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Kids Handle Pressure. And Others Fall Apart? Why

PO BRONSON and ASHLEY MERRYMAN, authors of ‘‘Top Dog: The Science of Winning and Losing’’ Published on February 6, 2013 in the NYT:

“Why Can Some Kids Handle Pressure While Others Fall Apart?”

Noah Muthler took his first state standardized test in third grade at the Spring Cove Elementary School in Roaring Spring, Pa. It was a miserable experience, said his mother, Kathleen Muthler. He was a good student in a program for gifted children.

But, Muthler said, “he was crying in my arms the night before the test, saying: ‘I’m not ready, Mom. They didn’t teach us everything that will be on the test.’ ”

In fourth grade, Noah was upset the whole week before the exam.

“He manifests it physically,” his mother said. “He got headaches and stomachaches. He would ask not to go to school.” Not a good sleeper anyway, Noah would slip downstairs after an hour tossing in bed and ask his mom to lie down with him until he fell asleep. In fifth grade, the anxiety lasted a solid month before the test.

“Even after the test, he couldn’t let it go. He would wonder about questions he feared he misunderstood,” Muthler said.

Students at Shaker Heights High School in Shaker Heights, Ohio, on Jan. 25, the day before they took the SAT or SAT math subject test.
Clockwise from top left: Elana Ross, Linda Fan, Aryanna Jones,  Sasha Rae-Grant, Patrick Reed, Jeremy McMillan. Platon for The New York Times More Photos »

So this year, Muthler is opting Noah out of the Pennsylvania System of School Assessment, using a broad religious and ethical exemption.
Just knowing he won’t be taking the tests in March has put Noah in a better frame of mind about school. “The pressure is off his shoulders now,” his mother said. When he doesn’t grasp a concept immediately, he can talk it through without any panic.
“He looks forward to science class and math class again,” Muthler said. “He wants to be a chemical or nuclear engineer.”

Muthler understands Noah’s distress; more mysterious is why her son Jacob, who is in eighth grade, isn’t the least bit unnerved by the same tests. He, too, is in the gifted program, but that seems to give him breezy confidence, not fear.

“You would think he doesn’t even care,” Muthler marveled. “Noah has the panic and anxiety for both of them.” Nevertheless, she will opt out Jacob from the tests, too, to be consistent.

Never before has the pressure to perform on high-stakes tests been so intense or meant so much for a child’s academic future. As more school districts strive for accountability, standardized tests have proliferated. The pressure to do well on achievement tests for college is filtering its way down to lower grades, so that even third graders feel as if they are on trial.

Students get the message that class work isn’t what counts, and that the standardized exam is the truer measure. Sure, you did your homework and wrote a great history report — but this test is going to find out how smart you really are. Critics argue that all this test-taking is churning out sleep-deprived, overworked, miserable children.

But some children actually do better under competitive, stressful circumstances. Why can Jacob thrive under pressure, while it undoes Noah? And how should that difference inform the way we think about high-stakes testing? An emerging field of research — and a pioneering study from Taiwan — has begun to offer some clues. Like any kind of human behavior, our response to competitive pressure is derived from a complex set of factors — how we were raised, our skills and experience, the hormones that we marinated in as fetuses.

There is also a genetic component: One particular gene, referred to as the COMT gene, could to a large degree explain why one child is more prone to be a worrier, while another may be unflappable, or in the memorable phrasing of David Goldman, a geneticist at the National Institutes of Health, more of a warrior.

Understanding their propensity to become stressed and how to deal with it can help children compete. Stress turns out to be far more complicated than we’ve assumed, and far more under our control than we imagine. Unlike long-term stress, short-term stress can actually help people perform, and viewing it that way changes its effect. Even for those genetically predisposed to anxiety, the antidote isn’t necessarily less competition — it’s more competition. It just needs to be the right kind.

Every May in Taiwan, more than 200,000 ninth-grade children take the Basic Competency Test for Junior High School Students. This is not just any test. The scores will determine which high school the students are admitted to — or if they get into one at all. Only 39 percent of Taiwanese children make the cut, with the rest diverted to vocational schools or backup private schools. The test, in essence, determines the future for Taiwanese children.

The test is incredibly difficult; answering the multiple-choice questions requires knowledge of chemistry, physics, advanced algebra and geometry, and testing lasts for two days. “Many students go to cram school almost every night to study all the subjects on the test,” says Chun-Yen Chang, director of the Science Education Center at National Taiwan Normal University. “Just one or two percentage points difference will drag you from the No. 1 high school in the local region down to No. 3 or 4.”

In other words, the exam was a perfect, real world experiment for studying the effects of genetics on high-stakes competition. Chang and his research team took blood samples from 779 students who had recently taken the Basic Competency Test in three regions of Taiwan. They matched each student’s genotype to his or her test score.

The researchers were interested in a single gene, the COMT gene. This gene carries the assembly code for an enzyme that clears dopamine from the prefrontal cortex. That part of the brain is where we plan, make decisions, anticipate future consequences and resolve conflicts.

Dopamine changes the firing rate of neurons, speeding up the brain like a turbocharger,” says Silvia Bunge, associate professor of psychology and neuroscience at the University of California, Berkeley. Our brains work best when dopamine is maintained at an optimal level. You don’t want too much, or too little. By removing dopamine, the COMT enzyme helps regulate neural activity and maintain mental function.

Here’s the thing: There are two variants of the gene. One variant builds enzymes that slowly remove dopamine. The other variant builds enzymes that rapidly clear dopamine. We all carry the genes for one or the other, or a combination of the two.

In lab experiments, people have been given a variety of cognitive tasks — computerized puzzles and games, portions of I.Q. tests — and researchers have consistently found that, under normal conditions, those with slow-acting enzymes have a cognitive advantage. They have superior executive function and all it entails: they can reason, solve problems, orchestrate complex thought and better foresee consequences. They can concentrate better. This advantage appears to increase with the number of years of education.

The brains of the people with the other variant, meanwhile, are comparatively lackadaisical. The fast-acting enzymes remove too much dopamine, so the overall level is too low. The prefrontal cortex simply doesn’t work as well.

On that score alone, having slow-acting enzymes sounds better. There seems to be a trade-off, however, to these slow enzymes, one triggered by stress. In the absence of stress, there is a cognitive advantage. But when under stress, the advantage goes away and in fact reverses itself.

“Stress floods the prefrontal cortex with dopamine,” says Adele Diamond, professor of developmental cognitive neuroscience at the University of British Columbia. A little booster hit of dopamine is normally a good thing, but the big surge brought on by stress is too much for people with the slow-acting enzyme, which can’t remove the dopamine fast enough. “Much like flooding a car engine with too much gasoline, prefrontal-cortex function melts down,” Diamond says.

Other research has found that those with the slow-acting enzymes have higher I.Q.’ s, on average. One study of Beijing schoolchildren calculated the advantage to be 10 I.Q. points. But it was unclear if the cognitive advantages they had would stay with them when they were under stress outside the security of the lab environment.

The Taiwan study was the first to look at the COMT gene in a high-stakes, real-life setting. Would the I.Q. advantage hold up, or would the stress undermine performance?

It was the latter. The Taiwanese students with the slow-acting enzymes sank on the national exam. On average, they scored 8 percent lower than those with the fast-acting enzymes. It was as if some of the A students and B students traded places at test time.

“I am not against pressure. Actually, pressure is good [for] someone,” Chang commented. “But those who are more vulnerable to stress will be more disadvantaged.”

As of 2014, Taiwan will no longer require all students to take the Basic Competency Test, as the country moves to 12-year compulsory education. The system will no longer be built to weed out children, but to keep them all in school. But academically advanced students will still take some kind of entrance exam. And those elite students will still feel the pressure, which, it bears repeating, will hurt some but help others.

“The people who perform best in normal conditions may not be the same people who perform best under stress,” Diamond says. People born with the fast-acting enzymes “actually need the stress to perform their best.” To them, the everyday is underwhelming; it doesn’t excite them enough to stimulate the sharpness of mind of which they are capable. They benefit from that surge in dopamine — it raises the level up to optimal. They are like Superman emerging from the phone booth in times of crisis; their abilities to concentrate and solve problems go up.

Some scholars have suggested that we are all Warriors or Worriers. Those with fast-acting dopamine clearers are the Warriors, ready for threatening environments where maximum performance is required. Those with slow-acting dopamine clearers are the Worriers, capable of more complex planning. Over the course of evolution, both Warriors and Worriers were necessary for human tribes to survive.

In truth, because we all get one COMT gene from our father and one from our mother, about half of all people inherit one of each gene variation, so they have a mix of the enzymes and are somewhere in between the Warriors and the Worriers. About a quarter of people carry Warrior-only genes, and a quarter of people Worrier-only.

A number of research studies are looking at COMT, including several involving the American military. Researchers at Brown University have been studying COMT’s connection to post-traumatic stress disorder in veterans of the wars in Iraq and Afghanistan. Quinn Kennedy, a research psychologist at the Naval Postgraduate School, is studying how the gene correlates with pilot performance. Douglas C. Johnson, a professor of psychiatry at the University of California, San Diego, is part of a consortium of researchers called the OptiBrain Center, where he is interested in COMT’s role in combat performance and well-being.

While the studies are ongoing, the early results show those with Worrier-genes can still handle incredible stress — as long as they are well trained. Even some Navy SEALs have the Worrier genes, so you can literally be a Worrier-gene Warrior. In Kennedy’s sample, almost a third of the expert pilots were Worriers — a larger proportion than in the general population.

Kennedy’s work is particularly revealing. She puts pilots through a series of six flight-simulator tests, where pilots endure turbulence, oil-pressure problems, iced carburetors and crosswinds while landing. They are kept furiously busy, dialing to new frequencies, flying to new altitudes and headings and punching in transponder codes.

Among recreational pilots with the lowest rating level — trained to fly only in daylight — those with Warrior genes performed best. But that changed with more experience. Among recreational pilots who had the next level of qualification — trained to fly at night using cockpit instruments — the Worriers far outperformed the Warriors. Their genetically blessed working memory and attention advantage kicked in. And their experience meant they didn’t melt under the pressure of their genetic curse.

What this suggests, Kennedy says, is that, for Worriers, “through training, they can learn to manage the particular stress in the specific pilot training, even if it is not necessarily transferred over to other parts of their lives.”

So while the single-shot stakes of a standardized exam is particularly ill suited for Worrier genotypes, this doesn’t mean that they should be shielded from all challenge. In fact, shielding them could be the worst response, depriving them of the chance to acclimate to recurring stressors. Johnson explains this as a form of stress inoculation: You tax them without overwhelming them. “And then allow for sufficient recovery,” he continued. Training, preparation and repetition defuse the Worrier’s curse.

There are many psychological and physiological reasons that long-term stress is harmful, but the science of elite performance has drawn a different conclusion about short-term stress. Studies that compare professionals with amateur competitors — whether concert pianists, male rugby or female volleyball players — show that professionals feel just as much anxiety as amateurs. The difference is in how they interpret their anxiety. The amateurs view it as detrimental, while the professionals tend to view stress as energizing. It gets them to focus.

A similar mental shift can also help students in test-taking situations. Jeremy Jamieson, assistant professor of social psychology at the University of Rochester, has done a series of experiments that reveal how the labeling of stress affects performance on academic testing.

The first experiment was at Harvard University with undergraduates who were studying for the Graduate Record Examination. Before taking a practice test, the students read a short note explaining that the study’s purpose was to examine the effects of stress on cognition. Half of the students, however, were also given a statement declaring that recent research suggests “people who feel anxious during a test might actually do better.” Therefore, if the students felt anxious during the practice test, it said, “you shouldn’t feel concerned. . . simply remind yourself that your arousal could be helping you do well.”

Just reading this statement significantly improved students’ performance. They scored 50 points higher in the quantitative section (out of a possible 800) than the control group on the practice test. Remarkable as that seemed, it is relatively easy to get a result in a lab. Would it affect their actual G.R.E. results? A couple of months later, the students turned in their real G.R.E. scores. Jamieson calculated that the group taught to see anxiety as beneficial in the lab experiment scored 65 points higher than the controls. In ongoing work, Jamieson is replicating the experiment with remedial math students at a Midwestern community college: after they were told to think of stress as beneficial, their grades improved.

At first blush, you might assume that the statement about anxiety being beneficial simply calmed the students, reducing their stress and allowing them to focus. But that was not the case. Jamieson’s team took saliva samples of the students, both the day before the practice test to set a base line, and right after reading the lines about the new science — just moments before they started the first question. Jamieson had the saliva tested for biomarkers that show the level of activation of the body’s sympathetic nervous system — our “fight or flight” response. The experimental group’s stress levels were decidedly higher. The biological stress was real, but it had different physiological manifestations and had somehow been transformed into a positive force that drove performance.

If you went to an SAT testing site and could run physiological and neurological scans on the teenagers milling outside the door right before the exam, you would observe very different bio-markers from student to student. Those standing with shoulders hunched, or perhaps rubbing their hands, stamping their feet to get warm, might be approaching what Wendy Berry Mendes and colleagues call a “threat state.” According to Mendes, an associate professor of psychology at the University of California, San Francisco, the hallmark of a threat state is vasoconstriction — a tightening of the smooth muscles that line every blood vessel in the body.

Blood pressure rises; breathing gets shallow. Oxygenated blood levels drop, and energy supplies are reduced. Meanwhile, a rush of hormones amplifies activity in the brain’s amygdala, making you more aware of risks and fearful of mistakes.

At that same test center, you might see students shoulders back, chest open, putting weight on their toes. They may be in a “challenge state.” Hormones activate the brain’s reward centers and suppress the fear networks, so the person is excited to start in on the test. In this state, decision making becomes automatic. The blood vessels and lungs dilate. In a different study of stress, Jamieson found that the people told to feel positive about being anxious had their blood flow increase by an average of more than half a liter per minute, with more oxygen and energy coursing throughout the body and brain. Some had up to two liters per minute extra.

Jamieson is frustrated that our culture has such a negative view of stress: “When people say, ‘I’m stressed out,’ it means, ‘I’m not doing well.’ It doesn’t mean, ‘I’m excited — I have increased oxygenated blood going to my brain. ”

As the doors to the test center open, the line between challenge and threat is thin. Probably nothing induces a threat state more than feeling you can’t make any mistakes. Threat physiology can be activated with the sense of being judged, or anything that triggers the fear of disappointing others. As a student opens his test booklet, threat can flare when he sees a subject he has recently learned but hasn’t mastered. Or when he sees a problem he has no idea how to solve.

Armando Rodriguez graduated last spring from Bright Star Secondary Charter Academy in Los Angeles, but he is waiting until next fall to start college. He is not taking a gap year to figure out what he wants to do with his life. He’s recuperating from knee surgery for a bone condition, spending his days in physical therapy. And what does he miss about being out of school? Competing.

“It’s an adrenaline rush — like no other thing.” He misses being happy when he wins. He even misses losing. “At least it was a feeling you got,” he said. “It made you want to be better, the next time.” Without a competitive goal, he feels a little adrift. He finds himself mentally competing with other physical-therapy patients.

Rodriguez recorded a 3.86 G.P.A. his senior year of high school and was a defender for the school soccer team. The knee injury happened during a stint on the school’s football team: his doctor had warned that it was too risky to play, but “I just had to try,” he said. He used to constantly challenge his friends on quiz grades; it’s how they made schoolwork fun.

But when he took the SAT last year, he experienced a different sensation. “My heart was racing,” he said. “I had butterflies.” Occasionally, he’d look up from his exam to see everyone else working on their own tests: they seemed to be concentrating so hard and answering questions faster than he was. “What if they’re doing way better than me?” immediately led to the thought, “These people are smarter than me. All the good schools are going to want them, and not me.” Within seconds, he arrived at the worst possible outcome: his hopes of a good college would be gone.

It might seem surprising that the same student can experience competition in such different ways. But this points to what researchers think is the difference between competition that challenges and competition that threatens.

Taking a standardized test is a competition in which the only thing anyone cares about is the final score. No one says, “I didn’t do that well, but it was still worth doing, because I learned so much math from all the months of studying.” Nobody has ever come out of an SAT test saying, “Well, I won’t get into the college I wanted, but that’s O.K. because I made a lot of new friends at the Kaplan center.” Standardized tests lack the side benefits of competing that normally buffer children’s anxiety. When you sign your child up for the swim team, he may really want to finish first, but there are many other reasons to be in the pool, even if he finishes last.

High-stakes academic testing isn’t going away. Nor should competition among students. In fact several scholars have concluded that what students need is more academic competition, but modeled on the kinds children enjoy.

David and Christi Bergin, professors of educational and developmental psychology at the University of Missouri, have begun a pilot study of junior high school students participating in math competitions. They have observed that, within a few weeks, students were tackling more complex problems than they would even at the end of a yearlong class. Some were even doing college-level math. That was true even for students who didn’t like math before joining the team and were forced into it by their parents. Knowing they were going up against other teams in front of an audience, the children took ownership over the material. They became excited about discovering ever more advanced concepts, having realized each new fact was another weapon in their intellectual arsenal.

In-class spelling bees. Science fairs. Chess teams. “The performance is highly motivating,” David Bergin says. Even if a child knows her science project won’t win the science fair, she still gets that moment to perform. That moment can be stressful and invigorating and scary, but if the child handles it well, it feels like a victory.

“Children benefit from competition they have prepared for intensely, especially when viewed as an opportunity to gain recognition for their efforts and improve for the next time,” says Rena Subotnik, a psychologist at the American Psychological Association. Subotnik notes that scholastic competitions can raise the social status of academic work as well as that of the contestants. Competitions like these are certainly not without stress, but the pressure comes in predictable ebbs and flows, broken up by moments of fun and excitement.

Maybe the best thing about academic competitions is that they benefit both Warriors and Worriers equally. The Warriors get the thrilling intensity their minds are suited for, where they can shine. The Worriers get the gradual stress inoculation they need, so that one day they can do more than just tolerate stress — they can embrace it. And through the cycle of preparation, performance and recovery, what they learn becomes ingrained.

It may be difficult to believe, as Jamieson advises, that stress can benefit your performance. We can read it, and we can talk about it, but it’s the sort of thing that needs to be practiced, perhaps for years, before it can become a deeply held conviction.

It turns out that Armando Rodriguez was accepted at five colleges. He rallied that day on the SAT. It wasn’t his best score — he did better the second time around — but it was not as bad as he feared. Rodriguez had never heard of Jeremy Jamieson. He had never read, or ever been told, that intense stress could be harnessed to perform his best. But he understood it and drew strength from it. In the middle of his downward spiral of panic, he realized something: “I’m in a competition. This is a competition. I’ve got to beat them.”

Editor: Vera Titunik

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Part 11. How Israel in 1948 committed Ethnic Cleansing of Palestinians, about 400,000 within days in first stage

The Expropriation of Palestinian Land

Resolution 181 and the Early Phases of the 1948 War

More rules of life: In very reduced numbers

Nhan-Ficti​on

And more:

Khalil Toubia shared ‎رابطه الطلاب الليبرالين‎’s photo.
هل عرفت معنى الرحمة !!</p> <p>Gebso
Adopt a puppy goat?

What’s the trouble with learning? Continuous learning as you keep growing in age?

Maxwell said, “Leaders are learners.”

By Dan Rockwell

The trouble with learning is unlearning.

The trouble with learning is it changes past thinking. Learning amplifies, modifies, or invalidates past learning.

The trouble with learning is rethinking. New thoughts evaluate old thoughts. Learning tests old assumptions, strategies, or methods.

The trouble with learning is being wrong.

All learners inevitably say, “I was wrong when I thought the earth was flat.”

  1. If you can’t be wrong, you can’t learn.
  2. If you can’t learn, you can’t grow.
  3. If you can’t grow, you’re compost.

Those who can’t learn become history lessons for learners. Don’t be like Kodak, for example.

Learning leaders:

  1. Welcome awkward and uncomfortable questions from underlings and outsiders. Insiders seldom put you on the spot. You sign their pay checks and impact their career.
  2. Explore the assumptions of others. Learning leaders assume the assumptions of others. Try getting in the head of someone else and defending their position. You never learn when all you do is defend what you know.
  3. Read every day.
  4. Ask, “What if?” often.
  5. Journal. Record and reflect upon what you learn.
  6. Adapt and change. Name one thing you’ve changed in the last few months. You haven’t learned till you change, regardless of what you know.
  7. Draw out thoughts and ideas from others. How is the idea-flow around you? Is your closed mind closing their mouths?

Bonus: Never fall back on, “When I was young we did it …”

Next step learning:

“Before you become a leader, success is all about growing you. When you become a leader, success is all about growing others.” Jack Welch

Leadership is about others. The most important thing leaders learn is how to grow others.

What hinders leaders from being learners?

How can leaders grow others?

Tidbits and notes posted on FB and Twitter. Part 220

Note: I take notes of books I read and comment on events and edit sentences that fit my style. I pa attention to researched documentaries and serious links I receive. The page is long and growing like crazy, and the sections I post contains a month-old events that are worth refreshing your memory

“A Berlin, on pourrait recruter 20 chomeurs pour controller si les proprietaires de chiens ramassent les crottes de leurs animaux” (Claudia Hammerlig, deputee’ Verte). Je pense que ces controlleurs de crottes doivent eux-meme les ramasser  s’ils donnent une amende: ou bien ils les ramassent ou bien les clients paient une amende. 

Les controlleurs de crottes de chiens doivent pouvoir louer aux proprietaires de chiens les equipement necessaire pour ramasser les crottes

 “Seul celui qui travaille doit pouvoir manger?” (Depute’ alleman Munteferingo). Et Tous ceux qui touchent des allocations doivent fumer et boire de la bierre?

La pauvrete’ decoule du comportement des gens de sous-culture? Sous-entendu, c’est pas le porte-monnaie qui est vide, mais l’esprit. Comme si les riches qui achetent des objets de luxes qu’ils n’utilizent pas, ou bien une seule fois, ont tant d’esprit a distribuer?

To where the 200,000 inhabitant of Al Raqqa were transferred to? The USA has the humanitarian duty to save all civilians and Not commit war crimes as ISIS and allow UN team to visit this totally bombed and demolished city. 

Now that Turkey entered Afrin, it want to attack the city of Manbej in the Syria Kurdish canton of Kobani? This city co-habit “Arab” tribes, Kurds, Turkmenes, tcherkess and Tchetchenes. It was liberated in 2015 from ISIS.

The northern region of Syria is at proximity of historic cities such as Mardin and Nusaybin that mandated France over Syria and Lebanon gave to Turkey in 1935

A Kobani, dans la residence Kongra Star, ce sont les femmes qui traitent les plaintes de vendetta des crimes d’honneur, avant de les referer a la justice quand elles ne trouvent pas de compromis.

En 2015, l’ organisation Kurde de Syrie (PYD), a l’instigation des Americains, ont rases des villages entieres dans la region de Tell Abyad pour que les Americains construisent leurs bases militaires (des crimes de guerre documentes par Amnesty)

A l’ Assemblee’ Legislative du canton Kurde Al Jazira (Cezire) dans la ville de Amoude siege 101 membres , dont la moitie’ sont feminins.

Rojava (Ouest du Kurdistan) de Syrie, Iraq et Turkie

Les grandes puissances coloniales ont l’intention d’hypoteque’ l’avenir du Nord Syrie, riche en hydrocarbure (25% des reserves de terre), surtout dans la region de Al Malikiyah (Rumeillah) pres de la riviere Tigre.

Le contrat social de la Federation democratique des Kurdes de la Syrie rejette le nationalism et prone une societe’ egalitaire, paritaire et le respect des droits des minorites. (Mireille Court et Chris Den Hond, envoyes speciaux du Monde Diplomatique)

Les organizations Kurdes PKK et le PYD se referent a Abdullah Ocalan (Kurdish/ Turkish leader in prison since 1999) et a l’ecologiste Americain Murray Brookchin (1921-2006)

Tidbits and notes posted on FB and Twitter. Part 219

Note: I take notes of books I read and comment on events and edit sentences that fit my style. I pa attention to researched documentaries and serious links I receive. The page is long and growing like crazy, and the sections I post contains a month-old events that are worth refreshing your memory

Frappe-toi le coeur c’est la’ qu’ est le genie”? (Alfred de Musset). Le genie de survivre tous les malheurs avec l’espoir de trouver l’amour?

L’existence est un miserable tas de secrets? Apparemment, je ne suis pas conscient de petits secrets: j’ai tout revele’ dans mon auto-biographie of Not a famous person.

Pour etre habilite’ professeur en medecine, il faut publier une douzaines d’articles pour des revues Americaines et sur un support informatique.

The Syrian Kurds are located in 3 cantons in north Syria (Afrin that Turkey captured), Kobani and Al Jazirat or Cezire). They elect their own parliaments. Those in the canton of Afrin and Kobani pay ideological allegiance to Abdullah Ocalan.

This Turkish/Kurdish leader, Abdullah Ocalan. has been in Turkish prison since 1999, on an island. Late Syrian President Hafez Assad had to deliver him after Turkey warned of imminent war if Ocalan is Not transferred over.

The Kurds in canton of Al jazira pay also allegiance to the American ecologist Murray Brookchin (1921-2006). The Kurds in north-west Iraq also have same ideological allegiance to those in Syria, but the feudal Barazani clan in eastern north Iraq is for sale to highest bidder.

Where the streets have no name: Israel leaves Palestinians in postal ‘dark age’ #Occupation

Europe relied on the silk, spices, perfume, and luxury items imported from China and India through Persia, Turkey and Egypt.

The Great Wall of China is the only human made construction that can be seen from space.  Three centuries before Portugal put to sea its galleons to circumnavigate oceans, China had fleet of ships 3 times bigger than the biggest that Spain constructed.

Tacit slaving system: Les jobs precaires “Nous fournissons aux employeurs un materiel humain bon marche’.

“7adrat al mo7taram. Iza ghafelt yawm 3an al siyaam wa salayt, hal salati makboulat?” Ya benti, bonsa7ik trouhi wa dabdabi

Ma fi bil midaan 7amlaat intikhabiyyat ella Jobran Bassil. Bakkiyat ma baka min kol al siyassiyeen wa al “zou3amat” 3am yel3abo bi shi tani. Bi sheddo 7alon ta ye laa2o al jam3a wa yestaffo 3ala karaassi lama bi ye3lno assamihom ka mourashaheen

Ma b7eb kazzeb al naass: iza talla3o isha3a enno la2eem, baddi thabett hal isha3a

Under fire in Britain:
Consultants are Overpaid or undervalued?

Mary Braid and Ian MacKinnon report in The Independent:

In the he predominantly middle-aged ranks of the medical consultant, Robert Williams is distinguished by precocious talent.

At 32 he became one of Britain’s youngest eye surgeons. Six years later, his expertise in one of medicine’s more lucrative specialisms earns him more than 90,000 pounds a year.

Like two-thirds of Britain’s 18,000 consultants, Mr Williams treats both health service and private patients. His NHS salary at Worthing Hospital, West Sussex, is 44,000 for roughly 40 hours a week.

He more than doubles his earnings by working 20 hours in the private sector. On an average ‘private’ afternoon, he can perform four or five cataract operations, charging about pounds 700 each.

He admits the sums to be made in private practice initially shocked him. But he is a pauper compared with some colleagues.

Doctors in full-time private practice can make more than pounds 300,000 a year.

For those who combine NHS and private work, William Laing, a leading health consultant, says the top 2,400 consultants earn pounds 95,000 from private practice, and many double this with NHS pay and bonuses.

Those with the highest earnings are invariably orthopaedic and ENT (ear, nose and throat) doctors, who build up thriving private practices by performing the most common or expensive operations.

Specialisms like public health and geriatrics are comparative Cinderellas.

With consultants’ earnings so high, there may have been some public glee at last week’s announcement by the Monopolies and Mergers Commission of an investigation into the price guidelines for private operations set out by the British Medical Association.

The BMA rejects suggestions that its guide prices create a consultants’ cartel, preventing competition between doctors. They are, it argues, simply an indication of the ‘going rate’ for a surgical procedure. (Just set the max price and allow competition)

Consultants, however, are beginning to feel persecuted by the questioning of their practices and earnings.

Conscious of their poor public image, few will speak on the record, but some suspect an orchestrated assault on the powerful institutions of the Royal Colleges, which critics say perpetuate an 18th-century guild model of training and education in medicine, turning on apprenticeship, patronage and promotion by preferment.

Two weeks ago, a government working party was set up under Kenneth Calman, the Chief Medical Officer, to investigate the Colleges’ failure to follow EC directives on the certification of doctors.

The directives, set out in 1977, were designed to allow doctors to work in all EC countries. A leak has already revealed that the Department of Health accepts the complaints from the European Commission that Britain’s system is ‘unlawful and discriminatory’.

Meanwhile, junior doctors are clamouring for admission to the select consultants’ ‘clubs’, arguing that the 10 to 15 years’ training needed to gain specialist accreditation is twice as long as it need be, barring them from private practice and NHS ‘merit money’ or bonuses.

Legal action is being taken to end ‘restrictive practices’.

Dr Anthony Goldstein, a Harley Street rheumatologist who has failed to gain consultant’s accreditation, has won a judicial review of the laws governing specialist medical training.

Private health insurers, increasingly concerned about poor profits and rising costs, are privately delighted by the Monopolies Commission inquiry.

Mr Laing, author of the annual review of private health care, said: ‘Health insurers want as good a deal as possible for their clients and they feel the fees are too high. How the level of fees was set in the first place is lost in the mists of time. But Bupa has never negotiated fees with doctors. They just started from the position that doctors’ charges had to be fully reimbursed.’

David Cavers, managing director of insurers Norwich Union Healthcare, has commissioned a detailed study by private health care consultants.

When it is published next week, it will show that consultant surgeons earn an average of pounds 50,000 a year from their private caseload in just one-sixth of their working week.

If they worked full-time in private practice, their annual salary would be pounds 300,000, compared with an NHS salary of pounds 50,000 a year.

‘You have to ask yourself, is that rate right?’ said Mr Cavers. ‘Initially, private insurers needed to pay a premium to attract consultants, because there were so few in private practice. But now two-thirds of consultants do at least some private work and the supply has gone up dramatically. But fees have continued to rise dramatically. In any other market you would have expected economies of scale.’

Insurers are beginning to examine other ways to force down costs.

Bupa, with the largest market share of about 44% may introduce cost-cutting clinical protocols for consultants.

The Government’s squeeze on consultants began two years ago after complaints that too many were leaving junior doctors to cope while they feathered their nests in private practice.

Ministers introduced new ‘job plans’ for consultants, formalising for the first time their NHS commitments.

Mr Williams believes that the prevalence of ‘shirking’ was exaggerated and the government’s measures to combat it have proved a waste of time.

He estimates that 10-12% of consultants neglected some of their NHS duties and that that remains unchanged. Flexible working patterns mean that much still depends on trust. The vast majority of consultants fulfill their contract or do a little more.

Under his contract, Mr Williams runs three outpatients clinics and three operating sessions a week for the health service.

NHS administrative work and private practice occupy the remaining two working days and spill into his evenings. He prefers not to operate or run clinics at the weekend except in emergencies.

He says it is difficult to know what to charge for an operation, and so the annual BMA guide prices introduced in 1989 are useful. He says rival guidelines produced by Bupa are too low and out-of-step with those of other insurers. ‘I frequently charge a great deal less than the BMA guideline price and in a couple of cases charge a bit more,’ he said.

Professor Miles Irving, chair of external affairs for the Royal College of Surgeons, claims that the BMA guide prices give little cause for concern. He says there is no intentional cartel, and many doctors prefer to follow the Bupa guidelines anyway.

Mr Williams points out that private practice involves costly overheads. He employs two administrators and three nurses part-time and has to fund his own offices. He sees no ethical conflict in combining private and NHS practice. Very committed to the NHS he has no desire to reduce his hours at Worthing Hospital. Private practice is in his own time and never interferes with NHS commitments, he says.

Professor Irving says private practice is a fact of life grasped by Worthing Hospital which is currently considering setting up a private wing in a disused ward. If Mr Williams carried out his private work there, then the hospital would get its cut of the profits which could be pumped back into the NHS.

Mr Williams says estimating one’s professional worth is always difficult. ‘In one sense I am a total parasite. I am trained by the state and I don’t produce anything. But on the other hand I am one of only 400 specialist eye surgeons in England and Wales. This is an extremely competitive profession.’

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