Reading Test 24
Sweet Trouble
The Australian town of Mossman in the state of Queensland sits in a tropical landscape between the rainforest and the Great Barrier Reef. Eco-tourism is important here; more than 80% of Douglas Shire, of which Mossman is the administrative centre, is protected by World Heritage listing. But for most of the town’s history, forest and reef have been largely irrelevant; since the sugar mill was built in 1894, the town has relied on sugarcane. Now Mossman is holding its breath. For two years, the mill used by all the farmers has been close to bankruptcy. It is at the centre of the economic shocks that have shaken Australia’s sugar industry, and for lifetime farmers and a long list of cane industry workers, a way of life will disappear if the mill closes. Mossman has roughly 100 growers, who now produce less than one million of the nation’s annual cane harvest of 30–40 million tonnes. But it is a microcosm of the industry. All across Australia, the cane-growing business is being squeezed between the pincers of economics and the environment.
The ten-year average return to sugar growers throughout the 1990s was about $350 a tonne. In early 2004, sugar prices plummeted, resulting in a 25-year-low average price for Australian sugar of about $232 a tonne. Although figures vary widely across farms and regions, that was about what it cost to grow a tonne of sugar in Australia. To forestall social and economic disaster, the Government offered more than $400 million to encourage growers to leave the industry. By the end of the year, 21 farmers had taken up the offer to leave, but another 1,000 are thought to be seriously considering it, allowing those remaining to buy the vacated land and improve their economies of scale.
Fourth-generation Mossman grower Bill Phillips-Turner is one who plans to fight on. “The consequences of losing the mill would be a catastrophe,” Bill says. “Sugar has a big economic multiplier effect: for every dollar generated from sugar, an additional $7 is generated in the wider community.” Because of limited options around here, most people now employed by the industry would have to leave the area to find work. The farmer-shareholders have so far saved the mill by accepting substantial cuts to cane payments, but this has come at a big cost to everyone. As chairman of the board of the mill, Bill has presided over some tough and unpopular decisions; the hardest was slashing the mill workforce. Assets were sold and maintenance costs cut. The board has also worked hard to find new ways of doing business. Ethanol production, where sugar is used to produce fuel, has potential, and co-generation — using cane waste to generate electric power — is another possibility. However, the most radical but preferred alternative is to create a future for the mill as a food factory, turning out quality sugar-based foods.
In addition to the economic struggle, there is the environmental one. The sugar industry has the reputation of being environmentally damaging, but it has some surprising supporters. Douglas Shire Mayor, Mike Berwick, is a well-known environmentalist and might be expected to be anti-cane. “There’s no question that part of the damage is done to the reef through chemical and nutrient run-off,” he says. “But there is a formula for sustainable cane production, and Mossman has nearly reached it.” Another endorsement for cane comes from the Queensland Environmental Protection Agency’s sugar liaison officer, Karen Benn: “I’m less worried about the effect of cane on the environment than I am about other agriculture,” she says. “There are good growers everywhere, but at Mossman they are ahead of the game for the challenges they face.” For example, sediment run-off, previously one of the main environmental problems caused by cane growing, is now down to almost nothing once again. According to Dr Brian Roberts, coordinator of the Douglas Shire Water Quality Improvement Program, “North Queensland has set the record for its low levels.” He says, “Now… cane growers in Mossman have worked out how to prevent erosion, and began exploring farming methods that cause minimal soil disturbance.”
However, none of these costly initiatives has helped him get better cane prices. Another cane grower, Doug Crees, comments that “Economically, it [cane growing] doesn’t make much sense. But there’s more to life than money.” It’s this addiction to the way of life that keeps many cane farmers growing an underperforming crop. “It’s a good lifestyle,” Doug says. “I spend eight months working on the farm and four months looking after our kids while my wife works in town. I’ve been looking at alternative crops, like forestry and cocoa, and it turns out that working away from the farm is the best diversification we could do. However, I still don’t want to do that.”
It is difficult to see how anyone can deal satisfactorily with the passing of a way of life. Cane farmers have been part of eastern Queensland for more than a century, but despite the efforts they have put into fighting the good environmental fight, there is no guarantee that the new way of life evolving there will include cane.
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The 2003 Heat wave
It was that summer, scientists now realize, when global warming at last made itself unmistakably felt. People in the Northern Hemisphere knew that summer 2003 was remarkable. Britain had record high temperatures; Europe had uncontrollable forest fires, great rivers drying to a trickle, and thousands of heat-related deaths. But how remarkable that summer was is only now becoming clear.
June, July, and August were the warmest three months recorded in western and central Europe. And they were the warmest by a very long way. Like Britain, Portugal, Germany, and Switzerland had record national highs. Over a great rectangular block stretching from the west of Paris to northern Italy, including Switzerland and southern Germany, the average temperature for the summer months was 3.78°C higher than the long-term average, says the University of East Anglia’s Tyndall Centre for Climate Change Research, one of the world’s leading institutions for monitoring and analyzing temperature records.
That might not seem like much until you consider the usual pattern. But then you realize it is enormous. There is nothing like this in previous data. It is considered so extraordinary that Professor Phil Jones, the unit’s director, openly suggests—in a manner that few scientists have done—that 2003’s extreme temperatures may be directly attributable to global warming caused by human actions, rather than natural climate variations.
Meteorologists have until now satisfied themselves with the idea that recent high temperatures are “consistent with predictions” of climate change. For the significant region in question, the unit possesses reliable temperature records dating back to 1781. Using the average summer temperature between 1961 and 1990 as a baseline, deviations from the norm—referred to as “anomalies”—can be easily plotted.
Over the past 200 years, there have been at least half a dozen instances of temperature anomalies exceeding, or even surpassing, 2°C. However, there has been nothing remotely comparable to last year when the anomaly was nearly 4°C. “That is quite remarkable,” Professor Jones says. “It’s very unusual in a statistical sense. If this series followed a normal statistical distribution, you wouldn’t get this number.”
The return period (i.e., how often it could be expected to occur again) would be something like one in 1,000 years. If we look at an excess above the average of nearly 4°C, then perhaps nearly 3°C of that is natural variability because we’ve observed that in past summers. However, the final degree of it is likely due to global warming, caused by human action.
That year’s summer had, in a sense, been one that climate scientists had long been expecting. Up until then, warming had mainly manifested itself in milder winters rather than significantly hotter summers. Last week, the UN predicted that winters were warming so rapidly that some of Europe’s lower-level ski resorts would disappear.
But sooner or later, the unprecedented hot summer was bound to occur—and that year it did. Over a large area of the western part of the European continent, records were broken in all three summer months. It wasn’t just monthly averages, but also extremes and the durations of periods above thresholds. National records were set in at least four countries.
One of the most striking features of the summer was the warm nights, especially in the first half of August. The high nighttime temperatures were linked to the 15,000 additional deaths in France alone, compared to previous years. They gradually increased during the first 21 days of the month, peaking at around 2,000 a day on August 12 and 13 and overwhelming the medical services. Deaths dropped dramatically after August 14 when minimum temperatures fell by about 5°C. The elderly were the most affected—their death rate rose by 70 percent.
For Britain, the year as a whole is likely to be the warmest on record. But despite the temperature record on August 10, the summer itself—defined as the June, July, and August period—falls behind 1976 and 1995, when there were longer periods of intense heat. At the moment, the year is likely to be the third hottest in the global temperature record (which goes back to 1656), behind 1990 and 2002. However, when the records for October, November, and December are collected, it might move into second place. The ten hottest years in the record have occurred since 1800.
Professor Jones is certain about the extraordinary nature of that year’s European summer. “The temperatures recorded that year were out of all proportion to the previous record,” he says. “It was the warmest summer in the last 500 years and probably even beyond that. It was exceptionally significant.”
His colleagues at the Tyndall Centre are planning a study of it. “It was a summer that hadn’t been experienced before, either in terms of the temperature extremes that were reached or the range and diversity of the effects of the extreme heat,” says the Centre’s executive director, Professor Mike Hulme.
“It will certainly have left its mark on several countries’ thoughts and plans for climate change, much like the 2000 floods transformed how the Government is considering flooding in the UK. The 2003 heatwave will have similar repercussions across Europe.”
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Improving Patient Safety
How improved drug packaging could provide some answers to patient safety issues
Packaging
One of the most prominent design issues in pharmacy is that of drug packages and the patient information leaflets (PILs) included in them. Many pharmacists are concerned that current designs are “accidents waiting to happen.” The UK government shares this concern and, in 2003, the National Patient Safety Agency created a new role, appointing Colin Lowe, who has 14 years’ experience as a designer in the private sector, as head of design and human factors.
Packaging design in the pharmaceutical industry is handled by either in-house teams or external design agencies. For packaging design of over-the-counter medicines, which do not have to be prescribed by a pharmacist but can be bought directly from a sales assistant, characteristics such as attractiveness and distinctibility are important and so these are usually commissioned from an external design team. The marketing team prepares the initial brief and the designers come up with five or seven designs. Two or three of these are then tested on a consumer group. In contrast, most designs for prescription-only products are created in-house. In some cases, this may simply involve the company’s design team applying the house design and then handing it over to design engineers rather than testing the design on a consumer group. Clearly this process cannot adequately address the needs of the wide variety of patients using medication.
Design Considerations
In her book Information Design for Patient Safety, Thea Swayne highlighted a multitude of design problems. For example, drugs that look or sound alike can lead to confusion, small type sizes and even the glare on silver foil packaging can lead to names or instructions being misread. One such example is a drug that was accidentally injected into a patient through the spine (intrathecally) rather than through the veins (intravenously). Investigations following this tragedy attributed some blame to the poor choice of typeface used on the drug container. Furthermore, according to Swayne, real situations in which medicines are used include a parent giving a cough medicine to a child in the middle of the night; packaging should be designed for moments such as these rather than for the ideal world of a hospital.
Safety and Compliance
Child protection is another area that gives designers opportunities to improve safety. According to the Child Accident Prevention Trust, 70% of children admitted to hospital with suspected poisoning have swallowed medicines, and although child-resistant lids have helped, they are not yet fully effective. There is scope for improving what is currently available, according to Richard Mawle, a freelance product designer who feels it is not just children who are blocked by child-proof closures. Many child-resistant packs are based on strength but older people may have the same level of strength as a child, he has remarked, and suggested that better designs could rely on cognitive skills (e.g., removing the lid using a three-step process).
Mawle also worked on a project which involved applying his skills to packaging and PILs. Commenting on the information presented, he said:
“There can be an awful lot of junk at the beginning of a leaflet. For example, why are company details toward the beginning of a leaflet when what might be more vital for the patient is that the medicine should not be taken with alcohol?”
Design Principles and Guidelines
Most designers work according to basic principles; for example, certain print styles are known to be more difficult to read than others. Look-alike boxes present the potential for errors and an obvious solution would be to use colours to highlight a larger dosage of a drug. However, according to Thea Swayne, designating a colour to a particular dosage is not recommended because this could lead to the user relying on colour rather than the words. Design writes that there is a danger that lengthy debates could surround redesign on a box. Design further suggests that PILs be redesigned with black lettering, people would have no choice but to read every box carefully.
The problem is that trials of drug packaging are few — common signage studies concern road traffic signs and visual display units. Although some designers take results from such studies into account, proving that a particular feature is beneficial can be difficult. For example, current UK legislation requires packaging to include the name of the medicine in Braille, but, according to Karel van der Waarde, a design consultant to the pharmaceutical industry, “it is not known how much visually impaired patients will benefit nor how much the reading of visually able patients will be impaired.” Van der Waarde is sceptical about current legislation and says that many regulatory authorities do not have the resources to handle packaging information properly. “They do not look at the use of packaging in a practical context — they only see one box at a time and not several together as pharmacists would do,” he said.
Innovation
On a positive note, a recent innovation exhibition revealed several new designs. The ‘popper’ aims to help arthritis sufferers remove tablets from blister packs, and ‘Pluspoint’, an adrenaline autoinjector (a device that allows diabetics to inject themselves), is aimed at overcoming the fact that many patients do not carry their medication due to its prohibitive size. The aim of good design is to try to make things more user-friendly as well as safer.
The guidelines in Information Design for Patient Safety are not intended to be legally binding. Rather, the book’s purpose is to create a basic design standard and to stimulate innovation. The challenge for the pharmaceutical industry is to adopt such a standard
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