Category: University of Toronto Journalism Fellows

  • Should research be free for all?

    Should research be free for all?

    In the past, Gitanjali Yadav, like many other Indian researchers, would have used illegal online libraries to access academic journal articles. Now a new initiative by the Indian government brings hope as a legal alternative, delivering free article access to researchers across India.

    While Yadav benefits from the new scheme, it has brought her new challenges.

    Despite being one of the world’s top scientific research countries, many Indian universities don’t have enough funding for researchers to read the papers they need. 

    The Indian government sought to solve this issue with the One Nation One Subscription (ONOS) scheme. ONOS gives public Indian academic institutions free access to academic journals.

    But just as soon as the government gave access, they also took it away. Following the ONOS launch, another important website for reading academic articles was shut down. 

    Previously Sci-Hub, an illegal academic library, was the one-stop shop to read and download academic literature. Many Indian academics relied on it to access articles behind paywalls. But now the platform has been banned, leaving many Indian academics, and their research, without options. 

    A researcher at the National Institute of Plant Genome Research, Yadav downloads and analyzes thousands of academic articles for her research. Now, her attempts to access these articles on a mass scale have led to blocks by publishers even though her institution has subscriptions. 

    Why access matters

    Researchers worry that ONOS will not be able to replace Sci-Hub effectively, and that this will lead to downstream effects in conducting research. 

    India’s access problems raise a bigger question: can countries in the Global South compete in science when they don’t have the same access to information as richer countries? 

    Obtaining academic articles isn’t always simple. Similar to checking a book out from a library, you can only read an article if it is held in a library’s collection. Access to research papers is given through universities and academic institutions. 

    Academic journal subscriptions and publishing fees are estimated to earn $10 billion annually in the United States alone. The average cost of an annual subscription to a single journal by an Indian institution is around $1,300, though journals are often sold together in packages. The costs of these packages can vary, but a large Indian institution could expect to pay $50,000 for one year’s access, making the fee unaffordable for many Indian institutions. 

    Meanwhile, the researchers who provide articles and provide peer review for the journals are unpaid for their work

    Paywall problems

    Without access through their university, many academic articles are kept behind paywalls. Researchers can pay to read a paper, but fees average around $50 for a single article, and Indian universities can’t pay for all the journals they need. 

    “You’re somebody working in an Indian laboratory,” said Peter Murray-Rust, Cambridge researcher and well-known advocate for Open Access science. “What are you going to do? You’re going to pirate it.” 

    Launched in 2011, Sci-Hub changed Indian research by allowing anyone to illegally read articles for free, even if the articles were behind paywalls. 

    One fan was Jonny Coates, the executive director of Rippling Ideas, an organization that advocates for open access to scholarly works. “There are some people who tell you, actually, what Sci-Hub’s done is it solved the access problem,” he said.

    At its peak, Sci-Hub provided access to over 81 million research articles. For academics in India, many started downloading articles illegally. The country downloaded over 5 million articles from Sci-Hub in 2017 alone. 

    Is ONOS a game changer?

    Comments from hundreds of Indian researchers can be found thanking Alexandra Elkyban, Sci-Hub’s founder, online: “The website Sci-Hub you have developed is like an oasis in the desert for people like me,” wrote Indian researcher Keshav Moharir. “God bless you.”

    Now the platform is banned, and the Indian research scene is changing. The Indian ban on Sci-Hub follows a 2020 lawsuit filed by major academic publishers like Elsevier and Wiley. 

    When the Indian government launched the $715 million ONOS initiative earlier this year it was heralded as a solution to the access problem because it gave eligible public institutions free access to 13,000 academic journals.

    The announcement was met with much excitement: cutting-edge research could now be pursued without financial barriers. Researchers from small institutions were enthusiastic that they could finally access the resources previously limited to top tier universities. Indian Prime Minister Narendra Modi described it as a “game-changer for Indian academia and for youth empowerment,” in an X post. 

    But ONOS has also faced criticism from researchers. For those offered ONOS, more than half are still waiting to use the platform, and it’s unclear why they remain without access. At the same time, ONOS also only covers a small portion of the some 40,000 academic journals worldwide, limiting access to specialized publications that can be important for researchers. And there are logistical challenges, highlighted by Yardav’s difficulties. 

    Private universities, meanwhile, are left without ONOS or Sci-Hub. And some say it will be difficult for them to conduct research going forward.  

    Beyond India 

    India’s challenges show a bigger problem in the Global South. In contrast to institutions in high-income countries, those in the Global South have less money and fewer legal ways to read papers. That means that Global South countries are less likely to be able to read paywalled papers and include them in their own research. And because of this, their research may not be as strong or influential. 

    Lack of access can also influence what type of research gets done. A recent study by researchers at NYU Abu Dhabi on paywalls and scientific data concluded that paywalls can compound disparities between who gets access and who doesn’t and who ends up contributing to the global production of knowledge.

    One researcher from Ghana quoted in the study noted that the availability of papers could affect which projects he recommends to his students. 

    Murray-Rust said that being able to read the body of research is so essential for conducting good science, that in many cases, piracy becomes a standard practice.

    Whether government-led schemes can replace grassroots alternatives like Sci-Hub effectively is yet to be seen. 

    Researchers like Yadav fear that ONOS will end up being more symbolic rather than a real change for India’s research community. For now, India’s academic community finds itself in a difficult phase of transition. 

    Questions to consider:

    1. Why does it cost money to access some research studies?

    2. Who should fund scholarly research?

    3. If you put a lot of time and money into conducting a research study, would you give away the results for free? Why or why not?

     

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  • Can you get better medical advice online than from a doctor?

    Can you get better medical advice online than from a doctor?

    PCOS is a metabolic and reproductive condition. Although it’s the most common hormonal disorder in women of reproductive age, up to 70% of women affected by it never get diagnosed. Dr. Jamie Benham, an endocrinologist and principal investigatorat the EMBRACE Women’s Health Research Lab at the University of Calgary, said that because patients with PCOS can have a variety of experiences and symptoms, it can be challenging for doctors to diagnose. 

    For Joslin, it wasn’t until she began to struggle with infertility that she finally received a proper diagnosis. “When I saw the infertility doctor … he looks at me [and the] first thing he said to me was, ‘You are textbook PCOS’,” she said.

    Joslin said that if it weren’t for the online community, PCOS wouldn’t have been on her radar at all. Through treatments from her fertility doctor and naturopath, she was able to start a family.

    Taking symptoms seriously

    Jade Broughton, a member of the PCOS Patient Advisory Council at the University of Calgary, said she initially downplayed her own symptoms for years. She assumed they were stress-related from her shift work as a nurse and she was told her symptoms were normal.

    “I started noticing, quite a few years ago, my hair started falling [out] in clumps,” Broughton said. “I was just gaining weight so rapidly, I started having facial hair, all that stuff. I went to my doctor, and she was like, ‘You just turned 30, that’s just normal’ … So, I felt like I was just being gaslit for years and years.”

    Through internet searches and the PCOS Reddit page, she was finally able to understand what her symptoms might mean. After about seven years of advocating for herself, she finally received a diagnosis from her family doctor.

    “I feel like women’s health is still not taken seriously when it should be,” Broughton said. “Just stand up for yourself and trust your gut if you know something’s wrong.”

    Lisa Minaker, a legal assistant student in Winnipeg, Canada said that her irregular periods were concerning to her family physician, who referred her to an endocrinologist. Through blood work, her endocrinologist diagnosed PCOS. Although she received a diagnosis relatively quickly, Minaker said she felt that her doctors were not always “overly helpful” when it came to managing her symptoms. She thinks that doctors lack sufficient training in women’s health.

    “Not that it’s their fault,” she said. “Finding out how women don’t metabolize things like men, and how it’s dependant on where you are in your cycle … we’re still treated as basically a smaller version of men.”

    Why expertise matters

    Due to the complexity of PCOS and its diverse range of symptoms, a team of healthcare practitioners can be helpful. Joslin and Minaker both say that including other healthcare professionals, such as a naturopathic doctor and acupuncturist, helped with symptom management.

    “The [naturopathic doctor] was that complement to the medical world,” Joslin said. “My fertility doctor would prescribe me medication, and the naturopath would talk to me about my blood work [and supplements] … It was the hand holding and just someone talking you through [your results] to make sure you know what’s going on.”

    “I 100% credit the fact that I’m a mom to my naturopath,” Joslin said. “I would not be a mom without her.”

    Minaker said that in her own health journey she learned more from social media than from any doctor. “The girls in the [Facebook] group are pretty helpful,” she said. “I had to do my own research because I wasn’t really given a choice.”

    Although social media has played a big role in educating women about PCOS and other health problems, it can sometimes provide misinformation. A common misconception Broughton hears from patients is that they’re afraid to exercise, believing it’s bad for their health because of internet claims that it will raise cortisol levels — a hormone released in response to physical or emotional stress.

    “This is not consistent with what we know about the condition and exercise is recommended for all people with PCOS,” said Benham. “Unfortunately, we’re limited in that PCOS is not well studied. It’s not well understood. It hasn’t been funded from a women’s health research perspective. So there’s a lot of people that are profiting off nutrition plans or exercise plans or giving different advice around supplements.”

    Combatting misinformation

    Minaker said she found it difficult in the beginning to distinguish which resources were helpful and which were targeted marketing scams.

    “I wasn’t always that intuitive to be able to tell who was truthful,” Minaker said. “[I was] trying to find as many answers as possible.”

    In some Facebook groups, women share their symptoms, medications and diagnostic test results. Chats in these groups often involve consultations, advice and, sometimes, bullying.

    Joslin said that instead of lifting others up, some members of fertility groups for women with PCOS create guilt, embarrassment and shame around a vital aspect of life that PCOS can affect — being able to start a family.

    “In some groups, like the PCOS groups that focus specifically on trying to get pregnant, I had to leave right away,” Joslin said. “It was very toxic … where, truthfully, in this journey you need support. I’ve found much more success with smaller localized groups.”

    Information from medical organizations

    To combat misinformation, some medical organizations have created their online forums and portals. Broughton pointed to Monash University in Australia, which released new PCOS guidelines and launched a phone application called Ask PCOS.

    “They actually have an app that has tons of resources on weight management, food, insulin resistance, all of that stuff,” Broughton said. “And they’re actually one of the big players that’s trying to have it renamed as well.”

    Since PCOS affects more than ovaries, a new name would reflect that and might make it less confusing for women with symptoms to get the help they need.

    Other institutions are bringing women together in person to share experiences face-to-face.

    The EMBRACE Lab at the University of Calgary, for example, formed a PCOS Patient Advisory Council to conduct patient-oriented research earlier this year. The council, which meets monthly, is a space for community.

    “It’s such an amazing experience to sit in the room with all these women,” Joslin said. “Knowing all the struggles I’ve had … and sitting with people who are newly diagnosed or on their fertility journey … I’m able to share my advice and say, ‘You’re not alone.’”

    Community, whether found online or through research, has been an important part of the journey for these patients.

    Benham said that PCOS is a lifelong condition, whose symptoms can be managed although it cannot be cured. Joslin adds that it’s important to bring awareness to the condition. “Because there’s so many of us that have it, let’s make this more known.”

    Questions to consider:

    1. Why might someone trust a random person on an online forum over a doctor for medical advice?

    2. How can medical information you find online leave you more confused?

    3. If you felt unwell where would you turn for information about your condition?

     

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  • The mining of sand scars Kenya’s land

    The mining of sand scars Kenya’s land

    From space, Kenya’s sand-mining crisis is starkly visible. Satellite images reveal scars gouging riverbeds throughout its historic Rift Valley and fully extending border to border, west to east, from the shorelines of Lake Victoria to the Indian Ocean. 

    These growing scars tell the story of the nation’s booming construction sector and of a largely unregulated trade: sand harvesting.

    Sand is the world’s second-most consumed natural resource after water. It fuels construction booms globally, including in Kenya, where urban expansion and large infrastructure projects have surged. Yet sand is also among the most illegally trafficked natural commodities.

    In Kenya alone, around 50 million metric tonnes of sand worth roughly US$600 million are extracted each year, mainly for expansion of the nation’s capital, Nairobi, and major infrastructure projects. Yet the true cost of this extraction, particularly illegal operations, is far higher in terms of environmental degradation and human impact.

    “The scale of environmental crime related to sand harvesting is significant but poorly understood,” says Dr. Willis Okumu, a senior researcher at ARIN Africa, an organization dedicated to sustainable management of natural resources and environmental governance. 

    A multinational problem

    Okumu describes Lake Victoria — Africa’s largest lake by area, bordering Tanzania and Uganda as well as Kenya — as a convergence point for environmental crimes. These include illicit sand harvesting, charcoal burning and timber smuggling, facilitated by weak enforcement across bordering countries.

    Illegal sand harvesting strips riverbanks and lakeshores. It weakens soil structures, causes landslides and floods and devastates aquatic habitats. River systems feeding into Lake Victoria have suffered badly, threatening fisheries crucial to local livelihoods.

    These operations cause severe environmental impacts. Unregulated extraction weakens riverbanks, disrupts ecosystems, and significantly increases risks of flooding and deadly landslides. 

    River ecosystems, including those around Lake Victoria, suffer profound damage. Aquatic habitats and biodiversity are severely disrupted, jeopardizing livelihoods that rely on fishing and farming. Communities struggle with declining water quality and availability that are directly tied to unregulated sand extraction.

    In Mombasa, a city in southeastern Kenya along the Indian Ocean, unregulated sand extraction has altered river flows. This has disrupted irrigation systems, making it harder for farmers to grow food in a region already hit by drought.

    Sand loss and social ills

    Socially, the consequences are equally dire. The United Nations Environment Programme reports that “sand extraction and its trade are fuelling a myriad of social issues in Kenya, with violence and deaths related to sand trade widely documented.” School dropouts, teenage pregnancies and drug abuse spike as impoverished youth turn to illegal sand mining for quick income.

    Communities in the Rift Valley face a difficult trade-off: short-term survival through sand work or long-term sustainability. In Nakuru County, uncontrolled sand extraction has left homes exposed to erosion and collapse. Residents report that land beneath their feet is quite literally disappearing.

    Consolata Achieng, of Asieko Village in Nakuru County, told a local news reporter that all the land surrounding her property had been sold off to harvesters over the last eight years. “We were assured that harvesting had stopped but we still see workers and lorries every day,” she said. “A lot of people live around here and have nowhere to go. This is the place we call home.”

    Communities can also find themselves caught between environmental concerns and lack of alternatives. “All you need is a spade,” noted one senior Kenyan civil servant, highlighting how easy it is to mine sand. Labourers, including school-aged children, work in dangerous pits for low wages. 

    The lucrative nature of sand mining has attracted organized criminal groups that exploit the resource with impunity. Violent confrontations have occurred between cartels and local communities attempting to protect their resources, leading to injuries and fatalities.  

    These organized crime groups — known locally as “sand cartels” — are central to the illegal trade, often operating under the protection of corrupt state officials, enabling them to bypass regulations and continue illegal activities. 

    Countering illegal mining requires coordinated efforts

    According to ENACT Africa, a program that focuses on addressing transnational organized crime in Africa, weak co-ordination among law-enforcement agencies across borders allows such networks to thrive. Violent confrontations have occurred between cartels and local communities attempting to protect their resources, leading to injuries and even deaths. 

    Efforts to regulate the industry have largely failed due to corruption and ineffective governance. In a UNEP Global Sand Analysis report, a senior official bluntly observed: “All you need to do is pay,” reflecting systemic bribery and regulatory capture, which occurs when a government agency that was created to act in the public’s interest ends up serving the interests of the industry it’s supposed to be regulating. 

    UNEP has warned that sand is becoming dangerously scarce. It advocates for stronger global regulations, regional co-operation and alternative construction materials such as crushed rock and recycled debris.

    In Kenya, sand isn’t just used locally. It’s also smuggled to neighbouring countries and, allegedly, to international markets — further complicating enforcement.

    However, there are signs of hope. Kenyan authorities have created specialized investigative units in the Mining Police Unit to crack down on illegal extraction. Officials are also piloting new tools, such as satellite tracking and GPS monitoring of trucks, to improve oversight.

    Protecting the land

    Some counties are fighting back. In West Pokot county, authorities recently launched new sand-harvesting policies to control extraction and protect the environment. 

    In Makueni County, the government implemented a comprehensive sand regulation act that has significantly reduced illegal activities and environmental damage within its jurisdiction. When the county lifted its decade-long ban on commercial sand mining to boost revenue, the move sparked concern among residents, who fear the return of water shortages and environmental degradation.

    The persistence of illegal sand mining underscores the need for robust enforcement of regulations, community engagement and the promotion of alternative construction materials to reduce reliance on natural sand resources. 

    Without urgent and co-ordinated action, Kenya faces continued ecological destruction and intensified community conflicts. As Okumu emphasized, transparent governance and meaningful community participation are critical. “With currently poor public participation, rehabilitation work rarely follows in Kenya’s land-based sand mining projects,” he said, underscoring the critical need for reform.

    Research across Africa shows a consistent pattern: profits flow to powerful players, while environmental costs fall on the poorest. Labourers risk their lives in collapsing pits. Farmers and fishers lose the very resources they rely on.

    “We are running out of time,” Okumu said. “Without immediate regional action, environmental damage from sand harvesting will become irreversible, devastating ecosystems and the communities dependent upon them.”

     

    Questions to consider:

    1. Why is sand so valuable?

    2. How are countries like Kenya trying to stop the mining of sand?

    3. Can you think of ways concrete and cement are used near you? Could you think of alternative materials?

     

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  • When musicians get the blues

    When musicians get the blues

    Music is known to boost cognitive and emotional wellbeing, yet those who pursue it professionally experience greater levels of psychological distress compared to the general population.

    Psychological distress among professional musicians is a global phenomenon, shown in studies from Norway, the United Kingdom, Australia and South Korea. More than two-thirds of professional musicians in the UK suffer from depression, according to a 2016 study involving over 2,000 musicians. In Canada, as many as one in five professional musicians experience suicidal ideation.

    Now, musicians are calling on the industry for change. In February, Grammy-winning artist Chappell Roan used her Best New Artist acceptance speech to advocate for healthcare and a living wage for developing artists.

    “I told myself if I ever won a Grammy, and I got to stand up here in front of the most powerful people in music, I would demand that labels in the industry profiting millions of dollars off of artists would offer a livable wage and healthcare, especially to developing artists,” Roan said.

    Major record labels have now provided commitments to the mental health of their artists. Universal Music Group recently partnered with Music Health Alliance to launch the Music Industry Mental Health Fund, which provides a new suite of outpatient mental health support for musicians.

    A lack of support systems

    Musicians’ mental health suffers from a paucity of institutional protections for freelancers, irregular work schedules and profound financial instability. This is often exacerbated by high instances of performance anxiety and perfectionism among professional musicians, said Dr. George Musgrave, senior lecturer in cultural sociology at Goldsmiths, University of London.

    “When people talk about music being good for health and wellbeing, they’re not talking about working musicians,” Musgrave said. “Those who are doing it for leisure or creation are not anxious and depressed in the same way that those who do it for their job are.”

    Unpredictability also characterizes the career trajectories of many professional musicians, said Noah Fralick, artist manager at Huxley Management.

    “You don’t really go to school, get training, then work your way into the workforce and slowly build up,” Fralick said. “There’s no linear path. You might go from total obscurity to huge amounts of popularity quite quickly.”

    Emotional labour is also inherent in this line of work, which can put musicians at risk for mental health pressures, said Dr. Sally Anne Gross, principal lecturer at the University of Westminster.

    “There’s an interrelatedness to sport, where the body’s running so fast and in doing that, you would expect it to get injured,” Gross said. “If you’re working with your emotions in your working environment … you can expect that you might have emotional injuries.”

    The strains of a music career

    The traditional trope of the “tortured artist” — the idea that an artist must suffer pain to generate authentic creative output — has taken on new significance in the digital age.

    “The digital world is desperate for real things,” Gross said. “The artist now has to be larger than life …  in this atmosphere, at this point in time, if you are a young emerging artist or a current artist, you have to engage in a way that is seen to be authentic and there’s nothing more authentic than pain.”

    Mass democratization of music creation has made it easier than ever for musicians to enter the industry, but with no guarantee that their music will find an audience. Musicians feel pressure to show vulnerability as a way to stand out in a market flooded with options.

    “About 100,000 new songs are uploaded to Spotify every day,” Fralick said. “Streaming has sort of eliminated the barrier to access the music industry, but diluted the potential for any one [musician] to be successful.”

    This creates an environment in which consumers fall back to familiar tunes and artists, as deciding between a multitude of new options can feel overwhelming. As a result, it’s a rare artist who becomes a star. But these success stories become well-known, and the dramatic publicization of those who succeed can explain part of the allure of the music business, Fralick said.

    “I always use this analogy of a lottery winner, and the way that lotteries are set up, we see the winner,” Fralick said. “We think ‘I’m going to buy a ticket because that could be me,’ because your brain is only seeing the success story.”

    Pressure to succeed

    Musgrave said that this mindset can be detrimental for musicians. “Many of them are afflicted with what I’ve referred to as cruel optimism. The optimism is cruel because it’s keeping them tethered to an unrealizable ideal,” he said.

    Aside from emotional investment, launching a professional music career can also entail hefty financial costs. These costs could include paying distributors, shooting music videos, receiving coaching and joining premium memberships.

    The opportunity cost can also be significant. “You give up a lot of earning potential in order to invest in this craft,” Musgrave said. 

    For female musicians, age can be a critical stressor and determining factor of success. As the marketability of their music often hinges upon maintaining a youthful image, it can place additional pressures to find success faster.

    Many female musicians see the age of 30 as a hard cut-off, Musgrave said. “Age is a spectre that haunts women’s musical lives in a way that doesn’t haunt men’s,” he said. 

    Getting help to those who need it

    The last 10 years has seen a sea of change regarding mental health interventions for musicians. 

    In the UK, all three major record labels — Universal Music Group, Warner Music and Sony — have mental health support offerings either in-house or through outsourcing. But in-house mental health counselling could present potentially challenging scenarios for conflict of interest, Musgrave said.

    Currently, the biggest source of musicians’ mental health support is the charitable sector. Organizations such as MusiCares, Music Minds Matter, Music Support and the Man Down Programme provide various offerings such as weekly support groups, 24/7 crisis support lines and training packages for music industry workers.

    Gross said that while poor mental health among professional musicians is an urgent concern, that shouldn’t stop schools from providing music education. Instead, the occupational health hazards of professional music careers should be clearly communicated, so that young people can make informed decisions.

    “I think we have to reassess and re-evaluate the ways in which creative industry jobs have been sold to the next generation,” Gross said. “We have to really think about what’s happening in the educational space … and it’s absolutely essential that we deal with the issues and challenges of the working environment for all professionals.”  

     

    Three questions to consider:

    1. What unique pressures do professional musicians face?

    2. What is meant by the term “cruel optimism”?

    3. Why do so many people dream of becoming famous performers?

     

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  • Too much of what’s healthy can be harmful

    Too much of what’s healthy can be harmful

    Some TikTok videos about health and fitness are hard to resist. People describe how they lost weight by eating only raw fruits and vegetables for a month or by substituting protein powder in place of flour or sugar. How many people take these recommendations to heart? What happens if they do?

    Jason Wood was one of them. “I would sprinkle [protein powder] on top of a peanut butter sandwich or a yogurt just to make what I was eating seem healthier,” he said.

    But Wood’s practice of adding protein powder to make his foods healthier wasn’t healthy. Eventually, Wood was diagnosed with orthorexia, an obsession with nutrition. Orthorexia is an eating disorder that differs significantly from better-known eating disorders like bulimia — bingeing and vomiting the food afterwards — and anorexia — not eating at all.

    Wood now works with the National Association of Anorexia Nervosa and Associated Disorders and speaks to audiences about eating disorders. 

    Studies in Australia, Turkey and the United States have found that the viewership of TikTok lifestyle influencers has led to an increase in orthorexia symptoms, which are not well understood by popular culture and are not explicitly defined in psychiatric textbooks. 

    Avoiding what’s bad isn’t always good.

    Rachel Hogg, psychologist and researcher at Charles Sturt University School of Psychology in Australia, defines orthorexia as “the avoidance of foods that are unhealthy or impure.” 

    The term was first coined in 1996 by California doctor Steven Bratman after he decided to eat only clean, nutritious foods. Eventually his research led him to narrow his food options so much that he cut out entire food groups which caused him physical suffering.

    Wood recalls being freezing cold in the middle of summer with his whole body hurting and frequent dizzy spells. Because it’s an outgrowth of healthy eating, the condition is difficult to identify, says Hogg, who calls it “the wolf in sheep’s clothing.”

    Experts feel it is time people paid attention to the risk of developing orthorexia when exposed to high amounts of TikTok content. 

    Todd Minor Sr. lost his youngest son Matthew in 2019 to the TikTok “Blackout Challenge”; people who took the “challenge” would have themselves choked till they blacked out. In a January 2025 edition of Tech Policy Press, Minor called for social media warning labels as a public health tool. “These labels have a proven track record of raising awareness about the risks of dangerous products, especially among young people,” he wrote. 

    People don’t know what’s bad for them.

    Warning labels inform the consumer of the potential risk of product use and advise limiting dangerous exposure to vulnerable groups of people to avoid premature death or disability. According to orthorexia experts, all of these needs exist when it comes to TikTok. 

    Hadassah Johanna Hazan, a licensed clinical social worker in Jerusalem, knows firsthand how the public is painfully unaware of the dangers of orthorexia from talking to her patients. She describes how over the last 10 years ideal beauty has increasingly been defined as a fit and toned physique for both men and women. 

    This has led people to normalize eating patterns that Hazan describes as “very limiting at best and very harmful and unhealthy at worst.” She said constant and regular avoidance of food groups such as carbs or regularly substituting protein powders for ingredients such as sugar become addictions that her patients do not know how to stop. 

    Even those who teach healthy eating can fall into the orthorexia trap. Research published in the June 2021 supplement of American Society of Nutrition by a group of researchers in the U.S. state of Washington indicated that knowledge of orthorexia was low both in the general public sample group and in the sample group of nutrition students.  

    In fairness to TikTok, the social media giant has established an eating disorder safety page but the term orthorexia is never mentioned and there is no mention of content on TikTok being linked to eating disorders. 

    A balanced diet is best.

    Another group of people who seem ignorant of the risk is the group of TikTok health and fitness influencers who are the ones putting out #WIEIAD (What I Eat In A Day) video diaries and other similar content. 

    Elaina Efird, registered dietician nutritionist and TikTok body positivity influencer, said that influencers don’t realize how much they are entrenched in the problem. What motivates these influencers, she said, is that they either truly believe what they are advertising is healthy or they are so distressed by the alternative of being in a larger body that they overlook the harm in what they promote.

    As a TikTok influencer, Efird creates a space where all body sizes are valued and she wants viewership of her positive message to grow. But as a provider of healthcare to eating disorder patients, she also recognizes her moral responsibility.

    “I tell my clients that if they’re struggling, don’t be on TikTok,” she said. This insight comes from an understanding that certain groups of people are at a higher risk of being triggered by TikTok videos than others. 

    Hogg shares this understanding and even used it when co-designing a research study with fellow researcher Madison R. Blackburn that was published in the peer-reviewed journal PLOS One in August 2024. 

    Each participant was screened to make sure they did not have past or present eating disorders before being asked to watch up to eight minutes of TikTok content, which is the equivalent of just over 50 videos. 

    Algorithms don’t know what’s best for us.

    Hogg said that the sad truth is that an eating disorder patient in remission might search for a body positive video but then suggestions pop up on the TikTok homepage, which is called #ForYou, that might tout orthorexia.  She called the algorithm of TikTok a “blunt instrument.”

    Another vulnerable population with strong connections to TikTok are teens and pre-teens. According to a Statistica 2022 survey, 68% of pre-teens were using social media applications and 47% of respondents ages 11–12 were using TikTok in particular.  As Hogg put it, TikTok is powered by “young people creating content for young people.” 

    The disturbing reality known by psychiatrists is that pre-teens are at the highest risk of developing eating disorders because symptoms manifest typically during adolescence. 

    But what scares the public most about any disease is its lethality. According to an article published in February 2021 by the American Society of Nutrition, some 10,200 people die each year in the United States from eating disorders. 

    Even when death is avoided, an obsession with nutrition can lead to nutritional deficiencies, compromised bone mass, extreme weight loss and malnourishment, including brain starvation, even if that seems counterintuitive. And none of that even touches on the effects on mental or emotional wellbeing. 

    Now that Wood is in remission he wants the label “healthy” to be redefined to indicate support of mental, emotional, social and spiritual health and not just support of physical health. 

    Individuals, he said, should stick to positive reasons for engaging with social media such as community building and avoid using it to make harmful comparisons. 


    Questions to consider:

    1.  How do psychologists define orthorexia?
    2. How does orthorexia differ from anorexia or bulimia?
    3. Has social media influenced what you eat? 

     



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  • Bite of the Big Four: India’s deadly snakebite crisis

    Bite of the Big Four: India’s deadly snakebite crisis

    Every year, an estimated 5.4 million people worldwide are bitten by snakes, resulting in as many as 138,000 deaths and three times as many cases of permanent disability.

    The World Health Organization classified snakebite as a neglected tropical disease in 2017 and set a target to halve related deaths by 2030.

    India, home to over 300 snake species, is at the heart of this global health issue, accounting for half of all snakebite-related deaths.

    While 95% of Indian snakes are non-venomous, it’s “The Big Four” species — the Indian cobra, common krait, Russell’s viper and saw-scaled viper — that cause the most harm said Dr. Sushil John, a public health doctor and amateur herpetologist from Vellore.

    “These snakes cohabit in the same spaces as humans, thriving in India’s agricultural fields, forests and urban outskirts,” said John. “So, they often come into close contact with people and might bite them.”

    A study conducted between 1998 and 2014, called the Million Death Study, found that almost 58,000 people in India died from snakebite each year. Second to India in recorded snakebite deaths is Nigeria, with a reported 1,460 deaths per year. 

    The missing data

    “Though India had a severe snakebite problem, accurate data on snakebite deaths in India was elusive for a long time,” said Dr. Ravikar Ralph, a physician at the Poison Control Centre at CMC Vellore.

    In 2011, the official reported number of snakebite deaths was only 11,000. The deaths reported in the Million Death Study highlighted the severe underreporting of snakebite mortality in the country.

    “This is because most studies available at the time were hospital-based, which led to the gross under-reporting of this issue,” said Ralph. “We knew from grassroots work that most patients were not reaching hospitals on time.”

    “Either people didn’t realize that being bitten by a snake required medical management, or they went to traditional healers, causing fatal delays in hospital-based care,” said Ralph. “The Million Death Study used community-based data collection to circumvent that barrier and document accurate numbers.”

    Harvesting the cure

    Snakebites are unique compared to other health issues. Snake venom, a potent mix of proteins, can destroy tissue, paralyze muscles and impair blood clotting, often leading to severe disability which is most likely loss of limbs which were bitten or death if untreated.

    “Unlike diseases caused by other agents such as viruses or bacteria where one can eliminate the causing agent, a similar approach cannot be taken for snakebites,” Ralph said.

    Antivenom is the only specific treatment that can prevent or reverse many of the effects of snakebite, when given early and in the right dosage.

    To produce antivenom, snake venom must be first collected, or “milked,” from live snakes kept in a specialized facility. Only one facility in India, located in Tamilnadu, harvests venom for anti-venom production in India.

    The venom is then diluted and injected in small doses into animals like horses, prompting their immune systems to produce antibodies. These antibodies are then harvested, purified and processed into antivenom.

    But India’s only anti-snake venom treatment targets only The Big Four snakes.

    “There are over 50 venomous snake species in India,” said Gnaneshwar Ch, project lead of the Snake Conservation and Snakebite Mitigation project at the Madras Crocodile Bank Trust.

    “The anti-snake venom’s limited scope means bites from less common species remain inadequately treated,” he said

    Despite its importance, antivenom is also not widely available, and its cost can be prohibitive for many rural families. The gaps in stocking and distribution further worsen the issue.

    While many countries produce antivenom, they tend to cater to the locally available species of snakes making it impractical to import it from other countries to India in order to solve the availability crisis.

    A national action plan

    The WHO has called for concerted global action to reduce deaths and disability in priority nations. In 2019, the WHO launched an international strategy for preventing and controlling snakebite, which was then regionally adapted for Southeast Asia and published in 2022.

    The Indian Union Health Ministry then launched the National Action Plan for the Prevention and Control of Snakebite Envenoming (NAPSE) in March 2024. The NAPSE aligns strategically with the WHO’s global roadmap and its regional adaptation for Southeast Asia.

    Many stakeholders need to join forces in order to balance snakebite mitigation with snake conservation, experts say.

    “Snakes tend to be very important to every ecosystem they are found in,” said Dr. Sushil John. “If snake numbers fall, we would see an increase in rodents which the snakes keep in check by eating. They would then destroy crops and spread diseases to animals and people.”

    While this strategy appears to be heading in the right direction, some experts caution that there might be barriers to implementation.

    “While public hospitals may adopt the reporting system, many Indians seek private health care,” said Professor Sakthivel Vaiyapuri, a venom pharmacologist at the University of Reading in England. “Mechanisms to ensure private hospitals comply with reporting requirements are essential.”

    Vaiyapuri helped work on the National Action Plan. He said health workers who are to report snakebite must understand the significance of their role which will motivate them to record the data accurately. He also said someone must verify the entered data independently to ensure accuracy. He suggests developing a mobile app to streamline data collection.

    While Vaiyapuri worries about the logistics of implementing such a plan for massive surveillance, there are also other worries about unintended consequences for snakebite victims, according to Dr. Anand Zachariah, a toxicologist at CMC Vellore.

    “When India made maternal deaths notifiable, many private clinics in India stopped treating high-risk pregnancies because they worried about the reporting process getting them in trouble if something went south,” said Zachariah. “I fear snakebite becoming a notifiable disease might trigger such defensive practices among physicians.”

    But he admits that at this point, the fear is only theoretical; what will eventually happen remains to be seen.

    “Despite the challenges, I think [the National Action Plan] is a pivotal initiative in tackling snakebite envenomation in India,” Vaiyapuri said.

    “By fostering accurate data collection, promoting intersectoral collaboration and engaging communities, the plan holds significant potential to drive meaningful change — ensuring effective prevention, timely treatment and a significant reduction in snakebite-related deaths and disabilities,” Vaiyapuri said.

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