April 7, 2012
This image has been posted with express written permission. This cartoon was originally published at Town Hall.
There are feelings you get when you enter an Ikea store. The vertiginous experience of getting lost in their craftily designed labyrinth. The surprise of wandering into something you hadn’t intended to buy. The discomfiting almost-warmth of a fake apartment. The faintly reassuring sense that your children and your car are in someone else’s hands. Then the odd realization that you’re really inside a high-security structure on the distant edge of town.
Would you like to feel that way all the time? The people who run the Swedish home-furnishings behemoth are launching a bold push into the business of designing, building and operating entire urban neighbourhoods. Where once they placed a couch in a living room, the Swedes now want to place you and 6,000 neighbours into a neglected corner of your city, design an entire urban world around you, and Ikea-ize your lives. Their bold, high-concept notion of an urban ’hood could be an important solution to the housing-supply shortages that plague many large cities – but it could take some getting used to.
“We are in keeping with the Ikea philosophy: We don’t want to produce for the rich or the super-rich; we want to produce for the families, for the people,” says Harald Müller, the head of LandProp, the property-development branch of Inter IKEA, the company that invests the profits from the furnishing giant.
“Our approach must be to get the right housing and office prices while delivering very good quality at the same time, he added. “We want to be smart enough in our design that we can offer the product for a reasonable price.”
I recently made the long drive into the vanguard of Ikea’s city-building ambition, in a triangle of post-industrial wasteland surrounded by goods-shipping canals and highway ramps in the far reaches of East London, not far from the 2012 Olympics grounds. Here is the site of Ikea’s effort to bring a very Scandinavian model of urban design and managed living into the English-speaking world.
Amid this 11-hectare expanse of ancient rusting machinery, waste piles and grinding construction equipment is a converted brick sugar warehouse where a team of Swedes and Brits are poring over blueprints and renderings. LandProp Services bought the land in 2009. Their vision is to turn this grey netherworld, once planning approval is done, into a tightly packed neighbourhood they’ll call Strand East.
It will look, once complete, like a reproduction of the sort of historic, chic downtown neighbourhoods you find in the far more central parts of London or Paris, not in this distant expanse of former dockyards and bloodless public-housing project. At its core are straight, car-free streets lined with simple townhouses and ground-floor-access flats in five-storey rows. In the alleyways behind – an imitation of the classic London backstreet, the mews – will be little two- and three-storey homes, all with direct access to the street.
The 1,200 homes and apartments, 40 per cent of them large enough for families (making it a much more child-filled place than most post-industrial developments), will be priced to appeal to a range of incomes, the Swedes promise. A few seven- to 11-storey condominium towers will pepper the area, and offices for high-tech firms and a hotel will fill the busier edges. Secreted beneath the whole structure is an underground parking garage, to keep cars off the interior streets. Bus lanes and pedestrian walkways will cut across it, squares and public areas abound. The whole thing is designed to create the sense of felicity and discovery you get when wandering a historic European neighbourhood – or, for that matter, an Ikea store.
It is a far more appealing design than most of the centrally-planned urban neighbourhoods that have blighted British cities for the last 60 years, and it promises the sort of pleasant population density – on a piece of wasteland that had once been considered uninhabitable – that could help Britain’s dire housing shortages.
As the Ikea people repeatedly tell anyone who will listen, this place will not be an Ikea. There will not be Poäng armchairs adorning the living rooms and Billy bookcases covering the walls. The houses will not require Allen keys to assemble. Meatballs in lingonberry sauce will not be served at the restaurants. And there will not, the company insists, be an Ikea store anywhere in or near the neighbourhood.
But what might make it seem alien to Brits and North Americans is Ikea’s very active role in the neighbourhood’s life – in large part because the houses will be fully owned by Ikea. In a model that is the norm in Sweden and other parts of continental Europe, but alien to English-speaking countries, this will be an all-rental private neighbourhood, run and overseen by a private company.
“We’re about human scale, we’re about building things to a high design and a good quality, because we are long-term investors,” explains Andrew Cobden, the project’s manager. “We don’t like to sell income-generating assets.”
What does it mean to live in a mixed-income urban neighbourhood in which none of your neighbours are owners? Ikea prefers to emphasize the upside: It will be less likely that people will buy, wait for the value to increase, then move to the suburbs and become absentee landlords (a problem in East London). But there are risks: without an equity stake in their neighbourhood, residents aren’t likely to rebuild it, transform it and shift housing, retail and light-industry spaces into one another to suit the community’s needs. It will be static, governed not by its own internal organic development but by a mega-landlord with a penchant for neat design and social order.
And here is where living in an Ikea neighbourhood might come to resemble a long day in an Ikea store: The company wants you to be in a neat, clean, pleasant environment. And it very much wants you to have fun. Those things that normally just happen in life will be carefully managed from above.
“We’d have a very good understanding of rubbish collection, of cleanliness, of landscape management,” Mr. Cobden says. “We would have a fairly firm line on undesirable activity, whatever that may be. But we also feel we can say, okay, because we’ve kept control of the management of the commercial facilities, we have a fairly strong hand in what is said in terms of the activities that are held on site.”
That, he says, means setting up and promoting things like farmers’ markets, antique shops and outdoor flower stalls. Presumably, it also means keeping out cheque-cashing shops, Internet cafes, bookmakers and the other detritus of the British shopping street, as well as the sort of down-at-the heels characters who make urban life colourful but challenging.
“And that,” Mr. Cobden says, “will give the residents an events calendar that arrives on their doorstep of things that are happening – and that kind of creates a sense of place. … We’ll shape it rather than force it on people – but we’ll be trying to knit the community together.”
Ikea’s builders say they’re not interested in a Disney-style kind of an animatronic spectacle. Rather, they’re seeding Strand East with evocations of spontaneous urban life in hopes that it will become spontaneous urban life; they say they’d be happy to see it shift and evolve to suit market conditions. It’s not clear, though, how this desire will coexist with Ikea’s desire to keep the place under its control.
The answer, Mr. Müller says, is that the Swedes have a long-term interest in success – much like a municipal council does, and, in fact, Ikea will be acting very much like a municipal government.
After all, what IKEA is really doing here is finding a place to sink a small part of its huge pile of cash. They want to earn a profit over 10 to 20 years, not the three or four years of a conventional property developer – and are therefore very interested in the long-term livability of the project.
“We’re just securing our money long-term – and of course creating more profits at the end,” Mr. Müller says. “But we are acting as a long-term investor, we are equity-driven, so we are acting very differently from a developer.” In a very real sense, the furniture company wants to invest its money in your entire life…
The Errors of Their Ways: The Epidemic Of Medical Mistakes And Deaths In An Era Of Sophisticated Medicine
April 7, 2012
DURING CHRIS HICKS’ third year of studies at a small medical school in southern Ontario, he developed a fear, one that must torment all aspiring physicians: that he would kill a patient — or, worse, all of them. His dread grew as he prepared for his 2003 clerkship, when medical education shifts from the classroom to the actual work of caring for patients in hospitals. He and his fellow students practised resuscitations on mannequins. Time after time, he tried to save his mannequin, and time after time it died. So he was terrified when he met his first real patient, a cyanotic baby girl who had turned blue from lack of oxygen. “I thought, ‘The killing spree begins,’” he says.*
But the infant survived, and so did Hicks, and a few weeks later he found himself on a neurology rotation, caring for a man in his sixties who had recently suffered a spinal cord infarction, a stroke that left him paralyzed from the chest down. The patient was affable and cheerful, despite his illness. Hicks liked him. The plan was to move him into a rehabilitation hospital or long-term care facility once his condition was stable.
A common complication in immobile patients are pressure ulcers, sores that develop where the skin meets the surface of a bed or a wheelchair for long periods. They can appear quickly: within hours, a warm, reddish or purplish spot turns into an open wound, and within a day or two the flesh becomes necrotic. Often they don’t heal, and if an infection develops and spreads to the bone or the bloodstream it can be fatal. These sores are particularly pernicious among the elderly and those who suffer from circulatory problems, diabetes, drug and alcohol addictions, or poor nutrition. The sicker the patient, the more serious the risk.
To prevent tissue damage from lack of blood circulation, patients must be turned every two hours. As a student, however, Hicks was unfamiliar with pressure ulcers and their treatment. After the patient had been on the neurology ward for a few weeks, he developed a large sore, about the size of a man’s palm, over his sacrum. The attending physician and the nursing staff knew the patient was at risk for bedsores and had ordered a special air mattress that reduces their incidence, but the hospital only had two, and both were in use. Still, given that the potential for sores had been recognized, Hicks was unsure why the ulcer had developed: Had the nurses neglected to turn him? Had the attending physician forgotten to instruct them to do so? Should Hicks have examined the man more thoroughly to determine whether he was developing sores? Was this a case of negligence, or a failure to communicate?
A plastic surgeon was called in to treat the ulcer and debride the wound. Because of his paralysis, the patient couldn’t feel anything, and Hicks remembers with horror listening to him happily chat with them while the dead tissue was dug away from his back, exposing his spine. Two days later, when Hicks returned to the ward, he looked at the patient’s chart. In capital letters, the plastic surgeon had written, “This was a medical error and it needs to be explained to the family as such.” Hicks remembers the moment, he says, “like it was the Kennedy assassination. I thought, that’s the end of my career.”
When the attending physician explained the situation to the family, they were understanding, even after the patient developed sepsis, a bacterial infection. In many cases, this would have set off a chain of mounting treatments and attendant complications: a prolonged stay in the intensive care unit; more antibiotics; and invasive procedures, such as intubations, that can cause damage or infection. The patient’s condition improved, however, and he was eventually able to leave the hospital.
Hicks, a lanky man with schoolboy glasses and a scruffy beard, is now in his early thirties. He works at St. Michael’s Hospital, a teaching facility in downtown Toronto, as an emergency physician and trauma team leader. Eight years afterward, this early experience continues to shape his interests as an academic; at the University of Toronto’s medical school, he conducts research in the fields of team performance, patient safety, and error prevention. He still wonders about his role in the case, and whether a better medical student would have recognized the ulcer sooner. Back then, he says, “I assumed that it was a knowledge problem, that when I learned more I wouldn’t make those kinds of mistakes.”
Writ large, the entire medical profession has been engaged in its own long stomp from ignorance to knowledge, from bloodletting and incantations to an ever more precise understanding of anatomy and disease, germs and genetics. Today the practice of medicine draws from a variety of disciplines, including biology, chemistry, physics, engineering, computing, and psychology, and the field exemplifies the triumph of human intelligence, diligence, and creativity. Vaccinations have eradicated polio from developed countries and are poised to do the same in the developing world. Kidneys, hearts, and lungs can be removed from one body and transplanted into another. Ultrasound and magnetic resonance imaging enable non-surgical access to the mysteries of the womb and the brain. Deadly micro-organisms are vanquished by antibiotics, shattered bones are mended, and sheared-off limbs are reattached, or replaced with bionic prostheses. Laser eye surgery allows the myopic to cast off their glasses like pilgrims at Lourdes. Three medications released over the past fifty years — the birth control pill, Prozac, and Viagra — have fundamentally altered our sexual, emotional, and social lives.
Yet as the tools for healing proliferate, so do the difficulties in determining and executing correct diagnoses and treatments; each discovery creates new opportunities for mistakes, side effects, and dangers. Modern medicine is plagued by adverse events such as the one suffered by Hicks’ patient: potentially preventable, unintended injuries or complications caused by health care management itself. They encompass the out-and-out mistakes (such as misdiagnoses or surgical slips), as well as the system breakdowns that bedevil hospitals (inconsistent hand washing protocols, or poor communication during patient transfers). A 2004 study estimates that 7.5 percent of Canadians who are admitted to hospitals each year experience at least one adverse event. These errors are responsible for more than a million extra days spent in medical facilities, and the resulting annual death toll may be as high as 24,000.
Consider some notable cases: in the 1980s, negligence in the testing of blood products by the Canadian Red Cross allowed the spread of HIV/AIDS infections to 2,000 people and hepatitis C to at least 30,000 others. More recently, the bungling of pathology reports in Newfoundland and Labrador led to hundreds of patients being given inaccurate breast cancer screening results. And according to a 2011 report from the Organisation for Economic Co-operation and Development, Canada ranks among the worst of the thirty-four member nations for adverse events related to surgery. The list of mishaps reads like a series of David Cronenberg plot treatments: obstetrical trauma, foreign objects left inside the body during procedures, accidental punctures or lacerations, and post-operative sepsis…
It’s not a great time, PR-wise, for the global cruise industry. It would be bad enough with all the attention surrounding the 100th anniversary of the sinking of the Titanic and James Cameron’s 3-D release of his blockbuster movie. But contemporary cruise disasters have been in the news with disturbing regularity as well.
In the latest incident, on March 30, a fire broke out on the luxury cruise ship Azamara Quest, forcing it to make an emergency stop at a Malaysian port. Thankfully, there were no deaths and the ship avoided the fate of the Costa Concordia, which ran aground off Giglio Island near Tuscany in January, killing at least 25 people, with seven more missing and presumed dead. Just a few weeks later, on Feb. 27, another of the Costa line’s ships — the Allegra — lost power in the Indian Ocean after an engine-room fire, leaving more than 1,000 people without power or water for nearly a week as the ship was towed to the Seychelles.
The media coverage of the Costa disaster has focused on Capt. Francesco Schettino, who stands accused of both piloting the vessel too close to the island as a publicity stunt and abandoning ship while thousands were still aboard. But these incidents are much bigger than the actions of one captain or even one company. They are evidence of an industry out of control.
Rather than being the exception to the rule, the Costa disasters are the products of a cruise-industry culture in which passenger safety, environmental impact, the exploitation of workers, and crime — including rampant sexual assault — are too often merely swept under the rug. If legislative steps aren’t taken to bring the industry under control, these recent unfortunate events may just be the tip of the iceberg.
The cruise industry likes to bill itself as the safest mode of commercial transportation. The claim is made on the Cruise Lines International Association’s website and is frequently repeated when reports of shipboard accidents or crimes have been raised in the media or in congressional hearings. But whether a cruise ship is safe is a matter of perspective. The facts are that 16 cruise ships have sunk since 1980, 99 have run aground since 1973, 79 have experienced onboard fires since 1990, and 73 have had collisions since 1990. Since 2000, there have been 100 incidents in which ships have gone adrift, lost power, experienced severe lists — when a ship nearly tips — or had other events that posed a safety risk to passengers.
Admittedly, passenger deaths are infrequent. As we saw, however, following the 1994 sinking of the cruise ship Estonia in the Baltic Sea, just one accident has the potential for massive casualties — more than 850 perished when that ship sunk within 30 minutes of taking on water during a storm.
Given the number of incidents, it’s surprising that major cruise lines can still be so lax when it comes to safety precautions. That the Costa Concordia was at sea without a functioning black box — imagine an airplane being allowed to fly passengers without a black box — is a testament to the less-than-conscientious attitude of the industry to passenger safety and security. (There were subsequent news reports suggesting the black box was recovered, but these appear to refer to bridge voice recordings, which are quite different.)
Unfortunately, ship accidents are not the only safety concerns facing cruise passengers. Between Oct. 1, 2007, and Sept. 30, 2008, the FBI received 421 reports of onboard crime from cruise ships, including 115 simple assaults, 16 assaults with serious bodily injury, 101 thefts, and 154 sex-related incidents. Cruise ships made these crime reports following March 2007 congressional hearings in which the cruise industry made a commitment to report to the FBI all crimes against U.S. citizens (though the data also include some reports regarding foreign nationals). The rate of sexual assault on Carnival Cruise Lines in 2007 and 2008 was a surprisingly high 115 per 100,000 passengers.
In addition to safety concerns, the cruise industry also poses major risks to the environment. These were brought to the forefront in the late 1990s after Royal Caribbean International was fined more than $30 million for illegally discharging oil and hazardous chemicals into U.S. and Alaskan state waters and for making false statements to the U.S. Coast Guard. The U.S. Government Accountability Office reported in 2000 that between 1993 and 1998, the U.S. government confirmed 87 illegal discharges from cruise ships (81 involving oil and six involving garbage or plastic). Seventeen “other alleged incidents” were referred to the countries where the cruise ships were registered.
Royal Caribbean is hardly the only culprit. Holland America Line was fined $2 million in 1998 for pumping oily bilge water into the Inside Passage off the Alaskan coast, in addition to other violations. In April 2002, Carnival Corp. entered a plea agreement and paid an $18 million fine, pleading guilty to numerous pollution incidents from 1996 through 2001. These included discharging oily waste into the sea from ships’ bilges and falsifying records of oily bilge water on six ships to conceal company practices. A few months later, in July 2002, Norwegian Cruise Line pleaded guilty to having discharged oily bilge water for several years and to having falsified discharge logs; it was fined $1.5 million.
There are more recent environmental offenses as well. In 2008, 12 of 20 ships permitted to discharge in Alaskan waters (the only jurisdiction where cruise ship discharges are monitored and measured) violated discharge limits, logging 45 violations involving seven pollutants, among them ammonia, chlorine, copper, fecal coliform, and zinc. The year 2009 was even worse, with 13 of 18 ships that were permitted to discharge in Alaskan waters violating Alaska’s discharge limits during the season, racking up 66 violations involving nine pollutants.
Many environmental offenses regularly perpetrated by cruise ships — include the discharge of sewage, the dumping overboard of solid waste, the use of incinerators (which are less regulated than incinerators on land), and the discharge of oily bilge — go unpunished due to the patchwork of U.S. regulations, which often allows cruise lines to pollute with impunity: Regulations in Alaska, Washington, and California are relatively stringent; there is very little regulation in Oregon, the Gulf states, and much of the Eastern Seaboard…