes for our brains. Major media, consumer data companies, and marketers     understand how their piece of art is framed MATTERS. A LOT. It is often     seen that they will frame things in different ways for different consumer     tastes and preferences. It is an extremely easy way to manipulate the masses.     And, once one recognizes this bias, one begins to see the frames around     everything.

Familiarity: Our comfort zone. Whether in the     physical sense or the literal, most of us have a pretty small comfort zone     surrounding every aspect of our lives. If something encroaches without     permission, or we are challenged to venture outside of our zones, it can     be stressful and uncomfortable. While the huge world outside of our zones     can be harsh and unforgiving, it can also hold the key to amazing new     discoveries in all areas of life.

Self-Attribution: A common example of this is     when working in a group, you feel like you’re doing more than everyone     else. The interesting thing about this is: if you ask 10 people in a group     if they feel like they’re doing more than others, you’ll likely get 9     responses that support their belief they are working harder than everyone     else.

Sunk-cost: You’ve invested a lot of time, effort,     and money into a project (or your career). But, it’s not going as you had     hoped. It’s difficult to walk away from something that is not serving its     intended purpose.

Anchoring: This is when you’re so focused on one     goal, that you miss out on opportunities to have a better outcome because     you refuse to deviate from the initial goal.

Survival: The celebs (and capitalists) make it     all look so easy. Like anyone can go to Hollywood and become a huge star.     But, what we often don’t hear about are all the failed talent who just     didn’t get the right break into the industry. If one does not succeed, one     is simply failing at trying hard enough (similar to the Just-World bias).

There are many others that fit into this conversation. The ambiguity effect (avoiding options where the outcome is unknown), anthropocentric thinking or anthropomorphism (common in discussions about AI), attentional bias (marketing and constantly being told capitalism is the best way), and so on.

But, even FALC supporters are sometimes clouded by their own biases. In addition to the few of the above, automation bias (excessively relying on automated systems which can give erroneous information that overrides correct decisions) is one. Berkson’s Paradox ( The tendency to misinterpret statistical experiments involving conditional probabilities) is another. And, especially the Bias Blind Spot (the tendency to recognize bias more in others, less in oneself).

So, regardless of these biases on both sides of the conversation, people want to see hard facts and plausible ideas about how this future may come to fruition or why it will not.

The truth is: NONE of us know for sure.

But, there are some things that should be considered before completely shutting the door on the idea of humanity living in a Fully Automated Luxury Communist structure in the future. So, back to the original article I am rebutting by Mr. Whitlock. I seriously doubt he read the book, though that is simply an assumption. But, this assumption stems from the fact that many of his rebuttals to the concept are deeply entrenched in a capitalist mindset, disregarding the very essence of the book.

1                                    Assumption One

For instance, many of the government labor statistics he quotes are based on a flawed system of tracking that the US is notorious for. He also claims that automation is a “long way off and not necessarily replacing jobs”. This is also a flawed analysis due to Moore’s law. But, Moore’s law aside — some even believe Moore’s law is dead or evolving— he goes on to state that according to McKinsey digital who stated two years ago that less than 5% of jobs are able to be automated over the next decade. That is a seemingly naive assumption compared to the breakthroughs we have seen in the past two years from companies like Boston Dynamics and their amazing robots.

And, to counter that McKinsey article showing an example of a lumberjack, or construction and raising outdoor animals:

So, now we get into the cost of all this automation. Sure, it is a prohibitive factor for many, especially small businesses. For now, that is. In accordance with Moore’s law, as things become smaller and more advanced, though, the prices tend to drop. The more assistance provided to small businesses (whether by government supplementation or not), the faster these technologies will drop in price and advance.

Then, by quoting articles that are years old (2014 & 2017), the argument is made that, for instance, self-driving cars are facing major logistical and regulatory issues. Again, without considering the major advancements made recently. In fact, he very conspicuously left out Tesla in this analysis. Or, for that matter, the drone taxis that started in Dubai in 2017, and are now being adopted and accelerated by Uber and Boeing.

So, by assuming that automation is not going to replace most jobs anytime soon, we are really turning a blind-eye on the advancements going on around the world.

2                                    Assumption Two

Moving on to asteroid-mining. Mr. Whitlock used an article from 2012 (nearly a decade old) to prove the point that we were a decade away from identifying suitable asteroids to mine. In 2015, Obama signed a law into effect called “Space Law” allowing private companies to mine asteroids. And, the example used — Planetary Resources — struggling only to be acquired by Consensys, Inc. (a blockchain company) is an extremely poor (on purpose?) example, considering that companies like (to name only a few) Deep Space Industries, Orbital Sciences Corporation, Bigelow Aerospace, and even The Blue Origin aerospace company owned by Jeff Bezos are going all-in on this concept.

In the article, he also tries to point out that these ventures being profitable are the highest concern. That is, again, a false assumption. While it is true that funding needs to happen to make these a reality, one must also realize that funding, in itself, is a fallacy. By this, I mean:

The idea of fiat currency having any sort of value is false. It can be created out of thin air. It is either simply a piece of paper or a number on a computer monitor. Nearly the entire world uses fiat currency.

Nor is the number of materials hidden in the asteroids “speculative, at best”. That is his own assumption, without any real-time understanding of how the above-mentioned companies conduct research to identify lucrative asteroids.

As noted in the original article, Mars One’s for-profit business went bankrupt (though the non-profit side is still running). That is a sign that for-profit in this sector will struggle. Perhaps an even bigger signal that non-profit will eventually win in this sector. As an added point of interest, space is a HUGE business and destined only to grow:

 The point is not profit. The point is to succeed at nearly any cost.

3                                    Assumption Three

Aside from the fact that the vast majority of people are essentially wage-slaves who toil away at mind-numbing tasks to make their bosses a little richer, this entire area completely leaves out the concept of AI and quantum computing. Mr. Whitlock is stuck in his own biases that only a company can do what is being talked about and that companies can only be run by humans. While this is certainly the case today, the advent of AI is not to be scoffed at. In fact, the entire premise of arguments against a system like FALC is akin to the people who 20 years ago scoffed at the idea of having hand-held computers that we know as smartphones. It is an archaic way of thinking… Fearful, even. The truth is: We are on the precipice of technological upheaval never before witnessed by humanity. We better get our heads right to understand the challenges we will face and how to make life better for all humans as a consequence of technology. Otherwise, we will find ourselves in dystopian lives as described by some of the dystopian authors people love to quote.

This concept is not some glorified hippie utopia (utopia is highly subjective, btw) of rainbows and lollipops all day. Stop fooling yourselves and diminishing the world we live in and are about to arrive in. This is the reality we face. When people are displaced from employment and when precious metals & minerals are no longer rare, it will not happen suddenly and it will not be a hundred years away. Try the next 10–30 years, MAXIMUM, for us to really start seeing these effects. Sure, you and I may not be around to see it, but my kids will be.

We need to expand our highly myopic understanding of what is in front of us. If you don’t, others will, and it will be you who is left in the dust.

DISRUPT, OR BE DISRUPTED. That is the motto of the 21st-century.

Finally, yes, the future may be run by corporate empires. That is a scary prospect. In the near future, it may be necessary to eliminate the idea of corporations. All other details aside, the idea of competition is only a hindrance to the advancement of these technologies. Why split the resources (money, labor, etc.) between so many different companies hoping for a profit for a few individuals? In many ways, this is a ridiculous notion. It means fewer resources for each company and wasted time between advancements. This problem is becoming more and more obvious as technology advances.

And, all of this is in addition to the people who are working to cure aging, upload minds into the cloud, and make us into something else to redefine what it means to be human like the Transhumanist movement. If one doesn’t take all of these considerations into account when thinking about the future, they are doing themselves and the future a disservice. Because even though you may stick your head in the sand to avoid seeing it, millions of others are working toward this future whether they realize it or not.

There is so much more I could add to this, but then I would need to write a book… A book explaining Fully Automated Luxury Communism…

[andersa]

The Biggest Mistake of My Life and How It Will Help You

The Biggest Mistake of My Life and How It Will Help You

FEBRUARY 10, 2017

Reading comprehension. The biggest mistake of my life was a reading comprehension error regarding something most of us don’t think twice about.

Antibiotics.

Our oldest is a bright 15 year old with a dust mite allergy that leads to an occasional sinus infection.  Cue the sinus infection just before Thanksgiving. Cue a 10 day course of antibiotics.

“Take 2 in the morning and 2 at night and you will feel better in no time,” I instructed as I handed over the prescription and rushed the kids out the door for several holiday overnighters with family.

A 10 day antibiotic course was accidently taken in 5 days due in part to the hustle and bustle of everything.  I read the instructions too fast and gave her the wrong instructions. She listened all too well.

2 ER visits, 3 InstaCare visits, 2 regular doc visits, 2 GI specialist visits, 10%+ of her body weight lost and her bathroom on quarantine and disinfected only with a 10:1 bleach solution to kill the spores and prevent this highly contagious disease from spreading.

Imagine a nuclear bomb going off in your intestines. That is exactly what happened to her gut with an overdose of antibiotics.

Our first InstaCare visit led to my new favorite doctor gently telling me our daughter was very sick and needed to go to the ER. Which ER would we like so they could call ahead and let them know we were coming and would we like an ambulance?

WHOA. WHAT JUST HAPPENED? We went from stomach ache, cramps and scoots to would we like an ambulance in the course of the 45 minute visit.

Deep breath. Put on brave face. Head to the ER. She was REALLY sick.

Long story short, the overdose led to a party in her gut by a bacteria known as c. diff (clostridium difficile). C diff is commonly in our gut but it is kept in check by the good critters working in the depths below.

The first two rounds of drugs used to treat the c diff failed, meaning severe scoots and cramps returned.  She is currently pounding down a 6 week tapered course of an antibiotic that kills the c diff. Once the taper ends we will pulse it another 3 weeks.

Praying like it’s all in God’s hands yet doing everything in our power to heal her along the way.

Needless to say, hours have been spent digging into learning more about c diff, our gut microbiome and how amazing our guts truly are.

As you can imagine, a few things have changed at our house when it comes to feeding, fueling and repairing our daughter.

Here is a quick rundown of things you could consider if you or yours

needs to rebuild immunity for whatever reason.

Caution: Exceptional long term heath may occur!

Carbohydrate only when occurring naturally in milk, fruits (take it easy on fruits for now too, fruit sugar is difficult to digest) veggies or whole grains

Minimal amounts of processed or packaged food –not much that comes in a wrapper is very good for your body

Avocado

Coconut Oil & Olive Oil

Sugar – limited to naturally occurring

Whole milk – she needs the calories, higher protein content and lower sugar level – if her stomach hurt after consuming dairy I would eliminate it all together but she is tolerating it well and only has one glass a day.

Kefir – homemade and purchased from the store (we LOVE the Lifeway brand raspberry and peach). As a fermented food it’s 99% lactose free = no problems digesting it plus it’s packed with probiotics!

Prebiotics – need the fiber from produce for fuel which fuels probiotics -  in the form of raw or cooked and all throughout the day to continuously feed the critter below

Probiotics – yes, even though she is on an antibiotic (spaced at the mid-point of antibiotic dosingie- 8a and 8p dose = probiotics at 2p) Currently we are using Dr Axe SBO Probiotic – soil based with 50 Billion CFU’s - one capsule with lunch and the other when she comes home from school.

Lentils – we call them tiny spaceships…protein and fiber packed amazingness eaten with lunch and dinner by simply adding to whatever the meal (tacos, soup and even pasta). Prebiotics LOVE the fiber in lentils. Happy prebiotics = happy probiotics!

Greens – spinach and kale (packed in smoothies)

Bone Broth Protein Powder (we are using Dr Axe Vanilla and Pure)

Classic Scary Smoothie (70/30 fruit and veggies + homemade kefir) daily

Water – plenty of crystal clear amazing water!!!

Meditation – we use an app called Calm – outstanding! Used to managed pain, cramps and fear.

Less stress – we had to withdraw her from an AP class to decrease homework and stress load from missing so much school (20+ days)

Gentle exercise – everyone is happier when they move

Breakfast Gut Re-Builder Smoothie

1 cup spinach – fiber feeds the prebiotics which feed the probiotics and are one of the most powerful sources of phytonutrients a person can consume

1/3 banana – sweetness and masks the flavor of spinach

¼ cup raspberries, blackberries or blueberries –  fantastic sources of antioxidants, phytonutrients, fiber which are all key in healing the body

½ cup raspberry kefir – probiotic source

¼ - ½  avocado – healthy fat

½ - 1 scoop vanilla bone broth protein powder

Water – enough to get the contents of the blender to churn

Antibiotics are scary dangerous drugs that are overused and underfeared.  Learn from my mistake and be cautious as you read the directions. Most conditions will resolve without the use of these drugs. Consider that as a primary approach to better health. Your gut microbiome will thank you!

We are approaching 3 months of dealing with this beast and are not out of the woods yet. The light at the end of the tunnel is in sight but this rollercoaster will still have dips and curves. We are thankful the dips and curves are getting easier to handle.

Keep your gut healthy, you have life to live!

Brooke

[andersa]

CF

 The clinical picture of cystic fibrosis (CF) can vary considerably. The most common symptoms are malnutrition and rapidly progressive obstructive lung disease, which for most CF sufferers can entail respiratory insufficiency, secondary heart disease (corpulmonale) and the need for lung transplantation. At present, treatment is only symptomatic and is aimed at slowing the rapid advancement of the disease. With optimal treatment, individuals with CF can live well into their adult years. Half of all patients with CF in Sweden and Norway are now older than 18 years, meaning that CF is no longer only a childhood disease. Since the beginning of the 1980s, fitness, strength and flexibility training have become an important part of the basic treatment. The choice of exercises, intensity, duration and frequency must be adapted to the individual’s requirements, conditions and current situation. For most patients, it is the continuing deterioration of lung function that gradually becomes the limiting factor for physical capacity, but all patients with CF can perform some kind of physical activity and training. Definition Cystic fibrosis (CF) is the most common hereditary (autosomal recessive) and potentially deadly disease in the white population (1–3), but occurs in all races. A recent estimate of the incidence in Sweden was approximately 1/5600 infants (4) and the incidence in Norway is estimated to be about the same. Cystic fibrosis is a disease that attacks several organs in the body and is due to disorders in salt transport across cell membranes. CF affects the body’s exocrine glands (mucous and pancreatic glands), affecting the transport of sodium 22. cystic fibrosis 301 and chloride through the cell membrane, which in turn leads to very thick, sticky mucus (1–3). Disorders in the transport system of salt also affect the patient’s sweat, which contains high levels of salt. The diagnosis is made on the basis of clinical symptoms with the aid of a sweat test (1) and can now often be confirmed with gene analysis. Symptoms Symptoms present primarily in the lungs and gastrointestinal tract but may also occur in other parts of the body. The changed environment in the airways of the lungs leads to the mucociliary clearance system not working properly. Peripherally, that is, behind the “mucus plugs”, this creates a deoxygenated environment, which serves as a breeding ground for the bacteria chronically found in colonised CF lungs. Studies have shown that seemingly asymptomatic infants have signs of infection and inflammation already at 4–6 weeks of age. Most of these children become chronic carriers of one or more types of bacteria found in our environment that do not affect healthy individuals. Stagnated secretions, inflammation and chronic bacterial infections of the pulmonary airways are the most common symptoms (1, 3). Without treatment, the disease leads to malnutrition, chronic obstructive bronchitis, repeated cases of pneumonia and destruction of the lung tissue in the form of bronchiectasis, fibrosis and emphysema (1). This leads to escalating impairment of lung function, which in time can lead to respiratory insufficiency and cor pulmonale. At this point, lung transplantation is the only possible treatment option. The chronic obstruction can be caused by a number of different factors such as bronchial spasms, swelling of the mucous membrane, a collection of mucus and instability of the airways. In some patients there may also be an element of bronchial hyperresponsiveness or an asthmatic component (3). The risk of losing fitness, mobility and muscle strength increases as lung function deteriorates. Some patients also suffer from chronic infections and sinusitis. Spontaneous rib fractures can occur secondary to frequent coughing, as can problems with incontinence, especially in women, even in younger years. Herniation of the abdominal muscle wall or the groin can also occur. The obstructive respiratory pattern and pulmonary hyperinflation can lead to a stiff thorax, straining of the muscles used for inspiration and coughing, and rupturing of the intercostal muscles. Spontaneous pneumothorax can occur, as can haemoptysis, ranging from small harmless streaks of blood in the sputum to severe bleedings that require acute treatment. In the gastrointestinal tract, the viscous secretion of the pancreas inhibits normal secretion of digestive enzymes, resulting in malabsorption of fat and fat-soluble vitamins (3), which also leads to vitamin- and mineral deficiencies. Left untreated, malnutrition in the childhood years leads to stunted growth and in adults to increasing weight loss. An obstructive respiratory pattern and increased respiratory exertion, chronically activated immune defenses and constant inflammation of the mucous membrane of the airways causes great expenditure of energy (7–9). The increased consumption of energy combined with malnutrition leads to increasing muscle atrophy (10). Osteopenia (diminished bone density) occurs as early as the late teens, with some individuals also developing osteoporosis (11). With age, CF-related diabetes may develop (3). 302 physical activity in the prevention and treatment of disease The clinical picture varies considerably. The disease is progressive in nature and treatment is symptomatic but primarily preventive. The rate of progression is also individual and varies between different periods of life in the same individual. Treatment and its goals There is at present no treatment that will cure CF, but symptomatic treatment is being developed continually (2). The goal of treatment is to prevent destruction of the lung tissue and to slow the disease’s rate of progression by controlling symptoms and maintaining good physical function of the patient (12). Treatment includes both short- and long-term goals and involves active daily intervention. Achieving good compliance with treatment requires active support and ongoing education of patients and their families. The physiotherapist must be able to define immediate and long-range problems and needs, and be able to present these in a positive manner. In order to maintain lung function and physical capacity in the long term, a practical and motivated treatment therapy must be the goal for every individual. To achieve good compliance, the agreed-upon treatment must be followed up, reviewed and evaluated frequently. The patient and physiotherapist always arrive at such agreements together, with both parties equal participants and willing to compromise. This is an important requirement to be able to achieve a high level of compliance with daily treatment (13–16). The basic treatment aims at the following: • Nutritional status The impaired ability to absorb nutrients (malabsorption) is treated by adding digestive enzymes, energy-rich food, vitamins and minerals. Active supervision of nutritional status is crucial, as are different types of nutritional supplements where needed (12). • Lung function Inhalation of bronchodilators, mucolytic and anti-inflammatory drugs are often part of the treatment. Treatment to mobilise and clear the mucus from the airways helps to prevent stagnation of secreted mucus and mucus plugs, to keep all airways ventilated. The bacteria of chronically colonised airways cannot be eliminated, but the numbers can be minimised and the chronic inflammation caused by the infection held to a minimum. The bacteria growth is controlled in part by mucus mobilising treatment/ physical exercise and in part with antibiotics. CF treatment incorporates a generous amount of antibiotics, given in tablet form, intravenously or via inhalation, as decided by using subjective and objective parameters (12). 22. cystic fibrosis 303 The mucus mobilising portion of the treatment is very time-consuming. There are many different techniques today to loosen, transport and evacuate the viscous sputum from the airways (17). It is important to find a technique or combination of techniques that suits the particular individual. It is also important for people with CF to learn to control their cough, both to avoid urinary incontinence as well as for social purposes. In order to achieve optimal effect, the inhalation and mucus evacuation treatment for each individual should be planned strategically. The goal is for the treatment to be as gentle and effective as possible, from both a short- and long-term standpoint, in addition to encouraging the independence of the patient (13). • Fitness, mobility and strength Physical training is carried out to maintain good functional status and counteract loss of fitness, poor posture, and to reduce the risk of a stiff chest (12, 13, 17). How the training is carried out varies according to the individual’s age, symptoms, personality and interests. Treatment outcomes and prognosis Treatment concentrated to CF centres has shown good (2, 4, 12). Breathing exercises and physical training are considered the cornerstones of the treatment, along with medical treatment and nutritional supplements (5, 12, 17–23). Treatment outcomes have improved markedly in recent decades (2, 4). In Sweden, there are currently some 535 people between the ages of 0–65 years living with CF, half of whom are over 18 years. The corresponding figure for Norway is 260 people, where similarly more than half are over the age of 18 years. Recent estimates regarding the prognosis for children with CF born in 1991 or later is that 95 per cent will live to be more than 25 years old (4). Thus, CF is no longer only a childhood disease, but also a concern for adult medicine. With adequate treatment and good support, most people with CF can live a fulfilling life of a good quality well into their adult years. Many manage to maintain a good functional capacity and lung function. Despite poor lung function, others still have a good physical capacity. A survey study from 1998 showed that 75 per cent of adult CF patients who had finished school were working, and 39 (26 women and 13 men) had children (4). Effects of physical activity The objective of physical training for individuals with CF is to: • Stimulate the respiratory apparatus and intervene with resting respiratory patterns to increase the ventilation volume and/or distribution of the ventilation, and to stimulate mucociliary clearance and mobilise the mucus. • Maintain normal working capacity. A high level of fitness reduces the risk of worsening in connection with exacerbations (deterioration), and makes recovery easier. Despite poor lung function, fitness may be good. 304 physical activity in the prevention and treatment of disease • Maintain good mobility, primarily of the thorax (24). Mobility of the thorax, back and shoulders must be maintained in order to perform effective mucus evacuation therapy (16). Stretching tense structures is time-consuming, painful and often unpleasant – preventing stiffness is easier and much more pleasant. • Maintain good muscle strength. Strength training for the postural muscles helps to preserve mobility and avoid thoracic kyphosis. Good posture also helps patients to maintain the image of looking like everyone else, despite their advanced lung disease. • Avoid osteopenia and osteoporosis. • Improve/maintain good body awareness. • Learn to coordinate muscle contractions to avoid urinary incontinence in connection with coughing or other physical exertion. • Learn to distinguish between acceptable shortness of breath and abnormal dyspnoea and be able to manage these conditions. • Increase self-confidence (25). Strength and endurance of the peripheral skeletal muscles can be impaired in patients with lung disease (10). Both oxygen transport and energy metabolism in the muscle cells are worse than in healthy individuals for many reasons, including a change in the distribution of different types of muscle cells, a low capillary density, and biomechanical changes. Possible causes are the effects of chronic inflammation, malnutrition, hypoxia (decreased concentration of oxygen in the body’s tissues), hypercapnia (increased concentration of carbon dioxide in the blood), use of corticosteroids and low level of physical activity. Strength training that focuses on peripheral skeletal muscles has, however, shown to be effective. Improved oxidative capacity reduces the production of carbon dioxide, which in turn reduces respiratory need, dyspnoea and muscular fatigability . Physical activity affects both circulation and ventilation . Many individuals experience a mucus-mobilising effect in connection with activity. This effect can likely be attributed to the increased ventilation, both general and regional, increased tidal volume, increased rate of air flow and a temporary elevation of functional residual capacity (FRC) during physical exertion in individuals with obstructive pulmonary disease (28). Blocked airways are thus opened, and mucus dislodged and transported to larger airways. An increase in mucociliary clearance and positive biochemical factors such as less viscous mucus also likely play a role (29). During regular breaks in the physical activity, for example, in interval or circuit training, or after an exercise session, the loosened mucus may be evacuated. The combination must be stressed, however, in order to achieve mucus evacuation (13). This method of managing the mucus-mobilising part of treatment has been shown to be equally effective (18), and in certain cases more effective than other respiratory exercises, and is associated with the following advantages: • It is effective from a time standpoint as well, also providing fitness training, mobility training and training of muscle strength. • Anyone can take part as long as the objectives are maintained – not only CF patients benefit from physical exercise, which can improve compliance with the treatment. 22. cystic fibrosis 305 • It can easily be changed and adapted according to the severity of the disease, the individual’s interests and moods, location, weather, etc. • It is easy to “take with you” to school, work, on holidays, etc. • It can be done on one’s own and thereby gives independence. • It is, for the most part, stimulating and fun. A high level of fitness impacts both survival and quality of life, helps individuals with CF to function like others, and enables them to function at work and have a family (21–23, 30, 31). Patients with a well-functioning basic therapy can, however, not expect to see further improvement in lung function from the increase in physical exercise. For these individuals, unchanged lung function values in the long term are seen as a positive outcome. However, if the current “treatment package” is insufficient, improvements in lung function can be achieved when treatment is optimised. Improved work capacity thus depends on the frequency, intensity and duration of the exercise training, similarly as in healthy individuals. Prescription Physical activity and training is an established and important part of the daily treatment of CF today. Physical activity/training should be carried out during antibiotic treatment despite the presence of chronic infection. Physical activity/training can serve as a part in mucus-mobilising treatment to increase ventilation and loosen secretions ) and/or as a supplement to other therapies . Treatment plans are holistic and include different types of strength training, for the core muscles as well as large and small muscle groups in both the upper and lower extremities, and exercises for the pelvic floor. Individual adaptation and dosage Physical activity/exercise must be adapted to the individual. Factors of importance for the type and dosage relate firstly to age, nutritional and functional status, lung condition, with special regard to the degree of obstruction, amount of secretion, and presence of hyperresponsiveness or instability of the airways. Exercise training can have an impact on the acceptable intensity level and perceived dyspnoea, while these are also dependent on daily condition and personality. Finding an exercise regime that can be tolerated in the patient’s current state and is perceived as positive is essential to achieve a high level of compliance (16, 31). The need for pre-medicating with inhaled bronchodilation therapy should be evaluated, as well as the warm-up before exercise sessions, whenever treatment or the requirements and conditions for treatment change. For patients who desaturate (oxygen saturation decreases) during physical exercise, the need for providing oxygen during training should be evaluated in order to maintain a saturation of more than 90 per cent in the blood. This helps to reduce ventilatory and cardiovascular demands during training. An alternative can be to control the exercise intensity to maintain oxygen saturation over 306 physical activity in the prevention and treatment of disease 90 per cent (32). Many patients benefit from “pursed-lip” breathing to lower the respiratory level, increase the size of each breath, and thereby improve gas exchange in the lungs. Constant optimisation of the treatment in cooperation with the patient strengthens the daily routines. Close follow-up and evaluation is required to motivate the patient to comply with the treatment. Options for using physical activity/exercise as a part of mucus-mobilising therapy There are four main ways of using physical activity/exercise for patients with CF to mobilise mucus with a loose delineation between them (13, 14). The factors that determine the option chosen for a particular individual are mainly age, amount of mucus in the airways, lung function, possible complications, and what subsequently proves to be the most effective (15). The choices are: • Alternate dislodging, moving and evacuating of mucus with physical activity/exercise This option involves short intervals of physical activity/exercise to loosen the mucus and breaks between the intervals to assess the amount of secretion/expectorate the mucus. The intensity of the intervals should be tailored to the individual, with high intensity activities having proven to be effective. The breaks can include careful chest compression and manual coughing support for the very young, followed by specific coughing technique, huffing and coughing. • Dislodge the mucus during physical/exercise and move and evacuate it afterwards This option involves 30 minutes of individually tailored physical activity/exercise to loosen the mucus, followed by cycles of individually tested mucus-mobilising techniques to evacuate the mucus using specific coughing technique, huffing and coughing. • Dislodge, move and evacuate the mucus before physical activity/exercise This option is for patients with large amounts of mucus who have a need for individually tested mucus-mobilising treatment before physical activity/exercise. • Dislodge, move and expectorate the mucus while conducting endurance training This option involves patients with small amounts of mucus and slightly reduced lung function being able to take short breaks to assess and expectorate possible mucus. The short breaks need not necessarily affect the intensity. Physical activity/exercise can affect mucus-mobilisation by, for example, opening blocked airways and getting air in “behind” the mucus as well as increasing the breathing movements (respiratory pump) of the thorax. This helps to loosen and transport the mucus from the small airways into the larger ones. Physical activity/exercise combined with a specific coughing technique, huffing and coughing, is then used as a mucus-mobilising treatment option. This treatment option is often the first choice for children since it can be perceived as a natural approach when it comes to treatment. 22. cystic fibrosis 307 One or more test treatments should be carried out to evaluate the individual effect of the physical activity/exercise. Evaluation of the response and effect determines whether physical activity/exercise can be used as part of the mucus-mobilising treatment for that individual. The trial treatment should provide an answer regarding the level and type of physical activity/exercise that will contribute to the treatment and, based on this, needs, possibilities/limitations and dosage can be determined (13). Patients with CF perform inhalation and mucus-mobilising therapy 1–3 times per day according to their individual needs. Seemingly symptom-free patients are generally treated once a day. Physical activity/exercise is part of the main therapy. For patients with more pronounced symptoms, additional treatment sequences on the same day can comprise inhalation combined with other mucus-mobilising techniques. Age-related treatment plans Physical activity for very young children, age 0 to 1 year, comprise motor stimulation according to the child’s motor development and activation of motor reflexes. Positive stimulation and activation of reflexes is done in different body positions with the aim of influencing the breathing pattern, increasing the amount of inspired air, affecting the ventilation distribution, and increasing the demands on the respiratory apparatus. The flow of exhalation can be increased with careful chest compressions to loosen and transport the mucus to the central airways. The compressions must be carried out with appropriate force during exhalation with the aim of increasing the expiratory flow and enabling the child to prolong exhalation. The compressions must also follow the breathing pattern, frequency and exhalation movement. Mobilised mucus induces a coughing reflex and the force of the cough can be enhanced manually. All of these techniques require education and training as the dosage of force must be such that it does not give the opposite effect. From the age of 1 to about 4 years, the physical activity/training comprises chasing games and other active play. These games should also include fun “exercises” for strength and mobility. Those conducting the physical activity and exercise training with the children must learn what games are suitable. At 2–3 years of age many children can begin to lengthen exhalation and hold obstructed airways open by playing “blowing” games. The children are made aware of coughing and coughing technique. “Steaming up the mirror” can be used as a starting point for later learning the huffing technique. The chest compressions can then be replaced by specific coughing technique, huffing and coughing (14). In time, most 4- and 5-year-olds will be able to control their breathing technique, huff effectively, control the strength of their cough and achieve peak expiratory flow (PEF). At 5–10 years old, the physical activity/training can be scheduled as various gym games or as relays and obstacle courses. The training should include fun exercises for fitness, strength and mobility. Breaks in the training are used for cycles of specific coughing technique, huffing and coughing to move and evacuate the loosened mucus. Those who began physical activity early are now well-developed from a motor standpoint and win over their peers, siblings, parents, the physiotherapist and physician, which as a rule creates selfconfidence and is a good investment for future treatment. 308 physical activity in the prevention and treatment of disease After the age of 10 years, the physical training can be planned as circuit training with various content. A combination of low and high intensity exercises is recommended, often in the form of interval training. This training includes exercises to maintain mobility and strengthen the muscles of the thorax. Breaks in the training are used for cycles of specific coughing technique, huffing and coughing to move and evacuate the loosened mucus. This type of exercise can be alternated with running with an adult. Running gradually becomes popular with some people since it is perceived as the most time-efficient and “normal”. Running can be complemented with simple mobility and strength exercises. Specific coughing, huffing and coughing are done at the end when the exercising is finished. Physical training as a complement to mucus-mobilising therapy All individuals with CF can perform physical training of some type regardless of their symptoms. For those with normal or slightly reduced lung function, training schedules, including intensity, are the same as for healthy individuals. In order to achieve as wide an effect as possible, a combination of different types of training should be used. Both high and low intensity training should be used. An effective way to exercise oxidative capacity is to perform high intensity training in intervals of 30 seconds at maximal exertion and 30 seconds at rest, for 30 minutes, or perhaps 3 minutes of intensive exertion and 3 minutes of rest, for 3–5 repetitions. All-round strength training and mobility training should also be included. A good starting point for many people is to find, early on, a type of physical training that is also socially stimulating and that can be done with friends, such as playing football, field or ice hockey, bandy, horseback riding, jogging, Nordic walking, swimming, spinning, etc. This activity can then be complemented with strength and mobility exercises. Many patients choose to go with their friends, spouse or partner to fitness, aerobics or other exercise classes that offer aerobic, strength and flexibility training. For others, in-home exercise programmes using simple aids such as an exercise ball, Bobath ball, trampoline, exercise bike, weights, Thera-bands, wall bars, etc., may be a better option. The programme is planned by the physiotherapist in cooperation with the patient/parents. 22. cystic fibrosis 309 Table 1. Specialised training/physical activity for different stages of cystic fibrosis. Status Training Normal lung function/strength/flexibility. No restrictions. Regular aerobic fitness and strength training principles. Enjoyable sports activities. CF-specific mobility and strength training. Normal or slightly reduced lung function – FEV1* > 70% of expected value – oxygen saturation does not decrease during exertion. As above. Close follow-up. Moderately reduced lung function – FEV1* 40–70% of expected value – risk for desaturation at night and during exertion – possibly dependent on supplemental O2 during sleep High intensity interval training with long breaks, and low intensity training. Flexibility training, above all for back, chest and shoulders. Strength training, above all for postural muscles and pelvic floor. Evaluate need for supplemental O2 during training. Severely reduced lung function – FEV1* < 40% of expected value – high risk for desaturation at rest – evaluate 24-hour dependency on supplemental O2. High intensity interval training with shorter training intervals and longer breaks, and low intensity training. Flexibility training, above all for back, chest and shoulders. Strength training, above all for postural muscles and pelvic floor. Need for supplemental O2 during training. Respiratory insufficiency while awaiting lung transplantation. Light physical exercise. Flexibility training, above all for back, chest and shoulders. Adequate strength training, above all for postural muscles and pelvic floor. Requires supplemental O2 during training. * FEV1 = Forced Expiratory Volume in one second. There are many examples of adults with CF who have been able to take part in sports at a high level. It has also been shown that patients with CF can run a marathon with normal biochemical, metabolic and endocrinological response (36, 37). Special considerations Pronounced dyspnoea Patients must be trained to distinguish between acceptable shortness of breath and abnormal dyspnoea, and to manage their shortness of breath and to recognise dyspnoea that can lead to panic and anxiety early. Training intensity, equipment and aids should be adapted to the individual’s level of function and ability. Acute infection and fever Temporarily stop physical exercise and strength training that give rise to an increased heart rate. Flexibility training can still be carried out. 310 physical activity in the prevention and treatment of disease Nutritional status and energy balance In the case of malnutrition, physical activity/training contributes to further weight loss and muscle atrophy. The need for proper nutritional support combined with dosage of physical activity/training is assessed in cooperation with a dietitian/nutritional physiologist and physician, in order to build up muscle mass and muscle function (38). Asthma or bronchial hyperresponsiveness The need for pre-medication is assessed with a reversibility test, both at work and in connection with exertion. The test should be repeated when the symptom picture changes. Diabetes Patients with CF-related diabetes can experience a substantial drop in blood sugar during physical activity/training, which they must learn to manage in cooperation with the dietitian/nutritional physiologist and physician. Over-exertion All-round training is recommended to avoid over-exertion and to enable optimal function in day-to-day life. Decrease in oxygen saturation of the blood The need for supplementation is determined with the help of an oxygen saturation meter (SpO2). Oxygen saturation < 90 per cent, measured as SpO2, should be avoided. Training intensity and/or oxygen supplementation during training is determined in relation to SpO2. Joint problems and arthritis (joint inflammation) The need for alternative forms of training and relief is assessed. Reduced spleen or liver function Avoid physical activity/training that can lead to trauma to the abdomen/back. Salt and mineral deficiencies Excess sweating can result in symptoms of extensive loss of fluids and salts (39). Ample fluids and salt tablets should be administered for long sessions of high-intensity physical training. Haemoptysis In the case of minor symptoms (streaks of blood in the sputum or small bloody expectorations), stop the training session. In the case of massive haemoptysis (large amounts of coughed up blood), seek emergency medical attention. 22. cystic fibrosis 311 Pneumothorax In the case of sudden, increased dyspnoea and chest pain, pneumothorax may be suspected. Stop the training session and seek medical attention immediately. Functional tests Patients usually visit the clinic every six weeks, and every visit includes contact with the physiotherapist. In Sweden, meeting with the physiotherapist always includes at least one treatment session, where evaluation of the prescribed inhalation therapy, mucus-expectoration treatment and compliance occurs. A spirometric examination and functional tests are also conducted, in which chest flexibility, muscle strength and work capacity are followed up. Many also have an out-patient visit to the physiotherapist in between. Once a year an extensive lung function test is carried out, at a clinical physiology laboratory, which includes both static and dynamic volumes, as well as maximal exercise test (12, 40, 41). The treatment is continually adjusted to the measured outcomes and compliance. The testing programme in Norway includes spirometry at every visit to the clinic. The physiotherapist evaluates and follows up the different parts of the pulmonary physiotherapy, that is, mucus evacuation therapy and physical function, posture, work capacity and work tolerance. When necessary, the patient is referred to a specialist in manual therapy. Every or every second year, an extensive 3-day cross-disciplinary review is conducted, covering lung function exams and maximal exercise tests. Interactions with drug therapy Many patients use inhaled beta-2 agonists, which have a heart rate-increasing effect. This seldom has significance for the planning of physical training or its outcomes, but be known for the evaluations. Insulin has a blood glucose-lowering effect as does physical training. Consideration should be given to the balance between blood glucose-lowering effect and food intake, especially in intensive and/or extended training. In connection with lung transplantation CF is a chronic destructive disease whose progression cannot always be slowed despite intensive treatment. Lung transplantation may ultimately be the only remaining treatment option. In this case, physical training is of utmost importance so that the patient will be in optimal physical condition before this big operation. The training does not differ from that described earlier however (see Table 1). Even patients being treated with non-invasive ventilation should engage in physical exercise. For the period immediately post-lung transplantation, the physical training is different than for other intensive care patients. Even patients who need extended assisted ventilation 312 physical activity in the prevention and treatment of disease should perform physical training. The goal is to successively regain normal physical function. The physical training can then be carried out according to the usual principles. Maximal oxygen uptake (> 30 ml/kg/min) is seldom attained, however, despite normal lung function. Many patients are limited by accumulation of lactic acid, experienced as tiredness in the legs, due to changes in muscle metabolism. A few individuals have taken part in a marathon race (37). The lungs are large organs and therefore require large doses of immunesuppressing drugs. Despite the lungs being extremely vulnerable to the environment, the immune defense against bacteria remain intact. Patients may, however,be more susceptible to occasional infections.