#Or say that they’re “spreading negativity” by just interpreting a ship in a different way

[candlelitcanvas]

“Flower husbands isn’t toxic, its more nuanced!”

Like. Why do you think toxic fh is so appealing in the first place??? I think most people recognize that cutting your king’s head off is toxic that cheating is toxic or that whatever gem and pearl has going on during Wild Life was at least a LITTLE bit toxic. But the MAIN THING (at least for me) that makes the toxic version of the ship so much more interesting that it’s not SO blatantly toxic. It’s more of uncomfortable dynamic, a creeping sense of “this couple has something else going on underneath the surface” which is really fun to analyze imo. Something something Sc0tt is in love with the idea of Jimmy rather than Jimmy himself and don’t recognize him as capable which is definitely a dynamic that’s. More fun to play around with than just murder and manipulation.

Tldr; toxic fh is not “just a way for people to be homophobic and hate on Sc0tt.” It has a different flavor of “toxic” than a lot of other relationships in the series and that’s what makes it interesting!

[glassessence]

Elriel Hint and Analysis - includes analysis of Feysand & Nessian (ACOSF Spoilers)

I’m pretty new to the fandom, but I am currently obsessed with Elriel. This is my ship and I will go down with it until the day I die. As a fairly casual reader, I honestly had zero doubts the next book would be Elain’s and that the couple would be Elriel. 

Then I discovered the existence of the extra POV chapters and Azriel’s threw me in for a bit of a loop. Especially with the ending (which I genuinely believe is a red herring. I lean very heavily into the lightsinger Gwyn theory).

However, stalking Tumblr made me come across this again: 

Life and death and rebirth

Sun and moon and dark

Rot and bloom and bones

Hello, sweet thing. Hello, lady of night, princess of decay. Hello, fanged beast and trembling fawn. 

Love me, touch me, sing me.

And then my brain accidentally vomited an essay on the symbolism in each sister’s journey... 

Life and death and rebirth so clearly symbolise Feysand’s journey. Feyre leaves behind her life of poverty for a brand new one with Tamlin. She journeys Under the Mountain for love of him and ultimately succeeds in saving not just him, but all of them. In the process, she dies. Not just in the physical sense, but spiritually too. Feyre the human perishes, giving rise to Feyre the High Fae. In a purely physical sense, this is definitely a rebirth. But it’s stilted, incomplete. She’s the newly born phoenix - young, fragile and yet covered in the ashes of its fiery death. Her spiritual rebirth lags behind her newly changed body. Like a bird in a cage, she is trapped in Tamlin’s realm, unable to finish developing, to spread wings and fly. 

That all changes when she is whisked away to the Night Court. She learns to read and some of the ash falls from her body. She makes friends and some more ash is brushed away by the Inner Circle. The final remnants of ash are blown away by the taste of freedom and the kiss of wind, and Feyre’s rebirth is finally complete. Spiritually and physically, she is changed. She becomes Feyre the High Lady. From life back to life, she is returned through the power of love. Take note that while love is important in all the sisters’ journeys, it is the focal point and highlight of Feyre’s. She is someone who has never been loved in that wholesome, selfless way Rhysand loves her. Tamlin was possessive and abusive; Nesta was barbed and sharp. Elain was fragile and ethereal. Love was something she had never really known and consequently something she desperately, desperately needed. That’s why the phrase that symbolises her is love me.

Sun and moon and dark refers very much to Nessian. Nesta is the sun and she is burning. Has been burning for a long, long time. She is aflame, nothing but ashes inside, and her words are fire. She scalds anyone who dares approach, just as everything melts before the sun. Like Feyre, she has had her physical rebirth, but not her spiritual one. She is trapped in her own head, locked behind her own self-hatred, her own raging inferno that yields to no one. Like Feyre, she is also a phoenix, but one whose fire never stopped. In that sense, she has never died. Her spiritual rebirth is not simply incomplete; it has never happened.

Until she starts training with Cassian. Until she starts befriending Emerie and Gwyn. This is what marks the death of Nesta the human and the emergence of Nesta the High Fae. (I use the term ‘human’ loosely here, mostly as a way of conveying my point about her spiritual journey rather than the state of her physical being). She loses her solar flare, that inner blaze that was killing her and blackening her soul. She mellows from unapproachable sun to a softer moon. It’s here that she stays a while, seeming to progress and regress in her healing journey as the moon waxes and wanes. It’s not until the hiking scene that she finally breaks. She weeps despite Cassian’s expectations to the contrary. Through her tears, she finally extinguishes the long-raging fire and hatred that has been destroying her. No more blazing sun, no more wavering moon. Only darkness to cradle her, and acceptance. Through Cassian’s ceaseless efforts and her friends, her journey reaches its apex. She finally becomes Nesta the Valkyrie. 

Her journey hinges heavily upon the fact that nobody could reach her through the flames. Nobody had kept trying after getting burned again and again. Nobody except Cassian. He reaches out, time after time, even when she hurts him. Even when she burns him. Until he succeeds and touches her soul. That’s why the phrase that symbolises her is touch me.

Of course that leaves only the last line: rot and bloom and bones. I wonder who this could symbolise! Surely not the Archeron sister who is associated with roses and has a complicated romance dilemma with someone from the Autumn Court (rot) and someone else from the Night Court (bones)! Surely not!

Jokes aside, I strongly believe this line reveals Elain’s journey. If we continue thinking of the words as a progression, I think it makes a lot of sense. Keeping in mind the theme of life, death and rebirth, this is how I think of it: 

Life / Rot / stagnation, the start of the journey

Death / Bloom / change, the start of healing

Rebirth / Bones / ascendance and acceptance, the start of the future

There are several interesting things to note about the sentence: 

The word bloom is nestled among rot and bones

Elain’s two potential love interests both have strong associations with those words

I’ll address each point as we delve into Elain’s analysis. 

Let’s start with Elain the human. As previously established, this is when the character is at their worst, blind in the dark before the dawn. I see this as Elain’s forced transformation by the Cauldron. Everything she knows is ripped away from her and her marriage crumbled to dust. She is thrust into a world both unknown and at war. She emerges changed and cursed with powers she cannot control and does not understand. Her life, once a slow-blooming flower, has just rotted into nothing. She is lost, confused and deeply depressed. Her physical rebirth may be complete, but her spiritual rebirth cannot begin until she gathers the shattered pieces of herself back together.

This happens slowly. So slowly, in fact, that it’s hard to notice and easy to dismiss. She befriends Nuala and Cerridwen. Begins gardening again. Talks to the Inner Circle and buys them gifts for Solstice. Slowly, so very slowly, she is starting to piece herself back together. Off-page, she quietly unravels Elain the human and emerges from her cocoon as Elain the High Fae. Like a wilted flower that has dropped its petals, a new season has come, bringing with it new buds. She is blooming, opening herself to new possibilities for companionship, love and for a new self to rise to the surface. But blooms are fragile, newly born things. Elain hasn’t dealt with the full force of her trauma, of her lifelong lack of choice (I’m not going to delve into this as there are so many amazing analyses out there!). She is a trembling fawn, still trying to learn how to walk.

But her spiritual rebirth will remake her. Bones. It’s so different from the previous two words that it really leaves an impact. Blooms rot and fade. Flesh breaks and dies. But bones are strong, the frame that holds up our entire beings. Bones are unyielding and solid, taking no other shape like blood nor bruising like flesh. I see this as Elain standing up for herself, unswayed by external forces that have always governed her life and breaking away from the fragile flower people have always thought she was. By cutting away the rotting flesh, she will reveal the backbone beneath and ascend as Elain the Kingslayer/Seer. 

Of course, closely tied to each sister’s personal growth arc is her love interest. For me, I don’t see it going any other way than Azriel. 

SJM chose rot not only to represent the ‘life’ section of Elain’s personal journey, but also to represent Lucien. He has connections to the Autumn Court, a season that is often associated with decay and rot, but also with harvest and bounty. Highlighting the negative aspects of autumn invokes a strong sense of wrongness. Lucien is not right for her. Not to say anything bad about his character; he’s just not right for Elain. His presence in the books eats away at her newfound boldness; he rots away the path she is trying to carve for herself. 

On the other hand, Azriel is closely tied with death, with blood and bones and shadow. He’s not only Rhys’ spymaster, he’s also his torturer. His association is with bones, a word that invokes a sense of everlasting, of persevering beyond death. Bones is also used to describe the ‘rebirth’ section of Elain’s personal growth arc, the final aspect that leads to ascendance, and acceptance of one’s past and present. Meanwhile, bloom represents Elain herself and the ‘death’ portion of her story, the aspect that heralds change and healing. 

Rot, bloom and bones represent both her personal journey and her love interests. It’s all intrinsically linked. Lucien is ‘life’ and stagnation, Elain is ‘death’ and change, and Azriel is ‘rebirth’ and acceptance. As a progression, this is how I interpret the sentence: 

By rejecting the bond with Lucien, she is stepping into herself and forging something everlasting with Azriel.

Lastly, let’s not forget that the phrase symbolising her is sing me. This didn’t make much sense to me until I read Azriel’s bonus POV. In it, he confesses to Gwyn that he does sing. Why include this if it’s not a subtle callback to this prophetic paragraph in ACOMAF? It feels like a treat to hardcore fans who like finding all the little connections (since they’re the ones most likely to have read the bonus chapters). The fact that Gwyn also sings signals to me there’s an important plot point regarding song. Maybe homegirl Elain will be forced to throw a hardcore metal concert to save Az XD Wouldn’t that be a plot twist HAHAHA. 

I don’t know when SJM started planting seeds for Elriel in any serious capacity, so perhaps I am reading WAY too much into this. Either way, I am super keen for the next book!

Please feel free to comment and let me know your thoughts! I am desperate for Elriel right now hahaha. Thanks for reading! 

OH, BUT ONE MORE THING. 

The greetings are really interesting. Sweet thing obviously refers to Feyre. Lady of night and princess of decay are clearly meant for Nesta. 

Fanged beast and trembling fawn are left for Elain. It’s easy to write this off as being about her LI and herself, respectively, but I don’t know. The sentences build upon each other. A single moniker grows to two - the first separated by a comma, the second expanding to use an and. It’s something you see a lot in poetry, generally used to emphasise a point. I’m not entirely sure what the point is; it might just be a nice writing flourish, but wouldn’t it be interesting if both those statements were referring to Elain herself? Wouldn’t it just be juicy? 

[daggersandarrows]

i’m not maintagging this in case it’s perceived as negative--it’s not, it’s a personal observation that is somewhat frustrated, but people can do what they want--but feel free to reblog if it resonates.

i think i’ve finally realized why almost all of the imodna shipping feels so far removed and foreign from my idea of imodna and what i enjoy about imodna. part of it’s just regular old “fanon will always differ”, sure, the way a lot of fanon!widowmauk is miles away from caleb and molly’s actual dynamic, but beyond that, it’s the treatment of imodna as a sort of endgame that hasn’t happened yet.

and i’m just sitting here like. ??? what?

if you’ve followed me for a while, you probably know that my ships (”ships”, sometimes) are a little...weird and unconventional. one of my favorites is yasha + molly. and while of course my fan content will always differ from canon purely by virtue of being fan content, i didn’t...want...more there? i mean of course i will always be wistful that molly died. but in the sense of the structure and nature of their dynamic, i never wanted it to be anything “different” or “better”. canon molly and yasha is my ship. “this is yasha, she’s the charm” and “you don’t think you’d wear a colorful coat” and sick of losing soulmates on the yasha playlist and giving lucien the clover and forehead kisses and screaming over his grave--that’s my ship. or qpr or whatever you’d like to call it. that’s my something of yasha and molly.

laudna and imogen seem to be treated as this relationship that hasn’t happened yet but almost certainly will, like it’s something that needs to evolve into a more conventionally romantic or sexual thing--and that’s (mostly*) fine! people are allowed to ship whatever they’d like, i mean, this is a fandom, a huge amount of the content is going to be ship related.

i’ve been puzzled because as a weird queer aroace bi-oriented whatever, the ship, so to speak...is already there. like. that’s already them. they sleep in the same bed, sometimes with other people and sometimes not, they’re highly defensive of one another, they flirt with other people but with a sort of comfort and security that seems to indicate that this is a mutually understood thing, they’re very normal about the weird things going on inside the other one’s head, and most significantly in my mind, when asked if she’s ever been in love, laudna says she hasn’t but clarifies that she deeply loves imogen. how i interpreted that was, “don’t get it twisted, she’s absolutely my girl. i just don’t have that specific feeling that other people do.”

and i’ve been sitting here going, holy shit! that’s what my��relationships look like! as a weird queer aspec polyam, like. that’s nearly exact! so why don’t i relate more to what i see the fandom putting out?

i think that’s where this mostly* comes in. i fully understand people wanting to see a relationship that they understand and relate to on a more conventional level. that’s cool! ship what you ship. what’s been bugging me is the insinuation which i believe is almost entirely unintentional that their relationship must “evolve” into something else, and further more, the widely spread joke or assertion or assumption that they must be in love and just haven’t realized or admitted it to themselves.

i get the whole “useless gays have been flirting for years, neither realizes the other is interested” joke. i do. but i’m also used to “oh you just haven’t had sex good enough”. i’m used to “trust me, one day you’ll fall in love and you’ll get it”.

...listen. i’ve been in love exactly twice in my life. once was with my sociopath ex boyfriend. once was with a straight girl who, for unrelated reasons, kind of destroyed my life. i “get” it. i also get that the relationships that i had dating people who i was not in love with? who i was not attracted to? who i slept next to and kissed and planned a life with? even the relationships that ended poorly...they were in no way inferior to the two relationships i had with the people i was “actually” in love with. they were good and comfortable and suited to my orientation and feelings. and i wasn’t going to some day wake up and realize i was in love. i wasn’t. but i did love them. when laudna told ashton that she loved imogen, i nearly cried.

yes. YES. that’s what it is. she gets it. that’s it.

[sugar-petals]

Tarot Reading Practice: Why Using Lenormand Cards Is Amazing

they’re originally from france and gorgeously vintage — what more does a card reader want?

it’s like tarot’s major arcana, but simplified and with cottagecore imagery. the nostalgia factor is off the charts, too.

the cards have an even longer tradition than the rider-waite tarot, going back to the 18th century. that means: plenty of material out there.

it is excellent to predict timing. each card is numbered and has a specific set time range, even season. you can pinpoint your prediction down to the day.

lenormand’s accuracy even has a historical anecdote. all of napoleon’s battle victories and losses were correctly predicted by madame lenormand, the inventor of the deck herself. who was looking fly as hell by the way.👌

there are only 36 cards to learn. if you buy oracle cards, it’s usually 44 cards or more to study, with tarot it’s 78 cards plus reversals. especially if you’ve already learned the tarot, this is peanuts.

and yes, no reversals in lenormand. god bless.

some decks have the meanings printed as little poems onto the cards themselves. that’s classy, that’s clever, and extremely handy for beginners. it’s brilliantly written and still open-ended enough to allow a different interpretation each session. it changes depending on what other cards it comes with, you’ll never be bored.

in other decks, they also have classic playing cards on them. 

buying lenormand cards is incredibly inexpensive. five bucks and you’re good to go, whereas other decks cost you 20 or more. and even if the price is low and the cards are a bit smaller (e.g. mine are 9 x 5.5 cm), the value you get out of those is... wow. i’ve even seen quality decks as cheap as two euros. 

there’s only one thing going on at a time on the card. no complicated symbolism, it can speak to you more instantly. the downside: with tarot, you can draw a story out of one card already. with lenormand, you need say a 2-card spread and benefit from knowing more about what card means what. 

which again is an advantage though. lenormand needs less intuition, you can squarely, shamelessly learn it by the book. whereas tarot, you know how it is. the card wants to tell you something specific that might not be the standard definition. while lenormand is like haha boom, you will travel next month! you will move in with your partner! you have beef with a colleague if you write email XYZ!

astrological signs and houses are associated with specific cards. i repeat, lenormand and the zodiac go hand in hand just like the tarot. do i even have to go on?!

the cards are petite but sturdy. you can carry them anywhere or create gigantic spreads. shuffling and storing will never be a problem. 

nothing is wishy-washy. the card is either positive, negative, or neutral. you can get a clear yes or no.

the querent has their own set card to symbolize them. let that sink in! if you have clients, they will love this. and it’s so easy for you to create spreads with that, too. if you read for yourself, same thing, the querent cards are one of lenormand’s coolest features. the ‘gentleman’ or ‘lady’ can stand in for the person who’s asking, two friends, or a couple. lenormand is THE deck for love questions. PS: not to worry, you can use it for non-heterosexual couples with ease. the querent cards can be whoever you want, the reading results will not be impacted.

because of their simple imagery, card names are easy to memorize. tarot has spreads like ‘THE HANGED MAN in reverse + THE WHEEL OF FORTUNE + THE HIGH PRIESTESS in reverse + TEN OF WANDS in reverse’. meanwhile, lenormand spreads are like ‘ship - dog - fox - fish - whip’ and that’s it. you don’t even have to know the card’s name, it’s so self-explanatory. you can learn this in one day.

the deck is not the most wide-spread among popular readers, but there are still a lot of websites with information online. simply because it’s such a strong tradition. 

solid, quick lenormand skills are the sign of a seasoned tarotist. you can recognize a trustworthy pro by it. if someone claims they are a veteran but they haven’t heard of lenormand... especially if your tarot reader is european, this is the go-to branch of cartomancy they should have heard about.

similarly, it’s a sign your cartomancy knowledge is about to climb to the next level if you got these pretty french cards on your hands and become naturally invested. it’s one of those cases where the deck finds you at the right time.

niche bonus: lenormand will be the #1 ace up your sleeve.

they’re so decorative and available for any visual taste you can think of. steampunk lenormand, fantasy lenormand, history lenormand, romantic lenormand, the list goes on. you will find whatever style is precious to you very fast. all while the classic vintage cards are a staple you can purchase very easily.

levelling up is possible to no end. you can use one, two, three, five, nine, or even all cards at once. customized spreads on top of that. you can have fast success with the helpful 9-card layout, or really get into it going big. 

lenormand’s 36-card ‘grand tableau’ (great table) reading is infamous and the one and only final boss. not one card will be redundant, their interconnection is what the interpretation is built on in the first place.

once you have the card meanings down, you learn the grand tableau principle faster than you assumed. you will be able to expound your answer by looking at the distances between cards, that’s the whole idea.

example. if the ring card is far away from the querent card, that means to wedding in sight. if the ring is next to the querent card, that means marriage. pretty simple. if the ring is surrounded by positive cards, even better. you can tell how easily you can answer a question this way.

or: if the dog (=card for friendship) is next to the child which is next to the heart, that means: possibility of falling in love with your childhood friend. it’s literally that straightforward. lenormand can’t leave you hanging, it never plays games. it gives you every concise warning (with concrete ways to prevent the outcome) and chance for a blessing.

the grand tableau is as powerful as tarot’s classic spread, the celtic cross. you have something to work towards/work on and get an impressive, highly informative spread that will leave not one question unanswered. this shit is amazing. lenormand is one of the most worthwhile essentials for card readers, i did not once regret learning about it.

[script-a-world]

hello. i want to write a story set in a very religious place. like fanatic level of religious. in my mind, this place is ruled by what the church says but has a "cover" figure to "connect" with the people. the people of this place are devoted to their religion, meaning they know passages, go to mass, and shun those who don't support it. here is my question: how does one go about creating a religion that feels real? what do i need to take into consideration (i'm not religious myself).

Mod Miri Note: At the same time this came in we also received from the google form the question “How do I world build a religion?” I can’t confirm they’re the same anon, but we’re combining them for the answer.

Brainstormed: You seem to have a very… narrow perception of religion? If you aren’t religious yourself and you’re (presumably) from a Western culture, it makes sense that the Christian church and more specifically Catholicism are your go-to images of hyperreligion. Saying “mass” and “church” and “passages” kind of gives away the fact that you’re trying to base your religion off of at least your idea of an Abrahamic religion, but I’d ask you to reconsider. Right now it sounds like you’re trying to create a negative critique of these religions, and even if that is what you’re going for, you need to do a lot of research on their theology, history, and practices before you can do so with any competence.

I’d suggest doing some basic research on types of religions, like animism, pantheism, polytheism, general superstition, etc. There are plenty of spiritual worldviews that you might consider way over the top, but whose believers find it more bizarre when people don’t follow their teachings. Fanatics are never fanatics in their own mind, and especially among their own people, but also… fanatic might be a relative term. If you’re approaching this from a nonreligious background, then you might consider X-amount of religion in one’s lifestyle to be fanatic-level. Whereas a person who actively practices religion would consider X-amount to be perfectly normal, and only folks who take it to XX-amount plus some shadier practices are the true fanatics.

Remember, religions start because people want to make sense of the world. There is a deeper feeling of wonder and personhood and power, both within a human being and in the whole world around us, that drives spirituality and generates superstition. Religion, at least to start, is beneficial to people, otherwise no one but sadists would follow its teachings. Now, like anything else, religion can devolve into a means of power hoarding and control of a populace, but only because of the people in charge getting greedy. The vast majority of religions I’ve studied have had radical, freeing, empowering teachings applicable to everybody when they first sprang up, and only later did adherents twist those teachings into societal oppression. If there is no satisfaction or benefit in your religion, there won’t exactly be any incentive for people to follow it so closely, aside from whatever negative consequences occur for those who fall away. And negative consequences aren’t often enough to keep people in a religion. If following religion is more painful than the consequences of leaving it, plenty of people will jump ship.

Religion can also show up in every single part of life. According to Wikipedia:

A religious experience (sometimes known as a spiritual experience, sacred experience, or mystical experience) is a subjective experience which is interpreted within a religious framework. The concept originated in the 19th century, as a defense against the growing rationalism of Western society. William James popularised the concept.

You look up and see a cloud, a spiritual person sees a portent, or a spirit, or a castle where the gods live. You take a break from work for a minute, a spiritual person now has time to mutter a prayer, or observe the mood of the world, or dedicate their work to their god. A person doesn’t have to be anywhere near a fanatic to have their religion be in every part of their life. Especially if they adhere to a more lax spirituality or superstitious worldview instead of an organized religion, the central spiritual experience of religious belief alters the perception of self and surroundings. It isn’t only a set of rules to follow.

It can even help areas of society that modern Western society considers nonreligious! Historically, medicine has always come under religion. Witch doctors, medicine men, witchcraft, even the hygiene laws laid out in the Christian Bible. Physical health has often been considered a reflection of spiritual health, which, in a way, is true! The placebo effect means tending to one’s mental and emotional health with the reassurance of religion will improve one’s physical health as well. Not only that, but the power of a “spiritual experience”, regardless of if you believe the supernatural is real, can cause religious ecstacy, something you might perceive as a serious psychological problem but those who experience it consider to be a deep form of spiritual expression to be treasured and sought after. The spread and preservation of information is also often aided by religion, even though that can change should those in power want to change history or obscure truth for their own reasons. Just look at the history of the printing press and how that was driven by the need for Bibles. Many cultures, most famously Australian Aboriginal peoples, have oral histories thousands of years long that tie in closely to their spirituality.

You also might be confusing religion with cults. If you think all religion is predatory, playing on people’s weaknesses and fears in order to coerce them into a miserable lifestyle of following strict laws and living under control of those in power, you definitely have conflated “religion” and “cult”. If you’d like to worldbuild a cult, go ahead! It’s likely to be smaller and less acceptable than an established organized religion, not very transparent to the outside world nor its members, and have a spirituality that is in fact just a veneer over gaining power, instead of genuine belief and devotion, and may in fact require people to murder or commit suicide. Just look at Scientology, or these, or even Jared Leto, and a more in-depth look from this organization covering many different kinds of cults.

On a more worldbuildy note, are those who practice this religion correct? Does their god(s) exist? Is the supernatural real? If yes, then are they really fanatics if they’ve been right all along? Even if they’re incorrect, the dedication and deep-held beliefs of religious people shouldn’t be mocked wholesale, in my opinion. Make sure to keep some genuine three-dimensional development for characters who are part of this religion, or include other religions with different practices, or the only thing you’ll accomplish is “waaaa religion bad believers dumb”. And if that is the story you want to write, feel free, but I can’t help you there.

Feral: What makes a religion feel real? Sincere faith.

Specifically among the leaders. I mean, sure, those lemming-like peasants who actually believe that superstitious nonsense will have sincere faith, but honestly? There is going to be a higher percentage of people faking it among the masses than among the clergy. Clergy members are generally required to go through rigorous studies and often take vows that can cause great discomfort. I am sure there are those who did it for the power - there are in atheist organizations as well, humans can be crap - but if you actually read the writings of important Church leaders of the past, not to mention rabbis, imams & mullahs, and archakas, you’re going to find that they have sincere faith.

Something you should always keep in mind when developing pre-modern religion in a Western context is that before the advent of modern scholarship, which starts to become a thing in the West during the Renaissance, all the important scholars were clergy. And again, those learned people either had to be really, really dedicated to their power-hungry ambitions or had to have sincere faith.

That does not make religions perfect by any means nor does it mean that the god they have sincere faith in is omnibenevolent (though the qualities of an omnibenevolent god will be strongly dependent on the culture that worships it). And religious leaders are absolutely capable of doing terrible, terrible things even if they profess to worship an omnibenevolent god, and politicians can definitely twist things around to suit their needs (again, this is not exclusive to religiosity). But your ask has this weird given that a major religion (on par with Catholicism/Christianity) in your world is a scam, and while yes, that happens in cults and alternative religions and in splinter groups*, as Brainstormed pointed out that’s just not how, at least, the four major religions of our world got started.

Yes, it’s true that bureaucracies of a certain size and age will inevitably begin to change focus to protecting its own existence. And yes, it’s true that ambitious sociopaths will be drawn to places of authority even if they are difficult to achieve. And yes, it’s true that an individual entering a toxic environment is more likely to be changed by the environment than to change the environment. But guess what! That has nothing to do with whether the organization is religious or not.

Why does a religion exist in the first place? It explains the universe in a pre-modern world; it provides organization and structure for community focus - in other words, many social programs have historically been run through religious organizations and leadership. And it provides hope and comfort in a very scary world.

Some clergy might be able to fake all of that for a little while, but a large bureaucracy with many clerics who are all in on the fake? No. Allow me to rephrase: hell no. People are not dumb. Maybe you believe that of all religious people, but you are wrong and they are not. The people in your world, if they’re anything like the people in our world, are gonna sniff out the bullshit if none of their religious leaders believe what they’re selling. There is a reason Scientology has to keep blackmail files on all its adherents, and I promise you, the Catholic Church does not do that.

*A note on cults, alternative religions, and splinter groups: Cults and alternative religions (their PR friendly name) are “religions” that are scammy and/or actively dangerous to the participants or others: People’s Temple, Branch Davidian, etc. Splinter groups are congregations that start as normal members of a large religion or denomination but its insular culture creates a divide that just takes things a little too far even for the most fanatical of the main sect (think terrorist groups that link themselves to religions). These types of religions might be what you are actually asking about. Groups like these can be highly, highly influential but in a very contained area. What cults often do is the leader settles in an area and buys property and builds a church and maybe a school and then encourages the members to all move either onto the plot of land if it’s large enough or to buy up surrounding land and homes and push out all the non-believers. That area can then be fortified or just have a de facto boundary with the rest of the world. Sometimes a group like this can become large enough to constitute an entire town, but rarely a city - groups that large will more often have centralized compounds but with the members living scattered among non-believers, as Scientology does. Obviously a group concentrated like that will have an impact on local politics, if they are allowed to participate, but it’s not going to go farther than the county line, so to speak. As we all know from the news, splinter groups like ISIS can become very large and globe spanning, but those types of groups have within them splinter groups and factions, and I don’t think that’s what you’re asking about anyway, so I’m just going to leave it there.

But frankly, your ask reads to me as “how do I create a fantasy!Catholic that is secretly evil and will show the audience how evil religion is in the real world? Opiate of the masses!” And my advice is… don’t. Because it lacks compassionate understanding of people of faith (many faiths), it lacks a factual understanding of how world religions differ and function, it totally lacks nuance, and finally, because it is absolutely, monumentally, extremely, really, very cliche.

Maybe the way your ask is coming across to me is totally not how you intended it. Maybe you only used the jargon you used because you assumed we wouldn’t know any other terms and maybe your understanding of world religions is actually quite sophisticated. Maybe you really do have this insanely clever way to spin a tired cliche into some new and original. In these cases, we strongly encourage you to come right back with as jargon-full and specific an ask as you can write, use our submission google form to do it. Otherwise, give our responses some thought and if after you’ve developed your religion, you want to come back with a specific ask other than “how do I world build a religion?” (which is a little too broad), please feel free.

[doctorstrangeaskblog]

One thing I’ve noticed about haters is that they basically dedicate a lot of time just to spread hate, making their target’s fans sad, they often want to impose their opinion, they often misinterpret the facts, make up facts or even exaggerate on interpretation of facts, and that’s not the problem, the problem is that they want to IMPOSE their thought on people, prevent them from having fun with what they like, as if the whole world had to hate what they hate, and this is wrong, because it attacks the other’s right to like something. People have the right to hate stuff, but they cannot harm anyone else’s right with their actions (and arguments), because that way we fall into intolerance, and not just racism, sexism or homophobia, but also social exclusion against personal tastes and opinions. They also sort of invade spaces that were supposed to be fun, such as tags on Tumblr and other social media with hateful, negative and even fake posts. A good example was people blaming Benedict for Doctor Strange whitewashing, while the character in question was the Ancient One and not Stephen per se, and then they start the “Doctor Strange should be Asian” movement, with so much superficiality, because we know we can’t just change the characters’ nationality and be like “see? We’re inclusive”, because that’s just so lame. People who suffer with exclusion feel every day the problem can’t be solved with simple replacement, but with the development of good, well built characters, good stories, with cultural inclusion and all the focus the character deserves, etc. Anyway, it’s not a simple matter, and suddenly haters were blaming the entire racism of the cinema on Benedict (?) while the guy has a big importance when it comes to inclusion, donations, charity, pacifism and a lot of relevant points I won’t list here because just google it.

Anyway, haters end up carrying misinformed people into hating people who actually are doing good things out there, with great projects and charity initiatives etc. (Keanu, Capaldi, Benedict, Hiddleston...). Also, whenever a hater comes to discuss about why the person or character you admire is the worst being in the world, they often get aggressive when you start pointing out logical arguments, they end up getting emotional and coming for the personal side and forcing some interpretations (example, a lot of doctors, actors, psychologists etc. study objects, animals and people so they can work and improve their profession, like, doctors study people with disabilities, from incapacitating ones to very light ones so they can understand the matter and work more efficiently, etc, I’ve seen people turn Benedict into a monster for observing people with autism, because he more than once had to play a role in which the character had autism. If we think about it and keep acting with such hateful attitude, we’ll end up agreeing with censorship, and autistic people wouldn’t either be characters in movies or we wouldn’t get actors working on such roles, meaning the characterization would be way more limited etc. anyway, it would be bad for culture and critique in general, there would be less representation, because even if autistic authors were called, it would make it harder in occasions where that wouldn’t be possible, movies would end up exploring that subject less, etc.), this was an example, but project this into wider areas of cinema and society in general, using your personal opinion to judge people and consider them the ultimate evil, to want to make the whole world hate that person and harming anyone who disagrees with the haters, that’s really bad!

I used some haters speech about Benedict as examples here because that’s what I’ve seen (and been attacked with) the most, because my blog is a Doctor Strange blog, anyway, but I’m talking about all the kind of haters. But understand a thing, being a hater is not the same as disliking something! Everyone has the right to dislike stuff, and people normally just stop there. People dislike something, people avoid that thing, if asked, they say they don’t like it and that’s it! People normally don’t spend hours making toxic posts about what they hate or spend hours arguing with strangers about how they should hate something! People tend to spend their time with things they like (or things they have to do), so if a hater comes to you and keeps babbling, just say you’re not interested or ignore or end the conversation, because normally these people aren’t well intentioned! Haters normally can’t be convinced, there will ALWAYS be a reason to justify their hating, while the truth probably is that they identified with a group and feel important there. Also, haters tend to spread high expectations about people, and that’s just toxic, we can’t judge someone’s entire life by something they said or did, people commit mistakes and that’s why LAW exists, if someone commits a crime, it’s up to the system to judge them, not people! When people assume that role and start writing stuff, a lot of fake news come out, and a lot of people actually believe it, and everything becomes a big hate toxic ball that hurts tons of people who had nothing to do with anything.

We do have to criticize actions we consider evil or wrong, as well as we have to think about  society and about cinema and racism etc. but we can do that with logical conversation, checking the facts in sources we can trust, we don’t have to become haters and hurt others to defend what we believe and trust every tabloid website in order to sustain our arguments, and I’m not even talking about extreme things such as racism and homophobia, I’m talking about something way more “silly” and superficial such as fandom hating, celebrity hating, ship hating etc.

To point out how it’s not normal to be a hater, let’s imagine a situation: there’s an actress or singer (etc) you like who said something really bad on TV, live, everyone saw and it’s impossible to claim it’s fake. You kind of used to like that person’s content before, but what she said really let you down, you don’t like her anymore and you’re sad. What’s your natural reaction? The reaction most people would have? Well, unfollow that person, stop reading their posts, stop listening to their music, stop recommending that person to friends, stop buying their stuff and little by little, that person would have a smaller and smaller space in your life, until you simply forget about that celebrity (they become irrelevant to you), you just avoid their stuff, you don’t even notice them anymore, you have other interests now and that’s it, things barely changed for you, you’re just indifferent. Now, what does a hater does? They create a page (or fill their social page) of stuff with hate against their target, they spend hours reading about how terrible that person is, they talk to that person’s fans to tell them they have to stop liking that celebrity, they invade all the tags of series, songs, movies (anything) the celebrity is in and spam it with negative things, such as “it’s a terrible singer” or “they should have  cast another actor”, anyway, anything really negative that would induce the fans to either quit having fun or start hating the celebrity as well, and that’s just soooo sad and toxic, because spamming a safe, fun environment like that can be considered imposing and even aggressive depending of the content they’re posting, that’s why social media websites often ban accounts that spam tags or other users.

Anyway, haters who spread fake news or aggressive thoughts or accusations often forget they actually could be sued by the celebrity/singer/actor/writer they’re hating on, that’s where personal opinion differs from being a little authoritarian offensive aggressive person. I can totally say “I don’t like that singer because they did X” or because “their song is bad” or “I don’t like their style”, however, we cannot accuse people of stuff they didn’t do, things they didn’t say or even write they thought something or said something they didn’t, because then we’re invading their space, and they have the legal argument to sue you. Normally celebrities don’t lose their time suing small silly haters on social media, however, if a hater writes something offensive about them, including false accusations, they totally CAN sue the hater, or report them so their account gets closed anyway. Haters often forget that some of their actions are criminal, cyber bullying is crime, false accusations and humiliations can be interpreted as injury, and that can be serious, specially if the person being offended is going a hard phase or suffers from psychiatric disorders, the consequences could be way worse for who’s suffering the stalking.

Something that’s very common is Benedict haters taking pics of him and making photoshops making fun of his appearance (they FIND) and making fun of his name. Benedict kind of seems to be okay with that during interviews, considering a lot of his fans also do that, but still, imagine people taking pics of you, making an offensive edit and spreading it in the tags about you or tags about the things you do and like, HOLY CRAP THAT WOULD BE HELL, I WOULD HATE THAT! I WOULD SUE! And not only the celebrity has to endure that as well as all the fans have to scroll past the sooo many hateful posts which are contributing to NOTHING at all. The only ones happy with all that are the little noisy hater communities, who keep spreading all the offensive things, being rude to people and satisfying their ego, because they often feel way superior to the people they hate (and the fans, and anyone else because they feel they have the right to impose their thoughts). Hate tags do exist, and fans normally won’t visit them because they don’t want to read hate, but even so, haters get expansive and spread all their hate to healthy tags as well, and that becomes toxic. That’s why hate posts and spams are really close in many Guidelines of social media, and such posts CAN BE REPORTED, because they kind of break the “behave online, respect people and don’t harm other people” guideline.

In conclusion, if you’re a victim of a hater(s), don’t quit what you like, just report and block the haters. If it turns into stalking, keep reporting, call the police if you feel threatened, cyber bullying is CRIME, and spamming people is considered a bad attitude on most social media. Preserve your well being! Don’t lose your time discussing with fanatic haters, they won’t listen to you. (If someone hates an actor/singer etc. because they are misinformed, they tend to be like “really? I didn’t know it was a lie. I’ll check it out” when you first tell them /or comment on how the information they’re sharing is fake. Misinformed people normally don’t want to impose their thought, normally they’re just confused or lost, and most of them won’t attack you).

If you’re a hater, please, stop that and if you feel you need, go search psychiatric help, because what you’re doing probably is hurting someone, and hate doesn’t make good at all, not to you, not to anyone. You’re free to have your personal group where you hate on stuff together, of course, but try to be careful to not hurt people or to be toxic to others. Some stuff you hate mean the world to other people, so respect their view just like they respect yours.

Just reminding this text isn’t about extreme things such as racism, homophobia, sexism etc. this text isn’t about that. (Wanting to kill someone because of their gender or color isn’t accepted in our society, it’s crime, and I’m not talking about this here.).

That’s it. Stay away from haters, they will try to make you feel bad for not listening to them , they will accuse you of being authoritarian for blocking them, but no, you don’t have to listen to them, you don’t have to spend you time listening to their hate, you have the right to preserve yourself and ignore them, that’s why the function “block and report” exist and you have the right to use them.

[irageneveart]

there are so many things a 16 years old person should be doing beside throwing hate, BUT HERE YOU ARE BEING A BRAT

@bfmyers I really can't take this anymore, are you really that full of hypocrisy to scream TOXIC left and right while you yourself use your free time to only spread hate? I don’t usually do this and I try to stay away from useless discourse but you're just kicking on my nerves way too much

under the cut cause boy I have a lot to say. (really, it’s long. I needed to point out everything)

I'm going to kindly tell you to fuck off artists' backs.

you have 0 fucking knowledge of what you're talking about yet you're making callouts and worse, people agree! the same people who supported the artists before by reblogging and liking their art are now shitting on them and "ihh no more reblogs from them" only because you write a lengthy shit in which not only that you threaten a human being, you don't even know how to argue. a link to a picture and screaming "toxic" ISN'T A GODDAMN ARGUMENT

people of this community, PLEASE use your fucking brains and don't bow your head to what every nameless kid has to say. you don't have to believe me either, just use your fucking brain and heart and do the decision making yourself

Now, you did a callout post on @dbd-omija pointing out how toxic they are!!! omg gasp animal death? abuse?? HOW IS THAT pOsSIbLe

where have you been until now because this is a horror community:

in the TCM universe inbreeding is mentioned multiple times

in the Halloween movies Michael kills two dogs and eats one of them

omija clearly stated they went with the 1978-2018 timeline BUT NO YOU KEPT SCREAMING BECAUSE HOW DARE THEY SAY SOMETHING AGAINST YOU

on that matter: in the halloween movies Michael's cult makes him rape his niece, in another movie Laurie, before jumping to what it seemed her death, kisses Michael's mask lips. GASP, when will you sue the directors?

after he escaped, Max literally slaughtered every living creature in that farm. put the DBD devs on your "I need to sue them cause I have something to say against this horror game!!!" list

If there’s something I can agree with you on, it’s about tags. Yes, these are triggers, yes tagging is important, but let’s not forget that being in this community IS about being surrounded by triggers. out of courtesy sure, we should tag our stuff accordingly, but to go all out to say “omija, if you’re reading this, i’m going to pee in your mouth.” HOW. IS. THIS. ACCEPTED?! HOW

HOW THE FUCK PEOPLE WHO REBLOGGED THAT CALLOUT THOUGHT YES THIS IS GOOD?!!?!

now you said that Omija's making all of these seem cute and that’s the real problem. this is where you are sooo wrong and let me explain:

a round head doesn't instantly make everything cute. there are many many details that the human eye perceives as cute, things that artists go to when they want their art to be seen as cute. from the color chosen to the way their eyes and mouths are drawn, to the very line work they’re using. yes, shapes count too, but this is not the case and we should get out of our tiny box and see the big picture. Their comics are not meant to be cute, actually much respect to them for being brave enough to approach well known subjects that are not explored. But that’s it. If YOU see it as cute then it’s your problem really. Art and fiction is prone to interpretation

If anything, how much cute stuff we have in the community should be the anomaly, not that someone draws anxious Bubba

omija's Amanda and Bubba art is problematic! someone asks why, you: because is toxic!!!

really? I actually think that, given their individual personalities, omija portraits the ship’s dynamic really well. Amanda is not dealing well with her feelings and with humans and Bubba has problems understanding things in general. they are two deranged people finding a way to cope and to accept another human presence nearby. "Amanda is picking on a disabled person how can you say it's well!!!!" let me remind you that his entire family is picking on his disabilities and the fact that he loves but also FEARS his family is a big theme in Leatherface's story and personality

Also, another argument of yours was about “the power play” and how that’s problematic. I’m...honestly surprised you even thought of this argument because the entire slasher fandom, the movies, everything slasher related IS BASED ON POWER PLAY. Have you read what they wrote for Laurie/Michael to say the ship is based on power play and it’s wrong? No, me neither, cause I don’t care, but you seem to care enough to vomit about it. Go read some things and tell me how problematic the writing is, you need to call out writers too after all

Btw, surprise! I don't ship neither of the mentioned ships, but I can use my brain enough to see what omija does is actually well made and well thought, sick, weird in some instances, but well thought. kudos to you artist. I can also see those who ship Laurie and Michael are still nice people

But just like you and many others I have my own morals (do you now? Exposing yourself like that to NSFW content while so many people are scared for their life because of people like you? hmmmm) and I can’t really stand explicit pedophilia. I’ve read so many books or seen so many movies where it was mentioned, it’s a trigger factor, it’s taboo, therefore is normal to be used in darker works. It all depends on the circumstances and the way it is presented, cause it’s a piece of fiction. Nobody attacked George R. R. Martin for the controversial things he had written in his books right? I wonder why

Because, another surprise, fiction is different than reality and only this argument alone should be enough, but some monkey brains out there will come to scream at me how fiction affects reality. Someone who writes a murder mystery isn’t actually killing people when they put pen to paper. People who play shooter games do not wish to shoot people in real life. Someone who writes about rape will not welcome the rapist in their arms nor do they wish to rape someone. So on, it’s simple, again, we just need to use our brains.

If you have bullying-related or a family related or any thing related trauma and you see a Michael/Laurie fic or Quentin/Freddy or whatever other ships or subjects you have seen around, and decide to click on it, and then you have a negative reaction, that fiction is not harming you. Your unresolved trauma is harming you. Your decision to read something when you know it triggers you is harming you. The past actions of yourself and those who inflicted harm upon you are harming you. All of those things – your trauma, your real-life bullies, your actions – are real, and have the ability to harm you. (the italic bits are from @dracfics who said it better than I ever could put in words. Thank you)

next on your "who am I going to shit on today" is @renlvbon

not gonna lie, for the omija callout I read everything searching to see whenever you are right or not. I don’t personally know either of the artists but I could read enough to see you’re just a self entitled person with something to say regarding everything. for ren's callout I simply skipped after I saw your argument.

you're not doing gods' work by opening people's' eyes that they can or should portray the characters the way they are, disabled and gross. no, you're just picking on someone's art style

Can we stop this toxic nonsense???

don't get me wrong, I agree that we shouldn't make them supermodels and we shouldn't erase what they are, fucking ugly and gross killers, but saying people who don't draw them a certain way are cowards or calling them out or whatever else shit is TOXIC and ANNOYING. We all change them more or less, we have to because none of us are the original creators! We’re just thirsty people making them to be what we want and what we imagine because they’re fucking fiction

I’ve seen people agreeing with you saying the artist should consider real people with disabilities or on the heavier side (“like me” they pointed out). I’m so sorry if this comes out as rude but if you search or need validation in a horror community that’s not a good thing at all! Body positivity and a healthy approach to disabilities should. not. be. searched. in. a. horror. community or any community on tumblr for that matter. You want some positivity on that? In a real case scenario with them we all would die, no matter how you look like

Going back to the artists, some people don't have experience/ are insecure/ are uncomfortable drawing body hair or fat bodies or whatever. That doesn’t make them fatphobic or whatever shit I saw you writing in your tags.

Drawing a black character less than the color YOU think is good? Have you ever tried to color skin? There are so many ways to do it, there are so so many colors you combine and you play around with + lighting and shading that alters everything. and yeah maybe some people pick a different color, a lighter one, or a more yellow one than they should for asiatic people, or whatever. but these tones are NOT easy to get well (you can always put a brown color down and to call it a day, but maybe people won’t want that. They don’t want to be disrespectful, exactly cause there are predators like you that don’t know how to help, only how to fucking scream). Or maybe they simply don’t know how. Every artist has their own range of comfort zone, be it about subject - composition - colors - etc. I don’t do well with neon colors for example, it happens. Hell even the screen you’re using alters the colors

How about giving actual tips, support and explanations instead of rude call outs? And don’t come at me with the “color picker” shit cause color picker from a real life photo is hell and if you don’t know some color theory your art is going to look dull and lifeless regardless

The only time I can agree that whitewashing is wrong is when white-supremacy, nazi and other ugly shits like these are coming into the topic. But it’s not the case here

some young artists don't have the skill to draw certain body shapes, or body hair, or even a non-anime face. some others think putting a scar on the character’s face make them 'uglier' and ‘scarier’ and for them that's enough AND THAT'S ALRIGHT

drawing something that's supposed to be ugly but still having anatomy and proportions and a functionable mouth or eyes placement or whatever ISN'T EASY. ofc, you can go all out if that's what you want, but personally I want things to still be working because at the end of the day every single one of them is human. I'm not drawing dark fantasy in this fandom, I'm drawing slashers

NO ONE IS DRAWING FOR YOU. NO ONE IS USING THEIR SKILL TO MAKE YOU FEEL GOOD. art and writing, especially when is made in the free time of the creator, is made FOR THEMSELVES. If there are people enjoying it? Yay, that’s a win, but no one expects everybody on this planet to like what they’re doing. We’re getting back to that golden rule, DON’T LIKE: MOVE THE FUCK ON/ BLOCK AND LIVE YOUR LIFE. EASY. no one uses these unnecessary callouts for anything, if you have something to say do so kindly, if you can’t, just vent to your friends

So now let’s wrap it up cause IDK how many of you even make it through this point

can we fucking stop making young artists and writers cowards for drawing or writing how they can and however they fucking want? Please and thank you

this shit going on with "the best artist/writer for x y z character" or "conventionally drawing ugly Bubba uwu" will just destroy the confidence of whoever wants to keep drawing or writing or joining the fandom. There’s no competition who draws Bubba the ugliest nor who writes Michael the best. if you can do things a certain way, do it, and let the rest draw and write whatever they can WITHOUT FEARING THEY'RE NOT GOOD ENOUGH.

now I'm waiting for your very "well" argumented reply but I hope you'll understand that what you're doing is TOXIC and you should stop or at least change your way to address things. You’re talking to other human beings, not a void when you can throw any random thought you have in the morning. I don't care about you to be honest, but there are so many people out there following your words mindlessly and the creators are suffering and it's not fair.

don't forget to tell me to go kill myself. have a nice day

[golden-redhead]

I’m actually a bit surprised that people are even bothering to respond to any of the bullshit that Oumota hater is spreading? like, if they want to project whatever hatred they want to project on the ship or its shippers - let them. I’m a strong believer that people who spread hatred and negativity are the ones who ultimately drown in it and it’s just... well, sad. But it’s their choice. They’re just trying to get a reaction and feed their ego, so don’t give them that satisfaction.   

Oumota literally went from being one of the most underrated ships in this fandom to the one who got a pretty big and dedicated fanbase and currently is the 4th most popular (as in, in terms of the amount of content ofc) ship on AO3 in like, maybe a year or something. This is super impressive! And honestly, the best and most productive (and I’m a huge way of productivity because yay, who doesn’t like to feel productive!) thing is to just mind our own business and focus on building our fun and positive Oumota fans community. It’s not like we need anyone’s approval for that and if someone chooses to disrespect an entire group of fans with delusions about what Oumota fans are like and how they interpret this ship then... welp, I say that it’s not someone who’s really worth anyone’s time. 

We know what we love this ship for and it’s all that matters anyway. We love it for the complex and often misunderstood relationship they have. For the way their stories and intertwined in the game and how one’s development is impossible without the other. We love it because in different circumstances maybe they would have been close. And because in many ways they are different sides of the same coin, especially in what they believe in and what they both die for in the end. We love it because despite their differences in the end they fight for the same goal and gain respect towards each other. We love it because they see through each other’s walls and insecurities, one way or another. There’s so much potential and so much to explore,both in and beyond the game and somehow I spent over a year and a half in this fandom and never once seen a fan who would enjoy Oumota for reasons that would have anything to do with abuse but rather for the vulnerability that is in both of these characters and how it would play out if there was ever a chance to explore it properly.  

[beyondthetemples]

{{ “Be Honest” mun meme

{{ Questions list taken from here:

https://www.tumblr.com/dashboard/blog/hellhaeths/182092480007

What would prevent you from following someone? Not trigger-tagging, or not using cuts for ns//fw scenes. (I have really intense emet*phobia, so if you don't tag for that, or won't tag for it upon request, I absolutely cannot follow. Savior catches most posts for me, even if they're not tagged, but there are just So Many Euphemisms and Various Ways to Describe It that it only works 75% of the time.)

Are aesthetics important to you? If they are, why? As far as blog theme, not really-- I just like fiddling around to find something that evokes their General Vibe, and seeing what themes other muns like! I won't judge by them though. When it comes to thread aesthetics, I actually prefer to leave them utterly unformatted and plain-text as possible. I have ADHD and Fancy Unicode and Symbols and All That makes it really hard for me to focus on what's going on in the thread, not to mention I don't have the attention span to match another mun's Styling like that. (Also, fun fact: I always have my Tumblr Dash at 75% zoom, and Dove’s theme already has text at a Very Readable Size, so nothing ever needs to be Smallified for me.)

What current rp trend do you hate? I don't think there are any I "hate", though I get confused on all the Different Verses that everyone has. (In all my years of writing fanfic, I've only ever written Exactly One (1) AU, and I never read them outside of rp. AUs just aren't my thing.)

How do you explain rp to someone in the real world? "Taking turns writing what the characters are doing." Everyone afk has been pretty supportive. (They all know I'm a writer, so like... it's Nothing New.)

Do you prefer interacting with male muses or female more? Why? I genuinely don't care either way! Guy, gal, nonbinary pal: as long as they're fun to write with, I don't mind a bit. (And Dove has no preference, either.)

Do you prefer writing male muses or female more? Why? Statistically, I have 3 female muses (4 if we count Evangeline as her own person and not just A Part of Dove Manifested)... and only 1 male. (And technically, both Srentha and Leyla are genderqueer, so it's really only Dove and Kary that are cis women.) But that's not intentional? Evangeline is feminine because Dove is feminine, and Kary was originally my girlfriend's-- if she was a male I still would've hardcore adopted him. It just kind of worked out that way. I just enjoy writing people, not gender roles.

Name any three things about the rpc that bother you. 1.) The aforementioned Verse Thing. (It doesn't really bother me, I'm just easily confused by Similar-Except-Vaguely-Different Things due to the ADHD.) 2.) Some people still don't know that godmodding isn't okay. 3.) The distaste for OCs??? I guess that doesn't exactly "bother" me either, because people are allowed to have preferences... but, I mean, I spent several years active in, and then Actually Running, a group of 1300 members on dA completely DEDICATED to OCs, and it was a blast, so I just don't understand why people don't like rping with them as much as canon characters. I personally find OCs more satisfying to explore, more surprising in every thread because you just don't know what to expect, and you have a LOT more freedom for plotting and reactions! Like! You can Shed the Constraints of Canon and Revel in your Newfound OC-Based Freedom!! Truly Become your Character's GOD!!!

What is your opinion on exclusivity? Do you practice it? Why / why not? Nah, I love the variety different muns can bring to the same muse! Other people can stay exclusive if they like. Being an OC mun, it doesn't exactly affect me. 8F

Have you ever had a bad experience with commissions? As either someone who makes them or as someone who buys them? (I don't really know how this pertains to RP?) But there was one time when someone gave me a really vague commission request, out of the blue, for a fandom I know absolutely nothing about, and just kept saying things like "Whatever you think they'd do!" when I asked for plot, characterization, or preference details... I never finished it because I Didn't Even Know how to START.

What do you know now about rp that you wish you knew when you first started? The reply doesn't have to be perfect. Or dramatic, even. Not every reply is going to shatter someone's heart or absolutely make their day. And that's perfectly okay!

Have you been involved in drama? Do you regret it? Nnnnot on Tumblr. (There was a LOT of drama amongst admins of the dA group, which strongly attributed to the decline of me RPing on dA, but I definitely do not regret standing up for myself. I do wish I'd been able to foresee it, though, and brought someone else on staff who was actually going to, you know, do the job they applied for?)

Have you ever thought about leaving rp? What caused it? What changed your mind? Never! Well not on Tumblr anyways. There was a period where my favorite partners were all going inactive, and I couldn't find anyone who wanted to interact with Dove, so of course I was despairing, wondering if I'd ever get to explore what I wanted to explore with her. But then I decided, you know what, so what if I can't find any canon Titans to advance her Tumblr timeline? I'll just fill in the blanks with fanfic canon, and work from there! Making that decision was so freeing.

Do you think rp has had a positive or negative affect on your life or you as a person? Oh, positive, absolutely. I may be too busy to really attend to it much nowadays, but my writing style has improved DRAMATICALLY, I've made so many friends, and I've learned things about Dove that I never would've discovered in the stories alone. (Or at least, it might've been discovered on a ten-year delay. 8F)

How has rp changed you personally? I was able to find fast friends, make connections with people over common interests, and my very first experience with leadership happened because I hung around a TTOC dA chatroom (because, specifically, I’d gotten ADDICTED to rp), came to love the people and characters, and decided, when the current admins had to step down, I would like to step up.

If you could change one thing about rp on tumblr, what would it be? Why? I'd like tags to stop breaking, that'd be nice. (But that’s an issue with Tumblr itself, not the rps.)

Have you ever sent a message to yourself on anon? Why? Pff, no. Mostly because if I really want something to happen, I'll either post an open, OR I'll do what I'm doing here, and just answer the questions myself. 8F I have a lot of fun doing this with headcanon question lists.

Have you ever sent hate to yourself on anon? Why? No, but that's because I'm all about learning (+spreading) positive self-talk, de-escalation, and avoiding drama. Drama doesn't serve anyone.

Do you delete anon hate or post and address it? Why? I address it and then block the sender, because I want everyone to know I don't stand for that. And I have this stubborn streak about standing up for myself, so, you know... Gotta Address It First. (And I've defended Dove from Mary Sue accusations since I started posting about her in 2006, so it doesn't bother me, but I love pointing out all the reasons that, Jack Rider voice: You Are Wrong!)

Have you ever felt pressured to write something you weren’t comfortable with? Nope, but that's because if I can't or don't want to, I'm open and transparent about it. (Not on Tumblr, anyways. There was one particular person in the dA chats that kept trying to make RPs All About His Muse, but we shut that down too.)

Have you ever followed someone because you felt like you had to, not because you wanted to? Hell no! I've never Automatically Followed Back, and it's right there in my rules, I need a little communication before I start interacting.

What would make you block someone? Anon hate, reblogging/replying to rps that don't involve them, starting their own rps on my posts, Bad Takes in the Tags, shipping something I genuinely can't stand... I use the block button pretty liberally. I just don't need that stuff in my life, in my tags, or on my dash.

Have you ever stolen something from someone else? Well I have adopted a couple of headcanons re: Canon Characters from the teentitansheadcanons blog. (Like hc that, one time, Beast Boy was a bug and someone almost squished him, so now they put all the bugs outside, just in case. I love that for some reason, so I adopted it.) And every now and again I'll see something in fanfic I like: Azarath Has Two Suns, I saw that in a fanfic and it just felt so RIGHT, so I adopted that too. But, I mean, rping as an OC, there's really not a lot I can steal. 8F

Have you ever had something stolen from you? If so, how did you handle it? Not on Tumblr, but somebody once stole a picture of Srentha from dA and used it in a random webs-page blog about their dreams? ??? I have no idea why they used him, or how they even fOUND him, but I kinda just shrugged and let it go.

Are you open to duplicates? Why / why not? (Isn't this basically the same question as "are you exclusive"? Because I have the same answer. I am, because I like seeing other muns' interpretations of the same character.)

How do you feel about vague posting? Use your own judgement for your own blog, but it's not something I do myself. If I have to vaguepost to vent something, I'll usually go on a more private blog, or at least stick it under a Read More.

Do you follow people even if they don’t follow you back? Yes! I like reading rps almost as much as I like writing them.

Do you read people’s rules before following or interacting? Always.

What is your opinion on “reblog karma” and do you practice it? I try to! Sometimes I can't figure out what to send in for the blog I get in from, but most of the time, I'll send something any time I reblog something. I really appreciate it when people send something in before reblogging from me, personally. c: (I get it if you can’t or don’t want to. But it sure is nice!)

How have you responded to popular slang used on tumblr? Do you use it in every day life? Do you use it at all? Not really, but I rarely use slang at all. Unless I'm actually talking about rp, muses, muns, etc, then I'll use those words.

Is there something you don’t know the meaning of but you haven’t asked anyone because you think it’s supposed to be general knowledge? Was there ever something you had to ask someone to explain? I'm that Ravenclaw who always asks questions as soon as I encounter I don't know, and I don't use words without knowing what they mean. Kinda defeats the purpose of words that way.

Have you ever experienced discrimination? Well, Dove has, since people have that "I don't like OCs" mindset. Or "she's related to a canon character, so she's automatically a Mary Sue". It's not as big of a Discrimination as sexism or racism, don't get me wrong! But it HAS limited our scope of interaction, and I personally think it’s a little unfair to make judgments like that.

How do you feel about personal blogs following your rp blog? Go for it.

Have you ever cried while writing a reply? Mmmmaybe once? More often my heartrate just raises a little in an exciting moment, or I write out a ten-paragraph response in a one-hour fit of delighted manic wordsmithing, but I've definitely been touched. (I'm just... not very good at crying when I'm focused on writing. 8F)

Do you read other people’s threads or do you only read your own? There's definitely a bias towards my own! (Before my EHD died, I had about a hundred and fifty rps saved as word documents.) But I also enjoy reading others' threads.

What’s one thing that other people seem to hate that doesn’t bother you? Hmm...Spelling and grammatical errors. When I was copying chat rps to word docs, I started editing the replies for readability, and that habit kinda transferred to Tumblr, so when I'm not in a hurry, or I have an Unusually Long Attention Span, when I copy the replies, sometimes I'll just edit them, but I'm not mad about it. Just got into that habit.

How do you feel about tagging triggers? Do you tag them? How do you determine what is triggering content and what isn’t? It is absolutely ESSENTIAL for me to have triggers tagged for ME, so of course I extend the same courtesy to others. I don't presume to know what triggers people; I've made it very clear that if anyone needs something tagged, they just have to ask, and I'll tag it. No questions asked. (Though if they want to vent about it, I'm open to that too.)

What advice would you give to someone new to rp? Just GO for it! I know it can be scary and intimidating and overwhelming to see a great writer and think, "Gosh I want to interact with them So Much".. .and you know what, sometimes you will get rejected. Sometimes you just won't mesh with muns. Sometimes your characters don't have a very exciting dynamic. But you'll never find those Goldmine RP Partners if you don't at least ASK.

[sometimesrosy]

I hate seeing things like this “Someone on reddit (a huge bellarke fan) has had infos on s6 regarding bellarke. She said it was someone she trusts and that unfortunately the person made it clear that bellarke wasn't happening this season, if not ever. She said she completely lost hope... so yeah, low your expectations” I know better than to believe fleakers on reddit or twitter from GOT but it still gets you down knowing you can’t completely disregard it until the season airs

Anonymous said:A reliable moderator on Reddit said she has an insider and so far Bellarke isn’t in Jason’s plans and she was told Bellarke isn’t happening in s6 if not ‘ever’. I really know i shouldn’t believe in things like this, that don’t have open source or sumn but I feel so down. I still have hope I can’t accept that they put all those scenes or dialogues for nothing

Okay. So that’s two on the same topic. So this is going around again…. Three different asks now. And one nagging ask declaring i won’t answer their first. And it’s all bugging me.

*sigh* fine.

honestly i wish y’all just wouldn’t read it. but i should get it out. and you should know why I don’t buy those rumors and understand that I have reasons, I did research when they first came out. I went back to the text. And I have been watching the source of that rumor for literal YEARS now, so I’ve made some analysis on the way she works. I think we all forget that this is the internet, and we know what you said last year, how many times your theories were wrong, and who you blamed when they turned out to be wrong. None of this I say here is being said lightly and I wish I didn’t have to say it, but I think more harm has come from letting these rumors stand without challenging them. So. I guess I should do it, even though I don’t want to. The other option is to just wash my hands of fandom all together. I guess I’m too stubborn. fine. This is going to be a mess because I wrote it all day long, trying to get it out, planning on deleting it, getting new asks, having conversations with people, taking things out, adding others. And I’m just gonna post it and let it go without editing anymore.

I am not delusional. I am not naive. I am not a blind bellarke shipper. I am JUST trying to stick to the text and watch the show. I AM critical, but that does not mean I am negative. I am looking to UNDERSTAND the show on screen. And when rumors or writer commentary doesn’t fit with what I see in the show, I put them aside and do not take them as confirmation of anything.

I have been sitting on this answer all day trying to figure out how to answer it, because it gets pretty negative about… well… about one particular person and I am trying to keep out of drama and mind my own business and stick to the text and my corner of fandom. But I’m so tired of this all the time. 

I just went to reddit to find out why it’s coming back and who this redditor is and what they said. So I couldn’t find it in the 100 reddit, but it was in bellarke reddit. I don’t know know WHO that moderator is, although it might be someone I know, who I know listens to the person who started the original rumor, and even if it isn’t him, it’s still pretty clear to me that’s where this new wave of negativity is coming from.

 I have been avoiding speaking out on this particular rumor because I did my research when it first showed up and tracked it back to a person I had a meta argument with YEARS ago. And because of that, I’ve been careful to not say too much about it because it ends up sounding like I have a grudge. But it’s too much now. It isn’t fair that this stuff goes around because someone decides they are all knowing and understand everything better than everyone else and they think it’s a good idea to spread bad feelings as “confirmation.”

First of all, I don’t do gossip. I do canon. I analyze canon and stories and film and visuals and symbolism. Whatever someone says outside of canon, I consider it and see how it reflects upon canon. The more official it is, the more I take it seriously. Someone having an unnamed source with no written confirmation of what they said? And then DECLARING their interpretation of undocumented source material to be ACTUAL CANON CONFIRMATION? No. That’s called gossip and rumor and innuendo and interpretation and speculation. NONE OF THAT IS CANON CONFIRMATION.

I am at about third hand here, one person told me what she said about what the inside source said, so I cannot confirm anything I say as truth. But I want to explain the stuff I heard, and why I have decided that, far from confirmation against Bellarke, it actually sounds to me like confirmation FOR bellarke. It’s about interpretation, confirmation bias, point of view, rumors, fears, and ego.

As far as I can tell, someone who is an insider, who is in the know about the writers room said something along the lines of, 

“The writer’s room used to argue all the time about whether or not to write romantic bellarke, and now they don’t argue about it anymore.”

The person to whom this was told interpreted that to mean that it was CONFIRMED that Bellarke was dead and JR was NOT GOING TO DO BELLARKE AT ALL. RIP. 

Even if the source who said this is a good, honest source, that’s not what was said. At all. That was an INTERPRETATION of the statement, which seems to be strongly influenced by prior assumptions. The statement is saying they decided. That means it could go EITHER one way or the other. EITHER they’re giving up on Bellarke OR they’re committing to it so no arguments needed.

And I don’t understand that interpretation. Because it means that this source of gossip believes that season 5 had absolutely no romance in it. That there was nothing romantic about bellarke to argue about NOT doing.

But in season 5 we had 2199 calls to Bellamy, She must be important to you/She is. Sexy hug. The hostage taker and his girlfriend. Clarke jealous of B/E kissing. TWICE. Another traitor who you love. I always cared about bellamy. Love is not a weakness. Don’t make the same mistake I made when I betrayed you.  Go save him. Do you know how much she cares about you? She called you every day. Bellamy inviting her to the bridge and then giving her the romantic “look back” before he leaves. Waking up ONLY Bellarke. Marper charging them with care of their child (that’s not romance that’s MARRIAGE) and facing the new world in each other’s arms, TOGETHER. 

I mean, maybe one of those things could be taken out of context and read as romantic when it’s not intended to be, but all of them, one after another? on and on? No. That’s evidence that supports a romantic storyline.

If they CHOSE to not do romantic Bellarke, then there would be NO explicitly romantic moments, Clarke would NOT be compared to Echo in Bellamy’s feelings. They would NOT have used the daily letter trope. The camera would not have closed in on his hand by so much skin and his lips brushing her shoulder. Clarke would NOT have been jealous– a shot that CLOSELY echoed when she saw finn and raven kissing, an explicitly romantic/jealous parallel to a canon love triangle.

 And if they had changed their minds about romantic bellarke, they would have wrapped up the 2199 calls as NOT romantic at that fireside. They would have had Bellamy tell Clarke he poisoned Octavia to save Clarke’s life, and it was no big deal. They would have had Clarke tell Echo that Bellamy was her best friend, like a brother to her. But instead, they leave all these things unsaid, unspoken, still to be discovered. There are ACTIVELY open romantic Bellarke plots, especially because Bellamy HAS to either choose Echo and NOT Clarke, or he has to break up with Echo and see what can happen with Clarke, because he loves them both, as stated by Octavia. Or he could keep them both like Finn did. WHICH takes us back to romantic storyline anyway. Not endgame, but romance definitely. Which, EVEN if they have decided to go with endgame B/E STILL makes Bellarke part of a romance. Bellarke was a canon romance in season 5. Love triangle. C/B/E.

The writers CHOSE to put that stuff in there. They CHOSE to announce Bellamy’s love for Clarke as a tipping point for a major MAJOR plot and character moment. If they were clear about NOT putting romance in, they wouldn’t have done that. They would certainly not leave the storylines OPEN and in need of resolution. LIke with Supergirl, where Kara and James kissed and then did a 180 and were like, “nah let’s just be friends, HEy do you think that bland white creep is cute?” They tanked karolsen for a new ship. THIS is not happening on The 100. They did not tank Bellarke. They brought it in tighter and made it more immediate and brought other people into the the story and are forcing the need to CONFRONT the feelings they have for each other, because Bellamy is not going to be able to pretend he doesn’t feel that, when his girlfriend is there, and he SHOULDN’T be feeling it at all.

 If they were in the middle and TEASING bellarke and not intending to make it GO romantic, or delaying it and intending to make it go there, they would still be arguing about it being too much or not enough or whatever. 

However, if they put all that in there WITHOUT arguing, that means the plan, for everyone, is to do romantic Bellarke. It means they’ve already started. 

They know how to do platonic. Raven and Bellamy are platonic. When THEY stood at that window looking into the future of a planet, they DID NOT TOUCH. Platonic. When Bellamy refused to leave Raven behind, it was the memory of CLARKE that made it painful, and Raven jollied him out of it by calling him names and lying to him. NOT romantic. If they had decided to NOT do Bellarke and NOT tease romance or foreshadow it, they know how not to make it romance. Which includes NOT comparing your love for her to your canon girlfriend. 

NOW TWO people have declared the source to be a good source. And this has been the problem with this rumor, because this person has a lot of authority within fandom, has been involved with production, has a broad audience and does indeed talk to people. SO she is seen as an authority that cannot be questioned.

There is no authority that cannot be questioned about their opinion. 

And I have had significant interaction with this person that calls into question her interpretations, her judgment, and her authority. I once called her a hypocrite because she said I could not possibly know authorial intent, because SHE knew authorial intent and I was wrong. Which, as a teacher, just pisses me the hell off, because she’s basically saying that only certain people are able to understand story, people with authority like hers. She was gatekeeping my interpretation. And, like, my JOB was to teach kids how to think for themselves and come up with interpretations. And that’s what I try to do here. Come up with my interpretations, show you how i got there, encourage you to come up with your own and back them up. I mean if you agree with me, great, but it’s fiction. We all get to interpret things. The better our analysis, the better we can defend it. To just flat out say that she was the authority and SHE knows and can tell everyone what to think? No.

So I guess that’s why I’m going all in on this. I wrote this this morning when I was ranting, but not sure I’d post the vague blog because I try not to be negative. But then I got the second ask so it’s all coming around again, and I already avoided speaking out about it the first time. And that didn’t make it go away. She’s still acting as an authority who knows everything and all she has to do is say it is confirmed, and other people take it as truth because she said it. It’s not like it will cause a rift in fandom. The fandom is in pieces anyway, and anyone who believes her thinks I’m delusional and an embarrassment, according to the anons I get, But I’m going to put this under the cut in the hopes that most people are too lazy to click more. But whatev, she’s not my friend, she doesn’t respect me I don’t respect her. And this whole gossip horror was the nail in my fandom coffin when it first came up a few months ago. I’m not naming names but if you know what’s happening or what happened the first time, you know the story. 

I hope this is too long and y’all won’t read it. This is why I have been sitting on this post all day, but I keep getting asks and I’m getting so angry.

I know who said that, and i never trust her interpretations, because she spent season 3 telling us all, definitively, that Lxa was the hero now, CLarke was the Love Interest, and CL was endgame because it was *pretty,* and we had no right to think CL was dark. First of all, pretty does not equal good, and hasn’t been assumed so for like idk a hundred years? But worse, that I had NO RIGHT, to look at it any other way but a beautiful love story. (incidentally silencing abuse victims.) That we COULD NOT understand authorial intent, did not have the ability to do so, but she did, and we were wrong. And not allowed to say anything else.

 When she doesn’t understand something in the show, she doesn’t bother trying to understand the story that JR is telling, she just says that he’s a bad writer. When she DOES understand something in the story, she says the writers are so bad that they didn’t do it on purpose, and it’s only because she’s so smart and clever that she figured out their underlying psychological misogyny that they didn’t know they were writing into the story. That’s the Finn as “Nice Guy” storyline. 

When the writers actually TELL her that they LITERALLY meant what she saw and they are surprised the fandom missed it, she again goes back to blaming the writers for not being clear enough. When she was TOLD that the CL story in polis was a dark story of Clarke’s psychology and she MISSED it, she AGAIN blamed the writers for not being clear and then. And THEN. Get this. Blamed the fandom for never looking critically at the CL story in POLIS, For only seeing it as pretty, unless they were screaming ABUSE.  Remember when I told you she told me I didn’t have a right to my interpretation and she was silencing abuse victims? So. Yeah. She’s referring to me, and those of us who were talking about that seriously, as abuse survivors or psychology students.

Anonymous said:She’s not the only one that claimed Bellarke is never happening. [XX] had some insider too as i remember and tweeted something along those lines of the moderator from Reddit publicly. {XX] is reliable enough and she said something like they aren’t planning canon but I don’t wanna put pressure on her I only saw her tweet she is not a part of fandom drama she’s a part of presskru.

Yeah. I’m not saying her name. That’s her. I’ve spent all morning trying to write my thoughts on this, and on what I’ve seen her do in this fandom for three years. And I found that reddit thread and I’m pretty sure that the mod’s “reliable source” is that woman who is NOT a reliable source. She’s a biased source who does not check her theories against the canon because she’s more interested in hearing herself talk and being right than in actually understanding the story. 

Being part of presskru does not mean she is right. The press writing about this show has OFTEN been wrong. DO you remember season 3 at ALL? Some of those people were still writing reviews in season 5 where Clarke and Bellamy did not exist almost. They were trying to rewrite the show as Octavia-Raven-Diyoza centered. She was part of the completely inaccurate interpretations of season 3. Just because someone tells you they are an authority that does not mean you should take what they say without questioning them. QUESTION EVERYTHING. 

She is not reliable. She has had consistently bad speculation and has interpreted this show ABSOLUTELY incorrectly MANY times. And when she’s wrong, she says the problem is with the story and the writers, not her meta. She refuses to question her own interpretations or even, really, to check it to the canon show. She believes Bellarke is dead so when someone said something, she IMMEDIATELY decided she had to tell EVERYONE that Bellarke was confirmed dead. This whole rumor comes from her.  From her unreliable interpretations and confirmation bias.

Please, don’t take my word for it. Go back over her meta and her speculation. See what she says when the writers tell her to her face that she was wrong, and how she is friends with them until she is facing fandom and then she calls them all bad writers and the show a bad show and the story making no sense. When really, she the show just WENT OVER HER HEAD AND SHE MISSED IT. Every time she calls a writer a bad writer, you can just assume that she did some lazy analysis, jumped to conclusions, and when the story didn’t do what she thought it should, decided the fault was with the writers, the story, the characters, or, well hell, why not just blame me. I did after all say CL was abusive. And that’s why she didn’t bother looking into the symbolism of Clarke’s character development in polis. 

Someone told her something, when she knows the whole cast and crew are on lockdown, and she ran to twitter and started telling everyone that she had insider information and she knew the truth. That is not reliable. That is HIGHLY suspect and arrogant and lacks any sort of honor. She needed to be the one who had insider knowledge, so she decided to hurt a whole fandom. She HURT people, because she HAD be the one to know the truth. She was NOT concerned with anyone else and did NOT allow them to be happy shipping their ship. 

As far as I can tell, her interpretation of what someone told her is par for the course for her, had nothing to do with the canon, and everything to do with fandom drama, ego, confirmation bias, and the desire to be the authority and have everyone think she’s the shit.

I do not think she’s the shit. Sorry. I think she is an irresponsible writer claiming authority and using it to control those around her. Worse, she’s a teacher. And as a writer and a teacher, that makes me ANGRY. She can’t bully me into following her, or convince me that she’s smarter than me and make me hang on her every word, and so she blocked me a long time ago. But I’ve tried to help people understand the story and come up with their own interpretations and she’s actively gone out of her way to claim her authority to kill a whole ship and fandom. Am I biased? YOU BET. But that bias means I pay very close attention to what she says. And what she says, is suspect.

Please don’t send me any more asks about gossip, rumors or drama. And definitely don’t send me any asks about her. 

I would prefer to talk about CANON, literature, film, science fiction, character development, symbolism, storytelling, and Bellarke.

[lakhwanabhishek]

5 Ways to Raise and Enhance Your eCommerce

5 Ways to Raise and Enhance Your eCommerce Website’s Customer Feedback Customer reviews affect how customers interpret you and your goods, how much they trust you, and whether or not you will be their favorite eCommerce store. On the other hand, losing feedback will send potential shoppers to other websites quickly and bust your marketing budget. So, you need to create feedback for your eCommerce site if you want to sell more. We’ve compiled a list of five basic considerations to help you get started and improve the effectiveness of your reviews.

5 Ways to Increase The Trustworthiness of Your eCommerce Website Make it easy for the goods to be checked Let’s begin with a mental change. Since they support your company, you want it to be as simple as possible for people to leave feedback. When reviews are positive and recent, studies show that they make your company look more trustworthy and inspire customers to buy from you. If your goods have five reviews on the page, compared to a product with zero reviews, there is a 270 percent greater likelihood that anyone will purchase them.

When you inquire, customers can leave feedback, however a complicated mechanism will stop them. It isn’t worth their time if the specifications and demands are unreasonable.

It’s the same if you place the onus on the customer to show they’re a legitimate buyer. Adding to their work (particularly when you could do this for the client instead) makes them less likely to complete a review process.

So, in your operations, eCommerce firms can look at policies and procedures that will help you find real customers to leave feedback.

This means ensuring that you obtain sales details and email addresses, enabling you to reach out to individuals about the particular items they have purchased. Instead of asking people to fill out multi-question surveys, simplify rankings or reporting criteria.

The mindset for approaching reviews, especially when you want to increase their number and enhance their quality, is to ask: What challenges do my clients have and how can I eliminate them in a way that makes it easier and more pleasant to leave a review?

2. Search for platform-specific tools

Look at your existing eCommerce website and email marketing services now that you are thinking about the benefits of feedback and have a desire to simplify them. To make the whole process simpler, get a list of the platforms and software you use. That list is where you can begin your quest for plugins and other resources for “analysis” and “rating.”

Starting with pre-made products that have an established track record of easy integration will speed up the process of adding features. You may find instruments that introduce feedback in ways that instinctively fit into the journey of a consumer in certain instances.

Customers who use email marketing platforms will be able to click a star rating and be taken to a landing page with options for more details, with the star they clicked already highlighted.

To make it easier to integrate all and have reviews populate your sales, product, and other sites, use “review” tools based on your eCommerce site. If you’re a one-person shop or don’t know where to start, most platforms, such as Shopify, have built-in product review apps. That’s not to say they’re always the best choice for everyone, but to get started, they seem to be quick.

Check your other tools and collaborators when you’re thinking about integration. For example, for companies that outsource eCommerce fulfillment, ensure that partners add shipping confirmation to order management software automatically. These measures will assist you in delivering the best possible customer service to your clients.

Customer Service In the Social Media Age. What is This Presentation About?  The impacts of social media and internet review sites on business today  The. - ppt download 3. Encourage people to write reviews.

If the past year has taught us something, it’s that there are many things that we promise ourselves we’ll complete “when we have the time,” but never do when we have none. That means for some of your audience, including those who enjoy your goods, the time to write a review will never arrive.

Encourage them by rewarding all feedback, not just the ones that are overly optimistic. One fast way to get more people to comment and post is to offer rewards. So that readers believe them, you want truthful feedback. It can erode whatever confidence you’ve built with your audience if it appears that you paid for fake reviews.

Split your contact lists if you’re worried about a flood of them from the same date. Request that some people post on your website, while others rate you on Google or Facebook. To get individuals to express their opinions, suggest running a user-generated content (UGC) campaign on a social platform. To avoid being flagged by an eCommerce website, spread elements out to reach a wider audience.

Inviting people to study, comment, share, and build is a good idea. It will show what they like and dislike about your products, as well as how they use them and where you may need to add something different. Plus, if the reward is a discount, it allows them to buy right after they’ve spent time thinking positively.

4. Showcase reviews from a range of sites across several pages.

Increasing the effectiveness of the feedback and comments you can produce is a part of improving reviews. Throughout your website and general sales process, you may want to completely exploit these products and use them as selling points. You get a wide range of content to use by incentivizing ratings across different channels.

Remember the buyer’s journey. They can go to a product or category page by clicking on an ad. These are stellar choices for favorable feedback of the particular product and you’ll want to support consumers as many of these pages as possible.

They add them to a sales cart from there and go to a page to check the cart and begin providing information. This is where your shipping choices are most likely to be found.

Why not add summary snapshots that talk about how fast and successful your shipping was? Show them how happy customers are by making goods and items arrive early. If your UGC campaign has contributed to content unboxing, embed a video to enable individuals to pay for faster shipping or add more to their order to meet a threshold for fast/free shipping.

Showcase feedback for your business in general and make your own post or video thanking customers for their kind words after checkout, when you take your audience to a confirmation page. Turn this page into a celebration of your ability to make customers happy.

You can use feedback again when you submit an email update with order or shipping information. Offer people the best way to contact your customer service, and include a rundown of how happy they were when you solved their problem.

It’s all about inspiring individuals to think about the goods, operation, and organization positively. You may also get a few customers who want to write their own reviews so that their names and words appear on your next email or confirmation page.

5. Respond publicly and privately to complaints

Admitting challenges and trying to fix them is a central tenet of enhancing customer reviews. You won’t be able to make everyone happy, but you should make amends. So, get your team to track your site and other locations proactively for adverse feedback and complaints. They need to be discussed publicly and in private networks of support when you encounter them.

Publicly answering components gives other readers a way of knowing that you take concerns seriously. This eliminates problems from only having negative feedback without rebuttal, which would make guests believe certain negative things. A public answer should recognize the issue, outline a general approach, and then notify the reviewer.

It’s easy to want these reactions to be formulaic. However, when anyone may see several reports about different problems, they become less legitimate, while all company answers are the same. You may allow responses to follow a pattern, but they shouldn’t all contain the same text.

Take this seriously when you turn someone to a private channel to solve their dilemma. If at all necessary, work tirelessly to solve the problem. Ask the client to amend their analysis with that information if you are able to answer it adequately. You don’t want to convince people to alter the whole analysis, but you might ask them to add to it so that others know you found a solution.

If the customer does not respond, you may want to consider updating your review instead. Keep it plain, such as saying: We’re glad we’ve been able to fix that. Please don’t hesitate to reach out if you have any more questions. Oh, thank you!

One of the most powerful ways to transform negative problems into positive ones for potential readers is to empathize with the client, solve the problem, and then circle around.

Must-Have Tool For Your Root Cause Analysis — 5 Whys (Examples Plus Free  Template) | by SlideUpLift | Medium Often return to the “why”

There’s a key explanation why you’ve come across this article and are curious about your reviews in eCommerce. You may need something to help persuade shoppers, or you’re just getting started, or you want to bury some negative or outdated feedback. Reviews can help in many ways, and one change or another is better for some of the strategies mentioned.

You need to ask smart questions about why you are trying to increase and boost ratings to get started with the right strategies and tools. See if the ideas that you consider are important to the audience that you want to target. Ask if you’re discussing the problems they’re having or if you’re giving them something that makes writing a review more appealing.

It would be easier for you to get the kinds of feedback you want and that your customers find useful if you focus on the “why” behind reviews. Throughout the process, you’ll be thinking about what’s most critical and significant, simplifying it and accelerating the gains you see.

Source:

whizzystack.co

#b2b ecommerce

#digital marketing

#social marketing

#ecommerce

[whizzystacksolutions]

5 Ways to Raise and Enhance Your eCommerce

5 Ways to Raise and Enhance Your eCommerce Website’s Customer Feedback Customer reviews affect how customers interpret you and your goods, how much they trust you, and whether or not you will be their favorite eCommerce store. On the other hand, losing feedback will send potential shoppers to other websites quickly and bust your marketing budget. So, you need to create feedback for your eCommerce site if you want to sell more. We’ve compiled a list of five basic considerations to help you get started and improve the effectiveness of your reviews.

5 Ways to Increase The Trustworthiness of Your eCommerce Website Make it easy for the goods to be checked Let’s begin with a mental change. Since they support your company, you want it to be as simple as possible for people to leave feedback. When reviews are positive and recent, studies show that they make your company look more trustworthy and inspire customers to buy from you. If your goods have five reviews on the page, compared to a product with zero reviews, there is a 270 percent greater likelihood that anyone will purchase them.

When you inquire, customers can leave feedback, however a complicated mechanism will stop them. It isn’t worth their time if the specifications and demands are unreasonable.

It’s the same if you place the onus on the customer to show they’re a legitimate buyer. Adding to their work (particularly when you could do this for the client instead) makes them less likely to complete a review process.

So, in your operations, eCommerce firms can look at policies and procedures that will help you find real customers to leave feedback.

This means ensuring that you obtain sales details and email addresses, enabling you to reach out to individuals about the particular items they have purchased. Instead of asking people to fill out multi-question surveys, simplify rankings or reporting criteria.

The mindset for approaching reviews, especially when you want to increase their number and enhance their quality, is to ask: What challenges do my clients have and how can I eliminate them in a way that makes it easier and more pleasant to leave a review?

2. Search for platform-specific tools

Look at your existing eCommerce website and email marketing services now that you are thinking about the benefits of feedback and have a desire to simplify them. To make the whole process simpler, get a list of the platforms and software you use. That list is where you can begin your quest for plugins and other resources for “analysis” and “rating.”

Starting with pre-made products that have an established track record of easy integration will speed up the process of adding features. You may find instruments that introduce feedback in ways that instinctively fit into the journey of a consumer in certain instances.

Customers who use email marketing platforms will be able to click a star rating and be taken to a landing page with options for more details, with the star they clicked already highlighted.

To make it easier to integrate all and have reviews populate your sales, product, and other sites, use “review” tools based on your eCommerce site. If you’re a one-person shop or don’t know where to start, most platforms, such as Shopify, have built-in product review apps. That’s not to say they’re always the best choice for everyone, but to get started, they seem to be quick.

Check your other tools and collaborators when you’re thinking about integration. For example, for companies that outsource eCommerce fulfillment, ensure that partners add shipping confirmation to order management software automatically. These measures will assist you in delivering the best possible customer service to your clients.

Customer Service In the Social Media Age. What is This Presentation About?  The impacts of social media and internet review sites on business today  The. - ppt download 3. Encourage people to write reviews.

If the past year has taught us something, it’s that there are many things that we promise ourselves we’ll complete “when we have the time,” but never do when we have none. That means for some of your audience, including those who enjoy your goods, the time to write a review will never arrive.

Encourage them by rewarding all feedback, not just the ones that are overly optimistic. One fast way to get more people to comment and post is to offer rewards. So that readers believe them, you want truthful feedback. It can erode whatever confidence you’ve built with your audience if it appears that you paid for fake reviews.

Split your contact lists if you’re worried about a flood of them from the same date. Request that some people post on your website, while others rate you on Google or Facebook. To get individuals to express their opinions, suggest running a user-generated content (UGC) campaign on a social platform. To avoid being flagged by an eCommerce website, spread elements out to reach a wider audience.

Inviting people to study, comment, share, and build is a good idea. It will show what they like and dislike about your products, as well as how they use them and where you may need to add something different. Plus, if the reward is a discount, it allows them to buy right after they’ve spent time thinking positively.

4. Showcase reviews from a range of sites across several pages.

Increasing the effectiveness of the feedback and comments you can produce is a part of improving reviews. Throughout your website and general sales process, you may want to completely exploit these products and use them as selling points. You get a wide range of content to use by incentivizing ratings across different channels.

Remember the buyer’s journey. They can go to a product or category page by clicking on an ad. These are stellar choices for favorable feedback of the particular product and you’ll want to support consumers as many of these pages as possible.

They add them to a sales cart from there and go to a page to check the cart and begin providing information. This is where your shipping choices are most likely to be found.

Why not add summary snapshots that talk about how fast and successful your shipping was? Show them how happy customers are by making goods and items arrive early. If your UGC campaign has contributed to content unboxing, embed a video to enable individuals to pay for faster shipping or add more to their order to meet a threshold for fast/free shipping.

Showcase feedback for your business in general and make your own post or video thanking customers for their kind words after checkout, when you take your audience to a confirmation page. Turn this page into a celebration of your ability to make customers happy.

You can use feedback again when you submit an email update with order or shipping information. Offer people the best way to contact your customer service, and include a rundown of how happy they were when you solved their problem.

It’s all about inspiring individuals to think about the goods, operation, and organization positively. You may also get a few customers who want to write their own reviews so that their names and words appear on your next email or confirmation page.

5. Respond publicly and privately to complaints

Admitting challenges and trying to fix them is a central tenet of enhancing customer reviews. You won’t be able to make everyone happy, but you should make amends. So, get your team to track your site and other locations proactively for adverse feedback and complaints. They need to be discussed publicly and in private networks of support when you encounter them.

Publicly answering components gives other readers a way of knowing that you take concerns seriously. This eliminates problems from only having negative feedback without rebuttal, which would make guests believe certain negative things. A public answer should recognize the issue, outline a general approach, and then notify the reviewer.

It’s easy to want these reactions to be formulaic. However, when anyone may see several reports about different problems, they become less legitimate, while all company answers are the same. You may allow responses to follow a pattern, but they shouldn’t all contain the same text.

Take this seriously when you turn someone to a private channel to solve their dilemma. If at all necessary, work tirelessly to solve the problem. Ask the client to amend their analysis with that information if you are able to answer it adequately. You don’t want to convince people to alter the whole analysis, but you might ask them to add to it so that others know you found a solution.

If the customer does not respond, you may want to consider updating your review instead. Keep it plain, such as saying: We’re glad we’ve been able to fix that. Please don’t hesitate to reach out if you have any more questions. Oh, thank you!

One of the most powerful ways to transform negative problems into positive ones for potential readers is to empathize with the client, solve the problem, and then circle around.

Must-Have Tool For Your Root Cause Analysis — 5 Whys (Examples Plus Free  Template) | by SlideUpLift | Medium Often return to the “why”

There’s a key explanation why you’ve come across this article and are curious about your reviews in eCommerce. You may need something to help persuade shoppers, or you’re just getting started, or you want to bury some negative or outdated feedback. Reviews can help in many ways, and one change or another is better for some of the strategies mentioned.

You need to ask smart questions about why you are trying to increase and boost ratings to get started with the right strategies and tools. See if the ideas that you consider are important to the audience that you want to target. Ask if you’re discussing the problems they’re having or if you’re giving them something that makes writing a review more appealing.

It would be easier for you to get the kinds of feedback you want and that your customers find useful if you focus on the “why” behind reviews. Throughout the process, you’ll be thinking about what’s most critical and significant, simplifying it and accelerating the gains you see.

[technicallyelegantruins]

5 Ways to Raise and Enhance Your eCommerce Website’s

5 Ways to Raise and Enhance Your eCommerce Website’s Customer Feedback Customer reviews affect how customers interpret you and your goods, how much they trust you, and whether or not you will be their favorite eCommerce store. On the other hand, losing feedback will send potential shoppers to other websites quickly and bust your marketing budget. So, you need to create feedback for your eCommerce site if you want to sell more. We’ve compiled a list of five basic considerations to help you get started and improve the effectiveness of your reviews.

5 Ways to Increase The Trustworthiness of Your eCommerce Website Make it easy for the goods to be checked Let’s begin with a mental change. Since they support your company, you want it to be as simple as possible for people to leave feedback. When reviews are positive and recent, studies show that they make your company look more trustworthy and inspire customers to buy from you. If your goods have five reviews on the page, compared to a product with zero reviews, there is a 270 percent greater likelihood that anyone will purchase them.

When you inquire, customers can leave feedback, however a complicated mechanism will stop them. It isn’t worth their time if the specifications and demands are unreasonable.

It’s the same if you place the onus on the customer to show they’re a legitimate buyer. Adding to their work (particularly when you could do this for the client instead) makes them less likely to complete a review process.

So, in your operations, eCommerce firms can look at policies and procedures that will help you find real customers to leave feedback.

This means ensuring that you obtain sales details and email addresses, enabling you to reach out to individuals about the particular items they have purchased. Instead of asking people to fill out multi-question surveys, simplify rankings or reporting criteria.

The mindset for approaching reviews, especially when you want to increase their number and enhance their quality, is to ask: What challenges do my clients have and how can I eliminate them in a way that makes it easier and more pleasant to leave a review?

2. Search for platform-specific tools

Look at your existing eCommerce website and email marketing services now that you are thinking about the benefits of feedback and have a desire to simplify them. To make the whole process simpler, get a list of the platforms and software you use. That list is where you can begin your quest for plugins and other resources for “analysis” and “rating.”

Starting with pre-made products that have an established track record of easy integration will speed up the process of adding features. You may find instruments that introduce feedback in ways that instinctively fit into the journey of a consumer in certain instances.

Customers who use email marketing platforms will be able to click a star rating and be taken to a landing page with options for more details, with the star they clicked already highlighted.

To make it easier to integrate all and have reviews populate your sales, product, and other sites, use “review” tools based on your eCommerce site. If you’re a one-person shop or don’t know where to start, most platforms, such as Shopify, have built-in product review apps. That’s not to say they’re always the best choice for everyone, but to get started, they seem to be quick.

Check your other tools and collaborators when you’re thinking about integration. For example, for companies that outsource eCommerce fulfillment, ensure that partners add shipping confirmation to order management software automatically. These measures will assist you in delivering the best possible customer service to your clients.

Customer Service In the Social Media Age. What is This Presentation About?  The impacts of social media and internet review sites on business today  The. - ppt download 3. Encourage people to write reviews.

If the past year has taught us something, it’s that there are many things that we promise ourselves we’ll complete “when we have the time,” but never do when we have none. That means for some of your audience, including those who enjoy your goods, the time to write a review will never arrive.

Encourage them by rewarding all feedback, not just the ones that are overly optimistic. One fast way to get more people to comment and post is to offer rewards. So that readers believe them, you want truthful feedback. It can erode whatever confidence you’ve built with your audience if it appears that you paid for fake reviews.

Split your contact lists if you’re worried about a flood of them from the same date. Request that some people post on your website, while others rate you on Google or Facebook. To get individuals to express their opinions, suggest running a user-generated content (UGC) campaign on a social platform. To avoid being flagged by an eCommerce website, spread elements out to reach a wider audience.

Inviting people to study, comment, share, and build is a good idea. It will show what they like and dislike about your products, as well as how they use them and where you may need to add something different. Plus, if the reward is a discount, it allows them to buy right after they’ve spent time thinking positively.

4. Showcase reviews from a range of sites across several pages.

Increasing the effectiveness of the feedback and comments you can produce is a part of improving reviews. Throughout your website and general sales process, you may want to completely exploit these products and use them as selling points. You get a wide range of content to use by incentivizing ratings across different channels.

Remember the buyer’s journey. They can go to a product or category page by clicking on an ad. These are stellar choices for favorable feedback of the particular product and you’ll want to support consumers as many of these pages as possible.

They add them to a sales cart from there and go to a page to check the cart and begin providing information. This is where your shipping choices are most likely to be found.

Why not add summary snapshots that talk about how fast and successful your shipping was? Show them how happy customers are by making goods and items arrive early. If your UGC campaign has contributed to content unboxing, embed a video to enable individuals to pay for faster shipping or add more to their order to meet a threshold for fast/free shipping.

Showcase feedback for your business in general and make your own post or video thanking customers for their kind words after checkout, when you take your audience to a confirmation page. Turn this page into a celebration of your ability to make customers happy.

You can use feedback again when you submit an email update with order or shipping information. Offer people the best way to contact your customer service, and include a rundown of how happy they were when you solved their problem.

It’s all about inspiring individuals to think about the goods, operation, and organization positively. You may also get a few customers who want to write their own reviews so that their names and words appear on your next email or confirmation page.

5. Respond publicly and privately to complaints

Admitting challenges and trying to fix them is a central tenet of enhancing customer reviews. You won’t be able to make everyone happy, but you should make amends. So, get your team to track your site and other locations proactively for adverse feedback and complaints. They need to be discussed publicly and in private networks of support when you encounter them.

Publicly answering components gives other readers a way of knowing that you take concerns seriously. This eliminates problems from only having negative feedback without rebuttal, which would make guests believe certain negative things. A public answer should recognize the issue, outline a general approach, and then notify the reviewer.

It’s easy to want these reactions to be formulaic. However, when anyone may see several reports about different problems, they become less legitimate, while all company answers are the same. You may allow responses to follow a pattern, but they shouldn’t all contain the same text.

Take this seriously when you turn someone to a private channel to solve their dilemma. If at all necessary, work tirelessly to solve the problem. Ask the client to amend their analysis with that information if you are able to answer it adequately. You don’t want to convince people to alter the whole analysis, but you might ask them to add to it so that others know you found a solution.

If the customer does not respond, you may want to consider updating your review instead. Keep it plain, such as saying: We’re glad we’ve been able to fix that. Please don’t hesitate to reach out if you have any more questions. Oh, thank you!

One of the most powerful ways to transform negative problems into positive ones for potential readers is to empathize with the client, solve the problem, and then circle around.

Must-Have Tool For Your Root Cause Analysis — 5 Whys (Examples Plus Free  Template) | by SlideUpLift | Medium Often return to the “why”

There’s a key explanation why you’ve come across this article and are curious about your reviews in eCommerce. You may need something to help persuade shoppers, or you’re just getting started, or you want to bury some negative or outdated feedback. Reviews can help in many ways, and one change or another is better for some of the strategies mentioned.

You need to ask smart questions about why you are trying to increase and boost ratings to get started with the right strategies and tools. See if the ideas that you consider are important to the audience that you want to target. Ask if you’re discussing the problems they’re having or if you’re giving them something that makes writing a review more appealing.

It would be easier for you to get the kinds of feedback you want and that your customers find useful if you focus on the “why” behind reviews. Throughout the process, you’ll be thinking about what’s most critical and significant, simplifying it and accelerating the gains you see.

[lauramalchowblog]

Artificial Intelligence vs. Tuberculosis, Part 1

By SAURABH JHA, MD

Slumdog TB

No one knows who gave Rahul Roy tuberculosis. Roy’s charmed life as a successful trader involved traveling in his Mercedes C class between his apartment on the plush Nepean Sea Road in South Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather. He seldom rolled down his car windows – his ambient atmosphere, optimized for his comfort, rarely changed.

Historically TB, or “consumption” as it was known, was a Bohemian malady; the chronic suffering produced a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in part, because consumption, like aristocracy, was thought to be hereditary. Even after Robert Koch discovered that the cause of TB was a rod-shaped bacterium – Mycobacterium Tuberculosis (MTB), TB had a special status denied to its immoral peer, Syphilis, and unaesthetic cousin, leprosy.

TB became egalitarian in the early twentieth century but retained an aristocratic noblesse oblige. George Orwell may have contracted TB when he voluntarily lived with miners in crowded squalor to understand poverty. Unlike Orwell, Roy had no pretentions of solidarity with poor people. For Roy, there was nothing heroic about getting TB. He was embarrassed not because of TB’s infectivity; TB sanitariums are a thing of the past. TB signaled social class decline. He believed rickshawallahs, not traders, got TB.

“In India, many believe TB affects only poor people, which is a dangerous misconception,” said Rhea Lobo – film maker and TB survivor.

Tuberculosis is the new leprosy. The stigma has consequences, not least that it’s difficult diagnosing a disease that you don’t want diagnosed. TB, particularly extra-pulmonary TB, mimics many diseases.

“TB can cause anything except pregnancy,” quips Dr. Justy – a veteran chest physician. “If doctors don’t routinely think about TB they’ll routinely miss TB.”

In Lobo, the myocobacteria domiciled in the bones of her feet, giving her heel pain, which was variously ascribed to bone bruise, bone cancer, and staphylococcal infection. Only when a lost biopsy report resurfaced, and after receiving the wrong antibiotics, was TB diagnosed, by which time the settlers had moved to her neck, creating multiple pockets of pus. After multiple surgeries and a protracted course of antibiotics, she was free of TB.

“If I revealed I had TB no one would marry me, I was advised” laughed Lobo. “So, I made a documentary on TB and started ‘Bolo Didi’ (speak sister), a support group for women with TB. Also, I got married!”

Mycobacterium tuberculosis is an astute colonialist which lets the body retain control of its affairs. The mycobacteria arrive in droplets, legitimately, through the airways and settle in the breezy climate of the upper lobes and superior segment of the lower lobes of the lungs. If they sense weakness they attack, and if successful, cause primary TB. Occasionally they so overpower the body that an avalanche of small, discrete snowballs, called miliary TB, spread. More often, they live silently in calcified lymph nodes as latent TB. When apt, they reappear, causing secondary TB. The clues to their presence are calcified mediastinal nodes or a skin rash after injection of mycobacterial protein.

MTB divides every 20 hours. In the bacterial world that’s Monk-like libido. E. Coli, in comparison, divides every 20 minutes. Their sexual ennui makes them frustratingly difficult to culture. Their tempered fecundity also means they don’t overwhelm their host with their presence, permitting them to write fiction and live long enough to allow the myocobacteria to jump ship.

TB has been around for a while. The World Health Organization (WHO) wants TB eradicated but the myocobacteria have no immediate plans for retirement. Deaths from TB are declining at a tortoise pace of 2 % a year. TB affects 10 million and kills 1.6 million every year – it is still the number one infectious cause of death.

The oldest disease’s nonchalance to the medical juggernaut is not for the lack of a juggernaut effort. Mass screening for TB using chest radiographs started before World War 2, and still happens in Japan. The search became fatigued by the low detection of TB. The challenge wasn’t just in looking for needles in haystacks, but getting to the haystacks which, in developing countries, are dispersed like needles.

The battleground for TB eradication is India, which has the highest burden of TB – a testament not just to its large population. Because TB avoids epidemics, it never scares the crap out of people. Its distribution and spread match society’s wealth distribution and aspirations. And in that regard India is most propitious for its durability.

Few miles north of Nepean Sea Road is Dharavi – Asia’s largest slum, made famous by the Oscar-winning film, Slumdog Millionaire. From atop, Dharavi looks like thousand squashed coke cans beside thousand crumpled cardboard boxes. On the ground, it’s a hot bed of economic activity. No one wants to stay in Dharavi forever, its people want to become Bollywood stars, or gangsters, or just very rich. Dharavi is a reservoir of hope.

Dharavi is a reservoir also of active TB. In slums, which are full of houses packed like sardines in which live people packed like sardines, where cholera spreads like wildfire and wildfire spreads like cholera, myocobacteria travel much further. Familiarity breeds TB. One person with active TB can infect nine – and none are any the wiser of the infection because unlike cholera, which is wildfire, TB is a slow burn and its symptoms are indistinguishable from the maladies of living in a slum.

Slum dwellers with active TB often continue working – there’s no safety net in India to cushion the illness – and often travel afar to work. They could be selling chai and samosas outside the Bombay Stock Exchange. With the habit of expectoration – in India, spitting on the streets isn’t considered bad manners – sputum is aplenty, and mycobacteria-laden droplets from Dharavi can easily reach Roy’s lungs. TB, the great leveler, bridges India’s wealth divide. Mycobacteria unite Nepean Sea Road with Dharavi.

Rat in Matrix Algebra

The major challenges in fighting tuberculosis are finding infected people and ensuring they take the treatment for the prescribed duration, often several months. Both obstacles can wear each other– if patients don’t take their treatment what’s the point finding TB? If TB can’t be found what good is the treatment?

The two twists in the battle against TB, drug resistant TB and concurrent TB and HIV, favor the mycobacteria. But TB detection is making a resurgence with the reemergence of the old warrior – the chest radiograph, which now has a new ally – artificial intelligence (AI). Artificial Intelligence is chest radiograph’s Sancho Panza.

Ten miles north of Dharavi in slick offices in Goregaon, Mumbai’s leafy suburb, data scientists training algorithms to read chest radiographs are puzzled by AI’s leap in performance.

“The algorithm we developed,” says Preetham Sreenivas incredulously, “has an AUC of 1 on the new set of radiographs!”

AUC, or area under the receiver operator characteristic curve, measures diagnostic accuracy. The two types of diagnostic errors are false negatives – mistaking abnormal for normal, and false positives – mistaking normal for abnormal. In general, fewer false negatives (FNs) means more false positives (FPs); trade-off of errors. A higher AUC implies fewer “false” errors, AUC of 1 is perfect accuracy; no false positives, no false negatives.

Chest radiograph are two-dimensional images on which three dimensional structures, such as lungs, are collapsed and which, like Houdini, hide stuff in plain sight. Pathology literally hides behind normal structures. It’s nearly impossible for radiologists to have an AUC of 1. Not even God knows what’s going on in certain parts of the lung, such as the posterior segment of the left lower lobe.

Here, AI seemed better than God at interpreting chest radiographs. But Sreenivas, who leads the chest radiograph team in Qure.ai – a start-up in Mumbai which solves healthcare problems using artificial intelligence, refused to open the champagne.

“Algorithms can’t jump from an AUC of 0.84 to 1. It should be the other way round – their performance should drop when they see data (radiographs) from a new hospital,” explains Sreenivas.

Algorithms mature in three stages. First, training –  data (x-rays), labelled with ground truth, are fed to a deep neural network (the brain), Labels, such as pleural effusion, pulmonary edema, pneumonia, or no abnormality, teach AI. After seeing enough cases AI is ready for the second step, validation – in which it is tested on different cases taken from the same source as the training set – like same hospital. If AI performs respectably, it is ready for the third stage – the test.

Training radiology residents is like training AI. First, residents see cases knowing the answer. Then they see cases on call from the institution they’re training at, without knowing the answer. Finally, released into the world, they see cases from different institutions and give an answer.

The test and training cases come from different sources. The algorithm invariably performs worse on test than training set because of “overfitting” – a phenomenon where the algorithm tries hard fitting to the local culture. It thinks the rest of the world is exactly like the place it trained, and can’t adapt to subtle differences in images because of different manufacturers, different acquisition parameters, or acquisition on different patient populations. To reduce overfitting, AI is regularly fed cases from new institutions.

When AI’s performance on radiographs from a new hospital mysteriously improved, Sreenivas smelt a rat.

“AI is matrix algebra. It’s not corrupt like humans – it doesn’t cheat. The problem must be the data,” Sreenivas pondered.

Birth of a company

“I wish I could say we founded this company to fight TB,” says Pooja Rao, co-founder of Qure.ai, apologetically. “But I’d be lying. The truth is that we saw in an international public health problem a business case for AI.”

Qure.ai was founded by Prashant Warier and Pooja Rao. After graduating from the Indian Institute of Technology (IIT), Warier, a natural born mathematician, did his PhD from Georgia Tech. He had no plans of returning to India, until he faced the immigration department’s bureaucratic incompetence. Someone had tried entering the US illegally on his wife’s stolen passport. The bureaucracy, unable to distinguish the robber from the robbed, denied her a work visa. Warier reluctantly left the US.

In India, Warier founded a company which used big data to find preferences of niche customers. His company was bought by Fractal, a data analytic giant – the purchase motivated largely by the desire to recruit Warier.

Warier wanted to develop an AI-enabled solution for healthcare. In India, data-driven decisions are common in retail but sparse in healthcare. In a move unusual in industry and uncommon even in academia, Fractal granted him freedom to tinker, with no strings attached. Qure.ai was incubated by Fractal.

Warier discovered Rao, a physician-scientist and bioinformatician, on LinkedIn and invited her to lead the research and development. Rao became a doctor to become a scientist because she believed that deep knowledge of medicine helps join the dots in the biomedical sciences. After her internship, she did a PhD at the Max Planck Institute in Germany. For her thesis, she applied deep learning to predict Alzheimer’s disease from RNA. Though frustrated by Alzheimer’s, which seemed uncannily difficult to predict, she fell in love with deep learning.

Rao and Warier were initially uncertain what their start-up should focus on. There were many applications of AI in healthcare, such as genomic analysis, analysis of electronic medical records, insurance claims data, Rao recalled two lessons from her PhD.

“Diseases such as Alzheimer’s are heterogeneous, so the ground truth, the simple question – is there Alzheimer’s – is messy. The most important thing I realized is that without the ground truth AI is useless.”

Rao echoed the sentiments of Lady Lovelace, the first computer programmer, from the nineteenth century. When Lovelace saw the analytical engine, the first ��algorithm”, invented by Charles Babbage, she said: “The analytical Engine has no pretensions whatever to originate anything. It can do whatever we know how to order it to perform. It can follow analysis; but it has no power of anticipating any analytical relations or truths.”

The second lesson Rao learnt was that the ground truth must be available immediately, not in the future – i.e. AI must be trained on diseases of the present, not outcomes, which are nebulous and take time to reveal. The immediacy of their answer, which must be now, right away, reduced their choices to two – radiology and pathology. Pathology had yet to be digitized en masse.

“The obvious choice for AI was radiology”, revealed Warier.

Why “Qure” with a Q, not “Cure” with a C, I asked. Was it a tribute to Arabic medicine?

“We’re not that erudite,” laughed Warier. “The internet domain for ‘cure’ had already been taken.”

Qure.ai was founded in 2016 during peak AI euphoria. In those days deep learning seemed magical to those who understood it, and to those who didn’t. Geoffrey Hinton, deep learning’s titan, famously predicted radiologists’ extinction – he advised that radiologists should stop being trained because AI would interpret the images just as well.

Bioethicist and architect of Obamacare, Ezekiel Emanuel, told radiologists that their profession faced an existential threat from AI. UK’s health secretary, Jeremy Hunt, drunk on the Silicon Valley cool aid, prophesized that algorithms will outperform general practitioners. Venture capitalist, Vinod Khosla predicted modestly that algorithms will replace 80 % of doctors.

Amidst the metastasizing hype, Warier and Rao remained circumspect. Both understood AI’s limitations. Rao was aware that radiologists hedged in their reports – which often made the ground truth a coin toss. They concluded that AI would be an incremental technology. AI would help radiologists become better radiologists.

“We were firing arrows in the dark. Radiology is vast. We didn’t know where to start,” recalls Rao.

Had Qure.ai been funded by venture capitalists, they’d have a deadline to have a product. But Fractal prescribed no fixed timeline. This gave the founders an opportunity to explore radiology. The exploration was instructive.

They spoke to several radiologists to better understand radiology, find the profession’s pain points, see what could be automated, and what might be better dealt by AI. The advice ranged from the flippant to the esoteric. One radiologist recommended using AI to quantify lung fibrosis in interstitial pulmonary fibrosis, another, knee cartilage for precision anti-rheumatoid therapy. Qure.ai has a stockpile of unused, highly niche, esoteric algorithms.

Every radiologist’s idea of augmentation was unique. Importantly, few of their ideas comprised mainstream practice. Augmentation seemed a way of expanding radiologist’s possibilities, rather than dealing with radiology’s exigencies – no radiologist, for instance, suggested that AI should look for TB on chest radiographs.

Augmentation doesn’t excite venture capitalists as much as replacement, transformation, or disruption. And augmentation didn’t excite Rao and Warier, either. When you have your skin in the commercial game, relevance is the only currency.

“Working for start-ups is different from being a scientist in an academic medical center. We do science, too. But before we take a project, we think about the return of investment. Just because an endeavor is academically challenging doesn’t mean that it’s commercially useful. If product don’t sell, start-ups have to close shop,” said Rao.

The small size of start-ups means they don’t have to run decisions through bulky corporate governance. It doesn’t take weeks convening meetings through Doodle polls. Like free climbers who aren’t encumbered by climbing equipment, they can reach their goal sooner. Because a small start-up is nimble it can fail fast, fail without faltering, fail a few time. But it can’t fail forever. Qure needed a product it could democratize. Then an epiphany.

In World War 2, after allied aircrafts sustained bullets in enemy fire, some returned to the airbase and others crashed. Engineers wanted the aircrafts reinforced at their weakest points to increase their chances of surviving enemy fire. A renowned statistician of the time, Abraham Wald, analyzed the distribution of the bullets and advised that reinforcements be placed where the plane hadn’t been shot. Wald realized that the planes which didn’t return were likely shot at the weakest points. On the planes which returned the bullets marked their strongest point.

Warier and Rao realized that they needed to think about scenarios where radiologists were absent, not where radiologists were abundant. They had asked the wrong people the wrong question. The imminent need wasn’t replacing or even augmenting radiologists, but in supplying near-radiologist expertise where not a radiologist was in sight. The epiphany changed their strategy.

“It’s funny – when I’m asked whether I see AI replacing radiologists, I point out that in most of the rest of the world there aren’t any radiologists to replace,” said Rao.

The choice of modality – chest radiographs – followed logically because chest radiographs are the most commonly ordered imaging test worldwide. They’re useful for a number of clinical problems and seem deceptively easy to interpret. Their abundance also meant that AI would have a large sample size to learn from.

“There just weren’t enough radiologists to read the daily chest radiograph volume at Christian Medical College, Vellore, where I worked. I can read chest x-rays because I’m a chest physician, but reading radiographs takes away time I could be spending with my patients, and I just couldn’t keep up with the volumes,” recalls Dr. Justy. Several radiographs remained unread for several weeks, many hid life-threatening conditions such as pneumothorax or lung cancer. The hospital was helpless – their budget was constrained and as important as radiologists were, other physicians and services were more important. Furthermore, even if they wanted they couldn’t recruit radiologists because the supply of radiologists in India is small.

Justy believes AI can offer two levels of service. For expert physicians like her, it can take away the normal radiographs, leaving her to read the abnormal ones, which reduces the workload because the majority of the radiographs are normal. For novice physicians, and non-physicians, AI could provide an interpretation – diagnosis, or differential diagnoses, or just point abnormalities on the radiograph.

The Qure.ai team imagined those scenarios, too. First they needed the ingredients, the data, i.e. the chest radiographs. But the start-up comprised only a few data scientists, none of whom had any hospital affiliations.

“I was literally on the road for two years asking hospitals for chest radiographs. I barely saw my family,” recalls Warier. “Getting the hospitals to share data was the most difficult part of building Qure.ai.”

Warier became a traveling salesman and met with leadership of over hundred healthcare facilities of varying sizes, resources, locations, and patient populations. He explained what Qure.ai wanted to achieve and why they needed radiographs. There were long waits outside the leadership office, last minute meeting cancellations, unanswered e-mails, lukewarm receptions, and enthusiasm followed by silence. But he made progress, and many places agreed to give him the chest radiographs. The data came with stipulations. Some wanted to share revenue. Some wanted research collaborations. Some had unrealistic demands such as share of the company. It was trial and error for Warier, as he had done nothing of this nature before.

Actually it was Warier’s IIT alumni network which opened doors. IITians (graduates of the Indian Institutes of Technology) practically run India’s business, commerce, and healthcare. Heads of private equity which funds corporate hospitals are often IITians, as are the CEOs of these hospitals.

“Without my IIT alumni network, I don’t think we could have pulled it off. Once an IITian introduces an IITian to an IITian, it’s an unwritten rule that they must help,” said Warier.

Warier’s efforts paid. Qure has now acquired over 2.5 million chest radiographs from over 100 sites for training, validation and testing the chest radiograph algorithm.

“As a data scientist my ethos is that there’s no such thing as ‘too much data.’ More the merrier,” smiled Warier.

“The mobile phone reached many parts of India before the landline could get there,” explains Warier. “Similarly, AI will reach parts of India before radiologists.”

Soon, a few others, including Srinivas, joined the team. Whilst the data scientists were educating AI, Rao and Warier were figuring their customer base. It was evident that radiologists would not be their customers. Radiologists didn’t need AI. Their customers were those who needed radiologists but were prepared to settle for AI.

“The secret to commercialization in healthcare is need, real need, not induced demand. But it’s tricky because the neediest are least likely to generate revenues,” said Warier in a pragmatic tone. Unless the product can be scaled at low marginal costs. An opportunity for Qure.ai arose in the public health space – the detection of tuberculosis on chest radiographs in the global fight against TB. It was an indication that radiologists in developing worlds didn’t mind conceding – they had plenty on their plates, already.

“It was serendipity,” recalls Rao. “A consultant suggested that we use our algorithm to detect TB. We then met people working in the TB space – advocates, activists, social workers, physicians, and epidemiologists. We were inspired particularly by Dr. Madhu Pai, Professor of Epidemiology at McGill University. His passion to eradicate TB made us believe that the fight against TB was personal.”

Qure.ai started with four people. Today 35 people work for it. They even have a person dedicated to regulatory affairs. Rao remembers the early days. “We were lucky to have been supported by Fractal. Had we been operating out of a garage, we might not have survived. Building algorithms isn’t easy.”

Finding Tuberculosis

Hamlet’s modified opening soliloquy, “TB or not TB, that is the question”, simplifies the dilemma facing TB detection, which is a choice between fewer false positives and fewer false negatives. Ideally, one wants neither. The treatment for tuberculosis – quadruple therapy – exacts several month commitment. It’s not a walk in the park. Patients have to be monitored to confirm they are treatment compliant, and though directly observed therapy, medicine’s big brother, has become less intrusive, it still consumes resources. Taking TB treatment when one doesn’t have TB is unfortunate. But not taking TB treatment when one has TB can be tragic, and defeats the purpose of detection, and perpetuates the reservoir of TB.

Hamlet’s soliloquy can be broken into two parts – screening and confirmation. When screening for TB, “not TB is the question”. The screening test must be sensitive –capable of finding TB in those with TB, i.e. have a high negative predictive value (NPV), so that when it says “no TB” – we’re (nearly) certain the person doesn’t have TB.

Those positive on screening tests comprise two groups – true positives (TB) and false positives (not TB). We don’t want antibiotics frivolously given, so the soliloquy reverses; it is now “TB, that is the question.” The confirmatory test must be specific, highly capable of finding “not TB” in those without TB, i.e. have a high positive predictive value (PPV), so that when it says “TB” – we’re (nearly) certain that the person has TB. Confirmatory tests should not be used to screen, and vice versa.

Tuberculosis can be inferred on chest radiographs or myocobacteria TB can be seen on microscopy. Seeing is believing and seeing the bacteria by microscopy was once the highest level of proof of infection. In one method, slide containing sputum is stained with carbol fuchsin, rendering it red. MTB retains its glow even after the slide is washed with acid alcohol, a property responsible for its other name – acid fast bacilli.

Sputum microscopy, once heavily endorsed by the WHO for the detection of TB, is cheap but complicated. The sputum specimen must contain sputum, not saliva, which is easily mistaken for sputum. Patients have to be taught how to bring up the sputum from deep inside their chest. The best time to collect sputum is early morning, so the collection needs discipline, which means that the yield of sputum depends on the motivation of the patient. Inspiring patients to provide sputum is hard because even those who regularly cough phlegm can find its sight displeasing.

Which is to say nothing about the analysis part, which requires attention to detail. It’s easier seeing mycobacteria when they’re abundant. Sputum microscopy is best at detecting the most infectious of the most active of the active TB sufferers. Its accuracy depends on the spectrum of disease. If you see MTB, the patient has TB. If you don’t see MTB, the patient could still have TB. Sputum microscopy, alone, is too insensitive and cumbersome for mass screening – yet, in many parts of the world, that’s all they have.

The gold standard test for TB – the unfailing truth that the patient has TB, independent of the spectrum of disease – is culture of mycobacteria, which was deemed impractical because on the Löwenstein–Jensen medium, the agar made specially for MTB, it took six weeks to grow MTB, which is too long for treatment decisions. Culture has made a comeback, in order to detect drug resistant mycobacteria. On newer media, such as MGIT, the mycobacteria grow much faster.

The detection of TB was revolutionized by molecular diagnostics, notably the nucleic acid amplification test, also known as GeneXpert MTB/ RIF, shortened to Xpert, which simultaneously detects mycobacterial DNA and assesses whether the mycobacteria are resistant to rifampicin – one of the mainline anti-tuberculosis drugs.

Xpert boasts a specificity of 98 %, and with a sensitivity of 90 % it is nearly gold standard material, or at least good enough for confirmation of TB. It gives an answer in 2 hours – a dramatically reduced turnaround time compared to agar. Xpert can detect 131 colony-forming units of MTB per ml of specimen – which is a marked improvement from microscopy, where there should be 10, 000 colony-forming units of MTB per ml of specimen for reliable detection. However, Xpert can’t be used on everyone, not just because its sensitivity isn’t high enough – 90 % is a B plus, and for screening we need an A plus sensitivity. But also its price, which ranges from $10 – $20 per cartridge, and is too expensive for mass screening in developing countries.

This brings us back to the veteran warrior, the chest radiograph, which has a long history. Shortly after Wilhelm Röntgen’s discovery, x-rays were used to see the lungs, the lungs were a natural choice because there was natural contrast between the air, through which the rays passed, and the bones, which stopped the rays. Pathology in the lungs stopped the rays, too – so the ‘stopping of rays’ became a marker for lung disease, chief of which was tuberculosis.

X-rays were soon conscripted to the battlefield in the Great War to locate bullets in wounded soldiers, making them war heroes. But it was the writer, Thomas Mann, who elevated the radiograph to literary fame in Magic Mountain – a story about a TB sanitarium. The chest radiograph and tuberculosis became intertwined in people’s imagination. By World War 2, chest radiographs were used for national TB screening in the US.

The findings of TB on chest radiographs include consolidation (whiteness), big lymph nodes in the mediastinum, cavitation (destruction of lung), nodules, shrunken lung, and pleural effusion. These findings, though sensitive for TB – if the chest radiograph is normal, active TB is practically excluded, aren’t terribly specific, as they’re shared by other diseases, such as sarcoid.

Chest radiographs became popular with immigration authorities in Britain and Australia to screen for TB in immigrants from high TB burden countries at the port of entry. But the WHO remained unimpressed by chest radiographs, preferring sputum analysis instead. The inter- and intra-observer variation in the interpretation of the radiograph didn’t inspire confidence. Radiologists would often disagree with each other, and sometimes disagree with themselves. WHO had other concerns.

“One reason that the WHO is weary of chest radiographs is that they fear that if radiographs alone are used for decision making, TB will be overtreated. This is common practice in the private medical sector in India,” explains Professor Madhu Pai.

Nonetheless, Pai advocates that radiographs triage for TB, to select patients for Xpert, which is cost effective because radiographs, presently, are cheaper than molecular tests.  Using Xpert only on patients with abnormal chest radiographs would increase its diagnostic yield – i.e. percentage of cases which test positive. Chest radiograph’s high sensitivity compliments Xpert’s high specificity. But this combination isn’t 100 % – nothing in diagnostic medicine is. The highly infective endobronchial TB can’t be seen on chest radiograph, because the mycobacteria never make it to the lungs, and remain stranded in the airway.

“Symptoms such as cough are even more non-specific than chest radiographs for TB. Cough means shit in New Delhi, because of the air pollution which gives everyone a cough,” explains Pai, basically emphasizing that neither the chest radiograph nor clinical acumen, can be removed from the diagnostic pathway for TB.

A test can’t be judged just by its AUC. How likely people – doctors and patients – are to adopt a test is also important and here the radiograph outshines sputum microscopy, because despite its limitations, well known to radiologists, radiographs still carry a certain aura, particularly in India. In the Bollywood movie, Anand, an oncologist played by Amitabh Bachchan diagnosed terminal cancer by glancing at the patient’s radiograph for couple of seconds. Not CT, not PET, but a humble old radiograph. Bollywood has set a very high bar for Artificial Intelligence.

Saurabh Jha (aka @RogueRad) is a contributing editor for THCB. This is part 1 of a two-part story.

The post Artificial Intelligence vs. Tuberculosis, Part 1 appeared first on The Health Care Blog.

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[kristinsimmons]

Artificial Intelligence vs. Tuberculosis, Part 1

By SAURABH JHA, MD

Slumdog TB

No one knows who gave Rahul Roy tuberculosis. Roy’s charmed life as a successful trader involved traveling in his Mercedes C class between his apartment on the plush Nepean Sea Road in South Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather. He seldom rolled down his car windows – his ambient atmosphere, optimized for his comfort, rarely changed.

Historically TB, or “consumption” as it was known, was a Bohemian malady; the chronic suffering produced a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in part, because consumption, like aristocracy, was thought to be hereditary. Even after Robert Koch discovered that the cause of TB was a rod-shaped bacterium – Mycobacterium Tuberculosis (MTB), TB had a special status denied to its immoral peer, Syphilis, and unaesthetic cousin, leprosy.

TB became egalitarian in the early twentieth century but retained an aristocratic noblesse oblige. George Orwell may have contracted TB when he voluntarily lived with miners in crowded squalor to understand poverty. Unlike Orwell, Roy had no pretentions of solidarity with poor people. For Roy, there was nothing heroic about getting TB. He was embarrassed not because of TB’s infectivity; TB sanitariums are a thing of the past. TB signaled social class decline. He believed rickshawallahs, not traders, got TB.

“In India, many believe TB affects only poor people, which is a dangerous misconception,” said Rhea Lobo – film maker and TB survivor.

Tuberculosis is the new leprosy. The stigma has consequences, not least that it’s difficult diagnosing a disease that you don’t want diagnosed. TB, particularly extra-pulmonary TB, mimics many diseases.

“TB can cause anything except pregnancy,” quips Dr. Justy – a veteran chest physician. “If doctors don’t routinely think about TB they’ll routinely miss TB.”

In Lobo, the myocobacteria domiciled in the bones of her feet, giving her heel pain, which was variously ascribed to bone bruise, bone cancer, and staphylococcal infection. Only when a lost biopsy report resurfaced, and after receiving the wrong antibiotics, was TB diagnosed, by which time the settlers had moved to her neck, creating multiple pockets of pus. After multiple surgeries and a protracted course of antibiotics, she was free of TB.

“If I revealed I had TB no one would marry me, I was advised” laughed Lobo. “So, I made a documentary on TB and started ‘Bolo Didi’ (speak sister), a support group for women with TB. Also, I got married!”

Mycobacterium tuberculosis is an astute colonialist which lets the body retain control of its affairs. The mycobacteria arrive in droplets, legitimately, through the airways and settle in the breezy climate of the upper lobes and superior segment of the lower lobes of the lungs. If they sense weakness they attack, and if successful, cause primary TB. Occasionally they so overpower the body that an avalanche of small, discrete snowballs, called miliary TB, spread. More often, they live silently in calcified lymph nodes as latent TB. When apt, they reappear, causing secondary TB. The clues to their presence are calcified mediastinal nodes or a skin rash after injection of mycobacterial protein.

MTB divides every 20 hours. In the bacterial world that’s Monk-like libido. E. Coli, in comparison, divides every 20 minutes. Their sexual ennui makes them frustratingly difficult to culture. Their tempered fecundity also means they don’t overwhelm their host with their presence, permitting them to write fiction and live long enough to allow the myocobacteria to jump ship.

TB has been around for a while. The World Health Organization (WHO) wants TB eradicated but the myocobacteria have no immediate plans for retirement. Deaths from TB are declining at a tortoise pace of 2 % a year. TB affects 10 million and kills 1.6 million every year – it is still the number one infectious cause of death.

The oldest disease’s nonchalance to the medical juggernaut is not for the lack of a juggernaut effort. Mass screening for TB using chest radiographs started before World War 2, and still happens in Japan. The search became fatigued by the low detection of TB. The challenge wasn’t just in looking for needles in haystacks, but getting to the haystacks which, in developing countries, are dispersed like needles.

The battleground for TB eradication is India, which has the highest burden of TB – a testament not just to its large population. Because TB avoids epidemics, it never scares the crap out of people. Its distribution and spread match society’s wealth distribution and aspirations. And in that regard India is most propitious for its durability.

Few miles north of Nepean Sea Road is Dharavi – Asia’s largest slum, made famous by the Oscar-winning film, Slumdog Millionaire. From atop, Dharavi looks like thousand squashed coke cans beside thousand crumpled cardboard boxes. On the ground, it’s a hot bed of economic activity. No one wants to stay in Dharavi forever, its people want to become Bollywood stars, or gangsters, or just very rich. Dharavi is a reservoir of hope.

Dharavi is a reservoir also of active TB. In slums, which are full of houses packed like sardines in which live people packed like sardines, where cholera spreads like wildfire and wildfire spreads like cholera, myocobacteria travel much further. Familiarity breeds TB. One person with active TB can infect nine – and none are any the wiser of the infection because unlike cholera, which is wildfire, TB is a slow burn and its symptoms are indistinguishable from the maladies of living in a slum.

Slum dwellers with active TB often continue working – there’s no safety net in India to cushion the illness – and often travel afar to work. They could be selling chai and samosas outside the Bombay Stock Exchange. With the habit of expectoration – in India, spitting on the streets isn’t considered bad manners – sputum is aplenty, and mycobacteria-laden droplets from Dharavi can easily reach Roy’s lungs. TB, the great leveler, bridges India’s wealth divide. Mycobacteria unite Nepean Sea Road with Dharavi.

Rat in Matrix Algebra

The major challenges in fighting tuberculosis are finding infected people and ensuring they take the treatment for the prescribed duration, often several months. Both obstacles can wear each other– if patients don’t take their treatment what’s the point finding TB? If TB can’t be found what good is the treatment?

The two twists in the battle against TB, drug resistant TB and concurrent TB and HIV, favor the mycobacteria. But TB detection is making a resurgence with the reemergence of the old warrior – the chest radiograph, which now has a new ally – artificial intelligence (AI). Artificial Intelligence is chest radiograph’s Sancho Panza.

Ten miles north of Dharavi in slick offices in Goregaon, Mumbai’s leafy suburb, data scientists training algorithms to read chest radiographs are puzzled by AI’s leap in performance.

“The algorithm we developed,” says Preetham Sreenivas incredulously, “has an AUC of 1 on the new set of radiographs!”

AUC, or area under the receiver operator characteristic curve, measures diagnostic accuracy. The two types of diagnostic errors are false negatives – mistaking abnormal for normal, and false positives – mistaking normal for abnormal. In general, fewer false negatives (FNs) means more false positives (FPs); trade-off of errors. A higher AUC implies fewer “false” errors, AUC of 1 is perfect accuracy; no false positives, no false negatives.

Chest radiograph are two-dimensional images on which three dimensional structures, such as lungs, are collapsed and which, like Houdini, hide stuff in plain sight. Pathology literally hides behind normal structures. It’s nearly impossible for radiologists to have an AUC of 1. Not even God knows what’s going on in certain parts of the lung, such as the posterior segment of the left lower lobe.

Here, AI seemed better than God at interpreting chest radiographs. But Sreenivas, who leads the chest radiograph team in Qure.ai – a start-up in Mumbai which solves healthcare problems using artificial intelligence, refused to open the champagne.

“Algorithms can’t jump from an AUC of 0.84 to 1. It should be the other way round – their performance should drop when they see data (radiographs) from a new hospital,” explains Sreenivas.

Algorithms mature in three stages. First, training –  data (x-rays), labelled with ground truth, are fed to a deep neural network (the brain), Labels, such as pleural effusion, pulmonary edema, pneumonia, or no abnormality, teach AI. After seeing enough cases AI is ready for the second step, validation – in which it is tested on different cases taken from the same source as the training set – like same hospital. If AI performs respectably, it is ready for the third stage – the test.

Training radiology residents is like training AI. First, residents see cases knowing the answer. Then they see cases on call from the institution they’re training at, without knowing the answer. Finally, released into the world, they see cases from different institutions and give an answer.

The test and training cases come from different sources. The algorithm invariably performs worse on test than training set because of “overfitting” – a phenomenon where the algorithm tries hard fitting to the local culture. It thinks the rest of the world is exactly like the place it trained, and can’t adapt to subtle differences in images because of different manufacturers, different acquisition parameters, or acquisition on different patient populations. To reduce overfitting, AI is regularly fed cases from new institutions.

When AI’s performance on radiographs from a new hospital mysteriously improved, Sreenivas smelt a rat.

“AI is matrix algebra. It’s not corrupt like humans – it doesn’t cheat. The problem must be the data,” Sreenivas pondered.

Birth of a company

“I wish I could say we founded this company to fight TB,” says Pooja Rao, co-founder of Qure.ai, apologetically. “But I’d be lying. The truth is that we saw in an international public health problem a business case for AI.”

Qure.ai was founded by Prashant Warier and Pooja Rao. After graduating from the Indian Institute of Technology (IIT), Warier, a natural born mathematician, did his PhD from Georgia Tech. He had no plans of returning to India, until he faced the immigration department’s bureaucratic incompetence. Someone had tried entering the US illegally on his wife’s stolen passport. The bureaucracy, unable to distinguish the robber from the robbed, denied her a work visa. Warier reluctantly left the US.

In India, Warier founded a company which used big data to find preferences of niche customers. His company was bought by Fractal, a data analytic giant – the purchase motivated largely by the desire to recruit Warier.

Warier wanted to develop an AI-enabled solution for healthcare. In India, data-driven decisions are common in retail but sparse in healthcare. In a move unusual in industry and uncommon even in academia, Fractal granted him freedom to tinker, with no strings attached. Qure.ai was incubated by Fractal.

Warier discovered Rao, a physician-scientist and bioinformatician, on LinkedIn and invited her to lead the research and development. Rao became a doctor to become a scientist because she believed that deep knowledge of medicine helps join the dots in the biomedical sciences. After her internship, she did a PhD at the Max Planck Institute in Germany. For her thesis, she applied deep learning to predict Alzheimer’s disease from RNA. Though frustrated by Alzheimer’s, which seemed uncannily difficult to predict, she fell in love with deep learning.

Rao and Warier were initially uncertain what their start-up should focus on. There were many applications of AI in healthcare, such as genomic analysis, analysis of electronic medical records, insurance claims data, Rao recalled two lessons from her PhD.

“Diseases such as Alzheimer’s are heterogeneous, so the ground truth, the simple question – is there Alzheimer’s – is messy. The most important thing I realized is that without the ground truth AI is useless.”

Rao echoed the sentiments of Lady Lovelace, the first computer programmer, from the nineteenth century. When Lovelace saw the analytical engine, the first “algorithm”, invented by Charles Babbage, she said: “The analytical Engine has no pretensions whatever to originate anything. It can do whatever we know how to order it to perform. It can follow analysis; but it has no power of anticipating any analytical relations or truths.”

The second lesson Rao learnt was that the ground truth must be available immediately, not in the future – i.e. AI must be trained on diseases of the present, not outcomes, which are nebulous and take time to reveal. The immediacy of their answer, which must be now, right away, reduced their choices to two – radiology and pathology. Pathology had yet to be digitized en masse.

“The obvious choice for AI was radiology”, revealed Warier.

Why “Qure” with a Q, not “Cure” with a C, I asked. Was it a tribute to Arabic medicine?

“We’re not that erudite,” laughed Warier. “The internet domain for ‘cure’ had already been taken.”

Qure.ai was founded in 2016 during peak AI euphoria. In those days deep learning seemed magical to those who understood it, and to those who didn’t. Geoffrey Hinton, deep learning’s titan, famously predicted radiologists’ extinction – he advised that radiologists should stop being trained because AI would interpret the images just as well.

Bioethicist and architect of Obamacare, Ezekiel Emanuel, told radiologists that their profession faced an existential threat from AI. UK’s health secretary, Jeremy Hunt, drunk on the Silicon Valley cool aid, prophesized that algorithms will outperform general practitioners. Venture capitalist, Vinod Khosla predicted modestly that algorithms will replace 80 % of doctors.

Amidst the metastasizing hype, Warier and Rao remained circumspect. Both understood AI’s limitations. Rao was aware that radiologists hedged in their reports – which often made the ground truth a coin toss. They concluded that AI would be an incremental technology. AI would help radiologists become better radiologists.

“We were firing arrows in the dark. Radiology is vast. We didn’t know where to start,” recalls Rao.

Had Qure.ai been funded by venture capitalists, they’d have a deadline to have a product. But Fractal prescribed no fixed timeline. This gave the founders an opportunity to explore radiology. The exploration was instructive.

They spoke to several radiologists to better understand radiology, find the profession’s pain points, see what could be automated, and what might be better dealt by AI. The advice ranged from the flippant to the esoteric. One radiologist recommended using AI to quantify lung fibrosis in interstitial pulmonary fibrosis, another, knee cartilage for precision anti-rheumatoid therapy. Qure.ai has a stockpile of unused, highly niche, esoteric algorithms.

Every radiologist’s idea of augmentation was unique. Importantly, few of their ideas comprised mainstream practice. Augmentation seemed a way of expanding radiologist’s possibilities, rather than dealing with radiology’s exigencies – no radiologist, for instance, suggested that AI should look for TB on chest radiographs.

Augmentation doesn’t excite venture capitalists as much as replacement, transformation, or disruption. And augmentation didn’t excite Rao and Warier, either. When you have your skin in the commercial game, relevance is the only currency.

“Working for start-ups is different from being a scientist in an academic medical center. We do science, too. But before we take a project, we think about the return of investment. Just because an endeavor is academically challenging doesn’t mean that it’s commercially useful. If product don’t sell, start-ups have to close shop,” said Rao.

The small size of start-ups means they don’t have to run decisions through bulky corporate governance. It doesn’t take weeks convening meetings through Doodle polls. Like free climbers who aren’t encumbered by climbing equipment, they can reach their goal sooner. Because a small start-up is nimble it can fail fast, fail without faltering, fail a few time. But it can’t fail forever. Qure needed a product it could democratize. Then an epiphany.

In World War 2, after allied aircrafts sustained bullets in enemy fire, some returned to the airbase and others crashed. Engineers wanted the aircrafts reinforced at their weakest points to increase their chances of surviving enemy fire. A renowned statistician of the time, Abraham Wald, analyzed the distribution of the bullets and advised that reinforcements be placed where the plane hadn’t been shot. Wald realized that the planes which didn’t return were likely shot at the weakest points. On the planes which returned the bullets marked their strongest point.

Warier and Rao realized that they needed to think about scenarios where radiologists were absent, not where radiologists were abundant. They had asked the wrong people the wrong question. The imminent need wasn’t replacing or even augmenting radiologists, but in supplying near-radiologist expertise where not a radiologist was in sight. The epiphany changed their strategy.

“It’s funny – when I’m asked whether I see AI replacing radiologists, I point out that in most of the rest of the world there aren’t any radiologists to replace,” said Rao.

The choice of modality – chest radiographs – followed logically because chest radiographs are the most commonly ordered imaging test worldwide. They’re useful for a number of clinical problems and seem deceptively easy to interpret. Their abundance also meant that AI would have a large sample size to learn from.

“There just weren’t enough radiologists to read the daily chest radiograph volume at Christian Medical College, Vellore, where I worked. I can read chest x-rays because I’m a chest physician, but reading radiographs takes away time I could be spending with my patients, and I just couldn’t keep up with the volumes,” recalls Dr. Justy. Several radiographs remained unread for several weeks, many hid life-threatening conditions such as pneumothorax or lung cancer. The hospital was helpless – their budget was constrained and as important as radiologists were, other physicians and services were more important. Furthermore, even if they wanted they couldn’t recruit radiologists because the supply of radiologists in India is small.

Justy believes AI can offer two levels of service. For expert physicians like her, it can take away the normal radiographs, leaving her to read the abnormal ones, which reduces the workload because the majority of the radiographs are normal. For novice physicians, and non-physicians, AI could provide an interpretation – diagnosis, or differential diagnoses, or just point abnormalities on the radiograph.

The Qure.ai team imagined those scenarios, too. First they needed the ingredients, the data, i.e. the chest radiographs. But the start-up comprised only a few data scientists, none of whom had any hospital affiliations.

“I was literally on the road for two years asking hospitals for chest radiographs. I barely saw my family,” recalls Warier. “Getting the hospitals to share data was the most difficult part of building Qure.ai.”

Warier became a traveling salesman and met with leadership of over hundred healthcare facilities of varying sizes, resources, locations, and patient populations. He explained what Qure.ai wanted to achieve and why they needed radiographs. There were long waits outside the leadership office, last minute meeting cancellations, unanswered e-mails, lukewarm receptions, and enthusiasm followed by silence. But he made progress, and many places agreed to give him the chest radiographs. The data came with stipulations. Some wanted to share revenue. Some wanted research collaborations. Some had unrealistic demands such as share of the company. It was trial and error for Warier, as he had done nothing of this nature before.

Actually it was Warier’s IIT alumni network which opened doors. IITians (graduates of the Indian Institutes of Technology) practically run India’s business, commerce, and healthcare. Heads of private equity which funds corporate hospitals are often IITians, as are the CEOs of these hospitals.

“Without my IIT alumni network, I don’t think we could have pulled it off. Once an IITian introduces an IITian to an IITian, it’s an unwritten rule that they must help,” said Warier.

Warier’s efforts paid. Qure has now acquired over 2.5 million chest radiographs from over 100 sites for training, validation and testing the chest radiograph algorithm.

“As a data scientist my ethos is that there’s no such thing as ‘too much data.’ More the merrier,” smiled Warier.

“The mobile phone reached many parts of India before the landline could get there,” explains Warier. “Similarly, AI will reach parts of India before radiologists.”

Soon, a few others, including Srinivas, joined the team. Whilst the data scientists were educating AI, Rao and Warier were figuring their customer base. It was evident that radiologists would not be their customers. Radiologists didn’t need AI. Their customers were those who needed radiologists but were prepared to settle for AI.

“The secret to commercialization in healthcare is need, real need, not induced demand. But it’s tricky because the neediest are least likely to generate revenues,” said Warier in a pragmatic tone. Unless the product can be scaled at low marginal costs. An opportunity for Qure.ai arose in the public health space – the detection of tuberculosis on chest radiographs in the global fight against TB. It was an indication that radiologists in developing worlds didn’t mind conceding – they had plenty on their plates, already.

“It was serendipity,” recalls Rao. “A consultant suggested that we use our algorithm to detect TB. We then met people working in the TB space – advocates, activists, social workers, physicians, and epidemiologists. We were inspired particularly by Dr. Madhu Pai, Professor of Epidemiology at McGill University. His passion to eradicate TB made us believe that the fight against TB was personal.”

Qure.ai started with four people. Today 35 people work for it. They even have a person dedicated to regulatory affairs. Rao remembers the early days. “We were lucky to have been supported by Fractal. Had we been operating out of a garage, we might not have survived. Building algorithms isn’t easy.”

Finding Tuberculosis

Hamlet’s modified opening soliloquy, “TB or not TB, that is the question”, simplifies the dilemma facing TB detection, which is a choice between fewer false positives and fewer false negatives. Ideally, one wants neither. The treatment for tuberculosis – quadruple therapy – exacts several month commitment. It’s not a walk in the park. Patients have to be monitored to confirm they are treatment compliant, and though directly observed therapy, medicine’s big brother, has become less intrusive, it still consumes resources. Taking TB treatment when one doesn’t have TB is unfortunate. But not taking TB treatment when one has TB can be tragic, and defeats the purpose of detection, and perpetuates the reservoir of TB.

Hamlet’s soliloquy can be broken into two parts – screening and confirmation. When screening for TB, “not TB is the question”. The screening test must be sensitive –capable of finding TB in those with TB, i.e. have a high negative predictive value (NPV), so that when it says “no TB” – we’re (nearly) certain the person doesn’t have TB.

Those positive on screening tests comprise two groups – true positives (TB) and false positives (not TB). We don’t want antibiotics frivolously given, so the soliloquy reverses; it is now “TB, that is the question.” The confirmatory test must be specific, highly capable of finding “not TB” in those without TB, i.e. have a high positive predictive value (PPV), so that when it says “TB” – we’re (nearly) certain that the person has TB. Confirmatory tests should not be used to screen, and vice versa.

Tuberculosis can be inferred on chest radiographs or myocobacteria TB can be seen on microscopy. Seeing is believing and seeing the bacteria by microscopy was once the highest level of proof of infection. In one method, slide containing sputum is stained with carbol fuchsin, rendering it red. MTB retains its glow even after the slide is washed with acid alcohol, a property responsible for its other name – acid fast bacilli.

Sputum microscopy, once heavily endorsed by the WHO for the detection of TB, is cheap but complicated. The sputum specimen must contain sputum, not saliva, which is easily mistaken for sputum. Patients have to be taught how to bring up the sputum from deep inside their chest. The best time to collect sputum is early morning, so the collection needs discipline, which means that the yield of sputum depends on the motivation of the patient. Inspiring patients to provide sputum is hard because even those who regularly cough phlegm can find its sight displeasing.

Which is to say nothing about the analysis part, which requires attention to detail. It’s easier seeing mycobacteria when they’re abundant. Sputum microscopy is best at detecting the most infectious of the most active of the active TB sufferers. Its accuracy depends on the spectrum of disease. If you see MTB, the patient has TB. If you don’t see MTB, the patient could still have TB. Sputum microscopy, alone, is too insensitive and cumbersome for mass screening – yet, in many parts of the world, that’s all they have.

The gold standard test for TB – the unfailing truth that the patient has TB, independent of the spectrum of disease – is culture of mycobacteria, which was deemed impractical because on the Löwenstein–Jensen medium, the agar made specially for MTB, it took six weeks to grow MTB, which is too long for treatment decisions. Culture has made a comeback, in order to detect drug resistant mycobacteria. On newer media, such as MGIT, the mycobacteria grow much faster.

The detection of TB was revolutionized by molecular diagnostics, notably the nucleic acid amplification test, also known as GeneXpert MTB/ RIF, shortened to Xpert, which simultaneously detects mycobacterial DNA and assesses whether the mycobacteria are resistant to rifampicin – one of the mainline anti-tuberculosis drugs.

Xpert boasts a specificity of 98 %, and with a sensitivity of 90 % it is nearly gold standard material, or at least good enough for confirmation of TB. It gives an answer in 2 hours – a dramatically reduced turnaround time compared to agar. Xpert can detect 131 colony-forming units of MTB per ml of specimen – which is a marked improvement from microscopy, where there should be 10, 000 colony-forming units of MTB per ml of specimen for reliable detection. However, Xpert can’t be used on everyone, not just because its sensitivity isn’t high enough – 90 % is a B plus, and for screening we need an A plus sensitivity. But also its price, which ranges from $10 – $20 per cartridge, and is too expensive for mass screening in developing countries.

This brings us back to the veteran warrior, the chest radiograph, which has a long history. Shortly after Wilhelm Röntgen’s discovery, x-rays were used to see the lungs, the lungs were a natural choice because there was natural contrast between the air, through which the rays passed, and the bones, which stopped the rays. Pathology in the lungs stopped the rays, too – so the ‘stopping of rays’ became a marker for lung disease, chief of which was tuberculosis.

X-rays were soon conscripted to the battlefield in the Great War to locate bullets in wounded soldiers, making them war heroes. But it was the writer, Thomas Mann, who elevated the radiograph to literary fame in Magic Mountain – a story about a TB sanitarium. The chest radiograph and tuberculosis became intertwined in people’s imagination. By World War 2, chest radiographs were used for national TB screening in the US.

The findings of TB on chest radiographs include consolidation (whiteness), big lymph nodes in the mediastinum, cavitation (destruction of lung), nodules, shrunken lung, and pleural effusion. These findings, though sensitive for TB – if the chest radiograph is normal, active TB is practically excluded, aren’t terribly specific, as they’re shared by other diseases, such as sarcoid.

Chest radiographs became popular with immigration authorities in Britain and Australia to screen for TB in immigrants from high TB burden countries at the port of entry. But the WHO remained unimpressed by chest radiographs, preferring sputum analysis instead. The inter- and intra-observer variation in the interpretation of the radiograph didn’t inspire confidence. Radiologists would often disagree with each other, and sometimes disagree with themselves. WHO had other concerns.

“One reason that the WHO is weary of chest radiographs is that they fear that if radiographs alone are used for decision making, TB will be overtreated. This is common practice in the private medical sector in India,” explains Professor Madhu Pai.

Nonetheless, Pai advocates that radiographs triage for TB, to select patients for Xpert, which is cost effective because radiographs, presently, are cheaper than molecular tests.  Using Xpert only on patients with abnormal chest radiographs would increase its diagnostic yield – i.e. percentage of cases which test positive. Chest radiograph’s high sensitivity compliments Xpert’s high specificity. But this combination isn’t 100 % – nothing in diagnostic medicine is. The highly infective endobronchial TB can’t be seen on chest radiograph, because the mycobacteria never make it to the lungs, and remain stranded in the airway.

“Symptoms such as cough are even more non-specific than chest radiographs for TB. Cough means shit in New Delhi, because of the air pollution which gives everyone a cough,” explains Pai, basically emphasizing that neither the chest radiograph nor clinical acumen, can be removed from the diagnostic pathway for TB.

A test can’t be judged just by its AUC. How likely people – doctors and patients – are to adopt a test is also important and here the radiograph outshines sputum microscopy, because despite its limitations, well known to radiologists, radiographs still carry a certain aura, particularly in India. In the Bollywood movie, Anand, an oncologist played by Amitabh Bachchan diagnosed terminal cancer by glancing at the patient’s radiograph for couple of seconds. Not CT, not PET, but a humble old radiograph. Bollywood has set a very high bar for Artificial Intelligence.

Saurabh Jha (aka @RogueRad) is a contributing editor for THCB. This is part 1 of a two-part story.

The post Artificial Intelligence vs. Tuberculosis, Part 1 appeared first on The Health Care Blog.

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[dreamofcentipedes]

(1) This chapter opens with a shot of an agehamodoki/butterfly moth (this again, which also happens to represent Touka as well as ghouls, particularly because Touka again is like the ghoul represent in TG) on the floor, seemingly part of all the debris in the abandoned building they have converted to a makeshift love hotel. A butterfly moth is like a fake/imitation, while actual butterflies are associated with illusion/dreams. awkward virgin sex.

(2) The mole on Touka’s breast, actually quite a few characters in TG have conspicuous moles which reminded me that “mole reading” is a thing. According to some Chinese and Indian fortune-telling beliefs, where a person has a mole can indicate something about their life be it their personality or prospects with various things like luck, wealth, love, etc. I have no idea from a preliminary search what a mole on the right breast means as you get widely varying results that can’t be considered 

conclusive. Note that at some point sheets appear under the pair. It’s like magic, because sex on a dirty floor is not too sexy is it? At one point Kaneki references last chapter’s hookline with “ah am I really doing this with Touka-chan?”. The OEK can’t unhook a girl’s bra lol Personally I find this panel kind of off-putting and unnecessary, but before Kaneki uh, gets going, Touka is posed like an angel with the sheets spread out like her wings.

(4) This is to denote her innocence which is about to be lost. You could also see those as her butterflymoth wings, which gives a different connotation of Touka not being what she seems…Of course the most unsettling part of this chapter is at the end, at which Kaneki unconsciously starts to cry right during the thick of things, but this is not the worst part. 

(5) The last page is a spread of Kaneki curled up in fetal position head resting on Touka’s lap as she understandingly and gently strokes his head, and interestingly enough the sheets(that came from nowhere) are creased to resemble an outline of the butterfly moth. So, wtf does all this even mean?

(5) First off the fetal position represents child-like vulnerability. Having sex with Touka, a girl he claims is quite attractive to him meant to be his lover, somehow unconsciously triggers something within Kaneki that upsets him to the degree that it leaves him feeling vulnerable as a child again.But why would this be? A few weeks prior Ishida posted a poem on his tumblr accompanied by artwork of Kaneki curled up in fetal position, which to me seems to have been about childbirth or

(6) mother-child relationship. Touka also appeared in a recent colour cover in which a blood splatter appears over the area where her womb could be, implying some connection to motherhood. If you put two and two together, Kaneki’s breakdown this chapter is related to his mother issues which seem to have been overlapped with Touka. Not good.

(7) The sex was actually “too good to be true”. Instead of Kaneki feeling whole and loved he broke down after being reminded of his troubled relationship with his mother. This spells trouble for the two as lovers, as it seems to indicate that Kaneki won’t be able to love and be loved until he can get over the issues of abandonment by his mother which has left him deeply scarred. That even when Touka was willing to both emotionally and physically give herself to Kaneki,

(8) it wasn’t enough to heal his heart like she had hoped. This I would guess is the “dream” part of the whole thing. Ishida’s way of dangling a carrot only to bring down the stick. (entire chapter of happy sex, you wish). It’s actually kind of a downer for TouKen shippers even though Ishida played it straight. For me, I didn’t care about the sex or the ship so I was able to dedicate my attentions to locating the origins of the mysterious sheets lol

Uhm, really can’t say I agree with this interpretation. The moth represents metamorphosis. Several moths have also appeared throughout the series during key events of change, like when Eto reveals to the world that she’s a Ghoul, for example. Its focus is to suggest a huge change in Kaneki’s emotional state, and as the Tarot of the Sun indicates, it’s a positive one which leads to greater wholeness in Kaneki. And before you might argue that the Tarot is reversed, a reversed Sun indicates “unrecognised hope” which fits Touka to a tee - in avoiding Touka, Kaneki didn’t realise she was his hope. Even if you don’t agree with that interpretation, it’s definite that the Sun is never a negative card, even when reversed.

Touka has had wing imagery for ages, long before she had anything to do with moths. She’s an ukaku and carries the image of a caged bird: “Your wing can’t fly anywhere”, “This world is like a twisted birdcage”, and also feeling explicitly sorry for an actual bird in an actual cage. Even if imagery here is meant to represent moth wings, which I contest, that wouldn’t be a bad thing either because the moth represents change and as the Tarot indicates, change here is positive.

Sometimes, a cigar is just a cigar and a mole is just a mole. Likely just for the sake of showing a realistic but still beautiful body.

Blankets are symbolic of warmth. Even if they’re actually doing it on a hard, dirty floor, the moment is so wonderful to them it feels no different than being on silk blankets. They give each other warmth in the cold, they give each other happiness in a world of pain.

Touka’s angelic appearance has nothing to do with the outdated concept of ‘losing innocence’ (she’s killed people for crying out loud). The image is reminiscent of our old friend the Sun Tarot - Touka practically glows with light above our naked child Kaneki. 

See how the darkness at the bottom of the page is dispelled by the light that Touka is bathed in? The positioning of her hands and the blanket behind her evokes angel symbolism to reinforce her imagery as a celestial being that brings light to Kaneki. It’s only “off-putting” and “unnecessary” if it doesn’t lend itself to your theory - for Sun Theory, it’s a giant boost.

Kaneki cried tears of happiness upon seeing Touka again in :re, and his tears here are meant to reflect that occasion, even to the extent that he has to be told that he is crying, and then asked why. He doesn’t provide an explanation in either case, but in both, it’s clear it’s because he holds strong romantic feelings for Touka. Haise’s inner monologue in :re confirmed this then, and Kaneki moving in for the kiss immediately afterwards confirmed it now. He’s crying because he’s finally found what he’s been searching for.

Your analysis in the next section relies on incorrect information. The caption for that image was “Don’t hit me, father”. It never mentioned a mother. Additionally, Kaneki (if it is him) isn’t in the same position in that image as he is in this chapter - in the image, his hands are wrapped around his legs, an image indicating curling up from abuse rather than a foetal position. 

Also, if this was a mother-related breakdown, why would Ishida be so randomly obtuse? His mother isn’t mentioned at all this chapter and unlike every other time Kaneki’s realised something about her, she doesn’t appear in his mind’s eye. If that’s what Ishida intended, wouldn’t the obvious thing to do would be for after Kaneki starts crying to have a small panel with the words “…Mother?” or the outline of her face? As it is, I’m afraid you’re drawing something from nothing here. 

Kaneki is in a foetal position for three reasons: 1) To hearken back to the image of him in a solitary foetal position vs him now with Touka to indicate the end of his loneliness. 2) To indicate that he is being reborn once more, imagery that we’ve also seen when he battled his suicidal urges vs Arima. 3) To appear childlike and naked as Touka smiles on above to match the Sun Tarot Card.

You argue that Kaneki won’t be able to love or be loved after he started crying, but you ignore that extremely passionate image of love-making that immediately followed it. And you say she couldn’t heal his heart, despite looking utterly peaceful with the Sun Tarot right next to him. This supposed stick seems totally illusory. Is it so hard to believe that we’d be given a carrot after facing the stick for so long?

This is why I can’t agree with your theory, anon - that, and because it flies in the face of the entire feeling and emotional impact of the chapter, aspects which certainly should not be ignored. You might not be interested in the ship, but Ishida has always seemed quite invested.