The term “addictive personality” is widely used. Are some people really more prone to developing an addiction? During the 1990s, the term “addictive personality” was used by some pharmaceutical companies – and, perhaps ironically, to promote addictive painkiller drugs.
While marketing the opioid prescription drug OxyContin, for example, US pharmaceutical company Purdue Pharma instructed their representatives to tell doctors that only people with an “addictive personality” were at risk of becoming addicted, despite knowing that it was highly addictive and widely abused.
Highly addictive drugs such as OxyContin and the opioid fentanyl are blamed for fuelling the opioid crisis in the US, which caused more than half a million deaths between 1999 and 2020. The idea that your personality determines whether or not you become addicted to a substance would have “suited the pharmaceutical industry very well”, says Ian Hamilton, associate professor in addiction at the University of York in the UK.
“It kind of lets them off the hook. The message is: ‘if you’re weak enough to develop a problem with our product, it’s due to your personality, it’s nothing to do with us’.”
But is there such a thing as an addictive personality? Are some people really more prone to developing an addiction? Many psychiatrists and addiction experts say there is no scientific evidence supporting the idea. They also warn that the concept is harmful as it suggests that people have little to no control over whether they become addicted.
They do note that there are some links between certain personality traits and addiction, but these are far more complex than the “addictive personality” claim often indicates. Mark Griffiths, distinguished professor of behavioural addiction at Nottingham Trent University in the UK, describes the “addictive personality” as a “complete myth”.
“For there to be such a thing as an addictive personality, what you’re saying is that there’s a trait that is predictive of addiction and addiction alone,” says Griffiths. “There is no scientific evidence that there is a trait that predicts addiction and addiction alone.”
Proprietary software is often seen as the holy grail for companies, a sure sign that they’ve “made it.” Ushering in digital transformation establishes a business as technologically advanced and innovative, while simultaneously boosting the company’s overall value.
However, when creating a software development budget, many upstart businesses tend to be overly cautious, leading them to spend more money in the long run. A tight initial budget doesn’t account for project changes that will inevitably crop up during the developmental stages.
Overhauls in software and app development can result in higher long-term costs when the necessary capital isn’t available from the onset. According to a 2020 report from the Consortium for Information & Software Quality, unsuccessful software projects cost companies $260 billion, and software systems with operational failures cost $1.56 trillion.
Building more budget into the front end of software development can help you anticipate failures and properly allocate resources to make the software successful. I connected with Mohan Karunanidhi, Consulting Director for Propel Technology, who has expertise in helping businesses navigate the processes of sourcing software and managing projects, including offering innovative ideas to solve budgetary problems.
When creating the budget for propriety software, here are three things that Karunanidhi recommends businesses consider:
1. Set expectations on what your software will accomplish.
What does the team want the software to actually do? Are there specific problems that the software will solve? How will it do so? Are there experts in-house already, or does a person or team need to be hired to help develop the software? Outlining the goals of the software and having an in-depth understanding of what it will do is an essential first step in establishing your budget.
“Budgeting for a software solution should be preceded by budgeting for a hypothesis or a proof of concept,” Karunanidhi said. “Having a deeper understanding of the requirement by identifying and onboarding the right people with subject matter expertise and industry experience is critical to having a keen sense of budgeting once the hypothesis is proven.”
2. Consider the end-user experience.
Who is your software’s intended user, and how will they use it? A key component in software development comes from real user trials and feedback implementation, where the trials are repeated until the software is completely dialed in. Conducting trials and integrating changes into the software require capital. If enough isn’t set aside up front, a business can—and ultimately will—lose funds from having to recreate its product or from a lack of product sales and revenue.
“A constrained budget will have a direct influence on time and quality—the triangle factor that stays relevant until this date,” Karunanidhi said. “When it comes to budgeting, the optimistic part of the human mind tends to associate only with the best-case situations. With so much to accomplish on a restricted budget, incompleteness and inconsistency in requirements are frequently uncovered later in the development lifecycle.”
Karunanidhi went on to say: “Failure to construct for scalability and test the solution is particularly damaging because the potential delay happens at the end of the development lifecycle, making recovery impossible. A limited budget forces the compression of many deliverables into a short period of time, diminishing the possibility to construct an application based on feedback from actual users.”
3. Create a realistic timeline.
“When is this software needed?” is always the big-picture question. But between now and the deadline, myriad risks and problems can occur, and they need to be budgeted for. You must widen the scope of work to include the “what ifs.” What could happen? What expectations does the team have? What kind of hiring and training is needed? Roughly 20% of software development is spent fixing problems that likely could have been avoided if a larger budget had been created.
Tight software budgets cause headaches for everyone involved because they directly influence the time and quality of the product. Budgeting with an optimistic mindset, as opposed to a realistic one, only allows for best-case scenarios to play out in development. The lifespan of production in software requires a lot of work. Attempting to accomplish it all on a restricted budget leaves room for an incomplete and inconsistent product, factors that are often uncovered later in the development lifecycle.
Failure to account for scalability and test the solution is particularly damaging because the potential delay happens at the end of the development lifecycle, making recovery impossible. A limited budget forces the compression of many deliverables into a short period of time, diminishing the possibility of constructing an application based on feedback from actual users.
As an example, Karunanidhi explained that a tight budget caused a company to build an app for users on only one platform. Later, the company discovered that the application should have been designed as a cross-platform solution (on iOS, Android, and the web). The software had to be redesigned for cross-platform user expansion, a consequence of starting the project with a too-conservative budget. This ultimately cost the company more money because it delayed the time to market for all platform users and affected users who had already used the application.
The new businesses that think incorporating propriety software into their companies is a sign that they’ve “made it” are forgetting a few things about software development: To truly “make it,” you must understand what your software solution aims to accomplish, onboard the right team to achieve your goals, and create a budget that allows for trial and error to fix problems as they arise. Ultimately, creating a larger budget for development will prove that your business has truly arrived.
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Lea Grinberg, a neuropathologist and associate professor at the UCSF Memory and Aging Center in San Francisco's Mission Bay, holds slides of brain tissue used for research on August 15, 2019. (Lindsey Moore/KQED)
People who donate their bodies to science might never have dreamed what information lies deep within their brains. Even when that information has to do with sleep. Scientists used to believe that people who napped a lot were at risk for developing Alzheimer’s disease. But Lea Grinberg with the UCSF Memory and Aging Center started to wonder if “risk” was too light a term — what if, instead, napping indicated an early stage of Alzheimer’s?
About a decade ago, Grinberg — a neuropathologist and associate professor — was working with her team to map a protein called tau in donated brains. Some of their data, revealed drastic differences between healthy brains and those from Alzheimer’s patients in the parts of the brain responsible for wakefulness.
Lea Grinberg uses a program that takes a microscope’s magnification of brain tissue on a slide and projects it on a computer screen on August 15, 2019. The different colors represent different biological features in the brain tissue sample, including neurons and tau protein. (Lindsey Moore/KQED)
Wakefulness centers in the brain showed the buildup of tau — a protein that clogs neurons, Grinberg says, and lets debris accumulate. Gradually, these clogged neurons die. Some areas of the diseased brains had lost as much as 75% of their neurons. That may have led to the excessive napping scientists had observed before. Although the team only studied brains from 13 Alzheimer’s patients and 7 healthy individuals, Grinberg says that the degeneration caused by Alzheimer’s was so profound they were sure of its significance.
“We are kind of changing our understanding of what Alzheimer’s disease is,” she says. “It’s not only a memory problem, but it’s a problem in the brain that causes many other symptoms.”
Although these symptoms aren’t as severe as complete loss of memory or motor functions, Grinberg says they can still hold real consequences for a person’s quality of life. “Because if you don’t sleep well every day and if you… are not in the mood to do things like you were before, it’s very disappointing, right? My grandparents were like this.”
Grinberg says it’s important to know whether napping could be an early sign of Alzheimer’s, for treating symptoms and developing drugs that could slow the progression of the disease. Although there are no prescription drugs available to treat tau buildup, she says, a few are in clinical trials.
A public health professor and neuroscientist at UC Berkeley says the new information offers hope to researchers. William Jagust, who has studied Alzheimer’s for over 30 years, says the results could help select patients for clinical trials of new drugs that require early treatment. “It’s also just very important for understanding the evolution of Alzheimer’s disease with the hope that we eventually will have a drug,” he adds.
It’ll be awhile before doctors can diagnose anyone with Alzheimer’s based on how often they doze off. “There’s no practical application of this to clinical medicine as of today,” Jagust says, “but I think it’s on the cutting edge of the very, very important questions.”
While estimatesdiffer, a prominent study found that the share of screened Flint children under the age of 5 with high lead levels reached 4.9 percent in 2015, up from 2.4 percent before the problems with lead contamination began. According to the CDC guidance at the time, a level of lead in blood that would be considered high was 5 micrograms per deciliter (µg/dL) (the agency has since lowered the threshold to 3.5 µg/dL).
That said, no level of lead exposure is considered safe, and even exposure well below public health recommendations can be quite harmful. That nearly 5 percent of young children in Flint faced exposure to rates that high is a travesty. As scandalous as the Flint lead crisis is, it’s sobering to know that it may be just the tip of the iceberg globally.
A recent systematic evidence review, widely cited and respected in the field, pooled lead screenings from 34 countries representing two-thirds of the world’s population. The study estimated that 48.5 percent of children in the countries surveyed have blood lead levels above 5 µg/dL.
Let me repeat that: Flint became the symbol of catastrophic lead exposure in the United States. The breakdown of a long-neglected system was so terrible that it led to headlines for months and even became an issue in the 2016 presidential election. Yet children in low- and middle-income countries are, per this estimate, 10 times likelier to have high blood lead levels than children in Flint were at the height of the city’s crisis.
The lead problem is global. It’s catastrophic in scope and hurting children’s ability to learn, earn a living when they grow up, and function in society. Yet lead has gotten comparatively little attention in the global public health space.
Lead is soft, plentiful, and easy to mine and manipulate, which is why humans have been harnessing it for various purposes for thousands of years. Ancient Romans used lead for everything from water piping to pots and pans to face powder to paint to wine preservatives.
Today, common uses of lead still include cookware, paint, and piping, along with lead acid batteries (a technology still used for most car batteries, even in hybrids), and plane fuel. For decades, a major use of lead was as an additive to gasoline meant to prevent engine knocking.
“Lead causes toxicity to multiple organs in the human body,” Philip Landrigan, a doctor and professor at Boston College who conducted key studies on the effects of lead in the 1970s, told me. “In infants and children, the brain is the big target. But we also know very well that adults who were exposed to lead — especially people exposed occupationally [and thus exposed to high amounts] — are at very substantially increased risk of heart disease, hypertension, and stroke.”
Lead exposure can be quite deadly. Some of the best evidence here comes from a recent study examining Nascar’s decision to ban leaded gasoline from its cars in 2007. Overall, mortality among elderly people fell by 1.7 percent in counties with Nascar races after the races stopped using leaded gas. The authors estimate that Nascar and other leaded gas races had caused, on average, about 4,000 premature deaths a year in the US.
The biggest costs of lead, though, are its effects on the brains of children. The developing brain is, in Landrigan’s words, “exquisitely sensitive” to the effects of lead. “It damages neurons; the active cells in the brain that we use for reflexing, running, and jumping, everything,” he explains.
The effects of lead “seem to concentrate in the prefrontal cortex,” Bruce Lanphear, a leading medical researcher on lead’s effects based at Canada’s Simon Fraser University, told me. That part of the brain is smaller in adults who were exposed to lead as children, he added.
Neuroscientists believe the prefrontal cortex plays a key role in executive functioning: the ability of people to choose behaviors in pursuit of conscious goals rather than acting on impulse. “It’s what distinguishes us from other animals, what makes us human,” Lanphear said.
For just about any variable you can imagine related to human behavior and thinking, there is probably research indicating that lead is harmful to it. High lead exposure reduces measured intelligence substantially. “If we compare kids at the lower and higher end [of lead exposure], we saw a 5-8 point IQ difference,” Aaron Reuben, a psychologist at Duke University and lead author on a study looking at a cohort in New Zealand, told me. Higher lead levels are associated with higher rates of ADHD and negative changes in personality.
Reuben says his research has found that kids exposed to lead are “less conscientious, less organized, less meticulous. They’re a little less agreeable; they don’t get along as well with others. They’re more neurotic, meaning they have a higher propensity to feel negative emotions.”
In recent years, some writers have embraced a theory that declining lead exposure (mostly due to the gradual removal of lead from gasoline) was a leading factor in the drastic decline in crime, especially violent crime, in the United States in the 1990s. Whether or not lead explains that specific historical phenomenon, several high-quality studies have found a relationship between high lead exposure and crime and delinquency.
This evidence is suggestive, not definitive. A recent meta-analysis argued that when you take into account the likelihood of publication bias (that is, that studies showing a strong effect of lead on crime are likelier to be published than studies finding little effect), the effect size could be quite small and not explain any of the decline in homicide rates in the US.
But the idea that lead has a high social cost does not hinge on a specific narrative about crime. Lead appears to be consistently costly across outcomes from IQ to personality to impulse control to elderly mortality.
“Lead has been really bad and very significant in the history of social behavior,” Jessica Wolpaw Reyes, an economist at Amherst College and author of that last paper, summed it up to me.
Lead exposure is still very common in the developing world
The story of lead exposure in the United States and other rich countries in recent decades has in fact been enormously positive. Yes, there have been disastrous lapses as in Flint, but they stand out precisely because they are such an exception to recent trends.
A recent paper from CDC researchers estimated that from 1976 to 1980, fully 99.8 percent of American children aged 1 to 5 had levels of lead in their blood of over 5 micrograms per deciliter. From 2011 to 2016, the share was down to 1.3 percent. In a major triumph for environmental public health, high-level lead exposure went from the norm to an aberration in just four decades, in large part due to the abandonment of lead in gasoline.
As bad as things are in developing countries today, lead exposure in those nations is much less prevalent than it was in the US 40 years ago — a sign of global progress. That said, lead exposure in developing countries appears to be quite high compared to exposure in rich countries today.
Several experts I spoke to pointed to the 2021 evidence review led by Bret Ericson that I referenced above as the best summary of what we know about how common lead exposure is in low- and middle-income countries. In 34 nations, which together account for over two-thirds of the world’s population, the researchers were able to find blood lead surveys they considered reasonably representative of the country’s children, usually conducted by nonprofits or government agencies.
Overall, those studies estimated that 48.5 percent of children had high lead levels (defined as above 5 ug/dL). Levels of exposure varied greatly, with surveys in a few countries (like Tanzania and Colombia) not finding any children with blood lead levels above 5 ug/dL, and other countries showing huge majorities with levels that high. In Pakistan, for instance, over 70 percent of children had high blood lead levels.
Lead in poor countries comes from everything from batteries to turmeric
While the numbers above give a sense of the lead problem’s scale, they are not definitive. One consistent message I heard from experts is that we simply need a lot more data on lead in low- and middle-income countries.
The Ericson evidence review concluded, “there is a paucity of rigorous data on lead exposure in the general populations of [low- and middle-income countries].” Most countries in Africa, and several in Latin America and Central Asia, did not have data usable for the review.
Lead experts also disagree about what the primary sources of lead exposure in developing countries might be. Pure Earth, the largest nonprofit working on lead contamination in developing countries, has generally focused on reducing exposure from informal recycling of lead-acid car batteries. In many developing countries, such recycling happens in mom-and-pop operations in backyards, with no protection for the recycling workers or neighboring residents from the resulting fumes.
Lead is very heavy, and in lead chromate form, it’s a vibrant yellow, which makes it an easy way to adulterate and amplify the color of turmeric. The problem likely spans beyond just Bangladesh. Consumer Reports has found that even in the US, grocery stores were selling turmeric cut with heavy metals.
Aluminum pots and pans in these contexts “are generally made in local recycling places where the recyclers are throwing all this scrap metal in,” he said. “It’s almost impossible for them to not get lead in.” In turn, that lead can seep into food cooked using these tools.
But other, smaller organizations focus on different lead sources. Lead Exposure Elimination Project (LEEP), founded in 2020, has mostly focused to date on lead paint. Just as lead can make turmeric more vibrant, it can make yellows and whites in paint more vibrant too. “We decided to start with lead paint because it seemed like a significant source of exposure, and there’s an obvious approach to tackling it, which is regulation,” Lucia Coulter, a medical doctor and LEEP’s co-founder, told me.
Tackling lead paint requires introducing new laws and enforcing old ones. Jerry Toe, an official at Liberia’s Environmental Protection Agency (EPA) who has worked with LEEP on lead paint, told me that while the country had adopted a law banning lead paint in 2004, the Liberian EPA had still not formalized any regulations deriving from it by 2019, when he came to the issue. It took a LEEP study in Malawi for regulators in that country to conduct regular monitoring of lead levels in paints for sale.
Imran Khalid, a researcher at Pakistan’s Sustainable Development Policy Institute and director at the World Wildlife Fund Pakistan, has had a similar experience. “The implementation [of lead regulations] is quite poor,” he told me. “Our environmental laws are primarily lip service.”
Khalid has been working with LEEP on paint sampling studies in which he and other researchers obtain paint from stores and test it for lead. Zafar Fatmi, a professor at Aga Khan University in Karachi, said that in his initial testing, around 40 percent of paints had high levels of lead.
Khalid notes that some high-lead paint comes from major multinationals, which makes enforcement a challenge. “For a country like Pakistan that’s already going to the IMF [International Monetary Fund] again and again” asking for loans, he explains, “people become very hesitant [about criticizing multinationals] when environmental issues come up.”
And there are other possible sources in poor nations as well, including some of the same ones still plaguing rich countries. “A lot of homes in African countries still have lead pipes, and nobody is talking about getting rid of them or what problems they’re creating,” Jerome Nriagu, a professor of environmental health sciences at the University of Michigan and one of the first US researchers to raise alarms about lead in Africa, told me.
An urgent need for more funding and more data
Last year, the effective altruist research group Rethink Priorities released a comprehensive report attempting to assess how many groups were working on lead exposure in poor countries and how much more could be done on the issue. Their answers: Not many are working on this, and those that are could likely use millions of dollars more every year to spend on effective projects.
Pure Earth, formerly known as the Blacksmith Institute, is by far the largest player, but it spends just $4 million to $5 million a year on lead. “Summing estimated budgets of other organizations, we believe that donors spend no more than $10 million annually on lead exposure,” Rethink Priorities’ Jason Schukraft and David Rhys Bernard conclude.
Much of that funding comes from government sources like the US Agency for International Development and the Swedish equivalent Sida. Outside support for nonprofits, there’s not much public evidence that international aid agencies are investing in lead abatement. With some notable exceptions, like the Center for Global Development, groups working on global health have largely ignored the issue.
Ten million dollars a year, tops, is not much money at all to spend fighting global lead poisoning, even with increased investments directed by donors in the effective altruism community toward Pure Earth and LEEP. “It’s a fairly small community, and it’s remarkably small given the scale of the problem and the scale of the impacts,” Pure Earth’s Fuller said.
That helps explain why effective altruist groups like Rethink Priorities and GiveWell have become interested in lead alleviation. It’s a neglected area, where each additional dollar can go a long way. So what else could be done with more money and resources? One simple answer is better research.
When I asked Fuller and his colleague Drew McCartor what additional studies they’d do if they could, they immediately said basic lead exposure surveys in affected countries and basic sourcing analysis to see where lead is coming from in those countries.
We have such poor data on how many people (especially children) are being exposed to lead and on how they’re being exposed to lead, that improving that data could in turn significantly enhance nonprofits’ ability to target interventions effectively.
If, say, lead pipes are a bigger source of exposure in sub-Saharan Africa than previously thought, that would change how Pure Earth and other groups allocate funds; likewise, a finding that lead paint is not a significant source of exposure might change LEEP’s approach.
Rethink Priorities concluded that “existing and potential new NGOs in the area currently have the capacity to productively absorb $5 to $10 million annually in additional money,” and that sums above that amount might be productively usable too.
That’s just not a lot of money in the context of US foundations or even foreign aid budgets — especially for something we know is severely injuring children and killing adults in the developing world.
I joined Vox as one of our first three employees in February 2014, and have been here ever since, writing about everything from furries to foreign aid. Right now I’m particularly interested in global development, anti-poverty efforts in the US and abroad, factory farming and animal welfare, and conflicts about the right way to do philanthropy.