This story was originally published in The Highlight, Voxs member-exclusive magazine. To get early access to member-exclusive stories every month, join the Vox Membership program today.The pod looked like a tanning bed from another planet: a human-sized chamber, white and sparkly purple with a clear glass door, resting on an inclined platform. Previously, it had been on display in public exhibitions, but now it was in Schaffhausen, in a large park in northern Switzerland, near the border with Germany. A woman stood in front of it, under a dense canopy of trees. She wore a white fleece jacket, dark pants, and flip-flops. It was late September 2024, and the air in this part of the country had become cool.The woman, a 64-year-old American whose name has not been made public, had come to the Alpine country, to this place of vineyards and rolling meadows and mountain views, to end her life.It was a private decision that, paradoxically, would have global implications for the debate over end-of-life care and whether people have a right to medically assisted suicide.For more than 25 years, Switzerland has been a destination for people who want a medically assisted suicide, thanks to the countrys longstanding and liberal law regarding the practice. Each year, the number of people choosing assisted suicide in the country grows; in 2023, that number reached more than 1,200. Most people who end their lives in Switzerland are elderly or have an incurable illness, though a person can sometimes get approval for an assisted suicide under other circumstances. And though the majority who die this way are citizens, Switzerland is one of the few countries that also allows foreigners to travel there for the purpose, a practice critics have derided as suicide tourism. The countrys largest assisted suicide nonprofit, Exit, takes only citizens and permanent residents. But other prominent organizations, including Dignitas and Pegasos, accept foreigners. People who are interested reach out to the groups online and apply for membership, which provides counseling and guidance around end-of-life care. Those seeking a medically assisted death are required to have consultations with a doctor associated with one of the organizations. After determining that the person is eligible, of sound mind, and, when applicable, has considered their full range of treatment options, the doctor writes a prescription for sodium pentobarbital, the same substance used for pet euthanasia and many lethal injection executions in the US, to be used at a later date chosen by the patient.The doctor is not allowed to administer the medication themselves. That practice is known as euthanasia, which is not legal in the country because it is considered deliberate killing. Instead, they provide the medication to the patient, who, in the presence of the doctor or an aide for one of the organizations, either swallows it or takes it with a gastric tube or an intravenous infusion. The entire process, for foreigners, costs about $11,000 and usually takes a couple of months. Had the American woman chosen to end her life under the standard Swiss protocol, it probably wouldnt have been controversial. She reportedly had skull base osteomyelitis, a rare and painful inflammatory condition that is often fatal if untreated. She told the group helping her that her adult children fully supported her decision.But she wasnt there to end her life the standard way. Instead, she was about to become the first person to try a controversial new method for suicide, using a technology that would roil public debate over assisted suicide in Switzerland and capture attention around the globe. She would use the Sarco pod, an invention of Philip Nitschke, a strident right-to-die advocate. Nitschke hopes that the 3-D printed pod, with a name thats short for sarcophagus, will revolutionize the practice of voluntary assisted death by taking doctors out of the picture. The Sarco, he has said, doesnt require a lengthy screening process or thousands of dollars. Rather than relying on sodium pentobarbital, a person who wanted to use the pod could buy nitrogen. They would lie down inside the pod, resting their head on a neck travel pillow. Then, they would close the door and push a button. The chamber would fill with nitrogen gas, and oxygen levels would quickly drop below levels humans need to survive. As a method of execution in the US, nitrogen hypoxia has been highly controversial. Earlier this year, UN experts raised concerns that the execution of Alabama death row inmate Kenneth Eugene Smith using nitrogen gas could constitute torture, and the state is currently being sued by another inmate alleging the practice is cruel and unconstitutional. Right-to-die advocates, though, say that when administered properly, its a relatively painless death because people exposed to high levels of nitrogen quickly lose consciousness.The American woman entered the chamber just before 4 pm, according to Dutch newspaper de Volkskrant, which had a photographer in the woods of Schaffhausen before and after the death to document the scene. To protect against the possibility that they might be accused of foul play, Nitschke and his colleagues also set up two video cameras to record. Then Nitschke went across the border to Germany, possibly to avoid the risk of arrest. The only person who remained with the woman at the scene the entire time was Florian Willet, a colleague of Nitschkes who co-founded The Last Resort, an organization to promote the Sarco pods use in Switzerland. Seconds after entering the pod, the woman pressed the button to release the gas. Willet waited with her, monitoring her vital signs on an iPad and relaying them to Nitschke over the phone. After confirming her death, Willet called the police a standard practice after an assisted suicide in Switzerland. Typically, police examine the scene to verify that there are no signs of foul play. But this wasnt a typical death. Police arrested Willet, his attorneys, and the de Volkskrant photographer nearby on suspicion of inducing and aiding and abetting suicide, according to Reuters. More than eight weeks later, Willet remained in jail, with police investigating the womans death as a possible intentional killing. And Switzerland, a country that has for decades maintained a public consensus in support of assisted suicide, has been confronted with a series of questions that have implications for one of the most significant moments of every persons life: To what extent should people have the right to determine when and how they die? What are the moral and philosophical implications for a society that sanctions the practice of medically assisted suicide? How does a nation handle the need for the safety of vulnerable people while also protecting their dignity and individual rights? Switzerland isnt the only country that allows assisted suicide. Other nations, including the Netherlands, Belgium, Luxembourg, Colombia, Spain, and Canada, also permit the practice, which some advocates call medical aid in dying (MAID) to differentiate it from the usual connotations of the word suicide. In late November, the British Parliament took the first step to pass a bill that would legalize assisted dying for some terminally ill patients.In some countries, the law goes further than it does in Switzerland, allowing voluntary euthanasia, where doctors can administer lethal doses for patients who cant or dont want to do it themselves. Belgium and the Netherlands, for example, allow physician-assisted euthanasia for mental illnesses if a doctor determines that the condition creates unbearable suffering. What constitutes unbearable suffering, though, is inherently subjective and open to interpretation.The number of deaths via euthanasia in both countries has grown considerably in recent years; the same is true of Canada, which recently passed some of the worlds most liberal euthanasia laws. Critics worry that the easy availability of assisted death creates incentives for people to see it as the only solution to their suffering, even when there might be effective treatments. They also worry about a slippery slope where doctor might approve assisted suicide for more and more reasons, ultimately resulting in suicides for non-medical reasons being enabled by law.The United States does not permit euthanasia, but physician-assisted suicide is legal in 10 states, including California, Oregon, and Washington. According to a Gallup survey earlier this year, 71 percent of Americans believed that a doctor should be able to administer a euthanasia drug if requested by a patient or their family member, and nearly the same amount supported physician-assisted suicide for people with terminal illnesses. Erika Preisig, a family physician and founder of the organization Lifecircle, which helps foreigners come to Switzerland for assisted suicide and advocates for other countries to legalize it, says the issue is going to become more important as more baby boomers reach the end of their lives. They will not let others decide how they have to die. They will decide themselves, says Preisig, who is a member of that generation. This will raise the percentage of assisted dying all over. Drew Shannon for VoxBut even with widespread support, the practice is still controversial in the US and elsewhere. The American public, despite supporting legalization, is more divided on the morality of doctor-assisted suicide. Its opposed by the Catholic Church and other Christian organizations, which believe the practice goes against Gods will. Some disability rights advocates have argued fiercely against it, saying that it allows medical professionals to offer disabled people death rather than finding ways to improve their lives. The American College of Physicians (ACP) also opposes medically assisted dying on the grounds that the practice is incompatible with a doctors duty as a healer who takes the Hippocratic Oath, promising to do no harm. [T]he focus at the end of life should be on efforts to prevent or ease suffering, the ACPs president said in 2017. Partly as a result of those disagreements, Americans have different rights regarding assisted suicide depending on which state they live in. Thats led some Americans, including the woman who used the Sarco pod, to come to countries like Switzerland to end their lives.The birthplace of Calvinism and an intellectual center of the Protestant Reformation, Switzerland has a long history of bucking the dogma of the Catholic Church and charting its own moral and philosophical path. Famously neutral during the World Wars, and now home to world governing bodies like the United Nations and the World Health Organization, the country can appear to be a tightly regulated place like many other Western European countries. In reality, its a society built on compliance with social and cultural norms moreso than government regulations. Political scientists point to it as among the most libertarian societies on earth, and Switzerland is consistently ranked as the number one country in the Human Freedom Index report put out by the Cato Institute, a libertarian think tank. Assisted suicide is no exception. The practice has been permitted in Switzerland longer than in any other country. In 1942, the government put into effect a statute outlawing abetting assisted suicide for selfish purposes, like gaining access to an inheritance, but otherwise, it wasnt explicitly banned which meant that, by omission, assisting suicide for non-selfish purposes was technically legal. To this day, the 1942 statute is the only law explicitly referring to assisted suicide. In an email to Vox, the prosecutor in charge of the case confirmed that Willet was arrested under suspicion of breaking this law.In place of those laws, requirements for obtaining a medically assisted suicide were developed by doctors and codified into guidelines maintained by Switzerlands medical professional organizations. The regulations are nonbinding, but disobeying them can in theory lead to professional sanctions. In practice, this has meant that the doctors are regulating themselves. We have one of the most liberal systems in the world, Yvonne Gilli, the president of the countrys professional association for doctors, told Vox in an email. For most of the medical community, the desire seems to be to keep it that way. We would therefore do well to leave doctors in a central role in assisted suicide, Gilli wrote. In a small, relatively homogenous nation of just under 10 million people, assisted suicide has never been quite the culture war issue it was in the United States in the 1990s and early 2000s, when Dr. Jack Kevorkian, a right-to-die advocate nicknamed Dr. Death by the media, filmed himself performing a voluntary euthanasia and sent the video footage to 60 Minutes, intentionally triggering a trial that would result in his conviction for murder.In 2011, a referendum that proposed a ban on assisted suicide in Zurich, the countrys most populous canton or state, was rejected with 85 percent of the vote. That high level of public support has allowed assisted suicide organizations to operate with relatively little friction and without much public debate, even as demand increases. According to a long-term study of assisted suicides in the country from 1999-2018, the total number of physician-assisted suicides doubled every five years. Suicide assistance has been quite calm. The Swiss assisted suicide organizations were under the radar; there wasnt much discussion about them, says Bernhard Rtsche, a professor at the University of Lucerne and an expert on assisted suicide in Switzerland. They care for their reputation. The whole branch of suicide assistance has been shaken up with this new method, and they dont like that, quite understandably.The intervention of Nitschke and his Sarco pod threatens to upend the status quo. In 1996, Nitschke became the first doctor in the world to help a terminally ill patient die legally by assisted suicide in Australia. A decade later, he and his partner Fiona Stewart published The Peaceful Pill Handbook, a guide that provides information about methods of assisted suicide and describes the process of obtaining one in Switzerland. Nitschke, according to Katie Engelharts book The Inevitable: Dispatches on the Right to Die, began his work believing that patients with terminal illnesses should have the right to choose an end to their suffering. But as his advocacy deepened, his thinking evolved. Why should doctors like him be the one to make the decisions? Why should doctors get to determine what counts as extraordinary suffering and what doesnt? Over time, Nitschke came to believe that the right to die should be entirely in the hands of individuals and not medical professionals. The deeper his advocacy became, the more he clashed with other members of the medical community. He burned his medical license in 2015 after a protracted battle with Australias medical board. He also became more critical of mainstream MAID groups that focus only on the sickest patients. He takes issue with the Swiss system, which he has said is too deferential to doctors and too expensive. We are convinced that no money should be charged for an assisted death. Especially when you realize that it is already very expensive for foreigners who wish to die to travel to Switzerland, Nitschke said of his organization, Exit International, in a recent interview. (Exit International, which is not related to the Swiss group Exit, pointed to statements on their website and declined to be interviewed before deadline.)Nitschke approaches end-of-life issues with the zeal of a libertarian techno-futurist. In interviews, hes spoken about a future where the Sarco pods blueprints are posted online, allowing anyone to 3-D print one anywhere in the world. He has said that AI could replace doctors in assessing whether a person meets the criteria to end their life. We really want to develop that part of the process so that a person can have their mental capacity assessed by the software, rather than spending half an hour with a psychiatrist, Nitschke told Wired.Nitschkes unapologetic belief that people should be able to choose how and when they die, combined with his confrontational style, has made him a lightning rod for controversy, leading some of the doctors who support assisted dying to think that he does more harm to their cause than good. Nitschke wants to give everybody, without thinking, the possibility to die. For me, this is unethical, says Preisig, the founder of Lifecircle. This is very bad for Switzerland. Its a big problem for us. Leaders of other assisted suicide organizations have also been critical. The debate over the Sarco pod has even reached the Swiss government. Nina Fehr Dsel, a member of the Swiss National Council (which is similar to the US Congress), has made a motion for the National Council to discuss assisted suicide in the coming months. Shes also asking her colleagues to consider banning the Sarco pod explicitly. I dont want to overregulate this, Fehr Dsel, a member of the populist right-wing Swiss Peoples Party, which controls the most seats in the federal assembly, tells Vox. She has concerns about the use of nitrogen, which is at this point cheap and easy to obtain in the country. In general, she says, the organizations that are already established in the country should be left alone. We already have these two longstanding organizations and that is enough, Fehr Dsel says.For others, the Sarco pod case has merely exposed the extent to which assisted suicide is operating without clear legal guidelines. We need some regulation that ensures that autonomy is safeguarded and capacity is properly assessed, and the means for suicide assistance the instruments and the medications are safe and comply with human dignity, says Rtsche, the professor at the University of Lucerne. According to Rtsche, the government should codify the existing standards doctors have established, with laws around the assessment of someones capacity, obligations to provide information and counseling to make sure the decision is well considered, requirements for how the process takes place (including what drugs and devices are allowed and what arent), and oversight for the assisted suicide organizations with the ability to ban a group for flouting the guidelines. Whether Switzerland moves forward with a new law remains to be seen. But the Sarco pods future seems more certain. Drew Shannon for VoxPolice confiscated the pod at the scene of the womans death. In November, Schaffhausen prosecutor Peter Sticher confirmed to Vox in an email that one person remained in police custody regarding the investigation. Willet, according to The Last Resorts website, has been held in jail for two months. Holding someone that long on suspicion of abetting a suicide for selfish purposes is highly unusual. But in late October, de Volkskrant, the Dutch paper, reported another reason that may explain Willets long detention: According to court records, a forensic doctor told investigators the woman was found with injuries to her neck, raising the possibility that Willet was the subject of an intentional killing investigation.The allegation of a [killing] is simply not true, and Id guess everyone involved knows this, says Andrea Taormina, the lawyer for the photographer who was detained after the womans death. There are no facts that would indicate differently. This is mainly an allegation brought forward simply to raise the stakes in this procedure.De Volkskrant, which had access to and reviewed the camera footage, said in their report that nothing on the recording showed Willet opening the pod or doing anything to disturb the woman. Ultimately, after 70 days in detention, Willet was released in early December.Exit International and The Last Resort, Nitschkes organizations, celebrated Willets release. The allegation of intentional homicide was, and remains, absurd, it said in a statement. But in response to an email, Sticher told Vox that both investigations remained open. All persons are still under investigations, for aiding and abetting a suicide for selfish purposes and for intentional homicide, Sticher wrote. But we had no more reasons to keep this last person in custody.While the drama brought by the Sarco pods use is exceptional, the broader debate shouldnt be. According to a UN report from 2023, the world population of people over 65 is expected to double, from 761 million in 2021 to 1.6 billion in 2050. In 25 years, people over 65 will make up 1 in 6 people on Earth part of a global trend toward aging. Thanks to legalization in several countries, many of these people now know that physician-assisted suicide is an option. Assisted suicide remains rare, both globally and in the US. But as more attention is paid to it, the moral, philosophical, and political questions that the case prompted will only become more urgent. In Switzerland, where assisted suicides are still a relatively small percentage of overall deaths, supporters say its important to maintain that right. Modern medicine is keeping people alive longer and longer. This is why there are more and more very old people, and therefore more and more medical problems towards the end of life, Marion Schafroth, the president of Exit, said in an email. Human support for suicide is certainly not morally wrong. It serves the dignity and self-determination and safety of those who wish to die.Even if they dont ultimately choose assisted suicide, says Preisig, the founder of Lifecircle, its important for people who are seriously ill to know they have the option. People are not afraid of death, theyre afraid of unbearable suffering, she says. When they know they could [die] if they wanted to, then they lose this fear of unbearable suffering. This is the most important point for me.Still, other countries, like Canada, are grappling with serious concerns about whether the criteria for approval is expanding too quickly, enabling or even encouraging people who arent suffering to end their lives. Canadas Medical Assistance in Dying (MAID) program is a primary example for critics of what can go wrong. When MAID was first legalized in 2016, Canada had strict criteria: It was only to be used to end unbearable suffering in patients whose conditions were advanced and whose impending death was reasonably foreseeable.In 2021, following a court ruling, the government removed the criteria that a death be reasonably foreseeable. Stories emerged of people who had been approved for euthanasia who didnt have terminal illnesses. Health care workers have said theyre struggling with the ethical implications arising from people requesting euthanasia not for incurable illnesses but because theyre on government subsidies, were recently widowed, or are dealing with chronic but nonfatal conditions like obesity. And in October, a Canadian committee found that people had received approval for euthanasia for reasons such as social isolation. Some disability rights groups in Canada are challenging the countrys expanded MAID laws in court. We are witnessing an alarming trend where people with disabilities are seeking assisted suicide due to social deprivation, poverty, and lack of essential supports, a leader of the group, Inclusion Canada, said in a statement in September. This law also sends a devastating message that life with a disability is a fate worse than death, undermining decades of work toward equity and inclusion. The controversies around these cases, like the Sarco case, are raising uncomfortable questions for which there might not be easy answers. A legalized assisted suicide program without strong guardrails runs the risk of creating opportunities for abuse. Among those who decide to die via assisted suicide will likely be complicated people with complicated motivations, some of which might not seem reasonable to others. On the other hand, in countries where assisted suicide is illegal, people often find other ways to end their lives. (The leading cause of suicide deaths in the United States is not a new technology like the Sarco pod but a much older one: guns.) How governments balance the need to protect their citizens rights while also safeguarding the most vulnerable among them is a real conundrum. Switzerland found a balance, but the Sarco pod threatened to upset it. Restoring the balance is more than just a major imperative. Its a matter of great moral significance and of life and death. Youve read 1 article in the last monthHere at Vox, we're unwavering in our commitment to covering the issues that matter most to you threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country.Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change.We rely on readers like you join us.Swati SharmaVox Editor-in-ChiefSee More:

This story was originally published in The Highlight, Voxs member-exclusive magazine. To get early access to member-exclusive stories every month, join the Vox Membership program today.The sharp decline in child mortality rates is one of the great global success stories of the past several decades. In 1990, nearly 13 million children died before their fifth birthday, primarily from infectious diseases or complications during birth. By 2022, that number had fallen by more than 50 percent, meaning that today, about 8 million fewer children are dying than were some 35 years ago. Overall development improvements, alongside a handful of targeted public health interventions ensuring that skilled health care workers are present during childbirth, improving access to clean water, providing postnatal care, and expanding vaccination, to name a few have helped ensure far more children live to see their fifth birthday and beyond. Yet despite that progress, around 5 million children younger than 5 years old still die prematurely each year, with about 80 percent of those deaths occurring in sub-Saharan Africa and southern Asia. And progress to reduce child mortality has slowed in recent years. Between 2015 and 2022, child mortality rates fell by only 2 percent, down from about 4 percent between 2000 and 2015.But one surprising intervention periodically distributing antibiotics prophylactically to young children en masse could help further reduce child mortality rates in some of the worst-affected countries. A study published in August examined children in Niger, a country in West Africa with one of the highest child mortality rates in the world. Researchers found that twice-yearly mass distributions of an antibiotic to children between the ages of 1 and 5 reduced child mortality by 14 percent. If this sounds too good to be true significant reductions in child deaths simply by giving them basic drugs designed to fight bacterial infections it may be. This intervention around one major health challenge childhood mortality is somewhat controversial because it seems to directly run against another major health challenge: the rise of drug-resistant infections. Such infections, which are caused by the overuse of antibiotics, claim an estimated 1 million lives every year, a number that could nearly double by 2050. If you increase the amount of antibiotic exposure in the population, you are guaranteed to increase the risk of having drug resistance, said Gautam Dantas, a professor at Washington Universitys School of Medicine who studies the human microbiome and antimicrobial resistance. These drug-resistant pathogens can spread around the world, creating a public health threat for everyone. And theres another question: While the positive results show promise, no one is exactly sure why giving antibiotics to children who have no overt sign of infection but still live in high-risk areas reduces overall child mortality in the community.Given the unknowns and potential to contribute to global drug resistance, the World Health Organization in 2020 strongly recommended against mass antibiotic distribution as a universal intervention. Instead, the agency suggested that public health officials pursue the intervention only in places where under 5 mortality is greater than 80 children per 1,000 births. In 2022, only 10 countries recorded under 5 mortality rates higher than this threshold. The scientists who study and advocate for the mass distribution of antibiotics are well aware of these issues. The essential question: How does one weigh saving childrens lives against fueling another deadly health threat? A safety net of antibioticsThe idea of mass distributing antibiotics to reduce child mortality has its origins in control programs for a specific disease: trachoma. Trachoma is a bacterial eye infection that can lead to visual impairment and irreversible blindness. Though the disease has plagued humanity for at least 10,000 years, by the early 20th century it had become a serious scourge, infecting anyone from soldiers to boarding school students. But the disease was wiped out in most developed countries in the 1950s and 1960s following the invention and widespread use of antibiotics, especially azithromycin. But trachoma has persisted in about 50 countries, mostly in poor, rural areas of Africa, Asia, the Middle East, as well as Central and South America. About 2 million people today have blindness or visual impairment caused by trachoma and another 103 million are considered at risk of contracting the disease. In communities where trachoma is still a problem, the disease prevalence is high, ranging from 60 to 90 percent. Because trachoma became so widespread, the World Health Organization in the early 1990s recommended that health officials treat everyone in an affected community with the antibiotic azithromycin, whether or not they had been diagnosed with the disease. The thinking was that treating the entire community with an antibiotic would reduce the amount of bacteria circulating in the community, thus reducing transmission much like mass vaccination is used to curtail viral outbreaks. In the early 2000s, researchers started noticing that mass distribution of azithromycin not only reduced trachoma, but also seemed to reduce overall child mortality. Scientists running a trachoma control study in Ethiopia hypothesized that because azithromycin was effective against other infectious diseases, including respiratory and diarrheal diseases and malaria all leading causes of childhood death in the country mass distribution of the drug might help save childrens lives. Other public health scientists probed this idea further by conducting mass antibiotic distribution trials in places where trachoma wasnt found. In one 2018 study known as the MORDOR trial (MORDOR stands for Macrolides Oraux pour Rduire les Dcs avec un Oeil sur la Rsistance, French for Oral Macrolides to Reduce Deaths with an Eye on Resistance), researchers randomly selected more than 1,000 villages across Malawi, Niger, and Tanzania to either receive the mass distribution of azithromycin or a placebo intervention. Children who were between one month and five years in the intervention villages received a small dose of azithromycin twice a year for two years. At the end of the study, in communities where children had received the antibiotic, the overall annual mortality rate was lower by about 3 percent in Tanzania, 6 percent in Malawi, and 18 percent in Niger compared to the villages that received a placebo. The drop in mortality was even greater, about 25 percent, among the youngest children, those between 1 and 5 months old.While the results are promising, researchers still do not fully understand how mass azithromycin distribution reduces child mortality. One explanation is that the intervention works in a similar way as it does in trachoma-endemic settings, but instead of providing communities a blanket of protection against merely the Chlamydia trachomatis bacterium that causes trachoma, it bestows protection against a wider range of bacteria, including the ones that cause the common respiratory diseases and diarrheal diseases that can kill young children in poor countries. It may not be just that you get lucky and you treat a kid that happens to be sick that week, said Thomas Lietman, a professor at the Proctor Foundation at the University of California, San Francisco who has led studies on trachoma and was the senior author of the 2018 and 2024 child mortality studies. We think its that were reducing the pathogen load in the community. And one of the reasons we think this is because there appears to be an indirect effect. In other words, you receive benefit just by your community being treated.The cost of saving livesEven during these early trials, researchers were concerned about how giving antibiotics to kids might fuel another massive global challenge: antimicrobial resistance, the process by which bacteria evolve the ability to evade antibiotics. Its simply a matter of evolution: the more that antimicrobials are used, the more opportunities pathogens have to develop resistance to them. If that process continues long enough, it will eventually render these critical, life-saving medicines ineffective. At the same time, most major drug developers have turned away from making new antibiotics. That means our stores of effective antibiotics are dwindling. If left unchecked, researchers predict that some 2 million people might die from drug-resistant infections by 2050, making it a leading cause of death. But people wont just die from drug-resistant infections. Life-saving surgeries and treatments such as chemotherapy, which massively damage the immune system, will become much riskier because it will be harder to prevent infections..In its antibiotic stewardship guidelines, the Centers for Disease Control and Prevention recommends that health care workers only prescribe antimicrobials if they know what pathogen is causing a patients illness. But the idea of mass distributing antibiotics to reduce childhood mortality runs entirely counter to that. Were taught in every health care field not to give antibiotics non-specifically; yet thats exactly what were doing here, Lietman said. Were giving antibiotics to children whether or not theyre sick, whether or not they have a particular pathogen.RelatedHowever, it is unclear what impact mass distribution interventions have on drug resistance. After the MORDOR trial, researchers conducted follow-up studies where they collected swab samples from the children who received the antibiotic during the study and those who did not. Among children who participated in the study in Tanzania, researchers reported that there was no significant difference in the number of azithromycin-resistant strains of two types of bacteria between the two groups. Yet in Niger, researchers found that children who received the antibiotic harbored more drug-resistant strains. Other studies, though not all, that have assessed drug resistance in the wake of mass distribution campaigns for trachoma control have documented measurable but short-lived increases in drug-resistant bacterial strains. Regardless of whether and to what extent mass antibiotic distribution contributes to drug resistance, the intervention uses a small fraction of the total antibiotics consumed worldwide either by humans or livestock animals. In the 2018 MORDOR study, children received about 20 milligrams per kilogram of body weight which equates to about 360 milligrams for a 40-pound child or a total of, at most, 36 kilograms of antibiotics for the roughly 100,000 children that received the intervention across four distributions. Compare that to, say, the 6.2 million kilograms of medically important antibiotics sold for use in livestock operations in the US in 2022. Perhaps it would be more effective to reduce antibiotic use in agriculture than target relatively miniscule antibiotic use during an intervention that saves childrens lives.But there may be other consequences to mass antibiotic use. A series of studies conducted mostly in the US and Europe have linked antibiotic use in childhood with an increased risk of developing obesity, attention deficit hyperactivity disorder, asthma, and other lifelong disorders. Still, it is important to note here that these studies are looking at a very different population than children in Niger who face a high risk of dying before they turn 5. Some research suggests the link between antibiotic use and obesity and other disorders may be related to alterations in the gut microbiome, but it remains unclear exactly how antibiotics might cause poor health outcomes and what role other lifestyle factors might play. And those factors could be entirely different in a country like Niger or Tanzania than in the US. Right now, the benefit outweighs the harm, Dantas said. Yes, you may encode some burden elsewhere, but youll save the life of a child.Its hard to argue that saving thousands if not millions of childrens lives doesnt outweigh future threats of drug resistance or a possible heightened risk of developing chronic diseases. There are plenty of other ways to address the public health challenges posed by antibiotic resistance and chronic diseases that dont put the lives of some of the poorest children in the world at risk. And there is one conclusion that is undeniable: If millions of young children were dying every year in the US, parents would demand that every possible intervention be used whatever the future consequences. Youve read 1 article in the last monthHere at Vox, we're unwavering in our commitment to covering the issues that matter most to you threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country.Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change.We rely on readers like you join us.Swati SharmaVox Editor-in-ChiefSee More:

Sorry to be that guy. Smartphone innovation has stagnated in favor of adopting artificial intelligence. Samsung, Google, and Apple made AI the primary marketing focus of each flagship phone in 2024. It wasnt about svelte hardware or the smartphones ability to serve as a solid daily computing device. It was about preparing users for the AI onslaught that will inevitably force them to update their phones to avoid being siloed. This year was marred by gimmicky feature add-ons and the rationalization that youll need a new smartphone to be compatible with whats to come if you want to be on the same page as everyone else. Design-wise, that produced a batch of phones that didnt move the needle. The Galaxy S24 Ultra looks just like the Galaxy S23 Ultra but with more square edges. Apples iPhone 16 Pro doesnt look all that different from the iPhone 15 Proyou cant even tell them apart from the backside. As for the Google Pixel 9 Pro, it has a revamped camera bar on the back. Still, now it just looks like the iPhone from the front, and everything else about the Pixel lineup prioritizes Gemini over anything else. Im down for the idea of AI correctly clocking in, whether Im trying to open up an app to get work done or disappear into doom-scrolling. But what will be the cost of prioritizing AI-enhanced performance over everything else? Can smartphones stay thin if power consumption is the priority? Wont they have to make concessions for bigger batteries and additional components as AI becomes the main power draw? These are all questions floating around as we exit the year into 2025. The Meteoric Rise of AI Samsung started 2024 right out of the gate with Galaxy AI. It already did some of what Googles Gemini purported to do, except this time, it also had a unique new feature to debut alongside: Circle to Search, which became the best thing to happen to Android this year, even before Android 15 went into developer preview. Samsung and Google combined forces for the Galaxy S24 launch event to keep the messaging honed, stating that Android would become a vessel for all that was happening with AI behind the scenes.Google followed, peppering the year with prolific Pixel Drops that enabled features like Circle to Search, Call Screen, and, most recently, Gemini extensions. When its developer conference rolled around in the spring, it was apparent that the Android platforms trajectory focused mainly on AI. Android was no longer the main event; instead, it was focused on explaining how Gemini would improve the user experience. The most significant indicator of this for me was when I booted up the Gemini beta and set it as my phones default assistant. It broke some of my Google Assistant-enabled hardware, like the Roav Bolt, which I use to command my phone hands-free while driving. Thankfully, whatever Google has done in the background since then has fixed it, though I had to wait half the year for Gemini to roll out fully. It was a harrowing reminder of what happens when the company behind your smartphone platform suddenly takes a left turn toward something new. Charles Anthony Davis/DreamSmith LLC Some of us had hoped that Apple would be the one to hold out on AI. Typically, Apple will take what Google does and neg it, then explain how its not possible because it would ruin the integrity of its product. But Cupertino surprised us with Apple Intelligence at WWDC, announcing that it was adding AI to its platforms and doing it in the most Apple way: completely rebranding what everyone else is doing and presenting it as a one-of-a-kind, bespoke new technology, even though it still requires some help from ChatGPT to tackle more sophisticated commands. At least the company remains characteristic about it. As a result of the name Apple Intelligence, the style guide requires that I spell it out every so often when referring to it, which helps me avoid the overuse of AI. Its notartificial intelligence; its Apples intelligence.The Cost of Image Generation Now, its months after all the new smartphones have debuted for the latest generation. We are stuck with a wealth of premium devices from Samsung, Google, and Apple, all focused on selling us this new way of predictive computing. Each platform also has an image rendering app for producing images: Image Playground on iOS and Pixel Studio on Pixel devices. Thanks, I guess, but this is hardly what people thought about when they asked for help with photos. Instead, Id hoped to have better lenses added to the back of these devices since they already cost upwards of a mid-tier digital camera. I was even willing to eschew thinness, knowing the hardware had to get thicker if I wanted a larger screen. Instead, I got a generative AI suite that makes my photos look like a Hallmark movie poster. Florence Ion / Gizmodo Im not saying the cameras didnt improve on Samsung, Google, and Apples devices. That happens every year with every new smartphone; everything gets a little bit better. But this time, all three seem wholly dependent on AI performing the magic to make the picture. The Pixels entire camera system is based on the premise that AI can automatically do what you would have attempted in an editing suite. Apple employs algorithms to ensure that any time you press the iPhone 16s new Camera Control button, the photo does not blur.Heres the Catch-22 of image generation on the phone in this AI-forward era. While AI and algorithms can help with battery management, like reducing background processes and automatically optimizing settings based on whats happening on screen, generating images within the apps takes up those same resources, even when pulling from the cloud. A smartphone also needs a whopping amount of memory to perform these tasks. Thats why we now see phones bundled with 16GB of RAM as the standard, including the Pixel 9 Pro.All that extra hardware to power AI will eventually increase manufacturing costs. Were already seeing higher price tags on iPhones and Android devices. Its not just the economy. Thats not to say that next years phones will be bulbous and cumbersome. They will likely still arrive in the same tempered glass chassis they came in this year. They will all have big, bright displays with high refresh rates and saturated colors. They will still fit into mens pockets. They may even be thinner than they were next year, at least according to rumors about the iPhone 17 and the Galaxy S25 Ultra. Theres even talk that Samsungs foldables might get bigger to cater to a different crowd. What will be interesting to see is how each manufacturer manages the demands of balancing what the industry says is essential for competition and what consumers want for utility. It doesnt make the AI worth it if it means piping-hot smartphones that peter out halfway through the day.

A Compact Yet Fundamental Survey of the Modern Movement: In Conversation with Kenneth FramptonPresented by:If there is one book every architecture student must have on their shelf, it must be an architectural history. There is no more comprehensive yet compact alternative than Kenneth Frampton's Modern Architecture: A Critical History, originally published in 1980 by Thames & Hudson. Its much-expanded latest fifth 734-page, 813-illustration edition came out in 2020. In 2023, I discussed the book at length with the author in a video interview, now available on YouTube.Regarding one compact yet fundamental survey of the evolution of the Modern movement, Modern Architecture: A Critical History is unquestionably the most authoritative, complete, and in-depth chronicle. The most valuable addition to the new book is the introduction of new chapters focusing on regions such as Canada, Mexico, Colombia, Australia, China, India, and Sri Lanka, among others. These chapters shed light on many before-overlooked practices that operated outside of traditional centers of power, namely Western Europe, the United States, and Japan. Save this picture!In the interview, Frampton, who is now 94 and living in London after a long career as a historian, critic, and educator, primarily at Columbia University in New York, talked in detail about the history of the book and the intentions behind it. He discussed other sources that served him as a model for the first edition and the last, the book's cover, the Modern Movement's origins, and the earliest projects that can be called modern. The book clearly illustrates the diminishing role of the individual in the profession, and Frampton offers his take on this trend. Naturally, we spoke about Russian constructivists, why their projects were missing from many earlier histories, and why Modern Architecture does not have a single photo of any of their buildings, as if it were purely a paper movement. Related Article Architecture Needed to Be Liberated from Itself: In Conversation with James Wines One of the key points in the conversation is the year 1980. In a way, it brought modern architecture to a close by starting a new chapter, namely, Post-Modernism, which was, of course, in the air for more than a decade by then. Still, the first Architecture Biennale that year, entitled The Presence of the Past with its central installation La Strada Novissima, pushed the discipline into the next paradigm. Did modern architecture end that year? Was it possible to practice it after 1980? Frampton, who was an outspoken critic of the new movement and even famously refused to get involved in the biennale organizers' invitation to participate as a curatorial advisor, thinks today that the shift was fundamental. He is convinced that even Critical Regionalism, which he championed soon after as a direct response to Post-Modernism, is inevitably a shade of Post-Modernism. All architecture after 1980 is. Whatever was done could not be undone. And how would he characterize architecture's contemporary moment? In the conversation, he lays out his thoughts and concerns.Save this picture!Save this picture!Save this picture!Other topics discussed include the work of Frampton's favorite architect, Alvaro Siza. The historian is fascinated by his aphorisms, particularly this one: "The idea is in the place, not in your head." Of course, whether the driving design idea is in the architect's head or the site is arguable. However, Frampton is convinced that this position to search for the idea in the project's context opens "a door," so to speak. Other topics include another one of his books, Studies in Tectonic Culture (1995), which he admitted he considers his favorite; David Chipperfield's 2012 Common Ground Biennale, Alejandro Aravena's 2016 Reporting from the Front Biennale, and their effects on the profession. We spoke about the decline in architectural education, the discrepancy between the profession and the public, why the public's favorite American building, the Empire State Building, is not in his book, non-spectacular architecture, why Frank Gehry's Guggenheim Bilbao is mentioned but not accompanied by an image, and why Gehry's residence in Santa Monica is viewed by Frampton as his best work. Save this picture!Save this picture!Closer to the conclusion, we discussed new architecture in China, what architects should do now, projects on the margins, the rise of adaptive reuse, Frampton's three most admired architects, and being pathologically addicting to writing.Image gallerySee allShow lessAbout this authorCite: Vladimir Belogolovsky. "A Compact Yet Fundamental Survey of the Modern Movement: In Conversation with Kenneth Frampton" 26 Dec 2024. ArchDaily. Accessed . <https://www.archdaily.com/1025082/a-compact-yet-fundamental-survey-of-the-modern-movement-in-conversation-with-kenneth-frampton&gt ISSN 0719-8884More interviews from ourYouTube ChannelSave!ArchDaily?You've started following your first account!Did you know?You'll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.Go to my stream

Speaker Assembly Factory / formalocalSave this picture! Sandrine IratabalFactorySoorts-Hossegor, FranceArchitects: formalocalAreaArea of this architecture projectArea:1215 mYearCompletion year of this architecture project Year: 2024 PhotographsPhotographs:Sandrine IratabalManufacturersBrands with products used in this architecture project Manufacturers: alde, carte atlantique, formalocal, irribaren External works: IMSMore SpecsLess SpecsSave this picture!Text description provided by the architects. Located within the extension of the Pdebert business district in Soorts, the Stereo building houses the production site of the speaker manufacturer La Boite Concept / CCLAB.Save this picture!With an area of 1215 m, the building is spread over two levels. The ground floor accommodates the entire industrial program, with double-height storage and a showroom. The first floor is dedicated to the office section of the program, with offices facing north, offering views of the maritime pines in the Landes forest.Save this picture!Save this picture!The building is organized based on a rational rectangular plan made up of five load-bearing bays. Its asymmetrical double-pitched roof echoes the traditional forms of Landes farmhouses. The treatment of the facades expresses a dichotomy between the gable ends and the long walls, which energizes its perception on the site.Save this picture!Save this picture!Save this picture!Save this picture!To the east and west, the raw concrete gable ends affirm the building's stability. They are recessed in the center to frame the two large glazed entrances on the ground floor and to offer terrace and social spaces on the office floor above.Save this picture!Save this picture!The metal facades of the long walls express a composition woven between the vertical rhythm of the building's structural grid and the horizontality of the floor, base, and sill lines. The facades are made with an alternation of infills, glazed, cladded, or polycarbonate.Save this picture!Project gallerySee allShow lessProject locationAddress:Soorts-Hossegor, FranceLocation to be used only as a reference. It could indicate city/country but not exact address.About this officeformalocalOfficeMaterialsMaterials and TagsPublished on December 26, 2024Cite: "Speaker Assembly Factory / formalocal" 26 Dec 2024. ArchDaily. Accessed . <https://www.archdaily.com/1024042/speaker-assembly-factory-formalocal&gt ISSN 0719-8884Save!ArchDaily?You've started following your first account!Did you know?You'll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.Go to my stream

Gazorgah House / Torab HomeSave this picture! Mina Abouei, Niloofar MojiRestorationYazd, IranArchitects: Torab HomeAreaArea of this architecture projectArea:200 mYearCompletion year of this architecture project Year: 2023 PhotographsPhotographs:Mina Abouei, Niloofar Moji Lead Architects: Omid Khowsravi Rad, Arefe Mousavi More SpecsLess SpecsSave this picture!Text description provided by the architects. Nestled within one of the prestigious alleys of the Gazorgah neighborhood in Yazd, the historic Gazorgah House stands as a distinguished emblem of Qajar-era architecture and traditional Iranian artistry. Over the years, the house has undergone extensive transformations, evolving into three distinct sections. The central section, mirroring the dimensions of the other two, reflects a meticulous design that harmonizes with the aristocratic identity of the neighborhood, striving to surpass its surrounding structures in elegance and detail.Save this picture!Save this picture!Save this picture!One of the house's most captivating features is its mezzanine, adorned with delicate columns and intricate muqarnasa hallmark of Iranian architectural brilliance. This is complemented by vaulted spaces (taq-o-tavizeh), where the interplay of light and shadow on the pointed arches (shakh-bozi) creates a mesmerizing visual effect. Such features not only enhance the building's aesthetic allure but also serve as a testament to the ingenuity of its original design.Save this picture!Save this picture!Save this picture!The restoration process of the Gazorgah House has been guided by a profound respect for its historical essence. Incongruous modern additions have been thoughtfully removed, revealing traces of the house's rich history. A particularly symbolic gesture in this preservation effort is retaining a section of the courtyard wall, serving as a tangible link to its storied past.Save this picture!The restored ceilings of the house, showcasing a harmonious blend of diverse traditional designs, stand as a testament to the exceptional craftsmanship involved in its revival. This meticulous attention to detail not only safeguards the house's cultural and historical significance but also elevates its visual splendor.Save this picture!Save this picture!Today, the Gazorgah House transcends its historical significance by functioning as an ecological residence. Visitors are invited to immerse themselves in the culture, lifestyle, and traditions of Iran, experiencing firsthand the timeless charm of this architectural treasure. By embracing its authentic character, the Gazorgah House offers a renewed perspective on the enduring legacy of Iranian heritage.Save this picture!Project gallerySee allShow lessProject locationAddress:Yazd, IranLocation to be used only as a reference. It could indicate city/country but not exact address.About this officeTorab HomeOfficePublished on December 26, 2024Cite: "Gazorgah House / Torab Home" 26 Dec 2024. ArchDaily. Accessed . <https://www.archdaily.com/1025014/gazorgah-house-torab-home&gt ISSN 0719-8884Save!ArchDaily?You've started following your first account!Did you know?You'll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.Go to my stream

The runaway success of the Gundam concept in anime and manga has unsurprisingly bled into the gaming medium over the years. Gundam stories typically focus on the titular machinery; powerful, robotic Mobile Suits piloted by human drivers. Here's our list of the best Gundam games for Mecha fans.

A new Call of Duty: Black Ops 2 datamine has revealed the iconic Zombies map, Five, which was initially planned to be released as part of the fifth DLC. That DLC never saw the light of day and has been simply a rumor for years now, but this is by far the most substantial piece of evidence regarding its existence in Call of Duty: Black Ops 2.

An interesting Genshin Impact poll has revealed the game's overall most popular character, as well as the best DPS and support picks. Genshin Impact's playable characters are the main focus of each update, which is very common for games with a gacha-based system.

Live-service gaming is in a difficult, transitional moment. Even as the sector consumes more and more millions of player hours, successful new launches are few and far between, and the frequency of shutdowns has increased. Franchises like Destiny and Overwatch have pivoted to free-to-play models in an attempt to keep their player numbers buoyant, and premium live-service games that is, games with a full purchase price, as well as some intention to monetize players over the long term are a dying breed.2024 saw two dramatic, high-profile failures in premium live service. Rocksteadys Suicide Squad: Kill the Justice League flopped to a $200 million loss for WB Games, while Sonys even more expensive Concord so failed to strike a chord with players that it was unceremoniously turned off after just a few weeks. (Sony did have a live-service hit in the form of Helldivers 2, but judging from the publishers marketing efforts on the two games, Helldivers was seemingly not one that Sony higher-ups expected or maybe even wanted to take off.)Yet Blizzards 2023 release Diablo 4 is a certified hit, with big sales, a strong expansion in 2024, and apparently an avid audience. How did it buck the trend? For Rod Fergusson the famed Gears of War producer turned general manager of the Diablo franchise its because Blizzard didnt set out to make a live-service game. The studio simply set out to make a Diablo game, but Diablos breed of action role-playing game essentially demands that it be a live-service game.An ARPG is inherently a live service. The question is what you do about itRod FergussonI go back to the genre, Fergusson told Polygon in an interview conducted in November. Early on, there were these conversations. [] Is Diablo 4 a live-service game, or should we roll credits and call it? And I was like, look, when you look at Diablo 3 and the millions of people that showed up every season, whether you want it or not, an ARPG is inherently a live service. The question is what you do about it.For Fergusson, live service is an opportunity to constantly refine and rebuild a game, but only if the audience demand to keep playing emerges naturally from the game design. To me, when youre a Diablo-like, [] people are going to look to play through the campaign, but then theyre going to look to play what I call the hundred- or the thousand-hour game. They want to be able to continue this progression, they want to have the power fantasy, they want to go back to it over and over again. This is what creates the space for the developers to keep feeding new ideas in the game to keep it fresh. That was one of the things that was great, Fergusson said. It wasnt this sort of fait accompli where were like, Its in the box and were done. Were going to have the ability to improve Helltide. Were going to have the ability to add the Pit, were going to have the ability to try the Gauntlet.Theres a simple lesson here for game publishers: Dont force it. When Suicide Squad was previewed, players commented immediately that the game seemed an odd fit for a live-service framework; it didnt flow naturally from the games storyline or genre. Concord belonged to a suitable genre it was a hero shooter but it appeared to have been made to satisfy a publishers demand for a live-service game, rather than players demand for an alternative to Overwatch. The game concept hadnt come first.Conversely, Diablo 4 worked because people wanted a new Diablo game, and they wanted to play it for hundreds of hours. Its like a reversal of the classic line from Field of Dreams: not If you build it, they will come, but They will come so youd better build it.