Dr Rajiv Desai Blog

THE PAIN

May 5th, 2012

THE PAIN:

Prologue:

Pain, as a proper subject of scientific observation and study, has long been neglected by medical science. Perhaps, like death, it reminds us too much of our failures as physicians. Or perhaps, like sex, it was seen as too private or subjective a subject for objective analysis. Whatever the reason, pain was never mentioned as a topic in my medical school, residency, or internship training. Pain is the most common symptom of disease and the request for its relief probably the most common demand placed on the doctor. Pain is too important a topic to continue to be ignored. Pain is clearly a multidimensional experience. It is neurophysiological, biochemical, psychological, ethnocultural, religious, cognitive, affective and environmental. The topic of pain is extremely complex to say the least. Pain is that pervasive, invasive, all-encompassing personal warning that something-is-wrong signal. Pain is associated with a wide range of injury and disease, and is sometimes the disease itself. It is your friend and yet not your friend. Sometimes it arrives uninvited and unexpectedly in a sneaky manner, creeping up insidiously as it starts to take over everything about you. Sometimes it happens in an accidental manner. It drains you of energy, depletes your creativity, lightens your memory and exhausts you beyond any known definition of the word exhaustion. Your view of the world changes radically and sometimes the world’s view of you changes too. We now recognize that acute pain and chronic pain are distinct entities physiologically, neuroanatomically, and psychologically. Chronic pain is not just acute pain that occurs over a long period of time. Chronic pain can be a soul destroyer. Statistics show that people who suffer from chronic pain are eight times more likely to commit suicide than those who suffer from depression alone. I am surprised to learn that the amount of money spent on chronic pain is greater than the combined cost of heart disease and diabetes.

History of pain:

The nature of pain has intrigued philosophers for millennia. The ancient Greeks conceived of pain as an emotion. In the late nineteenth and early twentieth century, the view of pain as sensation became preeminent: it was seen as a direct response to a stimulus. From the mid–twentieth century to the present, these two views have been combined, so medical scientists who study pain now think of it as a subjective experience with distinct discriminative and emotional components. Ancient civilizations understood pain when it was visible, such as a cut or scrape, and recorded their accounts of pain and their treatments on stone tablets. But when pain was internal they related it to magic, demons, and evil thus the responsibility of pain relief, through ceremonies and rites, was left to shamans, priests, and sorcerers. The Greeks (and Romans) were the first to advance the theory that the brain and nervous system have a role in producing the perception of pain – sensation. And they also gave us the word “pain” or Poine, who was the Greek goddess of revenge, who was sent to punish the mortal fools who had angered the gods. The ancient Greek Hippocrates, prescribed chewing willow leaves to women in childbirth for their pain-relieving benefits, and this was the “beginning of aspirin” as willow trees, genus Salix, contains a form of salicylic acid, the active ingredient in aspirin. During the 17th and 18th centuries, the French philosopher Rene Descartes (1664) was the first to describe how pain traveled within the body, now called the pain pathway. He illustrated how particles of fire come into contact with the foot, the sensation traveling to the brain and then he compared pain sensations to the ringing of a bell. From this came the concept that there can be false alarms and we have therefore come to distinguish “psychogenic pain” from “real pain”. This is now known to be a false distinction, but still we hear today the concept of hurt being not the same thing as harm, with the implication that much that hurts may be ignored. It was the 19th century that pain came to dwell under a new domain and huge advances in pain therapy. Physicians discovered that pharmaceuticals, such as opium, morphine, codeine, and cocaine, could be used in pain relief. Another significant discovery was the use of anesthesia for surgery, prior to that, physicians used some fairly unusual techniques, such as putting a wooden bowl over a patient’s head and hammering on the bowl until the patient passed out. Or they would hold a patient’s head over a gas stove, thus inhaling the gas, and wait until they lost consciousness. But it was Queen Victoria who popularized anesthesia – chloroform – for childbirth- she actually made it fashionable. Even though we have made huge leaps in treatments and understanding of pain, some believe that ancient and primitive cultures may have been way before their time. Today, people look at pain treatment as being very objective, rigid, and almost literal – a quick fix – instead of how ancient people saw pain as not only a physical condition but as an emotional and spiritual condition – working with the entire patient.

From what we remember from our undergraduate textbooks, when you get hurt, the pain receptors send pain signals up the brain and we sense pain. So if pain is indeed an accurate indication of tissue damage, can it explain the following:

1. Why do 40% of the people (alert, rational & coherent and “not in shock”) admitted to an emergency room with horrific wounds feel no pain or pain of low intensity even after long delays?

2. Why do studies repeatedly show gross abnormalities, like disc bulges, spinal stenosis, herniations, meniscus tears, and so on in 20-70% of people who have no history of pain?

3. Which treatment would help in relieving the pain experienced by amputees in their “missing limb”? And 70% of the amputees report limb pain and sensation even years after the amputation.

4. There are thousands of amputees running with prosthetic limbs and cerebral palsy patients walking with worst gait possible. These folks have more than 100% movement dysfunctions. Why are they not in bed wreathing in pain?

So pain is not merely an indicator of tissue damage even though tissue damage does cause pain.

The experience of pain is not easy to understand. Pain is not merely a biologic process. Certainly, pain is a neurobiologic process, but, it also is an emotional experience; it brings up memories of past painful experiences; and, there is an awareness of pain that can be changed or modified. The experience of pain varies from individual to individual and from culture to culture. These cultural influences of pain modify the way peoples of different cultures experience it. The pain of surgery or injury is called acute pain. This pain has a biologic purpose. It tells us where we are hurt so that we may protect ourselves. This pain also activates defensive fight and flight mechanisms which protect us when we are threatened by a hostile environment. The pain that lasts and lasts, in spite of the healing of injury is called chronic pain. This pain is not easy to understand. It has no biologic purpose. It appears that this pain is a disease itself.

The task of medicine is to preserve and restore health and to relieve suffering. Understanding pain is essential to both these goals. Because pain is universally understood as a signal of diseases, it is the most common symptom that brings a patient to a physician’s attention. The function of the pain sensory system is to protect the body and maintain homeostasis. Pain is the most common reason for physician consultation in the United States and probably the world. It is a major symptom in many medical conditions, and can significantly interfere with a person’s quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly modulate pain’s intensity or unpleasantness. Also, sadness can aggravate pain and happiness can reduce pain.

Pain management a human right:

The delegates to the International Pain Summit (IPS) of the International Association for the Study of Pain (IASP) (comprising IASP representatives from Chapters in 64 countries plus members in 130 countries, as well as members of the community) have declared that access to Pain Management is a Fundamental Human Right. They found that pain management is inadequate in most of the world because:

1. There is inadequate access to treatment for acute pain caused by trauma, disease, and terminal illness; and failure to recognize that chronic pain is a serious chronic health problem requiring access to management akin to other chronic diseases such as diabetes or chronic heart disease.

2. There are major deficits in knowledge of health care professionals regarding the mechanisms and management of pain.

3. Chronic pain with or without diagnosis is highly stigmatized.

4. Most countries have no national policy at all or very inadequate policies regarding the management of pain as a health problem, including an inadequate level of research and education.

5. Pain Medicine is not recognized as a distinct specialty with a unique body of knowledge and defined scope of practice founded on research and comprehensive training programs.

6.The World Health Organization (WHO) estimates that 5 billion people live in countries with low or no access to controlled medicines and have no or insufficient access to treatment for moderate to severe pain.

7. There are severe restrictions on the availability of opioids and other essential medications, critical to the management of pain.

Pain statistics:
New statistics released by IASP and EFIC indicate that one in five people suffer from moderate to severe chronic pain, and that one in three are unable or less able to maintain an independent lifestyle due to their pain. Between one-half and two-thirds of people with chronic pain are less able or unable to exercise, enjoy normal sleep, perform household chores, attend social activities, drive a car, walk or have sexual relations. The effect of pain leads to strained or broken relationship with family and friends in 25 % of chronic pain sufferers, according to the IASP/EFIC data.

Pain statistics in the U.S.

Pain is a prevalent medical complaint and is one of the primary reasons for which patients seek medical attention in the United States. According to the American Pain Society, 50 million Americans are partially or totally disabled by pain, and 45% of all Americans seek care for persistent pain at some point in their lives. It has been estimated that 50% to 80% of hospitalized patients experience considerable pain regardless of the reason for admission. Despite the introduction of novel analgesics and advances in analgesic delivery systems, pain continues to be an undertreated event in a large proportion of hospitalized patients. Up to 90% of individuals with pain associated with cancer or other terminal illnesses and 50% of patients with acute pain are undertreated.

Incidence of pain as compared to major conditions in the U.S.

A hallmark of many chronic conditions, pain affects more Americans than diabetes, heart disease and cancer combined.

The chart below depicts the number of chronic pain sufferers compared to other major health conditions.

Condition	Number of Sufferers	Source
Chronic Pain	116 million Americans	Institute of Medicine of The National Academies
Diabetes	25.8 million Americans	American Diabetes Association
Coronary Heart Disease and Stroke	16.3 million Americans and 7.0 million Americans respectively	American Heart Association
Cancer	11.9 million Americans	American Cancer Society

A recent market research report indicates that more than 1.5 billion people worldwide suffer from chronic pain and that approximately 3-4.5% of the global population suffers from neuropathic pain, with incidence rate increasing in complementary to age. Pain is a significant public health problem that costs American society at least $560-$635 billion annually. Pain is the main reason for visiting the emergency department in more than 50% of cases and is present in 30% of family practice visits. Several epidemiological studies from different countries have reported widely varying prevalence rates for chronic pain, ranging from 12-80% of the population. It becomes more common as people approach death. A study of 4,703 patients found that 26% had pain in the last two years of life, increasing to 46% in the last month. A survey of 6,636 children (0–18 years of age) found that, of the 5,424 respondents, 54% had experienced pain in the preceding three months. A quarter reported having experienced recurrent or continuous pain for three months or more, and a third of these reported frequent and intense pain. The intensity of chronic pain was higher for girls, and girls’ reports of chronic pain increased markedly between ages12 and 14.

Pain costs:

Millions suffer from acute or chronic pain every year and the effects of pain exact a tremendous cost on our country in health care costs, rehabilitation and lost worker productivity, as well as the emotional and financial burden it places on patients and their families. The costs of unrelieved pain can result in longer hospital stays, increased rates of rehospitalization, increased outpatient visits, and decreased ability to function fully leading to lost income and insurance coverage. As such, patient’s unrelieved chronic pain problems often result in an inability to work and maintain health insurance. According to a recent Institute of Medicine Report: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research; pain is a significant public health problem that costs society at least $560-$635 billion annually, an amount equal to about $2,000.00 for everyone living in the U.S.

Lost productive time and cost due to Common Pain conditions in the United States Workforce:

1.Over half (52.7%) of the workforce surveyed reported having headache, back pain, arthritis, or other musculoskeletal pain in the past two weeks, and 12.7% of all workforce lost productive time in a two-week period due to pain.

2. Headache (5.4%) was the most common pain condition prompting lost productive time: followed by back pain (3.2%), arthritis pain (2%) and other musculoskeletal pain (2%).

3. Overall, workers lost an average of 4.6 hours per week of productive time due to a pain condition.

4. Other musculoskeletal pain (5.5 hours/week) and arthritis or back pain (5.2 hours/week) produced the largest amounts of lost productive time.

5. Headache produced, on average, 3.5 hours of lost productive time per week.

6. Age did not seem to attenuate the findings.

7. Lost productive time from common painful conditions was estimated to be $61.2 billion per year, while 76.6% of lost productive time was explained by reduced work performance, not absenteeism.

Pain cost in Europe:

A new EU-wide study by The Work Foundation (www.theworkfoundation.org) has found that musculoskeletal disorders (MSDs) such as back pain, neck pain and RSI-type conditions, account for nearly half (49%) of all absences from work and 60% of permanent work incapacity in the European Union. The estimated cost to society in Europe is up to €240 billion every year, with 100 million European citizens suffering the misery of MSDs that are serious enough to warrant treatment and absence from work.

Effect on functioning:

Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control, working memory, mental flexibility, problem solving, and information processing speed. Acute and chronic pain are also associated with increased depression, anxiety, fear, and anger. If I have matters right, the consequences of pain will include direct physical distress, unemployment, financial difficulties, marital disharmony, and difficulties in concentration and attention…

The Neuron (nerve cell):

The neuron is the cell that animals use to detect the outside environment, the internal environment of their own bodies, to formulate behavioral responses to those signals, and to control their bodies based on the chosen responses. The brain, the spinal cord and peripheral ganglia are made up of many cells, including neurons and glial cells. A neuron (nerve cell) is an electrically excitable cell that processes and transmits information by electrical and chemical signaling. Chemical signaling occurs via synapses, specialized connections with other cells. Neurons are cells that send and receive electro-chemical signals to and from the brain and nervous system. There are about 100 billion neurons in the brain. There are many more glial cells; they provide support functions for the neurons, and are far more numerous than neurons. The neuron consists of a cell body (or soma) with branching dendrites (signal receivers) and a projection called an axon, which conduct the nerve signal. At the other end of the axon, the axon terminals transmit the electro-chemical signal across a synapse (the gap between the axon terminal and the receiving cell). A typical neuron has about 1,000 to 10,000 synapses (that is, it communicates with 1,000-10,000 other neurons, muscle cells, glands, etc.). Unlike most other cells, neurons cannot regrow after damage (except neurons from the hippocampus). Glial cells make up 90 percent of the brain’s cells. Glial cells are nerve cells that don’t carry nerve impulses. The various glial (meaning “glue”) cells perform many important functions including: digestion of parts of dead neurons, manufacturing myelin for neurons, providing physical and nutritional support for neurons, and more.

Neurons in a resting state normally have a membrane potential around -70mV (minus seventy millivolts). This means that the voltage difference between the fluid on the inside of the cell relative to the fluid on the outside of the cell is negative. This negative difference is maintained with ions like Na⁺, K⁺, Cl^- , and protein anions. The neuron has a pump that actively pumps three Na⁺ ions out and takes in two K⁺ ions. This means that a net positive charge flows out of the neuron. This is what gives the cell its negative potential. Ions are also what are responsible for the initiation, and transmission of action potentials. The first step of the action potential is that the Na+ channels open allowing a flood of sodium ions into the cell. This causes the membrane potential to become positive. At some positive membrane potential, the K+ channels open allowing the potassium ions to flow out of the cell. Next the Na+ channels close. This stops inflow of positive charge. But since the K+ channels are still open it allows the outflow of positive charge so that the membrane potential plunges. When the membrane potential begins reaching its resting state, the K+ channels close. Now the sodium/potassium pump does its work and starts transporting sodium out of the cell, and potassium into the cell so that it is ready for the next action potential.

The action potential travels down the length of the axon as a voltage spike. It does this by using the steps just outlined. As a section of the axon undergoes the above process, it increases the membrane potential of the neighboring section and causes it to spike. This is like a mini chain reaction that proceeds down the length of the axon until it reaches the synapse. Thus an action potential is an electric pulse that travels down the axon until it reaches the synapses, where it then causes the release of neurotransmitters. The synapses are extremely close to the dendrites of the target neuron. This allows the neurotransmitters to diffuse across the intervening space and fit into the receptors that are located on the target neuron. This causes some action to take place in that neuron that will either decrease or increase the membrane potential of the neuron. If it increases the membrane potential, then it is exciting the neuron; and if it decreases the membrane potential, then it is inhibiting the neuron. If it causes the membrane potential to pass the firing threshold then it will activate an action potential in the target neuron and send it down its axon. Afferent neurons convey information from outside environment and internal environment (tissues and organs) into the central nervous system and are sometimes called sensory neurons. Efferent neurons transmit signals from the central nervous system to the effector cells and are sometimes called motor neurons. Interneurons connect neurons within specific regions of the central nervous system. Further discussion on wide variety of voltage-gated channels (e.g., Nav, Cav, Kv) that transduce the receptor potential into an action potential or, more commonly, a set of action potentials that encode the intensity of a noxious stimulus applied to nociceptor is discussed later on in the article.

The table above shows difference between nociceptive specific (NS) and wide dynamic range (WDR) neurons which transmit pain signal to brain.

Definition:

The international association for study of pain (IASP) has defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. It follows that severity of pain does not correlate with the degree of tissue damage, and that each patient’s experience and expression of pain are different. Pain is a warning that something is wrong, pre-empts other signals, and is associated with an unpleasant affect. Pain is an unpleasant sensation localized to a part of body. It is often described in terms of a penetrating or tissue-destructive process (e.g. stabbing, burning, twisting, tearing, squeezing) and/or of a bodily or emotional reaction (e.g. terrifying, nauseating, sickening). Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the “funny bone.” Further-more, any pain of moderate or severe intensity is accompanied by anxiety and the urge to escape or terminate the feeling. These properties illustrates duality of pain, it is both sensation and emotion. When acute, pain is characteristically associated with behavioral arousal, and a stress response consisting of increased blood pressure, heart rate, pupil diameter, and plasma cortisol levels. In addition, local muscle contraction (e.g. limb flexion, abdominal wall rigidity) is often present. Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

From this definition we see that pain is a perception in the same way that vision and hearing are. By this I mean that its significance is determined by the cerebral cortex in the light of other activity there. It involves sensitivity to chemical changes in the tissues and then interpretation that such changes are, or may be harmful. This perception is real, whether or not harm has occurred or is occurring. Cognition is involved in the formulation of this perception. There are emotional consequences, and behavioral responses to the cognitive and emotional aspects of pain. Pain, in its simplest form, is a warning mechanism that helps protect an organism by influencing it to withdraw from harmful stimuli (such as a pinprick). In its more complex form, such as in the case of a chronic condition accompanied by depression or anxiety, it can be difficult to isolate and treat. Pain receptors, found in the skin and other tissues, are nerve fibers that react to mechanical, thermal, and chemical stimuli. Pain impulses enter the spinal cord and are transmitted to the brain stem and thalamus. The perception of pain is highly variable among individuals; it is influenced by previous experiences, cultural attitudes (including gender stereotypes), and genetic makeup. Pain is more complex than other sensory systems such as vision or hearing because it not only involves the transfer of sensory information to the nervous system, but produces suffering which then leads to aversive corrective behavior. So pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a protective mechanism for the body and causes a human or animal to react to remove the pain stimulus. It is a complex sensory experience with many subjective components: 1) discriminative; 2) learning and memory—associate pain with certain events; 3) unpleasantness, displeasure and 4) suffering, escape.

Pain, as a submodality of somatic sensation, has also been defined as a “complex constellation of unpleasant sensory, emotional and cognitive experiences provoked by real or perceived tissue damage and manifested by certain autonomic, psychological, and behavioral reactions”. The benefit of these unpleasant sensations, however, is underscored by extreme cases: patients lacking the ability to perceive pain due to hereditary neuropathies often maintain unrealized infections; self mutilate, and have curtailed life spans. Normally nociception (vide infra) and the perception of pain are evoked only at pressures and temperatures extreme enough to potentially injure tissues and by toxic molecules and inflammatory mediators. These high threshold physical and noxious chemical stimuli are detected by specialized peripheral sensory neurons (nociceptors). This is in contrast to the high sensitivity of visual, auditory, olfactory, taste, and somatosensory organs to their adequate stimuli. Pain is described as having different qualities and temporal features depending on the modality and locality of the stimulus respectively: first pain is described as lancinating, stabbing, or pricking; second pain is more pervasive and includes burning, throbbing, cramping, and aching and recruits sustained affective components with descriptors such as “sickening”. The intensity of these global reactions underscores the importance of avoiding damaging situations for survival and maintaining homeostasis. As opposed to the relatively more objective nature of other senses, pain is highly individual and subjective and the translation of nociception into pain perception can be curtailed by stress or exacerbated by anticipation.

Physiological to pathological pain:

Pain is produced by stimuli that usually cause damage to tissues. It is in the best interest of an organism to detect potential damage to the body so it can take appropriate steps to avoid being harmed. The presence of pain usually forces immobilization of the injured area and prevents additional tissue damage from taking place and allows for the healing and repair processes to occur. Without the aid of the body’s response to tissue damage, survival would be difficult. Pathological pain is considered abnormal given that there is no protective value to the organism. This is the “morphism” in the nervous system that involves plasticity in both the peripheral and central nervous systems. It affects the way the nervous system detects the type of stimuli from the environment – a shift from a normally protective physiological mechanism to an abnormal and possibly pathological mechanism. Consequently, this justifies the concept that pain should also be considered a disease process on its own especially in chronic form.

People who sought treatment through the College of Dentistry’s Parker E. Mahan Facial Pain Center, reported that due to their pain, routine tasks such as speaking on the telephone, eating, taking medications and carrying on a conversation, had became daily hassles. Pain is associated with a variety of behaviors. A painful stimulus will arouse us, as in “Pinch me to see if I’m awake.” It can focus our attention on the site of an injury: “I looked down at where it hurt and saw I was bleeding.” It can cue us to try to escape from the cause of an injury or immobilize us so that we do not suffer further damage. In addition, pain causes changes in heart rate and blood pressure, and an endocrine response with elevated stress hormones. For each response elicited by the pain-producing injury, there is a unique central nervous system pathway.

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The first aspect of pain is that although pain appears to be a simple, homogenous experience, it is actually a complex experience comprising sensory-discriminative, emotional-cognitive, and behavioral components. These components are normally linked together, but they can become disconnected and therefore, much to our astonishment, they can exist separately. The second aspect is that pain, once deprived of all its affective, cognitive, and behavioral components, loses all of its representational and motivational force: it is no longer a signal of threat or injury, and it no longer moves one’s mind or body in any way. The third aspect is that pain deprived of its sensory discriminative components comes to such sensory indeterminacy that it cannot be distinguished from other unpleasant sensations, or sensations of other quality, and loses all informational power with regard to the location, intensity, temporal profile, and nature of harmful stimuli.

In everyday life pain is recognized in two forms, namely acute pain and chronic pain. The former has a protective function. It alerts us to damage to the body, it increases our level of arousal, it directs our attention to the cause of the pain, and generates behavior that leads to an escape from it. The chief emotion associated with acute pain is anxiety, and this subsides when pain is relieved and the cause is understood. In contrast, chronic pain does not appear to the sufferer to have any purpose and indeed has negative qualities. It gives rise to feelings of anxiety and at times of depression. The behaviors generated include withdrawal from social activities and a search for relief. The latter may well lead the sufferer to move from one doctor to another and to non-medical practitioners in the hope of pain relief. At times that process itself may generate more physical suffering through unnecessary investigation and the end result is pain, despair, and depression.

Since pain is the most complex subject for discussion, let me begin with the nomenclature of pain so that various terms can be understood and interpreted in the right perspective.

Pain nomenclature:

Pain:

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Note: Pain is always subjective. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.

Allodynia: Pain due to a stimulus that does not normally provoke pain.

Note: The stimulus leads to an unexpectedly painful response. This is a clinical term that does not imply a mechanism. Allodynia may be seen after different types of somatosensory stimuli applied to many different tissues. The term allodynia was originally introduced to separate from hyperalgesia and hyperesthesia, the conditions seen in patients with lesions of the nervous system where touch, light pressure, or moderate cold or warmth evoke pain when applied to apparently normal skin. It is important to recognize that allodynia involves a change in the quality of a sensation, whether tactile, thermal, or of any other sort. The original modality is normally nonpainful, but the response is painful. There is thus a loss of specificity of a sensory modality. By contrast, hyperalgesia (vide infra) represents an augmented response in a specific mode, viz., pain. With other cutaneous modalities, hyperesthesia is the term which corresponds to hyperalgesia, and as with hyperalgesia, the quality is not altered. In allodynia, the stimulus mode and the response mode differ, unlike the situation with hyperalgesia. This distinction should not be confused by the fact that allodynia and hyperalgesia can be plotted with overlap along the same continuum of physical intensity in certain circumstances, for example, with pressure or temperature.

Analgesia: Absence of pain in response to stimulation which would normally be painful.

Anesthesia dolorosa: Pain in an area or region which is anesthetic.

Causalgia: A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.

Central pain: Pain initiated or caused by a primary lesion or dysfunction in the central nervous system.

Dysesthesia: An unpleasant abnormal sensation, whether spontaneous or evoked.

Note: Special cases of dysesthesia include hyperalgesia and allodynia. A dysesthesia should always be unpleasant and a paresthesia should not be unpleasant, although it is recognized that the borderline may present some difficulties when it comes to deciding as to whether a sensation is pleasant or unpleasant. It should always be specified whether the sensations are spontaneous or evoked.

Hyperalgesia: Increased pain from a stimulus that normally provokes pain.

Note: Hyperalgesia reflects increased pain on suprathreshold stimulation. This is a clinical term that does not imply a mechanism. For pain evoked by stimuli that usually are not painful, the term allodynia is preferred, while hyperalgesia is more appropriately used for cases with an increased response at a normal threshold, or at an increased threshold, e.g., in patients with neuropathy. It should also be recognized that with allodynia the stimulus and the response are in different modes, whereas with hyperalgesia they are in the same mode. Current evidence suggests that hyperalgesia is a consequence of perturbation of the nociceptive system with peripheral or central sensitization, or both, but it is important to distinguish between the clinical phenomena, which this definition emphasizes, and the interpretation, which may well change as knowledge advances. Hyperalgesia may be seen after different types of somatosensory stimulation applied to different tissues.

Hyperesthesia: Increased sensitivity to stimulation, excluding the special senses.

Note: The stimulus and locus should be specified. Hyperesthesia may refer to various modes of cutaneous sensibility including touch and thermal sensation without pain, as well as to pain. The word is used to indicate both diminished threshold to any stimulus and an increased response to stimuli that are normally recognized. Allodynia is suggested for pain after stimulation which is not normally painful. Hyperesthesia includes both allodynia and hyperalgesia, but the more specific terms should be used wherever they are applicable.

Hyperpathia: A painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold.

Note: It may occur with allodynia, hyperesthesia, hyperalgesia, or dysesthesia. Faulty identification and localization of the stimulus, delay, radiating sensation and aftersensation may be present, and the pain is often explosive in character.

Hypoalgesia: Diminished pain in response to a normally painful stimulus.

Note: Hypoalgesia was formerly defined as diminished sensitivity to noxious stimulation, making it a particular case of hypoesthesia. However, it now refers only to the occurrence of relatively less pain in response to stimulation that produces pain. Hypoesthesia covers the case of diminished sensitivity to stimulation that is normally painful.

The implications of some of the above definitions may be summarized for convenience as follows:
Allodynia	lowered threshold	stimulus and response mode differ
Hyperalgesia	increased response	stimulus and response mode are the same
Hyperpathia	raised threshold: increased response	stimulus and response mode may be the same or different
Hypoalgesia	raised threshold: lowered response	stimulus and response mode are the same

The above essentials of the definitions do not have to be symmetrical and are not symmetrical at present. Lowered threshold may occur with allodynia but is not required. Also, there is no category for lowered threshold and lowered response—if it ever occurs.

Hypoesthesia: Decreased sensitivity to stimulation, excluding the special senses.

Note: Stimulation and locus to be specified.

Neuralgia: Pain in the distribution of a nerve or nerves.

Note: Common usage, especially in Europe, often implies a paroxysmal quality, but neuralgia should not be reserved for paroxysmal pains.

Neuropathic pain: Pain caused by a lesion or disease of the somatosensory nervous system.

Note: Neuropathic pain is a clinical description (and not a diagnosis) which requires a demonstrable lesion or a disease that satisfies established neurological diagnostic criteria. The term ‘lesion’ is commonly used when diagnostic investigations (e.g. imaging, neurophysiology, biopsies, lab tests) reveal an abnormality or when there was obvious trauma. The term ‘disease’ is commonly used when the underlying cause of the lesion is known (e.g. stroke, vasculitis, diabetes mellitus, genetic abnormality). Somatosensory refers to information about the body per se including visceral organs, rather than information about the external world (e.g., vision, hearing, or olfaction). The presence of symptoms or signs (e.g., touch-evoked pain) alone does not justify the use of the term neuropathic. Some disease entities, such as trigeminal neuralgia, are currently defined by their clinical presentation rather than by objective diagnostic testing. Other diagnoses such as postherpetic neuralgia are normally based upon the history. It is common when investigating neuropathic pain that diagnostic testing may yield inconclusive or even inconsistent data. In such instances, clinical judgment is required to reduce the totality of findings in a patient into one putative diagnosis or concise group of diagnoses.

Central neuropathic pain: Pain caused by a lesion or disease of the central somatosensory nervous system.

Peripheral neuropathic pain: Pain caused by a lesion or disease of the peripheral somatosensory nervous system.

Nociception: The neural process of encoding noxious stimuli.

Note: Consequences of encoding may be autonomic (e. g. elevated blood pressure) or behavioral (motor withdrawal reflex or more complex nocifensive behavior). Pain sensation is not necessarily implied.

Nociceptive neuron:

A central or peripheral neuron of the somatosensory nervous system that is capable of encoding noxious stimuli.

Nociceptive pain: Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.

Note: This term is designed to contrast with neuropathic pain. The term is used to describe pain occurring with a normally functioning somatosensory nervous system to contrast with the abnormal function seen in neuropathic pain.

Nociceptive stimulus: An actually or potentially tissue-damaging event transduced and encoded by nociceptors.

Nociceptor: A high-threshold sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli.

Noxious stimulus: A stimulus that is damaging or threatens damage to normal tissues.

Pain threshold: The minimum intensity of a stimulus that is perceived as painful.

Note: Traditionally pain threshold has often been defined as the least stimulus intensity at which a subject perceives pain. Properly defined, the threshold is really the experience of the patient, whereas the intensity measured is an external event. It has been common usage for most pain research workers to define the threshold in terms of the stimulus, and that should be avoided. However, the threshold stimulus can be recognized as such and measured. In psychophysics, threshold is defined as the level at which 50% of stimuli are recognized. In that case, the pain threshold would be the level at which 50% of stimuli would be recognized as painful. The stimulus is not pain and cannot be a measure of pain.

Pain tolerance level: The maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation.

Note: As with pain threshold, the pain tolerance level is the subjective experience of the individual. The stimuli which are normally measured in relation to its production are the pain tolerance level stimuli and not the level itself. Thus, the same argument applies to pain tolerance level as to pain threshold, and it is not defined in terms of the external stimulation as such.

Paresthesia: An abnormal sensation, whether spontaneous or evoked.

Note: After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those that are unpleasant.

Sensitization: Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs.

Note: Sensitization can include a drop in threshold and an increase in suprathreshold response. Spontaneous discharges and increases in receptive field size may also occur. This is a neurophysiological term that can only be applied when both input and output of the neural system under study are known, e.g., by controlling the stimulus and measuring the neural event. Clinically, sensitization may only be inferred indirectly from phenomena such as hyperalgesia or allodynia.

Central sensitization: Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.

Note: This may include increased responsiveness due to dysfunction of endogenous pain control systems. Peripheral neurons are functioning normally; changes in function occur in central neurons only.

Peripheral sensitization: Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.

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Duration of pain:

Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years. Pain that lasts a long time is called chronic, and pain that resolves quickly is called acute. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the onset of pain. Generally speaking, acute pain lasts for less than 12 weeks and chronic pain lasts for more than 12 weeks. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is “pain that extends beyond the expected period of healing.” Chronic pain may be classified as cancer pain or benign (non-cancer pain).

Pain scales:

Pain rating scales, also called pain scales, are used by physicians and other health care providers to evaluate pain and measure pain levels. Pain measurements help determine the severity, type, and duration of the pain, and are used to make an accurate diagnosis, determine a treatment plan, and evaluate the effectiveness of treatment. Types of pain rating scales include verbal scales, numerical scales, and visual analogue scales. Verbal rating scales consist of a series of words commonly used to describe pain (e.g., no pain, mild pain, moderate pain, severe pain). The patient reads the words and chooses the one that best describes the pain he or she is experiencing. A score (e.g., from 0–3) that is assigned to each word is then used to measure pain levels.

The most commonly used pain scales in healthcare is the numerical rating scale which offers the individual in pain to rate their pain score. It is designed to be used by those over the age of 9. In the numerical scale, the user has the option to verbally rate their scale from 0 to 10 or to place a mark on a line indicating their level of pain. 0 indicates the absence of pain, while 10 represents the most intense pain possible. The numerical rating pain scale allows the healthcare provider to rate pain as mild, moderate or severe, which can indicate a potential disability level. Tracking your pain is a helpful diagnostic tool when dealing with repetitive stress injuries. A visual analog pain scale lets you bypass the cognitive level of your brain and give a truer representation of your pain. The Wong Baker Faces Pain Scale combines pictures and numbers to allow pain to be rated by the user. It can be used in children over the age of 3, and in adults. The faces range from a smiling face to a sad, crying face. A numerical rating is assigned to each of six faces totally.

Pain classification:

Pain can be categorized according to several variables, including its duration (acute, convalescent, chronic), its pathophysiologic mechanisms (physiologic, nociceptive, neuropathic), and its clinical context (e.g., postsurgical, malignancy related, neuropathic, degenerative). Acute pain follows traumatic tissue injuries, is generally limited in duration, and is associated with temporal reductions in intensity. Chronic pain may be defined as discomfort persisting 3–6 months beyond the expected period of healing. For clinicians dealing with soft tissue trauma, it is helpful to think of pain as being peripheral or central in origin. Peripheral pain originates in muscles, tendons, etc., or in the peripheral nerves themselves. Pain originating in the peripheral nerves, i.e. via trauma to the nerves, is neurogenic pain. Central pain arises from central nervous system pathology … a “primary” CNS dysfuntion. Some of this may arise due to maladaptive thought processes, true “psychogenic” pain. But most of it is due to structural changes in the CNS, e.g., spinal cord injury, multiple sclerosis, stroke and epilepsy. Somatogenic pain is a pain originating from an actual physical cause e.g. trauma, ischaemia etc while Psychogenic pain is pain for which there is no physical cause. It is not however imaginary pain and can be as intense as somatic pain.

Pain
Nociceptive		Non-Nociceptive
Somatic	Visceral	Neuropathic	Sympathetic

Nociceptive pain is pain in which normal nerves transmit information to the central nervous system about trauma to tissues (nocere = to injure, Latin). Nociceptive pain is due to direct stimulation of peripheral nerve endings (e.g. wounds, fractures, burns, angina). It is inflammatory pain which is associated with tissue damage and the infiltration of immune cells. Nociceptive pain may also be divided into “visceral,” “deep somatic” and “superficial somatic” pain.

Somatic Pain – a type of nociceptive pain. Pain felt on the skin, muscle, joints, bones and ligaments is called somatic pain. The term musculo-skeletal pain means somatic pain. Somatic pain could be superficial due to stimulation of receptors in skin and deep due to stimulation of receptors in muscles, joints and tendons. The pain receptors are sensitive to temperature (hot/cold), vibration, and stretch (in the muscles). They are also sensitive to inflammation, as would happen if you cut yourself, sprain something that causes tissue damage. Pain as a result of lack of oxygen, as in ischemic muscle cramps, are a type of nociceptive pain. Somatic pain is generally sharp and well localized – if you touch it or move the affected area the pain will worsen.

Visceral Pain – a type of nociceptive pain. It is felt in the internal organs and main body cavities. The cavities are divided into the thorax (lungs and heart), abdomen (bowels, spleen, liver and kidneys), and the pelvis (ovaries, bladder, and the uterus). The pain receptors – nociceptors – sense inflammation, stretch and ischemia (oxygen starvation). Afferent fibers from visceral structures reach the CNS via sympathetic and parasympathetic nerves. Their cell bodies are located in the dorsal roots and the homologous cranial nerve ganglia. Specifically, there are visceral afferents in the facial, glossopharyngeal, and vagus nerves; in the thoracic and upper lumbar dorsal roots; and in the sacral roots. There may also be visceral afferent fibers from the eye in the trigeminal nerve.

General characteristics of pain due to visceral pathology

1. Is poorly localized

2. Referred to other somatic structures (Referred pain)

3. Is not evoked from all viscera

4. Not necessarily evoked from visceral injury

5. Produces non-specific responses or whole-body moto responses

6. Produces strong autonomic responses (high-blood pressure, increase in heart rate, sweating, etc.)

7. Leads to sensitization of body structures

8. Produces strong affective responses

Sympathetic Pain:

The sympathetic nervous system controls our blood flow to our skin and muscles, perspiration (sweating) by the skin, and how quickly the peripheral nervous system works. Sympathetic pain occurs generally after a fracture or a soft tissue injury of the limbs. This pain is non-nociceptive – there are no specific pain receptors. As with neuropathic pain, the nerve is injured, becomes unstable and fires off random, chaotic, abnormal signals to the brain, which interprets them as pain. Generally with this kind of pain the skin and the area around the injury become extremely sensitive. The pain often becomes so intense that the sufferer daren’t use the affected arm or leg. Lack of limb use after a time can cause other problems, such as muscle wasting, osteoporosis, and stiffness in the joints.

Another classification:

Another researcher divided pain into three classes as per the figure above.

(A) Nociceptive pain represents the sensation associated with the detection of potentially tissue-damaging noxious stimuli and is protective. First, there is the pain that is an early-warning physiological protective system, essential to detect and minimize contact with damaging or noxious stimuli. This is the pain we feel when touching something too hot, cold, or sharp. Because this pain is concerned with the sensing of noxious stimuli, it is called nociceptive pain. The neurobiological apparatus that generates nociceptive pain evolved from the capacity of even the most primitive of nervous systems to signal impending or actual tissue damage from environmental stimuli. Its protective role demands immediate attention and action, which occur by virtue of the withdrawal reflex it activates, the intrinsic unpleasantness of the sensation elicited, and the emotional anguish it engages. Nociceptive pain presents itself as something to avoid now, and when engaged, the system overrules most other neural functions.

(B) Inflammatory pain is associated with tissue damage and the infiltration of immune cells and can promote repair by causing pain hypersensitivity until healing occurs. The second kind of pain is also adaptive and protective. By heightening sensory sensitivity after unavoidable tissue damage, this pain assists in the healing of the injured body part by creating a situation that discourages physical contact and movement. Pain hypersensitivity, or tenderness, reduces further risk of damage and promotes recovery, as after a surgical wound or in an inflamed joint, where normally innocuous stimuli now elicit pain. This pain is caused by activation of the immune system by tissue injury or infection, and is therefore called inflammatory pain; indeed, pain is one of the cardinal features of inflammation. While this pain is adaptive, it still needs to be reduced in patients with ongoing inflammation, as with rheumatoid arthritis or in cases of severe or extensive injury.

(C) Pathological pain is a disease state caused by damage to the nervous system (neuropathic) or by its abnormal function (dysfunctional). Finally, there is the pain that is not protective, but maladaptive, resulting from abnormal functioning of the nervous system. This pathological pain, which is not a symptom of some disorder but rather a disease state of the nervous system, can occur after damage to the nervous system (neuropathic pain), but also in conditions in which there is no such damage or inflammation (dysfunctional pain). Conditions that evoke dysfunctional pain include fibromyalgia, irritable bowel syndrome, tension type headache, temporomandibular joint disease, interstitial cystitis, and other syndromes in which there exists substantial pain but no noxious stimulus, and no or minimal peripheral inflammatory pathology.

By analogy, if pain were a fire alarm, the nociceptive type would be activated appropriately only by the presence of intense heat, inflammatory pain would be activated by warm temperatures, and pathological pain would be a false alarm caused by malfunction of the system itself. The net effect in all three cases is the sensation we call pain. However, because the processes that drive each are quite different, treatments must be targeted at the distinct mechanisms responsible.

The fundamental difference between nociceptive (including inflammatory) and neuropathic pain is the functioning of central and peripheral nervous system. When pain is felt with intact normally functioning nervous system, it is nociceptive pain but when pain is felt due to dysfunction and/or damage to nervous system, it is neuropathic pain.

Neuropathic pain:

Neuropathic pain is due to dysfunction of the pain perception system within the peripheral or central nervous system as a result of injury, disease, or surgical damage (e.g. continuing pain experienced from a limb which has been amputated – phantom limb pain). It is a pathological pain which is a disease state caused by damage or dysfunction of the nervous system. Neuropathic pain is pain in which there are structural and/or functional nervous system adaptations secondary to injury, that take place either centrally or peripherally (Jensen, 1996). Much of what has previously been considered psychogenic pain is now better understood as neuropathic pain of central origin. The IASP defines central pain as “pain initiated or caused by a primary lesion or dysfunction in the central nervous system” (Merskey, and Bogduk, 1994). “Neuropathic” should not be confused with “neurogenic”, a term used to describe pain resulting from injury to a peripheral nerve but without necessarily implying any “neuropathy”.

The figure below depicts various neuropathic pain syndromes.

Neuropathic pain can be defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system resulting from;

1. Trauma, for example, complex regional pain syndrome, chronic post-surgical pain;

2. Infection, for example, post-herpetic neuralgia;

3. Ischaemia, for example, diabetic neuropathy;

4. Cancer;

5. Chemically induced, for example, as a result of chemotherapy (Farquhar-Smith, 2007).

Some types of neuropathic pain may develop when the peripheral nerves have become damaged, causing the pain fibers to transmit pain impulses repetitively and become increasingly sensitive to stimuli. Neuroplasticity may also develop and is characterized by abnormal neuronal sprouting in the peripheral nerves and within the dorsal horn of the spinal cord. This sprouting may result in additional generation of and increased transmission of pain impulses.

Characteristics of neuropathic pain:

The International Association for the Study of Pain (IASP) classified pain according to specific characteristics:

This system has been criticized by some pain researchers as inadequate for guiding research and treatment.

Physicians and neuroscientists generally classify pain in the following ways:

1. Acute pain is caused by an injury to the body. It warns of potential damage that requires action by the brain, and it can develop slowly or quickly. It can last for a few minutes to six months and goes away when the injury heals.

2. Chronic pain persists long after the trauma has healed (and in some cases, it occurs in the absence of any trauma). Chronic pain does not warn the body to respond, and it usually lasts longer than six months.

3. Cancer (or malignant) pain is associated with malignant tumors. Tumors invade healthy tissues and exert pressure on nerves or blood vessels, producing pain. Cancer pain can also be associated with invasive procedures or treatments. Some physicians classify cancer pain with chronic pain.

Note that there is no consensus regarding differentiating acute pain from chronic pain based on duration of pain; whether 3 months or 6 months; and different authors have differing view on this subject.

Another way to classify pain is depending on the type of nerve fiber which carries pain impulse.

1. Fast pain transmitted by thinly myelinated A-delta fibers conduct at rates of 12–30 m/s. Fast pain felt within about 0.1 second after a pain stimulus is applied. Felt when a needle is stuck into the skin, when the skin is cut with a knife, or when the skin is acutely burned. Not felt in deeper tissues of the body.

2. Slow pain transmitted by unmyelinated C fibers conduct at low rates of 0.5–2 m/s. Slow pain begins only after 1 second or more and then increases slowly over many seconds and sometimes minutes. Usually associated with tissue destruction.

Acute pain:

Acute pain has been defined as “pain associated with tissue damage, inflammation, or a disease process that is of relatively brief duration (i.e. hours, days, or even weeks), regardless of its intensity.” Acute pain results from

1. Disease, inflammation, or injury to tissues.

2. Sudden onset e.g., after surgery or trauma

3. May be accompanied by anxiety or emotional distress

The cause can usually be diagnosed and treated confined to a given period of time and severity. Acute pain persists until healing takes place or stops long before healing has been completed. Healing can occur without medical intervention as an injury with acute pain does not overwhelm the body’s reparative mechanisms. Such healing usually takes a few days to a few weeks, and therefore acute pain lasts for the same duration. Additionally, acute pain has been associated with anxiety. The clinical observation that greater the anxiety the greater the perception of an injury as painful appears warranted. However, a clear empirical basis for this simple proposition does not exist. Different studies indicate that anxiety enhances, relieves or has no impact on pain.

In the United States alone, nearly 100 million surgeries take place annually. More than 80% of these surgical patients report postoperative pain. Over 70% of emergency department visits are due to pain; acute headache alone accounts for 2.1 million of these visits. Despite substantial advances in pain research in recent decades, inadequate acute pain control is still more the rule than the exception. Numerous studies show that fewer than half of postoperative patients receive adequate pain relief. Patients arriving at emergency departments with significantly painful conditions fare no better, as emergency medicine physicians tend to underuse pain medications. Acute pain is also a common problem in family practice, sports medicine, and especially in internal medicine.

Chronic pain:

Chronic pain has been defined as pain that persists for extended periods of time (i.e. months or years), that accompanies a disease process (e.g. rheumatoid arthritis), or that is associated with an injury that has not resolved within an expected period of time (e.g. myofascial pain syndromes, complex regional pain syndrome, and chronic pelvic pain) or persists even when injury has resolved. Chronic pain is widely believed to represent disease itself rather than symptom of a disease.

1. It can be made much worse by unpleasant environmental and psychological factors.

2. It persists over a longer period of time than acute pain.

3. It is resistant to most medical treatments.

4. It causes severe problems for the patient.

5. Chronic pain indicates that the pain has lost its biological role of triggering recuperative behavior.

6. Chronic pain, although triggered by injury or disease, however, has other factors associated with it that prolong its presence. These factors include continued tissue damage, loss of a body part, extensive trauma, or damage to the nervous system as a result of injury.

7. Due to these factors, the pain persists either beyond the expected course of disease, or beyond the time expected for an injury to heal, or it recurs at various times for months or years. In such situations, the injury may exceed the body’s capability to heal. Additionally, intensity of chronic pain may be out of proportion of original injury or damage, and syndromes, such as complex regional pain syndrome, may occur spontaneously without any signs of injury.

8. Chronic pain impairs an individual’s social, vocational and psychological well being. Among psychological factors, chronic pain has been frequently associated with depression, which may vary from minor to severe.

9. Depression also appears to intensify chronic pain. While some patients display depression, others maintain a dispassionate attitude. Patients with a dispassionate attitude appear to have either strong personal or social resources or the pain disorder provides a focus in life that enables them to ignore stressful life challenges, thereby controlling depression.

Phantom pain:

Phantom pain is pain from a part of the body that has been lost or from which the brain no longer receives signals. It is a type of neuropathic pain. Phantom limb pain is a common experience of amputees. The prevalence of phantom pain in upper limb amputees is nearly 82%, and in lower limb amputees is 54%. One study found that eight days after amputation, 72 percent of patients had phantom limb pain, and six months later, 65 percent reported it. Some amputees experience continuous pain that varies in intensity or quality; others experience several bouts a day, or it may occur only once every week or two. It is often described as shooting, crushing, burning or cramping. If the pain is continuous for a long period, parts of the intact body may become sensitized, so that touching them evokes pain in the phantom limb, or phantom limb pain may accompany urination or defecation.

When a limb is severed, the parts of the nerves past the point of separation are lost along with their nerve endings. Your brain no longer receives much electric impulse from these regions as a result. However, with time, the sensory deprivation undergone by these nerve centers makes them especially sensitive to even mild stimulus, just as your eyes become more sensitive to light after being in a dark room. As a result, even the mildest stimulation, often triggered by memories of past sensations, can be recognized by your brain as much stronger, strong enough in fact to seem very real. It is for this reason that people sometimes describe sensations of pain in limbs that were previously arthritic, or the sensation of resting their limb on the arm of a chair or a table when the limb has long since been removed. It is also for this reason that the sensations may actually seem stronger when some time has passed since the surgery. Phantom pains are not always triggered by memory. Especially severe phantom pains are often the result of an incorrectly performed surgery. Pain in a missing limb is sometimes associated with other sometimes temporary biological factors, as well. Minor to severe illness can cause an escalation in the degree of phantom pain, often to levels that should be reported to a doctor. While analgesics are the most obvious solution to phantom pain, there are other routes that an amputee can take to help relieve the pain. Warmth and exercise are known to increase circulation and to reduce the intensity of your pains.

Local anesthetic injections into the nerves or sensitive areas of the stump may relieve pain for days, weeks or, sometimes permanently, despite the drug wearing off in a matter of hours; and small injections of hypertonic saline into the soft tissue between vertebrae produces local pain that radiates into the phantom limb for ten minutes or so and may be followed by hours, weeks or even longer of partial or total relief from phantom pain. Vigorous vibration or electrical stimulation of the stump, or current from electrodes surgically implanted onto the spinal cord all produce relief in some patients. Paraplegia, the loss of sensation and voluntary motor control after serious spinal cord damage, may be accompanied by girdle pain at the level of the spinal cord damage, visceral pain evoked by a filling bladder or bowel, or, in five to ten per cent of paraplegics, phantom body pain in areas of complete sensory loss. This phantom body pain is initially described as burning or tingling but may evolve into severe crushing or pinching pain, fire running down the legs, or a knife twisting in the flesh. Onset may be immediate or may not occur until years after the disabling injury. Surgical treatment rarely provides lasting relief.

Mirror therapy, mirror neurons and phantom pain:

Mirror therapy was first reported by Ramachandran in 1996 and is suggested to help phantom limb pain (PLP) by resolving the visual-proprioceptive dissociation in the brain. The patient watches the reflection of their intact limb moving in a mirror placed parasagittally between their arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing so that the virtual limb replaces the phantom limb. The presence of mirror neurons in the brain is supported by the phenomenon of tactile sensation in the phantom limb elicited by touching the virtual image of the limb in the mirror. When a person with an intact limb observes a person with amputation, he can only “empathize about the amputation” rather than “feel it himself” because of the null input to the mirror neurons from his intact limb. However, a person with an amputation does not receive such null input as the limb is amputated and this result in the activation of mirror neurons which create a perception of tactile sensation. Consequently, since the activation of these mirror neurons modulates somatosensory inputs, their activation may block protopathic pain perception in the phantom limb. A randomized controlled trial of mirror therapy in patients with lower leg amputation has shown significant benefit of PLP versus the control group. Another controlled trial, however, reported that the mirror condition only elicited a significantly greater number of phantom limb movements than the control condition but did not attenuate phantom limb pain and sensations any more than the control condition.

Further evidence that the phenomenon of phantom limb is the result of a central representation is the experience of children born without limbs. Such individuals have rich phantom sensations, despite the fact that a limb never developed. This observation suggests that a full representation of the body exists independently of the peripheral elements that are mapped. Based on these results, Ronald Melzack proposed that the loss of a limb generates an internal mismatch between the brain’s representation of the body and the pattern of peripheral tactile input that reaches the neocortex. The consequence would be an illusory sensation that the missing body part is still present and functional. With time, the brain may adapt to this loss and alter its intrinsic somatic representation to better accord with the new configuration of the body. This change could explain why the phantom sensation appears almost immediately after limb loss, but usually decreases in intensity over time.

Referred pain:

Referred pain (also reflective pain) is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction (heart attack), where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury. The International Association for the Study of Pain, as of 2001, has not officially defined the term; hence several authors have defined the term differently. Radiation is different from referred pain. The pain related to a myocardial infarction could either be referred pain or pain radiating from the chest. Classically the pain associated with a myocardial infarction is located in the mid or left side of the chest where the heart is actually located. The pain can radiate to the left side of the jaw and into the left arm. Referred pain is when the pain is located away from or adjacent to the organ involved. Referred pain would be when a person has pain only in their jaw or left arm, but not in the chest. The cardiac general visceral sensory pain fibers follow the sympathetics back to the spinal cord and have their cell bodies located in thoracic dorsal root ganglia 1-4. As a general rule, in the thorax and abdomen, general visceral afferent (GVA) pain fibers follow sympathetic fibers back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibers. The central nervous system (CNS) perceives pain from the heart as coming from the somatic portion of the body supplied by the thoracic spinal cord segments 1-4. Also, the dermatomes of this region of the body wall and upper limb have their neuronal cell bodies in the same dorsal root ganglia (T1-5) and synapse in the same second order neurons in the spinal cord segments (T1-5) as the general visceral sensory fibers from the heart. The CNS does not clearly differentiate whether the pain is coming from the body wall or from the viscera, but it perceives the pain as coming from somewhere on the body wall, i.e. substernal pain, left arm/hand pain, jaw pain.

The following are some hypothesis to explain referred pain:

1. Common dermatome hypothesis: When pain is referred, it is usually to a structure that developed from the same embryonic segment or dermatome as the structure in which the pain originates. Radiating pain down the left arm is the result of a myocardial infarction, or pain originating from the shoulder (dermatomes 3-5).

2. Convergence and facilitation theories: Inputs from visceral and skin receptors converge on the same spinal cord neuron (i.e., viscerosomatic neurons). Therefore, visceral pain is referred to skin area because the nociceptors’ terminals from the viscera terminate in the spinal cord on the same neurons that receive input from the skin.

3. Facilitation or irritable focus: Pain impulses from the viscera alone are unable to pass directly from spinal cord neurons to the brain, but create an “irritable focus”. When visceral and skin impulses arrive together, the information transmitted to higher centers and the brain interprets the pain as being from the skin.

4. Learned phenomenon: Visceral information arrives in the CNS. However, the brain interprets that the impulses originate from the site of a previous surgical operation, trauma or localized pathologic process.

Breakthrough pain:

Breakthrough pain is pain that comes on suddenly for short periods of time and is not alleviated by the patients’ normal pain management. It is common in cancer patients who often have a background level of pain controlled by medications, but whose pain periodically “breaks through” the medication. The characteristics of breakthrough cancer pain vary from person to person and according to the cause.

Incident pain:

Incident pain is pain that arises as a result of activity, such as movement of an arthritic joint, stretching a wound, etc.

Pain asymbolia:

Pain without painfulness is found in patients who suffer from a rare neurological syndrome known as pain asymbolia. Characteristically, these patients feel pain upon harmful stimulation, but their pain no longer represents danger or threat to them. These patients do not mind pain at all; indeed, they may even smile or laugh at it.

Psychogenic pain:

Psychogenic pain also called psychalgia, is pain caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic. Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from a psychological source is not “real”. However, specialists consider that it is no less actual or hurtful than pain from any other source. Recent research in neuroscience suggests that physical pain and psychological pain may share some underlying neurological mechanisms. Of course, the term ‘psychogenic’ assumes that medical diagnosis is so perfect that all organic causes of pain can be detected; regrettably, we are far from such infallibility… All too often, the diagnosis of neurosis as the cause of pain hides our ignorance of many aspects of pain medicine. Also, people with long term pain frequently display psychological disturbance, with elevated scores on the Minnesota Multiphasic Personality Inventory scales of hysteria, depression and hypochondriasis (the “neurotic triad”). Some investigators have argued that it is this neuroticism that causes acute injuries to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self-esteem, often low in chronic pain patients, also shows improvement once pain has resolved. Emotional pain is a particular kind of psychological pain, more closely related to emotions.

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Neurobiology of pain:

The initial concept of pain perception was quite simple: the pain signal directly excited a peripheral nerve, synapsed at the spinal cord, and was perceived in the sensory cortex. There was no signal modulation; it just arrived in the brain as it came from the body. Like much in the rest of medicine, it was found to be not that simple. Neuroanatomical, physiological, psychological, and pharmacological research has shown that the pain pathway is amazingly complex, in keeping with its evolutionary importance to the survival of the organism. In addition, the pain signal is modulated at the site of the pain, at the dorsal horn, and in multiple areas of the central nervous system, both the spinal cord and the brain.

Neurobiology of pain can be divided into neurobiology of nociceptive and neuropathic pain. Also, delineating pain pathway can help alleviate pain by blocking various chemicals or nerves as seen in the table below.

Pathway	Method of pain control
Cortex ^	General anesthetic
Thalamus ^	Opioids
Spino-thalamic tracts ^	Cordotomy
Dorsal horn of spinal cord ^	Opioids
Sensory (nerve) fiber ^	Local anesthetic
Nerve endings	Prostaglandin inhibitor

Can one have pain and not know it? Pain vis-à-vis nociception:

It leads me to ponder the distinction between pain and nociception. If you were struggling to explain to someone the difference between pain and nociception, perhaps an easy way of doing so might be to point out that nociception may occur when someone is unconscious, whereas pain by definition cannot. A nociceptive, tissue-threatening stimulus evokes adaptive behavioral responses which aren’t necessarily intentional or reasoned, called nocifensive responses. They are to minimize or escape from noxious stimuli—like the flexor withdrawal response (muscle groups in the leg automatically bending the hip, knee and ankle after stepping on a spiky something). We don’t need to be conscious for nociception to occur. Pain however is an experience of the conscious brain, a sensory and emotional percept. The most potent way we have of suppressing someone’s pain is through general anesthetic, a process which globally eliminates sensory experience. It’s possible that even in an unconscious ‘pain-free’ state that nocifensive responses, like changes in cardiovascular rhythm, persist. So the key ingredient for pain is the conscious brain.

Pain= nociception + consciousness

Pain is subjective, and it cannot be ‘seen’ by anyone other than the person experiencing it. Even with neuroimaging we cannot assess it objectively. Imaging experiments tell us that there is a pattern, albeit variable, of spots in the brain that are active when someone is in pain. But no image can tell us that the pain experienced is rated by that brain as a 5 out of 10 pain, around L4/5, and can escalate to 9 out of 10 when you feel sad. The ‘pain neuromatrix’ (vide infra) is too widely distributed for that, and there’s immeasurable capacity for functional reorganization and redundancy in the system.

The distinction between pain and nociception provides the basis for focusing on pain as a psychological phenomenon. Nociception refers to the neurophysiologic processing of events that stimulate nociceptors and are capable of being experienced as pain (Turk & Melzack, 2000). Instigation of the nociceptive system and brain processing constitute the biological substrates of the experience. But pain must be appreciated as a psychological phenomenon, rather than a purely physiological phenomenon. Specifically, it represents a perceptual process associated with conscious awareness, selective abstraction, ascribed meaning, appraisal, and learning (Melzack & Casey, 1968). Emotional and motivational states are central to understanding its nature (Price, 2000). Pain requires central integration and modulation of a number of afferent and central processes (i.e., sending message toward the central nervous system and interacting with higher components of the central nervous system) and efferent processes (i.e., sending messages away from higher centers in the central nervous system and toward muscle or gland).

We have no ‘pain’ receptors. It is physiologically more correct to call them nociceptors because they are very similar to other receptors which sense temperature, pressure, and chemicals (called non-nociceptive receptors). The only difference between the two is that the nociceptors have a higher threshold than the non-nociceptors, and are only activated when the stimuli is in the higher range. Contrary to what most people believe, they don’t send ‘pain’ signals, they send the same signals as other non-nociceptors but just at a higher threshold.

Nociception:

Nociception is defined as “the neural processes of encoding and processing noxious stimuli.” It is the afferent activity produced in the peripheral and central nervous system by stimuli that have the potential to damage tissue. This activity is initiated by nociceptors, (also erroneously called pain receptors), that can detect mechanical, thermal or chemical changes above a set threshold. Once stimulated, a nociceptor transmits a signal along the spinal cord, to the brain. Nociception triggers a variety of autonomic responses and may also result in a subjective experience of pain in sentient beings.

Three neuron order for pain transmission:

First order Neuron: Cell body located in a spinal (dorsal root) ganglion, its peripheral process is associated with the receptor (nociceptor), while its central process enters the gray matter of the spinal cord to synapse in the Marginal Nucleus Substantia gelatinosa (lamina II) and Nucleus proprius.

Second order Neuron: Cell bodies located in the marginal nucleus and the nucleus proprius. Axons of second order neurons cross the midline and join other axons which also carry pain sensation. These axons form the Spinothalamic Tract in the spinal cord and ascend to brainstem.

Third order neuron: The axons of second order neurons synapse on third order neurons in the thalamus. The Thalamus is the crucial relay for the reception and processing of nociceptive information in route to the cortex. Axons terminating in the lateral thalamus mediate discriminative aspects of pain. Axons terminating in the medial thalamus mediate the motivational-affective aspects of pain (emotional aspects of pain; attention to and memory of pain). These third order neurons in the thalamus in turn send their axons to the cerebral cortex. Note: Neurons in the lateral thalamus (for discrimination) project to the somatosensory cortex. Neurons in the medial thalamus (for affective aspects of pain) project to other areas of cortex (prefrontal, insular and cingulate gyrus) and more importantly limbic system. A human becomes aware of painful stimuli at the level of the thalamus; the cerebral cortex is required for localization of the pain to a specific body region.

Nociception processes:

Acute pain is a physiological response that warns us of danger. The process of nociception describes the normal processing of pain and the responses to noxious stimuli that are damaging or potentially damaging to normal tissue. There are four basic processes involved in nociception (McCaffery and Pasero, 1999). These are:

1. Transduction;

2. Transmission;

3. Perception;

4. Modulation.

Nociceptors:

1. Nociceptors are found in all tissues of the body except nervous tissue.

2. Nociceptors convert noxious information into electrical information.

3. Nociceptors are sensitive to chemical, thermal, or mechanical stimuli.

4. At any one time, only 20% of the body’s nociceptors are activated, but in response to tissue injury and inflammation, up to 100% of the body’s nociceptor may be activated.

5. In response to injury, chemical changes occur within nociceptors to self regulate the body’s responses to the injury.

Nociceptor:

All nociceptors are specialized free nerve endings that have their cell bodies outside the spinal column in the dorsal root ganglia or trigeminal ganglia and are named according to their appearance at their sensory ends. The trigeminal ganglia are specialized nerves for the face, whereas the dorsal root ganglia associate with the rest of the body. In humans, the detection of peripheral pain begins at free nerve endings. It is here that the polymodal pain receptors TRPA1, TRPV1, TRPV2, ASICs, and high threshold mechanoreceptors detect noxious stimuli such as strong mechanical forces, H+, K+, chemicals, and temperature. Mechanical, thermal, and chemical stimuli are detected by nerve endings (nociceptors), which are found in the skin and on internal surfaces such as the periosteum or joint surfaces. The concentration of nociceptors varies throughout the body, mostly found in the skin and less so in deep internal surfaces. Internal nociceptors are in a variety of organs, such as the muscle, joint, bladder, gut and continuing along the digestive tract. Nociceptors have a certain threshold; that is, they require a minimum level of stimuli before they trigger a signal. Once this threshold is reached a signal is passed along the axon of the nerve into the spinal cord. In some conditions, excitation of pain fibers becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia. The mechanical, thermal or chemical stimuli which activate nociceptors are called noxious stimuli. Activation of these receptors results in nerve impulses which travel along the afferent fibers in the nerves and are transmitted to the central nervous system (CNS). Some nociceptors do not differentiate noxious from non-noxious stimuli, while others respond only to painfully intense stimuli.

Transduction:

Transduction begins when the free nerve endings (nociceptors) of C fibers and A-delta fibers of primary afferent neurons respond to noxious stimuli. Nociceptors are exposed to noxious stimuli when tissue damage and inflammation occurs as a result of, for example, trauma, surgery, inflammation, infection, and ischemia.

The C fiber and A-delta fibers are associated with different qualities of pain. These are listed in table below depicting characteristics and functions of C fiber and A-delta fibers

C fibers

A-delta fibers

Characteristics:

Primary afferent fibers
Small diameter
Unmyelinated
Slow conducting

Receptor type:

Polymodal respond to more than one type of noxious stimuli:
Mechanical
Thermal
Chemical

Pain quality:

Diffuse
Dull
Burning
Aching
Referred to as ‘slow’ or second’ pain

Characteristics:

Primary afferent fibers
Large diameter
Myelinated
Fast conducting

Receptor type:

High-threshold mechanoreceptors respond mechanical stimuli over a certain intensity.

Pain quality:

Well-localized
Sharp
Stinging
Pricking
Referred to as ‘fast’ or ‘first’ pain

Noxious stimuli and responses

There are three categories of noxious stimuli:

1. Mechanical (pressure, swelling, abscess, incision, tumor growth);

2. Thermal (burn, scald);

3. Chemical (excitatory neurotransmitter, toxic substance, ischemia, infection).

The cause of stimulation may be internal, such as pressure exerted by a tumor or external, for example, a burn. Chemical mediators that are released after tissue damage or inflammation can either activate or sensitize the nociceptors.

Activators of primary afferent fibers are:

Potassium – from Damaged Cells

Serotonin – from Platelets

Bradykinin – from Plasma Kininogen

Histamine – from Mast Cells

Sensitizers of primary afferent fibers are:

Prostaglandins – from Arachidonic acid

Leukotrienes – from Arachidonic acid

Substance P – Primary afferent

These chemical mediators activate and/or sensitize nociceptors to the noxious stimuli. In order for a pain impulse to be generated, an exchange of sodium and potassium ions (depolarization and repolarization) occurs at the cell membranes of first order sensory neuron.This results in an action potential and generation of a pain impulse. Non-steroidal anti-inflammatory drugs (NSAIDs) prevent pain by inhibiting the metabolism of arachidonic acid to prostaglandins by inhibiting enzyme cyclo-oxygenase; NSAIDs do not effect lipoxygense which is involved in leukotriene production.

Transduction and ion channels:

Transduction is a physiological process whereby a noxious mechanical, chemical, or thermal stimulus is converted (transduced) via specialized receptors on primary afferents into an electrical impulse (action potential). Transduction of noxious stimuli occurs at nociceptors, a subpopulation of primary sensory neurons that are activated by intense stimuli such as pressure, heat, mechanical insults (a surgical incision) or irritant chemicals (including those which are released by damaged cells). Some of these chemicals such as bradykinin, cholecystokinin and prostaglandins, activate or sensitize nearby nociceptors. Strong physical stimuli (heat or pressure) and disease processes (inflammation) cause tissue damage and release a variety of chemicals. Once released, these chemicals bind and activate specific receptors on the nerve endings of small diameter nerve fibers, increase the excitability of the neuronal cell membrane and lead to generation of propagated action potentials. In addition to this electrochemical reaction, secondary messengers are released and activated, which then interact with the nucleus of the neuron to modulate response properties of affected neurons, leading to a state of peripheral sensitization in certain circumstances. Action potentials can be generated at differing distances from the terminal ending depending on the extent of depolarization of the fiber and resulting inactivation of voltage-gated channels involved in conduction. Theoretically, the depolarizing receptor potential can be accomplished by multiple membrane conductance changes and electrogenic pump activity. Since the electrochemical gradients for sodium (Na+), calcium (Ca+2), and chloride (Cl–) are more positive than the resting membrane potential in sensory neurons, the opening of ion channels permeable to these ions will cause the membrane potential to shift in the positive direction (depolarize). Since the electrochemical gradient for potassium (K+) is more negative than resting potential, closure of active potassium channels not only depolarizes the membrane potential but amplifies current-induced voltage fluctuations due to the resulting increase in membrane resistance.

Nociceptors express a wide variety of voltage-gated channels (e.g., Nav, Cav, Kv) that transduce the receptor potential into an action potential or, more commonly, a set of action potentials that encode the intensity of a noxious stimulus applied within their receptive fields. There are 9 known Nav, 10 Cav, and 40 Kv genes in mammals, many of which have multiple splice variants with different functional characteristics. Cell excitability and firing behavior (e.g., threshold for action potential generation, action potential and undershoot amplitude and duration, and maximal firing frequency) depend on the complement of these channels as well as those contributing to frequency modulation (e.g., hyperpolarization-activated cyclic nucleotide-gated cation channel [HCN] and A-type Kv4.3 and Kv3.4 channels). For instance, nociceptors responsive to noxious cold require the expression of the tetrodotoxin-resistant (TTX-resistant) Nav1.8 channel at the peripheral terminal, and mice lacking Nav1.8 and Nav1.7 display deficits in mechanosensation. Peripheral CGRP release by inflammatory mediators is unaffected by TTX, suggesting an important role of TTX-resistant Nav in regulated pain thresholds, consistent with their robust modulation by bradykinin (BK) and PGE2. Since enhanced excitability of primary sensory neurons in inflammatory and pathologic pain states is a major contributor to the perception of pain, specific pharmacological agents that specifically dampen aberrant activity are desirable in the design of pain therapeutics. To this end, an understanding of species-specific differences is critical, as exemplified by the dramatically different phenotypes in mice and humans lacking Nav1.7: although mice lacking Nav1.7 show a mechanosensory (pinch) and formalin-induced (5%) pain phenotype, humans lacking Nav1.7 are insensitive to pain altogether.

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Na channel (sodium channel):

Voltage-dependent Na+ channels in sensory nerves contribute to the control of membrane excitability and underlie action potential generation. Na+ channel subtypes exhibit a neurone-specific and developmentally regulated pattern of expression, and changes in both channel expression and function are caused by disease. Recent evidence implicates specific roles for Na+ channel subtypes Nav1.3 and Nav1.8 in pain states that are associated with nerve injury and inflammation respectively. Insight into the role of Nav1.8 in pain pathways has been gained by the generation of a null mutant. Moreover, evidence that the Nav1.3 Na+ channel, upregulated in axotomy, plays a significant role in neuropathic pain states is accumulating. The development of selective blockers of Na+ channel subtypes, combined with an analysis of tissue-specific and inducible knockouts of various channel isoforms, should illuminate the possible use of targeting Na+ channels to induce analgesia.

Cl channel (chloride channel):

Although glycine receptor Cl− channels (GlyRs) have long been known to mediate inhibitory neurotransmission onto spinal nociceptive neurons, their therapeutic potential for peripheral analgesia has received little attention. However, it has been shown that α3-subunit-containing GlyRs are concentrated into regions of the spinal cord dorsal horn where nociceptive afferents terminate. Furthermore, inflammatory mediators specifically inhibit α3-containing GlyRs, and deletion of the murine α3 gene confers insensitivity to chronic inflammatory pain. This strongly implicates GlyRs in the inflammation-mediated disinhibition of centrally projecting nociceptive neurons. Future therapies aimed at specifically increasing current flux through α3-containing GlyRs may prove effective in providing analgesia.

Ca channel (calcium channel):

The figure above shows potential mechanisms of potentiation, prevention and de-potentiation at synapses between C-fibers and spinal cord projection neurons. Conditioning electrical nerve stimulation or natural noxious stimulation triggers release of glutamate and substance P which causes opening of NMDA receptor channels and T-type voltage-gated Ca2+ channel and Ca2+ release from intracellular stores. This activates Ca2+-dependent signal transduction pathways including protein kinases and transcription factors. Synaptic strength is probably increased by phosphorylation of synaptic proteins including AMPA receptor channels, altered trafficking of synaptic proteins, e.g. increased insertion of AMPA receptors into the sub-synaptic membrane and de-novo protein synthesis. According to this model, LTP can be prevented if release of glutamate and/or substance P is inhibited, for example by activation of pre-synaptic, G-protein-coupled mu-opioid receptors, or if opening of voltage sensitive and Ca2+ permeable ion channels is blocked, e.g. via postsynaptic inhibition by an opioid. Depotentiation could result from de-phosphorylation of synaptic proteins, changes in receptors trafficking and degradation of synaptic proteins.

Transmission:

The transmission process occurs in three stages. The pain impulse is transmitted:

1. from the site of transduction along the nociceptor fibers to the dorsal horn in the spinal cord;

2. from the spinal cord to the brain stem;

3. through connections between the thalamus, cortex and higher levels of the brain.

Once transduced and generated, action potentials (nerve impulses) are conducted to the central nervous system primarily via two types of primary afferent neurons: thinly myelinated, faster conducting A delta fibers and unmyelinated, slowly conducting C fibers, both termed primary afferents. Action potentials result from activation of specific sodium channels. Nociceptive impulses travel along these peripheral nerve fibers (peripheral transmission) to the dorsal horn of the spinal cord where they synapse with the second order neurons (synaptic transmission). Here, the impulse is further transmitted via neurons which cross the spinal cord and ascend to the thalamus and branches to the brainstem nuclei (central transmission). The nociceptive impulses are then relayed to multiple areas of the brain including the somatosensory cortex, the insula, frontal lobes and limbic system. Once the action potential from the periphery reaches the first synapse at the dorsal horn of the spinal cord, a number of neuroactive substances are released. These include several excitatory and inhibitory neurotransmitters and glial derived chemicals that participate in the immune responses. Astrocytes and microglia in the dorsal horn are also involved and the sum of activity at the synapse results from release of excitatory and inhibitory neurotransmitters, which ultimately lead to generation of action potentials and central transmission of pain signals to higher centers.

The C fiber and A-delta fibers terminate in the dorsal horn of the spinal cord. There is a synaptic cleft between the terminal ends of the C fiber and A-delta fibers and the nociceptive dorsal horn neurons (NDHN). In order for the pain impulses to be transmitted across the synaptic cleft to the NDHN, excitatory neurotransmitters are released, which bind to specific receptors in the NDHN. These neurotransmitters are:

Adenosine triphosphate;

Glutamate;

Calcitonin gene-related peptide;

Bradykinin;

Nitrous oxide;

Substance P.

Polypeptides contained within the primary afferent nociceptors (substance P, somatostatin, vasoactive intestinal polypeptide and cholecystokinin) are all present in different populations of small diameter unmyelinated primary afferents which terminate in the superficial dorsal horn.

Substance P – excites pain transmission neurons in dorsal horn.

Capsaicin (hot pepper extract) – destroys substance P and reduces pain response.

Peripheral response of Substance P: released from peripheral terminals of nociceptors; found in nerve fibers on blood vessels causes cutaneous wheal and flare reaction of inflammation. Capsaicin as an antagonist of substance P could provide a new approach to control of inflammation and pain; capsaicin cream is now used to treat pain associated with Herpes zoster.

Local anesthetics and some antiepileptic drugs block sodium channels and inhibit the production of action potentials along the nociceptive afferents. Opioids bind to presynaptic receptors in the dorsal horn and decrease release of neurotransmitters such as glutamate. Peripheral and spinal nerve blocks interfere with propagation of action potentials and pain transmission into the CNS (at the nociceptors, along the nerve, at the dorsal root ganglion and along the spinothalamic tracts). Epidurally and intrathecally administered analgesics may provide presynaptic and postsynaptic inhibition of receptors at the level of dorsal horn neurons and affect the transmission of nociceptive impulses.

Before reaching the brain, the spinothalamic tract splits into the lateral “neospinothalamic” tract and the medial “paleospinothalamic” tract.

1. Neospinothalamic tract:

Fast pain travels via type A-delta fibers to terminate in the dorsal horn of the spinal cord where they synapse on dendrites of the neospinothalamic tract. The axons of these neurons cross the midline (decussate) through the anterior white commissure and ascend contralaterally along the anterolateral columns. These fibers terminate on the ventrobasal complex of the thalamus and synapse with the dendrites of the somatosensory cortex. Fast pain is felt within a tenth of a second of application of the pain stimulus and is a sharp, acute, prickling pain felt in response to mechanical and thermal stimulation. It can be localized easily.

2. Paleospinothalamic tract:

Slow pain is transmitted via slower type C fibers to laminae II and III of the dorsal horns, together known as the substantia gelatinosa. Impulses are then transmitted to nerve fibers that terminate in lamina V, also in the dorsal horn, synapsing with neurons that join fibers from the fast pathway, crossing to the opposite side via the anterior white commissure, and traveling upwards through the anterolateral pathway. These neurons terminate throughout the brain stem, with one tenth of fibers stopping in the thalamus and the rest stopping in the medulla, pons and periaqueductal grey of the midbrain tectum. Slow pain is stimulated by chemical stimulation, is poorly localized and is described as an aching, throbbing or burning pain.

Perception:

Perception is the process by which a noxious event is recognized as pain by a conscious person. Multiple areas of the brain are involved. There is no one location where perception occurs, although major defining components of pain are attributed to processes that take place in specific areas of the brain. Perception of pain is the end result of the neuronal activity of pain transmission and where pain becomes a conscious multidimensional experience. The multidimensional experience of pain has affective-motivational, sensory-discriminative, emotional and behavioral components. When the painful stimuli are transmitted to the brain stem and thalamus, multiple cortical areas are activated and responses are elicited. These areas are:

1. The reticular system: This is responsible for the autonomic and motor response to pain and for warning the individual to do something, for example, automatically removing a hand when it touches a hot saucepan. It also has a role in the affective-motivational response to pain such as looking at and assessing the injury to the hand once it has been removed from the hot saucepan.

2. Somatosensory cortex: This is involved with the perception and interpretation of sensations. It identifies the intensity, type and location of the pain sensation and relates the sensation to past experiences, memory and cognitive activities. It identifies the nature of the stimulus before it triggers a response, for example, where the pain is, how strong it is and what it feels like.

3. Limbic system: This is responsible for the emotional and behavioral responses to pain for example, attention, mood, and motivation, and also with processing pain and past experiences of pain.

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Picture below shows brain areas functionally related to pain processing.

Pain has an inseparable affective-emotional component that defines the response and associated behavior resulting from the initiating noxious event or stimulus. Cognitive-behavioral therapies such as distraction, relaxation, and imagery operate at this level of the pain pathway. Some patients have a dominant affective emotional component and present with increased pain behaviors, anxiety, and depression that must be treated in order to achieve effective pain control.

In a nutshell:

The sensation of pain travels from the periphery to the spinal cord along A-delta and C fibers. These first order neurons enter the spinal cord via Lissauer’s tract. Because the A-delta fiber is thicker than the C fiber and is thinly sheathed in an electrically insulating material (myelin), it carries its signal faster (5–30 m/s) than the unmyelinated C fiber (0.5–2 m/s). Pain evoked by the (faster) A-delta fibers is described as sharp and is felt first. This is followed by a duller pain, often described as burning, carried by the C fibers. A-delta and C fibers synapse on second order neurons in substantia gelatinosa (laminae II and III of the dorsal horns). These second order neurons (spinothalamic tract) then decussate, crossing via the anterior white commissure before ascending contralaterally. Before reaching the brain, the spinothalamic tract splits into the lateral neospinothalamic tract and the medial paleospinothalamic tract. Second order neospinothalamic tract neurons carry information from A-delta fibers and terminate at the ventral posterolateral nucleus of the thalamus, where they synapse on third order neurons. Paleospinothalamic neurons carry information from C fibers and terminate throughout the brain stem, a tenth of them in the thalamus and the rest in the medulla, pons and periaqueductal grey matter. Pain-related activity in the thalamus spreads to the insular cortex (thought to embody, among other things, the feeling that distinguishes pain from other homeostatic emotions such as itch and nausea) and anterior cingulate cortex (thought to embody, among other things, the motivational element of pain); and pain that is to be distinctly located activates the primary and secondary somatosensory cortices. In the cortex, the primary and secondary somatosensory areas participate in nociception. The primary somatosensory area consists of postcentral gyrus and the secondary somatosensory area includes the superior lip of the lateral sulcus. The ventrobasal and intralaminar complexes of the thalamus project somatotopically to both primary and secondary somatosensory areas. Most cells in the primary somatosensory area are modality specific: they respond to either light touch, deep pressure, warming, cooling, or tooth pulp stimulation (pain). In the secondary somatosensory area, specific and nonspecific polymodal cells are found.

Parallel pathways originating from different nociceptors:

Pain consists of a sensory component (the detection and transmission of painful stimuli) and an affective component (the processing of emotional and behavioral responses). Researchers have shown that different populations of nociceptors — neurons that sense painful stimuli — might engage parallel ascending pathways that target limbic (affective) and motor regions of the brain. A major unanswered question concerning “pain” circuitry is the extent to which different populations of primary afferent nociceptors engage the same or different ascending pathways. In a study, researchers followed the transneuronal transport of a genetically expressed lectin tracer, wheat germ agglutinin, in Na(V)1.8-expressing nociceptors of the nonpeptide class. They found that interneurons of lamina II are at the origin of the major ascending circuits targeted by the nonpeptide nociceptors. These interneurons contact lamina V projection neurons, which in turn predominantly target fourth-order neurons in the amygdala, hypothalamus, bed nucleus of the stria terminalis, and to a remarkable extent, the globus pallidus. These circuits differ greatly from the lamina I-based projection that is targeted by the peptide class of nociceptors. The results indicate that parallel, perhaps independent pain pathways arise from different nociceptor classes and that motor as well as limbic targets predominate in the circuits that originate from the nonpeptide population.

Autonomic nervous system (ANS) and pain:

Pain signals can set off autonomic nervous system pathways as they pass through the medulla, causing increased heart rate and blood pressure, rapid breathing and sweating. The extent of these reactions depends upon the intensity of pain, and they can be depressed by brain centers in the cortex through various descending pathways.

How brain influence pain perception:

Several observations lead scientists to think that the brain does influence pain perception.

1. The pain from the cut on your hand eventually subsides or reduces to a lower intensity.

2. If you consciously distract yourself, you don’t think about the pain and it bothers you less.

3. People given placebos for pain control often report that the pain ceases or diminishes.

Pain is in your brain:

When these ‘warning’ signals from the nociceptors reach the brain, it is up to the brain to decide whether it is indeed a real danger or not. You will not feel pain unless and until the brain believes that there is a threat to the body and hence an action is required. This has been shown in numerous studies both in animals and humans. In other words, it’s not the signals that go to the brain from the body that matters, it’s what the brain decides to do with these signals that matters. This perhaps explains the countless examples we see of how people come to the emergency room with limbs missing and other horrific injuries, but feel no pain whatsoever. The likely explanation is that if the brain indeed thought that the missing limb or the injury was highly threatening, you will be crouched, caring for your wound and will most likely succumb to your injuries. If you think about it, pain does not serve a protective purpose when survival is at stake. However, people coming to emergency room with severed limb without pain would be an exception and not a rule. Also, not feeling pain with severed limb does not necessarily mean that pain has no survival value as world has some weird people who do behave aberrantly.

Researchers compared the degree to which people felt pain from similar injuries based on what the individuals thought the pain meant. Those who did not place a major consequence on the pain did not feel as great an intensity of pain as those who thought their pain indicated a life-threatening illness. Do not make the mistake, though, of thinking that this higher intensity of pain is any less real, or that the feeling of depression and anxiety you may see in your loved one, is not real. The person truly feels the pain and fear, and the depression.

We now know from imaging and animal studies that persistent pain or pain which lasts for months and years can change the pain pathways – peripheral receptors-spinal cord-brain (physically, functionally and chemically) to make it a lot more sensitive. And this hypersensitivity causes the brain to interpret anything related to those tissues to be highly threatening. Just like the concept, ‘the more your practice, the better you become at performing the skill’, the longer your pain persists, the more efficient the nervous system and the brain becomes in triggering and maintaining pain. Hence in chronic pain, pain has moved up to the nervous system and now has very little to do with the initial damage to the tissues that caused the pain. So some times when folks are in chronic pain, they did not get hurt or they did not re-injure themselves as many think. It is just that your brain and nervous system has become so good at constructing pain at the slightest of triggers –even those that don’t cause damage. These triggers could be in the form of a slight pressure on the affected tissues or nearby tissues or just even the thought of the injury-causing incident. Chronic pain has been a mystery because we were just looking at the tissues and joints while ignoring the nervous system and the brain. But it is in the brain and the nervous system that the action happens!

The role of the Cerebral Cortex in pain perception:

Brain tissue is not sensitive to pain! The brain itself does not have any receptors for pain. In fact, most brain surgery is performed using a local anesthetic only. The meninges (coverings of the brain), however, are very sensitive to pain. The experience of pain can only be defined in terms of human consciousness. However, anatomical studies in animals together with functional imaging studies in humans have made it possible to identify the main cerebral components of the human nociceptive system. These components comprise at least two main human nociceptive systems working in parallel, called the medial and lateral pain systems. This anatomical evidence has provided a physical construct for the concept of the human pain matrix (Melzack 1990). In addition, other nociceptive pathways have been identified in rodents that have not yet been described in primates.

There is a wide spectrum of pain experience, ranging from pain that may closely reflect physical events in tissue (e.g., events leading to excitation of nociceptors and hence nociceptive pain) to pain that is generated without any peripheral physical input (e.g., psychogenic and neuropathic pain). All these pains are equally valid and can only be recorded in terms of the individual’s subjective experience. A number of electroencephalographic (EEG) and functional imaging studies have demonstrated that changing the psychological context of a stimulus, in terms of attentional instruction or anticipation can completely alter neuronal activity within the pain matrix. The brain is therefore acting as a virtual reality system that may or may not be constrained by interactions with the body’s internal and external environment.

Electrophysiological pain-evoked potentials, i.e., electroencephalographic (EEG) frequency analysis and magnetoencephalography (MEG), as well as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) provide access to nociceptive processing mainly within the brain. However, recent studies have extended some of these techniques to the spinal cord (Gage et al. 2001). PET has provided the means to measure both metabolic and neurochemical aspects of nociceptive processing. This technique has allowed the identification of receptor systems and changes in their occupation during acute and chronic pain (Jones et al. 1994, 1999; Zubieta et al. 2001) in addition to imaging aspects of cholinergic (Gage et al. 2001) and dopaminergic transmission (Jaaskelainen et al. 2001). The great advantage of fMRI over PET is that it is possible to make repeated measures of nociceptive responses without the constraints imposed by the use of radioactivity, allowing much more complex experimental design. The weakness of all these techniques is that in the final analysis, we are left with significant activation sites in brain volumes without directional information and without information about the ascending or descending nociceptive inputs from which they result. They can therefore only be interpreted with reference to detailed anatomical and pharmacological studies derived from animal studies (Vania et al. 1989a,b,c; Sikes and Vogt 1992) and from human post-mortem studies (Bowsher 1957). Such interpretations, together with information from evoked potentials (Chen et al. 1998) and MEG (Hari et al. 1983) can begin to provide a working model of the circuitry concerned with nociceptive processing.

Human pain matrix:

Unfortunately there is no discrete centre where pain is recognized. Pain is so important to survival that almost the whole brain is involved. Pain involves cognition, emotion, and behavior. Therefore it is not surprising that PET scan data obtained during painful stimulation indicates activity in the following cortical areas. Brodmann’s tissue classification follows in brackets.

1. Sensory and motor cortex areas……………………………. (1-4)

2. Premotor cortex (for planning of movement)…………….. (6)

3. Other parts of the parietal cortex……………………………. (7 and 37-40)

4. Other parts of the frontal cortex……………………………… (8-10 and 43-47)

5. Cingulate cortex………………………………………………. (24 and 32)

6. Insula……………………………………………………………… (14)

7. Occipital cortex………………………………………………….. (19)

Pain also projects to the following subcortical structures:

Thalamus, putamen, caudate nucleus, hypothalamus, amygdala, periaqueductal grey matter, hippocampus, red nucleus, pulvinar, and vermis of the cerebellum (Wall,1996).

All of these support the claim that “the reign of pain is mainly in the brain”. But there is no one center “in control”. Rather we see that pain can be all-pervasive, affecting our thoughts and memories, attitudes and emotions, movements and behavior — and in turn be affected by each and all of them. So all the cortical and subcortical areas involved in pain processing is called “Human Pain Matrix” or Pain Neuromatrix.

Many years ago, single-unit recordings in the monkey established that nociceptive pathways in the somatosensory system project to areas 3b and 1 of the primary somatosensory cortex (Kenshalo and Willis 1991), as well as to the secondary somatosensory cortex (S2) and the neighboring posterior parietal cortex (Dong et al. 1989). It has been widely accepted that pain is a multidimensional experience that has sensory-discriminative, affective, motivational, and evaluative components (Melzack and Casey 1968). It has been suggested that these different components are likely to be processed within a “neuromatrix,” rather than in one center (Melzack 1990). Functional imaging experiments have identified such a matrix. A number of cortical structures such as S1 and S2, the anterior insula, and cingulate and dorsolateral prefrontal cortices are reproducibly involved in nociceptive processing (Derbyshire 1999; Peyron et al. 2000), as are subcortical structures including the amygdala (Derbyshire et al. 1997) and the thalamus and hypothalamus (Hsieh et al. 1996, 2001). If pain results from integrating processing within such a matrix, then it should not be surprising that ablation of one component of that matrix may not have immediately obvious effects, if other components of the matrix are able to compensate in some way. A clue to this possibility comes from the predominantly bilateral nociceptive inputs to most cortical components of the matrix on both anatomical and functional grounds (Schlereth et al. 2003; Youell et al. 2004). This parallel processing probably provides for considerable redundancy within this system, which is so essential for species survival.

The lateral pain system comprises the lateral thalamic nuclei and the somatosensory cortices. It is fast and somatotopic and may subserve the sensory-discriminative aspects of pain, which include localization, intensity, and duration. The insular cortex also has some somatotopic nociceptive inputs and may be involved in integrating them with inputs from other sensory modalities (Ostrowsky et al. 2002).

The medial pain system is slow (polysynaptic) and non-somatotopic, and is thought to process the affective components of pain (Treede et al. 1999). It includes the medial thalamic nuclei, anterior cingulate and dorsolateral prefrontal cortices, and possibly structures concerned with the processing of fear, such as the amygdala.

The main division of function between the medial and lateral pain systems is likely to be that of affective and sensory-discriminatory processing, respectively, with intensity probably being processed throughout the matrix.

The cingulate cortex, nociception, and the endogenous opioid system:

The role of the cingulate cortex in processing a variety of cognitive, motor, and nociceptive information has been well described (Vogt et al. 1993; Devinsky et al. 1995; Paus et al. 1998; Bush et al. 2000). The observation that the anterior cingulate cortex is the most commonly activated structure in functional imaging studies of pain (Derbyshire 1999) suggests that it has a pivotal role in nociceptive processing. There is substantial interindividual and interstudy variability of the location of anterior cingulate responses to nociceptive stimuli (Vogt et al. 1996; Derbyshire 2000). These locations were shown to extend from the more rostral perigenual cingulate to the caudal mid-cingulate cortex in studies using fMRI, PET, and EEG (Bentley et al. 2002b). The activity within the perigenual cingulate cortex during attention to unpleasantness is consistent with its relatively high concentration of opioid receptors (Jones et al. 1991b; Vogt et al. 1995a) as compared to the more executive areas of the cingulate cortex, and also with the perigenual changes in occupation by endogenous opioid peptides during chronic pain (Jones et al. 1994, 1999; Jones and Derbyshire 1996; Spetea et al. 2002). The perigenual cingulate and associated structures are most likely to be concerned with processing the affective components of pain, whereas the mid-anterior cingulate is more likely to be concerned with executive processing (response selection and monitoring) and control of attention.

Pain modulation:

The body possesses an endogenous analgesia (endogenous opioids) system, which can be supplemented with analgesic drugs to regulate nociception and pain. There is both an analgesia system in the central nervous system and peripheral receptors that decreases the grade in which nociception reaches the higher brain areas. The degree of pain can be modified by the periaqueductal gray before it reaches the thalamus and consciousness. According to gate control theory of pain, this area can also reduce pain when non-painful stimuli are received in conjunction with nociception.

1. Central:

The central analgesia system is mediated by 3 major components: the periaquaductal grey matter, the nucleus raphe magnus and the nociception inhibitory neurons within the dorsal horns of the spinal cord, which act to inhibit nociception-transmitting neurons also located in the spinal dorsal horn.

2. Peripheral:

The peripheral regulation consists of several different types of opioid receptors that are activated in response to the binding of the body’s endorphins. These receptors, which exist in a variety of areas in the body, inhibit firing of neurons that would otherwise be stimulated to do so by nociceptors.

Opioid Receptors:

Opiate receptors – or binding sites in the central nervous system – were discovered in 1973. These sites are areas of neuronal membrane to which opioids attach themselves and bring about inhibition in the underlying cell. It was noted that morphine attaches to specific binding sites which suggested that there must be naturally-occurring opioids within the body (Bowsher 1987). It is now known that there are four distinct types of opioid receptor, mu, kappa and delta and sigma. There is a widespread distribution of opiate receptors within the Central Nervous System. These are numerous in the paramedian system’s intralaminar thalamic nuclei, reticular formation and limbic structures. There are only a few in the neospinothalamic system’s ventrobasal thalamus and post-central gyrus. In the dorsal horn there are large numbers situated postsynaptically on neuronal membranes and there are some situated presynaptically on the intraspinal part of C afferent nerve fibres (Baldry 1993). Thus opioid binding sites (receptors) occur at many synaptic and non synaptic sites in the CNS, notably the spino-reticular system, and inhibition results from the action of exogenous opioids (e.g. morphine) or endogenous opioids (e.g. enkephalins, endorphins) at these sites (Bowsher 1987). Studies of the distribution of endogenous opioid peptides have shown that there are high levels of enkephalins and dynorphins in the limbic structures, periaqueductal grey area, the nucleus raphe magnus and the substantia gelatinosa of the dorsal horn (with spill-over into the cerebrospinal fluid); and anterior pituitary and adrenal medulla, with release into the plasma. Plasma enkephalins are released from the adrenal gland, the gut, sympathetic ganglia and peripheral autonomic neurons (Baldry 1993).

Endogenous opioid substances are endorphins, enkephalins(met-Enk and leu-Enk) and dynorphins synthesized by nerve cells.

1. Endorphin: anterior and intermediate pituitary lobes; hypothalamus

2. Enkephalin: periaqueductal gray matter; rostral medulla (raphe nucleus); dorsal gray horn of spinal cord

3. Dynorphin: hippocampus; deep layers of cerebral cortex; caudate; putamen; globus pallidus

These bind opioid receptors and action is blocked by the opioid receptor antagonist naloxone. These endogenous opioids are coded by separate genes and present in different cell populations of the brain, pituitary, adrenal gland, gut and sympathetic nervous system. The endorphin-mediated analgesia system (EMAS) demonstrates how narcotic analgesics relieve pain and drugs like morphine, pethidine and codeine mimic actions of endorphins at synapses in pain-modulating networks.

Following are some situations and conditions which are thought to stimulate endorphin production.

1) Emergency situations requiring the person to perform physical actions despite pain and injury.

2) Intense physical activity. Moderate physical activity over an extended period of time can also increase the supply of endorphin.

3) Positive beliefs and expectations (e.g., the “placebo effect”).

4) Positive emotional states such as happiness, joy, laughter, and love.

What this means is that psychological factors, including positive mental attitudes and positive emotional states can have a beneficial effect on your brain chemistry, which in turn can reduce your experience of pain.

Pain Modulation System:

The pain modulation system consists of endogenous opioid system, the serotonergic system and the descending pain pathways; all of them are inter-connected for pain modulation. Much of the pain modulation is carried out by the endogenous opioids. The electrical stimulation of rat brains produced a phenomenon called stimulation produced analgesia (SPA) which is a function of endogenous opioid release. Endogenous opioids caused selective reduction in pain with few side effects (warmth and/or sleepiness). Serotonin and norepinephrine are important neurotransmitters involved in modulating the pain response particularly because they can be manipulated by a variety of pharmacological agents.

Descending pain Modulation:

Descending Pain Modulation Pathways means pain modulating neurons from the cortex, hypothalamus, midbrain periaqueductal gray and rostral medulla alter pain response in the dorsal horn of the spinal cord. Descending input from the brainstem influences central nociceptive transmission in the spinal cord. Specific brainstem nuclei send projections to the dorsal horn of the spinal cord and when activated by ascending nociceptive impulses and other influences from the brain result in descending modulation. Just as there are ascending pain pathways from the body to the brain, there are also descending pain pathways communicating from the brain to the body which inhibit pain. The most important descending pathways begin in the periaqueductal gray (PAG). Stimulation of the PAG has been shown to produce analgesia, but no change in the ability to detect temperature, pressure, or touch. The neurons beginning in the PAG end on cells in the medulla, including the serotonergic cell bodies of the raphe nuclei. The serotonergic neurons then descend into the spinal cord to inhibit cell firing. Other cells in the PAG terminate close to the locus coeruleus in the brainstem. Thus, there are at least two major pathways that descend to the spinal cord to inhibit the projection of pain. Though not completely understood, modulation results in descending inhibition of nociception through the release of neurotransmitters such as serotonin, norepinephrine and endogenous opioids. Modulatory processes can also increase descending facilitation of nociception and consequently pain. Psychological factors such as fear and anxiety exert facilitatory influences through these modulatory systems.

The modulation of pain involves changing or inhibiting transmission of pain impulses in the spinal cord. The multiple, complex pathways involved in the modulation of pain are referred to as the descending modulatory pain pathways (DMPP) and these can lead to either an increase in the transmission of pain impulses (excitatory) or a decrease in transmission (inhibition). Descending inhibition involves the release of inhibitory neurotransmitters that block or partially block the transmission of pain impulses, and therefore produce analgesia. Inhibitory neurotransmitters involved with the modulation of pain include:

Endogenous opioids (enkephalins and endorphins)

Serotonin (5-HT)

Norepinephirine (noradrenalin)

Gamma-aminobutyric acid (GABA)

Neurotensin

Acetylcholine

Oxytocin

Endogenous pain modulation helps to explain the wide variations in the perception of pain in different people as individuals produce different amounts of inhibitory neurotransmitters. Endogenous opioids are found throughout the central nervous system (CNS) and prevent the release of some excitatory neurotransmitters, for example, substance P, therefore, inhibiting the transmission of pain impulses.

Certain antidepressants such as the tricylics and selective norepinephrine reuptake inhibitors (SNRIs) that inhibit the reuptake of serotonin and norepinephrine enhance descending inhibition. This may explain their effectiveness in neuropathic and other types of pain. Opioid analgesics have direct effects on descending modulation. Cognitive behavioral therapies are thought to modulate pain by reducing fear and anxiety. Spinal cord stimulation, epidural and intrathecal delivery of drugs such as opioids also modify descending modulation.

The Gate Control Theory:

Melzack and Wall (1965), developed their now-famous theory on pain mechanisms, which postulated that in each dorsal horn of the spinal cord, there is a gate-like mechanism which inhibits or facilitates the flow of afferent impulses into the spinal cord before it evokes pain perception and response. The gate control theory proposes that the substantia gelatinosa, which caps the grey matter of the spinal horn in the spinal cord, is the essential site of control. The control mechanism is referred to as a ‘gate’ and is operated by external and internal influences. Pain impulses can only pass through when the gate is open, and not when it is closed (Davis 1993). The theory, as originally propounded, stated that the opening or closing of the ‘gate’ is dependent on the relative activity in the large diameter (A-beta ) and small diameter fibers (A-delta and C), with activity in the large diameter fibers tending to close the ‘gate’, and activity in the small diameter fibers tending to open it (Baldry 1993). So if nociceptive input exceeds A-beta fiber input, then the gate is open and the pain impulse ascends the spinal cord to the brain. If A-beta fiber input exceeds nociceptive input, then the gate is closed and the pain impulse is stopped or diminished due to the action of the inhibitory neurotransmitters and, therefore, does not pass up the spinal cord (Davis 1993). An essential part of the theory ever since the time it was first put forward is that the position of the ‘gate’ is in addition influenced by the brain’s descending inhibitory system. Recent research by Garrison and Foreman (1994) supports this theory insofar as their study shows that dorsal horn neurons which can potentially transmit noxious information to supraspinal levels, can have their cell activity decreased during TENS (Transcutaneous electrical nerve stimulation ) application to somatic receptive fields. These findings are consistent with the concept of the ‘gate control theory of pain’ in that less noxious information would be involved in the pain perception process (Garrison and Foreman 1994). They also showed that there is a differential effect in that more cells respond to conventional high frequency, low intensity (TENS) variables than they do to low frequency, high intensity (ALTENS) variables. So entry into the central nervous system can be visualized as a gate, which is opened by pain-generated impulses and closed by low-intensity stimuli such as rubbing or mild electric stimulation (TENS), furthermore, it can also be closed by endogenous opioid mechanisms which can be activated from the brain or peripherally by acupuncture (Bowsher 1987) or by gentle rubbing, massage, electrical stimulation and hot or cold therapies. The gate control theory of pain postulates that nociception (pain) is “gated” by non-nociception stimuli such as vibration. Thus, rubbing a bumped knee seems to relieve pain by preventing its transmission to the brain. Pain is also “gated” by signals that descend from the brain to the spinal cord to suppress (and in other cases enhance) incoming nociception (pain) information.

Let’s go through the theory step by step:

1. Without any stimulation, both large and small nerve fibers are quiet and the inhibitory interneuron (I) blocks the signal in the projection neuron (P) that connects to the brain. The “gate is closed” and therefore no pain.

2. With non-painful stimulation, large nerve fibers (A-beta) are activated primarily. This activates the projection neuron (P), but it also activates the inhibitory interneuron (I) which then blocks the signal in the projection neuron (P) that connects to the brain. The “gate is closed” and therefore no pain.

3. With pain stimulation, small nerve fibers (A-delta and C) become active. They activate the projection neurons (P) and block the inhibitory interneuron (I). Because activity of the inhibitory interneuron is blocked, it cannot block the output of the projection neuron that connects with the brain. The “gate is open”, therefore, pain!!

Thoughts, emotions and “circuitry” can affect both ascending and descending pain pathways. So, several factors, physiological and psychological, can influence pain perception:

1. Age (vide infra) — Brain circuitry generally degenerates with age, so older people have lower pain thresholds and have more problems dealing with pain.

2. Gender (vide infra) — Research shows that women have a higher sensitivity to pain than men do. This could be because of sex-linked genetic traits and hormonal changes that might alter the pain perception system. Psychosocial factors could be at work, too — men are expected not to show or report their pain.

3. Fatigue — We often experience more pain when our body is stressed from lack of sleep.

4. Memory — How we have experienced pain in the past can influence neural responses (memory comes from the limbic system).

Wind-up:

Example: frequently touching the hot plate becomes painful

Low frequency repetitive stimulation of C-fibers produces a gradual increase in the discharge frequency of WDR neurons until they are in a state of nearly continuous discharge. In this state there are augmented responses to input and enlarged receptive fields. Input from areas that previously did not activate the WDR neuron now evoke a prominent response, and

Low threshold stimulation is able to drive the neurons. Wind-up is elicited by any prolonged or intense C-fiber input.

Pain sensitization and hypersensitivity:

Pain systems need to be sensitive enough to detect potentially harmful stimuli. But often they become too sensitive, causing us pain that provides no benefit. This hypersensitivity arises because our pain pathways actually increase in sensitivity when they relay pain messages, and the mechanisms of this sensitization are beginning to be revealed. Pain hypersensitivity takes two forms:

1. Thresholds are lowered so that stimuli that would normally not produce pain now begin to (allodynia).

2. Responsiveness is increased, so that noxious stimuli produce an exaggerated and prolonged pain (hyperalgesia).

Pain hypersensitivity after an injury helps healing by ensuring that contact with the injured tissue is minimized until repair is complete – an adaptive response. However, pain hypersensitivity may persist long after an injury has healed or occur in the absence of any injury. In this case, pain provides us with no benefits, and is a manifestation of pathological change in the nervous system.

Pain receptors become sensitized after tissue damage. When tissue is damaged or a noxious stimulus is repeated, nociceptors exhibit sensitization such that there can be a reduction in the threshold for activation, an increase in response to a given stimulus, or the appearance of spontaneous activity. This sensitization results from the actions of second messenger systems activated by the release of inflammatory mediators (bradykinin, histamine, prostaglandins and serotonin) at the site of injury. This causes some of the features of hyperalgesia produced by tissue damage or by pathological processes. Hyperalgesia after cutaneous injury can be divided into two phenomena: Primary hyperalgesia occurs at the site of injury and is characterized by hyperalgesia to mechanical and heat stimuli. Secondary hyperalgesia occurs outside the injury site and is characterized by mechanical hyperalgesia only. Hyperalgesia in inflammatory processes corresponds to primary hyperalgesia. Hyperalgesia in referred pain and neuropathic pain resembles secondary hyperalgesia,

Sensitization could be peripheral and/or central sensitization. ‘Sensitization’ here means an increase in the excitability of neurons, so they are more sensitive to stimuli or sensory inputs.

1.Peripheral sensitization:
Peripheral sensitization is a reduction in threshold and an increase in responsiveness of the peripheral ends of nociceptors, the high-threshold peripheral sensory neurons that transfer input from peripheral targets (skin, muscle, joints and the viscera) through peripheral nerves to the central nervous system (spinal cord and brainstem). Peripheral sensitization is the result of changes in key proteins and ion channels (known as transduction proteins) that determine the excitability of the nociceptor terminal. The transduction proteins are the means by which a noxious stimulus, for example excessive heat, is converted into electrical activity. Normally for heat this only occurs at around 42°C, the heat pain threshold. After peripheral inflammation, though, the threshold falls considerably. Peripheral sensitization contributes to the pain hypersensitivity found at the site of tissue damage and inflammation. A good example of this is the change in heat sensitivity after sunburn, when a normally warm stimulus such as a shower feels burning hot in the sunburned areas. Sensitization arises due to the action of inflammatory chemicals or mediators released around the site of tissue damage or inflammation. Some of these, such as ATP, can directly activate the ends of the peripheral nociceptors, signaling the presence of inflamed tissue and producing pain. Other chemical mediators are produced by activated inflammatory cells, such as neutrophils (a type of white blood cell). When activated, these cells begin making an enzyme known as COX-2, which leads to the production and secretion of prostaglandin PGE2. This mediator act as a sensitizer, altering pain sensitivity by increasing the responsiveness of peripheral nociceptors. Aspirin-like pain-killing drugs act by inhibiting Cox-2 and prostaglandin production.

Tissue damage results in a drop in pH and release of chemicals, e.g. histamines and bradykinin, to which small non-myelinated C fibers are sensitive. Fitzgerald and Woolf (1984) have hypothesized that C fibers are primarily chemical sensors, although they do respond also to high level mechanical and thermal stimulation. The C fibers respond by generating an electrical impulse which travels along the nerve to the dorsal horn of the spinal cord. Activity of the C fibers may be up-regulated peripherally by serotonin, prostaglandins, thromboxane, and leucotrienes in the damaged tissues. This is referred to as peripheral sensitization in contrast to central sensitization which occurs at the dorsal horn. Both occur in chronic pain. Substance P may also be released peripherally with resultant increase in peripheral vasodilation and further sensitization of the C fiber’s peripheral ending. Even chemical products of tissue breakdown may sometimes enter the neuron and be transported centrally to exert an effect at the dorsal horn synapse.

2. Central sensitization:

Central sensitization is an increase in the excitability of neurons within the central nervous system, so that normal inputs begin to produce abnormal responses. Unlike other sensory stimuli, relatively brief trains of activity in peripheral nociceptors have the ability to trigger long term changes in CNS circuitry and cause prolonged states of hypersensitivity. This ‘central sensitization’ contributes to an amplification of the noxious input and a spread of pain outside the original damaged region (secondary hyperalgesia) and the onset of pain from normally innocuous stimuli (allodynia). The central sensitization arises from increases in membrane excitability, strengthened excitatory synaptic outputs and reduction of inhibitory interneuronal activity, which in turn are regulated by shifts in gene expression, the production and trafficking of key receptors, channels, and downstream neuronal signaling pathways. The first phase depends on changes to existing proteins involved in synaptic transmission of nerve impulse while the second phase relies on new gene expression. The increased excitability is typically triggered by a burst of activity in nociceptors (such as that evoked by an injury), which alter the strength of synaptic connections between the nociceptor and the neurons of the spinal cord (so-called activity-dependent synaptic plasticity). Low-threshold sensory fibers activated by very light touch of the skin, for example, begin to activate neurons in the spinal cord (for inputs from the body) or in the brainstem (for inputs from the head) that normally only respond to noxious stimuli. As a result, an input that would normally evoke an innocuous sensation now produces pain. In effect, the synaptic changes increase the ‘gain’ of the system. Although the pain feels as if it originates in the periphery, it is actually a manifestation of abnormal sensory processing within the central nervous system. Central sensitization is responsible for tactile allodynia (pain in response to light brushing of the skin) and for the spread of pain hypersensitivity beyond an area of tissue damage so that adjacent non-damaged tissue is tender. Central sensitization can also occur after surgery, contributing to pain on movement or touch, in migraine attacks where brushing hair is often painful, and in some patients with nerve damage where even blowing on the skin produces excruciating burning pain.

There are treatments that may actually aggravate central sensitization pains–oxycodone working on kappa receptors, prolonged high dose opioid metabolites, excessive triptans or ergotamine for migraines, and untreated pain itself. It is also becoming clear there are some kinds of treatment that may have more specific advantages in treating central sensitization: gabapentin, pregabalin, tramadol, amitriptyline, buprenorphine, and ketamine, for example.

Mechanism of pain transmission at synapse in various pain conditions:

1. Normosensitivity

2. Central sensitization

3. Neuropathic

4. Hyperalgesia

5. Allodynia

The picture below shows excellent illustration of what happens to pain response following injury.

1. Normal pain response curve shows zero pain intensity with lower intensity stimuli (e.g. light touch does not elicit pain normally – innocuous stimuli) and as stimulus intensity increases (e.g. squeezing or pinching harder) one begins to feel pain with increasing intensity.

2. Following injury, the pain response curve shifts to the left.

3. Due to shift of pain response curve to left, a stimulus which would cause a low level of pain would now cause a much higher level of pain. This is the definition of hyperalgesia.

4. Normally innocuous stimuli now becomes painful – definition of allodynia.

The mechanisms of pain and the ability to control pain may alter in different pain states. Pain is a unique constellation of peripheral and central plastic changes. Central neuroplasticity occur due the phenomenon of central sensitization, whereby neuronal activity within the spinal cord is increased. This is linked to painful sensations such as hyperalgesia and allodynia and the generation of spontaneous pain. Also observed are increased peripheral receptive fields of individual spinal neurones, lowered threshold to peripheral stimuli and increased spontaneous firing. This plasticity is of great importance in consideration of a rational basis for the treatment of both inflammatory and neuropathic pain where the damage to tissue and nerve leads to alterations in both the peripheral and central mechanisms of pain signaling. In terms of existing drug therapies, this plasticity, the ability of the system to change in the face of a particular pain syndrome is the reason for the effectiveness of NSAIDs in inflammatory conditions yet also responsible for some limitations in the effectiveness of opioids in neuropathic pain.

Hypoalgesia:

Hypoalgesia denotes a decreased sensitivity to painful stimuli. Hypoalgesia occurs when nociceptive (painful) stimuli are interrupted or decreased somewhere along the path between the input (nociceptors), and the places where they are processed and recognized as pain in the conscious mind. Hypoalgesic effects can be mild, such as massaging a stubbed toe to make it hurt less or taking aspirin to decrease a headache, or they can be severe, like being under strong anesthesia. Hypoalgesia can be caused by exogenous chemicals such as opioids, as well as by chemicals produced by the body in phenomena such as fear- and exercise- induced hypoalgesia. Hypoalgesia can also be associated with diseases, such as CIP or in less severe cases with diabetes or other diseases associated with hypertension. Based on the existing evidence, hypoalgesia is argued to be a correlate of dysregulation of central nervous system structures involved in both pain control and cardiovascular regulation in individuals who are genetically predisposed to develop high blood pressure. As such, hypoalgesia may serve as a valuable method of identifying individuals at greatest risk for hypertension.

Pain perception in animals:

The most reliable method for assessing pain in most humans is by asking a question: a person may report pain that cannot be detected by any known physiological measure. However, like infants (Latin infans meaning “unable to speak”), non-human animals cannot answer questions about whether they feel pain; thus the defining criterion for pain in humans cannot be applied to them. Experts currently believe that all vertebrates can feel pain, and that certain invertebrates, like the octopus, might too. Nociception has been documented in non-mammalian animals, including fishes and a wide range of invertebrates, including leeches, nematode worms, sea slugs, and fruit flies. As in mammals, nociceptive neurons in these species are typically characterized by responding preferentially to high temperature (40º Celsius or more), low pH, capsaicin, and tissue damage. As for other animals, plants, or other entities, their ability to feel physical pain is at present a question beyond scientific reach, since no mechanism is known by which they could have such a feeling. In particular, there are no known nociceptors in groups such as plants, fungi, and most insects, except for instance in fruit flies. In vertebrates, endogenous opioids are neurochemicals that moderate pain by interacting with opiate receptors. Opioids and opiate receptors occur naturally in crustaceans and, although at present no certain conclusion can be drawn, their presence indicates that lobsters may be able to experience pain. Opioids may mediate their pain in the same way as in vertebrates. Veterinary medicine uses, for actual or potential animal pain, the same analgesics and anesthetics as used in humans.

It’s sometimes said that, “…animals don’t feel pain the way we do.” This is wrong. Anyone who’s stepped on a dog’s foot is quite well aware that higher beings (which certainly include all mammals and birds, and probably almost all vertebrates) have a similar reaction to such stimuli. If a man drops a rock on his toe we say he “screeches in pain,” but in animals, scientists hedge their bets (and avoid the cardinal sin of attributing human emotions to animals) by using the term “exhibits a pain-like response,” for the same noise, elicited by the same stimulus. This is quibbling: an animal clearly is capable of feeling “pain” in the same way we do.

The table below shows signs of pain in animals.

Almost all organisms, including bacteria, will attempt to escape from an aversive stimulus. Because bacteria are not thought to be capable of feeling pain (e.g. they lack a nervous system), possessing an escape response to an aversive stimulus is not enough evidence to demonstrate that a species is capable of feeling pain. To infer that a non-human vertebrate (mammals, birds and reptiles) is in pain, researchers rely on the vocalizations and physiological responses (e.g. the release of stress hormones) that an animal produces when faced with an aversive stimulus. Because these responses are similar to our own when we are in pain, researchers argue that, by analogy, animals showing these responses are also in pain. This technique cannot be used with invertebrates. Invertebrate physiology is different from our own. The invertebrates diverged from that of vertebrates hundreds of millions of years ago. Most, if not all, invertebrates have the capacity to detect and respond to noxious or aversive stimuli. That is, like vertebrates, they are capable of “nociception.” Examples of aversive stimuli include changes in temperature beyond the animal’s normal range, contact with noxious chemicals, mechanical interference, or electric shock. Under certain conditions, all of these might be expected to cause pain in humans. In general, invertebrates, like vertebrates, respond to such stimuli by withdrawing or escaping so as to reduce the likelihood that they will be damaged by the noxious conditions. Some invertebrates, like vertebrates, also have special sensory receptors called nociceptors, which respond specifically to noxious stimulation. Such nociceptive nerve cells have been found in the segmental ganglia of the medicinal leech, Hirudo medicinalis (Nicholls and Baylot, 1968). Nerve impulses are generated in these cells, which Nicholls and Baylor called N cells, specifically in response to noxious mechanical stimulation, such as such as pinching, squeezing, or cutting of the body wall. What evidence might help in distinguishing between nociceptive “responsiveness” and the perception of pain? At the outset, it should be pointed out that because pain is a subjective experience, it is highly unlikely that any clear-cut, definitive criteria will ever be found to decide this question. The “relatively simple organization” of the insect central nervous system, Elsemann et al. argue, “raises the question of whether any experience akin to human pain could be generated” in these animals (and by implication in other invertebrates with a similar or less complex nervous organization). On the analysis of Gould and Gould (1982), the answer to such a question would be “no,” for these authors can find no evidence for conscious experience in insects. Certainly, on the limited amount of evidence presented here, it seems very difficult to imagine that insects and the other simpler invertebrates mentioned above can “suffer” pain in anything like the vertebrate sense. Nevertheless, the issue certainly is not closed, and further questions should be asked. It might be inferred, incorrectly, that certain invertebrates experience pain simply because they bear a (superficial) resemblance to vertebrates-the animals with which humans can identify with most clearly. Equally, pain might incorrectly be denied in certain invertebrates simply because they are so different from us and because we cannot imagine pain experienced in anything other than the vertebrate or, specifically, human sense. The question of pain in invertebrates will be extremely difficult to resolve–if, indeed, it is resolvable. Although it is impossible to know the subjective experience of another animal with certainty, the balance of the evidence suggests that most invertebrates do not feel pain. The evidence is most robust for insects, and the consensus is that they do not feel pain. Perhaps the question of pain in invertebrates could be more easily settled where the “most highly organized of all invertebrates” (Russell-Hunter, 1979), the cephalopods, are concerned. These animals, which include cuttlefish, squid, and octopuses, “have the largest brains of all invertebrates” (Wells, 1962). The ratio of brain-weight to body-weight of many cephalopods also exceeds that of most fish and reptiles (Packard, 1972). The cephalopod brain has a “hierarchical” organization (see Boycott, 1961), the “higher” centers of the brain being concerned with sensory analysis, memory, learning, and decision-making. It has been suggested that these areas of the cephalopod brain might be regarded as analogous to the cerebral cortex of higher vertebrates (Russell-Hunter, 1979). According to Wells (1978), since in Octopus the brain “represents only the more specialized sensory integrative, higher movement control and learning parts of a rather diffuse nervous system…it becomes clear that one is dealing with an animal that might well be expected to possess a central nervous capability approaching that or exceeding that of many birds and mammals.” The evidence seems to suggest that at least some of the cephalopods might have a nervous organization that would allow them to experience something like pain. It is unclear, however, whether cephalopods are able to “suffer” pain.

In vertebrates, nociceptive information is collated and augmented in the brain and signals are relayed down the nervous system to alter the intensity of pain. All vertebrates possess the primitive areas of the brain to process nociceptive information, namely the medulla, thalamus and limbic system. However, one area of great importance for pain perception in humans is the cortex and its relative size decreases as we descend the evolutionary tree. For instance, in relative terms, the cortex gets smaller going from humans, through primates, mammals, birds, reptiles, amphibia and finally to fish, which possess only a rudimentary cortex. Although comparatively simple, fish have recently been shown to possess sensory neurons that are sensitive to damaging stimuli and are physiologically identical to human nociceptors. Fish show several responses to a painful event: they adopt guarding behaviors, become unresponsive to external stimuli and their respiration increases. These responses disappear when the fish are given morphine – evidence that they are, mechanistically at least, directly analogous to pain responses in more complex animals.

Some animals show reflex responses similar to our own. For example, when we accidentally touch a hot iron we respond almost immediately by retracting our hand. There is a lag period following this when no adverse sensations are felt but, if left untreated, the burn begins to throb and we alter our behavior to guard the affected area. Other animals respond to painful damage in a similar way. Their responses comprise several behavioral and physiological changes: they eat less food, their normal behavior is disrupted, their social behavior is suppressed and they may adopt unusual behavior patterns (typically, highly repetitive or stereotyped behaviors, such as rocking to and fro), they may emit characteristic distress calls, and they experience respiratory and cardiovascular changes, as well as inflammation and release of stress hormones.

Emotional pain in animals:

Are animals capable of feeling emotional pain? Humans can certainly feel pain without physical damage – after the loss of a loved one, or the break-up of a relationship, for example. Some scientists suggest that only primates and humans can feel emotional pain, as they are the only animals that have a neocortex – the ‘thinking area’ of the cortex found only in mammals. However, research has provided evidence that monkeys, dogs, cats and birds can show signs of emotional pain and display behaviors associated with depression during painful experience, i.e. lack of motivation, lethargy, anorexia, and unresponsiveness to other animals. Thomas Nagel concluded that unless we can get inside the head of an animal and actually be it, we will never know exactly how that animal feels.

Pain tolerance and pain threshold:

Pain tolerance is the maximum level of pain that a person is able to tolerate. Pain tolerance is distinct from pain threshold (the point at which pain begins to be felt). Pain Threshold is the level at which a person first begins to experience pain from a stimulus, either artificial or biological. A person’s Pain Tolerance level, is the overall level of pain a person can tolerate before breaking down either physically or mentally. This is the logic used by some police officers to employ third degree torture of the accused to extract truth and confession, believing that extreme pain will overwhelm pain tolerance of the accused and force him to speak the truth. While human Pain Threshold is relatively low for most people (it doesn’t take much to feel pain – even a needle or pin prick will do), Pain Tolerance is another matter. The human body can withstand a lot of pain before breaking down, and for those who deal with constant levels of high pain on a regular basis every day, the tolerance level is very high, almost dangerously so. It is widely believed that regular exposure to painful stimuli will increase pain tolerance – i.e. increase the ability of the individual to handle pain by becoming more conditioned to it. However, this is not true – the greater exposure to pain will result in more painful future exposures. Repeated exposure bombards pain synapses with repetitive input, increasing their responsiveness to later stimuli, through a process similar to learning. Therefore, although the individual may learn cognitive methods of coping with pain, these methods may not be sufficient to cope with the boosted response to future painful stimuli. An intense barrage of painful stimuli potentiates the cells responsive to pain so that they respond more vigorously to minor stimulation in the future. Because of this, trauma victims (or patients in pain) are given painkillers (such as morphine) as soon as possible – to prevent pain sensitization. Kalat suggests that morphine should be taken before surgery as people who begin taking morphine before surgery need less of it afterward.

Swearing increases pain tolerance:

Swearing occurs in most cultures – people swear to let off steam, or to shock or insult others. It is also a common response to a painful experience. We’ve all done it: after stubbing our toe, or hitting our thumb with a hammer, we draw a sharp breath and mutter a swear word. Until now, though, whether swearing actually alters our perception of pain had not been investigated. But according to a new study, swearing increases pain tolerance, enabling us to withstand at least one form of pain for longer. The authors suggest that it is because swearing induces negative emotions. It is well known that pain has a strong emotional aspect to it. Fear of pain, for example, is known to enhance pain perception, possibly by activating pathways which descend from the brain and modulate noxious stimuli entering the spinal cord. Swearing, too, is known to induce negative emotions (according to Steven Pinker, it taps into the “deep and ancient parts of the emotional brain”). It may therefore trigger a physiological alarm reaction known as the fight or flight response, which accelerates the heart rate and reduces sensitivity to pain.

Laughter increases pain Tolerance:

We all know how good it feels to have a hearty laugh, and now a new study suggests that a guffaw can also reduce the feeling of pain. University of Oxford researchers found that a good laugh is linked with feeling less pain, and it’s likely because laughing spurs the body to release feel-good chemicals called endorphins, which can also act as painkillers. In a 2007 study in the journal Evidence-based Complementary and Alternative Medicine, University of California, Los Angeles researchers also showed that funny videos helped kids tolerate pain for longer, suggesting getting kids to “humorous distraction” could help distract kids when they’re undergoing painful procedures.

Why does Pain Tolerance differ among people?

Research has been done that claims the source is genetic, psychological, or even gender-based. The first, and most evidentially-supported, argument—the genetic explanation—revolves around the gene that codes for COMT, an enzyme that metabolizes, or breaks down, the neurotransmitter dopamine. COMT depletes the dopamine supply in the brain, freeing receptors in the brain to which the dopamine was bound so that they are available to bind to endorphins, which lead to pain relief. The researchers caution that pain tolerance cannot logically be explained by a single gene, an argument supported by the fact that COMT has other functions in the body; however, COMT must play a very large part in the differences seen in individuals. The psychological research done on this topic operates under the understanding that pain can be manifested in negative emotions, such as anxiety, depression and anger, to name a few. These researchers argue that these negative emotional responses to pain stimuli can be counterbalanced by positive emotional responses; in one very compelling study, the positive emotional responses were produced by sexual fantasies. The pleasant emotions produced by the thought of a sexual fantasy counteract the unpleasant thoughts that are a result of pain. The implications of this are that if a person enduring a painful experience imagines something that evokes in them positive emotions, they are able to cope with the pain better, and actually report experiencing less pain. Conversely, if a person experiences negative sensations from sources other than the painful experience in combination with the painful experience, the subject cannot endure as much pain and reports experiencing more pain than other subjects. Researchers have found that estrogen can act as a natural painkiller. Higher estrogen levels result in a higher pain tolerance, and lower estrogen levels cause effectively lower pain tolerance in subjects. Granted, the study was done only in women, but it is curious that hormones can affect how one deals with pain.

Pain in clinical medicine:

Pain as an aid to diagnosis:

Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining physician to accurately diagnose the problem. For example, chest pain described as extreme heaviness may indicate myocardial infarction, while chest pain described as tearing may indicate aortic dissection.

Under-treatment of pain:

Inadequate treatment of pain is widespread throughout surgical wards, intensive care units, accident and emergency departments, in general practice, in the management of all forms of chronic pain including cancer pain, and in end of life care. This neglect is extended to all ages, from neonates to the frail elderly. In September 2008, the World Health Organization (WHO) estimated that approximately 80 percent of the world population has either no or insufficient access to treatment for moderate to severe pain. Every year tens of millions of people around the world, including around four million cancer patients and 0.8 million HIV/AIDS patients at the end of their lives suffer from such pain without treatment. Yet the medications to treat pain are cheap, safe, effective, generally straightforward to administer, and international law obliges countries to make adequate pain medications available. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. Moreover, the biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Other reasons may have to do with inadequate training, personal biases or fear of prescription drug abuse. This failure to adequately treat pain may be due to physicians’ fear of being accused of over-prescribing, despite the relative rarity of prosecutions, or physicians’ poor understanding of the health risks attached to opioid prescription. Current strategies for improvement in pain management include framing it as an ethical issue; promoting pain management as a legal right; providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right; categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies.

Pain, tissue damage and disability:

Pain is the most common reason for patients to enter health‐care settings and the most common reason given for self‐medication. Pain interrupts all other activity and arrests current behaviour. It functions to prime escape or protective behaviour. As it is an everyday and frequent experience, there is also a common understanding of pain, both lay and professional, that it is a useful signal of damage. Indeed, in the majority of cases pain is a relatively reliable signal of damage and one that refers well to its spatial location. Also, the intensity of pain often refers well to the extent of damage. For example, extracting two teeth hurts about twice as much as extracting one tooth.There is, however, a number of cases where the extent of damage does not refer well to the experience of pain. For example, some people report pain that has no identifiable lesion, as in many cases of back pain, headache and angina. It is also possible to have tissue damage without any pain. For example, up to 40% of patients with established reversible myocardial ischemia do not report pain. More recently, it has been recognized that it is possible to experience pain in a location distal to the damage or to experience pain in a missing or extra limb or location. Even under laboratory conditions, where we can control the intensity of the pain‐inducing stimulus, there is a great deal of variability in patient response. We should be mindful of the fact that pain is not a reliable indicator of tissue damage and that tissue damage is not a reliable indicator of pain. There is also a number of cases where the extent of damage and the extent of pain together do not refer well to the experience of disability. Some patients appear not to be disabled by extensive damage and pain, whereas other patients respond with extensive disability to seemingly minor damage and pain. This variability can be witnessed in everyday practice. Anyone doctor who is in the business of invasive procedure as part of their routine work will understand that different people respond differently to the same procedure under the same circumstances, and that the same people respond to the same procedure differently at different times or under different circumstances. A brief and unscientific survey of colleagues or friends as to their choice of analgesia during dental procedures will quickly exemplify this variability.

It seems that several factors can affect how you experience and interpret pain:

1. Emotional and psychological state;

2. Memories of previous pain;

3. Upbringing;

4. Expectations of and attitudes towards pain;

5. Beliefs and values;

6. Age;

7. Sex; and

8. Social and cultural influences.

Understanding differential responding:

We can successfully conclude that people are different and respond differently to pain‐inducing stimuli and to attempts at pain management. If we can understand what predicts these differences, we may be able to improve treatment delivery and effectiveness.

Personality:

A number of studies have attempted to describe or uncover what may be thought of as a pain‐prone personality. It was thought that those who were less hardy or less robust to the hardships of the world would show less tolerance of pain stimuli and would be more complaining of pain. In addition, there was also the idea that the pain expressed by patients was a manifestation of guilt or of loss, or that pain revealed a self‐destructive, sadomasochistic style of sexual development. There is no evidence, however, to support these ideas. The experience of pain does not prevent personality disorders but neither is it thought to be a mask or alternative manifestation of them.

Gender (vide infra):

In an excellent recent review of this field, Anita Unruh reported that ‘In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men.’ Women are more likely to experience recurrent pain, have moderate and severe pain from menstruation & childbirth and may be at increased risk of disability arising from pain. Unruh also reported that, despite the fact that women report more pain than men, women are at greater risk of being labeled as having a psychogenic disorder and are more vulnerable to pain being explained as a purely psychological (used negatively in this case to mean unreal) phenomenon.

Age (vide infra):

Very little is known about the specific effects of age and ageing and about the psychology of pain for specific age groups. For example, effective pain management in children has been hampered by the erroneous beliefs that neonates and infants could not feel pain and that children would respond addictively to opioid analgesia. We now know these ideas to be without support. An important but unresearched area is the effects of emotional and cognitive development upon the experience of pain for children and adolescents. At the other end of the lifespan, we are also only now beginning to learn about the effects of cognitive impairment on pain experience.

Culture (vide infra):

Early studies of the effect of culture focused upon the reports of ethnic differences in pain expression. However, the study of culture extends further than the ethnic group membership of patients. For example, a recent interesting study showed that ethnic differences (in a US sample) did not affect the report of post‐operative pain or patient‐controlled analgesia for post‐operative pain, but did, however, affect physician prescribing behavior. More recently, the study of cultural influences has extended to the broader study of the cultural construction of pain and has started to embrace the use of anthropological and sociological methods.

In nonverbal patients:

When a person is non-verbal and cannot self report pain, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes. Patients experiencing pain may exhibit withdrawn social behavior and possibly experience a decreased appetite and decreased nutritional intake. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part and limited range of motion are also potential pain indicators. In patients who possess language but are incapable of expressing themselves effectively, such as those with dementia, an increase in confusion or display of aggressive behaviors or agitation may signal that discomfort exists, and further assessment is necessary. Infants feel pain but they lack the language needed to report it, so communicate distress by crying. A non-verbal pain assessment should be conducted involving the parents, who will notice changes in the infant not obvious to the health care provider. Pre-term babies are more sensitive to painful stimuli than full term babies.

Pains you shouldn’t ignore:

Worst headache of your life:

Get medical attention immediately. If you have a cold, it could be a sinus headache but you could have a brain hemorrhage or brain tumor. With any pain, unless you’re sure of what caused it, get it checked out.

Pain or discomfort in the chest, throat, jaw, shoulder, arm, or abdomen:

Chest pain could be pneumonia or a heart attack. But be aware that heart conditions typically appear as discomfort, not pain. Heart patients talk about pressure. They’ll clench their fist and put it over their chest or say it’s like an elephant sitting on their chest. It is heaviness in chest rather than pain but do not wait for pain to suspect heart attack.

Pain in lower back or between shoulder blades:

Most often it’s arthritis. Other possibilities include a heart attack or abdominal problems. One danger is aortic dissection, which can appear as either a nagging or sudden pain.

Severe abdominal pain:

Still have your appendix? Don’t flirt with the possibility of a rupture. Gallbladder and pancreas problems, stomach ulcers, and intestinal blockages are some other possible causes of abdominal pain that need attention.

Calf pain:

One of the lesser known dangers is deep vein thrombosis (DVT), a blood clot that can occur in the leg’s deep veins. It can be life-threatening. Cancer, obesity, immobility due to prolonged bed rest or long-distance travel, pregnancy, and advanced age are among the risk factors.

Burning feet or legs:

Nearly one-quarter of the 27 million Americans who have diabetes are undiagnosed, according to the American Diabetes Association. In some people who don’t know they have diabetes, peripheral neuropathy could be one of the first signs.

It is neither possible nor desirable to discuss different pain syndromes in this article, nevertheless it is worthwhile to discuss few words about headache. Headache disorders are the most prevalent of the neurological conditions and among the most frequent of medical complaints seen in general practice. They take many forms, including migraine, tension-type headache, trigemino-autonomic cephalalgia (cluster headache), primary stabbing headache, primary sex headache, or rarer conditions such as trigeminal neuralgia or persistent idiopathic facial pain. Half of the general population experience headache during any given year, and more than 90% report a lifetime history of head pain. The most severely disabled 3% experience a headache such as chronic migraine and chronic tension-type headache at least 15 days per month. Headache disorders contribute to a considerable loss of work time and productivity.

Pain reporting by aged:

With about 20% of adults suffering from chronic pain, it is a substantial proportion of elderly patients who have this problem. We know that sensitivity to pain may be reduced in older adults, yet that does not mean that these people experience less pain. In the elderly, it is important to know that age-associated psychosocial phenomena, such as loss of family and friends and loss of independence, may contribute to pain and suffering. An aging adult may not respond to pain in the way that a younger person would. Their ability to recognize pain may be blunted by illness or the use of multiple prescription drugs. In the elderly, it is important to know that age-associated psychosocial phenomena, such as loss of family and friends and loss of independence, may contribute to pain and suffering. It is important to know that other symptoms such as depression and anxiety, sleep disturbances, weight loss and cognitive impairment may be related to pain, and even be a manifestation of pain in older persons. Pain is not only a verbal report, but pain behaviors such as guarding, agitation, facial expression and altered mobility could represent pain, for example, in Alzheimer’s disease. Depression may also keep the older adult from reporting they are in pain. The older adult may also quit doing activities they love because it hurts too much. Decline in self-care activities (dressing, grooming, walking, etc.) may also be indicators that the older adult is experiencing pain. The older adult may refrain from reporting pain because they are afraid they will have to undergo surgery or will be put on a drug they become addicted to. They may not want others to see them as weak, or may feel there is something impolite or shameful in complaining about pain, or they may feel the pain is deserved punishment for past transgressions.

The management of pain in older persons represents a particular challenge. Pain in many elderly patients is under treated. We know little about the pain manifestations in dementia, but it is often under treated and a proactive approach in treating these patients is often necessary. Pharmacological treatment of pain is particularly important. Many elderly patients tolerate analgesics such as opioids, anti-inflammatory drugs and adjunctive agents like tricyclic antidepressants less well than younger people. The result is often sedation & confusion, and NSAIDs produce more side effects in elderly. It is therefore important to recognize that there are other treatments than pharmacology available for this group of patients. For example, multidisciplinary pain programs combining pharmacological and non-pharmacological treatment are efficacious in the management of longstanding pain in older persons.

When to call doctor for child with pain?

Parents should notify their pediatrician if any of the following occurs in a child:

1. The child is in severe pain.

2. The child has pain that lasts for more than three days.

3. Parents have questions or concerns about their child’s treatment or condition.

4. The child is in the hospital and the parent thinks he or she is in pain. The sooner the pain is treated, the easier it is to control.

Understanding the anatomical pathways and neurochemical mediators involved in noxious transmission and pain perception is the key to optimizing the management of acute and chronic pain. Although acute pain and associated responses can be unpleasant and often debilitating, they serve important adaptive purposes. They identify and localize noxious stimuli, initiate withdrawal responses that limit tissue injury, inhibit mobility thereby enhancing wound healing, and initiate motivational and affective responses that modify future behavior. Nevertheless, intense and prolonged pain transmission, as well as analgesic undermedication, can increase postsurgical/traumatic morbidity, delay recovery, and lead to development of chronic pain.

Commonly observed pathophysiologic changes include, but are not limited to, the following:

(1) Neurohumoral alterations termed peripheral sensitization occurring at the site and in regions immediately adjacent to injury,

(2) Alterations in synaptic function and nociceptive processing occurring within spinal cord and limbic cortex,

(3) Sympathoadrenal activation resulting in an elevation of heart rate & blood pressure and a diminution in regional blood flow, and

(4) Neuroendocrine responses mediating hyperglycemia and a negative nitrogen balance.

The body’s reaction to unrelieved pain includes:

1. Increased heart rate and blood pressure

2. Changes to blood gases, namely reduced oxygen and increased carbon dioxide

3. Higher levels of stress hormones including cortisol and adrenaline

4. Gastrointestinal problems such as slowed digestion

5. Musculoskeletal problems such as tension and fatigue

6. Emotional problems such as anxiety and depression.

Pain cycle:

Let’s look at an example of how pain works as a process within the body. If you think about pricking your finger, this is where you get the pain sensation and a message is sent back quickly from your finger up to your brain and the brain responds by sending a message quickly back to say the pain is there, move your finger or take the needle out of your finger. But if you have a strong constant pain, the message from the nerve endings keeps sending up messages to the brain and the cycle of pain begins.

What factors affect the pattern of nociceptive processing in the brain?

1. Anticipation:

In terms of responses to experimental pain it is now very clear that the psychological context of the stimulus in terms of anticipation and attention may be as important as the stimulus parameters.

2. Chronicity (acute versus chronic pain):

It has been assumed for many years that the medial and lateral systems might respectively be concerned with processing chronic and acute pain (Albe-Fessard et al. 1985). Functional imaging studies have provided unequivocal evidence that this is not the case. Both systems are involved in acute nociceptive processing and at least one type of chronic pain (neuropathic pain), and these are processed in parallel (Jones 1999).

3. Empathy:
Recent studies have addressed the issue of pain empathy in terms of empathy for a partner experiencing pain. An elegant experiment compared brain activations when a volunteer or her partner, who was seated next to an MRI scanner, experienced pain. The results showed activation of mid-cingulate and anterior insular cortices, brainstem, and cerebellum during pain empathizing (Singer et al. 2004). The cortical components of these responses are within the medial pain system, providing a further example of segmentation of function within the pain matrix.

4. Sex.

So far there is evidence for subtle differences in cortical processing of pain between age-matched men and women, with the most convincing differences being a shift of processing in women within the cingulate cortex toward the perigenual cingulate cortex. Interestingly, this is one of the areas of the cortex with the highest levels of opioid receptors (Vogt et al. 1995a). Higher opioid receptor binding in women has been found in the temporal cortex, amygdala, and thalamus, but not so far within the cingulate cortex (Zubieta et al. 1999).[further discussion vide infra in gender and pain]

5. Learning.

Aversive conditioning in animals has been defined within circuitry comprising the hippocampus, anterior and posterior cingulate cortices, amygdala, striatum, and medial and anterior thalamic nuclei (Gabriel 1990, 1993; Uylings et al. 1990; Maren et al. 1991; Vogt et al. 1993). The motor outputs for these responses are by way of premotor components of the cingulate cortex and the striatum. The amygdala, thalamus, and cingulate cortices are involved in the acquisition of conditioned responses, forming a template that is compared with new sensory inputs. If there is a match, the appropriate motor response is initiated by way of the cingulate and motor cortices and the primed striatum. If there is a mismatch, the hippocampus is activated to block any motor response. Damage to the amygdala has been associated with impairment of acquisition of conditioned autonomic responses and with impairment of affective memories without significant impairment of nonaffective cognitive functions (Cahill et al. 1995). Functional MRI studies have allowed preliminary access to some of the processes that may be taking place in humans during aversive conditioning. Temporal difference models that allow the modeling of prediction error during the acquisition of aversive conditioning have identified the ventral striatum, anterior insular, and anterior cingulate cortices as being important in these processes (Ploghaus et al. 2000; Seymour et al. 2004).

Why Cancer Pain?

For the more than 10 million people worldwide who are diagnosed with some form of cancer each year, pain associated with their condition is a serious concern. Although pain is not necessarily inevitable for everyone with cancer, it is common. Approximately one-third of adults who are actively receiving treatment for cancer and two-thirds of those with advanced malignant disease experience pain. Children with cancer have similar pain experiences. While increasing numbers of medical professionals and governments are beginning to place more attention on the pain suffered by long-term survivors of cancer, much more research is needed. The consequences of unrelieved cancer pain are devastating and can include functional impairment, immobility, social isolation, and emotional and spiritual distress. In some cases, cancer pain that is not managed can lead to the cessation of potentially curative therapies, ultimately having a negative impact on the patient’s survival. Cancer patients express greater fear of dying in pain (i.e., suffering) than dying. Family and friends also suffer as they witness the pain and anguish experienced by a loved one with cancer.

Painful sex:

Intercourse pain, or dyspareunia, can cause problems in a couple’s sexual relationship. In addition to the physically painful sex, there is also the possibility of negative emotional effects. For both men and women, pain can occur in the pelvic area during or soon after sexual intercourse. It can happen at any time during sex — for example, at the time of penetration, erection, or ejaculation — or after sexual activity. Eventually, ongoing pain may cause a person to lose interest in any sexual activity. In many cases, a woman can experience painful sex if there is not sufficient vaginal lubrication. When this occurs, the pain can be resolved if the female becomes more relaxed, if the amount of foreplay is increased, or if the couple uses a sexual lubricant. In some cases, a woman can experience painful intercourse if one of the following conditions is present:

1. Vaginismus. This is a common condition in which there is a spasm in the vaginal muscles, mainly caused by the fear of being hurt.

2. Vaginal infections. These conditions are common and include yeast infections.

3. Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration, so problems with the cervix (such as infections) can cause pain during deep penetration.

4. Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.

5. Endometriosis. A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.

6. Problems with the ovaries. Such problems might include cysts on the ovaries.

7. Pelvic inflammatory disease. The tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.

8. Ectopic pregnancy. A pregnancy in which a fertilized egg develops outside of the uterus.

9. Menopause. The vaginal lining can lose its normal moisture and become dry.

10. Intercourse too soon after surgery or childbirth.

11. Sexually transmitted diseases. These may include genital warts, herpes sores, or other STDs.

12. Injury to the vulva or vagina. These injuries may include a tear from childbirth or from a cut (episiotomy) in the perenium (area of skin between the vagina and the anus) that is made during labor.

13. A diaphragm that does not fit properly

14. Sexual abuse or rape

Causes of painful intercourse in men include:

1. Hemorrhoids

2. Herpes sores, genital warts, or other sexually transmitted infections (STIs)

3. Prostatitis — inflammation of the prostate

4. Reaction to the latex of a diaphragm or condom

Can you die from pain?

Yes, but hardly ever. In a patient with a heart or cerebrovascular condition, a severe pain could cause death by inducing a fatal stroke, infarction or arrhythmia. In some cases, the increase in the sympathetic outflow caused by the distress of the pain would stress the cardiovascular system to a point in which a fatal tachyarrhythmia is precipitated or an already damaged blood vessels could break in the brain causing death. Occasionally the vaso-vagal reflex could cause a lethal bradyarrhythmia.

Pain and emotions:

For more than 60 years, the experience of pain has been reported to be associated with various negative emotional states, including depression, anxiety, fear, and anger (Chapman et al., 1946; Hemphill et al., 1952; Ramzy & Wallerstein, 1958; Schachter, 1957; Webb & Lascelles, 1962). Studies have generally found that higher levels of negative emotions are associated with greater acute and chronic pain intensity (e.g., Bruehl et al., 2002; Janssen, 2002; Linton, 2000; Staud, 2004), and possibly with increased risk of developing chronic pain (Linton, 2005). Although these positive associations between pain and negative emotional states undoubtedly exist, underlying mechanisms remain only incompletely understood. From an evolutionary perspective, an association between emotions and pain responses might be expected, given that pain in times past was often the result of situations threatening survival of the organism (e.g., attack). Anger and fear would be the two emotions most likely to be elicited under such threatening circumstances, as they reflect motivational states underlying the fight and flight responses, respectively (Averill, 1983; Fendt & Fanselow, 1999; Sewards & Sewards, 2002). Consistent with the idea of anger as a primary emotional reaction to physical pain, human experimental studies confirm that acute physical discomfort triggers significantly increased anger and anger-related thoughts, even more so than fearful reactions (Berkowitz, 1990). In addition to pain triggering emotional reactions, acute emotional states can also affect pain, and in some cases are even associated with analgesia. For example, there is a significant animal literature indicating that acute fear reactions to threat are associated with subsequent reductions in pain sensitivity, in part via endogenous opioid mechanisms deriving from the periaqueductal gray (De Oca et al., 1998; Lichtman & Fanselow, 1990; Rau et al., 2005). Similarly, interconnections between neural systems underlying anger and pain might be expected, although the nature of these interactions may be complex. Literature is reviewed indicating that greater tendency to manage anger via direct verbal or physical expression (trait anger-out) is associated with increased acute and chronic pain responsiveness. Neuroimaging data are overviewed supporting overlapping neural circuits underlying regulation of both pain and anger, consisting of brain regions including the rostral anterior cingulate cortex, orbitofrontal cortex, anterior insula, amygdala, and periaqueductal gray. These circuits provide a potential neural basis for observed positive associations between anger-out and pain responsiveness. Endogenous opioids appear to modulate activity in this brain network. Results of a series of studies support the hypothesis that the hyperalgesic effects of elevated trait anger-out derive in part from deficient endogenous opioid activity, most likely resulting from altered activity or connectivity in these brain regions.

Empathy through Pain perception:

There are patients with congenital insensitivity to pain (CIP) which is a rare condition. They don’t feel pain; cognition and sensation is otherwise normal; for instance they can still feel discriminative touch (though not always temperature), and there is no detectable physical abnormality. They offer a unique opportunity to test the model of empathy. Does the lack of self-pain representation influence the perception of others’ pain? CIP patients globally underestimate the pain of others when emotional cues were lacking, and that their pain judgments, in contrast with those of control subjects, are strongly related to interindividual differences in empathy trait. In other words, if you cannot feel the pain yourself, you would not feel the pain of others provided all other biological variables are same.

Pain and psychology:

Pain itself, and the ensuing disruption in normal lifestyle, can lead to depression. When people feel helpless and hopeless their pain is more intense. In fact, the emotional effects of chronic pain-including depression, anger and anxiety-may do more damage to long-term health than the actual physical degree of discomfort, report researchers in recent issues of Cranio and The Clinical Journal of Pain. In studies of patients with chronic facial pain, researchers found that the psychological effects of being in pain were more disruptive to patients’ daily lives than the pain itself.

Both acute and chronic forms of pain are familiar, but in addition pain occurs in two other quite different situations. It may occur as a symptom in a depressive illness. In other words it is not, as is commonly thought in such situations, that depression has developed because pain is being experienced but, in fact, the pain is part of a primary depressive illness. Up to half of those who develop depressive illnesses experience physical symptoms unrelated to any obvious underlying pathology, and of those symptoms pain is the most common. The failure of doctors to appreciate this fact does occasionally lead to a prolonged search for a physical cause for pain because its presence overshadows other features of a depressive illness. Pain occurs in individuals experiencing anxiety, or emotional tension. For example, tension headaches are very common. The presence of anxiety in a pain sufferer tends both to increase the severity of pain experienced and to reduce the individual’s tolerance or ability to cope with it. Pain may occur in the absence of an obvious physical cause and where the features of a mental illness are not detectable. Individuals with this type of pain may have had a trivial injury but the level of pain and disability with which they present is out of all proportion to the severity of that injury. In addition, the behavior shown by the sufferer reveals considerable dependence upon others, loss of willingness to take responsibility for themselves, their home, and their work, and a preoccupation with a search for a ‘cure’ for the pain, which they regard firmly as physical in origin.

Specific psychological factors:

Although early theories focused on global factors, more recent areas of study have developed our understanding of specific psychological traits or specific states of experience that affect the report of pain and suffering.

1. Fear:

Pain functions to threaten danger and invoke an escape or ameliorative response. This threat component of pain is not an addition to the sensory component, nor does it follow from the sensory aspects. Instead, it is a primary and central component as it urges analgesic behavior. Fear and anxiety processes have been studied from a number of perspectives, although they cover essentially the same issue. The most relevant to clinical practice are reviewed here.

2. Attention and vigilance:

Threatening pain is a stimulus that orients attention to both the source of pain and the potential for escape or analgesia. Some people have increased or heightened attention to pain sensation. In particular, where the threat of pain is constant or recurrent, a pattern of vigilance to pain can develop. McCracken developed a measure of vigilance to pain with a sample of chronic low back pain patients and found that patients who report high levels of attention to pain also report higher pain intensity, increased use of health‐care resources and more emotional distress. Vigilance to pain was a significant predictor of disability, distress and use of health‐care resources. Hypervigilance or excessive attention to threat has also been offered as a possible explanation for the dominant anxiety and poor concentration observed in patients with diffuse idiopathic or fibromyalgia pain. One test of this hypothesis found that fibromyalgia patients reported a lower threshold and higher tolerance to an experimentally induced pain than did a sample of patients with rheumatoid arthritis, who, in turn, reported lower threshold and higher tolerance than a non‐pain control sample.

3. Catastrophizing and worry:

The consequences of repeated attention to threat may be the development of a fixed pattern of responding to threatening stimuli and pain. One particular response to threatening pain, which is proving to be predictive of the severity of complaint of pain, has been termed ‘catastrophic thinking’ or ‘catastrophizing’. Put simply, this is a habitual, almost immediate, appraisal of a situation as extremely and globally catastrophic. Sullivan and colleagues have developed a measure of catastrophic thinking about pain that assesses the extent to which we magnify the outcome and effects of pain, consider ourselves helpless to respond, and have little control over whether we think this way or not. They conducted two experiments, the first with pain‐free students, who they subjected to a cold‐pressor procedure, and the second with patients undergoing an aversive medical procedure. They found that catastrophizers reported significantly more negative pain‐related thoughts, more distress and higher pain intensity compared with non‐catastrophizers. Keefe and colleagues have used a different measure of pain control and catastrophizing in studying clinical populations. For example, they studied patients with rheumatoid arthritis who had undergone knee replacement surgery and found that those who rarely catastrophized had much lower levels of pain and disability than patients who catastrophized often. So now we have well-described phenomenon of pain catastrophizing, or the maladaptive responses to pain (tendency to focus on and magnify pain sensations with an intense sense of unbearable suffering and helplessness) that plays an extremely important role in how pain is perceived and processed. Pain catastrophizing now accounts for a substantial proportion of pain-related disability. Studies in patients with fibromyalgia show that pain catastrophizing is associated with increased activity in brain areas related to anticipation of pain (medial frontal cortex, cerebellum), attention to pain (dorsal ACC, dorsolateral prefrontal cortex), emotional aspects of pain (claustrum, closely connected to amygdala) and motor control. Thus, catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.

4. Avoidance:

One consequence of the urgency effect of pain, the fact that pain demands a change of behavior, is that patients with pain avoid pain‐inducing activity. A number of studies now show that the pain alone is insufficient to explain disability and avoidance. McCracken and colleagues, for example, demonstrated that the fear of pain made a unique and significant contribution to the prediction of disability. Taking this further, some authors have argued that the fear of pain is more disabling than pain itself. In a recent study of this idea, Crombez and colleagues replicated the finding that pain‐related fear is a better predictor of disability than pain, but also extended the findings to a behavioral performance test. They showed that, when instructed to engage in a behavioral performance task that involves musculoskeletal loading, chronic low back pain patients performed poorly on the task. Poor behavioral performance was predicted by elevated levels of fear of (re)injury due to movement and the fear of the effect that physical activity would have on the pain. Pain‐related fear is thought to mediate the effects of pain upon performance. A recent authoritative review of this emerging field argues that the avoidance of pain or injury‐inducing activity is a normal mechanism of survival. However, when pain becomes chronic, those with marked fear of pain chronically avoid activity that leads to disability. Counter‐intuitively, in many cases of chronic non‐malignant pain, it may be healthier to confront or engage in physical activity that, in the short term, produces pain and the fear of pain & (re)injury, but in the long term relieves pain and disability.

5. Depression (vide infra):

The experience of pain and the threat of pain can lead to negative or low affect. Chronic low affect, including persistent feelings of frustration and anger & negative or destructive self‐appraisal are common effects of persistent pain. Unsurprisingly, the majority of adult chronic pain patients who present for treatment at pain clinics are also depressed to some degree. However, this depression is not brought about directly by the pain severity but by the disabling consequences of how one reacts to the chronic pain. There are a number of facets of depression that are important in understanding the pain patient.

6. Anger:

Anger is not always associated with depression. However, it is included here as the angry pain patient is often poorly understood. Anger is a relatively common experience for pain patients and so, in turn, for the pain professional. Where there is no clear immediate object of anger (e.g. an aggressive other person or an immediate agent of injustice), it is often associated with global frustration and hostility, feelings of aggression and a feeling of being blamed. Anger in chronic pain patients is often unrecognized as a means by which patients attempt to claim self‐control or self‐esteem. Anger and hostility can have significant deleterious effects upon both health and treatment effectiveness.Treatment of the very angry patient requires a high degree of trust and honesty in an environment of cynicism and hostility. Aggression and overt anger often increase the probability of treatment ineffectiveness as either patient or therapist will withdraw from therapeutic contact, thereby fuelling anger. Treatments designed for the chronic pain patient should directly address in some form the effects of anger and frustration.

7. Self‐denigration:

A key component of depression is the extent to which individuals appraise their self‐worth and abilities negatively (e.g. ‘I’m useless and pathetic’, ‘I’ll never be able to control this pain’). Early research suggested that negative self‐appraisal may promote a self‐fulfilling prophecy in which patients learn to be helpless and hopeless. Research with rheumatological patients did not find any convincing evidence for this case. Rather, recent evidence indirectly suggests that what may be important about depression in chronic pain is the extent to which the pain refers critical judgment onto the self. Recent experimental studies demonstrate that patients have specific, not global, memory biases for pain information that refers negatively to the self. Although a focus on the specific self‐denigrating effects of depression and pain is only now being developed and data are certainly needed, it could have far‐reaching effects on current self‐management approaches to chronic pain. Simply instructing patients that the route to successful management of pain lies with them may be an invitation to fail. Indeed, many pain patients, when presented with the idea of self‐management, first understand this to mean a threat to their worthiness for treatment.

8. Coping:

The term ‘coping’ is often used to denote two similar events. First, it is understood to mean anything that one does in response to a stressful event, regardless of its efficacy in removing the stressor or in relieving the stress response. Secondly, it is understood to mean a positive effect of either removing the stressor or relieving the stress response. Here the first meaning is taken. Whenever we are faced with a stressful event such as pain, or the fear of pain, we respond. This response can have both positive and negative effects. The personality variables discussed above will have a strong effect on the response people make to pain and/or the fear of pain. However, the search for patterns of responding or types of responding has also included other ideas worth mentioning.

9. Action and control:

First, the idea that there are passive and/or active ways of responding is commonly held. Patients who are passive in response to threat show greater distress and disability than patients who attempt to solve problems. Similarly, those who believe that they have the personal ability to have control over pain also show improved function and fitness. One interesting investigation found that if women in active labor are given some control over parts of the delivery process, positive effects can be seen in terms of reduced pain, reduced tiredness and increased energy even if this control is only at the level of monitoring. Taking some control over the cause of pain or the method of analgesia has a beneficial effect. Those who respond actively to pain or the fear of pain are more likely to adjust effectively.

10. Information and predictability:

Related to whether one takes action or takes part in analgesic procedures is the effect of whether one seeks to predict the effects of pain or whether one prefers to be distracted. Many experimental studies of the possible effects of distraction from, or attention to, pain and analgesia have been conducted. The key finding is that both approaches can be effective. However, the most important finding suggests that only those strategies that fit with a person’s preferred or habitual method will be effective. For example, if someone is used to managing the pain of dentistry by thinking of anything else but dentistry, giving the patient detailed information about the procedure will simply undermine an effective strategy. Crombez and colleagues reported an interesting study of what information it might be useful to have for those who pay attention to the pain. They found that information about the sensation of the expected pain did not improve the reaction to the pain. However, knowing how long a pain will last did improve the reaction to the pain.

11. Making sense of the pain:

People are intrinsically motivated to make sense of experience. Except in extreme cases of depression or in specific circumstances of prolonged restriction or incarceration, people are motivated to reach an understanding of personal events. Until a pain is understood within a system of knowledge, it will interrupt current thinking and promote worry and concern. Knowing what has caused a pain and what it may mean and does not mean is critical for effective coping. Those patients who are most difficult to help are those who repeatedly present with problems that have no known etiology. Not knowing compounds distress and an uncertain diagnosis leads to an increased belief in illness.

Clinical implications of psychological factors in pain management:

Most clinicians ignore these factors and do not attempt to harness their effects. Worse still, there is a large industry dedicated to the eradication of these effects as they pollute otherwise neat designs for testing the effects of pharmacological agents upon an analgesic response. For it is these effects that make up the placebo element of all analgesics. One could suggest that in most acute pain situations, these factors take care of themselves and do not need attending to. However, psychological factors are central to the experience of pain, the delivery of effective analgesia and for the specific treatment of chronic pain and disability.

Pain and depression:

A strong association between chronic pain and depression has long been suggested. Not surprisingly, serotonin and norepinephrine, the neurotransmitters most associated with depression, play key roles in the modulation of pain. Pain and depression are closely related. Depression can cause pain — and pain can cause depression. Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain. In many people, depression causes unexplained physical symptoms such as back pain or headaches. Sometimes this kind of pain is the first or the only sign of depression. Pain and the problems it causes can wear you down over time, and may begin to affect your mood. Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues. Depression doesn’t just occur with pain resulting from an injury. It’s also common in people who have pain linked to a health condition such as diabetes or migraines.

Physical symptoms are common in depression, and, in fact, vague aches and pain are often the presenting symptoms of depression. These symptoms include chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes. A high percentage of patients with depression who seek treatment in a primary care setting report only physical symptoms, which can make depression very difficult to diagnose. Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine. Dysregulation of these transmitters is linked to both depression and pain. Antidepressants that inhibit the reuptake of both serotonin and norepinephrine may be used as first-line treatments in depressed patients who present with physical symptoms.

The prevalence of pain indepressed cohorts and depression in pain cohorts are higherthan when these conditions are individually examined. The presenceof pain negatively affects the recognition and treatment ofdepression. On average, 65% of patientswith depression experience one or more pain complaints, anddepression is present in 5% to 85% (depending on the study setting)of patients with pain conditions. Depression is most prevalentin pain, psychiatric, and specialty clinics v/s population-basedor primary care studies. When pain is moderate to severe, impairs function,and/or is refractory to treatment, it is associated with moredepressive symptoms and worse depression outcomes (e.g., lowerquality of life, decreased work function, and increased healthcare utilization). Similarly, depression in patients with painis associated with more pain complaints and greater impairment.Depression and pain share biological pathways and neurotransmitters,which has implications for the treatment of both concurrently.

The biochemical theory of depression posits that depression is the result of a neurochemical imbalance or a functional deficiency of key neurotransmitters, the monoamines: serotonin, norepinephrine, and dopamine. A common theory holds that depression and painful symptoms follow the same descending pathways of the central nervous system. Eight studies described the biological link between depression and pain. Although nociceptive fibers transmitting pain signals from the periphery of the body through the dorsal horn to the medulla, midbrain, hypothalamus, thalamus, limbic cortical areas (anterior cingulate and insular cortex), somatosensory cortex, and posterior parietal cortex have been carefully mapped, there is an increasing interest in the neuroanatomy of a descending system of pain modulation (vide supra). The increasing knowledge about this system allows scientists and physicians to better understand mechanisms of pain modulation via medications as well as psychological mechanisms such as expectation, attention and distraction, and negative and positive affect.

Pain transmission occurs via ascending (excitatory) and descending (inhibitory) pathways involving norepinephrine and serotonin, or 5-HT. Serotoninergic neurons originate in the brain stem raphe region and project throughout the central nervous system (CNS), including descending projections to the spinal cord, which result in suppression of sensory input. They also project to areas of the brain including the frontal cortex (mediating mood), hypothalamus (mediating appetite and sleep), and amygdala (mediating anxiety and fear response). A reduction of presynaptic serotonin release and a compensatory upregulation of 5-HT2, a postsynaptic serotonin neuron, have been found in depressed patients. Limited research has also suggested that pain may increase the turnover of serotonin.

Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself. The mysterious disorder known as fibromyalgia may illustrate these biological links between pain and depression. Its symptoms include widespread muscle pain and tenderness at certain pressure points, with no evidence of tissue damage. Brain scans of people with fibromyalgia show highly active pain centers, and the disorder is more closely associated with depression than most other medical conditions. Fibromyalgia could be caused by a brain malfunction that heightens sensitivity to both physical discomfort and mood changes.

The presence of pain negatively affects the recognitionand treatment of depression. Depression is often under recognizedand thus frequently undertreated. At least 75% of primary carepatients with depression present with physical complaints exclusively and seldom attribute their pain symptoms to depression orother psychiatric illness. These physical complaints may bedue to amplification of chronic physical disease and remainmedically unexplained after extensive workup. As a result, providersfrequently assess for physical causes of pain and treat medicallyinstead of exploring the pain symptoms in a broader, biopsychosocialcontext.Primary care providers should recognize that pain is a commonsymptom of depression, that depression and painful conditionsfrequently coexist, and that evaluation and treatment of bothare important.

To get symptoms of pain and depression under control, you may need separate treatment for each condition. However, some treatments may help with both.

1. Because of shared chemical messengers in the brain, antidepressant medications can relieve both pain and depression.

2. Psychological counseling (psychotherapy) can be effective in treating both conditions.

3. Stress-reduction techniques, meditation, staying active, journaling and other strategies also may help.

Treatment for co-occurring pain and depression may be most effective when it involves a combination of treatments.

The two major types of antidepressants, tricyclics and selective serotonin reuptake inhibitors (SSRIs), may have different roles in the treatment of pain. Amitriptyline, a tricyclic, is one of the antidepressants most often recommended as an analgesic, partly because its sedative qualities can be helpful for people in pain. SSRIs such as fluoxetine and sertraline may not be quite so effective as pain relievers, but their side effects are usually better tolerated, and they are less risky than tricyclic drugs. Some physicians prescribe an SSRI during the day and amitriptyline at bedtime for pain patients. Both drug classes act in brain pathways that regulate mood and the perception of pain. Tricyclics heighten the activity of the neurotransmitters norepinephrine and serotonin; SSRIs act more selectively on serotonin. Some researchers and clinicians believe that a newer antidepressant which acts strongly on both neurotransmitters, the so-called dual action drug venlafaxine , is superior to both tricyclics and SSRIs for treating pain. Physicians and psychiatrists are also considering the uncertain potential of the anticonvulsant drug gabapentin and drugs that block the activity of substance P, another neurotransmitter involved in the regulation of both pain and depression. Electroconvulsive therapy (ECT), a standard treatment for severe depression, may have independent analgesic effects.

A differing study:

Treat chronic pain and depression independently:

In a study appearing in the May 2005 issue of Arthritis & Rheumatism, the researchers used functional magnetic resonance imaging of the brain to determine that in patients with fibromyalgia, their level of depression has little influence on the intensity of pain they experience. “We have seen that if you give antidepressants to the average patient with fibromyalgia, they’ll come back a couple of months later and say, ‘My pain isn’t any better, but I don’t feel so sad about it,’ ” researcher said. ”Our research provides further evidence that these pathways are quite independent.” While other clinical research has supported the idea that pain and depression should be treated independently of each other, the researchers say this is the first time it has been shown using functional imaging brain scans. There is an incorrect impression among many doctors that if you treat a patient’s depression, it will make their pain better. Not so. If someone has pain and depression, you have to treat both. Approximately 30% to 54% of people with chronic pain also have a major depressive disorder.

Pain and cognition:

Research suggests that pain-related negative emotions and stress potentially impact cognitive functioning independent of the effects of pain intensity. The anterior cingulate cortex is likely an integral component of the neural system that mediates the impact of pain-related distress on cognitive functions, such as the allocation of attentional resources. A maladaptive physiologic stress response is another plausible cause of cognitive impairment in patients with chronic pain, but a direct role for dysregulation of the hypothalamic-pituitary-adrenocortical axis has not been systematically investigated. Pain catastrophyzing as discussed earlier is a type of cognitive error developed by people in pain. In other words they develop an unnecessarily negative view of their condition and its likely outcome. In such a state they tend to focus to an extent upon the negative features of their disorder.

Pain, society and culture:

It has been acknowledged that pain (like the brain itself) occupies a strange liminal position between biology and culture. We know that expression of personal response to pain (even when measured objectively under test conditions) is bewilderly varied, not only between individuals but also between cultures. It seems that our particular sensitivity to pain, is not simply a matter of genetics, physiology and circumstance, but also one of learned “hermeneutics” , the way we interpret our pain is all important for the mode of our suffering of it.

As a consequence of the need to encompass the physical, psychological, and social aspects of pain experience, clinicians and pain researchers have developed what is known as the biopsychosocial model of pain. It is based upon what we know about the generation and control of pain within the nervous system, and also its psychological aspects and the social factors that influence the thinking of individuals about pain and their behavior. This approach to pain has lead to the development of powerful psychological tools for pain management, which come under the broad heading of cognitive-behavioral theory and practice.

Cultural barriers can also keep a person from telling someone they are in pain. Religious beliefs may prevent the individual from seeking help. They may feel certain pain treatment is against their religion. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction and avoid pain treatment so as not to be prescribed addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing the pain should be borne in silence, while other cultures (e.g. Jewish) feel they should report pain right away and get immediate relief.

The nature or meaning of physical pain has been diversely understood by religious or secular traditions from antiquity to modern times. Physical pain is an important political topic in relation to various issues, including pain management policy, drug control, animal rights or animal welfare, torture, and pain compliance. In various contexts, the deliberate infliction of pain in the form of corporal punishment is used as retribution for an offence, or for the purpose of disciplining or reforming a wrongdoer, or to deter attitudes or behavior deemed unacceptable. In some cultures, extreme practices such as mortification of the flesh or painful rites of passage are highly regarded.

Pain is so unique from other sensations such as touch, smell and taste that pain is defined as an ‘emotion or experience’. Pain, just like your emotions, is influenced by your thoughts, culture, beliefs and attitude. In the 1950’s Henry Beecher, a military doctor in World War II, looked at the magnitude of injury and the morphine dose soldiers took to control pain. As expected, the greater the injury, the greater the morphine dose. And hence he concluded that there is no influence of your emotions and thinking on your pain. To apply these finding to civilians, he did the same study on civilians. And he found the same: the greater the injury, the greater the morphine. But there was one critical difference – for the same amount of tissue damage, the civilians took three times more morphine that the soldiers! How the heck is that possible? For a soldier, the injury meant he survived the war and he can recover and go back home. However, a civilian looked at the injuries from a completely different and negative perspective. For the civilian, the injury meant an awful situation which will dramatically change their life for the worse. Their emotions, attitudes and beliefs influenced how the brain perceived the threat level of the injury and modulated pain accordingly. It is now clear from brain imaging studies that that there is no single ‘pain centre in the brain’ as we used to believe. Many areas in the brain are actively involved in constructing and modulating this multisensory experience called pain (known as the Pain Neuromatrix). It is very appropriate to say that pain is an output constructed in the brain and not an input to the brain as we used to believe.

Consideration of socio-cultural and learning factors reveals that learning about pain takes place within a definite social context, and the way each of us behaves when in pain reflects that fact. At a national level it is customary in general for those who are from Northern European countries to regard complaints about pain, especially amongst men, as a weakness of character. In contrast, in Southern European countries to complain about pain is regarded as beneficial to the sufferer. These are very broad generalizations but do have some basis in fact. An important psychological mechanism by which we learn the behaviors we exhibit when in pain is defined as operant learning. It is a process by which overt behavioral responses to a stimulus are significantly influenced by their consequences, including the responses of others to them.

Operant learning & conditioning:

Operant learning is well illustrated by the effects of a simple injection upon a child. The sight of the needle and the pain experienced is an ‘unconditioned stimulus’ and as a response to it the child cries. On the next occasion the child cries at the sight of the syringe and needle, which has become ‘the conditioned stimulus’. If crying leads to the abandonment of the injection the child has developed a ‘conditioned escape response’. Seeing another child crying before an injection which is then not given leads to another type of learning — ‘an observational learning model’.
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In some individuals such mechanisms lead to the development of pain behaviors that have a negative effect upon their lives — for example, the excessive use of rest to relieve pain, or the abuse of powerful narcotic-related drugs may actually lead to increasing chronicity of pain and disability. To counter such developments, psychologists have developed techniques based upon operant conditioning, which are designed to reverse maladaptive pain behaviors and to replace them by adaptive behaviors. In other words, their techniques involve the use of learning of behavior designed to lead to coping with pain and everyday life rather than withdrawing from them. Put in simple terms, ‘good behavior is rewarded and bad behavior is punished’.
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Operant conditioning has been criticized on the grounds that it does not take sufficient account of mental activity. In other words, individuals have thoughts about pain and attitudes towards it. They draw on memories of past experience when in pain, and this leads to thinking and behavior, which is the result of those experiences. Such thoughts and attitudes, or cognitions, as they are called, cannot be ignored when a clinician is evaluating a person in pain and planning their treatment. For this reason, a purely behavioral approach has been replaced by a cognitive-behavioral approach to pain analysis and management. The main cognitive elements that have been identified include beliefs about pain and its causes, beliefs about the extent to which the individual feels he or she has control over pain, and the extent to which individuals believe that they are able to function despite pain. Therefore, self-efficiency is a significant factor in determining ability to cope

Pain Management:

The Cartesian model of thinking was proposed by the philosopher Descartes almost 450 years back. Descartes wrote, “The flame particle jumps from the fire, touches the toe, moves up the spinal cord until a little bell goes off in the brain and says, ‘ouch, it hurt’.” Now we believe that pain is perceived, processed and felt as pain by brain.

The figure above shows the old Cartesian model of pain and the new model which shows pain as a multisensory experience affected by both bottom-up and top-down inputs.

Bottom-Up Approach (Nociceptive Mechanisms):

This involves any treatments which lowers or inhibits the nociceptive signals (bottom) to the brain (hence called bottom-up approach). Most current pain therapies targeting the tissues and joints are based on this ‘bottom-up’ approach. A simple example would applying ice or heat to the damaged area. Another example would be lowering the body weight for if you have knee or low back pain. McKenzie’s method, Postural correction, Sahrmann’s movement impairment syndrome, Trigger Point therapy, ART, Functional Movement Screens and all come under this category. But the problem with this ‘bottom up’ approach is that the treatment is rationalized in a context which reinforces the belief that there is something wrong in their tissues and joints (and thereby raising the threat level) and may only bring temporary relief.

Top-Down Approach (Non-Nociceptive Mechanisms):

This is done by educating the person about the physiology of pain, the role of brain in pain, and ”how pain does not mean harm” (hence called top-down approach). If we explain pain based on our structural-pathology model, every time people feel pain they think they got hurt or re-injured themselves and naturally try to avoid pain-causing behaviors. This thinking process heightens the threat level in the brain leading to pain persistence (fear-avoidance belief model). The fear-avoidance model is now seen as a central mechanism of how acute pain turns into chronic pain. Pain education should make them understand that “pain does not mean harm”. Most of our current treatments based on the structural-pathology model may provide temporary pain relief, but pain explained based on our current model only helps to heighten fear of pain and anxiety in the patient. It has been shown in recent studies that teaching patients about modern pain biology can change beliefs and attitudes about pain and lower the pain sensitivity. Further, when education about pain physiology is included into physiotherapy treatment of patients with chronic pain, pain and disability are reduced.

It would be more scientifically correct to include both methods in pain management.

Pain management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team. Treatment approaches to long term pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy. Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Palliative care doctors are also specialists in pain management. As well as medical practitioners, the area of pain management may often benefit from the input of physiotherapists, chiropractors, clinical psychologists and occupational therapists, amongst others. Together the multidisciplinary team can help create a package of care suitable to the patient.

There is now growing recognition that poorly relieved acute pain increases the occurrence of cognitive dysfunction, immune suppression, and chronic postsurgical pain. Consequently, perioperative treatments may have long-term implications on patient outcome and quality of life. The figure below shows that earlier the pain is controlled, better it is.

Acute pain management variables:

Acute pain management is influenced by a number of patient variables that have been shown to affect the intensity, duration, and interpretation of pain, as well as the safety and efficacy of analgesic therapy. To develop an appropriate plan for acute pain management, factors such as patient age, race, sex, pharmacogenomics, and surgical or medical comorbidites must be considered. In general, traditional as-needed (PRN) dosing regimens have difficulty accounting for variabilities in analgesic response and interindividual differences in pain, perception, and coping skills. Patient variables also influence the safety and effectiveness of more modern and sophisticated forms of analgesic administration, such as patient-controlled analgesia (PCA), neuraxial opioids, and peripheral neural blockade. Age is among the most important patient variables influencing analgesic response. Advancing age can alter analgesic dose response in several ways. A decrease in hepatic enzymes, particularly cytochrome P450 (CYP450), microsomes and glucoronidases, as well as diminished hepatic blood flow, can reduce opioid and local anesthetic metabolism and delay drug elimination. With regard to opioids, age-related reductions in plasma albumin may increase the fraction of unbound or active drug, whereas diminished pain transmission and central nervous system (CNS) activity may significantly reduce perception and subsequent processing of pain. Because of these factors, a negative correlation between age and postoperative opioid consumption is commonly observed.

Pain management misconceptions:

The biggest misconception that I see in pain management is that some patients believe that medications are the primary way to alleviate their pain. In reality, patients need a comprehensive treatment plan, including cognitive, behavioral, pharmacological, surgical, and rehabilitative modalities, in order to successfully address their painful symptoms. Many patients are not aware of the multitude of treatment options available to help decrease their pain, and improve their overall quality of life. Another misconception is that the patient thinks that years of neglecting their body can be remedied in one or two visits. They will almost always say, “All I did was to bend over to pick up the . . . and my back went out.” Yet, another misconception I see regularly is that the pain can be “cured” or eliminated, just because people are entitled to have this relief. For the vast majority of chronic pain patients, this is unrealistic. Pain management is not like the ads on TV: “I had pain, I took a pill, my pain went away!” Our culture is so sold on the idea that you can assign blame for something and then demand (and receive) complete relief (in the legal as well as the medical sense) from what they see on TV that the realities of actual pain management are truly inconceivable to them.

Analgesia and anesthesia:

Analgesia refers to the reduction or relief of pain. This is what commonly happens for example when you take paracetamol (acetaminophen) for a headache or when patients are given morphine after an operation for pain. Analgesia implies pain relief – but does not imply that all sensation is taken away. In other words, analgesia does not mean numbness. Anesthesia refers to lack of sensation. This can be accomplished with local anesthetics, for example the injection that your dentist gives you when you have a tooth filled. Almost always this also results in a lack of pain – therefore analgesia usually accompanies anesthesia. Note that when local anesthetics are used to provide anesthesia they also frequently cause muscle weakness or muscle relaxation. As you can see, there is a clear difference between pure analgesia (pain relief, sensation and muscle ability normal) and anesthesia (lack of sensation, might be accompanied by muscle weakness or relaxation). The analgesic drugs work in the peripheral and central nervous systems of the human body. Examples of such drugs that are considered to be analgesic are paracetamol, anti-inflammatory drugs (salicylates or ibuprofen), morphine, Flupirtine, and others. Anesthesia, meanwhile, has only three major classifications and that is the local anesthesia, the regional anesthesia and the general anesthesia. Each group of anesthetics focuses mostly on removing the sensation and feeling from the one part of the body or perhaps the entire human body, depending on the extent of the surgery. Analgesia is taken only after the effects of anesthesia have worn of. Anesthesia should be properly administered by a licensed physician while analgesia can easily be taken orally. General anesthetics work by shutting down the forebrain regions whose activity regulates cycles of arousal and quiescence. There are several kinds of general anesthetics, but those most commonly used enhance or mimic the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).In contrast, a local anesthetic works by blocking the transmission of the pain message along a primary afferent nociceptor’s axon. The message thus never reaches the central nervous system.

Graded Exposure Approach or Activity:

In this approach, the person is gradually exposed to feared activities without causing pain and thereby lowering the threat level in the brain. These feared activities could be imagined movements, exercise, or daily functions. Many researchers believe that a large part of pain relief seen with exercise and other rehabilitation methods is from lowering the threat level in the brain using the graded approach. So when your patients talk about how they have less pain after lifting weights, it is because they were just gradually exposed in a graded manner to the threatening exercise.

Rest:

Resting can sound difficult, especially if you are being asked to rest when you are experiencing pain, or have plenty of tasks that you want to do, but learning relaxation techniques can relieve tension and ultimately constant pain messages to the brain. Fatigue will affect how you perceive pain and how you cope with it. Learning ways to relax completely can be a real trial for some people, others are gifted at it! You need to find the best way to help you relax. Some people find certain types of music help, others like absolute quiet. It is useful to try resting on a bed for a short time each day when the pain is bad; lying in a dark room, without any additional noises or distractions. A short sleep may even be worthwhile. Set an alarm to ensure that you only sleep for a certain period of time so that over time you don’t lose your normal night sleep patterns.

Exercise

The balance of rest, relaxation and exercise can improve pain control and maintain mobility. For most types of arthritis exercise is essential. This is because joints and muscles need to move regularly and muscles need to maintain their muscle strength and bulk. Some of the pain experienced in arthritis is related to the stiffness that can be experienced following periods of inactivity or early morning stiffness (EMS). The different types of exercise may vary according to the type of problems you have and the difficulties you are experiencing. If you are seeing a rheumatologist they will refer you to a physiotherapist to advise you on an exercise regime. However it is important to know whether you are doing ‘active exercise’ or ‘passive exercise’.

a) Active Exercise:

Active exercise is what most people do to keep fit and reduce weight. It involves things like going for a walk or gardening. They often require the body and the joints to bear weight and work against a force – such as lifting or digging in a garden.

b) Passive Exercise:

This is where the joints and muscles are worked but not against a specific weight or force. It involves moving the muscles and joints through a wide range of movements, this can be done while lying on the bed or sitting in a chair.

Many sedentary people believe that all exercisers have to experience pain if they are to become fitter: this belief is encouraged by the well known training motto: ‘No pain, no gain’. Sensible people interpret this as meaning that it takes effort, dedication, and commitment to improve fitness; it does not mean that exercise has to be a masochistic ordeal. On the contrary, if real pain is experienced, an exerciser should stop. Of course, an athlete who is training for top-class competition must be able to tolerate greater discomfort than a recreational athlete, but even an elite athlete must learn to distinguish between real pain and discomfort. Real pain acts as an important warning signal that something is wrong. If the signal is ignored, serious injury may result.

Weight Loss:

It is very difficult to lose weight, particularly when problems with mobility significantly reduce opportunities to undertake vigorous exercise regimes. However, it is worthwhile knowing that people with arthritis who are overweight have greater damage to the joints and increased difficulties with mobility and exercising. Losing weight can be a very effective way to reduce your pain. It may be worth seeking advice about a suitable diet that will help you lose weight yet ensure you maintain a healthy balanced diet.

The Use of Aids (walking sticks, joint protection, footwear):

For healthcare professionals, encouraging individuals to use various aids or assistive devices is often the hardest thing to achieve, yet it is one of the simplest ways of reducing fatigue, improving mobility, reducing pain and protecting joints. This is partly because most of us simply do not wish to consider the use of any form of aid, seeing it as recognition of a problem or as ‘giving in’. Yet the use of some equipment can be liberating, allowing more energy and time for other activities. Coming to terms with using any form of aid is often most effective when supported by help and advice from a member of the multidisciplinary team.

Walking Aids:

The way we use our body and our joints is taken for granted when everything works well. When a joint fails or is painful it is common for people to continue to walk, go up and down stairs etc but with pain and increasing difficulty. It is often achieved without the use of aids but usually is achieved at the cost of the other joints having to take the extra weight. This means that other joints will take the weight but not in a way that they are designed to. This means the weight will be distributed differently and add an extra load to healthier or less painful joints. An example of this is when you have a painful knee. To continue to walk you protect the painful joint by throwing your weight onto the ‘good’ knee. This results in your body changing the mechanics of how you position your back before movement, distributing the weight onto the ‘good’ knee joint. The good knee has to cope with the abnormal load by distributing the force through other joints. This can result in not only a painful knee but in addition a painful ankle or hip too. To minimize the risk of this, a walking stick could help by taking some of that additional load and maintaining a better body posture. When the knee settles and pain & function improves, you can then put the walking stick away.

Joint Protection:

Some types of arthritis or functional problems can be improved with the use of joint protection. It is quite common for people who have some types of arthritis (e.g. rheumatoid arthritis) to be assessed by an occupational therapist or rheumatology practitioner. The therapist or practitioner will assess the activities you undertake and see where stress on joints can be reduced to protect the joints and keep them in their normal alignment. The process of assessment will often include providing practical advice on how to avoid abnormal stresses or forces on the joints and can include additional pieces of equipment such as kettle tippers, reducing the need to lift a full kettle of water. When joints are more effectively protected pain can be reduced. The occupational therapist can provide information on the benefits of splinting and how to protect your joints.

Footwear:

Podiatrists are specialists trained in managing foot problems and other difficulties related to the foot and diseases that affect the feet. For many forms of arthritis early practical advice on footwear can be very effective. Our joints work as shock absorbers taking up the impact and reducing the force applied to the joints. When we are young there is a tissue called cartilage that lines all healthy joints and is nice and spongy and provides an effective cushioning for movement. As we grow older this cartilage becomes less flexible and in osteoarthritis may become worn away allowing two joints to move against each other without the cushioning effect of cartilage. One way of improving the ‘shock absorber’ or cushioning effects that used to be achieved by our young healthy joints is to ensure that shoes have good cushioning included in them. Trainers are a good example of cushioning support that a shoe can provide. However, there are a number of problems that might be experienced with different types of arthritis. A thorough foot assessment often proves very useful. The assessment will look at whether the arch support of your foot is maintained, and that you are bearing you weight down effectively onto your ankle and foot. Sometimes the use of an arch support can be very effective.

I have damaged meniscus in each knee and I found use of “knee support” and sports shoes excellent knee protector and pain reliever. My advice to any patient with mechanical/degenerative knee problem (osteoarthritis) is to maintain ideal body weight, not to sit on floor, not to climb stairs, wear knee support and a good pair of sports shoes; all of these will reduce pain substantially without any pain killer and prevent further damage to knees.

Analgesics:

An analgesic (also known as a painkiller) is any member of the group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- (“without”) and algos – (“pain”). Analgesic drugs act in various ways on the peripheral and central nervous systems; they include paracetamol (also known in the US as acetaminophen), the non-steroidal anti-inflammatory drugs (NSAIDs) such as the salicylates & ibuprofen, and opioid drugs such as morphine and opium. They are distinct from anesthetics, which reversibly eliminate sensation. Acute pain is usually managed with medications such as analgesics and anesthetics. Management of chronic pain, however, is much more difficult and may require the coordinated efforts of a pain management team, which typically includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, physician assistants, and nurse practitioners.

The types of drugs that you need to treat your pain depend on what type of pain you have. Everybody who has pain should consider taking painkillers but different painkillers work better for different types of pain. For pain associated with inflammation, such as acute back pain or headaches, paracetamol and anti-inflammatory medicines work best. If the pain is caused by sensitive or damaged nerves, as is the case with shingles or sciatica, it is usually treated with tablets that are also used for epilepsy and depression. These tablets change the way the central nervous system works.

Pain, inflammation and NSAIDs:

Cyclooxygenase (COX) is an enzyme that is responsible for formation of important biological mediators called prostanoids, including prostaglandins, prostacyclin and thromboxane. COX-1 is considered a constitutive enzyme, being found in most mammalian cells. COX-2, on the other hand, is undetectable in most normal tissues. It is an inducible enzyme, becoming abundant in activated macrophages and other cells at sites of inflammation. Let’s say you hit your finger with a hammer. The part of your finger that is damaged has nerve endings in it having nociceptors which get stimulated by mechanical force. The damaged tissue in your finger also releases some chemicals that make those nerve endings register the crushing shock even stronger — like turning up the volume on your stereo so you can hear it better. Some of these chemicals are prostaglandins, and working cells in the damaged tissues make these chemicals using an enzyme called cyclooxygenase 2 (COX-2). Because of the prostaglandins, the nerve endings that are involved now send a strong signal through nerves in your hand, then through your arm, up your neck and into your brain, where your mind decides this signal means, “pain”. The prostaglandins seem to contribute just a portion of the total signal that means pain, but this portion is an important one. In addition, prostaglandins not only help you to feel the pain of the damaged finger, but they also cause the finger to swell up (this is called inflammation) to bathe the tissues in fluid from your blood that will protect it and help it to heal. Remember this is a simplified version of the pain story; lots of chemicals seem to be involved in this process, not just prostaglandins. Pharmacological inhibition of COX can provide relief from the symptoms of inflammation and pain. Aspirin, ibuprofen and naproxen treat pain, swelling and fever by blocking enzyme COX-2 reducing prostaglandins produced in response to inflammation. These medicines are called the non-steroidal antiinflammatory drugs (NSAIDs) because they decrease swelling but they aren’t steroids, which are the most potent antiinflammatory chemicals we have. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, exert their effects through inhibition of COX. Older generation NSAIDs block both COX-1 and COX-2. The problem with the fact that NSAIDs go through your entire bloodstream is that your body needs prostaglandins for some reasons. One place they are useful is in the stomach; it turns out that COX-1 makes a prostaglandin that seems to keep your stomach lining nice and thick. NSAIDs also block COX-1 from working, and your stomach lining gets thin, allowing the digestive juice inside to irritate it. Selectivity for COX-2 is the main feature of celecoxib, rofecoxib, and other members of this drug class. Because COX-2 is usually specific to inflamed tissue, there is much less gastric irritation associated with COX-2 inhibitors, with a decreased risk of peptic ulceration. The selectivity of COX-2 does not seem to negate other side-effects of NSAIDs, most notably an increased risk of renal failure, and there is evidence that indicates an increase in the risk for heart attack, thrombosis, and stroke through an increase of thromboxane unbalanced by prostacyclin (which is reduced by COX-2 inhibition). Rofecoxib was withdrawn in 2004 because of such concerns. Some other COX-2 selective NSAIDs, such as celecoxib, and etoricoxib, are still on the market. Another family of medicines related to aspirin includes acetaminophen (paracetamol), which decreases fevers and pain, but it doesn’t affect either swelling or your stomach as much as the true NSAIDs do. Recent findings do suggest that it is highly selective for COX-2. While it has analgesic and antipyretic properties comparable to those of aspirin or other NSAIDs, its peripheral anti-inflammatory activity is usually limited by several factors, one of which is the high level of peroxides present in inflammatory lesions.

NSAIDs are considered more effective because of their better patient compliance due to the better dosing regimens and because they contain a higher effective dose. Also, parenteral administration of NSAIDs may allow them to be used for treatment of pain syndromes associated vomiting or because of the severity of the pain; e.g. renal and biliary colic. Also, various studies demonstrate that NSAIDs may be effective in the treatment of severe pain syndromes. NSAIDs are recently used to prevent post-operative pain by prophylactic administration before surgery decreasing inflammation via blocking prostaglandin synthesis and prevent sensitization of the peripheral terminals of nociceptive afferents.

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Two NSAIDs are not better than one:

Millions of people take NSAIDs every day for arthritis, acute injury, and menstrual cramps. According to research presented at the 2007 Annual Scientific Meeting of the American College of Gastroenterology, patients underreport their use of over-the-counter NSAIDs. Survey results have shown that patients who don’t report over-the-counter NSAID use believe the drugs are insignificant because they are available without a prescription. Taking two different NSAIDs is not good — it can increase the risk of undesirable side effects and serious adverse events. It has also been found to worsen health-related quality of life (the ability to perform usual daily activities). The increased risk associated with taking two NSAIDs is significant. A study published in the European Journal of Clinical Pharmacology concluded that the risk of severe drug reactions causing injury to the liver and acute renal failure was 6 to 7 times higher in reported cases of simultaneous use of two NSAIDs. Don’t let that happen to you. I know many doctors prescribing two strong NSAIDs for acute pain in the hope that patient will be relieved quickly but it is unscientific and dangerous practice. Taking two NSAIDs do not add up their analgesic potential but it will certainly add up their side effects. However, it is commonly found that when one NSAID fails, replacing it with another may work. This is because all the variables in NSAIDs pharmacokinetics and prostaglandin metabolism are not known to us. So if anybody says that by taking two NSAIDs, his pain is relieved, it would mean that one of the two NSAID is actually relieving pain and the other is only contributing to side effects.

NSAIDs and GI side effects:

The major adverse drug reaction (ADR) associated with NSAIDs relate to gastrointestinal (GI) effects. These effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death, limiting the use of NSAID therapy. An estimated 10-20% of NSAID patients experience dyspepsia, and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits. A US study puts the human impact of NSAID-related gastrointestinal deaths into perspective: the rate is higher than that found from cervical cancer, asthma or malignant melanoma. Through systemic and topical effects, NSAIDs impair the mucosal barrier to gastric acid, which, together with the action of pepsin, may result in upper GI symptoms, peptic ulcers and ulcer complications. Although COX-2 selective NSAIDs are associated with a lower risk of peptic ulceration compared with non-selective NSAIDs, patients with risk factors and those taking concomitant low-dose acetylsalicylic acid (ASA) therapy for cardioprotection remain at risk. NSAIDs cause ulcers in some people. Some of those who have ulcers also have symptoms, which include bleeding. In some of those who have bleeding ulcers, the bleeding is sufficiently severe to result in hospital admission, and may cause death. This is a fairly simplified version of events, and many of the papers in this field have as many as 10 different classifications of upper gastrointestinal complaints from which to classify an event. Clearly, the important issue is the overall incidence of severe adverse events, including hospital admission and death, however much we might like information about the risk of any particular event happening to any particular patient. The variables are drug and dose, duration of exposure, and patient characteristics. Most of the publications referenced in this focus have realm about the scale of the problem of NSAID-related GI problems. They make good reading, and would repay the effort if someone were to pull the information together. But for those with little time, a flavor is given in Table below:

NSAID-related deaths and admissions to hospital:

Event	UK	USA	Canada
Annual NSAID prescriptions	25 million	70 million	10 million
NSAID-related admissions	12,000	100,000	3,900
NSAID-related deaths	2,600	16,500	365

Both Helicobacter pylori and NSAIDs cause ulcers, so there may be some interactions. The evidence up to now has been unclear, perhaps because there are so many different things going on in epidemiological studies. A randomized trial indicates that perhaps eradicating the bug in people on NSAIDs may be a good thing. The evidence we have is that using paracetamol as a first-line agent is sensible. It is an effective and safe analgesic at therapeutic doses. It is worth remembering that NSAIDs given by topical routes are not associated with any of the gastrointestinal adverse effects seen with the oral route. Meta-analysis has also shown them to be effective, with NNTs of about 3 in chronic conditions. Thereafter the rule would seem to be to use ibuprofen for preference, at the lowest effective dose, and with mucosoprotective agents for those at highest risk of developing severe adverse gastrointestinal effects. Of course, combining NSAIDs with proton pump inhibitors (omeprazole group) would reduce GI side effects and many studies have proved it.

Effect of pain and NSAIDs on blood pressure:

Acute pain increases blood pressure by increasing sympathetic activity, but the role of chronic pain on blood pressure is less well understood. Hypertension and co-existing musculoskeletal problems are two of the common conditions for which antihypertensives and analgesics are prescribed together. Among analgesics, NSAIDs are most frequently prescribed. NSAIDs decrease the synthesis of prostaglandins (PG) by inhibiting cyclo-oxygenase, an enzyme essential for transformation of arachidonic acid into PGs. The PGs are important in control of blood pressure by virtue of their effects on the kidney and blood vessels. Two meta-analyses have demonstrated that, after pooling data drawn from published reports of randomized trials of younger adults, NSAID use produces a clinically significant increment in mean blood pressure of 5 mm Hg, most marked in patients with controlled hypertension. Stratification by NSAID type revealed that piroxicam, naproxen and indomethacin had the greatest, and sulindac the smallest, pressure effect. The NSAIDs antagonize the antihypertensive effect of diuretics, beta-blockers and ACE inhibitors more than that of calcium-channel blockers. The elderly and those with salt-sensitive hypertension experience greater rise in blood pressure with NSAIDs. Physicians should avoid NSAIDs and instead use alternative analgesics such as paracetamol and physical therapy for control of pain. If necessary, the dose of the antihypertensive medications may have to be increased for better control of blood pressure. Since both pain and hypertension are common, it is important that their relationship be well understood by the primary care physicians.

Analgesic nephropathy:

Analgesic nephropathy involves damage to one or both kidneys caused by overexposure to mixtures of medications, especially over-the-counter pain remedies (analgesics). Analgesic nephropathy involves damage within the internal structures of the kidney. The specific kidney injuries induced by analgesics are renal papillary necrosis and chronic interstitial nephritis. They appear to result from decreased blood flow to the kidney, rapid consumption of antioxidants, and subsequent oxidative damage to the kidney. This kidney damage may lead to progressive chronic renal failure, abnormal urinalysis results, high blood pressure, and anemia. A small proportion of individuals with analgesic nephropathy may develop end-stage kidney disease. It is caused by long-term use of analgesics, especially over-the-counter (OTC) medications that contain phenacetin or acetaminophen and NSAIDs such as aspirin or ibuprofen. About 6 or more pills per day for 3 years increases the risk for this problem. This frequently occurs as a result of self-medicating, often for some type of chronic pain. Analgesic nephropathy occurs in about 4 out of 100,000 people, mostly women over 30. The rate has decreased significantly since phenacetin is no longer widely available in OTC preparations.

Hearing loss and analgesic use:

Regular analgesic use was independently associated with an increased risk of hearing loss. The increased risk of hearing loss seen with regular analgesic use was greatest among younger men, particularly those below age 60 years. In men aged 60 years and above, there was no relation observed between the risk of hearing loss and regular aspirin use, and the relation between regular use of NSAIDs and acetaminophen (paracetamol) was attenuated. The risk of hearing loss increased with longer duration of analgesic use for both NSAIDs and acetaminophen. The ototoxic effects of high-dose salicylates, reversible hearing loss and tinnitus, are well documented. In animal models, salicylate administration results in abnormal outer hair cell function and decreased cochlear blood flow. Salicylates induce biochemical and electrophysiological changes that alter membrane conductance of outer hair cells and vasoconstriction in auditory microvasculature, possibly mediated by antiprostaglandin activity. Similar to salicylates, other NSAIDs inhibit cyclooxygenase and decrease prostaglandin activity, potentially reducing cochlear blood flow.

Asthma and analgesics:

The development of wheezing, sometimes accompanied by rhinorrhoea and urticaria, in some asthmatic patients shortly after taking aspirin has been recognized for at least 50 years. Aspirin, indomethacin, fenamates, and phenylbutazone have different chemical structures but in one study, all of them inhibited biosynthesis of prostaglandins and all of them also precipitated the asthma attacks in aspirin-sensitive patients. Recent data have suggested that frequent use of paracetamol (acetaminophen) may contribute to a deterioration of respiratory function in asthma. A small proportion of patients with asthma who are NSAID-intolerant experience short-lived deterioration in respiratory function with the use of high doses of paracetamol but this is uncommon and has not been implicated in life-threatening reactions. Routine warnings about paracetamol use in asthma are, therefore, not warranted. Medical personnel, however, should be aware of the potential for worsening of symptoms in some individuals with asthma using paracetamol and institute formal investigation or withdrawal of the drug if they suspect such a reaction.

Common painkillers can raise heart risk:

Taking daily doses of over-the-counter painkillers can increase the risk of heart attacks and stroke by up to 40 per cent, researchers have warned. Patients who regularly use diclofenac, a common anti-inflammatory drug, were shown to have a two-fifths higher chance of suffering heart problems. Ibuprofen, one of the most common painkillers, was linked to an 18 per cent higher risk of heart attack and stroke. The figures were published in a new paper compiling evidence from 51 international studies into the impact of a range of NSAIDs on more than 2.7 million patients.

Opioids:

‘Narcotic’ is a somewhat imprecise term because it suggests “narcosis”, which is indicated of a somnolent state or “sleepy” state. “Opioid analgesic” therefore is a more appropriate term emphasizing the clinically important analgesic property which is the pharmacological property of importance in the therapeutic application of these agents. Opioids are defined as all natural/semisynthetic opium alkaloid derivatives, synthetic agents, and other agents whose opioid-like effects are blocked by classical opioid antagonists, such as naloxone or naltrexone. Opium is derived from plant opium poppy (Papaver somniferum). Opium is obtained following drying the milky juice from unripe seed pod. Opium has a characteristic odor and bitter-taste with its chief active ingredient being morphine. Also present are codeine, thebaine (a non-analgesic agent), noscapine and papaverine, a non-analgesic vasodilator. Even though the words opioid and opiate are used interchangeably, opiates strictly means natural opioid substances derived from opium plant.

Endogenous Opioid Peptides:

The rationale for endogenous opioid peptides came from the idea that opioid receptors are present in the body for the purpose of interacting with endogenous or naturally occurring substances. As a consequence, research proceeded to attempt identification of these naturally occurring substances now known as beta-endorphins and related peptides. Morphine (and related agents) causes analgesia by acting on opioid receptors in nervous system. Various opioid receptor subtypes are depicted in the table below.

Drug	Mu (m)	Delta (d)	Kappa (k)
Opioid Peptides
Enkephalins	Antagonist	Agonist
beta-endorphin	Agonist	Agonist
Dynorphin	Weak Agonist		Agonist
Agonists
Codeine	Weak Agonist	Weak Agonist
etorphine	Agonist	Agonist	Agonist
fentanyl	Agonist
meperidine	Agonist
methadone	Agonist
Morphine	Agonist	Weak Agonist
Agonist-antagonists
Buprenorphine	Partial Agonist
dezocine	Partial Agonist	Agonist
nalbuphine	Antagonist		Agonist
pentazocine	Antagonist or Partial Agonist		Agonist
Antagonist: naloxone	Antagonist	Antagonist	Antagonist

The site of opioid action is at spinal cord. It reduces neurotransmitter release; by closing a voltage-gated Ca2+ channel on presynaptic neuronal terminals and inhibit postsynaptic neurons (hyperpolarization) by increasing K+ channel conductance. Reduced transmitter released– affects acetylcholine, norepinephrine, glutamate, serotonin, substance P.

The most dangerous side effect of opioids is respiratory depression. Minor degrees of respiratory depression may be detected following standard doses of opioids, but this is not clinically important. With higher doses or in frail patients, the respiratory rate decreases (less than 12 per minute), the patient becomes increasingly sedated, and the pupils very small.

Tramadol:

Tramadol is commonly referred to as an atypical centrally acting analgesic because of its combined effects as an opioid agonist and a serotonin and noradrenaline reuptake inhibitor (Lotsch, 2005). Although an effective analgesic, it may not provide adequate pain relief if used as the sole agent for the management of moderate to severe acute pain in the currently recommended doses (Thevenin et al, 2008 Level II). Tramadol is an effective treatment of neuropathic pain with an NNT of 3.8 (Hollingshead et al, 2006 Level I).

The figure above shows role of NSAIDS and opioids in inflammatory pain.

NSAIDs and opioids both alter the pain pathway in different ways, so combining the two classes of drugs to enhance analgesia makes sense. Also, opioids and tricyclic antidepressants combination would enhance opiate analgesia by potentiating biogenic amine links in the endorphin circuit. Also, NSAID plus tricyclic antidepressant can be used for refractory pain with inflammatory component.

Pain killer comparison charts:

OVER – THE – COUNTER (OTC) Pain Medicine:

generic name (not capitalized)	Dose (per pill)	PAIN RELIEF SCORE	Uses According to Label	Best Uses (according to Consumer’s Guide)	Problems Caused
aspirin (acetylsalicylic acid) NSAID	81 mg 325 mg	1	Minor aches, pains cold, headache, muscular ache	minor aches and pains	aspirin allergy, asthma, stomach bleeding, Reye’s Syndrome
acetaminophen (N-(4-hydroxyphenyl) acetamide) also known as paracetamol	500 mg	2	Headache	fever, if allergic to aspirin, arthritis, rheumatism, musculo-skeletal	June 2009, again 7-04-06- paracetamol Liver Damage “paracetamol is the No. 1 cause of acute liver failure in the U.S.” “[Acetaminophen] is a leading cause of death from pharmaceuticals,”
Combination of aspirin (NSAID), and acetaminophen	325 mg 500 mg	2.25	Headache Muscle ache	headache	same as above not for children and teens
ibuprofen (2-(4-Isobutyl-phenyl)- propionic acid) (analgesic, antipyretic) NSAID	200 mg	2.5	Aches, pains, colds, toothache, muscle aches, backache, menstrual, fever	fever, muscle ache	aspirin allergy, asthma, upset stomach, not for last trimester
naproxen sodium (anti-inflammatory) NSAID	220 mg	3	Joint and muscle pain	arthritis, rheumatism, musculo-skeletal	Naproxen heart risk upset stomach, not for nursing mothers
ibuprofen (analgesic, antipyretic) NSAID	800 mg	3.5	(listed above)	(as above)	(as above)
ketoprofen (anti-inflammatory) NSAID	12.5 mg	3.6?	Anti-inflammatory, analgesic	arthritis	Ketoprofen side effects

Note:

More Warnings on OTC Drugs:

NSAIDs increase blood pressure

Aspirin and NSAIDS cause stomach bleeding resulting in death.

NSAIDS Linked to Erectile Dysfunction.

Prescription pain killers:

generic name	Dose (per pill)	PAIN RELIEF SCORE	Uses According to Label	Problems Caused
celecoxib (COX-2 inhibitor) NSAID	100 mg 200 mg	3.7	Osteoarthritis, rheumatoid arthritis, short term pain, painful menstruation	increased heart risk, stomach bleeding, stroke
tramadol	50 mg	3.8	Moderate pain	nausea, constipation, dizziness, headache, drowsiness, vomiting
tramadol	50 mg	3.8
meperidine HCl	50 mg 100 mg	4	The opiates and synthetic opiates (from 4 down to 10) are the most effective pain killers, but they are subject to the most abuse, and prescription pain killer addiction. All the opiates and derivatives are habit-forming.The inclusion of high amounts of acetaminophen with all these medications is to increase opioid analgesia but one has to watch for liver side effects of acetaminophen (paracetamol).
hydrocodone and acetaminophen	5-500 mg	5
hydrocodone and acetaminophen	5-600 mg	5
hydrocodone and acetaminophen	7.5-650 mg	5.5
hydrocodone and acetaminophen	7.5-750 mg	6
hydrocodone-APAP, and acetaminophen	5-325 mg 7.5-325 mg 10-325 mg	6.5
hydrocodone and acetaminophen	10-500 mg	7
hydrocodone and acetaminophen	10-660 mg	7
oxycodone HCl with acetaminophen	2.5-325 mg 5- 325 mg 7.5-325 mg 7.5-500 mg 10-325 mg 10-650 mg	7	Oxycodone is very effective.
oxycodone HCl, oxycodone terephthalate, and aspirin	4.50 mg 0.38 mg 325 mg	7
oxycodone HCl	40 mg	8.5
morphine sulfate	15 mg 30 mg 60 mg 100 mg	9	Morphine may be one of the strongest pain relief medicines available.
fentanyl	Skin patch Lollipop	10	Fentanyl is very effective for gunshot wounds, and fragmentation wounds. However, there have been serious problems with fentanyl dosing (overdosing). Death has resulted from simply handling the medication with the fingers. One must use great care when handling fentanyl.
hydromorphone hydrochloride AKA dihydromorphinone	1 mg 2 mg 3 mg 4 mg	11	It is more effective than morphine, and that it has fewer side effects, although just as serious.
oxymorphone extended release	5 mg 10 mg 5 mg 7.5 mg 10 mg 15 mg 20 mg 30 mg 40 mg	?	3 hours (also, injection and suppository)5 – 8 hours

DISCLAIMER:

The above mentioned OTC and prescription pain killers are discussed for the purpose of education and awareness. No advice is intended. Consult your doctor for personal pain reliever advice. Although I have tried to be as accurate as possible, errors and misstatements are possible.

Creams/ patches:

These can be applied to painful joints, sprains and strains, particularly useful for smaller joints, e.g. knuckles. It is important to know that when creams are applied too frequently or liberally they can be absorbed by the body and have effects throughout. Some of the anti-inflammatory creams can be bought over the counter at the chemist. They have been shown to be effective for pain relief in the short term (up to two weeks). There are also creams that reduce pain sensors on the skin and at the fine nerve endings which recognize the pain and reduce the pain message that the brain receives from the painful area. These creams can sometimes take several weeks before the pain relief is felt and when first used can cause an initial burning sensation. Some people find this counter irritant effect quite soothing and the burning sensation itself does reduce when you get used to the cream. Examples include Ketoprofen (an anti-inflammatory cream) and Capsaicin cream (reduces pain sensors). Capsaicin is the active ingredient in chili peppers that makes them hot. Capsaicin is used in medicated creams and lotions to relieve muscle or joint pain. Capsaicin used on the body causes a sensation of heat that activates certain nerve cells. With regular use of capsaicin, this heating effect reduces the amount of substance P, a chemical that acts as a pain messenger in the body. Capsaicin topical is used for temporary relief of muscle or joint pain caused by strains, sprains, arthritis, bruising, or backaches. Topical gels and creams are often combined with NSAIDs and narcotic analgesics for severe pain due to sprains, strains, joint pains, and for other types of arthritis. A higher concentration Capsaicin topical is used to treat nerve pain (neuralgia) in people who have had herpes zoster, or “shingles.”

Fentanyl skin patches are very strong narcotic painkillers that may cause death from overdose.

Adjuvant analgesics & potentiators:

Adjuvant analgesics (co-analgesics) are primarily used for treating some other condition, but they also relieve pain. These compounds are useful in treating neuropathic pain (chronic pain that comes from injury to the central nervous system). They include the following:

1. Anti-epileptic drugs reduce membrane excitability and action potential conduction in neurons of the central nervous system.

2. Tricyclic antidepressants affect synaptic transmission of serotonin and norepinephrine neurons in the central nervous system, thereby affecting pain-modulating pathways.

3. Anesthetics block action potential transmission by interfering with sodium and potassium channels in nerve cell membranes. Examples include lidocaine, novocaine and benzocaine.

Drugs which have been introduced for uses other than analgesics are also used in pain management. Both first-generation (such as amitriptyline) and newer anti-depressants (such as duloxetine) are used alongside NSAIDs and opioids for pain involving nerve damage and similar problems. Antidepressants like imipramine and doxepin reduce depression and therefore pain associated with depression; also produce analgesia by acting directly upon pain modulation systems. Tricyclic Antidepressants are the most useful group of psychotropic drugs used for pain management by blocking serotonin and norepinephrine (NE) reuptake, increasing the levels of 5-HT and NE, which are part of the endorphin-mediated analgesia system (EMAS). Tricyclics can also produce analgesia directly or by enhancing the action of opiates. Other agents directly potentiate the effects of analgesics, such as using hydroxyzine, promethazine, carisoprodol or tripelennamine to increase the pain-killing ability of a given dose of opioid analgesic. Adjuvant analgesics, also called atypical analgesics, include nefopam, orphenadrine, pregabalin, gabapentin, cyclobenzaprine, scopolamine, and other drugs possessing anticonvulsant, anticholinergic and/or antispasmodic properties, as well as many other drugs with CNS actions. These drugs are used along with analgesics to modulate and/or modify the action of opioids when used against pain, especially of neuropathic origin. Dextromethorphan has been noted to slow the development of tolerance to opioids and exert additional analgesia by acting upon the NMDA receptors; some analgesics such as methadone and ketobemidone and perhaps piritramide have intrinsic NMDA action. Phenothaizines are usually used as adjuncts to narcotic analgesics.

Anticonvulsants relieves pain by

1. Blocks Na Channels: Examples include Carbamazepine, Oxcarbazepine, Phenytoin, Valproic Acid and Lamotrigine

2. Blocks Ca Channels: Examples include Gabapentin and Pregabalin

3. Inhibits glutamine release + others e.g.Topiramate

Pregabalin is a substituted analogue of gabapentin that binds to a 2-d protein subunit of voltage gated calcium channels and reduces glutamate, substance P, NE.

Epidural and neuraxial analgesia:

The use of epidural analgesia has shifted from a purely obstetrical practice to managing pain in patients undergoing multiple types of surgery, including thoracic, gastrointestinal, urologic, gynecologic, orthopedic, and vascular procedures. Epidural analgesia is the second most common form of pain management used in the United States after systemic opioids. More importantly, epidural analgesia has been shown to provide superior postoperative analgesia both at rest and with activity compared with systemic opioid administration. Epidural infusion provides more consistent pain relief resulting in a lower overall consumption of opioid and decreased related side effects. Patients mobilize faster, are less sedated, and have improved respiratory functions compared to those receiving systemic analgesia only. Neuraxial analgesia defines the administration of opioids alone, or in combination, with local anesthetics and, occasionally, clonidine into the spinal or epidural space. This form of analgesic delivery provides powerful and highly efficient anesthetic augmentation and pain relief in a variety of clinical settings. Following epidural and spinal injection, a small fraction of opioid molecules leaves the cerebrospinal fluid (CSF) and binds to receptors in dorsal horn. Activation of these receptors effectively suppresses afferent noxious transmission at the first synapse with cells in the CNS. Epidural and intrathecally administered opioids provide greater analgesic potency than similar doses administered parenterally.

Patient-controlled analgesia:

Patient-controlled analgesia (PCA) describes the conceptual framework for on-demand, intermittent administration of opioid and nonopioid analgesics under patient control. The broader concept of PCA should neither be restricted to a single route or mode of administration, nor should PCA imply a mandatory need for a sophisticated or expensive infusion device.

Multimodal analgesia:

The combination of multiple modalities of analgesic therapies otherwise called balanced analgesia or multimodal analgesia, has been proposed as the rational approach to pain management and many consider this concept as the most effective way in managing acute postoperative pain; this practice has evolved rapidly. The rationale behind this concept has been that analgesic drugs, acting through different mechanisms, result in additive or synergistic analgesia.

WHO pain ladder for cancer relief:

The cornerstone of the WHO document rests on five simple recommendations for the correct use of analgesics to make the prescribed treatments effective. This advice is applicable today, not only for cancer patients with pain, but also for all patients with either acute or chronic pain who require analgesics. The five points for the correct use of analgesics are as follows:

1. Oral administration of analgesics. The oral form of medication should be privileged whenever possible.

2. Analgesics should be given at regular intervals. To relieve pain adequately, it is necessary to respect the duration of the medication’s efficacy and to prescribe the dosage to be taken at definite intervals in accordance with the patient’s level of pain. The dosage of medication should be adjusted until the patient is comfortable.

3. Analgesics should be prescribed according to pain intensity as evaluated by a scale of intensity of pain. This point is important because pain-relief medications should be prescribed after clinical examination and adequate assessment of the pain. The prescription must be given according to the level of the patient’s pain and not according to the medical staff’s perception of the pain. If the patient says that he has pain, it is important to believe him. This point makes reference to the levels of the analgesic ladder that will be explained in detail further below.

4. Dosing of pain medication should be adapted to the individual. There is no standardized dosage in the treatment of pain. Every patient will respond differently. The correct dosage is one that will allow adequate relief of pain. The posology should be adapted to achieve the best balance between the analgesic effect and the side effects.

5. Analgesics should be prescribed with a constant concern for detail. The regularity of analgesic administration is crucial for the adequate treatment of pain. Once the distribution of medication over a day is established, it is ideal to provide a written personal program to the patient. In this way the patient, his family, and medical staff will all have the necessary information about when and how to administer the medications.

Three different types of painkillers are set out in an ’analgesic ladder’.

1. Mild pain – Mild painkillers e.g. paracetamol or anti-inflammatory drugs e.g. ibuprofen, diclofenac sodium or celecoxib.

2. Moderate pain – Weak opioid painkillers e.g. dihydrocodeine, codeine phosphate or tramadol.

3. Severe pain – Strong opioid painkillers e.g. morphine, oxycodone, fentanyl or diamorphine.

The idea behind the analgesic ladder is that if a person’s pain is not controlled by the painkillers on one level, their doctor should prescribe a drug from the next level rather than try a different painkiller from the same group. For example, if you’re taking a painkiller such as ibuprofen but are still getting pain, or if your pain gets worse, your doctor should prescribe a weak opioid (moderate) painkiller such as dihydrocodeine, codeine phosphate or tramadol. If the pain still isn’t controlled or if it increases, your doctor could then prescribe a strong opioid painkiller.To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand” This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective.

Cancer pain management:

Cancer pain is often very complex, but the most intractable pain is often neuropathic in origin, arising from tumor invasion of the meninges, spinal cord & dura, nerve roots, plexuses and peripheral nerves. Multimodal therapies are necessary. It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers worldwide, may have limitations in the context of long-term survival and increasing disease complexity. The neurophysiology of cancer pain is complex: it involves inflammatory, neuropathic, ischaemic and compression mechanisms at multiple sites. Knowledge of these mechanisms and the ability to decide whether a pain is nociceptive, neuropathic or a combination will lead to best practice in pain management. Opioids remain the mainstay of cancer pain management, but the long-term consequences of tolerance, dependency, hyperalgesia and the suppression of the hypothalamic/pituitary axis should be acknowledged and managed in both non-cancer and cancer pain, in addition to the well-known side effects such as constipation. NSAIDs, antiepileptic drugs, tricyclic antidepressants, NMDA antagonists, sodium channel blockers, topical agents and the neuraxial route of drug administration all have their place in the management of complex cancer pain. Psychological distress increases with the intensity of cancer pain. Cancer pain is often under-reported and under-treated for a variety of complex reasons, partly due to a number of beliefs held by patients, families and healthcare professionals. There is evidence that cognitive behavioral techniques that address catastrophizing and promote self-efficacy lead to improved pain management. Group format pain management programs could contribute to the care of cancer survivors with persistent pain. Physiotherapists and Occupational Therapists have an important role in the management of cancer pain and have specific skills which enable them to be both patient-focused and holistic. Therapists utilize strategies which aim to improve patient functioning and quality of life, but the challenge remains for them to practice in an evidence-based way and more research is urgently needed in this field.

Transcutaneous Electrical Stimulation (TENS):

Action of TENS is based on premise that large diameter myelinated axons have a lower electrical threshold than smaller diameter axons and do not produce pain when activated, it is possible to stimulate them selectively without producing discomfort and stimulation of large diameter fibers causes inhibition of small diameter pain fibers and modulation of pain response (gate control theory). TENS machines have two small electrode pads that need to be attached to the skin. The TENS machine works by providing mild electrical impulses that stimulate the touch sensors in the skin reducing the pain messages to the brain. A small battery powers the electrical impulses, the level and type of impulses can be adjusted. TENS machines can be purchased from chemists. TENS is most effective when stimulation is applied to the injured nerve proximal to the site of injury; also used for spinal cord injury. It is used routinely used for postoperative pain. Although TENS machines may be useful to some people it might be worth taking specialist advice from the hospital physiotherapist/practitioner about whether you might benefit from using one. Research evidence to date has not proved conclusive evidence of the value of TENS for chronic pain.

Physiatry:

Physical medicine and rehabilitation (physiatry/physiotherapy) employs diverse physical techniques such as thermal agents and electrotherapy, as well as therapeutic exercise and behavioral therapy, alone or in tandem with interventional techniques and conventional pharmacotherapy to treat pain, usually as part of an interdisciplinary or multidisciplinary program.

Common uses of Physiotherapy for Pain Relief:

Physiotherapy involves treatment that focuses on prevention of injuries or disabilities. Physiotherapy helps to relieve pain, promote healing and restore function and movement. Physiotherapy is practiced by professionally trained physiotherapists who are specialists, skilled and educated specifically in proper rehabilitation. Right from minor injuries to major injuries, physiotherapy has been established to be an effective tool against injuries and pain. Various methods of physiotherapy are applied for different injuries in various regions of the body. Particularly beneficial for sufferers of lower back pain, physiotherapy is used to release tension and so reduce pain in the back. Various tactics are used such as exercise, traction and massage and the process helps millions of people around the world overcome constant back pains. Utilized to rehabilitate patients after a stroke or hip replacement, physiotherapy is also used to reduce pain induced by sports injuries, and various methods are used to make it possible for the patient to lead a normal life again. Patients may also be shown various methods for lifting, for instance, to avoid future strain on the lower back. A therapist may focus on decreasing pain with either passive or active therapy.

Examples of passive techniques include:

1. Heat/ice packs

2. TENS units

3. Ultrasound

Examples of active techniques include:

1. Stretching and range of motion exercises

2. Strengthening exercises

3. Pain-relief exercises

4. Low-impact aerobic conditioning

Psychological therapy of pain:

Individuals with more social support experience less cancer pain, take less pain medication, report less labor pain and are less likely to use epidural anesthesia during childbirth or suffer from chest pain after coronary artery bypass surgery. Suggestion can significantly affect pain intensity. About 35% of people report marked relief after receiving a saline injection they believe to have been morphine. This “placebo” effect is more pronounced in people who are prone to anxiety, so anxiety reduction may account for some of the effect, but it does not account for all of the effect. Placebos are more effective in intense pain than mild pain; and they produce progressively weaker effects with repeated administration. It is possible for many chronic pain sufferers to become so absorbed in an activity or entertainment that the pain is no longer felt, or is greatly diminished. Cognitive behavioral therapy (CBT) is effective in reducing the suffering associated with chronic pain in some patients but the reduction in suffering is quite modest, and the CBT method employed seems to have no effect on outcome. Evidence for the usefulness of behavioral therapy (BT) and cognitive behavioral therapy (CBT) in the management of adult chronic pain is generally weak, due partly to the proliferation of techniques of doubtful quality, and the poor quality of reporting in clinical trials. The crucial content of individual interventions has not been isolated and the important contextual elements, such as therapist training and development of treatment manuals, have not been determined. The widely varying nature of the resulting data makes useful systematic review and meta-analysis within the field very difficult. Other psychologically oriented pain management includes hypnosis, biofeedback, guided imagery and psychotherapy. However, many patients unwilling to take this approach, or unable to pay for it. Since chronic pain produces anxiety, depression and other emotional problems, it is useful to evaluate these patients psychiatrically; psychiatric factors are difficult to quantify and it is difficult to determine efficacy of psychiatric therapy.

The manipulation of coping mechanisms is of great significance when considering the management of pain and especially of chronic pain. We are all familiar with coping strategies, some of which are regarded as active — for example, indulging in active and distracting behavior, whereas others are passive — for example, taking rest or medicines. If the strategy used maximizes function in the presence of pain and reduces anxiety, then it is said to be adaptive. On the other hand, if the strategies used involve too much rest, too great a dependence on medication or on others, or conversely too much activity which provokes excessive pain, they are maladaptive. Cognitive therapies involve changing thoughts and attitudes about pain with a view to changing self-management in the direction of adaptive behavior: a change which often leads to a lessening of pain.

Complementary and Alternative medicine (CAM):

Pain is the most common reason for people to use complementary and alternative medicine. An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 in the British Medical Journal, concluded that there is little difference in the effect of real, sham and no acupuncture. There is interest in the relationship between vitamin D and pain, but the evidence so far from controlled trials for such a relationship, other than in osteomalacia, is unconvincing. A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of pain in some conditions, though the number of patients enrolled in the studies was low, bringing up issues of power to detect group differences, and most lacked credible controls for placebo and/or expectation. The authors concluded that although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions. A 2003 meta-analysis of randomized clinical trials found that spinal manipulation was “more effective than sham therapy but was no more or less effective than general practitioner care, analgesics, physical therapy, exercise, or back school” in the treatment of low back pain.

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These CAM approaches do not involve drugs or surgery.

1. Chiropracty manipulates joints to relieve compression of nerves.

2. Massage stimulates blood flow, relieves muscle spasms and increases somatosensory information, which can relieve pain through the gate control theory.

3. Hot applications increase blood flow, and cold applications reduce inflammation, which contributes to pain.

4. Stimulation of the skin with small electrodes can close the gate to pain.

5. Acupuncture may stimulate nerve cells and release endorphins. The increased stimulation might also close the gate to pain.

6. Mental control techniques rely on the ability of the mind and emotions to control and alleviate pain through descending neural pathways. They include relaxation techniques, hypnosis, biofeedback and distraction techniques.

About Scientific Evidence on CAM Therapies:

Scientific evidence on CAM therapies includes results from laboratory research (e.g., animal studies) as well as clinical trials (studies in people). It encompasses both “positive” findings (evidence that a therapy may work) and “negative” findings (evidence that it probably does not work or that it may be unsafe). Scientific journals publish study results, as well as review articles that evaluate the evidence as it accumulates; fact sheets from the National Center for Complementary and Alternative Medicine (NCCAM) base information about CAM research primarily on the most rigorous review articles, known as systematic reviews and meta-analyses. Authors of such reviews often conclude that more research and/or better designed studies are needed.

	Promising Evidence of Potential Benefit	Limited, Mixed, or No Evidence To Support Use
Low-Back Pain
Acupuncture	√
Massage	√
Spinal Manipulation	√
Progressive Relaxation	√
Yoga	√
Prolotherapy		√
Herbal Remedies		√
Arthritis
Acupuncture	√
Glucosamine/Chondroitin		√
Gamma Linolenic Acid (GLA)		√
Herbal Remedies		√
Balneotherapy (Mineral Baths)		√
Tai Chi		√
Headache
Acupuncture	√
Relaxation training	√
Feverfew		√
Neck Pain
Acupuncture		√
Spinal Manipulation		√
Scientific Evidence on CAM for Pain

Caution:

If you are considering CAM for Chronic Pain, do not use a CAM therapy as a replacement for conventional care or to postpone seeing a doctor about chronic pain or any other medical problem. Learn about the therapy you are considering, especially the scientific evidence on its safety and whether it works. If you are considering CAM, keep in mind that they can act in the same way as medications. They can cause medical problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements you take. Your health care provider can advise you. If you are pregnant or nursing a child, or if you are considering giving a child a dietary supplement, it is especially important to consult your health care provider.

Acupuncture and pain:

Despite the favorable research, some experts caution that it’s difficult to test acupuncture in a clinical setting. In part, this is because any valid clinical study will include a control group that is given a sham treatment (placebo). In the case of acupuncture, the placebo consists of needles inserted in random points, rather than at actual pressure points. This can lead to what’s called the placebo effect — when study participants believe that they’ve received the real treatment and expect their symptoms to improve. As evidence, a 2006 study in the “British Medical Journal” found that acupuncture reduced the number of days patients suffered from tension headaches, but sham acupuncture in the study had almost the exact same results. Also, the quality of the research conducted so far on acupuncture hasn’t been consistent. Many of the studies in the past have been small, and have focused on short-term, rather than long-term results.

Hypnotherapy for the management of Chronic Pain:

Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems. Also, hypnosis was generally found to be more effective than nonhypnotic interventions such as attention, physical therapy, and education. Most of the hypnosis interventions for chronic pain include instructions in self-hypnosis. However, there is a lack of standardization of the hypnotic interventions examined in clinical trials, and the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up.

Magnet therapy:

How do Magnets Work? Magnets do not block pain signals, they treat the cause of the pain. Joint wear and tear, chronic damage from earlier injuries or chronic inflammation can cause pressure upon nerves. The pressure upon the nerves is usually caused by swelling or inflammation around the injury, this extra fluid causes the tissues to swell and thus places pressure upon the nerve endings. Compression of the nerves causes constant pain stimuli to be sent to the brain. This causes the chronic constant pain that is often associated with long term ailments. To relieve the pressure on the compressed nerves, the excess fluid in the tissues must be removed. Once the pressure has been removed the pain will subside. Magnets do reduce the inflammation in the tissues therefore they are very effective at reducing pain at the point of injury. Because the cause of the pain has been removed ( i.e. the inflammation), the pain relieving results will last for a much longer period of time than pain killers, which are just blocking the signal. Whilst the magnetic field is reducing the inflammation, it is also improving blood supply to the injured area. The extra blood flow brings fresh rich oxygen, nutrients and hormones. One of these hormones is endorphin. Endorphin is known as the “happy” hormone as it is responsible for mood enhancement. The other function of endorphin is to kill pain naturally. As increased blood flow reaches the injured area the concentration of endorphins increases and pain is reduced. To be frank, magnet therapy appears to be science fiction to me but who knows when fiction becomes fact. Also, thousands of patients undergo MRI daily but none report pain relief even coincidentally.

Non-specific effects:

Some of the pain relief with every pain treatment could also be attributed to the effects which are not specific to the treatment. These could include the person’s beliefs, expectations and experiences with other illnesses, previous use of the current treatment or other treatments, context and the interaction between the patient and the practitioner and so on (placebo effect). But, mind you, they all work by affecting how the brain perceives pain. Every pain treatment out there, whether it is acupuncture, postural correction, movement dysfunctions, trigger point therapy, stretching, active release technique, manual therapy, McKenzie methods, meditation, yoga and so forth, works by the above mechanisms to affect the brain since the experience of pain comes from your brain and may have very little to do with eliminating the ‘pathology’ in the body as claimed. While many people do have “issues in the tissues”, that’s far from the only consideration.

Music therapy for pain:

Music therapy acts as an intervention for pain perception by affecting pain in all of its facets, impacting one’s quality of life in the moment. It is known that emotions, thoughts and feelings are a result of neurons firing, as is nociception (pain). Perhaps the messages instigated by the “mind” are able to overpower the message of nociception. PET scans (positron emission topography) reveal that the endocrine system and the limbic system are stimulated by music releasing endorphins (body’s natural pain killers) and dopamine (pleasure) into the body. Low levels of dopamine results in feelings of anxiety, worthlessness and fatigue, all factors likely to contribute to an increase in pain perception. Serotonin is also controlled by the limbic system; it is responsible for regulating mood and enhancing the affects of analgesics. Research measuring serotonin pre and post music therapy sessions would be useful in determining serotonin’s role in the effects of music therapy as an intervention for pain perception. The parallels between music therapy and pain are evident in this research. Pain is a subjective experience and the perception of that pain can be influenced in a music therapy session. Patients are able to benefit from interventions, such as music therapy, that offer flexibility within routine yet unpredictable venues, such as hospitals. The treatment, unlike pharmaceuticals, does not have any time restrictions or contraindications. This flexibility provides an opportunity for patients to regain some control over their pain management by not being restricted from when they can or cannot take part in the therapy. Music therapy as an intervention for pain perception is able to affect the multiple variables involved in pain while providing a more pleasant environment for fellow patients and staff. It is cost effective, without side effects, and improves one’s overall sense of well being, contributing to quality of life.

Backache:

About 80 percent of the adults in the U.S. have been bothered by back pain at some point. Lower-back pain disrupts many aspects of life. In one survey, 46 percent said that it interfered with their sleep, 31 percent reported that it thwarted their efforts to maintain a healthy weight, and 24 percent said that it hampered their sex life. The percentage of people highly (completely or very) satisfied with their back-pain treatments and advice varied by practitioner visited.

Professional	Highly satisfied
Chiropractor	59%
Physical therapist	55%
Acupuncturist	53%
Physician, specialist	44%
Physician, primary-care doctor	34%

Interventional pain management for backache:

The goal of interventional pain management is to find the source of a person’s pain, then to treat it in the most effective, least invasive way possible. Finding the cause of the pain is crucial in thoroughly treating it. Medication can sometimes be effective in pain relief, but it doesn’t address the underlying cause. It’s not that you shouldn’t use pain medications but it’s that medications treat the symptom of pain rather than the source of it. And there are risks with any medication. Interventional pain techniques can provide other effective and safe options. Because interventional pain management is so comprehensive, there are a variety of treatments available. The type of treatment any given patient receives depends on his or her unique condition. However, interventional pain doctors typically start with the least invasive treatments, then work their way through other treatments if necessary. The following are effective intervention methods for back pain:

Trigger point injections:

Facet Joint Injections:

Medial Branch Nerve Blocks:

Radiofrequency Neurotomy:

Epidural Steroid Injections:

Cryoablation of Peripheral Nerves:

Botox Injections for Muscle Spasms and Pain

Intradiscal Electrothermal Therapy

Percutaneous Disc Decompression

Percutaneous Vertebroplasty/Kyphoplasty

Spinal Cord Stimulation
Intrathecal Drug Delivery:

Nonsurgical spinal decompression therapy for chronic pain:

Spinal decompression therapy is an FDA cleared revolutionary, nonoperative neck and back pain treatment that has shown excellent results for decreasing pain. Spinal decompression therapy is a treatment based on computerized intermittent traction that can allow patients to become pain-free and avoid surgery with the following painful conditions:

Neck pain
Arm and Leg Pain
Sciatica
Degenerative Disc Disease
Facet Syndrome
Spinal Stenosis
Low Back Pain
Herniated or Bulging Discs
Failed Neck or Back Surgery

The research has shown that over 75% of patients achieved good to excellent outcomes. The treatment works by providing an intermittent traction that is gentle and provides pressure relief for the spine. This works well for both that pain issues along with back pain problems. The spinal decompression machine provides a gradual application and release of traction which works by tricking the muscles around the spine not to spasm or guard. This allows increased blood flow into the spine along with a significant amount of nutrients and oxygen. This can permit the injured disc to heal or can even pull back in a bulging or herniated disc backward supposed to be anatomically. It also provides substantial pain relief for spinal arthritis conditions such as spinal stenosis or facet syndrome and even degenerative disc disease.

RFA:

Another technique to alleviate chronic pain is Radiofrequency ablation (RFA). Radiofrequency ablation represents a cutting-edge treatment that is often able to reduce the amount of pain medications that are necessary and provide typically a much longer pain relief then a standard cortisone injection. Research studies looking at radiofrequency ablation have shown anywhere between a 50% to 90% good to excellent results in both the neck and the low back. One study performed in the last few years showed average pain relief of 470 days with the treatment which is approximately 16 months.

Other interventional modalities include:

1. Surgical Lesions –disruption of the spinothalamic tract

2. Sympathetic Blocks and TENS: use independent modulatory mechanisms and can be used together to enhance analgesia. Sympathetic block reduces abnormal excitatory influences on peripheral nociceptors; sympathetic therapy may be enhanced using catecholamine depleting agents such as reserpine or guanethidinne and only proven to work when given by regional perfusion in high concentrations.

Counter irritation:

Counter irritation is one of the earliest forms of healing. It has long been thought that pain can be relieved and healing promoted by irritating an area of the skin. A counterirritant is a substance which creates inflammation in one location with the goal of lessening the inflammation in another location. Capsaicin is a counterirritant during initial phase but later on it blocks substance P by actions on nerve cells.

Methods of Counter Irritation:

Many things from noxious chemicals to sharp instruments have been used to provide the irritant stimulus. The following is a list of a few:

1. Cupping: The air inside a small jar is heated and the mouth of the jar is placed on the skin, as the air inside cools a vacuum is created. This draws blood and other body fluid to the surface of the skin creating bruising and swelling.

2. Scarification: use of a sharp instrument to scratch the skin.

3. Blistering: use of heat or very irritant chemical to produce blisters on the skin.

4. Massage: if deep enough massage will produce reddening and minor& transient damage to the underlying tissue, this in turn will cause minor irritation. Deep massage generally has greater therapeutic benefit than the light surface variety.

5. Irritant chemicals: Very many of these have been used over the years. Those commonly used are belladonna (deadly nightshade) and mustard plasters, both of these will cause blisters if left on long enough. Many embrocations are mildly irritant substances which cause low level inflammation; examples are menthol, turpentine and camphor.

How Counter Irritation Works:

The most popular view involves the gate theory of pain. This postulates that sensation from non-pain nerve endings such as those which transmit heat and pressure sensation will, if given enough stimulation, cause an overload in the nerve traffic up the spinal cord to the brain. When this happens it is more difficult for signals from pain receptors (nociceptors) to reach the brain. Since pain is only felt when nerve impulses from pain receptors get to the brain, pain will be diminished or not felt at all.

Nutritional Approaches:

Nutritional approaches to pain management can involve both changes in diet and the use of dietary supplements, including vitamins, minerals, enzymes and other substances. These strategies can be used to prevent pain, such as migraine headache, or promote the relief of pain and inflammation as part of a comprehensive pain management strategy. Like the herbal remedies, research in nutritional approaches is in an early phase. Although nutritional therapies are often perceived to have fewer side effects than pharmaceuticals, this may or may not be true and some nutrients are known to be unsafe in certain circumstances or at certain doses. The use of these therapies should be discussed with a health professional.

1. Dietary manipulation may influence pain perception or inflammation, and there have been numerous studies to evaluate the outcomes associated with different quantities of food or specific dietary factors. Although the data are limited, studies have begun to assess the effects of fasting, food allergies, and various dietary constituents, such as a glycemic diet, lectins, dietary blue green algae, and green tea polyphenols. Recently, animal studies have measured the effect of phytoestrogens (plant estrogens) in soy-containing diets on pain physiology. Green tea polyphenols are flavonoids, and like other food substances (e.g., grape seed proanthocyanidins and citrus flavonoids) may have anti-oxidant effects. These anti-oxidant effects could potentially have a variety of health benefits, including a treatment effect in painful inflammatory disorders. Vegetarian diets have been advocated for fibromyalgia (Kaartinen, 2000) and rheumatoid arthritis (Kjeldsen-Kragh, 1994, 1999).
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2.Essential fatty acids (omega-3 and omega-6) perform a variety of functions in the body, including the regulation of immune and inflammatory responses. Recent research suggests that the levels of these chemicals, and the balance between them, could be involved in human disease, such as arthritis and other inflammatory conditions. Common sources of omega-3 fatty acids are coldwater fish such as salmon, herring, sardines and halibut, and nonhydrogenated oils such as canola, grape seed, walnut, hemp and flaxseed oils. Common sources of omega-6 fatty acids include cottonseed, corn and other types of vegetable oils that are used in most processed foods. Studies have suggested that the use of a dietary supplement containing specific essential fatty acids could have favorable effects on pain in patients with osteoarthritis or inflammatory disorders. They may enable patients with osteoarthritis to reduce their use of nonsteroidal anti-inflammatory drugs and allow those with rheumatoid arthritis to reduce the use of other medications. Studies also have shown that higher intake of omega-3 correlates with reduced menstrual pain.
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3.Gamma-linolenic acid (GLA) is an unsaturated fatty acid derived from plant seed oils, such as evening primrose and borage seed oils. A number of studies have suggested that it reduces inflammation and produces improvement in patients with rheumatoid arthritis. Improvements include decreases in the duration of morning stiffness, joint pain and swelling, and the ability to reduce other medication usage. In addition GLA’s may be useful in the preventive approach to migraine headaches by reducing the severity, frequency and duration of migraine attacks. Since GLA is an omega-6 fatty acid, it is optimally taken with a balance of omega-3s.
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4.Amino acid tryptophan is converted into 5-hydroxytrytophan, which is converted to serotonin, a neurotransmitter that plays a role in pain and inflammation. Increasing tyrptophan levels in the body may help to reduce chronic pain and reduce episodes of migraine headaches in those who are predisposed to migraines. Foods that contain high levels of tryptophan include salmon, tuna, garbanzo beans, cashew nuts, sunflower seeds, turkey, yogurt, bananas and dairy products.
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5.Vitamin deficiencies are associated with a variety of diseases, some of which (like neuropathy) may be painful. The recommended daily allowances of vitamins are calculated to prevent deficiency, and a vitamin supplement should be taken if the ability of the diet to provide these substances is in question. There is limited evidence that the additional use of specific vitamins may be therapeutic in some disorders. Vitamins B6 and B2 may play a role in reducing muscle spasms and cramps, preventing migraine, and reducing the symptoms of carpal tunnel syndrome. Vitamin B12, which helps to maintain the sheath that surrounds and protects nerve fibers, may help pain from peripheral neuropathies and low back pain with sciatica. The use of vitamin E, an anti-oxidant, may be effective in relieving pain and improving mobility in those osteoarthritis and a mixed anti-oxidant supplement containing vitamin C, vitamin E, selenium and L-methionine has shown promise in patients with pancreatic inflammatory pain. In Germany, alpha-lipoic acid, another anti-oxidant found mostly in red meat, is an approved treatment for peripheral neuropathy. Administered intravenously, this substance appears to decrease the pain, burning, and numbness associated with neuropathy.
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6.Minerals also may have therapeutic uses. Zinc and copper may help in wound healing and reduce pain and inflammation. Magnesium is analgesic for neuropathic pain in animal studies and has shown clinical benefit in the treatment of migraine, cluster and tension headaches. It is unclear whether magnesium can reduce pain related to surgery. Magnesium’s mechanism of action in pain management may be partly due to NMDA blockade.
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7.Enzymes are substances that influence chemical reactions. Bromelain, a complex enzyme of pineapple, is commonly used in Europe as an anti-inflammatory compound for many forms of musculoskeletal injury, arthritis, cramps, post-surgery and post-traumatic swelling. It has been shown to be beneficial in reducing swelling, inflammation and pain by blocking the creation of proinflammatory compounds like prostaglandins, decreasing the production of kinins, and inhibiting fibrin production. Although it is generally well tolerated, it can aggravate ulcers or esophagitis, and can interact with antiplatelet agents.
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8.Glucosamine sulfate and chondroitin sulfate may favorably influence cartilage and have been studied as treatments for arthritis. Although some studies have had negative results, others suggest significant benefit from both these agents. Glucosamine sulfate has been shown to reduce symptoms of osteoarthritis and temporomandibular joint pain. The onset of improvement may take from one to three months; side effects are mild. Chondroitin sulfate was shown to be significantly superior to placebo in reducing pain in osteoarthritic joints, producing at least 50% improvement compared to placebo. Further studies are needed to clarify its role in the treatment of arthritis and other pain conditions.

Foods that fight pain:

1. Whole grains: whole grains are a good source of magnesium, a mineral that has been shown in animal studies to short-circuit muscle pain.

2. Ginger: Ginger is the best pain killer having analgesic properties like the popular ibuprofen. It contains a quartet, gingerols, paradols, shogaols, and zingerone which are active ingredients to reduce pain. Drink ginger tea in monsoons and winter to get relief from that recurring pain.

3. Turmeric: It contains curcumin that helps nip pain

4. Olive oil: It is rich in antioxidant polyphenols that help reduce common pain-causing mechanism in the body. But use it carefully as it has 120 calories per tablespoon.

5. Salmon and mackerel: It is rich in pain-busting omega-3 fatty acids and a great source of another pain fighter: vitamin D.

6. Nuts: Almonds, walnuts are great source of omega 3 fatty acids and anti oxidants that help in pain control.

7. Strawberries: Strawberries are full of vitamin C, an antioxidant with powerful pain-reducing properties, according to research.

8. Dairy: Milk and yogurt contain two bone-building nutrients – calcium and vitamin D. Vitamin D can diminish chronic pain according to research findings.

9. Grapes: Resveratrol in grapes and grape juice can often have an analgesic effect similar to aspirin, according to a handful of studies.

Alcohol as pain killer:

High-alcohol liquor, two forms of which were in the US Pharmacopoeia up until 1916 and in common use by physicians well into the 1930s, has been used in the past as an agent for dulling pain, due to the CNS depressant effects of ethyl alcohol, a notable example being the American Civil War. However, the ability of alcohol to relieve severe pain is likely inferior to many analgesics used today (e.g. morphine, codeine). As such, the idea of alcohol for analgesia is generally considered a primitive practice in virtually all industrialized countries today.

Alcohol and pain killer:

There is a common misconception that you can safely consume over the counter painkillers and alcohol. The effects of mixing alcohol and painkillers are variable for every painkiller and are also affected by the amount of alcohol that has been consumed by the patient. The reason that painkillers and alcohol should not be taken at the same time is that both the substances are depressants, i.e., they affect the nervous system. The double effect of both the substances is not very healthy for the human nervous system and respiratory system. The respiratory system and the nervous system, due to the effects of both depressants, get relaxed and eventually slow down. The rate of breathing reduces, thus decreasing the volume of essential oxygen in the body. The second effect is that these substances also tend to affect the digestive system, especially the liver.

How does alcohol interact with painkillers?

1. Anti-convulsants: Combining alcohol with an anticonvulsant can put you at risk for seizures, even if you are taking an anticonvulsant for chronic pain. The combination can also cause severe drowsiness or make you lightheaded.

2. Opioids: Mixing alcohol and opioids can be lethal. The combination can make you drowsy or cause memory problems. In some cases, mixing the two causes breathing problems or leads to an accidental overdose.

3. NSAIDs: Mixing alcohol with over-the-counter or prescription NSAIDs is not necessarily dangerous in the short term. However, it can increase your risk for developing ulcers or liver damage.

4. Antidepressants: When combined with antidepressants, alcohol can increase feelings of hopelessness and suicidal thoughts, especially in adolescents. Mixing the two can also cause drowsiness and dizziness, as well as lead to an accidental overdose.

Novel agents to relieve pain:

Flupirtine:

Flupirtine is a centrally acting K+ channel opener with weak NMDA antagonist properties. It is used in Europe for moderate to strong pain and migraine and its muscle relaxant properties. It has no anticholinergic properties and is believed be devoid of any activity on dopamine, serotonin or histamine receptors. It is not addictive and tolerance usually does not develop. However, tolerance may develop in occasional cases.

Bone cement with local anesthetics:

Bone cement is used for fixation of artificial joints/implants to the skeleton. It acts as a filler between the bone and the implant. It consists of poly-methyl methacrylate (PMMA), which is a transparent thermoplastic. It is a synthetic polymer of methyl methacrylate. Addition of crystals of barium sulfate gives it radiopacity. Incorporation of substances such as local anesthetics, antibiotics, anti-inflammatory drugs, immunomodulators, osteogenic promoters, and diagnostic substances such as radioactive tracers into bone cement has been attempted. The combination of a local anesthetic with methyl methacrylate cement offers the promise of selective analgesia following surgery or injury to bone. Analgesia from incorporated local anesthetic is thought to be due to the elution of the drug into the surgical site. However, much research into the efficacy, duration of analgesia, and side effects needs to be done. Some elution behavior of local anesthetics has been preliminarily studied.

CR845:

CR845 is a novel peripherally restricted, all-d-amino acid tetrapeptide kappa opioid selective agonist under development for the treatment of acute and chronic pain. It belongs to a novel class of opioid ligands which has a reduced ability to cross the blood–brain barrier and therefore acts without inducing central side effects. It is currently available as an intravenous formulation in a sterile isotonic 0.04 M acetate buffer of pH 4.5 composed of acetic acid, sodium acetate trihydrate, sodium chloride, and water, with addition of hydrochloric acid for pH adjustments. CR845 acts to reduce pain by selectively activating kappa opioid receptors located on peripheral nerve terminals, and kappa receptors on certain immune cells. CR845 has no activity at the mu or delta subtypes of opioid receptors, or other known receptors. Stimulation of kappa receptors by CR845 results in the initiation of an intracellular cascade that leads to the inhibition of ion channels necessary for peripheral nerve activity and culminates in reduced afferent nerve activity. Activation of kappa receptors on immune cells results in reduced release of nerve-sensitizing pro-inflammatory molecules.

Cannabis derivative:

Cannabis sativa is the genus and species name of a flowering plant which has been used medicinally for thousands of years. Delta-9-tetrahydrocannabinol (THC) is responsible for almost all the psychoactive effects of cannabis, but is only one of more than 60 similar compounds found in cannabis which, together, are collectively known as cannabinoids. Cannabinoid agonists that share the basic chemical structure of delta-9-tetrahydrocannabinol have been increasingly studied in recent years for potential benefits in various types of pain and pain syndromes. Delta-9-tetrahydrocanabinol (THC), the active ligand in Cannabis sativa extract, was thought to exert its pharmacological effects by activating cannabinoid receptors in the central nervous system. These receptors were identified in 1988, and endogenous ligands termed endocannabinoids were isolated in 1992. Two major cannabinoid receptor subtypes termed CB1 and CB2 have been characterized. Central CB1 receptors are primarily localized in neocortex and the limbic system, and are responsible for many of the behavioral and analgesic effects of cannabinoid agonists. Peripheral CB2 receptors and some CB1 subtypes are primarily localized in immune cells such as leukocytes and mast cells, which have been shown to be involved in pain and inflammatory responses. CB2 receptors are not present in the CNS; however, they are also found in peripheral nerve fibers and are particularly concentrated in injured neural endings. Marijuana (cannabis) contains a principle active ingredient THC which binds to the same receptors as the body’s natural endogenous cannabinoids. This fact has made marijuana the subject of heated debate in the last decade because THC is able to mimic the action of natural cannabinoids that the body produces in signaling cascades in response to a peripheral pain stimulus. THC binds to cannabinoid receptors called “CB1″ on cells of the spinal cord and pain-modulating centers of the brain to decrease sensitivity to pain. Patients with multiple sclerosis, cancer, AIDS, and a number of other conditions have sought marijuana for years to treat their various symptoms.

Note:

Many species of plants produce biologically active ingredients to protect against herbivores that feed on the plants’ tissues. For example the milky juice of milkweeds is very bitter, toxic, and sticky. An insect feeding on the milkweed can be trapped in the sticky juice, repelled or killed by the chemicals. THC is most likely a repellent to many insects and grazing animals. So cannabis plant has THC for its own survival and not for human pain relief. The way marijuana contain THC and the way opium contain morphine; and both of these have biological receptors in human brain; and the way body produces endogenous opioids & cannabinoids which target the same receptors; makes me think that during evolution of species over millions of years, some cross-connection exist between plant kingdom and animal kingdom at the basic level of DNA, genes, proteins and molecular biology and therefore presence of these receptors in human brain which readily accept plant based chemicals is not a mere coincidence but an evolutionary design.

Injectable capsaicin:

The injectable analgesic Adlea™ is a concentrated and purified form of capsaicin (8-methyl-N-vanillyl-6-nonenamide). It is an unapproved preparation, currently in phase 3 trials for relief of post-surgical acute pain, nerve trauma-induced neuropathic pain, and for chronic musculoskeletal, tendon-related, and arthritic pain. Capsaicin is an alkaloid derived from plants and has been a common ingredient in food and spices for many centuries. It is concentrated in the seeds and inner stem of chili peppers and is the active ingredient responsible for making them taste hot.

TRPV:

Transient receptor potential vanilloid (TRPV) channel blockers (antagonists) are new drugs, which are not currently approved for clinical use, yet have great analgesic potential. An example of this class of drugs is capsazepine, a synthetic analog of capsaicin, which inactivates TRPV1 channels by competitively occupying TRPV1 binding sites in sensory neurons. Although capsazepine, the first TRPV antagonist, exhibited certain analgesic and anti-inflammatory properties, its effects were of low potency as well as variable within different species. As a result, capsazepine never reached the clinical arena. It is used now in the laboratory as an investigating tool for the study of other TRPV antagonists. The next compound studied was iodo-resiniferatoxin (I-RTX), an analog of resiniferatoxin (RTX). This drug was more potent than capsazepine and more specific for TRPV receptors but lacked consistent analgesic effects. The functional importance of the TRPV channels in pain was further elucidated with the cloning of the vanilloid receptor. The search for the perfect TRPV antagonist has been intensified and currently there are several drugs undergoing clinical trials. The new generation of TRPV antagonists has structures completely different from the agonists and therefore they are devoid of partial agonistic effect.

Neramexane:

Neramexane is a central-acting N-methy-d-aspartate receptor antagonist which first underwent preclinal trials in Germany. In 1998, it was investigated for both neuroprotective and alcoloholism effects. Neramexane is an open-channel blocker against the NMDA receptor. It has moderate affinity to the NMDA receptor, with strong voltage-dependency and fast-onset blocking kinetics. It is investigated for role in treating neuropathic pain. Metabolic pathways, drug clearance and elimination: in the phase I study, an oral dose (5–40 mg) demonstrated a plasma half-life of approximately 29–42 hours. Metabolism has not been clearly elucidated yet. After administration of a single dose, 30–40% of the drug was excreted from the kidney unchanged.

Nociceptin:

Nociceptin (orphanin FQ) is a novel neuropeptide whose actions have yet to be completely elucidated. However, stimulation of the nociceptin receptor has been implicated in the modulation of many neurobehavioral processes, including pain, substance dependence, sexual behavior, anxiety, locomotor activity, learning capacity, memory, and adaptation to stressful stimulus. Continued research in this area has the potential to lead to a new class of drugs for pain medicine and beyond.

BL-7050 for neuropathic pain:

A new drug developed by Tel Aviv University researchers, known as BL-7050, is offering new hope to patients with neuropathic pain. The medication works by targeting a group of proteins which act as a channel for potassium. Potassium has a crucial role in the excitability of cells, specifically those in the nervous system and the heart. When potassium channels don’t function properly, cells are prone to hyper-excitability, leading to neurological and cardiovascular disorders such as epilepsy and arrhythmias. These are also the channels that convey pain signals caused by nerve damage, known as neuropathic pain. In both in-vitro and in-vivo experiments measuring electrical activity of neurons, the compound has been shown to prevent the hyper-excitability of neurons — protecting not only against neuropathic pain, but epileptic seizures as well.

Local adenosine:

Researchers have published a new method to eliminate pain using acupuncture point location as a basis for the procedure. It all started when researchers measured that adenosine, an inhibitory neurotransmitter with antinociceptive properties, is produced by acupuncture stimulation. Nociceptors are blocked by adenosine. Acupuncture stimulates the natural production of adenosine within the body. Based on these findings, the researchers decided to inject prostatic acid phosphatase (PAP) into an acupuncture point. PAP is an ectonucleotidase that converts AMP to adenosine. The results showed a powerful dose dependent antinociceptive response in mice. Antinociception was boosted by adding additional AMP and was blocked with adenosine antagonists. The researchers say that this approach to pain management would “bypass side-effects associated with opioid-based analgesics, and hence could provide a novel abuse-resistant way to treat pain.”

Neurotoxin for chronic pain:

Management of chronic pain is often challenging since commonly prescribed analgesics do not have direct effects on damaged nerves, but, rather, nonspecific effects on pain receptors and other mediators of pain. Neurotoxins are a new class of medications that are being evaluated as potential analgesics. Using these medications, researchers hope to achieve pain relief by suppressing the activity of injured nerve tissue and directly targeting the source of some types of chronic pain. A challenge in developing these medications is that in addition to affecting nerves causing pain, they could also damage other nerves, including those in the brain and spinal cord. Neurotoxins could therefore cause serious harm related to unintended nerve damage, and are undergoing careful testing to understand how well they selectively affect already damaged nerves.

Anti-nerve growth factor is the first highly selective neurotoxin to be investigated for use in humans. Discovered in the 1950s, investigators found that this immunotoxin stunts neural growth.

Various ways in which pain can be controlled:

Method	Possible Mechanism(s)	Uses/Examples
Aspirin	Acts mostly in peripheral nervous system. Reduces inflammation.	Headache, musculoskeletal pain
Morphine	Acts in central nervous system (brain and spinal cord) to block pain messages. Activates pain-modulating systems in the brain that project to the spinal cord.	Post-operative pain; other pain conditions
Other pain reducing drugs	Act on a variety of neurotransmitter systems.	Variety of pain conditions
Hypnosis	May activate the pain-inhibitory pathway from the brain to the spinal cord (but not opioid pathways). May act somewhere in the brain (frontal lobe?) to shift a patient’s attention away from the pain.	Dental procedures, childbirth, burns, headache
Acupuncture	Stimulation of large diameter nerve fibers that inhibit pain (“close the gate”). Could be placebo effect. Causes release of endorphins (“the body’s own morphine-like substances”). Some types of acupuncture may stimulate small diameter nerve fibers and inhibit spinal cord pain mechanisms (this would not agree with the gate control theory) Stimulate adenosine production locally	Back pain, minor surgical operations
Placebo	Reduces anxiety. Causes release of endorphins	Headache, post-operative pain
Transcutaneous Electrical Nerve Stimulation (TENS)	Stimulation of large diameter nerve fibers which “close the gate” and reduce pain. Could be placebo effect.	Post-operative pain, arthritis, cancer pain
Neurosurgery	Removal or blockade of painful signals	Cancer pain
Stress	Activation of endogenous opiate system (endorphins) Activation of non-opiate pain inhibitory system	Football player continues to play regardless of injury. Soldier continues to fight regardless of wounds.

Pain and obesity:

Pain is one of the most common and debilitating problems in patients challenged by severe obesity. Not just a consequence of mechanical complications of obesity (osteoarthritis, back pain, plantar fasciitis, fibromyalgia, etc.), pain is often a key barrier to physical activity and thus weight management. In fact, excess pain can promote psychological (e.g. depression, anxiety) and behavioral (e.g. binge eating) factors that may further promote weight gain. The relationship between pain catastrophizing and eating behavior is of particular interest, as high-fat and high-sucrose foods have been shown to increase pain tolerance. Thus, binging on highly-palatable foods may be a compensatory response to emotional distress and pain. It is not difficult to see how patients can enter into a vicious cycle of pain, increased eating, weight gain, more pain, more eating, and so on.

Difference between tolerance and addiction to pain killers:

Needing a higher dose of painkillers to manage your pain does not mean you’re addicted. But it’s important to be able to distinguish between addiction and tolerance. People who use opioid painkillers for months or years often develop a tolerance to the drugs — which means they need higher doses of the medication to achieve the same results. Many people who take painkillers worry about their risk of addiction and see signs of tolerance as the early hint of a downward spiral, but this is not necessarily an accurate. Tolerance is an absolutely normal expected phenomenon when people take many pharmacological substances on a regular basis. As your body adjusts, you need more of a dose to get the effect you’re looking for. Your body, primarily your liver, starts to process the medication more efficiently while your brain requires more of the medication to achieve the same effects. If you need a painkiller for months or years, the dose that was adequate at the beginning might be five- or ten-fold less than what you will need after those months or years. Addiction, on the other hand, leads to less rational behaviors. For example, a person developing an addiction might start to argue with himself, day after day, telling himself that taking an extra dose “because of a hard day” is okay without calling the doctor. Where people get into trouble is when they start to self-medicate. A classic sign of addiction from the doctor’s perspective is when a person whose pain is under control asks for more painkillers. Doctors have various ways of determining whether pain is under control or not beyond a patient’s self report. Addiction is when we organize our lives around a substance and continue it despite it causing problems, or when we use more than we plan or intend to. It’s important for people taking painkillers to know that tolerance will keep building as long as you are taking the medication, but if you stop for some time, it will begin to fade.

Pain killer addiction:

Opioid addiction and opioid dependence:

Addiction to prescription painkillers is a disease that has become increasingly prevalent in the United States and elsewhere. Opiate, or narcotic pain medications are commonly prescribed by physicians to treat pain. Often, patients continue taking their medication as prescribed and become physically dependent upon the drug. However, physical dependency and addiction are different. Psychiatry defines addiction as compulsive use of a substance despite negative consequences—and it is this craving, impairment and loss of control over substance use. People who are addicted to opioids take opioids not for pain killing potential but because they are addicted to it. Physical dependence to a drug can be identified by withdrawal symptoms if the drug is abruptly stopped or decreased. While physical dependence may be a component of addiction, it is not, in and of itself, addiction. In fact, physical dependence is a consequence of many medications. For example, certain blood pressure medications can cause physical dependence. Yet, these medications do not lead to addiction. Dependence is a physical state that occurs when the lack of a drug causes the body to have a reaction. Physical dependence is solely a physical state indicating that the body has grown so adapted to having the drug present that sudden removal of it will lead to negative consequences such as a withdrawal reaction. This can occur with almost any kind of drug. A good example of dependence is a heavy coffee drinker’s use of caffeine. If you are used to drinking several cups of coffee each day, you soon learn about physical dependence when you miss a day or two. This does not mean you are addicted to the caffeine; it only means your body is surprised not to see what it has come to expect. Addiction occurs when a patient begins to raise their dose without first consulting their doctor, they find multiple sources for the drug without their primary doctors knowledge (doctor shopping), they lie about their usage, and they will not stop using the medication when the doctor stops the treatment. Addiction is both a biological and psychological condition whereby a person exhibits compulsive behavior to satisfy their craving for pain medication even when there are negative consequences associated with taking the drug. Dependence is an unavoidable consequence of opioid therapy. An opioid-dependent pain patient has improved function with the use of the drug while an opioid-addicted patient does not. Dependence happens because of the following physical process:

1. The brain has responded to the presence of the pain medicine by increasing the number of receptors for the drug, and the nerve cells in the brain cease to function normally.

2. The body stops producing endorphins (the body’s natural painkillers) because it is receiving opiates instead.

3. The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, and reducing or stopping intake of the drug causes a painful series of physical changes called the withdrawal syndrome. At this point the patient may continue taking the pain medication to avoid the withdrawal symptoms, rather than taking it to treat the pain that caused them to take the medicine initially. When this occurs the patient is considered to be dependent on the prescription pain medicine. Addiction, on the other hand has genetic/familial component to it and many addicts have a prior history of psychiatric illness.

Prescription Drug Abuse Facts from the Office of National Drug Control Policy (ONDCP):

1. Prescription drugs are the second-most abused category of drugs in the United States, following marijuana.

2. Among 12th graders, pharmaceutical drugs used non-medically are six of the ten most-used substances.

3. From 1998 to 2008, the proportion of all substance abuse treatment admissions age 12 or older who reported any pain reliever abuse increased more than fourfold.

4. Prescription painkillers are considered a major contributor to the total number of drug deaths. In 2007, for example, nearly 28,000 Americans died from unintentional drug poisoning, and of these, nearly 12,000 involved prescription pain relievers.

5. Nearly one-third (29 percent) of people age 12 or older who used illicit drugs for the first time in the past year began by using prescription drugs non-medically.

6. According to a 2008 Department of Defense survey, about one in nine active-duty service members (11 percent) reported past-month prescription drug misuse.

7. The estimated number of emergency department visits linked to non-medical use of prescription pain relievers nearly doubled between 2004 and 2009.

8. In 2009, the number of first-time, non-medical users of psychotherapeutics (prescription opioid pain relievers, tranquilizers, sedatives, and stimulants) was about the same as the number of first-time marijuana users.

9. Approximately two million adults age 50 and older (2.1 percent of adults in that age range) used prescription-type drugs non-medically in the past year.

10. Substance abuse treatment admissions for individuals age 50 or older nearly doubled from 1992 to 2008, climbing from 6.6 percent of all admissions to 12.2 percent. The percentage of primary admissions for prescription drug abuse among older individuals increased from 0.7 percent to 3.5 percent over the same time period.

Why people abuse Prescription Painkillers:

1. Painkillers numb physical pain very effectively

2. Non-Drug pain management services are inaccessible

3. Painkillers distance you from emotional pain

4. Painkillers can be Pleasurable. Opioids, in particular, have a side effect of euphoria.

5. Painkillers induce relaxation

6. Tolerance builds up quickly

7. Physical neglect intensifies pain: physical behaviors such as overuse of an injured part of the body, poor posture resulting from a lack of sensation when in positions that would otherwise be uncomfortable, and a lack of moderate exercise that would otherwise strengthen the weakened area are bad habits resulting in the person will often just take more painkillers, creating a vicious cycle of physical neglect being concealed by the effects of the drugs.

8. Withdrawal is very unpleasant

9. Painkillers are Legally Available

10. Addiction leads to stigma, which leads to Illicit Drug Use.

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Newborns addicted to pain killers:

Neonatal withdrawal syndrome or neonatal abstinence syndrome is when a group of problems occur in a newborn that was exposed to drug abuse in the womb. There are two types of neonatal abstinence syndrome: neonatal abstinence syndrome due to prenatal or maternal use of substances that result in withdrawal symptoms in the newborn and postnatal neonatal abstinence syndrome secondary to discontinuation of medications such as fentanyl or morphine used for pain therapy in the newborn. Neonatal abstinence syndrome mostly occurs when the mother takes addictive illicit or prescription drugs. About three percent of the 4.1 million of women able to bear a child who abuse drugs are believed to continue drug abuse during pregnancy. Opiates & narcotics, Selective serotonin reuptake inhibitors (SSRIs), Antihistaminics (Diphenhydramine, Hydroxyzine), Marijuana, Ethchlorvynol, Nicotine, or Meprobamate etc are offending drugs. Symptoms depend on the specific drug the mother used during pregnancy, the amount of drug used, whether the baby was born premature or full-term, and how long the drug was used. Some symptoms can occur one to three days after birth or five to ten days and they include: diarrhea, blotchy skin coloring, vomiting, seizures, excessive crying, sweating, trembling, sleep problems, sneezing (stuffy nose), irritability, or poor feeding. Treatment depends on the baby’s overall health and symptoms. Babies are usually watched for vomiting and dehydrating and sometimes receive fluids through a vein. Some need medicine for withdrawal; Benzodiazepines for alcohol withdrawal and Methadone for heroin and other opiate withdrawal. Some doctors prescribe the baby whatever drug they were born addicted to and slowly wean the baby off by lowering dose. Babies who experience feeding problems need high calorie formula that provides more nutrition and smaller portions more often. Treatment relieves symptoms but how well the baby does depends partially on whether the mother continues to abuse drugs.

Pain killers in pregnancy:

Concern remains about common painkiller use during pregnancy. There doesn’t seem to be any evidence that paracetamol, if used occasionally, increases the risk of problems for the baby, but you should always be careful about taking them more than two or three times a week and see your doctor if you need to use them regularly. It’s probably best to avoid ibuprofen and codeine in early pregnancy and they shouldn’t be taken at all later in pregnancy, as the potential risks to the fetus are well known. Aspirin is also best avoided, especially towards the end of pregnancy, although there’s some research looking at whether in low doses, in the early stages, it may help to prevent recurrent miscarriage in some women.

Now new research published in the journal Human Reproduction suggests that mild painkillers such as aspirin, acetaminophen and ibuprofen may be linked to an increase in male reproductive disorders. The scientists from Denmark, Finland and France found that women who either took a combination of mild analgesics during pregnancy or took them during the second trimester of pregnancy had a greater risk of giving birth to baby boys with undescended testicles, a condition known as cryptorchidism, which may forecast poor semen quality and testicular cancer. Specifically, the researchers found that women who used more than one painkiller at the same time had a seven-fold increased risk of having sons with some form of cryptorchidism in comparison with women who took no analgesics. In the second trimester, any painkiller use more than doubled the risk of cryptorchidism, and simultaneous painkiller use increased the risk 16-fold. The scientists also pointed to work conducted on rats by two of the researchers who found that analgesics toyed with androgen production and led to decreased levels of testosterone when male fetal organs were forming. Researchers aren’t sure why that happens. The most important message is that if you take the occasional paracetamol, it’s not going to do your baby any harm.

Opioids and pregnancy:

Moms-to-be who take prescription opioid painkillers such as codeine, hydrocodone or oxycodone may increase the risk of birth defects in their newborns, according to a new U.S. government report. For women who took prescription pain killers, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect was about double. Taking these types of analgesics just prior to pregnancy or in the early stages of pregnancy was linked to a modest risk of congenital heart defects in an ongoing population study, according to the national Centers for Disease Control and Prevention. The risk for spina bifida, hydrocephaly, congenital glaucoma and gastroschisis was also heightened, the report said.

Labor pain:

Pain experienced during labor is probably the most painful event in the lives of women. Labor pain is a complex and subjective interaction between multiple physiologic, psychosocial, environmental plus cultural factors and a woman’s interpretation of labor stimuli. It must be emphasized that a women’s internal experience of pain is affected by the environment in which she is laboring. Environment itself influences a mother’s experience of pain. Environment can influence pain perception in women. Tension and stress resulting from pregnancy crisis and labor increase when the mother is hospitalized, which is concomitant with stressful situations and factors that affect pain perception during labor. A study found significant positive correlations between pain and tension from environmental factors in primiparous (r=0.16, p<0.01) and in multiparous (r=0.22, p<0.05) women. Furthermore, primiparous women believed that a crowded delivery room (70%) and restriction of movement and mobility (67%) contributed to their environmental stresses. Multiparous women believed that noise in the delivery ward (84%) and restrict of fluid intake (78%) increased their stresses. Performance of routine diagnostic tests in hospitalized pregnant woman, provision of invasive medical care during labor process and a noisy & crowded environment all influence the mother’s experience and perception of pain. Therefore, the medical staffs seem to play a great role in alleviating labor pain by reducing stressors, especially the objective ones that are more stressful.

Hot fomentation and cold fomentation:

A fomentation, from the Latin word fomentum, which means soothing application or poultice, is any warm, moist application that delivers heat to the body for healing. Nowadays, fomentation means applying or extracting heat from tissues by using various methods. Cold and hot fomentations have been used for many years to treat people with various ailments. Hot fomentations are more common than cold fomentations. Pain is the most common problem that is treated with hot fomentations. In the early stage of an injury cold fomentations can be given to treat the condition. As the condition becomes sub acute, hot fomentations replace the cold fomentations. For epistaxis (bleeding from nose), I used to advise ice packs (cold fomentation) to arrest bleeding as cold temperature will cause vasoconstriction and reduce bleeding from the blood vessel.

For acute injury, hot fomentation and massage will harm the patient. Massage will injure more number of blood vessels and prevent arrest of bleeding; which may enhance the swelling and worsen the pain. If a fracture is already present the gap will widen creating more problems to manage. Hot fomentation will cause vasodilation and prevent arrest of bleeding in acute injury. Also, hot fomentation will dilate the blood vessels more and help to increase the swelling by more extravasations of blood. That will give rise to more pain and swelling. So the rationale for icing an acute injury initially is to decrease the inflammation. This clearly helps. After 48-72 hours it is generally recommended that heat be applied to the area of injury. The impression is that this (heat) helps with pain relief in the majority of patients 48-72 hours after injury. After 48 to 72 hours, increased temperature given by hot fomentations will cause an increase in the blood flow in the body of the person affected. The increased blood flow causes the transport of nutrients from the other parts of the body to the wounded site and so helps in increasing the rate of healing. The increased blood supply to the injured part also helps in removing all the debris from the affected area. For sub-acute or chronic injury, heat can also help the tissue to be relaxed. Hot fomentations help to relieve these muscle spasms.

Indications for heat applications:

1. Muscle spasm, including infant colic caused by muscle tightness

2. Poor local circulation

3. Musculoskeletal pain (muscle soreness, stiff joints, arthritis pain, chronic back pain)

4. Muscle tightness

5. Warming of tissue to make it more pliable and stretchable before massage, especially for athletic persons with very dense tissue or areas with sensitive scar tissue

6. Soreness after deep massage

7. Menstrual cramps

8. Active trigger points

9. When derivation (a tissue-shifting effect) is desired moving blood toward the hot application and away from congested areas. Useful for migraine headache.

10. Nervous tension

11. Chilled local area

12. Chilled client

Local contraindications for heat application:

1. Loss of sensation (lack of feeling), which can be caused by spinal cord injury, diabetic neuropathy, other medical condition, or the use of some medications. These conditions can render the person unable to feel the pain of a too-hot application. Never put a hot application on a numb area.

2. Rash or other skin condition that could be made worse by heat

3. Inflammation

4. Swelling

5. Broken skin—burn, wound, sore, cracked skin from eczema or severe chapping

6. Malignancy

7. Implanted device such as cardiac pacemaker, stomach band, and infusion pump

8. Diabetics should not receive hot applications to the legs or feet.

9. Peripheral vascular disease, including diabetes, Buerger’s disease, and arteriosclerosis of the lower extremities

10. Sensitivity to heat, especially in those with thin skin, such as the elderly and small children, who might burn more easily

11. Any acute injury of less than 48 hours duration.

Caution for heat application:

1. Elderly (over 60 years old)

2. Children

A child’s pain perception: Plasticity and complexity:

A child’s pain perception can be regarded as plastic from a psychological, as well as biological, perspective. Tissue damage initiates a sequence of neural events that may lead to pain, but many developmental, social, and psychological factors can intervene to alter the sequence of nociceptive transmission and thereby modify a child’s pain. Child characteristics, such as cognitive level, sex, gender, temperament, previous pain experience, family, and cultural background generally shape how children interpret and cope with pain (Katz et al. 1980; Blount et al. 1991; Bennett-Branson and Craig 1993; Schanberg et al. 1998; Peterson et al. 1999; Chen et al. 2000; Chambers et al. 2002).

Pain in children:

Few studies reliably document the prevalence of pain in children. Research on the neurobiology of pain in early development has shown that infants, and children of all ages, have the capacity to perceive pain (Fitzgerald 2005). We must therefore assume that any experience expected to be painful for an adult is likely to cause pain in infants and children. Indeed, many factors increase the impact of pain in children, who are also often exposed disproportionately to pain.

Everyday pain: Minor bumps and bruises are very common in children in the course of active play and sport. They are usually not medically significant, nor can they all be reasonably avoided, but each episode provides an opportunity for learning about how to cope with pain, either magnifying or reducing the distress.

Short-term pain: lasting minutes, hours, or days may be caused by illness, trauma, or medical procedures such as immunization, blood tests, and surgery. Equivalently intrusive events are reported to be more painful by younger than by older children. Children are generally unable either to refuse or to rationalize painful experiences, so they suffer especially from invasive diagnostic procedures. There have been improvements in management of acute pain in some pediatric hospitals and units, but pain management techniques in many centers around the world have not progressed in the past 20 years. Advances in health care, such as new knowledge of pain prevention strategies, have not been consistently translated into decreased prevalence or intensity of pain experienced by children in hospitals.

Recurrent pain: in childhood arises from complex and multifaceted causes. Stomachaches, headaches, limb pain (“growing pains”), and chest or back pain are experienced occasionally to frequently by up to 30% of children. Even when such pain seems relatively minor in intensity, it may interfere with school and family life, causing both emotional and financial stress. So-called “functional” pains that lack an obvious pathological basis may be caused by subtle neurophysiological dysfunctions that are not easily characterized by everyday medical investigations, and thus are frequently minimized by clinicians.

Disease-related and chronic pain: Pain is the initial symptom of many childhood diseases. Cancer pain is a well-recognized concern in developed countries, and much of the focus of non-governmental organizations worldwide has been in this area (WHO 1998). Many children in the world live in developing countries and suffer an additional burden of pain from malaria, HIV/AIDS, sickle cell disease, and other conditions endemic in poorer countries with inadequate health care resources. For example, available options to man-age sickle cell pain vary significantly from country to country. Some children have diseases such as juvenile arthritis, migraine, and inflammatory bowel disease that cause chronic daily or near-daily pain. Children, like adults, can suffer neuropathic pain from complex regional pain syndrome or peripheral nerve or spinal cord injury. Children with chronic pain experience high levels of pain-associated disability. We still do not fully understand the risk factors for development of chronic pain in childhood, but prior untreated pain must be regarded as a likely candidate. Children’s chronic pain affects and is influenced by family factors. Children with chronic pain may be at higher risk for chronic pain in adulthood. Children with terminal illness experience pain from the cumulative effects of progressive disease, invasive procedures, treatment, and psychological distress. Special challenges arise in managing their pain and the side effects of pain treatment in the home setting.

Pain in children undertreated:

Two studies highlight how children’s pain problems were undertreated during this period. In 1968, Swafford and Allan surveyed analgesic use for all children treated in an intensive care unit during a 4-month period. Only 14% of children (26 of 180) had received any opioids for pain relief. Moreover, only 3% of children received analgesics after general surgery, presumably because “Pediatric patients seldom need relief of pain after general surgery. They tolerate discomfort well” (Swafford and Allan 1968). Subsequently, Eland (1974) compared medication use for 18 adults and 25 children with similar medical conditions during their hospitalization. While 372 opioid doses and 299 non-opioid doses were administered to adults, only 24 analgesic doses were administered to children. In fact, more than half of the children did not receive any analgesics, despite undergoing major trauma including amputation of the foot, excision of neck mass, and heminephrectomy.

Treating Children’s Pain

Most pain can be prevented, treated, or at least reduced using inexpensive pharmacological, psychological, and physical techniques. Yet even in developed countries, deficiencies in children’s pain management persist (Ellis 2002; Jacob and Puntillo 2000; Johnston 2005), and it is certain that most children in the developing world receive inadequate pain care. A substantial body of research shows the effectiveness of cognitive and behavioral techniques, such as information giving, paced breathing, progressive muscle relaxation, hypnosis, and imagery for reducing children’s pain and distress from invasive procedures (Kuttner and Culbert 2003). Despite this evidence, few children and parents are taught anxiety-reducing skills to prevent or reduce pain during and after procedures. There is broad clinical experience and considerable research on pharmacological treatment for children’s acute pain in pediatric specialty settings in developed countries, although data on chronic pain is sparse. However, this knowledge is applied inconsistently in North America, Europe, and other developed countries, and hardly at all in many low and middle- income countries of the developing world (Forgeron et al. in press). Health care providers and parents often worry that pain medication will be dangerous for children. In fact, developmental concerns with analgesic treatment are minimal once the neo-natal period is past, other than dosing appropriate for the size of the child. There is no evidence that children become addicted to strong opioids that are prescribed appropriately for pain treatment.

Distraction is a simple and very effective way to reduce pain for infants and children:

Distraction tends to work best for mild pain and how you distract your child will depend on his or her age. Babies can be distracted with colorful mobiles and mirrors. Younger children can be distracted with blowing bubbles or party blowers, reading a favorite book, playing with a musical toy or with the use of virtual reality glasses. Older children can choose what they wish to be distracted with, a hand-held video game, for example.

Sucrose for analgesia in newborn infants undergoing painful procedures:

Forty-four studies enrolling 3,496 infants were included in a meta-analysis. Sucrose significantly reduced duration of total crying time (seconds). There were no differences in adverse effects between sucrose and control groups. Sucrose is safe and effective for reducing procedural pain from single events. An optimal dose could not be identified due to inconsistency in effective sucrose dosage among studies.

Fetal pain:

Fetal pain has so many implications that it requires a scientific appraisal independent of the heated controversies regarding abortions, women’s rights, or the beginnings of human life. These implications include pain perception in preterm neonates, anesthesia for fetal surgery or intra-uterine procedures, and the long-term consequences of perinatal anesthesia/analgesia on brain development. The available scientific evidence makes it possible, even probable, that fetal pain perception occurs well before late gestation. Those attempting to deny or delay its occurrence must offer conclusive evidence for the absence of fetal pain at given levels of maturity. When developmental time is translated across animal species to humans, it is clear that functionally effective patterns of sensory processing develop during the second trimester. Thalamocortical interactions located in the subplate zone persist into maturity, thus providing a functional template for subsequent cortical processing. Several lines of evidence indicate that consciousness depends on a subcortical system and that certain contents of consciousness are located in cortical areas. These subcortical structures, which develop much earlier than the cortex, may play a pivotal role in sensory perception. Our current understanding of development provides the anatomical structures, the physiological mechanisms, and the functional evidence for pain perception developing in the second trimester, certainly not in the first trimester, but well before the third trimester of human gestation.

Gender difference in pain perception:

Traditionally, biomedical research in the field of pain has been conducted with male animals and subjects. Over the past 20–30 yr, it has been increasingly recognized that this narrow approach has missed an important variable: sex. An ever-increasing number of studies have established sex differences in response to pain and analgesics. These studies have demonstrated that the differences between the sexes appear to have a biological and psychological basis. The terms “sex” and “gender” are not synonymous. According to the Institute of Medicine definition, sex is “the classifications of living things, generally as male or female according to their reproductive organs and function assigned by the chromosomal complement.” Gender is “a person’s self-representation as male or female, or how that person is responded to by social institutions on the basis of the individual’s gender presentation.” The lack of semantic precision in the literature can and has led to confusion and faulty conclusions.

The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 & 42 weeks and with 25 &120 hrs of life were studied. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.

Science is providing new insights into pain relief, anesthesia and, oddly enough, redheads. Females are more sensitive to pain, less tolerant and more able to discriminate different levels of pain than males. This is true in studies of both humans and animals. Women are also much more likely to suffer from chronic pain conditions than men. Researchers originally suspected that this was primarily due to the fact that they are more likely to seek medical care in general. But while women do indeed seek more care, they’re also genuinely more likely to develop painful conditions like fibromyalgia, rheumatoid arthritis and migraines. For example, 80 to 90 percent of people with fibromyalgia are women, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Scientists have discovered that women’s experience of pain may be not only quantitatively different, but qualitatively as well. Pregnancy actually is the exception to the rule. While pregnant, women do become progressively less sensitive to pain as they get closer to giving birth. Natural painkillers like endorphins are elevated during pregnancy and labor, helping fight pain.

Picture above shows while experiencing pain, the right amygdala is activated more in men, and it has more connections to regions of the brain involved with external environment. In women, the experience of pain activates the left amygdala more, which has more connections to regions of the brain associated with internal functions.

Center for Neurovisceral Sciences & Women’s Health (CNS) at UCLA, which conducted the study and published in the June 2003 issue of the journal Gastroenterology, the study examined 26 women and 24 men with IBS. UCLA researchers took positron emission tomography (PET) brain scans of patients during mild pain stimuli. Although researchers found some overlapping areas of brain activation in men and women, several areas of male and female brains reacted differently when given the same pain stimulus. The female brain showed greater activity in limbic regions, which are emotion-based centers. In men, the cognitive regions, or analytical centers, showed greater activity. The reason for the two different brain responses may date back to primitive days, when the roles of men and women were more distinct. These gender differences in brain responses to pain may have evolved as part of a more general difference in stress responses between men and women. Men’s cognitive areas may be more highly triggered because of the early male role in defending the homestead, where in response to stress and pain, the brain launched a calculated fight-or-flight reaction. The female limbic regions may be more responsive under threat because of their importance in triggering a nurturing and protecting response for the young, leading to a more emotion-based response in facing pain and stress. Researchers noted that both responses have advantages and neither is better. In fact, under conditions of external threat, the different responses may lead to complementary behaviors between men and women. Men were more unwilling than women to report pain, and that women seek medical advice more often than men as this difference may be an evolutionary survival advantage for women, rather than a perceived weakness, some researchers speculate. Because pain drives most people to seek treatment in the first place, women may reduce the chance of significant tissue damage if they get checked out early.

Biological explanations for gender based pain differences:

A number of scientists have hypothesized about potential biological explanations for gender pain differences. Berkley described three aspects of male and female biology that plainly differ: the pelvic reproductive organs, types of circulating hormones, and cyclical changes in hormone levels. Other biological explanations for the differences in pain response include mechanisms of analgesia having to do with opioid receptors in the body, mechanisms of nerve growth factor, and sex-based differences in sympathetic nervous system function (e.g., sex-based differences in areas of the brain associated with reproduction). That these differences could result in men and women experiencing different emotional responses to pain (e.g., anxiety, fear, depression, or hostility). A number of studies have added to the body of literature on the influence of reproductive hormones on biological pain differences. Berkley concluded that the reproductive hormones appear to influence sex-based pain differences through the action of a number of neuroactive agents, such as dopamine and serotonin. Giamberardino and colleagues found that a woman’s pain sensitivity increases and decreases throughout her menstrual cycle, with skin, subcutaneous tissue, and muscles being affected differently by female hormonal fluctuations. They also found that sex-based differences in pain response may depend on the proximity of the stimulus to external reproductive organs. Fillingim and colleagues found that the menstrual cycle produced greater effects on ischemic (i.e., lack of blood flow and oxygen), compared with thermal, pain sensitivity. The authors suggest that opiate receptors could be desensitized by reproductive hormones during certain phases of a woman’s menstrual cycle, thus increasing pain sensitivity (particularly ischemic pain sensitivity) at those times. Some research has shown differences in the brain and central nervous system of men and women that may contribute to differences in pain response. For example, Fillingim and Maixner describe neural mechanisms that contribute to sex based differences in the perceptual, emotional, and behavioral responses to noxious stimuli. These include peripheral afferents (impulses sent to the brain), brain and central nervous system networks, and peripheral efferents (commands sent from the brain to the muscles). The authors note differences in female tissue thickness and sensory receptor density as one example of structural differences in females that may contribute to enhanced perception o sensation to the skin.

Culture, gender, and pain:

There are [so many] overlays of societal and cultural norms and other factors that go into the reporting of pain that it may not have a biological basis at all. The interplay between behavior and the value systems of a culture is complex and may influence pain perception in many ways. Children are socialized from a very young age to think about pain and to react to painful events in certain ways. In many societies, boys are actively discouraged from expressing emotions. When a boy falls down and cries due to pain; parents say, don’t cry, don’t behave like a girl. So in many cultures, boys must bear pain and not express it, otherwise they will be ridiculed.

Gender and Pain Management

There is a growing body of literature that indicates women are more likely than men to be undertreated for their pain. It appears that gender affects not only pain perception, pain coping, and pain reporting, but also pain-related behaviors, including use of healthcare and the social welfare system. It is also probable that men and women differ systematically in their responses to pain treatments, although further research is needed in this area. Whatever the pain prevalence differences for men and women, most studies show that women seek healthcare for pain at a higher rate than men. On the other hand, studies have shown differences in the attitudes of healthcare providers toward men’s and women’s experiences of pain with neglect of women’s pain by physicians. Historically, medical literature has portrayed women as hysterical and oversensitive. By extension, physicians often view women’s statements as emotional, rather than objective. In one study of patients with chronic pain, female patients were more likely than their male counterparts to be diagnosed with histrionic disorder, excessive emotionality, and attention-seeking behavior. Also, regarding physician’s perception of female patients with pain, Hadjistavropoulos and colleagues found that physicians distinguished between their “attractive” and “unattractive” patients. Attractive female patients were perceived as experiencing less pain than unattractive female patients, evidencing a “healthy is beautiful” stereotype. One study indicated that women are more likely to be given sedatives for their pain and men to be given analgesics.

A striking discovery is that the painkiller morphine works differently in the brains and spinal cords of males and females. Animal experiments have revealed that females require twice the dosage as males to experience the same amount of pain relief. Morphine binds to mu opioid receptors – cell membrane proteins that influence the behavior of cells – in order to decrease pain. Previously, studies of opioid receptors had focused exclusively on males. Although this protein is located in the same brain region, males seem to have higher levels of the receptor than females, and it is expressed differently. Researchers suspect that this distinction may account for sex differences in pain relief.

Pain and race:

Past research has shown that race can affect the way that adults express their pain. A 2002 study published in the International Journal of Intercultural Relations found that black patients were less likely to disclose the fact that they were in pain than their white counterparts. When they did discuss their pain they were less likely to describe its intensity. And doctors might also be less skilled in recognizing the pain of certain races. Specifically, doctors were almost twice as likely to underestimate the pain of black patients compared to other ethnicities in a 2007 study from the University Of Tennessee College Of Medicine. Whether either of these findings applies to pain in children is simply not known. However, a new study found that black children seen in the emergency department for abdominal pain are less likely to receive pain medication than white children.

Few words about of chronic pain:

Chronic pain has been increasing in prevalence. It is considered the most underestimated health care problem impacting quality of life. A number of epidemiological studies conducted in different parts of the world, reported prevalence rates of chronic pain ranging from 12-80%. Chronic pain has detrimental effects on physical and mental health, daily activities, family relationships, employment, and economic well-being of the sufferers and family caregivers.

The table above shows magnitude of chronic pain

The figure above shows domains of chronic pain.

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The exact mechanisms involved in the pathophysiology of chronic pain are complex and remain unclear. It is believed that following injury, rapid and long-term changes occur in parts of the CNS that are involved in the transmission and modulation of pain (nociceptive information) (Ko and Zhuo, 2004). Central nociceptor pathways are sensitized and reorganized if pain is prolonged and tissue is damaged. A central mechanism in the spinal cord, called ‘wind-up’, also referred to as hypersensitivity or hyperexcitability, may occur. Wind-up occurs when repeated, prolonged, noxious stimulation causes the dorsal horn neurones to transmit progressively increasing numbers of pain impulses. The patient can feel intense pain in response to a stimulus that is not usually associated with pain, for example, touch. This is called allodynia. This abnormal processing of pain within the PNS and CNS may become independent of the original painful event. In some cases, for example, amputation, the original injury may have occurred in the peripheral nerves, but the mechanisms that underlie the phantom pain are generated in both the PNS and the CNS.

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Chronic pain (also called persistent pain) can be caused by ongoing tissue damage, such as in osteoarthritis. However, in some cases no physical cause for the pain can be found or pain persists long after the injury has healed. In many cases chronic pain is a disorder in itself rather than being the symptom of a disease process.

At the cellular level, several processes can contribute to pain becoming chronic.

1. Pain receptors and neurones along the pain pathway may become too easily activated.

2. Connections between the neurons in the pathway can be altered.

3. The brain and spinal cord may fail to dampen down the pain signals.

4. Pain receptors that are normally silent (dormant) can become activated by inflammation.

5. After nerve injury, nerves may regrow but function abnormally.

The table above shows possible mechanisms of chronic pain

The figure above shows how chronic pain builds up and persists.

The figures below shows gray matter loss in chronic pain:

Chronic pain and sex:

Sexual intercourse usually causes some degree of discomfort in people who suffer from chronic pain. If some part of the body is very painful, then, whether you’re a man or a woman, sex is bound to suffer. The extent to which your sex life is affected depends on how widespread the pain is and which part of your body is affected. If you take medication to control your pain, try to time sex for when your medicine’s therapeutic effect is at its peak. Experiment with different positions that lessen physical strain, such as lying side by side. It can help to warm the bed in advance with an electric blanket to ease muscle and joint discomfort. Also, do some gentle stretches and use polyester or silk sheets to make it easier to turn and move in bed. Try touching, cuddling, massaging and kissing, without intercourse initially. Talk openly and honestly to your partner about how pain affects your enjoyment of sex, and what you want & need from your relationship and each other. On the other hand, research suggests that sexual activity, when comfortable, is often followed by several hours of pain relief. The key is to return to some form of sexual activity as soon as possible. The longer you avoid sex, the bigger the fear of resuming sex becomes, and a downward spiral sets in. The lack of intimacy can damage your relationship.

Heritability of pain:

From a Darwinian perspective, nociceptive pain is neither possible to eliminate nor is it desirable to do so. Nociception is essential for survival and, if a variation in a pain mechanism gene alters the function of a nociception-related molecule, the survival rate would be diminished. For instance, without pain mechanisms, people would not recognize the danger of leaving their hand on a hot stove. Mutations leading to decreased pain sensitivity occur in well under 1% of the population and lead to frequent injuries and inadvertent self-mutilation, which are incompatible with longevity or transmission to offspring.

The genetics of human pain has been the subject of intense study in the past decade. The completion of the human genome project in 2003 has provided a better understanding of why patients may experience pain syndromes. Substantial evidence from preclinical models suggests that basal nociceptive sensitivity—neural processes of encoding and noxious stimuli—as well as antinociceptive responses to drugs show significant heritability. Evidence of genetic influences on pain sensitivity in humans has yet to be clinically applied. Polymorphisms—the normal differences in DNA sequences among individuals in a population—of receptors, transporters, metabolizing enzymes, and targets of pharmacotherapy are under investigation. Substantial evidence indicates that a large component of the pain experience, such as acute pain thresholds or efficacy of analgesics, is inherited. The involvement of channelopathies in human pain conditions has been highlighted by evidence from analysis of pain phenotypes in transgenic animal models. Aberrant channel expression has also been linked to chronic pain evoked by physical insults. Hence understanding the ion channels involved in the pathophysiology of human pain conditions could provide opportunities for the development of novel therapeutic agents as well as furthering our insights into the functioning of the nervous system.

The figure above shows schematic of ion channels in nociceptor function. The cell bodies of nociceptors are contained within the dorsal root ganglia and terminate as free endings in peripheral tissues. The peripheral terminals respond to noxious stimuli or tissue damage through receptors and ion channels including TRP channels, acid-sensing ion channels (ASIC), serotonin (5-HT) receptors, ATP-gated P2X receptors, tyrosine kinase receptor A (TRKA), and numerous GPCRs that indirectly activate ion channels. Receptors at the terminals respond to noxious stimuli such as heat or pressure. When a defined threshold of depolarization is reached, voltage-gated sodium channels are activated and an action potential is generated. During an action potential, an IFM-inactivating segment moves to block the channel within 0.5–1 ms. In this inactivated state, the channel cannot be opened. Meanwhile, potassium channels open, acting to repolarize the membrane. As the membrane repolarizes, the sodium channel gate is closed and inactivating segment is displaced, returning the sodium channel to a resting closed state. This process is repeated to propagate the action potential along the axon. The action potential is propagated along the axon to the presynaptic terminals synapses with second-order neurons in the dorsal horn. Calcium influx through voltage-gated calcium channels (VGCC) triggers the release of neurotransmitters such as glutamate from presynaptic terminals. Glutamate activates ionotropic AMPA, NMDA receptor (NDMAR), and metabotropic glutamate receptors (mGluR) on the postsynaptic terminals in the spinal cord, and the signal is transmitted through the ascending pathways to higher centers in the brain.

Biophysical properties of ion channels can determine nociceptor excitability, and hence abnormal channel function or expression could lead to chronic or neuropathic pain. The time and voltage dependence of activation and inactivation processes modulate duration and frequency of action potentials in nociceptors. The Na+ channels Nav1.7 (SCN9A) and Nav1.8 (SCN10A) have been shown to be important in nociceptive pathways. As importantly, slowly inactivating Na channels contribute to sub-threshold potentials that determine whether a spike is generated in response to a depolarizing noxious stimulus. Nav1.9, preferentially expressed by nociceptors, has slow activation and inactivation kinetics that allow it to amplify response to sub-threshold stimuli. Nav1.7 has fast activation and inactivation kinetics but is also able to respond to slow depolarizations because of the properties of the channel in the closed state, and hence can amplify sub-threshold potentials. Thus the biophysical properties of ion channels can determine nociceptor responses to noxious stimuli and ultimately the level of pain experienced. Many inherited human sodium channelopathies impact the activation and inactivation of these channels, resulting in altered neuronal response to stimuli.

Familial hemiplegic migraine (FHM), Congenital insensitivity to pain (CIP), Paroxysmal extreme pain disorder (PIPS) and Familial episodic pain syndrome (FEPS) are few disorders inherited as monogenic channelopathy. The table above shows a synopsis of monogenic channelopathy–associated human pain syndromes. Although they are extremely rare, study of these familial pain syndromes has provided a unique insight into the ion channels involved in human pain. In addition, discussion on transgenic animal models has broadened our knowledge of the functional role of ion channels in pain transduction and the mechanisms of pathological pain. Translating data obtained from animal models to human pain pathology remains challenging, because there are subtle differences in pain mechanisms between mice and humans. For instance, antagonists of substance P acting at the NK1 receptor are analgesic in mice but not humans. The use of transgenic mouse models is nonetheless generally useful in advancing the molecular understanding of pain sensation and the development of novel therapeutics, because there are broad similarities in pain processing in mice and humans. The central role of ion channels in chronic pain and in diseases of excitability such as epilepsy is underscored by the utility of similar drugs for both pathologies. The study of human heritable disorders of pain has suggested new analgesic drug targets, but many mouse knockout studies of ion channels implicated in pain have yet to be linked to human pain conditions. Results from ion channel gene deletion studies in mice are informative but highly dependent on a comprehensive analysis of phenotype. Understanding subtle changes in function and the levels and spatiotemporal patterns of ion channel expression holds the key to controlling neuronal excitability in altered pain states. Thus, information from monogenic human pain syndromes coupled to human pain GWASs, together with in-depth phenotyping of targeted mutant mouse models will help identify channels and regulatory genes that contribute to pathological pain.

CIP:

Congenital insensitivity to pain (CIP), also known as congenital analgesia, is one or more rare conditions where a person cannot feel (and has never felt) physical pain. For patients with this disorder, cognition and sensation are otherwise normal; for instance patients can still feel discriminative touch (though not always temperature), and there are no detectable physical abnormalities. Children with this condition often suffer oral cavity damage both in and around the oral cavity (such as having bitten off the tip of their tongue) or fractures to bones. Unnoticed infections and corneal damage due to foreign objects in the eye are also seen. Because the child cannot feel pain they may not respond to problems, thus being at a higher risk of more severe diseases or otherwise. This disorder can be due to mutations in the voltage-gated sodium channel SCN9A (NaV1.7). Patients with such mutations are congenitally insensitive to pain.The disorder is primarily found in homogeneous societies. For example, it is found in Vittangi, a village in Kiruna Municipality in northern Sweden, where nearly 40 cases have been reported. Also, Ashkenazi Jews have been found to have a higher risk, though it is still unusual.

Mu opioid receptor (MOR):

The mu receptor OPRM1 is the primary target site for opioid medications. The gene for this receptor is located on chromosome 6 and is a significant factor in the variability of how a patient responds to opioids. The most common single nucleotide polymorphism (SNP), or base-pair change, of the MOR gene consists of a change of adenine to guanine in the 118 position that leads to a substitution of the amino acid asparagine for aspartate. This substitution affects the function of the receptor by increasing its binding affinity for β-endorphins and subsequently affects the action of opioids at the receptor site.

Pain research:

Research on pain is focused on neurobiology studies concerning neuronal plasticity development, nociceptors molecular identity, signaling mechanisms, ionic channels involved in the generation, modulation & propagation of action potentials in all type of excitable cells. All these findings open the possibility for developing new therapeutic treatment. The interest of researchers for receptors, neurotransmitters, second messengers, transcription factors involved in neuronal processing, in spinal cord and in cortical areas, increased dramatically. There are evidences clarifying the origin of chronic pain.

Recent breakthroughs in our understanding of pain mechanisms can be traced to the introduction of molecular biology techniques into pain research. New ion channel proteins involved in generating, modulating, and propagating action potentials along nociceptor axons have been cloned and characterized using molecular biology techniques. These techniques continue to reveal nociceptive mechanisms involving molecules, receptors, and neural networks that underlie neural reorganization (“plasticity”) in the spinal cord and brainstem after peripheral tissue damage or nerve injury. At the latest IASP World Congress, in his presidential address Professor Besson voiced concern that clinical and basic research appear to be diverging, even as dramatic new insights into fundamental mechanisms of nociception promise therapeutic breakthroughs. It is normal for considerable time to elapse between the development of new information from basic research and its application in the clinic.

Cravatt has been studying how fatty acid amines that are found in neural tissue and fluids can reduce sensitivity to pain. He and his researchers have been testing mice to see if they are less sensitive to pain in response to changing amide levels. On the molecular level, Cravatt’s lab is the first to actually manipulate the entire fatty acid communications system. During the course of his investigations, Cravatt came across fatty acid amide hydrolase (FAAH), an amino acid membrane-bound enzyme that is a target for pain therapy not only because it breaks down the molecules that provide the pain relief but also because it turns out that FAAH seems to be the only enzyme responsible for doing so.

Pain and Peptides:

TSRI Professor Tamas Bartfai, Ph.D., Director of the Harold L. Dorris Neurological Research Center is interested in the neuropeptide galanin. This chemical exists specifically in hippocampus neurons and is released into the gaps, or synapses, between two neurons during the signaling from one neuron to another that takes place during cognitive processes. Galanin also controls the pain threshold at the spinal cord level through the same neuronal action in the spinal cord that morphine uses – hyperpolarizing primary sensory neurons. Transgenic models with no galanin receptors have different pain thresholds. One possible application for this is to develop a class of galanin receptor agonists – non-opiate pain relievers that could be taken with morphine, for instance, to lower required doses of morphine.

Neuronal heterogeneity and pain processing:

Everyone knows how it feels to bite into a hot chili pepper or burn the roof of one’s mouth with a hot drink. This activates nerve cells that relay the potential threat to the brain, which then causes the person in question to perceive pain. Over 14 years ago, researchers discovered the first receptor molecule that reacts to heat as well as to capsaicin, the active substance in chili extracts. At the time it was believed that science had come a big step closer to understanding the emergence of pain and its treatment with medicine. The disappointment was great when it was found several years later that laboratory mice from whom the gene of this receptor had been artificially removed still perceived pain. Despite repeated attempts to explain the causes of this observation, it has remained a mystery until now. Researchers at the University of Freiburg have now deciphered basic mechanisms governing the perception of pain. Their findings, published in the journal PLoS One, demonstrate that even simple organisms possess sensor systems with multiple safeguards for the perception of painful stimuli like heat. The roundworm only has 302 nerve cells at its disposal, but this small number is sufficient for complex behaviors and even for learning processes. The study shows that the worm uses at least six of these cells as sensors to detect dangerous heat. In order to perceive pain, however, the worm needs to use more than one of them at a time. In addition, one and the same cell can react to the painful stimulus with two different molecular mechanisms. According to the researchers, the findings can now be used to discover and understand the interactions between the various mechanisms for these processes in humans.

N type calcium channel and opioids:

At the synapse — the point of connection between nerve cells — N-type calcium channels control the release of neurotransmitters. These chemicals carry messages between nerve cells — messages that include sensations of pain. So if you block N-type channels, you can block pain. In 2004, Lipscombe and her colleagues discovered a unique form of the N-type channel at synapse between first order sensory neuron and second order sensory neurons responsible for nociception. These are the channels that opioids act on. Opiods act on a special form of N-type calcium channel, the cellular gatekeepers that help control pain messages passed between nerve cells. All N-type channels are made up of a string of about 2,400 amino acids. In nociceptor N-type channels, that string differs by a mere 14 amino acids. This small difference in molecular make-up makes these channels much more sensitive to the pain-blocking action of opioids. By blocking these channels, pain signals are inhibited.

LTP:

Long-term potentiation (LTP) at synapses of nociceptive nerve fibers is a proposed cellular mechanism underlying some forms of hyperalgesia. LTP at synapses between primary afferent C-fibers and a group of nociceptive neurons in spinal cord lamina I which express the NK1 receptor for substance P is a potential mechanism underlying some forms of pain amplification in behaving animals and perhaps human subjects. Both, LTP and hyperalgesia involve the same essential elements, i.e. primary afferent C-fibers and lamina I neurons which express the NK1 receptor. Further, induction protocols, pharmacological profile and signal transduction pathways are virtually identical.

The capsaicin receptor: a heat-activated ion channel in the pain pathway:

Capsaicin, the main pungent ingredient in ‘hot’ chilli peppers, elicits a sensation of burning pain by selectively activating sensory neurons that convey information about noxious stimuli to the central nervous system. Researchers have used an expression cloning strategy based on calcium influx to isolate a functional cDNA encoding a capsaicin receptor from sensory neurons. This receptor is a non-selective cation channel that is structurally related to members of the TRP family of ion channels. The cloned capsaicin receptor is also activated by increases in temperature in the noxious range, suggesting that it functions as a transducer of painful thermal stimuli in vivo.

Anticipating Pain:

For some people, anticipating pain can be as bad as the real thing. Dread can be a real pain describes research conducted by Dr. Gregory Berns of Emory University. The brain activity measured during the anticipation phase was actually occurring in the brain’s pain center, according to fMRI used to show dread responses in brain: The scans showed that brain activity related to dread was localized in the areas of the brain associated with pain. Dread was found in the parts of the pain network linked to attention. This is important because it suggests that dread is not as simple as fear or anxiety, which are emotions controlled by different brain regions. The findings also showed that the mild and extreme dreaders had different patterns of brain activity. The extreme dreaders had more activity in the attentional parts of the pain matrix, and this activity was seen much earlier in each trial compared to the mild dreaders. Marketers have long used graphic representations of pain in advertisements. Research on whether an ad can trigger similar dread feelings or create activity in the same pain centers hasn’t been published yet, but it seems likely. Between mirror neurons “simulating” an observed (or even heard) action by another, and pain centers being triggered by thinking about future pain, it’s clear that marketers may have the opportunity to create discomfort among their targets.

Stress induced analgesia:

Scientists have long known about the phenomenon of stress-induced analgesia (SIA), best exemplified by the many reported cases of wounded soldiers and injured athletes who feel no pain while the battle or the game is on, but do feel it afterward, as soon as they are back in conditions of safety and calm. From an evolutionary standpoint, stress-induced analgesia can be regarded as a component of the fight-or-flight response. It would not be highly adaptive if pain from injuries could prevent us from fighting or fleeing even when our lives depended on it. But once the threat of death has passed, our normal pain-sensing mechanisms have to do their work in order to immobilize the injured part of the body and prevent the injury from getting worse. Research done on the mechanisms of the descending control pathways for pain since the early 1980s has now given us a better understanding of stress-induced analgesia. We now know that the tendency to experience this phenomenon varies from one individual to another and is influenced by variables such as age, sex, degree of sensitivity to opiates, and past stressful experiences. The mechanisms by which stress-induced analgesia inhibits pain seem to involve the descending systems of the midbrain, applying both opioid and non-opioid mechanisms. Research is also tending to show that neurotransmitters associated with stress, such as norepinephrine, and brain structures associated with fear reactions, such as the amygdala, are also involved. Many other endogenous substances, such as anandamide and its cannabinoid receptors, also seem to play a role, in this case in the non-opioid effect in the periaqueductal grey matter.

Current scientific view on pain:

Neuroscientists nowadays think of the nervous system as plastic. They no longer believe the relay of pain information to be based on an immutable relationship between a painful stimulus and the sensory output of pain. Rather, the perception of pain results from the integration of information from a variety of sources. Of course information is relayed from the injured tissue or organ in the periphery, but the strength of this signal can be modified by emotional and behavioral information coming down from the brain, as well as by inputs from other peripheral sensations. Furthermore, biologists now think that the integration of these signals actually takes place in the spinal cord, not in the brain, and that the integrated information is then carried up to the brain for further processing. C. Woolf and M. Salter (Science 2000 288:1765) recently enumerated the three general levels at which neural information could be modified in response to chronic pain. They noted that the extent and duration of the response to the stimulus at the periphery could be modified. Alterations can also take place at a chemical level within any one or several of the neurons along the pain-conduction pathway. These include changes in the number or sensitivity of receptors, ion channels and internal signaling molecules. Finally, chronic pain can induce a modulation of the neurotransmitters that affect the flow of information from one neuron to the next, or it can even alter the anatomical features of these neurons and their interconnections. The set of alterations described by Woolf and Salter may lead to long-term changes in the connectivity and organization among nerve cells. This, in turn, may lead to a “pain memory”, not much different from ordinary memory in the brain.

Pain benefits:

Although pain is something that we invariably want to escape or to stop, it serves several very important functions. Pain protects us by triggering a reflexive withdrawal from something damaging before we can suffer further injury, such as when we drop a hot pan before we sustain extensive burns. It is also a warning system that lets us know when an injury is about to occur: the burning ache in our muscles during extreme exertion warns us to stop using them. Pain forces us to immobilize or protect an injured part, such as a broken ankle, thus giving it a chance to heal. Pain also lets us know when we need to seek medical help, and teaches us what behaviors to avoid in the future.

Pain not only a warning but could help recovery:

The intense pain of a heart attack could actually help patients, researchers have discovered. They have found that during an attack – when a blood clot blocks an artery that is serving the heart with oxygen – pain signals from cardiac nerves help to attract stem cells to repair the damage. Heart attack patients are routinely treated with morphine to ease the intense pain, but morphine operates by blocking pain-inducing substances, including the one that stimulates stem cell activity in artery walls. Its use could therefore have serious implications for a patient’s long-term recovery. A key molecule in the body’s ability to sense pain, called Substance P, is released from nerve terminals in the heart during a heart attack. Substance P then mobilizes stem cells from the bone marrow to the site of the artery blockage. These stem cells have the ability to generate new blood vessels to bypass the blockage and restore some of the blood flow. Pain is a very complicated process. It’s not just the body’s way of warning you that something is wrong; when we feel pain, it can also be a sign that the body is doing what it can to fix the problem.

Pain vis-à-vis pleasure, evolution and duality of existence:

On the evolutionary hypothesis, the fact that pleasures are generally associated with beneficial, and pains with detrimental, experiences, is the result of natural selection among random variations: those individuals who happen to have an association of this kind have higher biological fitness than those who have no such association, or the reverse association. The fact that pain states are associated with damaging experiences is the result of natural selection. Pain is an adaptive trait and improves the survival value.

Evolutionary and behavioral role:

Pain is part of the body’s defense system, producing a reflexive retraction from the painful stimulus, and tendencies to protect the affected body part while it heals, and avoid that harmful situation in the future. It is an important part of animal life, vital to healthy survival. People with congenital insensitivity to pain have reduced life expectancy. The most fit creature would be the one whose pains are well balanced. Those pains which mean certain death when ignored will become the most powerfully felt. The relative intensities of pain, then, may resemble the relative importance of that risk to our ancestors (lack of food, too much cold, or serious injuries are felt as agony, whereas minor damage is felt as mere discomfort). This resemblance will not be perfect, however, because natural selection can be a poor designer. The result is often glitches in animals, including supernormal stimuli. Such glitches help explain pains which are not, or at least no longer directly adaptive (e.g. perhaps some forms of toothache, or injury to fingernails). Idiopathic pain (pain that persists after the trauma or pathology has healed, or that arises without any apparent cause), may be an exception to the idea that pain is helpful to survival, although some psychodynamic psychologists argue that such pain is psychogenic, enlisted as a protective distraction to keep dangerous emotions unconscious.

There is strong evidence of biological connections between the neurochemical pathways used for the perception of both pain and pleasure, as well as other psychological rewards. One approach to evaluating the relationship between pain and pleasure is to consider these two systems as a reward-punishment based system. When pleasure is perceived, one associates it with reward. When pain is perceived, one associates with punishment. Evolutionarily, this makes sense, because often times, actions that result in pleasure or chemicals that induce pleasure work towards restoring homeostasis in the body. For example, when the body is hungry, the pleasure of rewarding food to one-self restores the body back to a balanced state of replenished energy. Like so, this can also be applied to pain, because the ability to perceive pain enhances both avoidance and defensive mechanisms that were, and still are, necessary for survival. On an anatomical level, it can be shown the source for the modulation of both pain and pleasure originates from neurons in the same locations, including the amygdala, the pallidum, and the nucleus accumbens. At the systems level, the major regions that have been implicated in pain and reward processing by functional imaging studies and direct brain stimulation in humans, as well as by electrophysiology and tracing studies in animals, show striking overlap. Not only have Leknes and Tracey, two leading neuroscientists in the study of pain and pleasure, concluded that pain and reward processing involve many of the same regions of the brain, but also that the functional relationship lies in that pain decreases pleasure and rewards increase analgesia, which is the relief from pain. There is also scientific evidence that one may have opposing effects on the other. Pain and pleasure are powerful motivators of behavior and have historically been considered opposites. Emerging evidence from the pain and reward research fields points to extensive similarities in the anatomical substrate of painful and pleasant sensations. Recent molecular-imaging and animal studies have demonstrated the important role of the opioid and dopamine systems in modulating both pain and pleasure. Understanding the mutually inhibitory effects that pain and reward processing have on each other; and the neural mechanisms that underpin such modulation; is important for alleviating unnecessary suffering and improving well-being. So why would it be evolutionarily advantageous to human beings to develop a relationship between the two perceptions at all? Dr. Kringelbach suggests that this relationship between pain and pleasure would be evolutionarily efficient, because it was necessary to know whether or not to avoid or approach something for survival. According to Dr. Norman Doidge, the brain is limited in the sense that it tends to focus on the most used pathways. Therefore, having a common pathway for pain and pleasure could have simplified the way in which human beings have interacted with the environment.

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Tonic dopamine signaling:

To maintain homeostasis, animals must aim for the ‘Golden Mean’ — that is, the right balance between pleasure-seeking and pain-avoidance. Tonic dopamine activity refers to the level of extrasynaptic dopamine that is present at a steady-state concentration in the extracellular space. The responsiveness of the phasic dopamine system (a system which is caused by brief bursts of neuronal firing and relates to reward motivation and prediction error) is important for the regulation of appetitive and aversive behaviors. Impulsive behavior and schizophrenia have been linked to an excessively responsive phasic dopamine system, whereas depression, chronic pain and anhedonia have been associated with low responsiveness to reward cues. Increased tonic dopamine is known to result from prolonged stress or pain as shown in the figure above, a mechanism that might have evolved to ensure rest and low activity levels during injury. Unfortunately, the same mechanism is thought to cause increased pain sensitivity in certain pain syndromes through its inhibition of endogenous phasic dopamine antinociception. Abstinence from addictive drugs has also been associated with hyperalgesia and increased tonic signaling. The resulting inhibition of phasic signaling is thought to underpin reduced responsiveness to pleasure (anhedonia) during abstinence, and can be reversed by re-administering the addictive drug. At the other extreme, decreased tonic dopamine, causing hyper-responsiveness of phasic dopamine, has been related to positive symptoms in schizophrenia. Impulsivity in schizophrenia is associated with excessive pleasure-seeking and substance abuse.

Pain-pleasure inhibition:

Figure above shows schematic illustration of pain–pleasure inhibition. The Motivation-Decision Model of pain posits that anything of potentially greater importance than pain should have antinociceptive effects (be it a greater threat or the possibility of a reward). By the same evolutionary-psychology rationale, it is clear that anything that is potentially more important than a reward (such as an even greater reward or a threat for which action is needed) should similarly decrease its pleasantness, thus allowing for the appropriate avoidance or approach behaviors. The opioid and mesolimbic dopamine systems are the prime candidates for systems that transmit signals relating to motivational and hedonic aspects of both pain and pleasure and, in particular, their interactions, as illustrated above.

a) Both pain and pleasure have been shown to elicit opioid release in the orbitofrontal cortex (OFC), the amygdala (Amy), the nucleus accumbens (NAc) and the ventral pallidum (VP). Pleasure and reward expectation are also associated with increased phasic dopamine signaling from the ventral tegmental area (VTA) to the NAc and VP42, which in turn causes increased -opioid release in the NAc55. Pain has been associated with both increases and decreases in mesolimbic dopamine signaling, depending on the type of measurement and pain model that have been used.

b) opioid receptor antagonists, such as naloxone, reverse pleasure-related analgesia.

c) opioid receptor agonists, such as morphine, have been shown to re-enable pleasure that has been previously reduced by concomitant pain.

Read my article on “The anger”. Anger and fear are the two sides of the same coin of primitive survival instinct. Anger is associated with fierceness, daring, possessiveness and taking risks. Fear is exactly opposite. The primitive survival instinct is in dual mode, fight (anger) or flight (fear); depending on the assessment of circumstances by the organism. This fact substantiates my theory of “Duality of Existence” in living organisms. From an evolutionary perspective, an association between emotions and pain responses might be expected, given that pain in times past was often the result of situations threatening survival of the organism (e.g., attack). Anger and fear would be the two emotions most likely to be elicited under such threatening circumstances, as they reflect motivational states underlying the fight and flight responses, respectively. On the other hand, from an evolutionary standpoint, stress-induced analgesia can be regarded as a component of the fight-or-flight response. It would not be highly adaptive if pain from injuries could prevent us from fighting or fleeing even when our lives depended on it. But once the threat of death has passed, our normal pain-sensing mechanisms have to do their work in order to immobilize the injured part of the body and prevent the injury from getting worse. So stress response, basic emotions anger & fear (fight or flight), and pain & pleasure are all correlated evolutionarily, neurobiochemically and genetically. Higher the organism evolutionarily, greater the correlation. Since humans are highest on evolutionary ladder, we have highest correlation. Non-human animals have lower correlation. Invertebrates have least correlation. My theory is that pain and pleasure are two sides of the same coin of organism survival based on duality of existence just like anger (fight) and fear (flight) reaction. Pleasure encourages organism to perform the task and pain provokes organism to avoid the task, both for survival.

Myths about the risks and dangers of analgesics:

Myth1: Toughing it out is always better than relying on painkillers.

Fact: Although many pride themselves on their toughness, those who refuse medications despite severe pain may be putting their health— and their jobs and relationships— at risk. Uncontrolled pain is associated with adverse consequences in terms of daily functioning, mood, sleep, overall quality of life, energy level, the ability to work and marital relationships. Newer studies actually show that persistent pain causes changes in the brain and spinal cord that begets more pain. Some animal studies suggest that controlling pain could help prevent these problems.

Myth 2: People on opioids are always impaired—and cannot drive safely or work in demanding jobs.

Fact: Studies of drivers on steady doses of opioids do not find impairment. In fact, at least one study by Finnish researchers showed that impairment on standard driving measures was more correlated with poorly controlled pain than with taking medication for it.

Myth 3: When taken as directed, opioids are more likely to kill you than aspirin, ibuprofen or naproxen.

Fact: When taken as directed, opioids are safe drugs. The vast majority of opioid-related deaths occur amongst recreational users or deliberate suicides. Deaths amongst pain patients are rare— in fact, recent research finds that even for people with advanced illnesses, use of high-dose opioids does not significantly increase risk of death. Nearly three times as many people die from complications of correctly taking painkillers like aspirin and ibuprofen— known as non-steroidal anti-inflammatory drugs—than die from opioid overdose. More people die from gastro-intestinal bleeding from NSAIDs taken in correct doses than from inadvertent opioid overdose.

Myth 4: Accidental overdose is common amongst pain patients on opioids.

Fact: Most opioid overdoses do not result from medical use. As patients take opioids over weeks and months, they develop a tolerance to the respiratory depressive effect, which is the thing that can cause death. This means that even if people forget they’ve taken their medication already and accidentally double their dose— unless they have dementia and do this rapidly and repeatedly— the risk of death is low. Instead, the vast majority of opioid overdoses involve combinations of drugs that cause sedation— typically alcohol and sleeping pills or anti-anxiety medications like benzodiazepines. At least 80 percent of opioid overdoses are actually caused by such drug mixing—and while some severe pain patients need both benzodiazepines and opioids, they are prescribed together with great caution. In many overdose deaths, use is obviously non-medical because the victims injected or snorted drugs meant to be taken orally.

Myth 5: Most people who get addicted to painkillers are “accidental” addicts who sought pain treatment and had no prior history of drug problems.

Fact: The vast majority of people who become addicted to prescription opioids have significant prior histories of drug problems. Nearly 80 percent of Oxycodone addicts have taken cocaine, for example, according to large national survey research. This means either that pain patients prescribed Oxycodone suddenly start using cocaine—or, more plausibly, that most people who misuse opioids have a past or current drug problem. Even having chronic medical problems—which includes chronic pain—did not increase risk for Oxycodone addiction. If you do not have a personal or family history of addiction—especially if you have never suffered psychiatric problems like depression, schizophrenia or bipolar disorder, and especially if you are middle-aged or older—your risk for developing addiction during pain treatment is very low.

Myth 6: Addiction is inevitable if opioids are taken long-term or in high dose.

Fact: This myth stems from confusion about the nature of addiction. Many people believe that addiction is simply needing a substance to function—but if this were the case, everyone would have to be considered addicted to food, air and water. Average people view addiction as physical dependence. In fact, psychiatry defines addiction as compulsive use of a substance despite negative consequences—and it is this craving, impairment and loss of control that people fear. However, while most people who take opioids for long enough will develop physical dependence and suffer withdrawal if the drugs are stopped abruptly, addiction in pain patients is rare. The reality is that addiction appears to be distinctly uncommon in patients without a prior history of addiction or a family history of addiction.

Myth 7: Because most people don’t get addicted to painkillers, I can use them as I please.

Fact: You need to use prescription painkillers (and any other drug) properly. It’s not something patients should tinker with themselves. They definitely have an addiction potential. Use prescription pain medicines as prescribed by your doctor and report your responses — positive and negative — to your doctor.

Myth 8: I’m a strong person. I won’t get addicted.

Fact: Addiction isn’t about willpower, and it’s not a moral failure. It’s a chronic disease, and some people are genetically more vulnerable than others. The main risk factor for addiction is genetic predisposition.

Myth 9: If I need higher doses or have withdrawal symptoms when I quit, I’m addicted.

Fact: That might sound like addiction to you, but it’s not how doctors and addiction specialists define addiction. Everybody can become tolerant and dependent to a medication, and that does not mean that they are addicted. Tolerance and dependence don’t just happen with prescription pain drugs, they occur in drugs that aren’t addictive at all, and they occur in drugs that are addictive. So it’s independent of addiction. Many people mistakenly use the term “addiction” to refer to physical dependence. That includes doctors. Physical dependence, which can include tolerance and withdrawal, is different. Even though it is a part of addiction but it can happen without someone being addicted. In other words, dependence may be a component of addiction but dependence is not synonymous with addiction. Addiction is uncommon while dependence is common after long term opioid use.

Myth 10: Opioid withdrawal is extremely debilitating and potentially deadly.

Fact: We’ve all seen the movies: the desperate addict shivering, shaking and vomiting from heroin withdrawal, pleading for relief. While opioid withdrawal can be unpleasant, it doesn’t have to be. You can probably take 80 percent of people off opioids by decreasing the dose 50 percent every other day and they will be asymptomatic. In fact, many patients go through withdrawal without even realizing that their “flu symptoms” are linked to the fact that they decided to stop their pain medication suddenly. The severity of withdrawal also appears to have a genetic component—some people are susceptible to miserable symptoms, while others suffer few or even no effects. While withdrawal from alcohol or barbiturates is potentially fatal if not properly managed, even the worst opioid withdrawal is unlikely to be deadly. However, withdrawal can be risky if the patient is still in pain or on other drugs. Managed incorrectly and in concert with other drugs, it can be very dangerous. The main reason people suffer withdrawal has “nothing to do with medicine, but rather to societal pressures that have led to laws that the Drug Enforcement Agency is required to enforce.” For example, it is illegal for a doctor to prescribe opioids for addiction outside of certain settings, so some physicians are afraid to taper patients’ doses for fear of being arrested for having “maintained” an addict. Similarly, doctors may drop patients suddenly if they suspect addiction, without tapering their medications.

Myth 11: All that matters is easing my pain.

Fact: Pain relief is key, but it’s not the only goal. The focus is on functional restoration when analgesic or any intervention is prescribed to control patient’s pain.

Myth 12: My doctor will steer me clear of addiction.

Fact: Doctors certainly don’t want their patients to get addicted. But they may not have much training in addiction, or in pain management. You need a specialist trained in de-addiction measures.

The moral of the story:

1. Pain is a biopsychosocial phenomenon.

2. When we look at the scientific research on pain, we see that the science of pain has increasingly conceived of pain as less like perception of an objective reality and more like emotions by first drawing the sensory/affective distinction and then emphasizing more and more its affective aspect. There are sufficient scientific grounds to state that pain is a homeostatic emotion.

3. About 35% of people report marked pain relief after receiving a saline injection they believe to have been morphine. This is not only a placebo effect (of which CAM practitioners take advantage to claim their efficacy); but makes clear that pain is not merely a sensation or perception but a basic emotion just like lust, anger etc.

4. Evolutionary biologically, acute pain is essential for survival of a species.

5. Women are more sensitive to pain, less pain tolerant, more pain reactive and more able to discriminate different levels of pain than men, which is due to evolutionary higher survival value as they bear and nurture children.

6. Access to pain management is a fundamental human right and it must be included in the constitution of various nations.

7. One in five people suffers from moderate to severe chronic pain, and that one in three is unable or less able to maintain an independent lifestyle due to their pain.

8. Pain is a significant public health problem that costs American society at least $560-$635 billion and European society up to €240 billion annually. Statistics from developing world is unavailable.

9. It is widely believed that regular exposure to painful stimuli will increase pain tolerance but this is not true – the greater exposure to pain will result in more painful future exposures. Repeated exposure bombards pain synapses with repetitive input, increasing their responsiveness to later stimuli. Therefore, although the individual may learn cognitive methods of coping with pain, these methods may not be sufficient to cope with the boosted response to future painful stimuli. Because of this, trauma victims (or patients in pain) are given painkillers as soon as possible – to prevent pain sensitization. Researchers suggest that analgesics should be taken before surgery as people who begin taking analgesics before surgery need less of it afterward.

10. Analgesic under-medication is one of the most important factor for delaying recovery in acute injury/inflammation and leads to chronic pain.

11. Unnecessary legal/societal restrictions on opioid use for the treatment of pain must be removed.

12. Hot fomentation should not be given in any acute injury as it will worsen inflammation, increase swelling and increase pain. Cold application (ice application) will help relieve pain in acute injury. Hot fomentation may be given 48 hours after injury to speed up healing.

13.The way marijuana (cannabis) contain THC and the way opium contain morphine; and both of these have biological receptors in human brain; and the way body produces endogenous opioids & cannabinoids which target the same receptors; makes me think that during evolution of species over millions of years, some cross-connection exist between plant kingdom and animal kingdom at the basic level of DNA, genes and molecular biology; and therefore presence of these receptors in human brain which readily accept plant based chemicals which plants synthesized for its own survival, is not a mere coincidence but an evolutionary design, the intent of which ought to researched.

14. Pain and pleasure coexist in same brain pathways as two sides of the same coin of task performance for survival. Pleasure encourages organism to perform the task and pain provokes organism to avoid the task, both for survival. This validates the theory of ‘Duality of existence” in living organisms.

15. I axiom that the spinal cord plays a greater role in pain modulation than researched so far. I propose a theory of spinal consciousness which contributes to overall consciousness (cortex + sub-cortical structures) of humans but plays a more significant role in animals who lack neocortex in their brain.

Dr. Rajiv Desai. MD.

May 5, 2012

Postscript:

This is the most complex subject I have discussed so far. My endeavor has been to provide genuine and accurate information to the people along with innovative ideas. However, the subject is so vast that it is not possible to cover all aspects. Any inadequacy or inaccuracy is deeply regretted.

Tags: action potential, acute pain, allodynia, analgesia, analgesic, anesthesia, backache, cancer pain, causalgia, chronic pain, cold fomentation, counter irritation, dysesthesia, gate control theory, gender and pain, headache, heritability of pain, hot fomentation, hyperalgesia, hyperesthesia, hyperpathia, hypoalgesia, hypoesthesia, inflammation, ion channel, narcotics, neuralgia, neurobiology of pain, neuron, neuropathic pain, nociception, nociceptive pain, nociceptor, novel analgesic agents, NS neuron, NSAID, opiates, opioid addiction, opioid dependence, opioid receptors, opioids, pain and culture, pain and depression, pain and emotions, pain and pleasure, pain asymbolia, pain costs, pain in children, Pain management, pain matrix, pain modulation, pain pathways, pain perception in animals, pain psychology, pain research, pain scale, pain sensitization, pain statistics, pain threshold, pain tolerance, pain transmission, painful sex, paresthesia, phantom pain, physiotherapy, psychogenic pain, referred pain, somatic pain, sympathetic pain, TENS, visceral pain, WDR neuron, WHO analgesic ladder
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ENTERTAINMENT

April 5th, 2012

ENTERTAINMENT:

Prologue:

Most of us have, at some point, become so immersed in a book or game or movie that the activity temporarily assumes a profound significance and the importance of the outside world begins to fade. Although we are likely to enjoy these experiences in the realm of entertainment, we rarely stop and think about what effect they might be having on us. But maybe we should. For all that has been written about individual pop icons, movie stars, sport stars and sitcoms, and the liberating or oppressive power of popular culture, basic questions remain unanswered. What do we know about the overall effect of living in a society in which entertainment is so central? What do we know about how entertainment affects society and the people who participate in it? Why entertainment activities are so important to us, yet frequently dismissed as being unworthy of serious reflection? Is entertainment indispensable for humans? American children and adolescents spend 22 to 28 hours per week viewing television, more than any other activity except sleeping. By the age of 70 they will have spent 7 to 10 years of their lives watching television. Indian audience watch television 14 to 21 hours per week less than the U.S. because in smaller towns where capability to watch television exists, the quality and supply of electrical power becomes a big issue.What do they get in return? Besides entertainment; nothing. I quote a favorite quote. Art is moral passion married to entertainment, moral passion without entertainment is propaganda, and entertainment without moral passion is television. As entertainment becomes a trillion dollar per year industry worldwide, as our modern era increasingly lives up to its label of the “entertainment age,” and as economists begin to recognize that entertainment has become the driving force of the new world economy, it is safe to say that scholars are beginning to take entertainment seriously.

History of entertainment:

Before the rise of human civilization, there was little time for anything but survival. All time and energy went to providing food, water and shelter for yourself and dependents. The primitive population had little time for art or entertainment or, more generally, diversions to distract them from their toilsome existence. Artifacts show that at least one of the activities cavemen enjoyed during their precious free time was cave painting. No one knows why these paintings were created, though theories abound. Speculation can easily conjure images of a gregarious caveman describing a particularly exciting hunt to his clan as he draws the events on the cave wall illuminated by a flickering fire. It was probably a lightning strike upon a tree 200,000 years ago in Africa that caused the first fire to be seen by prehistoric humans. It may be few thousands of years later our ancestors realized power of fire to be used for warmth, light, cooking, security and… entertainment. Humans sat around fire for thousands of years and even today, in some part of developing world, engage in singing and dancing after finishing a day work of cooking, hunting and gathering firewood. At some point in prehistoric time, a storyteller was born who used imagination verbally to tell stories or songs, and visually to paint a picture. The aesthetic nature and sophisticated composition of the pre-historic paintings indicate that they were not for utilitarian purposes. They could only have been diversions from the drudgery of daily life, thus cave painting marks the twin birth of art and entertainment forever memorialized on stone. Only once agriculture rooted itself as the primary means of sustenance did large enough populations congregate to facilitate role specialization. The artist and the entertainer were born out of the new free time afforded by specialization and, most likely, as a mixture of the two. Throughout centuries, audience have watched, clapped and cheered various types of performances right from listening to music, to display of dancing, drama or athleticism. As technologies developed, buildings were constructed as theaters or stadiums to witness, hear and experience such spectacles. The development of written words into books led audiences into mentally escapes in another world as their minds process words into images. Invention, innovation and commodification in the industrial world (North America and Europe) have seen creation of devices that have specifically designed to captivate audiences. Music, cinema, radio, television and telephone have flourished due to continued cycle of reinvention, innovation and creativity. Societal changes led to disposable income, leisure time, changing fashion and continued consumer demand to be kept entertained led to development of entertainment industry with one common goal; to captivate audience and to be paid for doing so. As business flourishes, large corporation were created for broadcasting, print media, radio, television and cinema. Amusement parks and museums were created to attract visitors and tourists. In last 20 years, computers and internet invaded many houses providing entertainment at home.

Boredom:

No discussion on entertainment can start without mentioning boredom. I remember a young woman pilot Akshi Gupta who came to see me for treatment of medical illness. She told me that she is bored. As a pilot working in coast-guard far away from her home with no friends, she was free whole day with no useful activities except flying for few hours. The picture below shows that even babies get bored.

Boredom is an emotional state experienced when an individual is left without anything in particular to do, and is not interested in their surroundings. Boredom has been defined by C. D. Fisher in terms of its central psychological processes: “an unpleasant, transient affective state in which the individual feels a pervasive lack of interest in and difficulty concentrating on the current activity”. Though we have hundreds of entertainment options today–video games, the Internet, CD and MP3 players, home entertainment centers, sporting events, megamalls, movie theaters, and even robotic toys–our culture is battling an insidious disease. It’s an epidemic of boredom. There are three types of boredom, all of which involve problems of engagement of attention. These include times when we are prevented from engaging in some wanted activity, when we are forced to engage in some unwanted activity, or when we are simply unable, for no apparent reason, to maintain engagement in any activity or spectacle. Boredom is a condition characterized by perception of one’s environment as dull, tedious, and lacking in stimulation. This can result from leisure and a lack of aesthetic interests. People ranked low on a boredom-proneness scale were found to have better performance in a wide variety of aspects of their lives, including career, education, and autonomy. Boredom can be a symptom of clinical depression. In a learning environment, a common cause of boredom is lack of understanding; for instance, if one is not following or connecting to the material in a class or lecture, it will usually seem boring. However, the opposite can also be true; something that is too easily understood, simple or transparent, can also be boring. Boredom is often inversely related to learning, and in school it may be a sign that a student is not challenged enough, or too challenged. An activity that is predictable to the students is likely to bore them. Boredom has been studied as being related to drug abuse among teens. Boredom has been proposed as a cause of pathological gambling behavior.

Boredom is so endemic to our culture, particularly among youth, that we imagine it to be a near-universal default state of human existence. In the absence of outside stimuli we are bored. However, Bedouins can sit for hours in the desert, feeling the ripples of time, without being bored. Apparently, boredom was not even a concept before the word was invented around 1760, along with the word “interesting”. The tide of boredom that has risen ever since coincides with the progress of the Industrial Revolution, hinting at a reason why it has, until recently, been an exclusively Western phenomenon. The reality that the factory system created was a mass-produced reality, a generic reality of standardized products, standardized roles, standardized tasks, and standardized lives. The more we came to live in that artificial reality, the more separate we became from the inherently fascinating realm of nature and community. Today, in a familiar pattern, we apply further technology to relieve the boredom that results from our immersion in a world of technology. We call it entertainment. Have you ever thought about that word? To entertain a guest means to bring him into your house; to entertain a thought means to bring it into your mind. Nowadays to be entertained means to be brought into the television, the game and the movie. It means to be removed from yourself and the real world. When a television show does this successfully, we applaud it as entertaining. Our craving for entertainment points to the impoverishment of our reality. Getting entertained to relieve boredom means to applaud fantasy. Aside from the impoverishment of our reality, we are uncomfortable doing nothing because of the relentless anxiety that dominates modern life. We desire constant stimulation and entertainment because in their absence, we are left alone with ourselves doing nothing meaningful. So cricket, movies and soaps bring meaning to our bored life. Also, technology contributes directly to boredom by bombarding us with a constant barrage of intense stimuli, habituating our brains to a high level of stimulation. When it is removed, we suffer withdrawal. We are addicted to the artificial human realm we have created with technology. Now we are condemned to maintain it. Have a hangover? Take an aspirin. Have a runny nose? Take a cold medicine. Depressed? Have a drink. Bored? Entertain yourself. In other words, absence of entertainment means boredom. So we have a new definition of boredom.

Do you want to know what to do when you’re bored?

Well, there are a lot of interesting things that you can do to pass your time. Some people may love to read novels, play computer games, cook, read, etc. It is up to you when it comes to what to do when you are bored. Many of us like to view blogs and read books that are interesting and knowledgeable. There are many social networking sites that connect people from all parts of the world. You can easily make friends and chat with them and spend hours in communication. The best way to do something useful when you are bored is to sit at your computer and run a complete computer scan. This is necessary but mostly we ignore it and later, our computers are full of viruses and unwanted data. There are a lot of videos that are uploaded by so many people. Some contain funny videos, stories, movies, news, scenes captured from day to day lives, and so on. All are a good source of providing entertainment to bored people. If you like movies, then you can watch latest movies and write comments. It is very interesting to get to comment on the stuff that is posted. You can upload your photos/videos and have people comment on it. Computer Games are full on entertainment for kids and now even for the youngsters. It may be racing car or bike games, pokers, Sudoku and others, everyone loves to play and score. It is actually good and you can have the fun of that of play station. If you are studious and like learning on subjects related to studies then you can make the use of tutorials as a part of the learning material. You may get a lot of tutorials online on different topics like computers, mathematics, science, history and so on. It is a great way to learn things like this. It is a modern way that is adopted in most colleges because it facilitates learning by sitting wherever you want. You can invite a few friends over for a themed informal potluck dinner and ask them to bring a dish to your home. If you’re still wondering what to do when you’re bored, take a drive to another city that’s not far from where you live. If you just heard about a new mall that opened up in a nearby city, spend the whole day there.

Leisure:

Leisure, or free time, is time spent away from business, work, and domestic chores. It is also the periods of time before or after necessary activities such as eating, sleeping and, where it is compulsory, education. Leisure is a place for even the busiest people to take a break. You can learn to play cards, check out your horoscope, bet on your favorite game or find out more about arcades. The distinction between leisure and unavoidable activities is loosely applied, i.e. people sometimes do work-oriented tasks for pleasure as well as for long-term utility. A distinction may also be drawn between free time and leisure. For example, Situationist International maintains that free time is illusory and rarely free; economic and social forces appropriate free time from the individual and sell it back to them as the commodity known as “leisure. Time for leisure varies from one society to the next, although anthropologists have found that hunter-gatherers tend to have significantly more leisure time than people in more complex societies. As a result, band societies such as the Shoshone of the Great Basin came across as extraordinarily lazy to European colonialists. Workaholics are those who work compulsively at the expense of other activities. They prefer to work rather than spend time socializing and engaging in other leisure activities. Men generally have more leisure time than women. In Europe and the United States, adult men usually have between one and nine hours more leisure time than women do each week. Free time has potential for youth development, which is influenced by parental attitudes of interest and control, mediated by adolescent motivational style.

Entertainment, recreation and leisure:

The English word “‍entertainment‍” comes from the Latin inter (among or across) and tenere (hold or keep). Entertainment is that which holds the interest and attention. The English word “‍recreation‍” is also from the Latin: re (again) and creare (make or beget). Recreation is that which renews and revitalizes us. The Merriam-Webster dictionary defines recreation as “refreshment of strength and spirits after work.” However, entertainment is defined as “amusement or diversion provided especially by performers.” Both are diversionary; they take our minds off of work. But while recreation is the purposeful attempt to restore or refresh creative energy, too much entertainment tends to be mind numbing failing to rekindle mental energy. In fact, television can actually prevent people from falling asleep, while reading (though it involves mental processing) prepares the body and mind for more restful sleep. I think we need to start by remembering that some recreation is essential. Working constantly is at best foolish and inefficient, leading to burnout. There are advantages to recreating alone but excessive solitary recreation can become an outlet for selfish indulgence and the abdication of responsibilities towards others. Cultivating refreshing pastimes that also allow connecting with others is a useful way to kill two birds with one stone. Going on a walk with a spouse, friend, or child, visiting a museum, or taking in the Christmas lights downtown with your family all yield refreshment while providing uninterrupted time for developing relationships. There seems to be a de-facto acceptance in American society that entertainment is recreation. It’s gone so far that phrases like “‍recreational drug use‍” mean the exact opposite of what the word means. Even fairly innocuous entertainment is often not recreational, being instead a holding-pattern or escapism. We spend hours in entertainment without any noticeable renewal. While recreation may be defined as those activities which an individual is not compelled to do, but rather which are chosen based upon the establishment of their value as being enjoyable, satisfying, interesting, diverting, or otherwise capable of sustaining pleasure for that individual, the exact method or application of recreation varies greatly from individual to individual. That is, two individuals may agree that the best thing to do on a Sunday or after work is to engage in recreation, but the first will consider an afternoon at the art museum recreation, while the second may consider sports as a much more accurate expression of his or her recreative pleasure. The key or core elements being that the activity is beneficial by way of being amusing, stimulating, refreshing, or relaxing in some form, either physical, mental, or the combination of the two. Leisure can be accurately defined as some measure of time from which a person is released from those responsibilities which normally or routinely pertain to the duties they are compelled to perform. This is most often used as an expression referring to the periods of time in which a person is freed from paid work at a job. However, leisure can also include times one is temporarily released from other compulsory, but unpaid duties, such as child care, home or other maintenance, or personal obligations and matters. Recreation and leisure definitions, then, are at once established as containing the element of choice — either an activity or non-activity which deviates from the normal or routine structure of compulsory activity — and the element of satisfaction, by way of some attribute which the individual finds positive or pleasing.

The figure below shows connections between recreation, leisure, entertainment and routine daily compulsory activities.

Definition of entertainment:

Entertainment is an action, event or activity that aims to entertain, amuse and interest a public (“public” can consist of one person). Entertainment can be passive entertainment such as watching TV and active entertainment like participating in sports. Entertainment needs audience, without it entertainment cannot exist. Entertainment attracts an audience and influence their actions and thoughts. The audience can have a passive role, as in the case of a play, a show on a TV or a movie; or active as in the case of a video game. Entertainment consists of any activity which provides a diversion or permits people to amuse themselves in their leisure time. Entertainment may also provide fun, enjoyment and laughter. Over the years entertainment has come to refer to a constructed product designed to stimulate a mass audience in an agreeable way in exchange for money. Entertainment is created on purpose by someone for someone else. Entertainment is easily located, accessed and consumed. And of course, entertainment is also attractive, stimulating, sensory, emotional, social and moral to a mass audience. Entertainment may exist as a product, service or experience. The industry that provides entertainment is called the entertainment industry. There are many forms of entertainment for example: cinema, theatre, sports, games and social dance. Puppets, clowns, pantomimes and cartoons tend to appeal to children, though many adults may also find them enjoyable. Active forms of amusement, such as sports, are more often considered to be recreation. Activities such as personal reading or practicing a musical instrument are considered to be hobbies or pastimes. Novelty is an important aspect of entertainment. In other words, something which is never experienced commonly, so when it does occur, diverts attention of those who experience it, hence becomes audience of that novelty. Novelty is also a measure by which audience measures quality of entertainment. Entertainment also means something affording pleasure, diversion, or amusement, especially a performance of some kind: The highlight of the ball was an elaborate entertainment. An act of entertaining is an agreeable occupation for the mind: Solving the daily crossword puzzle is an entertainment for many. Entertainment could also be a divertingly adventurous, comic, or picaresque novel.

What is not entertainment?

Entertainment is not

1. Art; although it may aspire to and attain the level of art at times (vide infra).

2. Ordinary life; it has a difficult feel, time, and emotional association with it.

3. Truth; because it uses whatever will be more stimulating and whatever will make for a better experience.

4. Intelligent thought; rather it is more like simple and familiar thought with a touch of surprise.

5. Moral; because entertainment won’t be judged as good or bad for people, just entertaining.

The holidays, reading and viewing works of art are not generally considered entertainment, but rather as a pastime. The entertainment generally requires that the supplier of the show is visible to the viewer, with the exception of video games.

______

Entertainment is any activity that makes people happy and relaxed during their free time. People are always tired with their daily routines, jobs and household works; and feel relaxed and happy when they have some entertainment. It diverts the people from their job tension and tiredness. There are many types of entertainment and each one’s interest on this will vary from person to person. This is because different people have various types of interests. Entertainment can be anything like a movie show, a concert, dance show, comedy show etc. A life without entertainment will be very dull and boring. Nowadays there are many ways to get entertained in your busy life. Televisions, radios, iPods, laptops are some of the electronic items that keeps you entertained. Watching favorite’s shows in the televisions or any comedy programs will bring a small smile in everybody’s lips and it also releases your stress. Most of the people are interested in music and many studies have also proved that music is a good medicine to release your tensions. For some people singing or playing musical instruments makes their mind cool and relax. Some people love to read books and get relaxed and diverted from their tensions. These are some common examples that people do in order to get entertained and hence to get relaxed. Apart from the above mentioned, other sorts of entertainment that people adopt are spending time with family, chatting with friends or going out for a picnic or going for a walk in the sea side or in park or playing some sports. This will keep their mind fresh and relaxed. In hotels, hospitals and shopping malls you can find televisions kept and playing some channels. This is just to keep the people minds divert from the boredom or tension they have.

Entertainment environment:

The entertainment environment is a location where people interact with entertainment provided by entertainment industry.

Entertainment or engagement vis-à-vis students:

The general perception is that nowadays students need constant entertainment to draw their attention. So the terms “entertain” and “engage” are being used synonymously. Is there a difference between entertaining and engaging a learner? How do you make the distinction? There are important distinctions.

1. Entertainment’s primary purpose is to create an enjoyable experience; engagement’s primary purpose is to focus attention so learning occurs.

2. Entertainment is ephemeral, often frivolous; engagement creates long-lasting results and deals with important issues.

3. Entertainment needs have little relevance to the reader/watcher/listener; engagement experiences most often relate directly to the learner.

4. Entertainment is an escape from problems; engagement involves solving problems.

5. Entertainment results through the creativity of others; engagement asks for creativity on the part of the learner.

6. Perhaps the greatest distinction is that entertain is often passive, whereas engagement is active or interactive.

It’s fairly easy to see the difference- its passive v/s active. If I look to entertain you with technology, I’m looking for flashy websites, videos that tell you how to do something, and tools that get you to pay attention but honestly don’t require you to do much. It’s fun, it’s easy for you as a student, you’ll probably behave better for a while and it is a lot of work for me because I have to keep updating the ante. When I engage you, it’s still lots of work for me, but it requires something from you as the student. So how do I as a teacher make the leap? It comes from taking a hard look at what I want students to know, and more importantly, why I want them to know it. Is it because it is a foundation skill for future learning? Is it connected to decisions they will have to make later in life? Is it preparing them for ways to approach problem solving? I need to be clear before I begin to engage my students. The transition from entertainment to engagement is transition from passivity to activity.

‘The new entertainment culture’ is seen in the picture below.

The main take-away is that all forms of entertainment are having levels of interactivity added to them – from the advent of reality television allowing people to affect the outcome of programs, to theatre that you can walk around, to socially created literature, to film and TV drama that adds layers beyond the superficial fiction, through guerilla campaigns on and offline. At the same time social media is allowing us to create profiles of ourselves that help to create fiction around our lives – portraying the best, the most exciting, the most dramatic aspects (many people even editing away the bits they don’t like that others have added). And games are becoming watchable in their own right as the cameras capturing the play become more sophisticated, and they are starting to be used to tell stories rather than merely displaying destruction or slick moves. Finally there is a space in the middle where they all meet.

Entertainment and culture:

Entertainment has been a part of all cultures, from the Chauvet cave paintings to the iPad. For Rothman, it is “the storehouse of national values”. Perhaps nowhere is that observation more apt than in the United States, a nation that Gabler terms a “republic of entertainment”. Many Americans seem to feel entitled to high-quality entertainment, and more and more entertainment jostles for their attention. Zillmann goes so far as to predict that entertainment “will define, more than ever before, the civilizations to come”. Despite the centrality of entertainment to society, however, academia has treated the subject in a disjointed, scattershot, sometimes condescending fashion, for a variety of reasons. To start with, the earliest communication theorists chose to study the mass media in terms of persuasion rather than entertainment. Furthermore, many scholars look on entertainment as too trivial for study (Shusterman 291). They believe that entertainment amounts principally “to taking up large amounts of the daily time of individuals, but not representing an important force for human behavior changes” (Singhal and Rogers 120). In addition, different disciplines have asserted dominance over different aspects of the topic.

Shakespeare was writing for the audience. Not for the Queen. (Ben Jonson was writing masques for the Queen, and none of them are still put on. Look what happens to “cultural” programming.) That’s why you have the moments of high drama and the detours for silliness. A cultural event is only cultural because it affects the culture of the place it occurs. That means people have to see it. If a play is not entertaining, no one sees it. If no one sees it, it does not have an impact on the culture. It neither preserves nor disturbs the culture. Various shows on TV especially soaps reflect culture of population. The Academy Awards are a cultural event. Entertainment is cultural. What we see on TV and in the movies and hear on the radio affects how we perceive ourselves and the society we live in. Cop shows tell us what the laws are and what is supposed to happen when they are broken. Doctor shows help us deal with our fear of illness. However, to equate “culture” with entertainment diminishes it. It makes it sound discretionary. Like something you might check out once the hard work of building a society is over for the day. Culture might embrace entertainment but culture is much more fundamental to social development than the industry of entertainment. I would say that entertainment is one part of culture, but not the only part. Culture also includes the way we drive out cars, how much we tip waiters and the way we queue at the bank. Culture also includes how we treat our parents, our neighbors and the strangers.

Culture of entertainment:

There are some people, actually lots of them, who are so besotted with the Harry Potter books that they come to idolize people whose only accomplishment is that they are public and visible Harry Potter fans. “Wizard rock,” is a genre of music about the Harry Potter series. And the wizard rock musicians depicted in the movie are, for the most part, utterly incompetent. Most of them cannot sing and seem to have been playing their instruments for a few weeks at best. All this sounds very appealing, right? But here’s the fascinating part: People flock to wizard rock concerts, idolize the bands, etc. The fans of wizard rock are willing to endure hours of listening to bands that should never get out of the basement. Any reference to the stories and characters is so exciting that the musical part doesn’t matter. In other words, a person can become a celebrity simply by getting up on a stage and referring to the series, he or she needs have no other talent whatsoever. What does this tell us about fans? It hints at a little secret that we all already know: Presumably we admire celebrities for their talent, but there are many celebrities who don’t actually have any talent. (Kim Kardashian, Paris Hilton, etc.) The one thing that underlies all fan behavior is popularity. We get excited about something because other people are excited about it. Usually, something becomes popular because it is appealing in some way—catchy music, an attractive face, a dominant sports performance—but sometimes there is no apparent reason for popularity. However, once something starts to catch on, more people want to join in. An important part of the appeal of wizard rock, like anything else, is that others are getting excited by it; that excitement is itself exciting. The music doesn’t have to be any good. In the early 1970s, renowned anthropologist Clifford Geertz published his most influential book, The Interpretation of Cultures. The book was widely read throughout the social sciences and humanities, and influenced intellectual agendas in these realms for decades. Geertz points out that human beings have evolved to be dependent upon culture to help them adapt to different environments. This flexibility allows human beings to exist on almost every corner of the planet, but it also implies that humans have had to give up instinctual, “wired-in” behavior patterns. Contemporary neuroscientific research has shown that significant aspects of human behavior are in fact wired into our make-up. We do have instincts, plenty of them. But human communities also have powerful ways of promoting preferred behaviors, of making people behave in certain sorts of ways. These technologies of cultural learning are in fact so powerful that they can overwhelm humans’ natural tendencies. Human beings are quite capable of ecstatic emotional states, emotions that are so powerful that they provoke the sense of a presence that comes from beyond the everyday world. This is what happens when people become possessed by spirits, or are overwhelmed by the powerful currents in a crowd. Or, to return to the example I have focused on, it happens when the powerful and stimulating feelings of entertainment come to be associated with particular persons or products or ideas. Thus, for example, we develop the faith that the people in entertainment—celebrities—are special sorts of beings, fascinating creatures whose every action is worthy of our attention. It’s our culture of entertainment that creates this feeling, not some universal part of human nature. But it’s our universal human nature that makes it so easy for our cultures to shape us in ways over which we have little control. In India, cricket has become a religion because every TV channel talks about cricket in prime time and so people’s minds are bombarded with cricket emotions which overwhelm hardwired instincts and cricket stars become gods.

Korean wave as an example of spread of culture of entertainment:

The Korean Wave refers to the spread of South Korean culture around the world. The term was coined in China in mid-1999 by Beijing journalists surprised by the fast growing popularity of Korean entertainment and culture in China. The Korean wave is responsible for the $4.2 billion dollars of revenue in 2011 for South Korea through cultural exports. In 1999, reports of an emerging “Korean Wave” in Japan, China, Taiwan, Vietnam, Hong Kong and other Asian countries started to come out. Korean dramas continued to spread throughout Asia, achieving mainstream success in Japan, China, and Southeast Asia, as well as carving niche markets in Europe and North America. Korean pop music, referred to as K-pop, has become a large part of the Korean Wave. In recent years, Korean entertainment companies have started to recognize YouTube as a key component to the international spread of Korean culture. According to Bernie Cho, president of a Seoul-based agency specializing in the marketing of international K-pop acts, the entertainment companies are “aggressively steering their efforts to go international via the Internet”. The Korean wave also reflects the spread of other aspects of Korean culture, including food, clothing, video games, and the language.

Teenagers and entertainment:

Most teenagers nowadays are very interested in entertainment. Based on recent survey, most teenagers in America spend their time blogging, surfing internets, social networking, watching movies, playing guitar, and even making fun of foreigners. Most teenagers in the world spend their time by listening to music, watching movies and dramas, surfing internets, shopping and fantasizing about their idols. I believe that their daily activities are mostly related to entertainment. Talking about entertainment, television plays a main role in determining a teenager’s lifestyle. Movies and dramas (soaps) are popular among teenagers. They watched dramas episode by episode without fail. An average time of a movie is about 2 hours. That is long enough needed to read through a chapter of one biology topic. When they spend too much time watching movies or dramas, they will not have much time to study or do other important activities with their families. It is generally agreed today that music is part of a teenager’s life. Without music they will probably go insane. Most teenagers enjoy studying while listening to music. Some believe this can increase their concentration level. It is not unusual to see students studying in a quiet library wearing earphones- this shows that they are listening to music. Studying for them should not be boring. A silent and quiet atmosphere while studying is not the best way for some to enjoy their studies. When they cannot enjoy it, then they will lose concentrations and will not understand what have been read. Music and teenagers should not be kept apart. Even though people might think studying while listening to music is not good, but for them learning can be done in many ways. If music gives them comfort, then this will benefit them more rather than gives them more harm. However, they have to make sure that they are concentrating on their studies and not on the music. Teenagers also like to keep up with entertainment news. They fascinated by the appearance of their idols. They want to be like their idols and they like to imitate the way their idols dress up, talk or walk. Being knowledgeable about what’s happening in the entertainment world helps boost one’s self esteem and confidence level. Teenagers with the latest entertainment information can communicate well with other people around them because other people like to listen to the entertainment news. However, they cannot be too occupied with it and spend too much time reading about entertainment news. They also have to think about their studies and other important things. Entertainment should not become hindrance for them for studying.

Home entertainment center:

A home entertainment center is a piece of furniture seen in many homes in North America, which houses major electronic items, such as a television set, a VCR and/or DVD player, stereo components (such as an AM/FM tuner, multi-disc Compact Disc changer, record player, one or more cassette players and graphic equalizer), and cable or satellite television receivers. In many homes, an entertainment center is often placed in the living room, family room or recreation room. The term home entertainment center was widely used in the 1980s. It is being replaced by home theater system for large rooms.

Digital entertainment center:

A digital entertainment center houses all the digital equipment in one unit. It allows users to access their music, movies, home videos and photos from a single device via a remote control. Users can purchase a digital entertainment center that doubles as a media center for their TV or projector and have access to all the media functions at one place. Any device such as a DVI, component video, VGA, S-Video or composite video can be used to make this connection. With a digital entertainment center, it is possible to perform a number of operations from a single device. A user can pause, replay and record any TV program from cable, digital cable, digital satellite or over-the-air TV with the help of a personal video recorder, and transfer photos from a camera. Some entertainment centers allow a person to perform various functions simultaneously. For instance, it is possible to simultaneously watch TV or a video in one room and play music in another. It is also possible to record a favorite program and write them on DVDs. The best part about digital entertainment centers is that they allow a user to perform so many different tasks at once. The quality of its media output is also enhanced. As they are not bulky and do not occupy as much space as the traditional entertainment centers, it is possible to merge them into the décor of a home irrespective of its size.

Pleasure:

Pleasure describes the broad class of mental states that humans and other animals experience as positive, enjoyable, or worth seeking. It includes more specific mental states such as happiness, entertainment, enjoyment, ecstasy, and euphoria. In psychology, the pleasure principle describes pleasure as a positive feedback mechanism, motivating the organism to recreate in the future the situation which it has just found pleasurable. According to this theory, organisms are similarly motivated to avoid situations that have caused pain in the past. Many pleasurable experiences are associated with satisfying basic biological drives, such as eating, exercise or sex. Other pleasurable experiences are associated with social experiences and social drives, such as the experiences of accomplishment, recognition, and service. The appreciation of cultural artifacts and activities such as art, music, and literature is often pleasurable. In recent years, significant progress has been made in understanding the brain mechanisms underlying pleasure showing that pleasure is not a unitary experience. Rather, pleasure consists of multiple brain processes including liking, wanting and learning subserved by distinct yet partially overlapping brain networks. Recreational drug use can be pleasurable: some drugs, illicit and otherwise, directly create euphoria in the human brain when ingested. The mind’s natural tendency to seek out more of this feeling (as described by the pleasure principle) can lead to dependence and addiction. The addiction results from drugs hijacking the ‘wanting’ system through a sensitization of the mesolimbic dopamine system. Certain chemicals are known to stimulate the pleasure centers of the brain. These include dopamine and various endorphins. It has been specifically stated that physical exertion can release endorphins in what is called the runner’s high; and equally it has been found that chocolate and certain spices can release or cause to be released similar psychoactive chemicals to those released during sexual acts. There has been debate as to whether pleasure is experienced by other animals rather than being an exclusive property of humankind. Animals do experience emotions, though these are not necessarily the same as human emotions.

We need to distinguish entertainment from other intrinsic motivation activities that give pleasure like eating, sleeping and sexual activities. When you are hungry, you enjoy eating. Eating gives nourishment to body for survival. Such pleasure is pleasure of satisfaction of biological need which is not entertainment. These biological needs are hardwired genetically in us and evolutionary guided for our survival. What is puzzling about entertainment is that it appears to fail to deliver the real thing, and to fail by design. So the key feature of entertainment is pretense.

Is entertainment always pleasurable?

There is a popular misconception that entertainment is something which has to be funny or pleasing- it simply is not the case. In broadcast media, light entertainment means to be amusing, non-offensive like comedy, music, soap opera etc. invoking mostly positive emotions. All these fuels the theory that entertainment should provide fun but there is great deal of entertainment that provokes negative emotions including anger, grief and fear. Not every film that is produced result in fun, comedy or “feel good” provoking pleasing emotions, but in fact most of them do just the opposite yet entertaining the audience. The quality of entertainment is often measured by audience to the degree that it invokes emotional response, greater the emotional response, the better is the performance. However, the emotional response need not be pleasurable but could be sad and tragic.

Forms of entertainment:

I will briefly discuss various forms/types of entertainment.

Animation:

Animation is a form of entertainment which appeals especially to younger audiences. Animation involves the display of rapid movement in any kind of artwork. Animation is the technique in which each frame of a film is produced individually, whether generated as a computer graphic, or by photographing a drawn image, or by repeatedly making small changes to a model unit, and then photographing the result with a special animation camera. When the frames are strung together and the resulting film is viewed at a speed of 16 or more frames per second, there is an illusion of continuous movement (due to the persistence of vision). Generating such a film is very labor intensive and tedious, though the development of computer animation has greatly sped up the process.

Comics:

Comics contain text and drawings which convey an entertaining narrative. Comic strip, series of adjacent drawn images, usually arranged horizontally, that are designed to be read as a narrative or a chronological sequence. The story is usually original in this form. Words may be introduced within or near each image, or they may be dispensed with altogether. If words functionally dominate the image, it then becomes merely illustration to a text. The comic strip is essentially a mass medium, printed in a magazine, a newspaper, or a book. A comic book is a bound collection of strips, each of which typically tells a single story or a gag (joke) in a few panels or else a segment of a continuous story. Most of the more popular newspaper comic strips eventually are collected over a varying period of time and published in book form. Several famous comics revolve around super heroes such as Superman and Batman. Marvel Comics and DC Comics are two publishers of comic books.

Caricature:

Caricature is a representation, especially pictorial or literary, in which the subject’s distinctive features or peculiarities are deliberately exaggerated to produce a comic or grotesque effect. Caricature is a graphical entertainment. The purpose may vary from merely putting smile on the viewers’ face, to raising social awareness, to highlighting the moral vices of a person being caricatured.

Comedy:

Comedy provides laughter and amusement. The audience is taken by surprise, by the parody or satire of an unexpected effect or an opposite expectations of their cultural beliefs. Slapstick film, one-liner joke and observational humor are forms of comedy which have developed since the early days of jesters and traveling minstrels.

Games:

Games have been played for thousands of years and are common to all cultures. Throughout history and around the world, people have used sticks to draw simple game boards on the ground, making up rules that incorporate stones or other common objects as playing pieces. Games are governed by sets of rules. People engage in games for recreation and to develop mental or physical skills. Games come in many varieties. They may have any number of players and can be played competitively or cooperatively. Some games, such as chess test players’ analytic skills. Other games, such as darts and electronic games require hand-eye coordination. Some games are also considered sports, especially when they involve physical skill. Games may be classified in several ways. These include the number of players required (as in solitaire games), the purpose of playing (as in gambling games), the object of the game (as in race games, to finish first), the people who play them (as in children’s games), or the place they are played (as in lawn games). Many games fall into more than one of these categories, so the most common way of classifying games is by the equipment that is required to play them. Equipment may be necessary to play the game such as a deck of cards for card games, or a board and markers for board games such as Monopoly, or backgammon. This can include ball games, Blind man’s bluff, board games, card games, children’s games, croquet, Frisbee, hide and seek, number games, paintball and video games. Games provide relaxation and diversion. Games may be played for entertainment, achievement or money such as gambling or bingo. Racing, chess or checkers may develop physical or mental prowess.

Live entertainment:

It is often set on (or within) a purpose-built area where a pre-determined story and/or routine is recited, acted or performed. Most live entertainment expects or requires an audience to be passive. Live entertainment include watching live performance such as circus, plays, musicals, concerts, farces, monologues and sports. Staged story and variety can be divided into 5 main sub-sectors and each of this itself comprises of many performances as depicted in the figure below.

Types of live entertainment include Circus and zoos, Musical theatre, Performance art, Comedy, Sports, Concerts, Amusement parks, Funfairs, Themed retail and Trade show. The benefits of attending live performances are complex but include engagement, distraction, escapism, inspiration, education, wonder, awe and humor.

Concert:

A concert is a live performance (typically of music) before an audience. The performance may be by a single musician, sometimes then called a recital, or by a musical ensemble, such as an orchestra, a choir, or a musical band. Concerts are held in a wide variety and size of settings, from private houses and small nightclubs, dedicated concert halls, entertainment centers and parks to large multipurpose buildings, and even sports stadiums. A concert tour is a series of concerts by an artist or group of artists in different cities or locations. Revenue from ticket sales typically goes to the performing artists, producers, venue and organizers. In the case of benefit concerts, a portion of profits will often go towards a charitable organization.

Amusement park:

Amusement and theme parks are terms for a group of entertainment attractions, rides and other events in a location for the enjoyment of large numbers of people. An amusement park is more elaborate than a simple city park or playground, usually providing attractions meant to cater specifically to certain age groups, as well as some that are aimed towards all ages. Most amusement parks have a fixed location, as compared to traveling funfairs and carnivals. Walt Disney is often credited with having originated the concept of a themed amusement park.

Family entertainment center (FEC):

A family entertainment center, often abbreviated FEC in the entertainment industry, is a small amusement park marketed towards families with small children to teenagers, and often entirely indoors or associated with a larger operation such as a theme park. They usually cater to sub-regional markets of larger metropolitan areas. FECs are generally small compared to full-scale amusement parks, with fewer attractions, a lower per-person per-hour cost to consumers than a traditional amusement park, and not usually major tourist attractions, but sustained by an area customer base. Many are locally owned and operated, although there are a number of chains and franchises in the field. FECs are sometimes called family amusement centers, family fun centers or simply fun centers.

Sports:

Sports are all forms of competitive physical activity which through casual or organized participation, aim to use, maintain or improve physical fitness and provide entertainment to participants. However, a number of competitive, but non-physical, activities also claim recognition as sports. The International Olympic Committee recognizes both chess and bridge as bona fide sports. Sports are usually governed by a set of rules or customs, which serve to ensure fair competition, and allow consistent adjudication of the winner. Sports are a major source of entertainment for non-participants, with spectator sports drawing large crowds to venues, and reaching wider audiences through sports broadcasting. Sports can be described as an exercise (physical and/or mental), entertainment and recreation.

Different Types of Sports:

Have a look at the different types of sports with examples.
1.Physical sports – Under physical sports, there is archery, air sports like hand gliding, parachuting, ballooning, bowling, mountain climbing, rope climbing, relay, marathon, hurdles, fast walking, jumping like long jump, high jump, discus throwing, javelin shot put, weightlifting etc.

2.Cycle and motor sports – This is inclusive of formula racing, kart racing, dirt track racing cycling like BMX freestyle, BMX racing, road bicycle racing, grand prix motorcycle racing etc.

3. Water sports – Wakeboarding, surfing, snowboarding, kayaking, canoeing, boat racing, rafting, rowing, sailing, water skiing, windsurfing, water polo, swimming which includes freestyle, breaststroke, and butterfly stroke.

4. Combat sports – Under combat sports, there is sumo wrestling, judo and wrestling. Combat sports with weapons include fencing, kung fu and sword fighting. Striking sports includes boxing, kickboxing, taekwondo and karate.

5. Cue sports – Carom, billiards, snooker and pool games all come under cue sports.

6. Dance – Dance forms are also considered sports. This includes ballroom, salsa, tango, flamenco, lyrical hip-hop, jazz and the likes.

7. Animal sports – This includes horse racing, fishing, horse polo and elephant polo. Under animal sports, there is cock fighting, bull fighting, dog racing etc.

8.Ball games – This includes football, soccer, rugby, handball, water polo, hockey which also includes ice hockey, basketball, cricket, baseball, netball, volleyball etc.

9. Gymnastics – Vaulting, bar gymnastics, group gymnastics, trampoline jumping are all different forms of gymnastics.

10. Other games – Other games include kho-kho, kabaddi, hide and seek, sac race, lemon and spoon race.

11. Racquet sports – This includes table tennis, squash, tennis and badminton.

12. Mind sports – Card games like rummy, bridge, board games like mahjong, Chinese checkers, snakes & ladders and chess are all mind games.

There are several forms of each type of sport. For e.g. in cricket, you have the T20, one-day international and the test format.

Table below highlights some of the best examples of sportertainment and demonstrates how they are connected to other types of staged story and variety.

Theatre:

It is characterized by storytelling using gestures and spoken words. Today, there are different types of theatres characterized by different manifestations as depicted in table below.

Mass media (vide infra):

Mass media refers collectively to all media technologies that are intended to reach a large audience via mass communication. Broadcast media (also known as electronic media) transmit their information electronically and comprise of television, film and radio, movies, CDs, DVDs and some other gadgets like cameras or video consoles. Alternatively, print media uses a physical object as a means of sending their information, such as a newspaper, magazines, brochures, newsletters, books, leaflets and pamphlets. Photography can also be included under this subheading as it is a medium which communicated through visual representations. The term also refers to the organizations which control these technologies, such as television stations or publishing companies. “Mass media” is sometimes used as a synonym for “mainstream media”, which is distinguished from alternative media by the content and point of view. Alternative media are also “mass media” outlets in the sense of using technology capable of reaching many people, even if the audience is often smaller than the mainstream. In common usage, the term “mass” denotes not that a given number of individuals receives the products, but rather that the products are available in principle to a plurality of recipients.

New-age media (digital media):

Mobile phones, computers and Internet are sometimes referred to as New-age Media. Internet media is able to achieve mass media status in its own right, due to the many mass media services it provides, such as email, websites, blogging, Internet and TV.

Cinema:

A film, also called a movie or motion picture, is a series of still or moving images. It is produced by recording photographic images with cameras, or by creating images using animation techniques or visual effects. The process of filmmaking has developed into an art form and industry. Films are cultural artifacts created by specific cultures, which reflect those cultures, and, in turn, affect them. Film is considered to be an important art form, a source of popular entertainment and a powerful method for educating – or indoctrinating – citizens. The visual elements of cinema give motion pictures a universal power of communication. Although the words “film” and “movie” are sometimes used interchangeably, “film” is more often used when considering artistic, theoretical, or technical aspects, as studies in a university class and “movies” more often refers to entertainment or commercial aspects. The Indian film industry is the largest in the world, churning out up to 1000 films each year that are watched by 3.5 million people every day.

Radio:

Radio programming is the broadcast programming of a radio format or content that is organized for commercial broadcasting and public broadcasting radio stations. In the early 1950s, television programming eroded the popularity of radio comedy, drama and variety shows. By the late 1950s, radio broadcasting took on much the form it has today — strongly focused on music, talk, news and sports, though drama can still be heard, especially on the BBC.

Television (vide infra):

Television is one of the things which human beings have not abandoned when newer technologies have come forward. Of course, the type of technologies used to make the television have changed significantly in the past few years. You will not find the cathode ray tube these days, in the age of LED and LCD televisions. In fact, the CRT televisions are something which is bound to reach the museums within a few years; such is development of the television technology in the world. It has become impossible to imagine a life without spending at least a few hours in front of the idiot box. From movies to soaps and from news to sports, everybody watch television. So what exactly is the attraction to this gadget? Perhaps everybody is more interested to know about the lives of other people because it is well hidden from the world on how they live and go about in life. Or maybe, it is because it is an inherent human nature to be curious and relish in the life situations of others, be it good or bad. There is nothing more interesting than celebrity gossip, or as heartbreaking as a celebrity breakup. People are obsessed with the lives of celebrities. The most popular TV show in the world is “The Bold and the Beautiful,” with 500 million viewers in 98 countries.

Magic:

Magic is a performing art that entertains audiences by staging tricks or creating illusions of seemingly impossible or supernatural feats using natural means. These feats are called magic tricks, effects, or illusions. One who performs such illusions is called a magician. As a form of entertainment, magic easily moved from theatrical venues to television specials, which opened up new opportunities for deceptions, and brought stage magic to huge audiences. Most TV magicians perform before a live audience, who provide the remote viewer with a reassurance that the illusions are not obtained with post-production visual effects. Magic has been misused by:

1. Fraudulent mediums have long capitalized on the popular belief in paranormal phenomena to prey on the bereaved for financial gain.

2. Fraudulent faith healers have also been shown to employ sleight of hand to give the appearance of removing chicken-giblet “tumors” from patients’ abdomens.

3. Con men and grifters may use techniques of conjuring for fraudulent goals. Cheating at card games is an obvious example.

Storytelling:

Storytelling is the conveying of events in words, images and sounds, often by improvisation or embellishment. Stories or narratives have been shared in every culture as a means of entertainment, education, cultural preservation and in order to instill moral values. Crucial elements of stories and storytelling include plot, characters and narrative point of view. For many multi-media communication complex institutions, communicating by using fiction storytelling techniques can be a more compelling and effective route than using only dry facts. Storytelling is increasingly used in advertising today in order to build customer loyalty. I was a popular storyteller when I was studying in school. I remember, when there was a free period in school (sixth standard), I used to tell stories to fellow students to pass time and entertain. None of the stories were preconceived. I used to tell stories on the spur of the moment using my imagination. I believe that in order to be excellent storyteller, you ought to be highly imaginative.

Street performance:

Street performance or busking is the practice of performing in public places, for gratuities, which are generally in the form of money and edibles. People engaging in this practice are called street performers, buskers, street musicians, minstrels, or troubadours. Street performance dates back to antiquity, and occurs all over the world. This art form was the most common means of employment for entertainers before the advent of recording and personal electronics. Performances can be just about anything that people find entertaining. Performers may do acrobatics, animal tricks, balloon twisting, card tricks, caricatures, clowning, comedy, contortions and escapes, dance, singing, fire eating, fire breathing, fortune-telling, juggling, magic, mime and a mime variation where the artist performs as a living statue, musical performance, puppeteering, snake charming, storytelling or recite poetry or prose as a bard, street art (sketching and painting, etc.), street theatre, sword swallowing, and even put on a flea circus.

Literature:

Literature is the art of written work, and is not confined to published sources (although, under some circumstances, unpublished sources can also be exempt). The word literature literally means “acquaintance with letters” and the pars pro toto term “letters” is sometimes used to signify “literature,” as in the figures of speech “arts and letters” and “man of letters.” The four major classifications of literature are poetry, prose, fiction, and non-fiction. Literature may comprise of texts based on factual information (journalistic or non-fiction), as well as on original imagination, such as polemical works as well as autobiography, and reflective essays as well as belles-lettres. A play or drama offers another classical literary form that has continued to evolve over the years. It generally comprises chiefly dialogue between characters, and usually aims at dramatic / theatrical performance rather than at reading. Many works of drama have been adapted for film or television. Conversely, television, film, and radio literature have been adapted to printed or electronic media. Even in closed societies such as Iran, bookstores are filled with Persian translations of novels by John Grisham, Danielle Steele and Sidney Sheldon.

Adult entertainment:

Adult entertainment are of a sufficiently high sexual or erotic nature not considered suitable for minors; and the laws of many jurisdictions prohibit minors of a certain age to be present at a venue where such entertainment is taking place. The examples include pornography, blue films, live sex shows, sex comedies etc.

Media and entertainment:

Definition of mass media is already discussed above. Now I will discuss media vis-à-vis entertainment.

Let me start with classification of communication:

Communication classification is tabulated below.

One-to-Many

One-to-One

Mediated

Mass Media

Internet Chatting

Telephone Talking

Unmediated

Speech

Interpersonal

Conversation

The Media Stimulation Curve:

The media stimulation curve is a graduated curve of media stimulation as seen in the figure above. The x-axis reflects the various ages of humankind. The y-axis could contain any one of three stimulation-related exposure variables: amount, types, and variation. The nature of the relationship curve will be similar in all cases. That is over time, the amount of stimulation, the types of stimulation, and the variation in stimulation that the human race has been exposed to has increased dramatically at an exponential rate. This is an intuitive notion, and one can easily surmise that the angle of the curve has dramatically angled upward over time. This change in the angle has become most pronounced during the 20th century. From Guttenberg’s introduction of the printing press in 1455, to radio and moving pictures (i.e., movies) in early 1900, to television in 1940, to internet in 1990, media entertainment has moved. Today, with multiple types of media, we are bombarded by various forms, changing formats, and increased variation of stimulation, the vast majority of which we now take for granted or tune out; one can imagine the impact that today’s amount and variation of stimuli would have had on a human being 100 years ago, let alone a person living a thousand years ago or earlier. This evolutionary change in the rate of exposure to the amount, types, and variation of stimulation has also brought about changes in how humans process this stimulation. While one might logically argue that such stimulation has increased our potential exposure to diversity, and it clearly has, the graduated curve also suggests that if we were able to process most of this stimulation, at best it would be at a very shallow level, or subliminally, and we would likely filter most of it out very quickly. However, what is more likely is that we select (either intentionally or unintentionally) to ignore much of the stimuli that we are exposed to today. It is clear that never before in history has so much entertainment been so readily accessible to so many people for so much of their leisure time.

Mass media enjoys a very prominent role in our lives. There are various effects of mass media on the society at large. Media tends to influence and it’s obvious, there are positive as well as negative influences of mass media. However, it also depends upon the way audiences perceive things. The power of the mass media is by far recognized by everybody in terms of advertising, marketing and as a medium to broadcast information to people at large. Since mass media is used to communicate and interact with people from various walks of life, it can often result in a conflict of options. Print media (magazines, newspapers, brochures, press releases, newsletters, etc), electronic media (television, radio etc) and the Internet are all part of mass media. Today, mass media can give a person phenomenal exposure and this can result in various effects on the society.

Schramm’s Four Functions of (Mass) Media:

(1)Information

(2)Entertainment

(3) Education

(4) Persuasion

Media and journalism:

Media is a compilation of different forms of communication (TV, Radio, blogging, Internet, twittering, newspapers, magazines etc) to transmit information, but it does not have to adhere to the scrutiny of editing, nor ensure the impartial analysis of current events. The main focus of media needs not to be educational or informative- it can also be used to entertain and amuse. Journalism is a specific area in the field of communications (which is now part of the whole media compilation) that has, for generations, earned the public trust in the area of communications precisely because it is meant to be impartial and objective, and its main purpose is to inform, not entertain, nor amuse like with media.

Infotainment:

Infotainment is “information-based media content or programming that also includes entertainment content in an effort to enhance popularity with audiences and consumers.” It is a neologistic portmanteau of information and entertainment, referring to a type of media which provides a combination of information and entertainment. According to many dictionaries, infotainment is always television, and the term is “mainly disapproving.” However, many self-described infotainment websites exist, which provide a variety of functions and services. Infotainers are entertainers in infotainment media, such as news anchors or “news personalities” who cross the line between journalism (quasi-journalism) and entertainment. Notable examples in the U.S. media are Barbara Walters, Katie Couric, Keith Olbermann, Glenn Beck, Anderson Cooper, Maury Povich, Deborah Norville, and Geraldo Rivera among others. The label “infotainment” is emblematic of concern and criticism that journalism is devolving from a medium which conveys serious information about issues affecting public interest, into a form of entertainment. Some blame the media for this perceived phenomenon, for failing to live up to ideals of civic journalistic responsibility, while others blame the commercial nature of many media organizations, the need for higher ratings, combined with a preference among the public for feel-good content and “unimportant” topics like celebrity gossip or sports. Some define “journalism” only as reporting on “serious” subjects, where common journalistic standards are upheld by the reporter. Others believe that the larger “news business” encompasses everything from professional journalism to so-called “soft news” and “infotainment”. Because the term “news” is quite broad, the terms “hard” and “soft” denote both a difference in respective standards for news value, as well as for standards of conduct, relative to the professional ideals of journalistic integrity.

The idea of hard news embodies two orthogonal concepts:

1. Seriousness: Politics, economics, crime, war, and disasters are considered serious topics, as are certain aspects of law, business, science, and technology.

2. Timeliness: Stories that cover current events—the progress of a war, the results of a vote, the breaking out of a fire, a significant statement, the freeing of a prisoner, an economic report of note.

The soft news is sometimes referred to in a derogatory fashion as infotainment. Defining features catching the most criticism include:

1. The least serious subjects: Arts and entertainment, sports, lifestyles, “human interest”, and celebrities.

2. Not timely: There is no precipitating event triggering the story, other than a reporter’s curiosity.

Timely events do happen in less serious subjects—sporting matches, celebrity misadventures, movie releases, art exhibits, and so on. Also, the spectrum of “seriousness” and “importance” is not well-defined, and different media organizations make different tradeoffs.

Entertainment news:

Entertainment news is something which takes the burden of day to day activities from people’s minds and let them have some time for themselves. This would help them to relax and have some fun by amusing themselves with the news and gossip available in the news. Entertaining articles and write ups are always in demand no matter where you write them.There can be many advantages of entertainment news. One such advantage is just as said above, about letting yourself have some amusing time to yourself away from your hectic schedules and tiring jobs. It is a way in which you can refresh yourself, both mind and body so that you are ready to take on the next form of entertainment that comes your way. Another advantage of entertainment news would be to let your depression fade away when you amuse yourself with news from around the globe. This is one way which most of the people might have tried out at one point of time or the other. They may have read through a paragraph or an article which would have told them about the latest fling of their favorite celebrities or who is back biting whom. Most people find it amusing but there are those who are not interested in gossip. These people find solace in reading through serious things such as the political news in the world. They find reading informative stuff more interesting and so go for things which are more serious. Nevertheless they find it amusing in their own way and would have taken some off from their work schedule. Having a column in the newspaper which can provide entertainment to people is essential as it would make the circulation of the paper increase no doubt, but it would also help the publishers to make their customers happy and satisfied, which is very important in this industry. If you are feeling down then you should probably look for some interesting articles. Entertainment has many more advantages. Just know them for your benefit.

Should newspapers give readers what they want or what they need?

One trend is the increase in reporting about celebrities. It is not the question whether stories about celebrities should be reported; it is more about the balance. Until recently, celebrity newsmakers were kept in their place: big-city tabloid newspapers, special scandal-hungry publications etc. No one disputed that such news should be covered, but rarely did celebrity happenings warrant top-line news play. That has changed in the last dozen years. The proliferation of cable television broadcasts and other media, an infatuation with Hollywood scandal, and a pronounced focus on the personality of newsmakers are pushing serious news off news broadcasts and the front pages of newspapers large and small. The reason for this change might be that newspapers are trying to deliver what people want in order to stay competitive. The public, particularly the much-sought-after young reader, has an insatiable appetite for celebrity coverage. And newspaper-owning corporations are more interested these days in responding to raw market demands, no matter how demeaning. The media give the public what the public wants, but maybe it’s time to give the public what it needs instead. With ever more entertaining news, the media don’t fulfill the social-responsibility role …, which should serve as a catalyst for an informed citizenry. The struggle for ratings, which translate into advertising dollars, is behind the media’s insatiable appetite for sensational stories. Perhaps we should start exploring new ways to fund the media so they won’t be susceptible to market forces. Could uncoupling the media from market forces be a solution? What would be the alternatives? Why should we wish to abandon private, market-driven mass media? After all, to remain relevant, an alternatively funded newspaper would still need to maintain an audience. Wouldn’t that audience simply go elsewhere if the said newspaper didn’t give it what it wanted? One must realize that the value of entertainment as a business model is driven by the idea of maximum return on investment. So we are back to square one.

Does entertainment-media lead or follow society?

This question has been hotly debated for the last several decades and continues to draw supporters from both viewpoints. Does Hollywood observe society and merely recreate it on film? Or do the media lead society and, over time, change it? Over 5 hours a day are spent by the average American family watching movies, television or videos. When you spend that much time watching something, you have just developed new role models and a new window on life. And I think that’s the destructive value of some television and movies… Viewers get the wrong impression and a distorted view of what life is really like. It certainly is causing us to have a society that’s being corrupted and cancerously destroyed in terms of its moral values. Arguments about the harmlessness of movies on our society don’t ring true when compared with over 6,000 independent studies that prove exactly the contrary. Recently, the cable television industry sponsored a multiple-year study performed by Media Scope. The study conclusively proved through gathering those existing studies, plus the addition of its own independent that, in fact, art does lead life – that life does follow art and society does reflect the values of film and television. So entertainment mass media do have a powerful influence and effect on people. But that having been said, it is much too simplistic just to blame all of this on TV. And we see that very much when we look at other cultures such as Japan. The media in Japan is more violent that it is in the United States. But notice the factor such as the structure of the family. In the United States, 30% of children are born out of wedlock. Among African Americans the figure is up to 70%. Compare that with Japan where the figure is about 1%. Teenage pregnancy rates are directly related to that. In the United States, the teenage pregnancy rates are 16 times what they are in Japan. And if you look at Japanese society, the rates of violent crime are much lower than they are in the United States. Murder rates and rates of rape are 1/10th to 1/20th of what they are in the United States. Just blaming film and television for all these problems is much too simplistic if we look at other cultures. So it is the family structure that is very important in Japan. The government has gone out of the way in realizing that an intact family unit is a very important thing to maintain. Governmental policies foster it. Tax policies encourage it. University and school acceptance programs encourage it. Children born out of wedlock can have a very difficult time in Japanese society. Schools discriminate against illegitimate children and will refuse acceptance. There continues to be a sense of shame in Japan in looking upon children born out of wedlock. Japan has an intact family structure and that is incredibly important in terms of why the rate of violent crime in Japan is incredibly low. Now, why intact family is less susceptible to violence shown on mass media? If your child is watching television and you see something inappropriate that’s coming around the bend and you interfere with that and stop it, you’ve given that child a very important message: you’ve taught them that that is not appropriate for them. If a parent goes with a child to a movie theater and there’s something inappropriate that’s coming on the screen and the parent says, “This isn’t for you to see, let’s leave,” and takes the child out, that’s a profound message to the child. The most important step in helping your children to really be able to use the media properly and to become your allies in the battle against this tidal wave of media that’s happening, is to help them understand what your values are – to help them understand the difference between good and evil, and what you believe about what makes a man worthy, humble, kind, loving and generous. You need to teach them the things you want them to model. Taking control of our TV set will not eliminate the moral issues from our lives. Everyone needs a proper value system in order to deal with the media, the entertainment and other aspects of life. And that means recognizing that it’s we who determine what’s right or wrong and not media. It is time for society to develop their own family and cultural values rather than blindly follow entertainment culture propagated by media. It is time for society to rule over media and not the converse.

How media ruins society through entertainment:

A nine-year-old boy sits down to watch TV on a typical Thursday afternoon. He is flipping through the channels when suddenly he comes across a bloody, atrocious fight between two men with handguns. He is mesmerized by the image, a mixture of curiosity and horror. He cannot help himself from watching, like a car wreck one cannot take their eyes off of. This, unfortunately, is the state of entertainment in our world. Many different forms of entertainment are desensitizing our society, and are taking over the world. From tabloid celebrities to reality shows to violence in movies and video games, slowly, the media is ruining the values of the people. The presence of tabloid magazines is everywhere in free societies. Every news stand and TV network has stories about a celebrity marriage or stint in rehab. These “tabloid celebrities” are having a dramatic effect on our society. Suddenly, we are all obsessed with celebrities and their lives, and model what we do after them. Anywhere they shop, anywhere they eat, anything they buy, we want to emulate. In addition, these celebrities are becoming role models for some of our younger generations. Scandals such as Miley Cyrus’ inappropriate pictures or Jamie Lynn Spears’ teen pregnancy send the wrong message to children and teenagers: If Hannah Montana can do it, why can’t I? These adolescents want to be exactly like their idols. It doesn’t help the matter that their idols are gallivanting around, doing inappropriate things. Reality TV is also having a huge effect on our country. People enjoy watching other people’s lives, especially if something horrible is happening. This is the most evident on the TV show “Moment of Truth,” where people must answer questions while hooked up to a lie detector. The real truth about this show is that people will do anything for money, and TV viewers are amused by that fact. Network executives know that the people will watch real human drama, so they put on as many reality shows as possible. Reality TV and reality shows are farce of our society and millions of people waste billions of hours watching the farce. I wonder where the world would be if billions of hours were utilized for development and progress of mankind.

Television (TV):

TV share equal importance in urban life and in rural life too. It is also accepted that Television has both advantages and disadvantages and for one it is very difficult to decide what to watch and what to leave, and sometimes we want to watch everything but could not be done. It is obvious that television is the major source of information. TV communicates with people as their friends, as the characters on TV are doing direct conservations with the people who are watching them outside. Watching has become a habit for people. Obviously TV does not give an impression of loneliness and does not let people bore when they have nothing to do. Daily a large number of people listen and watch a news program that provides them with the essential information. TV has become a reliable source to believe about world happenings without any doubt. In 2000, the total number of TV homes in India was close to 67 million homes of which cable and satellite were 40 million homes. Today it is 142 million cable homes. In a quiet revolution, Indians with high-speed Internet are simply going online to watch their favorite television shows. Of the total Internet users (100 million) in India, 18% are engaged in time-shift television as an activity. Simply put, these are people watching TV programs online. By the end of 2012, this number will grow to 28 %. And it is the only country in the world where there are still 100 million homes without connection to television. This is the statistics from a developing country India but developed countries would have far higher TV audience.

How and why strong (and in some cases, addictive) bond to TV form?

Our psychological bonds to TV shows parallel our need as social animals to connect with people, to identify our place in our social networks and to share common interests. Cristel Russell, Andrew Norman and Susan Heckler explored how we connected to TV shows and found 3 common bonds: viewer to program, viewer to viewer and viewer to character. The viewer to program bond comes from an aesthetic or artistic appreciation of the show. You applaud its production values, or the script. This is probably the most detached bond, and interestingly, is more common in men than women. The next bond is viewer to viewer. Here, a TV show becomes a social lubricant. If gives you something in common to talk about with your friends. The final bond is viewer to character. Here, the veil between reality and fantasy starts to slip a little. At its most benign, it’s just identification with a character in a show. Like tends to bond with like. Grey’s Anatomy if a favorite amongst those that work in the medical profession, for example. Sometimes viewer-character bonds become less grounded in the real world and turn into delusional obsessions. Because these bonds to TV are often grounded on social connections, whether real or imagined, it’s not surprising that they are nurtured in the same way face-to-face relationships are. These relationships grow over time, as we learn more about the characters we’re watching. They seem to grow strongest when there is a continuing storyline and character developments we can become engaged in. And finally, this ongoing narrative comes in a language our brains were built to process. We get stories. And we particularly like stories that play out the way we think they should. We like happy endings. Can we predict what would make a successful TV show? The show that causes all three bonds to flourish will make it a hit show.

TV provides a great supply of entertainment. It offers the viewer to take them on trip along with the program and let them relax while they watch the show sitting on their sofas. This is also a comfort, that people visit many places while watching TV shows. Everybody knows TV alone cannot run itself. It requires the help of advertisement. Advertisement is making people brand conscious. It creates awareness among masses that what to buy, which one is better than other, what are the trends prevailing nowadays. Most of the time people know the weaknesses of the product but they are compelled to buy because of the cosmetic value of the product.

There are many disadvantages of watching TV. It is harmful to stay in front of the TV for a long time. It hurts the viewers’ eyes and health. Lying on bed for a long time or keep a positioning without movement may harm our health. It is considered as over relaxing which makes people lazy as said by the doctors.TV has made people crazy that can be said as addiction. Children do not miss their favorite cartoons or shows and no matter if their school works are missed. Housewives forget their kitchen work while watching their favorite shows. Many a girls prefer their celebrity shows over any party. Similarly boys miss their classes for the sake of football or cricket match, which is telecasting live on TV. TV can also cause anxiety among public. It makes people inactive and despite knowing many disadvantages we still love to watch TV. Indeed because of so many disadvantages, TV is also called “Idiot Box”.

Children and television:

There’s been talk of the benefits and dangers of children watching television virtually since the medium’s beginnings in the late 1940s. Parents wishing to allow their children to enjoy television’s virtually limitless power to educate and entertain just as often find themselves taken aback by mature themes and subject matter. For decades, public television and certain child-friendly cable networks offered safe harbor from conventional television programming, though in recent years the educational value of some of its programming has fallen under criticism too. The accusations stem from a belief that so-called educational programming has compromised its standards for the sake of competing with mainstream television entertainment. If these programs become more commercial, the argument states, where can parents find trustworthy program for their children? The discussion regarding the quality of children’s television in many ways obscures the larger issues of how much time children should spend watching television and what kinds of television should be made available to them. Child development experts caution that smaller children (aged two and up) be allowed no more than two hours of television per day. Children younger than two years old, they say, should be allowed no television at all. However, some studies point to increased language development among children with access to television. The interaction between characters, these studies suggest, allow children a firmer grasp of the uses of language and an appreciation for how conversational skills develop and take shape. Nevertheless, the dangers of too much television consumption – obesity from a weakened metabolism, lackluster reading and comprehension skills, and diminished motor reflexes – would seem to outweigh the benefits. The individual parent should decide what’s best for their child.

The Pros and Cons of watching TV:

Pros:

1. Entertainment and Laughter:

We are entertained by shows we love to watch. We laugh at things we find funny and comical in the TV program we are watching. We also love to dance or sing along with celebrities we see on TV and some of us even copy their dance moves and singing styles.

2. Information and How to do:
We learn a lot of information about places and people that we usually don’t learn on magazines, books and newspapers. There are travel shows that show us beautiful places in the world and inform us the culture of different countries which can be a great help especially if we are planning to travel. We also easily learn how to cook new recipes by watching cooking shows and we can learn doing some other stuff through programs that show step-by-step procedures of performing a particular work, exercise or other interesting stuff.

3. Easy Learning:
For children, it is easier to learn math, science, alphabet and other subject matters if someone can show them how to do it like counting, identifying objects and a lot more. Educational TV shows are available for children to watch and learn.

4. Bonding with Family and Friends:
Watching TV is a great way to bond with family and friends especially on weekends. You can laugh and discuss things that you see on TV. That can be really fun.

5. Awareness and Alertness:
Weather reports and current news on different parts of the worlds can make you aware of what is happening outside your country. You can also be alert when there is an incoming typhoon in your area and that can help you get prepared.

Cons:
1.Decline in creativity and imagination:
TV shows including commercials have tendency to share their alleged creative works on us and impart their ideas and opinions on us which is not favorable and can lead to a decline in our own creativity and imagination since we cannot think on our own because these stuffs are compelled on us. Massive load of audio-visual data at fast rate blunt critical and divergent thinking.

2. Health problems (obesity):
Sitting in front of the TV burns only 68 calories per hour and is not good for your health. We usually eat junk foods or any of our favorite snacks while watching TV. This is not good for our health because we tend to eat a lot while we are sitting down facing the television. This can lead to obesity since we don’t move a lot when we watch TV. This can also lead to other serious ailments caused by eating a lot and moving less.

3. Makes people lazy:
Most of us get hooked when watching programs of our favorite TV channel. We sometimes even forget to do our work or other important things because we got engaged in the show we are watching. Some people forget to do their household chores because they would rather watch TV than work. My view is that TV makes people lazy and in fact, lazy people watch TV all the time to escape from their duties & work. So people are trapped in the vicious cycle of TV and laziness.

4. Many shows don’t teach good values:
There are TV programs that do not teach good values particularly to children. Instead of teaching them good deeds they even imitate, re-enact or spoof important things happening around us which is not good for children to watch.

5. Insomnia:

TV implies less sleep which is an essential component of growth in children and of health maintenance in adults. Sleeping disorders have been positively correlated with the number of hours of television in subjects. So, when parents tell their children to switch off the TV and go out and play, or do something more useful, it really has sense to listen to them.

6. Vision impairment:

It spoils your vision- People who watch too much TV from a young age tend to get spectacles very early.

7. Violence:

It spreads violence- children who watch violent shows or movies fight and argue more than children who watch useful shows.

8. Waste of time:

It wastes so much of your time and gets you addicted.

9. Lower intelligence:

It makes you dumb- a study in the United States in 2005 showed that kids who had TV in their own rooms scored lower in their tests. It is important to encourage kids to read books rather than watch TV.

Negative Effects of Television on your Intelligence:

Theoretically, it has been asserted that television has a bad impact on our emotional as well as learning intelligence, if not directly, at least indirectly. One of the major cons of TV is that it does not require the viewer to use his intellect. It simply feeds constant streaming audio-visual data at an amazing rate, most of which simply passes through as it is impossible for an average person to store that amount of data at one go. Studies have tried to link TV viewing with intelligence levels in children (taking proxy measures of intelligence such as grades, IQ tests, etc.) and have succeeded more often than not in showing that more TV leads to less brains. It is difficult to quantify the extent of damage, but it has hampered our creative and imaginative mind. This is true particularly in the case of small children. Children who spend long hours in front of the television, often seen to face problems like being inattentive in class. It has been observed that the attention span of these children is quite low. Social and emotional skills fail to develop among teenagers due to the drastic decrease in social interaction, which results from spending long hours in front of the television and neglecting all other activities. It is also a common complaint that these teenagers often develop an attitude of disrespect towards elders and that they are losing out on the ability to think and react positively or creating something new. There are certain programs, which show a lot of violence that is cited to be the reason of the growing intolerance.

To sum up, in watching TV you should choose and monitor the TV programs that you and your children should watch. Choose programs that can help you learn and grow as a person. You should also limit the time your children spend in watching TV. The maximum number of hours small kids should watch TV is 3 hours while for teenagers you should make sure they watch good shows only when they are done with homework and projects.

Electronic screen games:

According to the Henry J. Kaiser Family Foundation, 83 percent of children under 6 years old participate in some form of screen media daily; the screen can be a television, computer or video game. Exposing children to electronic games is ultimately a personal choice of the parents. Video and electronic games for children have both pros and cons. Choosing games that are age-appropriate and limiting screen time to an hour or two each day is a recommendation put forth by the American Academy of Pediatrics. Exposing children to electronic games can be educational in the right setting. Not all video games carry educational benefits and are purely for entertainment. Games that are centered around reading, math and other academic subjects may help children learn analytical and critical thinking skills that are required for problem-solving. Even playing non-educational electronic games on occasion may aid this process; for example, choosing which road to take in a car race can teach a child about the consequences of his actions if he ends up falling into a ditch. Playing electronic and video games can help kids blow off some steam from their long day at school, and may help them feel refreshed for the new day to come. When electronic games are used as “light entertainment,” in this way, the stress relief they bring can be a benefit to the entire family. Exposure to violence, aggression and other behaviors that are seen as negative in most parenting circles is a downside of allowing children to play electronic games. Games that focus on killing opponents to earn points and rewards may lead to a difficult differentiation between reality and fantasy, and may produce a desensitized reaction to violence. Excessive exposure to electronic games can contribute to limited physical activity and childhood obesity. Parents and caretakers must remember that children must focus on their school work as well as playing games. Children who spend hours each day playing video games may not be spending enough time on homework and other academic-related activities.

Animals in entertainment:

“Animals in Entertainment” refers to any animal(s) used to act, perform, fight and/or kill for the enjoyment of humans. The term encompasses many different forms of entertainment – from circuses to movies to bullfighting. Except for a few situations, most animals are taken out of their natural environment to perform acts not typically in their behavioral repertoire. It appears as though animals were used for entertainment purposes since ancient times. Archeological findings in Macedonia that date back to 2,000 B.C.E. (Library Index) reveal that lions were kept in cages for the benefit of humans. The Circus Maximus in Rome began in 2 B.C.E. and is one of the most well-known entertainment venues in history. Chariot races, which involved horses, were the most popular and often resulted in death to both human and horses. Another popular event involved lions and human gladiators fighting to the death. Man and animals have walked this planet Earth together for thousands of years. But nature made Man smarter than the other species. A species that could make up for their lack of physical strength with their incredible mental capabilities. A species that could survive in almost anywhere in the world given the necessary resources. A species that grew up to be proud and arrogant of their superiorities, such that they began to make use of the other creatures to do their bidding. One might argue that we use animals for entertainment because of our fascination for them and that we respect them, which is why we want to show them to the society, to be awed by their beauty. But is it proper to lock them up in cages or to deny them the freedom they were meant to be born into or make them do silly, humiliating juggling acts? This obviously does not prove our admiration and fascination in anyway but it only shows that we wish to humiliate them as much as possible, almost as though we hate them. We use them as entertainers in circuses and at zoos where they are openly humiliated. Animals may be less smart than Man, but that does not give us the right to make use of them as toys to entertain us when we feel like it. If that is the case, why not we use people with mental retardation or people with mental problems to entertain us because of their lack of mental capacity. We do not do this because they are of our own kind. Similarly, who gives us right to use animals for the purpose of entertainment just because they are less smart than us?

Animals are abused and exploited in a variety of forms of “entertainment.” In circuses, elephants, lions, tigers, and other animals are sentenced to a lifetime of misery in order to provide a few moments of human amusement. Animals are used extensively in the entertainment industry, including in circuses; zoos and pseudo-sanctuaries; marine parks; the exotic “pet” trade; advertisements, television shows, and movies; cruel “sports” such as bullfighting, rodeo events, and horse racing; and more. Businesses that exploit animals exist to make money, so the animals’ needs are usually put last. Animals are forced into the role of unwilling performer in various venues, including:

1. Marine parks, where captive marine mammals such as dolphins and orcas are doomed to a life of confinement, deprived of normal social and environmental interaction. Animals in marine parks typically show signs of psychological disturbance are often forced to perform degrading tricks that run counter to their natural instincts.

2. Roadside zoos and aquariums, where, under the guise of “conservation” and the name of “education,” animals are too often treated as disposable specimens. Many animals held in captivity in these facilities continue to be bored, cramped, lonely, and unable to perform normal social behaviors. Too many zoos still sell off older and “surplus” animals who may end up in roadside menageries, breeding facilities, circuses, or even as “game” in canned hunt facilities.

3. Movie and television sets, where animals are used as involuntary “props” to sell products and services, and to boost the profits of studios and production companies. In addition to all the problems associated with keeping wild animals in captivity, animals used in filming have been mistreated, injured, or even killed on set. There have been numerous cases of animals who have received severe beatings during filmmaking. Some animals have suffered serious injuries, and others have even died. Some animals are drugged to make them easier to work with, and many have their teeth and claws surgically removed or impaired or their jaws stitched shut. Not many filmmakers realize that even if animals are not treated cruelly during the shoot, they are almost always mistreated behind the scenes. Exotic animals are either captured in the wild or bred in captivity, and they are trained using a combination of punishment and food deprivation. Physical punishment has long been the standard training method for animals in filmmaking.

4. Cockfighting: Roosters raised for fighting are often confined to cramped cages and tormented to make them aggressive. Razor-sharp spurs are attached to the birds’ feet to make fights more “exciting” (i.e. bloody). The birds suffer broken wings and legs, punctured lungs, severed spinal cords and gouged-out eyes. Those who die during or after the fight are really the “lucky” ones: the survivors are forced to fight again. There is no real “victory” for fighting cocks. Although cockfighting is illegal under the Prevention of Cruelty to Animals Act, many birds are forced to fight to the death every year in different parts of many countries. Gambling is the norm at cockfights. Young children are often present at cockfights, and exposure to such violence can promote insensitivity to animal suffering and lead to other forms of violence. Cruelty to animals has been shown to lead to violent crimes against humans.

5. Bull fighting: Bull fighting is a legal blood sport in Spain, Portugal and Latin America and is enormously popular. Like dog fighting and cockfighting, bull fighting has strong historical significance. Killing a bull was considered part of a sacred ritual in Roman times. There is some opposition to bull fighting but the sport continues to be a popular attraction.

6. Begging Elephants: Elephants who are forced to beg are constantly exposed to confusing and alien automobile traffic. The cacophony of horns and urban noises assaults the elephants’ ears, and the scorching, pothole-ridden roads hurt their feet. Elephants are chained by their legs and terribly neglected when they are not working. They suffer from skin ailments, eye infections, cataracts and diseases of the feet. Elephants need at least 200 kilograms of food and 150 liters of water daily, but working elephants often receive too little food and water.

7. Bullock Racing: Bullocks are forced to take part in cruel cart races in villages and towns all across India. Most of these races inflict pain and suffering on the animals. PETA has received many complaints about cart drivers who poke the animals with nails and sticks, whip them mercilessly and even drug them with alcohol in order to make them run faster. Some cart owners harness a bullock and a horse together.

8. Snake Charmers: Snake charmers throng the streets with cobras and other snakes in cane baskets. Devotees offer milk to the snakes and gather around to see them “dance” – the snakes spread their hoods and sway, apparently to the tune of a pungi, a wind instrument. Most people are under the impression that the snakes are being charmed by the music, but they are actually rearing up as a defensive reaction to a perceived threat. After the snakes are captured from their homes in the forests, they are kept in cramped boxes or bags. The snakes’ teeth are yanked out, their venom ducts are pierced with a hot needle and sometimes their mouths are sewn shut. Snakes normally never drink milk, but the handlers starve them so that they consume it thirstily when it is offered to them. This later causes allergic reactions and often dysentery and dehydration – and can lead to death. Also, the toxic tikkas which are applied to the snakes’ hoods during the worship ritual sometimes trickle into the snakes’ eyes, blinding them.

9. Horse joy ride: In many cities horses are forced to give joy rides. They can often be seen struggling to pull heavy carts loaded with people, and they are frequently beaten or whipped when they become tired or slow down. They are forced to pull carts until late at night without adequate rest. Often, the horses are denied shade or any sort of protection from sun or rain. They are given substandard food and have hardly any access to water. The stables where they are housed are typically filthy. Some owners simply tie their horses at garbage dumps for the night so they do not even have to provide food for them.

10. Exotic Pets: Life in captivity often leads to pain and death for “exotic pets” such as turtles and tortoises. These animals can easily suffer from malnutrition and the overwhelming stress of confinement. The exotic animal trade is also deadly for the animals we do not see: for every animal who makes it to the store, countless others die along the way.

11. Other venues: Animals are also exploited and mistreated for human amusement in horse and greyhound racing and in shopping malls and schools where they are put on public display. Exotic animals are often used in photo opportunities, or are shot and killed in canned hunts or on hunting ranches. Unfortunately, people can be very creative in finding ways to make a profit of animals.

Animals on the Internet:

The Internet is a very useful tool in learning everything there is to know about animals. It is both educational and entertaining. However you must beware of unscrupulous people who use the Internet to show inappropriate movies with animals, who sell outlawed and endangered animals, sell dogs from puppy mills – the list is long. Be sure to check out the sites you visit to ensure they are legitimate.

Cruelty on animals:

Animals are not novelties; they have their own needs, interests, and rights — including the right to engage in their natural behaviors in their natural environment. We are committed to using every tool at our disposal, from lobbying to lawsuits to grassroots organizing, to end the cruel exploitation of animals for human amusement and profit. Chimpanzees, bears, tigers, elephants, and other animals aren’t actors, spectacles to imprison and gawk at, or circus clowns. Yet thousands of these animals are forced to perform silly, confusing tricks under the threat of physical punishment; are carted around the country in cramped and stuffy boxcars or semi-truck trailers; are kept chained or caged in barren, boring, and filthy enclosures; and are separated from their families and friends—all for the sake of human “entertainment.” Many of these animals even pay with their lives. Bears, elephants, tigers, and other animals used in circuses do not voluntarily ride bicycles, stand on their heads, balance on balls, or jump through rings of fire. To force them to perform these confusing and physically demanding tricks, trainers use bullhooks, whips, tight collars, muzzles, electric prods, and other painful tools of the trade. When they’re not performing, elephants are often kept shackled by two legs, and lions, tigers, bears, primates, and other animals are forced to eat, sleep, and relieve themselves in tiny cages. Not only are elephants, horses, hippopotamuses, birds, dogs, camels and other animals often beaten by trainers, they suffer from loneliness, boredom and frustration from being locked in cramped cages or chained for months on end as they travel from city to city. Instead of being loaded and unloaded like furniture into trucks and warehouses, these animals should be in their natural habitats – exploring, seeking mates and raising families. To treat animals as objects for our amusement is to treat them without the respect they deserve. When we degrade the most intelligent fellow mammals in this way, we act as our ancestors acted in former centuries. They knew nothing about the animals’ intelligence, sensitivities, emotions, and social needs; they saw only brute beasts. To continue such ancient traditions, even if no cruelty were involved, means that we insist on remaining ignorant and insensitive.

Circus:

Animals in the circus are taken from their families and deprived of all the things that they would experience in their natural habitats. If you were able to watch these animals in the wild, you’d never find them riding bicycles, jumping through flaming hoops, standing on their heads, walking around on their hind legs, or balancing balls on their noses! You’d see them roaming around, foraging or hunting for food, and bonding with their family unit or herd. Circus animals are dragged around the country in cramped, dirty boxcars for as many as 50 weeks a year—keep in mind that there are only 52 weeks in an entire year! When they’re not performing, the big cats, bears, and other animals actually live in these small barren boxcars or cages, and sometimes, they’re not able to get to food and water when they are thirsty or hungry. The elephants spend about 20 hours a day in chains and are usually only unchained long enough to perform for a noisy crowd. But in the wild, elephants walk between 30 and 50 miles a day, play in mud pits, swim in watering holes, and interact with their loved ones. Did you know that female elephants stay with their mothers for their entire lives? Males are a bit more independent, so they stick with Mom until they’re about 15 years old. But circuses take young elephants away from their families.

Zoos:

Zoos claim to educate people and save endangered species, but visitors often leave without having learned anything meaningful about the animals’ natural behavior, intelligence or beauty. Furthermore, most animals in zoos are not endangered species. PETA investigators visited many zoos throughout India and found appalling neglect, decrepit facilities and animal suffering on a massive scale. Every facility was seriously deficient in terms of food, drinking water, housing, veterinary care, environmental enrichment, safety and security. Countless animals were found to have no food or water. Many live in concrete and iron cages which do not have any enrichment or even a blade of grass. Some cages are so small that the animals can barely move. Many animals exhibit neurotic and abnormal behavior, including pacing, head-bobbing and extreme agitation. Some have visible injuries and are clearly ill. Animals are often housed inappropriately. Some facilities have few or no staff members present – much less security. Many zoos which are officially closed are still functioning. Visitors were seen feeding the animals with no zoo personnel in sight. Few investigators saw visitors teasing and taunting animals and throwing rocks and debris. Few or no educational materials were available. Animals in zoos become bored and stressed from confinement, and they develop a mental illness called “zoochosis”. Animals with zoochosis pace back and forth, sway from side to side, throw feces, bite the cage bars, repeatedly lick the bars and walls of the cages, and over-groom themselves, which can cause bald spots. Some people think that zoos work to save endangered species, but that is not the case.

Don’t zoos contribute to the saving of species from extinction?

Zoos often claim that they are “arks”, which can preserve species whose habitat has been destroyed, or which were wiped out in the wild for other reasons (such as hunting). They suggest that they can maintain the species in captivity until the cause of the creature’s extirpation is remedied, and then successfully reintroduce the animals to the wild, resulting in a healthy, self-sustaining population. There are several problems with this argument, however. First, the number of animals required to maintain a viable gene pool can be quite high, and is never known for certain. If the captive gene pool is too small, the inbreeding can result in increased susceptibility to disease, birth defects and mutations; the species can be so weakened that it would never be viable in the wild. Some species are extremely difficult to breed in captivity: marine mammals, many bird species, and so on. Pandas, which have been the sustained focus of captive breeding efforts for several decades in zoos around the world, are notoriously difficult to breed in captivity. With such species, the zoos,by taking animals from the wild to supply their breeding programs, constitute a net drain on wild populations. The whole concept of habitat restoration is mired in serious difficulties. Choosing zoos as a means for species preservation, in addition to being expensive and of dubious effectiveness, has serious ethical problems. Keeping animals in zoos harms them, by denying them freedom of movement and association, which is important to social animals, and frustrates many of their natural behavioral patterns, leaving them at least bored, and at worst seriously neurotic. While humans may feel there is some justifying benefit to their captivity (that the species is being preserved, and may someday be reintroduced into the wild), this is no compensating benefit to the individual animals.

How will people see wild animals and learn about them without zoos?

To gain true and complete knowledge of wild animals, one must observe them in their natural habitats. The conditions under which animals are kept in zoos typically distort their behavior significantly. There are several practical alternatives to zoos for educational purposes. There are many nature documentaries shown regularly on television as well as available on video cassettes. Specials on public television networks, as well as several cable channels, such as The Discovery Channel, provide accurate information on animals in their natural habitats. Magazines such as National Geographic provide superb illustrated articles, as well. And, of course, public libraries are a gold-mine of information. Zoos often mistreat animals, keeping them in small pens or cages. This is unfair and cruel. The natural instincts and behavior of these animals are suppressed by force. How can anyone observe wild animals under such circumstances and believe that one has been educated?

Don’t animals live longer in zoos than they would in the wild?

In some cases, this is true. But it is irrelevant. Suppose a zoo decides to exhibit human beings. They snatch a peasant from an underdeveloped country and put him on display. Due to the regular feedings and health care that the zoo provides, the peasant will live longer in captivity. Is this practice acceptable? The substitution of quality of life by quantity of life is not always decided in favor of quantity.

Some countries in the European Union (e.g. Sweden, Denmark and Finland), as well as India have already begun to ban or restrict the use of animals in entertainment. The United States should learn from these examples since there is no place in a democratic and compassionate society for such well-documented examples of abuse. Many forms of animal entertainment have unfortunately become a mainstay in our society and therefore remain unquestioned. As responsible, caring citizens we can boycott the use of animals in the entertainment industry (e.g. zoos, aquariums, rodeos, circuses, etc.) and patronize non-animal venues such as Circque-du-Soleil.

What would the supporter of ‘animals in entertainment’ say?

Hunting is often referred to as cruel and inhumane but that is not entirely true. Humans have been hunting animals as far back as humans have existed. Hunting is our core for survival, we hunt for food and other basics we need. How do you think our ancestors got their food? They would hunt for it, as simple as that. People have acknowledged that hunting is a part of history but in modern society we have merely crafted it into a sport and all of a sudden it is cruel. How do you think fancy restaurants will get their meats that aren’t necessarily farmed? They would hunt for it, deer meat, crocodile meat, and others are all delicacies of other races. We eat animals everyday so there is no reason they shouldn’t be used as objects of sport and entertainment too. It is acceptable to use animals for sport or entertainment as long as people are entertained and animals are not harmed. Well, I am a pure vegetarian and I do not eat meat or fish. I also find use of animals in entertainment rather disgusting. Few examples of animals in entertainment will be sufficient to provoke outrage. During calf-roping events in rodeos, a calf may reach a running speed of 27 miles per hour before being jerked by the neck to an abrupt stop by a lasso. This event has resulted in punctured lungs, internal hemorrhaging, paralysis, and broken necks. Once greyhounds begin their racing careers, they are kept in cages for more than 20 hours a day. The cages are made of wire and are barely big enough for the dogs to turn around. Dogs who are considered too slow to race are often sold to research facilities or killed. Thousands are killed each year; very few are adopted. Horses used in racing are bred for one purpose: to make money. Because of this motive, horses are often forced to run even when injured. More racehorses are bred than can prove profitable on the racetrack. As a result, hundreds of racehorses are sent to slaughter every year.

Edutainment:

Edutainment (education + entertainment) is a form of entertainment designed to educate as well as to amuse. It can be argued that edutainment has existed for millennia in the form of parables and fables that promoted social change. The most effective forms of learning are fun. So let’s package tasks that function to measure and sort children into something that is pleasurable. That way, the kids will have fun, they will also get ahead in life, and parents can feel they have fulfilled the impossible imperatives of contemporary middle-class parenting that say they must support competitive successes while also keeping their children happy and entertained. This is an approach that looks at “fun” as an extrinsic motivator of learning, rather working to support learning that is intrinsically motivated. The focus on entertainment as a motivator tends to “designate the role of games as a form of educational ‘sugarcoating’—making the hard work of mathematics or language arts easier to ‘swallow’.” These are the discourses that currently dominate the production and marketing of academically oriented commercial games. other forms include television productions, film, video games, radio, museum exhibits, teaching techniques in colleges, corporate learning and computer software, all of which can use entertainment to attract and maintain an audience, while incorporating deliberate educational content or messages. Edutainment is criticized by some as it emphasizes fun and enjoyment, often at the expense of educational content. The idea is that people are used to flashy, polished entertainment venues like movie theaters and theme parks that they demand similar experiences at science centers and museums. Thus, a museum is seen as just another business competing for entertainment dollars from the public, rather than as an institution that serves the public welfare through education or historical preservation.

The museum environment allows the concepts of learning, education and entertainment to closely overlap in positive ways as shown in the diagram above. The learning, entertainment and education are not competing concepts or opposites — they are complementary. Museums should not be concerned about their entertainment value and role, as results indicated that adult visitors felt that entertainment added to learning, not detracted from it, and overall, museums should promote themselves as places for enjoyable and entertaining learning experiences.

Education to Entertainment ratio: also called Education Versus Entertainment ratio (EVE ratio):

Entertainment and education are necessary as both are useful to us. Take away either one of them and our life will not be complete. In most cases, the tools used for getting an education and entertainment are same. For example, TV can be used for entertainment as well as for education. Similarly, computers and books can be used for both purposes. EVE is the ratio of amount of time used in education to amount of time used in entertainment. EVE for American population is 1:50 meaning for every one hour spent on education, people spend 50 hours in entertainment. The average American who considers themselves “successful” and making good money at what they do, spends about 3% of their monthly income on personal growth activities (education). The same average American spends up to 33% of their monthly income on Entertainment activities…some more, some less. That is over 10 times the amount on their education.

Calculate your EVE:

Take a notebook and write two columns, one titled: Education and the other one: Entertainment. Under education write down how much time you spend on areas such as: seminars, trainings, books, classes, personal development, online learning, educational CD/DVD etc and on the entertainment side write down how much time you spend on: TV, Movies, Sporting Events, Internet, night life, hobbies and so forth. The categories on either side are not exhaustive you can throw in some more. Add up the time spent on either side; how is your ratio? By the way, visiting my website www.drrajivdesaimd.com would be educational activity.

According to the department of labor statistics of the year 2010, an average American spends 0.05 hrs/day on educational activities and 2.13 hrs/day watching television. That is a ratio of 1:42. In other words, for every hour spent on educational activities, 42 hrs were spent watching television. Since watching television is just one form of entertainment and if I include the time spent on movies, blogging, web surfing, facebooking, twittering etc., then the ratio will be even lower.

Actually, a study done by Harvard School of Business shows that those who actively seek to upgrade and improve their personal skills and business acumen double, and in some cases, triple their incomes every 3-5 years. While the people who stop learning and just work for wages, never improve and never get raises, and always complain the most about the lack of opportunity at their present jobs. It is an easy conclusion of the observant mind, that the society of America, at least, has worked itself into poverty by placing too much emphasis on its entertainment over its education, leaving them in debt to their future. Some researchers say that anybody who raise EVE ratio from 1:50 to 1:5 can become rich. I have raised my EVE ratio by concentrating on my website rather than wasting time in entertainment, I did not become rich but nevertheless indeed famous. Regardless of how low EVE ratio is, you can start today and up your investment in personal development and education. You can reorder your life and put in more time and money on the side of education and less and less on the side of entertainment. Reduce entertainment and increase education. This may be the most difficult part if you’re used to drowning yourself in entertainment every day of the week. To be more clear, when I refer to entertainment I really mean any activity where you are turning off your brain and stunting your personal growth. This could include everything from watching TV and blindly surfing the web, to going to sporting events or taking off on vacation. The goal is not to eliminate entertainment; it is to identify activities in your life that waste your time or do not add any significant value to your life. Enhance your education with direct, applicable, and bold action. Education can easily become another form of entertainment if it’s not coupled with bold action. In other words, if you stopped watching TV to read a non-fiction book instead but you never used the information from the book, you have simply entertained your brain and made no real progress. Some education does not have direct action associated with it and not everything you learn can be put on a to-do list. But if you find information that you know should be acted on, then you should just do it. More action equals more progress and that is the ultimate goal.

Effects of Music Entertainment on Society:

Music influences a lot of our emotions, especially the basic emotions of sadness, happiness and anger. Happiness can be increased through listening to upbeat and happier songs. While listening to slower sadder songs can often make you cry, or cry harder as the case may be. Anger is also an emotion that can be enhanced through music. One of the most common forms of music that enhances anger is rock or metal music. Rock can be said to be the father of metal music, where metal was formed from rock itself. Metal is harder, but both metal and rock can ignite or add fuel to one’s anger, or release it as the case may be. All these emotions however prove one thing about music; it is a great stress reliever. Also, classical music stimulates different areas of the brain, which stimulates better connections in the brain and increase in connectors will result in enhanced memory. For the unborn, there are also studies showing the ability of a fetus to hear sounds while in utero. Babies respond with an increase in heart rate and other physiologic indicators. Many studies have reported that a positive sign the fetus has been stimulated by music is indicated by a change in heart rate. The exposure to music in the prenatal period increases attention of newborns, more sound imitation and earlier vocalization. The fetus hears its mother’s voice mostly, as well as it’s mother’s breathing and her other internal sounds. This is why new born babies prefer to hear its mother’s voice because a mother’s voice is literally music to a child’s ears. Thus, singing along with music while your child is yet unborn will have some positive benefits at birth. Some scientists don’t agree with the theory that an increase in heart rate signals a positive response in the fetus. It could be that the increase in heart rate of a fetus signals that a baby is not comfortable with the sound. Of course not all kinds of music can be played for an infant. The baby does respond to what he or she hears. Multiple studies have shown that babies recognize the sounds or music they hear during pregnancy. It is very important that the mother is relaxed and comfortable as the baby is affected by the mother’s emotions. Soothing music helps the mother and the baby to relax, while loud music disturbs the mother and startles the baby. Expectant mothers should carefully choose which music her baby should hear. Classical music and nature sounds could be soothing for the baby while loud ones may not be as pleasing.

Evolutionary psychology of music:

From a psychological viewpoint, the question of the origin of music is difficult to answer. Music evokes strong emotions and changed state of awareness. Generally, strong emotions are associated with evolution (sex and survival). But there is no clear link between music and sex, or between music and survival. Regarding sex, musicians often may use music to attract mates (as for example male birds may use their plumage to attract females), but that is just one of many functions of music and one of many ways to attract mates. Regarding survival, societies with a musical culture may be better able to survive because the music coordinates their emotions, helps important messages to be communicated within the group (in ritual), motivates them to identify with the group, and motivates them to support other group members. However it is difficult to demonstrate that effects of this kind can enhance the survival of one group in competition with other groups. Once music exists, effects of this kind may promote its development but it is unclear whether effects of this kind can explain music’s ultimate origin. Another possible origin of music is motherese, the vocal-gestural communication between adults (usually mothers) and infants. This form of communication involves melodic, rhythmic and movement patterns as well as the communication of intention and meaning, and in this sense are similar to music. Motherese has two main functions: to strengthen bonding between mother and infant, and to help the infant to acquire language. Both of these functions enhance the infant’s chances of survival and may therefore be subject to natural selection. The human fetus can hear for 20 weeks before birth – considerably longer than other animals, most of which cannot hear before birth at all. The fetus can also perceive movement and orientation for 20 weeks before birth. This is presumably not an accident of evolution, but an adaptation that promotes the survival of the infant after birth by improving bonding between the infant and the mother. If the fetus learns to perceive the emotional state of the mother via the internal sounds of her body (voice, heartbeat, footsteps, digestion etc.), it can presumably adjust its postnatal demands (e.g. crying) depending on her availability and in that way enhance its own survival as a fragile being in a dangerous world. Research on the ability of the fetus to learn and remember sound patterns, and on the active two-way nature of mother-infant communication, is consistent with this theory. It has been recently suggested that the primary function of music was a defense (through the intimidating audio-visual display), used by early hominids against the major predators of Africa after they descended to the ground. Joseph Jordania suggested that singing in hominids was communal and had two evolutionary functions: internal and external. The internal function of loud rhythmic group singing (and drumming) was to alter the hominid brain through strong emotions and to make group members lose themselves in order to get them into a state of battle trance, where they forgot their instinctive fear for the big predators & death and did not feel pain during combat. The external function of the loud rhythmic group singing (together with vigorous body movements, drumming, stone hitting and stone throwing) was to intimidate large African predators (or competitors). As the continuation of the initial defense/military function of music, humans had been using battle cry and military songs from the prehistoric times in order to raise their confidence and to intimidate the opponents. Long hours of military drills are a well-known means for developing the sense of unity and obedience in new recruits. Loud rhythmic music is still widely used to assist soldiers in preparing them for combat situations.

According to a recent paper by Nidhya Logeswaran and Joydeep Bhattacharya from the University of London, music even affects how we see visual images. In the experiment, 30 subjects were presented with a series of happy or sad musical excerpts. After listening to the snippets, the subjects were shown a photograph of a face. Some people were shown a happy face – the person was smiling – while others were exposed to a sad or neutral facial expression. The participants were then asked to rate the emotional content of the face on a 7-point scale, where 1 mean extremely sad and 7 extremely happy. The researchers found that music powerfully influenced the emotional ratings of the faces. Happy music made happy faces seem even happier while sad music exaggerated the melancholy of a frown. A similar effect was also observed with neutral faces. The simple moral is that the emotions of music are “cross-modal,” and can easily spread from sensory system to another. Although it probably seems obvious that music can evoke emotions, it is to this day not clear why. Why doesn’t music feel like listening to speech sounds, or animal calls, or garbage disposals? Why is music nice to listen to? Why does music get blessed with a multi-billion dollar industry, whereas there is no market for “easy listening” speech sounds? Music is exquisitely emotionally evocative, which is why a touch of happy music makes even unrelated pictures seem more pleasant. My rationale is that music always has a rhythm and it gets entangled in various biological rhythms in human brain and therefore evokes a far greater emotional response than mere listening to speech sound.

Music has a powerful potential to affect society. The music of a society can both reflect the collective consciousness of the culture and transform it. The words and music can be a mirror reflecting the actions of a society or a lighthouse giving guidance and direction.

1. Political: Music can have a political influence on a society. Political campaigns have traditionally used music and theme songs. John Lennon’s “Imagine” communicated the globalist worldview clearly and effectively. Toby Keith inspired patriotism and support for the troops with “Courtesy of the Red White and Blue.”

2. Linguistic: Music can impact vocabulary by introducing new words and verbal forms into the language. Snoop Doggy Dogg’s trademark, “For Shizzle” has become part of the lexicon of the culture. Terms such as “crunk” and the use of “da” instead of “the” can be attributed to popular music.

3. Religious: Music has been a vehicle to carry messages of inspiration and religious devotion inside and outside of church services. Today music genres such as gospel, contemporary christian, and praise & worship fill the airwaves as well as the churches. Faith is built and strengthened today by songs of cross-over artists such as Randy Travis, Amy Grant, and Sandi Patti. Musical bhajans and kirtans convey religious devotions in traditional Hindu temples.

4. Moral: Music can be the arena in which moral conflicts are presented. Songs are filled with messages about appropriate and inappropriate attitudes and actions toward sex, drugs, alcohol, marital fidelity and the sanctity of life. Artists on all sides of the issues write tunes that reflect their positions on issues of morality.

5.Educational:Music can be educational as well when song writers use literary references and allusions, cite historical events, and include scientifically accurate statements in their songs. “The Night Chicago Died” by Paper Lace and “Pride” by U2, about Al Capone and Martin Luther King Jr., respectively, are two examples of historically-based songs.

Danger of music entertainment:

Electrical recordings of the human brain show that it is particularly sensitive to the rhythmic stimulation by percussion and bright light among other things, and certain rates of rhythm can build up recordable abnormalities of brain function and explosive states of tension sufficient enough to produce convulsive fits in predisposed subjects. Of the results caused by such disturbances, the most common one is temporarily impaired judgment and heightened suggestibility. In Vancouver, during a 30 minute Beatles performance, 100 people were stomped upon, gouged and assaulted. In Melbourne, nearly 1000 people were injured at a rock concert. “Our music is capable of causing emotional instability, disorganized behavior, rebellion and even revolution” (Beatles, 1960). A popular rock singer said this about their music. “Rock and roll has always been sexual. Rock and roll has always been violent. It has teeth. It will scratch your face off. That’s why I like it…..if you like having your brains blown out and pushed up against a wall, then it’s for you.” There must be a condition of harmony or perfect balance between the mental, emotional and physical operations of the organism if it is to function properly. It is precisely at this point that rock and roll, and much modern music, becomes potentially dangerous. This is because, to maintain a sense of well being and integration, it is essential that man is not subjected too much to any rhythms not in accord with his natural body rhythms. There are some Lyrics that promote drugs, sex, crime, suicide, promiscuity and rebellion. In most Music videos’ the settings for the performers are often in back alleys, junk yards, abandoned buildings, or in places where only the physical senses are excited and the body movements are vulgar and suggestive. When music is too loud, it blocks out our other senses and we lose touch with reality. Our thinking and actions are changed and under a prolonged exposure to loud music, a moral apathy pervades. Consider the following three types of damage that takes place in our bodies under exposure to loud music volume.
1. Loud music slows down our ability to memorize and do other brain functions by reducing the flow of blood to the brain because the blood vessels undergo a narrowing of caliber in the presence of loud sound.

2. Loud music can cause a form of schizophrenia. When a person is exposed to high level sound, a chemical is formed in the brain that is normally found in schizophrenia patients in mental institutions.

3. Loud music can cause ulcers. When susceptible individuals are exposed to loud sound over a period of time, certain stomach functions are disrupted and an increase of hydrochloric acid is released, causing ulceration of the stomach.

Art vis-à-vis entertainment:

Webster’s defines art in terms of what is beautiful, or aesthetically appealing, or extraordinarily significant. Art signifies – I’ll say it incarnates – beauty. In art, things come near to us that we can never define – truth, goodness, transcendence – but that we know make us truly alive. Webster’s describes entertainment in terms of amusement. Entertainment diverts our attention. It passes the time agreeably. Art is inspiring, a form of pure self-expression, unique creation but not always widely accepted and entertainment is amusing, popular, widely accepted and business related. One of the many reasons why art is so important in human life is because it is inspiring, and beautiful. It contains a message which could bring your heart to warmth. Entertainment is more focused on how entertaining and how amusing it is. Let’s face it – we watch TV shows or movies when we are bored because they are entertaining. They are fun to fill our free time. Do they have any valuable messages or something we could remember for the rest of our life? Probably not. On the surface, these terms seem very different. Then why do they come together so often?

“Entertainment wants to give you what you want. Art wants to give you what you don’t know you want.” Entertainment is part of an evening — mini-golf, pizza, a movie, and ice cream. Art is the evening — you generally have to make plans to see an art movie, and then you find somewhere to sit and discuss it afterward. Entertainment is terrified of losing you, and is willing to change itself to be more to your taste. Art doesn’t care whether it loses you — if you’re lost, that’s your problem. Entertainment condescends to what it perceives as your level. Art assumes you’re at a high level and wants to take you higher — it conascends. Entertainment wants to make you think you’re thinking, but actually steers you toward its chosen conclusion. Art actually does make you think, and allows you to arrive at your own highly subjective conclusion. Entertainment generally isn’t personal or obsessive or visionary. Art often is. Good entertainment often is not artistic. Good art often is entertaining. If entertainment is unappealing, offensive, and hell to sit through, you just wasted your ticket money. If art is unappealing, offensive, and hell to sit through…maybe you should see it again.

Some quotes:

‘Art is a necessity and entertainment is a luxury.’ – Deborah Borda, president of the Los Angeles Philharmonic.

‘Art can be life-changing, but entertainment need not be,’ and ‘the arts nurture the spirit.’ – Hilda Ochoa-Brillembourg, CEO of Strategic Investment Group and chair of the Youth Orchestra of the Americas.

‘People pay for entertainment. Art is subsidized.’ – Matthew Bishop, New York bureau chief of the Economist.

Art is by its nature an expression of the person who creates it one way or another. The audience may relate on some intellectual or emotional level–that is another essential element of art, that it stirs the mind and soul, that it evokes feeling–but it is not created simply to please the audience nor designed for them in any way. If they like it, great. If not–make your own if you want to be exactly what’s in your head. Otherwise, move on and look for other avenues of pleasure and fulfillment. Of course it is a mark of good art that an audience can relate, but this is ultimately secondary to the artist’s needs and desires, for art is one’s expression of one man , which another may perchance appreciate but which he need not be obligated to give the time of day if he is not inclined to do so. This is the difference between art and entertainment: the one is designed for self-expression while the other is designed purely to appeal for others. Art can constitute entertainment where it stirs the observer emotionally or intellectually and entertainment can be art if sufficiently effective to its aim. But whereas entertainment must be pleasing to others, art need only please the artist. Art can be life-changing, but entertainment “need not be”. Art addresses the whole person, body, mind and spirit, whereas entertainment doesn’t.

Art is a work that speaks to those who are willing to rise to it; a work that speaks to all genders, races, sexualities, religions, etc., at any time and in any place, and yet is not blandly homogenized — i.e., it isn’t that way by cowardly design, intended to reach a mass audience. It may in fact not reach an audience until decades or even centuries later. Perhaps one wildly generalized difference between art and entertainment is that the latter takes you out of yourself and into another world, whereas the former takes you deeper into yourself, where you and the artist co-create an inner world. Entertainment is mostly about mass appeal and plays on the moods and prejudices of the moment. It is generally unreflective. It is a straight narrative arrow, a good story well told. This is the big difference between art and entertainment, art has a much greater emphasis on implementation, whereas entertainment is purely about enjoyment or stimulation. The two can and do overlap, but I think that it’s important to judge them each on their own merits. Many people seem to want to gauge the quality of entertainment based on artistic standards (this especially applies to things like movies and video games); however, it seems to me that there is an obvious and growing place in our culture for entertainment that may not live up to the standards of “good” art. It shouldn’t have to; after all, entertainment is about stimulation and fun. Even in environments where everyone takes art very seriously, true masterpieces are few and far between.

What is the difference between art and entertainment? This, for many people, is a crucial question, because the value of the arts—and especially the value of classical music—seem to hang on it. Art, many people think, is lofty and profound. Entertainment, by contrast, is shallow and predictable. The very word “entertainment” seems to carry and inherent qualifier: mere entertainment, diverting, maybe, but worthless compared to art. Naturally popular culture, and especially pop music, is dismissed this way. It’s all entertainment, and nothing more. The arts (as traditionally defined) should be funded not because they’re better than popular culture, but because they’re different, and because the different things they do are valuable. Artists don’t mind at all when people like their work, and when their work can make a living for them. Art and entertainment are separate qualities, and any piece of music, film, or play (or poem, painting, pop song, jazz performance, sculpture, dance, or graphic novel) could be either, both, or maybe even neither. Art might be a quality of freshness and unpredictability that tells us something new about our world and ourselves; entertainment, as a quality we potentially might find in any human endeavor (or in nature), would be the mere fact of being entertaining. With this in mind, we can rate things separately for their art and entertainment value. The Schoenberg Violin Concerto is pretty artistic, but not very entertaining. Webern’s little pieces for soprano, E flat clarinet, and guitar, on the other hand, are wildly artistic and also wildly entertaining. And maybe other people won’t find Webern as entertaining as you do, but that, as the old line goes, is why there’s chocolate and vanilla. All of us like different things, and, on top of that, we like them in different ways. The important thing here, for me, is to clarify what entertainment and art really are. Are they entirely separate concepts, which in practice can often be united in a single endeavor? Should they never be opposed to each other? Let me give a classical example. Cricket is played in 5 day match format, one day international and T20 match lasting for 3 to 4 hours. Five day match is an art but T20 match is pure entertainment and one day international is combination of art plus entertainment. So number of people watching 5 day format are less as those are the people who care about aesthetical aspect of cricket while number of people watching T20 format are plenty who want only entertainment from cricket. Why critics must impose the arbitrary, mutually exclusive label of “entertainment” or “art” will forever be a mystery to me. The difference between the terms is a matter of the creator’s intent and the work’s presentation, but doesn’t mean a work can’t be both.

“Fine art”:

Arts give us a way to explore our lives and the lives of others, whether it’s on canvas, on-stage or on a page. Entertainment is a large part of our daily lives. Whether we take our enjoyment from music and the radio, television, theater, dance, movies or video games, we still find time every day to devote to “the arts.” Yes, that’s right, the arts. Though we may not think of it, television, movies, and video games are just as much art forms as poetry, theater, dance and music, and just as much forms of entertainment. What, then, separates them? What makes the content of one medium somehow more “acceptable” than another? What makes one form’s portrayal of subject matter better than another? Whenever we refer to paintings hanging in a museum, or sculptures, we refer to this as art. When we talk about general forms of expression, such as writing in books, poetry, cinematography, or even choreography, we also refer to these as arts. Larger forms of entertainment are also referred to as art: the art of movies, television or production, theater production. Defining the term “art” is like trying to define poetry. However, one of the most common uses of the word art is to refer to this subset of art which is sometimes referred to as “fine” art: putting these forms above other forms of expression. These forms of art are usually enjoyed frequently by a select number of people, usually the elite, and they are open to artistic criticism and analysis. There are special schools and professions devoted to its study and analysis. In some circles, the better you are at discussing the intricacies of these arts, the more cultured, intelligent, and generally popular you are. Currently, these arts include opera, theater, poetry, ballet, and occasionally underground movie productions. These art forms are somehow better than more popular media, deal with more “serious” issues, and capture the essence of humanity far better than all the others.

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To some experts, distinguishing between entertainment and art is seemingly contradictory, because one cannot exist without the other. What is art without entertainment? It is common practice for people to visit the museum and gaze at various works of art for fun, using art for entertainment. Once within the museum patrons can browse from gallery to gallery and entertain themselves by inspecting paintings individually. Every painting is visually stimulating and offers us a form of entertainment. People use the practice of looking, along with the rest of the senses, to perceive entertainment. The duration of their gaze is directly proportional to how exciting they find the sensory stimuli. If the entertainment value of the image is high, the painting will capture the viewer’s gaze, and the reverse is also true. Art is meant to entertain, or it wouldn’t be on display and certainly wouldn’t garner massive crowds of art enthusiasts. For instance, the Mona Lisa exhibit in the Louvre is filled to capacity with the shoulders and elbows of anxious guests chatting excitedly and snapping photos of the venerable masterpiece. Every day of the year the exhibit is swamped with tourists jockeying for the best view of the painting for no other reason than entertainment. What is entertainment without art? Besides entertaining yourself with blades of grass or bubbles, every form of entertainment is a creative artistic expression of the producer, reflecting his/her personal beliefs, intentions and distinctive style. That is precisely why we are entertained; the uniqueness of the entertainment draws us into the media form and spurs us to want to know more, to identify with the work and to hold our gaze a little longer. If entertainment was not artistic it would cease to be entertaining. Viewers quickly tire of watching uninspired commercial film productions, reading predictable novels, and even playing through familiar level designs in video games such as Halo. Each of these is a different example of entertainment lacking creativity and inspiration, or more generally, artistry. Consequently, these examples are among the least entertaining. For entertainment to entertain, a high amount of creative art or artistic vision must go into its creation. In this perspective, entertainment and art are closely tied together.

Why perform music that is not meant to be heard? Is that even music?

That brings me to the crux of my argument: art is only art if it’s seen (or heard in the case of music), for it is the seer or hearer who bestows purpose, or its art-ness as Aristotle would say. And if it’s created with the intention of being seen or heard, it is necessarily created with the intention of entertaining – if you’ve created something no one wants to see or hear, your art has failed as art because you’ve lost the seer or hearer who makes it art in the first place. I’ll even take it a step further – not only does art, in order to qualify as art, need to be created with the intention of being seen or heard, but it needs to express goodness, truth, or beauty… and if it expresses one, it probably expresses all three. Goodness, truth, and beauty are naturally so attractive to the human soul, so captivating, that we can’t help but be entertained. Goodness, truth and beauty – in their nature – are what entertaining is about art. It all depends on how you present it. It is marketing – you know the communication of value. An individual may not be able to understand the goodness, truth, or beauty in a piece of art, but the nature of the piece can contain the value of entertainment. Better art moves the observer to the message. Great art leaves you better than you were before. Entertaining art has the courtesy to draw you in it.

Art film or entertainment film:

There are huge numbers of artists who died in poverty or whose works never took hold with the masses or even the critics of their time. In fact, Shakespeare’s plays themselves completely fell out of popularity in the 17th century, and only regained commercial popularity when their artistic values were recognized. The simple historical fact is that, particularly in the story telling field, ‘art’ almost seems to happen as an accidental consequence of commerce. It’s not particularly useful to ask about a film “Is this art?” – i.e. was it made to serve some lofty ideal – because at the most basic level the answer is always “No, it’s commerce.” If the money doesn’t make sense nothing ever gets made. The interesting question, the one where you can actually make meaningful distinctions and evaluations, is not the question of art but of artisanry, or craftsmanship. Whatever the story is, does its teller tell it well? Is it well crafted and shaped and performed? If the answer to all of those questions – is yes then sometimes a product, and film is a product created to serve a particular market just the same as a well made piece of furniture, can transcend its commercial origins and become art. Art and entertainment are not on opposite sides of the scale, they are not adversaries any more than are commercialism and creativity. If anything, the urge to entertain, has directly given rise to the creation of more works now considered art than any other. However, what one sees as a work of art, can be nothing more than entertainment for another. So art and entertainment can be on opposite sides of the spectrum just because these notions are all subjective no matter the intention of the studios and/or filmmakers or what you felt about a particular film. Viewers have every right to interpret a film as nothing more than entertaining junk food with no redeeming art in it whatsoever because it just didn’t speak to them, it didn’t impact them. Film is an industry driven by profit, profit by volume and volume by the ability to draw and entertain as many people as possible. Just as in Shakespeare’s day if you can’t sell tickets you’ll quickly find yourself unemployed. On a very basic level, every film you’ve ever loved, every film that made you fall in love with the medium in the first place, was approved and brought to life for the simple, basic purpose of entertaining you and as many people like you as possible and, in the process, to separate you all from your money. In other words, the film that is bombed at box office is an art film and the film that is hit at box office is an entertainer no matter the content of a film. In other words, art becomes entertainment if it is appreciated by many people and commercially successful. However, the converse is not true. Entertainment cannot become art just because nobody liked it.

As a scientific person, I have been detached from art and entertainment. I do not know whether art and entertainment are two sides of the same coin or two different coins. What I know is that celebrities who become rich & famous in entertainment business, be it movies, modeling or sports, always project themselves as artists rather than entertainers as subconsciously in their own mind, they feel that being entertainer means being mediocre, and the only way to raise their self-esteem is to hang on to the label of artist because artistry gives them the mask of creativity. So Indian cricket stars & movie stars believe that they are creative individuals who have contributed immensely to the society even though their absence would make no decline in the society.

Sex as entertainment for humans:

As discussed earlier, pleasure derived from satisfying biological needs like food and sex is not considered entertainment. However, humans in search of entertainment have modified relationship between pleasure and biological needs. People drink ‘soft drinks’ not because they are thirsty but because they want to pass spare time and enjoy. Fertilization stopped being the inevitable consequence of an act of love between a man and a woman as soon as humans invented reliable and harmless contraceptives. On the other hand, one does not need to have sex nowadays to have a child – a woman can get pregnant without a man now. Researchers say that about 19,000 male orgasms occur in the world every second. However, it is obvious that modern people prefer to avoid such painstaking consequences as pregnancy when they undress and start warming up their beds. The international birthrate level makes up only four babies a second, which is a meager number in comparison with 19,000 orgasms during the same ultra-short period of time. Sex has become probably the best way for people to enjoy each other. It does have a lot of advantages as opposed to other kinds of pastime. For example, it is much cheaper to have sex than go skiing or play tennis. One does not have to be a professional in sex (experience is always welcome, for course), but it cannot be said about surfing, for instance. Furthermore, sex brings the pleasure of physical satisfaction a lot quicker than reading, collecting stamps or doing the needle-work. Finally, if you have a terrible wish to play basketball, you will need to find several other people having the same wish for a team, otherwise the game will be dull. If you want to have sex, all you need is to find one person, who burns with desire from inside, just like you. It is also important to say at this point that sex unveils true colors of a human being and shows him or her naked, metaphorically and literally. So sex has become the best entertainment that humans could ever invent. Please note that sex as entertainment is the heterosexual consensual sex between two humans above the age of consent outside sex industry. Commercial sex in sex industry is a paid rape which cannot be considered as entertainment as discussed by me in the article “Sex trafficking”.

Can watching pornography be considered as a mode of entertainment:

The pornography debate is not new, but it’s surprisingly far from resolved. Some defend pornography, saying that critics overreact and that porn may act as an outlet for aggression. Others, however, say pornography can ruin relationships, deadens our erotic senses, is immoral, and perpetuates sexism. Some says that pornography is akin to adultery and is sexist exploitation. Some anecdotal studies suggested that “pornography and violent entertainment might serve as exhaust valves for our aggressive impulses”–sexual violence appears to go down as access to porn goes up. I disagree. In my article on “Sex trafficking”, I have shown evidence to link pornography with sex trafficking. However, the world is full of creepy men who might even consider sex trafficking and prostitution as entertainment.

Advertainment: Fusing Advertising and Entertainment:

The term advertainment was coined to reflect the increasingly intertwined connections between advertising and entertainment. It refers to promotional practices that integrate brand communications within the content of entertainment products. Brand communications are now present in the content of a broad range of entertainment vehicles, including TV and movies, radio shows, songs and music videos, video games, plays, and even novels. The increased mingling of advertising with the entertainment world has generated a host of newly coined terms to reflect these trends, such as hybrid advertisement or the “Madison and Vine” expression, reflecting the physical intersection of the advertising industry’s New York City hub, on Madison Avenue, and the entertainment hub on Vine Street. Advertainment has grown mainly in reaction to the increasing advertising clutter, escalating advertising costs, and the reduced effectiveness of traditional advertising messages. Consumers are exponentially exposed to commercial messages but at the same time they are finding new ways to avoid them. An In-Stat/MDR survey found that 54.3% of consumers claim to skip 75-100% of commercials. In 2004, a Knowledge Networks study concluded that 47% of viewers switch channels while watching TV ads. The same study also determined that the proportion of viewers doing other activities while watching TV – such as eating, reading, or using the internet – increased from 67% in 1994 to 75% in 2004. With viewers’ attention to TV advertising declining, major brand advertisers responsible for $20 billion in ad spending per year in the U.S are losing confidence in the effectiveness of TV advertising. According to a 2006 survey by the Association of National Advertisers (USA) TV Ad Forum, 78% of advertisers expressed a loss of confidence in the effectiveness of TV advertising. These numbers present serious concerns for the marketing and advertising industries and one fifth of industry leaders believe that online TV will lead to the death of the traditional 30-second spot. As the convergence of TV and the internet continues, consumers will only gain more control over what they see and when they see it. So advertisers are looking at alternatives such as branded entertainment within TV programs (61%), TV program sponsorships (55%), interactive advertising during TV programs (48%), online video ads (45%) and product placement (44%).

Religion and entertainment:

Are religion and entertainment manifestation of escapist tendency? At times we “escape” so that we can return refreshed by a vision of better things, or by a world in which brave or good characters call on the divine. This is different from refusing our responsibility for the tasks before us, and running away to avoid work or struggle or risk. That’s desertion. Of course telling the difference is not always so clear-cut! In fact, even if we think we’re running away — deserting — we’re brought face to face with our own world in stories. Stories are not a place for you to escape the real world. They are images of the real world. They are not idealized life, but elevated life. Through stories we see our own world ever more clearly. And through their invented wonders we more clearly see the wonders of our own world and characters and societies. So what looked like escape can at least potentially become an education, an inspiration to return and act with grace and power. What is the difference between entertainment and religion? Does God reside more at the altar than on the stage? Many people stated, “We’ve made a religion out of entertainment and an entertainment out of religion.” What has happened to our view of entertainment? The devotion originally given to religious practices has been transferred to films and television shows that worship celebrities and cultural icons. In India, cricket has become a religion, a sport brought by colonial rulers to pass their time. Many actors, sportsmen and entertainers have sacrificed their own convictions, ethics and standards for the fame, wealth, and prestige; and yet, these cricket stars & movie stars are given status of demi-gods and people worship them especially in the largest democracy India. So entertainment has become a religion. On the other hand, many religious festivals in India provide family entertainment including Diwali (festival of lights) & Holi (festival of colors). Christmas is the birthday of Jesus Christ and it also provides entertainment to kids and teens. Everybody knows about Santa Claus.

Photography and entertainment:

Photography is indispensable. It is involved in everything you do. Just like it records memories, entertainment industry & showbiz needs visuals both still and motion pictures for it to be able to entertain the public. People remember more of graphic things than literary things. Photography sells them. It is what is used in advertising; it is in fashion, modeling and movies. It is everywhere. Photography is like the pulse of entertainment and it would be almost impossible to do anything without it in the industry. Even the Bible has pictures, some silhouette. My facebook profile picture reveals everything. People say that one photograph reveals more than thousand words.

Entertainment sectors:

Entertainment industry:

The entertainment industry (also informally known as show business or show biz) consists of a large number of sub-industries devoted to entertainment. It applies to every aspect of entertainment including cinema, television, radio, theater and music. In the popular parlance, the term show biz in particular connotes the commercially popular performing arts, especially musical theatre, vaudeville, comedy, film, and music. However, the term entertainment industry is often used in mass media to describe the mass media companies that control the distribution and manufacture of mass media entertainment.

Entertainment industry in the U.S.:

The entertainment industry is often considered to be one of the most interesting and exciting industries in which to work. It is a business in which many people would like to work and, as a creative industry, it is one that offers people the chance to be involved in the creation of art, even if they are not themselves an artist. Working in the entertainment industry enables people to spend time with artists and to gain an insight into the creation of entertainment products such as music. The allure of the entertainment industry is partly based around the chance that it offers people to meet and mix with artists and to enjoy a taste of what it is like to be rich and famous. People working in this industry can enjoy attending concerts, events and awards ceremonies, and spending time seeing the parts of the industry that most people will never experience. There is an element of glamour involved in the idea of working in the entertainment industry. As long as people have had free time, they have pursued leisure activities. Musical troupes, theaters, and sports have been a part of culture since ancient times. As leisure time and personal incomes have grown across nations, so has the arts, entertainment, and recreation industry. As per the U.S. Bureau of labor statistics 2008, the entertainment industry is characterized by a large number of seasonal and part-time jobs and the employment of relatively young workers. About 37 percent of all workers have no formal education beyond high school. The industry includes about 125,500 establishments, ranging from art museums to fitness centers. Practically any activity that occupies a person’s leisure time, excluding the viewing of motion pictures and video rentals, is part of this industry. The diverse range of activities offered by this industry can be categorized into three broad groups—live performances or events; historical, cultural, or educational exhibits; and recreation or leisure-time activities. Jobs in arts, entertainment, and recreation are more likely to be part time than those in other industries. In fact, the average nonsupervisory worker in the arts, entertainment, and recreation industry worked 24.1 hours a week in 2008, as compared to an average of 33.6 hours for all private industry. Many types of arts, entertainment, and recreation establishments dramatically increase employment during the summer and either scale back employment during the winter or close down completely. The arts, entertainment, and recreation industry provided about 2 million wage and salary jobs in 2008. About 45 percent of all workers are under 35 years old. About 59 percent of wage and salary workers in the industry are employed in service occupations. Industry earnings, earnings in arts, entertainment, and recreation are relatively low, reflecting the large number of part-time and seasonal jobs. Nonsupervisory workers in arts, entertainment, and recreation averaged $355 a week in 2008, compared with $608 throughout private industry.

An average American spends more money on entertainment than on gasoline, household furnishing and clothing. The global entertainment and media (E&M) industry has entered a solid growth phase and will increase at a 6.6% compound annual growth rate (CAGR) to $1.8 trillion in 2010, according to PricewaterhouseCoopers’ “Global Entertainment and Media Outlook: 2006–2010″ report.

U.S. economic recession affected entertainment industry:

Due to flagging health of U.S. economy, entertainment industry suffered in the U.S. Just last year it was entirely unclear whether the NFL and NBA (American professional football and basketball, respectively) would even be able to schedule any games for the season, as the players and owners could not agree on how much each faction would get of a still large, yet rapidly dwindling pie of profits. Those issues were finally resolved at the last minute. The movie industry is no better, and has already been hit quite hard since the beginning of the financial crisis in 2008. Movie studios require a certain amount of funding upfront before they can give the thumbs up for expensive productions to get underway or to continue, and those are funds that simply aren’t available for many of the studios right now, including relatively large ones. For every fancy, whiz-bang movie that comes out into theatres these days, there are perhaps dozens of others that were downsized, terminated or put on hold indefinitely. Attendance at North American movie theaters hit a 16-year low last year. DVD sales continue to drop. Although some emerging overseas markets are picking up steam, Europe and other important sales territories are uneven. And there are no indications of an immediate reversal of the trends. Game, the computer games retailer has decided to shut 277 UK stores and cut up to 2,500 jobs. It is the way in which economic collapse metastacizes in all the organs of a cultural society. When multiple generations around the world would rather go without food for a day rather than the season-ticketed event or the latest computer/video game, and may be forced to go without all three, you know we are in for rough times ahead.

Global Entertainment Industry to Reach US$1.4 Trillion by 2015:

Entertainment has and continues to be one of the fastest changing industries worldwide. With television marking the beginning of society’s addiction to entertainment decades ago, the advent of the Internet as a more versatile form of media now has society obsessed with media driven entertainment. Continuously growing demand for high definition TVs, Smartphones, music players, DVD multimedia players, satellite radio, video game consoles, among others augurs well for the future of the entertainment industry. As myriad vectors of entertainment technologies, such as, instant messaging, video sharing, steaming, social networking sites, roll down the proverbial hill gathering lucrative market opportunities all rolled one behind the other, strong growth is forecasted for the industry in the upcoming years. Presently, the digital wave is engulfing the industry and all the major enterprises in the entertainment industry are reviewing their business activities with a view to imbibe technology and be prepared for the digital future. Despite the recession casting a dampener on entertainment, certain segments such as movies, video games and home entertainment industry continued to remain afloat in the tough economic climate. The fact that entertainment offers an escape route to ease out pressure during troubled times, to a large extent withheld the industry from slipping into the red. Global Entertainment Industry to reach US$1.4 Trillion by 2015, according to New Report by Global Industry Analysts, Inc (GIA). GIA announces the release of a comprehensive global outlook on the Entertainment Industry. Modern society is hooked onto media driven entertainment as reflected by the widespread use of multi-functional phones and handheld devices and the trickling of media i.e. music, videos, movies, into every nook and cranny of people’s lives. Digitalization, which is seeping into the very fabric of the entertainment industry and the strong yet untapped potential in emerging markets in Asia Pacific and Latin America, will drive market growth in the next few years.

Growth of entertainment industry:

1. Worldwide box office ticket revenues have increased 25%, jumping up from $25.5 billion in 2006 to $31.8 billion in 2010.

2. Overall, the entertainment industry grew 50% over the past decade.

3. In 1995, there were 1,723 feature films produced worldwide; in 2005, that number grew to 5,635; in 2009, it was 7,193.

4. The global value of the music industry rose from $132 billion to $168 billion from 2005 to 2010.

5. During the period of 1998 to 2010, the value of the worldwide entertainment industry grew from $449 billion to $745 billion.

Entertainment industry and largest democracy India:

The Media and Entertainment (M&E) industry in India recorded revenues of US$ 16.3 billion in 2010 and is expected to be in excess of US$ 25 billion in the next four years, according to an Ernst & Young report ‘Spotlight on India’s Entertainment Economy.’ Growing digitization, media consumption and improving demographics are the most important drivers responsible for the growth of this industry. Factors such as economic liberalization, near double-digit annual growth, fast-growing middle class and a huge volume of demand for leisure and entertainment, have enticed global media companies to scale up investments in India. The Indian media and entertainment industry now finds itself at a new turning point—digital media. A rise in mass broadband adoption is expected, led by the launch of 3G and 4G services. By 2015, 90 per cent of India’s projected 187 million broadband subscribers will access the net through wireless devices. Some of the important findings in the report indicate that media and entertainment industry is a lucrative option for making investments. India’s increasing per capita income, growing middle class and working population are generating huge domestic demand for leisure and entertainment. India has more than 600 television channels, 142 million cable-television households, 70,000 newspapers and produces more than 1000 films annually. India has diverse regional markets with different cultures, languages and content preferences. These markets provide global media and entertainment companies’ ample amount of opportunities to deliver localized content. India’s favorable regulations and reforms are creating investment opportunities for global media and entertainment companies.

How Facebook could remake the entertainment industry:

In seven years, the social networking site has grown from a project hatched in a college dorm to the largest social networking site in the world, well on its way to hitting its goal of having 1 billion users. The initial public offering documents that Facebook filed recently reveal just how big an advertising and distribution juggernaut it has become. The company said that last year it made $1 billion on $3.7 billion in revenue, making it more than twice as profitable as Google was when it went public in 2004 and almost as profitable as the CBS television network is today. Facebook’s reach turned out to be even bigger than previously thought — it has 845 million monthly active users (more than a third of the Internet), 483 million daily active users and more than 37 million fan pages. Facebook has $1 billion in cash now. It will have at least $6 billion when its IPO is complete later this year.

Entertainment lawyer:

Entertainment lawyers provide legal help for artists, employees, companies and individuals involved in all areas of the entertainment industry, including film, radio, television, music, publishing, theater and digital or multimedia entertainment like video games. This could mean helping an actor negotiate a contract with a studio, filing suit over a pirated film, ensuring that stuntmen have adequate medical coverage, overcoming an impasse in union contract negotiations, assisting a young recording artist with financial or real estate decisions, protecting a recording star from illegal use of a copyrighted song or even preventing invasion of a client’s privacy. Also, entertainment lawyers do plenty more in all areas of the entertainment industry, sometimes even acting as agents helping artists manage their assets and careers. Entertainment law covers an area of law which involves media of all types (TV, film, music, publishing, advertising, internet & new media, etc.), and stretches over various legal fields, including but not limited to corporate, finance, intellectual property, publicity and privacy.

Money spent on entertainment:

The picture below shows consumer spending on entertainment per person per year in the U.S.

By some accounts it would be shocking to find that even newspapers still command a larger per person per year spend than movies in the theater, and that home video commands nearly three times the revenue of “box office.” The notion of new films being released either directly to DVD, the Internet or television seems decreasingly far-fetched.

Time spent on entertainment:

American Time Use Survey conducted by U.S. Bureau of Labor Statistics found following facts: On an average day, nearly everyone age 15 and over engaged in some sort of leisure activity, such as watching TV, socializing, or exercising. Of those who engaged in leisure activities, men spent more time in these activities (5.8 hours) than did women (5.1 hours). Watching TV was the leisure activity that occupied the most time (2.7 hours per day), accounting for about half of leisure time, on average, for those age 15 and over. Socializing, such as visiting with friends or attending or hosting social events, was the next most common leisure activity, accounting for nearly three-quarters of an hour per day. Men were more likely than women to participate in sports, exercise, or recreation on any given day–22 percent compared with 16 percent. On the days that they participated, men also spent more time in these activities than did women–1.9 hours compared with 1.3 hours. On an average day, adults age 75 and over spent 7.7 hours engaged in leisure activities–more than any other age group; 35- to 44-year- olds spent 4.2 hours engaged in leisure and sports activities—less than other age groups. Time spent reading for personal interest and playing games or using a computer for leisure varied greatly by age. Individuals age 75 and over averaged 1.1 hours of reading per weekend day and 18 minutes playing games or using a computer for leisure. Conversely, individuals ages 15 to 19 read for an average of 6 minutes per weekend day while spending 1.1 hours playing games or using a computer for leisure. Employed adults living in households with no children under 18 engaged in leisure activities for 4.5 hours per day, nearly an hour more than employed adults living with a child under age 6.

Time spent by children and teenagers on entertainment:

We have seen that children and teenagers have become progressively adept at multitasking, exemplified by the increasing proportion of time in which they are using more than one medium at once. The variety of activities in which they engage is striking as seen in the table below, many of which would have been shared with use of one or more media. As the data from the recent nationally representative, probability sample of more than 2,000 in grades three through twelve (8- to 18-year-olds) collected by Roberts, Foehr, and Rideout (2005) indicate, television consumed the most time, but a larger total was spent on social activities—“hanging out with parents” and “hanging out with friends,” by definition social, and “exercise, sports” and “listening to music,” which often involve others. There was also an amazing 53 minutes a day spent talking on the telephone among teenagers.

In the United States, television markedly reduced movie going, radio listening, and the reading of certain types of magazines (confessions, detective, screen, and pulp adventure) by young people.

Why do we need entertainment?

Why do we need entertainment? There are so many factors, which define the need for entertainment. First and foremost factor is ˜to relax’. You may be feeling distracted, bored, irritated, or simply you need a laugh. For this you need entertainment. Second reason is ˜to feel happy’. In this case, you may go out for movie, celebrate, and eat out. Third reason is ˜loneliness’. In this case, you go out with friends, or dating, or chatting. One more factor is ˜to kill time’. In this age of hectic schedules, where the work pressure has become almost unbearable, the importance of entertainment has increased manifold. Children after their school and homework need something to refresh their mind. For this they indulge in sports, light reading or many of the recreational activities available to them. Working men after the hectic work in office go for Movies, drinks, theatre shows and much more. House wives go for shopping, mall hoping, etc., etc. So, in brief, everyone needs entertainment in one form or another. In older times entertainment avenues were very few. Theatres, live shows, sports events were some of the few entertainment options available. But now with the coming up of so much technological advancement, the option for entertainment has multiplied many times. Now you can have your choice of entertainment from cinema, theatre, dance, music, sports, amusement venues, Television and much-much more. Entertainment can be passive as well as active. Examples of passive entertainment are watching movies, theatre shows and examples of active entertainment are sports activities. Book reading, playing musical instruments comes under the heading of the hobby. In our modern age, the free time, the time to enjoy, the time for yourself is very limited. Everyone wants to enjoy as much as they can in this limited time. This need is also recognized by entertainment industry. The entertainment industry is now producing the kind of entertainment, which is of short duration but very intensive. Movies of short duration, live shows, theatre shows live, dance shows are some instances. Entertainment plays an important role in the lives of children. The child tends to feel frustrated and bored without fun. Fun and entertainment plays an important role in raising a child. Entertainment can help a child develop their motor and mental skills, and help in learning new things.

The picture above shows mind map image of why do we need entertainment.

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Why Family Entertainment is very important:

As a parent it is natural to be caught up with pressing matters such as work because of the need to provide food, shelter, clothing and education for the children and the family as a whole. And as we approach a more modern era, especially with today’s economy, we find ourselves in an increasing frenetic pace in life. It is indeed very overwhelming. So overwhelming that as parents, we just tend to forget to pay attention to the other things that matters. Our duty as a parent and as part of the family, is not only exclusive to being a bread winner, there are other duties as well that you need to tend to. While it is indeed important that you have your children sleeping under a roof on their kids sleeping bags, have decent clothing and full stomach, every member of the family also needs to feel loved. And that is done by spending time together as a family. And spending time with your family does not mean you have to take it in a literal sense. As a family you need to be engaged in fun activities that every member of the family can enjoy. Family entertainment is very important because spending time this way will surely create memorable memories and strengthen your bond as a unit. As the saying goes, the family plays together stay together, is indeed true. But there seems to be a notion that family entertainment can be quite expensive especially considering the state of the economy these days, which is why some family doesn’t bother with the idea. But such notion is not true at all, spending quality time with the family does not necessarily equate to an expensive dinner or a trip abroad. There are many activities that you can do with your family without burning a hole through your budget. One good way to spend a day with your family is to go outside. The outdoor usually means fun for everyone. If you see the lovely sun shining outside then maybe you can gather the whole family to have a quick trip to a theme park or a zoo or maybe head to the playground and engage in some sports activity. This activity is not only fun for everyone but it can also serve as a good exercise. Another good recommendation for family entertainment is to cook as a family. As they say, the kitchen is the heart of every home, and that holds very true in this case. You’ll be surprised at how good food can bring the family closer together. Involve everyone. Have the children help out by having them lend a helping hand. And after you are done, enjoy your masterpiece as a family over a movie. It is guaranteed fun for everyone. Also indulging your kids with toys like kids furniture, will allow you to connect with them more by playing with them. There are many ways in which you can enjoy your time as a family. It does not need that you have a fat bank account; you just need to be creative in coming up with ways to enjoy that will suit your family best. Whenever you want to spend time with your family, be sure that is would be fun and memorable for everyone.

Entertainment does affect us:

We have all been affected by some form of entertainment at one point in our lives, whether it’s the disturbing truth from a report on the news, or a show we watched everyday in our childhood. But truly, we can all look at our lives and find that it has somehow been influenced by entertainment in some form. Photographs in magazines, depicting a number of things, from severely thin super models to starving children in 3rd world countries, are an example. The media is another great example of entertainment that affects us every day. We can get up in the morning and see an uplifting story about a kitten that has been rescued from a bleak and abusive world, and have a good day simply thinking about that hopeful story. Other days, we will wake to find the world in a dismal state, with war and killing flashing before our eyes on a news report, and we just can’t get it out of our heads. Music is another influential thing that we hear everyday-holiday music, for example, is a weird little thing in our lives. Some of us simply can’t wait for the holidays, to hear cheery carols and feel the holiday spirit. Others just want the holidays to go away, for several reasons, from not having anyone to share the joy with, or just to get some peace from all the relatives and holiday marketing hype around them. Ultimately entertainment is aimed at affecting us, whether it be a in a good way or a bad way. Fashion magazines are aimed at getting people to follow certain trends and styles, and ultimately buying products that they advertise. News reports are a matter of opinion-you may think they are simply reporting facts, or simply throwing propaganda at you, or trying to get ratings. These days you’ll notice that many companies, bands, governments, etc. are taking advantage of the internet to get messages into the world. With entertainment websites like You Tube, they hope to convey their objectives through entertainment, because it’s what people pay attention to now. Entertainment does and continues to affect us, whether we want it to or not.

Advantages of entertainment:

Having fun and lowering your stress level are some advantages of entertainment. Entertainment not only relieves you of stress, but also helps you regain your energy and thus recharge your batteries. Your mind diverts away from your day to day worries and tensions and you are able to divert your mind from the normal schedule. So, everyone must have a daily dose of entertainment. Entertainment has an important role in socialization, relaxation, family ties, community structure and forms of expression beyond sheer logic. It strengthens the emotional ties between individuals and around groups of individuals. A well rounded individual, and also society as a whole, benefits from many activities and interest beyond those just needed to provide food and shelter.

Disadvantages of entertainment:

All the above will be of great disadvantage if any form of entertainment is not used moderately and on a selective basis by those who seek fun and laughter. Any kind of entertainment will be bad for children who get addicted to any kind of habit, become couch potatoes and finally end up with obesity, lack of interest in studies and finally become a burden to the society. Also, you may end up spending too much time playing video games or watching TV, and forget to do your homework or another important task. You may also risk losing friends because of spending too much playing games or lose touch with family members.

The entertainment industry has virtually eliminated physical activity. The internet has made shopping a home-bound chore. Customers don’t have to talk to a store. They don’t even have to walk to a car to drive to a store. Buying an item is a mere click away and all a person has to do is wait an allotted amount of days for that item to be delivered right to their doorstep. Video games and television have taken the traditional place of basketball and camping. Outdoor activities have taken the back seat to first-person shooter games on Xbox. The lack of physical activity is a consequence of such mindless “fun,” which in turn has contributed to the growing obesity epidemic that is currently plaguing the U.S.; and the growth of the entertainment industry and the growth in nationwide obesity is not mere coincidence. It is the people who utilize entertainment is such a mindless way and fail to combat the repercussions that add to its capacity. If society were to use entertainment and still keep up with physical activity and social ties, society wouldn’t be as susceptible to demise. People subject themselves to such entertainment knowing the consequences, and yet they don’t do a thing to contest the negative results.

Entertainment ruins the society:

Entertainment has the capacity to “ruin” society and, although this is undeniable but it is the society who gives entertainment such a capability. While most people view entertainment as harmless, leisurely fun; researchers were able to see that the enjoyment people felt from it was merely a disguise that masked the ruin and corruption that has become of it. Entertainment has the capacity to warp one’s views of reality, making him or her believe in a world that doesn’t exist, thereby slowing the progress of mankind. Different forms of entertainment have caused a great deal of irreparable damage to today’s society. Many people, who have been captivated by whatever it is they watched, are somehow influenced to imitate its characters. When children see wrestlers on TV, they want to wrestle and break things. The same goes to adults who see violence on TV. After the release of movies such as Fast and Furious, there was an increase in illegal drifting for both teens and adults. Drinking, drugs and partying became increasingly popular the more of it had been done by characters in TV shows and movies, whereas, dirty dancing and getting drunk was considered crude and immoral before it appeared on popular TV shows and movies. Music videos, particularly rap videos, have been glorifying sex, drugs, and stupidity, dumbing down hundreds of thousands of youth who may have had the potential to brilliant career. Girls are dressing in skimpier outfits and getting pregnant left and right. People are getting high while driving a car. Both music videos and television popularized Ebonics and ditching school, causing thousands of kids who are enrolled to a school to become illiterate. These sorts of entertainment set off an entire chain of effects that led to the deterioration of morality, and the corruption of society. Entertainment not only diminishes the morality of society, it also makes people feel insecure. Many TV programs, such as Laguna Beach, began to define what was beautiful and acceptable to society from their flawless characters and unrealistic scenarios. Girls misled by entertainment to believe that only thin women are beautiful.

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The movies, the television are the worlds into which we escape, leaving our own lives in the past. Go to a movie theater and watch people’s faces, they are enthralled with the story they are being led through. Movies offer a world, an escape from reality. Television offers people from kids to adults, a false world in which some like to emulate. For example: Harry Potter. When this multi-million dollar idea of a `wizarding world’ was brought to the minds of countless youngsters there were surprising consequences. Children were dressing like wizards, believing in `magic’, trying to emulate these characters. Entertainment pulls the reality away, instead leaving us with a fantasy world into which we dwell. This idea of taking us from our lives in un-nerving. This makes children not think about their future but about a Fantasy. Such shows as “Sabrina the Teenage Witch” or “Charmed” yet again pull people into a world that does not exist. This ‘harmless’ entertainment puts us into our seats every Tuesday and Thursday detracting from our own lives. Entertainment is literally brain washing our youth in believing in an imaginary world. Shows such as “Pranked” and “Fear-Factor” demean people. Tricks and ‘pranks’ are played on innocent victims for the public’s viewing pleasure. “Fear-Factor”, displays people doing usually disgusting ‘feats’ for money. This is demeaning our society; this is just tapping into our barbaric ancestry. We are supposed to be higher beings yet our minds are being eroded by shows that don’t mentally challenge us but intellectually stunt us. We enjoy the occasional escape from reality; but more and more entertainment is shoving its way into our world. While we look to entertainment as a source of fun and leisure, it is actually a source of escape that serves to ruin our society. Entertainment brainwashes our youth into believing in an imaginary world, and it prevents them from obtaining the knowledge of their predecessors. And entertainment is ruining our quality of life, leaving our mental capacities wide open to useless, garbage material.

Audiences around the world are inundated with entertainment content at the local, regional, national, and global levels. Entertainment via television, movies, and music, is highly influential because it’s really bigger than life, and it’s what we go to when we’re bored or we need an escape. The problem with entertainment is that what sells is normally what shocks, and what shocks is normally sex, sin, being scandalous and controversial, and continuing to push the envelope on our definition of wrong. Over time, we get desensitized and start to believe the message we are getting, that it is ok and normal to do the things that we are seeing. We start emulating fiction of entertainment into reality of life. Entertainment brings pleasure to billions around the world, but it has been accused of harming our children, shortening our attention spans, trivializing culture, vulgarizing taste, sanctioning violence, polarizing audiences, and undermining communities. Entertainment has been attacked for making a mockery of art, for promoting cheap thrills before thoughtful reflection, for appealing to the lowest common denominator.

Do entertainers get more money than they deserve?

After discussing the ruins brought by entertainment, I find uncomfortable to even discuss the money earned by entertainers. They make more money because the entertainment brings a huge audience, so the actors/sportsmen ask for more money. The average annual salary of an NFL player is 1.2 million dollars. For this, they are expected to play a game in an entertaining manner. The average salary of a university professor is less than a hundred thousand dollars, and for that sum, it is expected that they will educate many individuals, and perhaps through their influence, cause their students to change the destiny of mankind. The average annual salary of an NBA player is four million dollars. For this, they are expected to play a game in an entertaining manner. The average doctor earns 187 thousand dollars a year, with the expectation that they will save the lives of hundreds of people. The average annual salary of a baseball player is 2.1 million dollars, and an individual can make as much as 25 million a year. For this, they are expected to play a game in an entertaining manner. A physicist will earn eighty-five thousand dollars, and it is hoped that they will gain a better understanding of the nature of reality, and perhaps contribute toward the advancement of technology in order to make life better for all of humanity. An attractive movie star can make 20 million dollars for appearing in a film, and for this they are expected to entertain us for a couple of hours. Academic biochemists are paid an average of seventy-five thousand dollars a year, with the hope that they will cure what ails us, and potentially extend the lives of billions of individuals. My total earning per month is rupees 60,000 (1300 dollars) while many bollywood stars spend more money on their dogs than my monthly income.

Those who support that entertainer should get so much money—their arguments first:

Professional sportsmen are not overpaid because their salary is based on performance and that seems fair. Professional sportsmen get paid a lot of money, but it’s not necessarily a bad thing. These sportsmen train all year long, on top of playing in their regular season competitions. These players also bring fans into the stadiums and sell more jerseys for the NBA. If an athlete is working that hard and still is able to give a great performance during games, they deserve the money they are paid. These people work their butts off to make sure they stay in top condition so they can play or sing the best they can. The highest compensation for entertainers is significantly higher than the highest compensation for non-entertainers because the skills that entertainers possess are scarcer, in high demand and exist in specialized markets than those who are non-entertainers. For example, many people can play basketball or can sing, but there is only one Michael Jordan and Mariah Carey. As a result of their rare talent and the demand for that talent, they both can command higher compensation than someone whose occupation is more common. In another example, although most medical doctors have highly specialized skills in high demand that result in a higher than average compensation as compared to the average worker, there are far more medical doctors in the world than entertainers and this, coupled with constraints placed upon their compensation (i.e., insurance companies), results in the highest paid medical doctor earning significantly less than the highest paid entertainer.

Those who support that entertainers are too much overpaid – their arguments:

They are role models? Poor excuse to use. It is insulting to the rest of society as we work hard to make a living. They easily make money just by having their face on Adidas/Nike goods! Wow, so easy. The only reason why they made it big is because they chose entertainment as career. Professional athletes are overpaid, because their services are not as important as other, more necessary professions. While they are earning millions of dollars playing games for the entertainment of others, teachers are scrounging to get by. Many school districts are so overwrought with debt and corruption that the children end up suffering for it. This is an example of gluttony; greed and excess in our society. Any rational person would be embarrassed to accept a huge remuneration like Madonna or Britney Spears knowing that there is suffering, hunger, and disease in this world. Professional athletes/actors earn a lot more than they actually are worth. There seems to be a lot of hype surrounding them and their personal lives which drive their prices up. It does seem absurd compared to the actual time they spend in sporting events. Also, most professional athletes are overpaid because they are not contributing that much to society. What do professional athletes give to society? Really it is just entertainment a few times a week. What signal does this send to children? As a society, we need to support education and jobs that contribute to society rather than paying for entertainment and the trouble that many athletes get into. These are people getting paid millions to play games that we play in our spare time for fun, and yet they get so much money. It’s a waste of money that could be spent in so much more useful ways to people much more deserving. Along with other celebrities, professional athletes are paid way out of proportion to the work they do and the contribution they make to society. When compared to the work load of teachers, police, firemen, social workers, doctors, nurses and others who do contribute to their communities, the wages of professional athletes are grossly out of line. Even if one argues that entertainment is important in society, still so much money given to actors & sportsmen is waste of public money. It is sad to look at our society’s values through the ways we compensate professions. For example, professional athletes are paid huge salaries by the teams they play for, in addition to lucrative sponsorship deals from various corporations, for what essentially boils down to entertainment. They may occasionally become role models for young people, but they also demonstrate a level of success which is unattainable to the average person. On the other hand, the people who have direct contact with our children and on a daily basis serve as role models and occasionally even as “parent-substitutes” make less than even an average actor. I’m speaking, of course, about teachers. They truly influence the future of our society, and they make in a year less than a professional athlete or movie actor makes in a month.

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Most people feel that entertainers are overpaid, and are amazed at how much the salaries are increasing year after year. But the situation is market driven, and many of the people who complain about it are part of the cause. Supply and demand means that, to create larger profits for those supplying the product, those wanting it are willing to pay a higher and higher premium. A market correction occurs when supply exceeds demand, and the costs to produce the product fall to meet the reduced level of demand. In other words, the fault lies with the consumer; and people who entertain us through competition, performance art, and music are more important than educators, scientists, and medical personnel because it is what the masses have decided. Members of modern society primarily live for the moment. The destiny of us and our children is a concern that requires foresight; something lacking in our culture. Because each individual is a component of the sum, every person contributes to what is the “will of the people”. Therefore each individual who refuses to pay exorbitant admission prices, or a premium to be a walking billboard, alters the status quo. It was not really that long ago when entertainers thought of themselves as extremely fortunate to be able to earn a middle-class wage for doing something they would do for free anyway. Realistic salaries would not change the quality of our entertainment. Would an NFL player rather work eight hours a day for fifty weeks in a factory, or continue to work a few hours a day over sixteen weeks, if the salary was the same?

It is not at all surprising that greed is the driving force behind the entertainment industry; one only has to look at the disparities in the world to realize that most people are entirely self-serving. There is no logic to the accumulation of riches for its own sake; in one year the average professional sports entertainer makes enough money to live comfortably for the rest of their life. The annual income of one superstar could feed an entire Third World nation. The money spent on sports alone could put an end to poverty and suffering on this planet. It is the collective “we” that is responsible for this situation. Each of us in the society causes this disparity by our decision to fund entertainment over utility. The fact of the matter is that we don’t really care that this is the case; people will think that, yes all those billions of dollars could be put to better use, and next week go out and spend a couple of hundred dollars on tickets for the next game. Individuals will contemplate how it would be wonderful to find a cure for heart disease; and then spend their extra money on a replica jersey of the player they have chosen to be their sexual surrogate. Each of us contributes to the human condition, and each of us determines what is personally most important. The world is exactly what we make it to be.

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Back in the old days, the gladiators who fought each other and animals with the utmost brutality were not at fault, but those who cheered them on and forced them to make a living or the ending thereof doing what they are known for, entertainment, grotesque or just downright perverted, such as the comedy shows of today, with their perverse innuendos, gestures, and jokes. Ultimately, the entertainers are not innocent, but they are pawns who are payed to do what they do, and that is to amuse us (cause us to think less and less with each and every performance), as they would have found or sought other professions had they not had the ability to do what they do for what they are being payed. Therefore, they are generally pleased with their lifestyle, though most of them are unable to do anything else for money, other than the occasional surprising performance or some random or purposeful violation of the law, which increases their popularity as well as their chances of boosting their ticket sales or any other business venture that they think that they can successfully pull off a profit with.

Why do we place a greater value on entertainers in particular, than on the people who are more of a tangible asset to humanity, contrary to common sense?

A major reason is due to the one thing that can always supersede common sense: sex. Physical attributes, whether involving appearance or athletic ability, signify the superior sexual partner in the animal kingdom. It is not just that we idolize some as the ideal sexual companion, we identify with them. We live vicariously through these alphas; their successes are our successes. In the same way that lesser males in a chimpanzee troop have a desire to touch the alpha male as he passes by, we feel that we can somehow share in the aura of the superior mate. We cheer on our team because it represents the best of our primate troop, hence “we” contend with other troops for sexual dominance. In general humans, like other animals, compete to demonstrate their superiority as mates, and to us, money represents sexual dominance. In the hyper-competitive culture we have created, our basic instincts are magnified by the artificial standards we set via materialism. Perhaps this attitude should continue; but because it is an abstract manifestation of primitive drives, we must then consider ourselves simply as confused animals, using a symbolic representation of labor to haphazardly substitute for natural selection. What we interpret as moral values and justice are in reality the instincts of gregarious creatures; where all members of the herd are relatively equal in terms of available resources and protection from harm. We have confused social structure with sexual hierarchy. Gregarious animals persevere due to what we perceive as ethics; communal social interaction has evolved to ensure the survival of the species as a whole, with any divergence from this system being, by definition, unnatural. Of course, there is no harm in experiencing a thrill of a subconscious sexual nature; and we will always have a need for athletes and other celebrities to play a role. However, there seems to be no limit to the obsession with such pursuits. Billions upon billions of dollars are directed toward the infrastructure that provides us with entertainment. The individuals who are showcased receive outrageous sums because the corporations behind them are reaping huge profits. Our priorities are absurd, and it would not be too extreme to say that we suffer from a form of cultural madness. Entertainment is the most significant thing in our lives. Sure, we want all the medical, social, and technological advances to occur; but we’ll reward the person who may have the capacity to find a cure for cancer three hundredfold more if they can excel at hitting a baseball or have the looks to be a movie star. We financially encourage people to choose the path we see as most important. If people were as passionate about curing cancer, and directed the same amount of disposable income toward research as they now do for spectator sports, companies would compete for a share of the wealth; subsequently driving up salaries for scientists, and motivating young people into making science a career choice. The marketplace rewards success, hence the researchers who get results would be the high paid stars of the discipline. Just as modern athletes have pushed human physical limits past that of their predecessors, so too would science drive human knowledge to new heights. So the buck stops at people for overrating and overpaying entertainers.

People must wake up:

Almost every professional athlete and actor has no other skill that would offer them a fraction of the income that they make as athlete or actor. If they woke up tomorrow and were told that their paychecks would be cut by 75%, they would probably stay home and pout for as long as their reserve money would last, then they would return to the movie set or the ball game – as the case may be. They would have no other choice because they could find no other job that would pay anything close to 25% of their current income. What else would they do? Would they turn down 25 % of their current income a year to play a sport or act in a movie, and opt to work in a bank or sell real estate or cars, or take a regular job like the rest of the people in the real world? The public has stopped thinking about what’s going on and they just keep paying more and more to watch sports and movies. Even when the movies are slapped together junk to make a few million dollars quickly or the sports team is not doing anything close to exceptional – everybody still gets in line with money-in-hand, waiting for the chance to watch the amazingly repetitive and average stuff. The public needs to finally say, “Enough is enough”. All movie stars would still work in movies if they earned only 25 % per movie than before because they cannot do anything else. The public needs to finally say, “No more! I’ll pay $3 – $4 and not a dime more to watch a movie or watch one of the 162 mediocre baseball games in each season in the U.S”. If the public paid $4 to watch a game or a concert or a movie, the athletes and the entertainers would still be among the wealthiest people in America, but everyone else would have a little extra money in their pockets. The difference would be that entertainers and athletes wouldn’t be totally out-of-touch with reality and do absurd things like sending their private jet more than 2,000 miles to get the coffee they prefer (Britney Spears did that). Celebrities are not only overrated and overpaid, but they give out a negative message to almost every teen in the nation that looks up to them. Teens idolize celebrities, seeing someone beautiful and successful, someone with no problems, but look to any tabloid and you’ll see a celebrities name in highlights for sex scandal, drugs, drunken driving, attacking hotel guests etc. Is this the image that we pay for? Celebrities having meltdowns, cheating, divorcing, and rehab trips seem to be what we’re really paying for and looking up too.

Popularizing science through entertainment:

In 1980 Luis Alvarez and his son Walter Alvarez and two other scientists from the University of California – Berkeley proposed that a large asteroid struck the earth 65 million years ago and wiped out the dinosaurs. For many years the scientific community scoffed at the Alvarez impact hypothesis as “outlandish.” In 1998 two major Hollywood films about NEOs Deep Impact and Armageddon were released. NEO means near-earth-objects. Each film opens with an NEO hitting the Earth 65 million years ago. In addition, the multitude of TV programs on NEOs in the late 1990s, such as the fictional Asteroid (1997) and the science documentary Fire From the Sky (1998), also featured the asteroid impact hypothesis as the cause of the dinosaurs’ extinction. This episode clearly indicates the power that entertainment media have in regards to our understandings of science and technology. Many of our perceptions of the natural world originate from entertainment media sources, such as science fiction novels, popular science magazines, nature documentaries, TV shows, fictional films, and comic books.

Why is entertainment more important to people than knowledge?

Because knowledge and wisdom are abstract ideas and made abstract by our society. The great many individuals who possess these qualities are either in fairy tales or in history or in the oblivion or are rarely in contact with “us”. I have great admiration for mathematicians, scientists and philosophers. Cauchy, Leibniz, Newton, Einstein, Copernicus, Galileo, Euler, Dedekind, Bertrand Russell, Kierkgaard, Locke, Kant, Darwin and many more. But sadly none of these guys has ever been emphasized in the media, despite their revolutionary works in their respective fields. On the other hand, athletes, movie stars and celebrities are routinely worshiped by the media, even though NONE of them has ever made any lasting impacts for the human civilization. They die and become forgotten. We die and we will become forgotten. That been said, it is apparent to me that wisdom and knowledge are in a separate dimension from our miserable existence. My view on ordinary people of this world is that 80 % of them have intellectual impairment and they just cannot appreciate scientific and technological geniuses who revolutionized this world in last 200 years from horse-carts to cars to aircraft to space shuttle; saved lives from malaria to tuberculosis; and invented electricity, fans, refrigerators, air conditioners, televisions, radios, computers and internet. Intelligence is always appreciated by intelligence and not by mediocrity. Another characteristic of this world is ungratefulness. How many people even know the names of scientists who invented TV or radio or cell phones even though they use it daily? But all of them know Sachin Tendulkar and Amitabh Bachchan just because they provide entertainment. So we live in a world of poor intelligence and poor gratefulness. No need to blame celebrity stars. People are at fault.

Scientific study of entertainment vis-à-vis psychology and neurology:

The study of entertainment brings out many psychological aspects of active-passive participation in emotional or mental adventure and these could be:

1. Identification – Viewers often identify with characters in movies or figures in art and this strong identification helps explain the value of entertainment. Young children have seen to imitate film stars as they begin identifying with movie characters.

2. Fantasy – Entertainment feeds on the need for fantasy in people and provides an escape route from the real world. Addiction to entertainment could be the basis of reality anxiety in people.

3. Projection – Individuals tend to project their own emotions or state of mind on to a painting or a song and could derive pleasure from this.

4. Regression – Entertainment could often remind individuals of their past or a part of their own life they may have forgotten and in some cases bring out the child in them. For example when older people enjoy video games, it brings back their childhood and they may become addicted to this sort of entertainment.

5. Sublimation – Entertainment is also a form of sublimation of our impulsive desires and this especially true when we participate in entertainment as in the interpretation of art.

6. Displacement – In non participative and passive forms of entertainment, individuals tend to escape from reality and displace their emotions from real people to characters in movies.

All of the above processes are ego defense mechanisms delineated by Freud and the interplay of so many defense mechanisms in entertainment suggest that entertainment is more than simply a source of pleasure and could trigger complex psychological processes in the human mind. More research would be required in this field of psychology for a complete understanding of the advantages or disadvantages of entertainment in modern society.

Entertainment as emotional response:

Entertainment can be defined as any activity, which allows people to entertain themselves in their spare time. Entertainment conditions our values, behavior and thinking. This is especially true in case of media entertainment such as T.V and movies, which provide potent touching experiences. Our emotions powerfully influence our actions in ways that remain outside of our control and cognizance. Hence, it is very possible to be influenced by entertainment unconsciously. Humans are rational beings but emotions compel us to do things that are unreasonable. Enjoyment of entertainment switches us from the initial phases of interest to emotional connection and finally to addiction stage. Entertainment triggers complicated psychological processes in the human brain. For example, a man may be in love with a girl, whom he cannot achieve in real life, so he may fall in love with an actress in a movie who may resemble his dream girl.

Some people develop addictive relationships to activities that don’t involve ingesting drugs, activities such as gambling or playing games on the Internet. In fact, people often fall rather easily into being controlled by our desires; even those who have no addictions often struggle to control their spending or their food intake. We need to give attention to the importance of the emotionally powerful experiences that we have when we become “caught up” in entertainment activities. I suspect everyone is familiar with such experiences–who hasn’t had the feeling of being so absorbed in a book that it’s hard to put down, or so immersed in a game that one loses track of everything else? In such experiences we have the sense that we are to some extent being controlled by something beyond ourselves, and we are bound to wonder what that something is. The answer that comes most easily to mind is that we are controlled by the ideas or practices or substances that are prominent in whatever fantasy it is that we are caught up in. For instance, we become caught up in a tale of romance and we conclude-more on the basis of our feelings than our thoughts-that romance is a powerful force, impossible to resist. We become caught up in an advertisement for a car and we conclude that certain cars (or material products generally) can transform our experience. We become caught up in an acting performance by an attractive celebrity and we conclude that the celebrity is irresistible. When much of the population has such experiences repeatedly throughout the day, many begin to feel that they are powerless to resist potent emotional experiences.

Participation in any book, film or creative art is almost like sitting on a reclining chair that has the technology to soothe your muscles while you relax. In the case of entertainment we participate almost in a passive manner and although we may be very alert and awake in the process of watching a movie, entertainment gives us the illusion of non participation as we don’t have the opportunity to get voluntarily involved in the scenario. Anything that gives us some form of pleasure could be considered as entertainment although entertainment could also give us pain as when we cry when we get emotionally involved with characters while we watch a movie. Entertainment could trigger emotional involvement and emotional reactions such as happiness, sorrow, anxiety, fear and despite these strong emotional participation, there is little or no physical activity necessary on the part of the viewer. This active-passive process is the main attraction of entertainment as entertainment enables us to be both active (in terms of emotion) and passive (in terms of physical or voluntary mental involvement). Entertainment means like films are influential yet they influence subtly rather than aggressively and this subtle influence seems to work better on the human mind than any aggressive forms of influence. We see work as duty and entertainment as pleasure although both involve some form of emotional involvement. Work at the same time requires voluntary participation, decision making and physical involvement along with emotional involvement. Yet why is work perceived as something heavy and entertainment as methods of relaxation? The answer is responsibility & accountability. In case of entertainment, most of the times, we are without responsibility and accountability about what we watch in a movie or TV. Entertainment is usually a form of mental and emotional adventure. In cases where we do know what a movie is about, it is the feeling of emotional familiarity that drives us to experience what we already know. Suppose a video game gave us a pleasurable feeling or evoked aggression and competitiveness in us, we go back to feel the same emotion as it was pleasurable or exciting. Stretched too far these forms of entertainment could easily become addictive.

We humans are rational beings and yet emotions still seem to rule our lives and form the core of our existence as emotions still draw us to do things that may be irrational. Entertainment being primarily emotion provoking rather than reason provoking has a major impact on people’s lives. Appreciating any forms of entertainment could switch from the stages of interest to emotional involvement and finally addiction. The celebrity culture is a direct result of the last stages of appreciation for entertainment. An interest in celebrities comes from emotional involvement with characters in movies and there may be substantial lack of differentiating between fantasy and reality, so fans of celebrities are more in love with the characters these celebrities play or the traits they project rather than the personality of celebrities. The celebrity culture seems to take people to a persistent fantasy world and individuals are seen as discussing all aspects of celebrities from their shoes to their hairstyle to the cars they possess. This sort of culture could however be explained with individual need to escape reality and identify with someone in a fantasy world and would be an important element in the study of fantasy.

Emotions override reason:

Every day we override reasons with emotions. For example, while driving, eating or crossing railway track, we do things which our own intelligence does not subscribe. You eat outside food from hawkers knowing that it may cause diarrhea. You cross railway track knowing that incoming train can kill you. You drive after drinking knowing that it may cause accident. Every time, your intelligence is override by your emotions under pretense of false logic. Oh, so many people are eating food from hawker and nobody falls sick. Oh, bypassing Railway Bridge will save lot of time. Oh, I know my limits and I know how to drive well after drinking etc. Entertainment works on the basis of provoking emotion which overrides reason. What is the point of wasting 5 days to watch test cricket? The same time can be utilized for much better purpose which will help you and society but millions watch test cricket. What is the false logic used by emotion to override reason? Oh, they are playing for our country, we must support them. Does it really matters whether India wins or Pakistan wins in cricket match as far as ground realities of these countries are concerned? Does satisfying false pride help people of these countries to live better life? No.

Right versus left brain:

”Getting” humor appears to depend on a delicate balance between right brain and left brain processing. The left brain deals with reason (logic) and right brain deals with feeling. The left brain (the logical side) tends to assemble the required information, but it’s the right brain that comprehends the situation and, at a subconscious level, finds the humor in it. The “click” of getting a joke happens on the right side. That’s why jokes cease to be funny when we overanalyze them (which happen on the left side). It’s also why an academic paper on humor is probably the least funny thing you’ll ever read. As we start to look at the different types of humor, we start to see some divisions in what we find funny. Women, for example, are drawn to humor that involves social situations. Men tend to laugh more at jokes that involve sex and scatological references. And while slapstick can elicit belly laughs, wit tends to draw a smile. Slapstick taps into the fear/humor circuit, where wit is more of a social aspiration. Coming back to the distinction of work and entertainment or play, work involves responsibility and despite the emotional involvement in entertainment, apart from being a passive participant, we do not have to be responsible for anything, there is no problem solving or decision making, and that is how entertainment in all its form is so pleasurable as the left brain activities of reasoning, logic and decision making are not activated completely, and yet the pleasure sensations and emotions such as the limbic system and right brain activities are usually activated, so we tend to associate entertainment with emotions rather than problem solving and decision making. In other words, right brain and limbic system (emotions) override left brain (reason).

Distinction between Explicit and Implicit Memory:

The research in the 1980s led to a critical classification of memory into two dimensions: consciousness (or awareness) and intent as two dimensions captured in the distinction between explicit and implicit memory (Graf & Schacter, 1985; Roediger & McDermott, 1993; Schacter, 1987). Explicit memories are both conscious, in the sense that the person is aware of remembering prior events, and intentional, in the sense that the person in some sense wants, or voluntarily intends, to retrieve them. In contrast, implicit memories are unconscious, in the sense that the person is unaware of retrieving or otherwise being influenced by prior events, and their retrieval is thought to occur involuntarily or without intent (Jacoby, 1984). Explicit memory is typically assessed with recall and recognition tasks that require intentional retrieval of information from a specific prior study episode, whereas implicit memory is assessed with tasks that do not require conscious recollection of specific episodes. In his research Schacter found distinct areas of the brain are involved in these two types of memory as seen in the figure below.

For explicit memory to occur, the frontal lobes must be active, which is an effortful process. Implicit memory, on the other hand, relies more on the older sections of the brain, the subcortical areas, the cerebellum and part of the limbic system, the amygdala, where the fight-flight response emerges. Both implicit and explicit memory involve the limbic system—the brain’s emotional center—particularly the hippocampus, which is involved in laying down and retrieving memories. According to the memory systems view, then, memory is the process of activating the representations stored in a particular system. Once activated, the representations are able to influence a person’s performance with the nature of that influence being dependent on the kind of information or content residing in the representation.

Subconscious programming of humans by stimulating implicit memory through entertainment media:

Usually, people are more influenced by their innate subconscious desires or intent than a rational and planned decision. This aspect of human nature is heavily influenced by your daily activity. In western society, the subconscious mind of the individual is often subject to a number of heavy influences, through entertainment mediums especially. Television, movies, and music create a profound subconscious effect on the human mind that influences and dictates the choices that they will make to at least some degree. If you see a certain car advertisement, whether or not you rationally decide your stance on it, you are being pre-programmed to at least accept or acknowledge any claims made by the advertisement itself. Likewise, the choice of television shows and dramatic elements appearing on TV have a psychological influence on those who watch them. According to statistics, by age 18 the average American youth will have seen over 200,000 simulated acts of violence. The glorification of drug and alcohol use predisposes an individual to rationally accept and sometimes consent to these actions. The human self image is psychologically manipulated. When you compare yourself to a famous individual or a person who is depicted as ‘successful’, you may be setting yourself up to subconsciously feel less valuable from the comparison. This subconscious act creates people who are wildly insecure about their physical and mental image. Romance and sex is also psychologically implanted through advertisements and drama. The use of sex appeal to sell products is obvious. Similarly, dramatic scenes of love and romantic feelings often prey on the human desire to feel loved, and will program an individual to act or react to those situations in certain ways. Displays of sexual suggestiveness and simulated depictions of sexual relations in media all contribute to influencing increased sexual activity in young people. Not only that, but they also lead to unhealthy obsession with sex into later years, generally resulting in pornography usage. It is not just television and movies either. With internet advertising, viral videos depicting most of these things in horrific detail, and video games, a horde of negative media pervades over society. This power of subconscious influence guides and decides the goals, desires, and opinions of each individual. A blurring of reality with fiction occurs in this scenario, where the individual is influenced to orient themselves in alignment with these false goals and aspirations that are implanted into them through these mediums. In extreme cases, their ability to distinguish reality from fiction is impaired, and culminates in some explosive form. If you add drugs to the entire equation (legal or illegal), you may end up with self destruction. So in a nutshell, entertainment subconsciously affects your behavior & performance by consolidation & retrieval of implicit memory stored in the limbic system of your brain. You have to unplug yourself from subconscious psychological programming by entertainment. Once you are aware of the psychological programming, you can intellectually dissent to it, despite the fact that its continued appearance will dull your senses. People who are exposed to simulated violence, sex, substance abuse, sports and drama simply accept these things easily as they have been incrementally conditioned to lose perspective. It’s highly important to be aware of the psychological programming that occurs on a daily basis by entertainment. People are taught and conditioned to live in a simulated reality, with predetermined goals, aspirations, and false expectations. Unplug yourself and others from this form of subconscious influence, thereby unlocking your full potential- rather than being unconsciously controlled by a vague ideal or false images or false icons.

Priming:

Priming is the tendency for a recently presented stimulus to facilitate subsequent judgments or behavior. Priming occurs when prior information to which we are exposed influences our behavior without our awareness. Several types of priming effects have been observed in the psychological literature: perceptual, conceptual, and emotional priming. Perceptual priming occurs when we respond to the modality or surface attributes of the prime rather than its meaning. Conceptual priming is based more on semantic memory, in which the meaning of words activates an existing belief and influences behavior. Emotional priming uses a prime that has an emotional connotation, such as a picture of a smiling or frowning face. Priming is one of the mechanisms by which entertainment influences our behavior without our awareness.

Cognitive psychologists are vigorously experimenting with ways to measure and understand how exposure to a stimulus can affect subsequent judgments, emotions, and behavior, with or without awareness. Whereas some researchers have placed emphasis primarily on explicit measures, in which people are expected to consciously recall the entertainment, I assert that it is the subconscious (reason overriding by emotion, retrieval of implicit entertainment memories and priming) that is primarily responsible for people to go for entertainment.

Classical example:

You bring a Chinese villager who has never seen cricket in his life to India and ask him to see IPL cricket matches. Would he be entertained? Would he feel happy? Would he clap? No. His memory system has no memory of cricket. His mind is not primed to cricket in past. We all know the story of Tarzan, a boy brought up in jungle by animals. Would a Tarzan enjoy watching a cinema? No. His mind is not primed to get entertained by cinema. So where is the fault? No fault in cricket or cinema but the way we have primed our brain since childhood, the way we have consolidated implicit entertainment memory subconsciously and the way we override reason by emotions. Why Indian people are crazy after cricket and bollywood? Not because cricket and bollywood are most entertaining. There are many ways to get entertained in India besides cricket and bollywood. But since childhood, Indian boys & girls have been primed to watch cricket & cinema by TV, radio, print media, parents, peers, neighbors and relatives; also since childhood their memory is full of cricket & bollywood and more importantly Indians are generally emotional people.

Fact versus fantasy vis-à-vis entertainment:

Rambo had conquered Asia. In China, a million people raced to see First Blood within ten days of its Beijing opening, and black marketers were hawking tickets at seven times the official price . . . In Chengdu the locals heard John Rambo mumble his First Blood truisms in sullen machine-gun Mandarin and saw the audience break into tut-tuts of head-shaking admiration as our hero killed seven cops in a single scene . . . “I think he’s very handsome” cooed a twenty-three year old Chinese girl to a foreign reporter. “So vigorous and so graceful. Is he married?”

Entertainment takes us to a different world and feeds our need for fantasy and an escape from real life. This is especially true for entertainment that is more public or provided by the media and entertainment provided by films, theatre, music, and all forms of creative art. Films and theatre transposes us to a world of fantasy and grabs our attention so we remain engrossed as almost a part of this alternative reality. Entertainment could also be in the form of magazine stories and gossip or even celebrity culture and the psychology of entertainment could also explain the extreme craze of celebrity culture that we have in the modern world. Celebrities seem to open up a world of fantasies and for some people knowing every move of celebrities could bring immense satisfaction as it would almost mean participating in fantasies. Fantasies help in overcoming frustrations and serve as therapeutic as they aid in the escape from realities of life. Real emotions and real life are stressful and entertainment helps us to move beyond real life and moments of stress to participate in fantasies that are soothing as we do not have to be directly involved in these fantasies and yet as spectators we can still participate in a tacit or passive manner.

The darkened hall of the movie theatre lulls us into a zone where we can play out our fantasies. We mentally cheer as the good guys win over the evil ones. We watch with bated breath as apocalyptic events threaten our planet. We get teary eyed when a character beats all odds to find happiness. When we finally step out of the movie theatre into the glare of the lobby, our return to reality may not be completely successful. The images created by the entertainment media, whether encountered in a darkened movie theatre or in sitcoms, soaps, news reports, and advertising, do appear to blur the lines between reality and what we perceive it to be. These images can have a persisting influence on people’s attitudes, beliefs, and behavior in ways that we have only recently begun to uncover. People fail to distinguish between their memories for actual events they have read about or personally experienced and their memories of fictional events they have seen on television. Consequently, they often retrieve and use these latter events to estimate the likelihood that the events occur in daily life. In many instances, people are unaware of the biasing influence of the media on their estimates. But even when they are conscious of bias, they do not know how much they should adjust to compensate for it (Petty &Wegener, 1993). Consequently, they can often fail to adjust enough or, at other times, can adjust too much. In the latter case, the biasing factors could have a negative, contrast effect on the judgments they report. Also, concepts and knowledge that become easily accessible in memory as a result of exposure to movies and television can affect the interpretation of new information and the implications that are drawn from it. To this extent, the concepts can influence the impact of the information on judgments and decisions to which it is relevant. So visual images, stimulated by pictures or video presentations of the sort people encounter in movies or on television, can influence the impact of information that people receive subsequently.

Entertainment media often present fictional portrayals of events, and individuals regularly alter their real-world beliefs in response to fictional communications. Most entertainment products are clearly distinguished as fiction, such as a sitcom, or nonfiction, such as a news report, although the line between the two is becoming increasingly blurred (Bruner, 1998). It seems reasonable to think that we should learn more about the world from a newscast, which at least attempts to be an accurate reflection of real events, rather than from a television drama, which may engage in inordinate amounts of artistic license. Although the relative strength of attitudes changed by fiction and narrative remains an open question, it is clear that individuals regularly alter their real-world beliefs and attitudes in response to fictional communications (Garst et al., 2000; Green & Brock, 2000; Prentice et al., 1997; Slater, 1990; Strange & Leung, 1999; Wheeler et al., 1999). Despite the prevalence of fiction in everyday life, there has been relatively little empirical investigation of how individuals may be influenced by products of imagination. Similarly, individuals often shift their beliefs in response to stories or narratives which need to be researched.

So in a nutshell, when you are bored or tired or want to escape or have spare time, you go for entertainment. Entertainment takes you to the world of fantasy away from reality of your life. Fantasy may relieve your frustrations & stress and you feel better. However, after entertainment is over, you often fail to distinguish between memories of realities and memories of fantasies, so you retrieve fantasy to guide your behavior & performance in real life and live on false perspective. Also, as your memories get flooded by concepts & information from entertainment, it affects interpretation of new information. All of these affect your rational judgment and decision. We start living in the fictional world due to daily entertainment overdose so much so that we ignore and neglect realities of life. Thousands of youth have spoiled their lives due to cricket, cinema and soaps. What more can I say?

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Entertainment as biological addiction:

In most human characteristics determined by our genome (weight, height, intelligence, etc) the population plays out on a normal distribution curve, with the majority of us clustered around a central norm. Researchers Timothy Brock and Stephen Livingston found the same is true for our need for entertainment. They found there is an unusually high need for entertainment amongst a significant segment of our population. While the norm seems to indicate that we’re very attached to our TV set, in extreme cases, researchers have found that TV consumption borders on true biological addiction. For some people, entertainment is addictive. They cannot live without entertainment. For them, entertainment is not passive. TV, film, radio, theatre, prints or sport exhibits are not simply leisure activities but lifeline for them. In a Scientific American article about the stylistic tricks of television, Kubey and Csikszentmihalyi (2002) showed how TV functions physiologically like a habit forming drug and includes severe withdrawal symptoms: “Families have volunteered or been paid to stop viewing, typically for a week or a month. Many could not complete the period of abstinence. Some fought, verbally and physically. . . . When the TV habit interferes with the ability to grow, to learn new things, to lead an active life, then it does constitute a kind of dependence”. So Robert Kubey and Mihaly Csikszentmihalyi found troubling evidence of a true biological addiction to TV.

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Degree of addiction:

What value do we place on the ability to watch TV? Brock and Livingston gave 115 undergrads two scenarios. In the first, they could correct a hypothetical mix up in their official state citizenship in return for a onetime cash gift. The undergrads were asked to put a value on changing their official allegiance from one state to another. 15% would do it for free and another 40% would do it for under $1000. The next scenario asked the students what compensation they would require to give up TV for the rest of their lives. A permanent tracking implant in their ear would notify a monitoring service if they cheated and the entire gift would be forfeited. 8% were willing to do it for free, but over 60% would need at least a million dollars to give up TV forever.

Why do we love Violent Entertainment?

Our taste for violent entertainment actually has a physiological basis. Violence taps into a basic good v/s evil archetype, but this alone doesn’t explain its appeal. We love violence because it tweaks the danger detection circuits of our brain, releasing neuro-chemicals that give us a natural high. Our bodies become primed for action through the images and sounds we see, and this makes us feel more confident, ready for action and hyper-alert. Violent entertainment tricks our bodies into believing that we’re in danger, so the body responds appropriately. Not all people are alike in this regard. Some of us have a higher need for this type of sensation than others. This trait was quantified in the 70′s by Marvin Zuckerman and his sensation seeking scale. It has been found that those with the greatest taste for violent sensation also tend to exhibit other addictive tendencies.

Are Video Games too real?

If violent entertainment fools our brain into delivering an artificial high by getting us ready for a fight, how can we manage to stay in our seats through a 2 hour movie? The danger alert circuit is modulated by our cortex, which dampens down the impact of the alert. Essentially, our brain keeps telling itself that it’s not real, so just calm down. But the new technology being incorporated into video games is making it more and more difficult for our brains to determine what’s real. As games become more sophisticated, with photo-realistic graphics (even in 3D), more interactive and controlled by real body motions and not just a control pad, our brains could be forgiven for forgetting it’s all a game. We already know violent games are mildly addictive as we become dependent on the potent chemical cocktail that gets released as the brain is partially fooled into thinking the danger is real.

Mirror neurons and entertainment:

A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. Thus, the neuron “mirrors” the behavior of the other, as though the observer were itself acting. Such neurons have been directly observed in primate and other species including birds. In humans, brain activity consistent with that of mirror neurons has been found in the premotor cortex, the supplementary motor area, the primary somatosensory cortex and the inferior parietal cortex. So mirror neurons are specific kind of brain cells that fires both when performing an action and when observing someone else perform the same action. It turns out that mirror neurons, which are normally associated with physical activities, might also be responsible for signaling the human brain’s emotional system, which in turn allows us to empathize with other people. Their failure to work normally might explain why some people, including autistic people, do not interact well with others. Mirror neuron systems are involved in understanding intentions, empathy, self-awareness, language, automatic imitation and motor mimicry. Why do sports fans feel so emotionally invested in the game, reacting almost as if they were part of the game themselves? According to provocative discoveries in brain imaging, inside our heads we constantly “act out” and imitate whatever activity we’re observing. These our so-called “mirror neurons” help us understand the actions of others and prime us to imitate what we see. That is the reason why sports fans get emotionally involved in the game as if they are playing themselves. Since mirror neurons are directly responsible for guiding our emotions taking cue from environment and since entertainment itself is an emotional response, mirror neurons are invariably involved in the genesis of being entertained.

This adaption to rhythm comes from activities of mirror neurons. Mimicry and entrainments occur due to imitation and learning by mirror neurons.

Entertainment also involves conversation (interaction) with the environment.

Entertainment is also an emotional response to imaginary events.

Motor mimicry is a function of mirror neurons however subtle the expressions may be.

That is why we cry on seeing a tragedy in a movie knowing fully that it is only a movie and not reality.

This “emotional contagion” is responsible for our behavior when we watch cricket or football in a crowd. We love being entertained in a crowd.

This proves the point that while being entertained, we do lose self control due to complex voluntary and involuntary processes and that is why fans get angry when their celebrity cricket star or movie star is criticized. Emotions have overtaken logic. I never became fan of any celebrity because I never allowed my emotions to override my intelligence.

Selective exposure vis-à-vis entertainment:

Selective exposure is a concept in media and communication research that refers to individuals’ tendency to favor information that reinforces pre-existing views while avoiding information that contradicts their views. The premise of selective exposure relies on the assumptions that information-seeking behavior continues, even after an individual has taken a stance on an issue, and that this subsequent information-seeking behavior will be colored by characteristics of the issue that were activated during the decision-making process. In this way, selective exposure operates by reinforcing beliefs rather than exposing individuals to a diverse array of viewpoints, which is considered an important aspect of a functioning democracy. Selective exposure has achieved more relevance and empirical support in recent decades. Some scholars suggest that as media consumers have more options for information, they may tend to select content that confirms their own ideas and avoid information that argues against their opinion. The classical example is Indian cricket. Whenever Sachin Tendulkar got out, Indian anchors starts talking about poor umpiring. Oh, that ball touched the ground. Oh, that ball missed a stump. Oh, bowler’s action is chucking. Why? Because in their mind, Sachin Tendulkar is invincible and cannot make a mistake.

Cognition vis-à-vis entertainment:

In their scale of the need for entertainment, Brock and Livingston assessed three factors: Drive (how actively do you pursue passive entertainment?), Utility (how useful is passive entertainment, both to you specifically and in general?) and Passivity (how active do you like your entertainment to be?). So, how we fare on our need to be entertained is based on Brock and Livingston’s scale. First of all, men seem to have a stronger drive to be entertained than women. Males scored higher on the amount they spend on entertainment, the daily need for entertainment and the inability to function without entertainment. One would assume that the “couch potato curve” would skew to the male side of the demographic split. Also interestingly, Brock and Livingston found an inverse relationship between the need to be entertained and the “need for cognition” – a measure of how much people like active problem solving and critical thinking. Again, the more you think, the less reliant you are on TV. Does that mean that women have better cognition than men? No because there are many factors responsible for cognition besides entertainment.
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Is entertainment against our survival instincts?

One of the interesting things we found about the 20th century was that humans are not really built to deal with abundance. Anytime we have too much of anything, our evolutionary guidance control systems seem to go awry. The human survival mechanisms were designed in an environment of scarcity. We were built to rise above the odds, to survive in spite of adversity and hardship. In that scenario, the resiliency of humans is astonishing. But once the fight is over, we tend to languish and drift. History has repeated the story over and over again. The first well documented case was the fall of the Roman Empire. What does that have to do with the psychology of entertainment? Well, everything. With abundance comes leisure time. With leisure time comes a desire to seek entertainment. And when we seek entertainment to excess, we tend to get mired down as a society. As Edward Gibbon documented, the Roman Empire fell because of many factors – a wide spread empire that overcame its notion of centralized government, the rise of Christianity, economic reasons, but most of all, Rome fell because most Romans found themselves in the leisure class and didn’t know what to do with themselves. They got soft and getting soft does not equal to survival. My gut feeling is that we’re currently following in Rome’s footsteps. Let me discuss American obesity statistics and entertainment. Over 70% of Americans are fat or obese. If we look at the last 50 years, the percentage of US adults who are obese or extremely obese has gone from under 15% (in 1960) to 41.3% (2006) according to the National Health Examination Survey. And the latest AC Neilsen numbers indicate that the average American spends over 5 hours a day watching TV. That’s 153 hours of TV every single month. Of course, TV’s not the only passive form of entertainment Americans consume, but it’s by far the most measurable and easiest to identify. Using the internet is rapidly catching up, with Forrester reporting Americans spend about 12 hours a week, or 50 hours a month, online. Of course, one of the challenges we’ll identify with online time is that it’s difficult to categorize it as entertainment. But let’s say that at least 25% of American time online is spent being entertained in some way (consumption of online video is a popular activity). That brings the grand total to about 165 hours a month being passively entertained, about the same time Americans spend at our jobs and almost as much time as Americans spend sleeping. In other words, Americans spend almost a third of our lives being entertained, in one way or the other. This is not active entertainment, this is not social entertainment, and in most cases, this is not intellectually stimulating entertainment. This is sitting in front of a screen consuming mindless entertainment. Humans were not built to do that. We became a soft state. 9/11 attack on America and 26/11 attack on India occurred because we have become a soft state. Had we spent more time on vigilance than entertainment, the outcome could have been different. So much entertainment has reduced our survival instincts just like that of Romans. We entertain ourselves at the cost of our survival.

A saying goes, “Seek not to cover the world in leather—just wear shoes.” It is a spiritual cliché that happiness is not to be found by engineering the world so that everything goes your way: such happiness is transient, doomed. But that’s the way we act, culturally and individually, much of the time. Instead of making the whole world entertainment to relieve our boredom, we must search pleasure in our mind.

Entertainment and future generations:

Please read my article on “The Stress”. Stress in biology is defined as a response to change. Changes in environment motivate genetic changes which in turn will help you & your offspring to cope up with new environment and this is how stress propagated evolution. Entertainment (watching TV, movie or sports) is a major change in environment of humans. The prolonged exposure to entertainment will make changes in genetic code including the creation of novel genes, the alteration of gene expression in development, and the genesis of major genomic rearrangements which are carried forward in next generation to help next generation to adapt to stress. However, entertainment by and large produces imaginary changes in environment and not real changes; and therefore the genetic changes produced by entertainment will help adapt organism to the fantasy environment and not real environment. Obviously, such genetic changes will reduce ability of coming generations to cope up with stresses of real environment. Hence prolonged exposure to entertainment (e.g. cricket in India) over several generations will produce weak human species unable to cope up with the stresses of real life. One of the most common argument in favor of entertainment is to reduce stress but as logically deduced, excessive entertainment will reduce ability of future generation to cope up with the stress. Entertainment is a fantasy world. Whether Sachin Tendulkar scored a hundredth century or Amitabh Bachchan marveled in a movie will not make any change in the real lives of Indians. But prolonged exposure to fantasy of entertainment over generations will make genetic changes to adapt to fantasy and not reality; and coming human generation will not be competent to deal with stresses of real life.

The moral of the story:

1. Entertainment came into existence as utility of leisure time, relief of boredom & stress and relaxation; has now become so much pervasive that people use their prime time in entertainment ignoring learning, productive work & social duties.

2. The psychological basis for entertainment is subconscious mechanisms through priming, overriding reason by emotions and consolidation & retrieval of implicit entertainment memories. The only way to overcome these subconscious mechanisms is to strengthen our consciousness by making positive efforts to dominate subconscious.

3. Mirror neurons are involved in guiding our emotions taking cue from environment and since entertainment is an emotional response, mirror neurons are invariably involved in the genesis of being entertained.

4. The more you need cognition, the less you need entertainment and vice versa.

5. Entertainment blurs distinction between reality and fantasy leading to altered behavior, impaired performance and flawed decisions which may ruin life of a youth.

6. Education versus entertainment ratio (EVE) [also called education to entertainment ratio] is defined as the ratio of the amount of time used in education to the amount of time used in entertainment. Generally speaking, the ratio is 1:50 for common people and we need to raise it to 1:5 [I have raised it so that I can work for my website in my spare time. You can do it too.]

7. The emotional response evoked by music is far greater than listening to speech sound because music invariably has a rhythm which gets entangled in various biological rhythms of the brain.

8. Entertainment in the form of cricket and movies has become biological addiction to Indian population and will lead to withdrawal symptoms when attempt is made to de-addict them. Entertainment in the form of television in general has become biological addiction to American population.

9. Television is responsible for reducing intelligence, imagination and creativity of young mind besides numerous adverse effects. Nobody should watch TV more than 2 to 3 hours per day with focus on educative and informative programs rather than soaps. Intact family structure & values do reduce bad effects of TV on children.

10. The growth in nationwide obesity is directly related to the growth of entertainment industry in the U.S.

11. The buck stops at people for overrating and overpaying entertainers, be it sportspersons or actors.

12. Widespread entertainment with abundant leisure time leads to mired down society, reduced survival instincts and soft state.

13. Too much entertainment in 21^st century in the form of television, movies, sports and video games may lead to development of future generations incapable of coping with stresses of life due to genetic changes mediated by fantasy. Try to live in reality not only for yourself but also for your future generations.

Dr. Rajiv Desai. MD.

April 5, 2012

Postscript:

I am not against entertainment. Even I do listen to music or watch movies when I am bored or during leisure. The issue is unlimited pervasive entertainment that reduces our ability to survive and make our future generations incompetent to deal with the stresses of the life.

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SEX TRAFFICKING

March 8th, 2012

SEX TRAFFICKING:

Prologue:

Anna was a pretty blond, 25 year old Russian woman who had trained to be an exhibition ballroom dancer in her native town. . . She was recruited to be a dancer in Germany by answering an ad in a Russian newspaper. She was transported to Germany through Poland by a bus where she was taken to an apartment, locked in a room and told that she would be working as a prostitute. There was another Russian girl in the apartment who had been horribly beaten for having resisted forced prostitution. Anna was terrified and she initially agreed to work for the German pimps—but after being repeatedly raped by over 20 male “clients” during her first day, she refused to cooperate any further. She was beaten with a metal pipe for resisting. Both of her arms were broken before she was systematically raped by the pimps. Stories like Anna’s are not rare: trafficking human beings for the purpose of sexual exploitation has exploded into a sophisticated industry that generates billions of dollars in profit every year yet devastates the lives of millions of innocent victims. “Can people really buy and sell women and get away with it? Sometimes I sit here and ask myself if that really happened to me, if it can really happen at all.” said Ukrainian woman who was trafficked, beaten, raped, and used in the sex industry in Israel. After a police raid, she was put in prison, awaiting deportation. Every year, hundreds of thousands of women and children are abducted, deceived, seduced, or sold into forced prostitution, coerced to service hundreds if not thousands of men before being discarded. These trafficked sex slaves form the backbone of one of the world’s most profitable illicit enterprises and generate huge profits for their exploiters; for unlike narcotics, which must be grown, harvested, refined, and packaged; sex slaves require no such “processing,” and can be repeatedly “consumed.” Within the last decade, the trafficking of women and children for sexual exploitation has become a major concern for governments, NGOs and the media. Every 30 seconds another person becomes a victim of the sex trafficking industry. No race, religion or region is unaffected. Since most of sex trafficking is comprised of women and girls, this leaves a small percentage of victims within the male gender as well but I will discuss female sex trafficking.

Abbreviations:

ILO = International Labor Organization

IOM = International Organization for Migration

UNICEF = United Nations Children’s Fund

UNODC = United Nations Office on Drugs and Crime

CATW = Coalition Against Trafficking in Women

UN.GIFT = United Nations Global Initiative to Fight Human Trafficking

Human trafficking is a worldwide form of exploitation in which men, women, and children are bought, sold, and held against their will in involuntary servitude. In addition to the tremendous personal damage suffered by individual trafficking victims, this global crime has broad societal repercussions, such as fueling criminal networks and imposing public health costs.

Human trafficking as per UN:

The Trafficking Protocol was adopted by the United Nations in Palermo, Italy in 2000, and is an international legal agreement attached to the United Nations Convention against Transnational Organized Crime. The Trafficking Protocol defines human trafficking as: the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs. The consent of a victim of trafficking shall be irrelevant. The recruitment, transportation, transfer, harboring or receipt of a child for the purpose of exploitation shall be considered “trafficking in persons” even if this does not involve any of the means as narrated before. “Child” shall mean any person under eighteen years of age. The Trafficking Protocol entered into force on 25 December 2003. By June 2010, the Trafficking Protocol had been ratified by 117 countries and 137 parties.

The definition on trafficking consists of three core elements:

1) The action of trafficking which means the recruitment, transportation, transfer, harboring or receipt of persons

2) The means of trafficking which includes threat of or use of force, deception, coercion, abuse of power or position of vulnerability

3) The purpose of trafficking which is always exploitation and includes the prostitution of others, forced labor, slavery or servitude.

The “Palermo Protocol” distinguishes between trafficking in children (under 18 years of age) and adults. In the case of children, the recruitment and movement of a child for exploitation by a third party is considered human trafficking even if it does not involve the illicit means included in the definition above.

In addition to the criminalization of trafficking, the UN Trafficking in Persons Protocol requires criminalization also of:

1. Attempts to commit a trafficking offence.

2. Participation as an accomplice in such an offence.

3. Organizing or directing others to commit trafficking.

There are three main types of human trafficking:

1. Trafficking for forced labor;

2. Trafficking for sexual exploitation (the focus of my discussion);

3. Trafficking for organ harvesting.

Human trafficking is the recruitment, transportation, and sale of individuals; through force, fraud, deception or other means; with the aim of exploiting them for economic gain. It is the fastest-growing and second-largest criminal enterprise in the world. Almost every country is affected by human trafficking, whether as a place of origin, transit or destination for victims. In the eyes of the United Nations, this is a crime against humanity. Human trafficking not only involves sex and labor, but people are also trafficked for organ harvesting. According to the U.S. State Department’s 2011 Trafficking in Persons Report (TIP), there are as many as 27 million victims of human trafficking, with as many as 100,000 in the U.S. Many factors have contributed to the rise of modern slavery, including population growth, especially in the developing world, displacement of people to urban areas, civil wars, lack of job security, and extreme poverty. Attractive characteristics for trafficking include the presence of military bases, large immigrant populations, large service industries, open expanses of land, airports, and open water. Government corruption is also a big factor, as is the low cost of a slave. The average price of a modern slave is a mere $90. The major forms of human trafficking are forced labour, sex trafficking, forced child labour, child sex trafficking, involuntary domestic servitude, and bonded labour. Victims are forced to work without pay, cannot escape from their captors, and live under constant threat of violence. Trafficking victims normally don’t seek help for fear that they or their families will be hurt or killed. Many are also afraid of being deported. Roughly 50 percent of trafficking victims are children (under the age of 18), and 80 percent are female. The International Labor Organization—the UN agency charged with addressing labor standards, employment, and social protection issues—estimates that there are at least 12.3 million adults and children in forced labor, bonded labor, and commercial sexual servitude at any given time. Of these victims, 1.4 million are victims of commercial sexual servitude Also, 56% of all forced labor victims are women and girls (ILO). In the case of all forced labor, 40-50% of persons exploited may be children (ILO). People are trafficked from 127 countries to be exploited in 137 countries (UN). The total market value of illicit human trafficking is estimated to be in excess of $32 billion (UN).

Human traffickers are increasingly trafficking pregnant women for their newborns. Babies are sold on the black market, where the profit is divided between the traffickers, doctors, lawyers, border officials, and others. The mother is usually paid less than what is promised her, citing the cost of travel and creating false documents. A mother might receive as little as a few hundred dollars for her baby.

Worldwide trafficking estimates:

Agency Year of publication	Estimate	Target Population	Sources and Links	Methods and limits
US STATE 2008	600 to 800 000 people	Transborders Focus: Human trafficking global estimation based on TVPA 2000	Trafficking in persons report, Washington DC, 2008, p.7	Use of Monte Carlo simulation as the basis for estimating the risk of being trafficked.This estimation will depend on several quantitative criteria such as “age”, “sex”, neglecting other qualitative criteria as important as “knowledge of migration network”, “cultural factor”….
ILO 2008	2.44 millions Specifics : _{43%: sexual exploitation}_{32%: labor exploitation}_{25%: mixture of both} _{1.2 million are minors}	Trans and intra borders Focus: Human trafficking global estimation based on trafficking protocol The report also estimates the annual profits made by traffickers worldwide	General report, 18^th International conference on labor statistics, 2008, p.10“ A global alliance against forced labor”, 2005“Forced Labor and Human Trafficking: estimating the profits”, 2005	ILO used “capture/recapture method”, here based on reported cases, to estimate the total number of trafficking victims worldwide between 1995 and 2004Estimation reliability depends mainly on the quality and the quantity (proportionality) of those cases
UNICEF 2005	“however, one estimate suggests that 50% of trafficking victims worldwide are children”	Trans and intra borders Focus: Estimation of child trafficking	Combating Child trafficking; An handbook for parliamentarian, 2005,p13 ILO/IPEC: Every child counts, a new global estimates on child labor, ILO, Geneva, 2002	“There are no exact estimates of the numbers of trafficked children at this time”
UNIFEM 2009	“Estimates of the number of trafficked persons range from 500 000 to 2 million per year”	Undeterminated/ unavailable	UNIFEM Website, Facts & Figures on Violence Against Women, 01/2009	“While exact data are hard to come by”
UNHCR 2008	Reference to ILO estimation (2.5 million men, women and children) Reference to US dept. of state estimation (800 000 people)	Trans and intra border	Review of UNHCR’s efforts to prevent and respond to human trafficking, 09/2008, p.5	“Although there is a wide range of estimates regarding the extent of the problem, it is difficult to state with a high degree of certainty how many trafficking victims there are world wide”
UNDOC 2008	“This Report does not estimate the number of victims trafficked. The indicators used in this report are based on the frequency with which the subject is reported by the source institutions”.	The report contains detailed information on 161 countries, including information on persons trafficked from, through, to, and within a country; trafficking routes; trafficking for sexual exploitation versus forced labor; and the nationality, sex, and age of victims and offenders.	UNODC Report:”Trafficking in Persons: Global Patterns”, 2006, p.120 UNODC e-newsletter, Perspectives n.3	UNODC analyzes data from government statistics, reports of international organizations and NGOs, academic research, and media reports on over 5,000 episodes of trafficking
IOM 2008	Relatives information’s on registered cases such as: Victims (Sex, age, socio eco. status, education):Traffickers: Trafficking routes and modus operandi: Patterns of exploitation and re-trafficking	Focus:Registered human trafficking cases	Trafficking Module Database, which includes13018 registered cases in June 2008—from 50 source countries and 78 destination countries—registered since November 1999	Fragmented approach.Data only collected where IOM has a presence.Findings may not easily be generalize.

The picture below shows worldwide trafficking estimates by different organizations:

Trafficking does not necessarily have to involve being moved from one location to another. If a person is forced, coerced, abducted, deceived into a situation of enslavement, even if it is in the same town, it is considered trafficking. So human trafficking may occur locally or domestically, without any movement, such as within the same city. When human trafficking occur from one country (origin country) to another country (destination country), victims may be transported by plane, boat, train or any type of vehicle, and often a combination of them, using genuine and/or fraudulent documents that are usually removed from them upon arrival at their destination. Victims may then be isolated and/or taken to illicit businesses where they may be subjected to physical & sexual abuse and concealment.

What if a trafficked person consents?

It is important to note that the consent of the trafficked person becomes irrelevant whenever any of the ‘means’ of trafficking are used. A child cannot consent even if the ‘means’ are not involved.

The United Nations Global Initiative to Fight Human Trafficking (UN.GIFT) was conceived to promote the global fight on human trafficking, on the basis of international agreements reached at the UN. The UN Office on Drugs and Crime (UNODC) has assisted many non-governmental organizations in their fight against human trafficking. Within UN.GIFT, UNODC launched a research exercise to gather primary data on national responses to trafficking in persons worldwide. This exercise resulted in the publication of the Global Report on Trafficking in Persons in February 2009. The report gathers official information for 155 countries and territories in the areas of legal and institutional framework, criminal justice response and victim assistance services. The Global Initiative is based on a simple principle: human trafficking is a crime of such magnitude and atrocity that it cannot be dealt with successfully by any government alone. This global problem requires a global, multi-stakeholder strategy that builds on national efforts throughout the world. To pave the way for this strategy, stakeholders must coordinate efforts already underway, increase knowledge and awareness, provide technical assistance, promote effective rights-based responses, build capacity of state and non-state stakeholders, foster partnerships for joint action, and above all, ensure that everybody takes responsibility for this fight. By encouraging and facilitating cooperation and coordination, UN.GIFT aims to create synergies among the anti-trafficking activities of UN agencies, international organizations and other stakeholders to develop the most efficient and cost-effective tools and good practices. UN.GIFT aims to mobilize state and non-state actors to eradicate human trafficking by reducing both the vulnerability of potential victims and the demand for exploitation in all its forms, ensuring adequate protection and support to those who fall victim, and supporting the efficient prosecution of the criminals involved, while respecting the fundamental human rights of all persons. In carrying out its mission, UN.GIFT will increase the knowledge and awareness on human trafficking; promote effective rights-based responses, build capacity of state and non-state actors, and foster partnerships for joint action against human trafficking.

The data contained in the Trafficking Database of UNODC was generated largely from research reports produced by international organizations (32%), and by governmental organizations (27%). NGOs and research institutes account for approximately 18% of the sources that contribute information to the Trafficking Database.

According to UN.GIFT, these are facts of human trafficking:

An estimated 2.5 million people are in forced labor (including sexual exploitation) at any given time as a result of trafficking.

Of these:

1.4 million – 56% – are in Asia and the Pacific

250,000 – 10% – are in Latin America and the Caribbean

230,000 – 9.2% – are in the Middle East and Northern Africa

130,000 – 5.2% – are in sub-Saharan countries

270,000 – 10.8% – are in industrialized countries

200,000 – 8% – are in countries in transition2

Risk factors for human trafficking are depicted below:

The victims of human trafficking:

The majority of trafficking victims are between 18 and 24 years of age. An estimated 1.2 million children are trafficked each year. 95% of victims experienced physical or sexual violence during trafficking (based on data from selected European countries). Many trafficking victims have at least middle-level education. 161 countries are reported to be affected by human trafficking by being a source, transit or destination count. People are reported to be trafficked from 127 countries to be exploited in 137 countries, affecting every continent and every type of economy. 75-80% of human trafficking is for sex, followed by forced labor and organ harvesting. 80% of those sold into slavery are under the age of 24. Some are as young as 6. Currently only 1-2% of victims are rescued. The total market value of illicit human trafficking is estimated to be over $32 billion – more than Nike, Starbucks and Google combined!

Council of Europe:

In Warsaw on 16 May 2005, the Council of Europe Convention on Action against Trafficking in Human Beings was opened for accession and has since been signed by 43 member states of the Council of Europe. The Convention established a Group of Experts on Action against Trafficking in Human Beings (GRETA) which monitors the implementation of the Convention through country reports. Complementary protection is ensured through the Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse. In 2003 the OSCE (Organization for Security and Cooperation in Europe) established an anti-trafficking mechanism aimed at raising public awareness of the problem and building the political will within participating States to tackle it effectively. The OSCE actions against human trafficking are coordinated by the Office of the Special Representative for Combating the Traffic of Human Beings.

Problems with the concept of human trafficking:

According to some scholars, the very concept of human trafficking is murky and misleading. It has been argued that while human trafficking is commonly seen as a monolithic crime, in reality it is an act of illegal migration that involves various different actions: some of them may be criminal or abusive, but others often involve consent and are legal. Some argues that not everything that might seem abusive or coercive is considered as such by the migrant. For instance, ‘would-be travelers commonly seek help from intermediaries who sell information, services and documents. When travelers cannot afford to buy these outright, they go into debt’. One scholar says that while these debts might indeed be on very harsh conditions, they are usually incurred on a voluntary basis. The critics of the current approaches to trafficking say that a lot of the violence and exploitation faced by illegal migrants derives precisely from the fact that their migration and their work are illegal and not primarily because of some evil trafficking networks. Some believes that the whole trafficking discourse can be actually detrimental to the interests of migrants as it denies them agency and as it depoliticizes debates on migration.

Human trafficking versus migrant smuggling:

Human trafficking differs from people smuggling. In the latter, people voluntarily request or hire an individual, known as a smuggler, to covertly transport them from one location to another. This generally involves transportation from one country to another, where legal entry would be denied upon arrival at the international border. There may be no deception involved in the (illegal) agreement. After entry into the country and arrival at their ultimate destination, the smuggled person is usually free to find their own way. While smuggling requires travel, trafficking does not. Victims of human trafficking are not permitted to leave upon arrival at their destination. They are held against their will through acts of coercion and forced to work or provide services to the trafficker or others. The work or services may include anything from bonded or forced labor to commercialized sexual exploitation. The arrangement may be structured as a work contract, but with no or low payment or on terms which are highly exploitative. Sometimes the arrangement is structured as debt bondage, with the victim not being permitted or able to pay off the debt.

Simply put, there are four main differences between human trafficking and migrant smuggling.

1. Consent – migrant smuggling, while often undertaken in dangerous or degrading conditions, involves consent. Trafficking victims, on the other hand, have either never consented or if they initially consented, that consent has been rendered meaningless by the coercive, deceptive or abusive action of the traffickers.

2. Exploitation – migrant smuggling ends with the migrants’ arrival at their destination, whereas trafficking involves the ongoing exploitation of the victim.

3. Transnationality – smuggling is always transnational, whereas trafficking may not be. Trafficking can occur regardless of whether victims are taken to another state or moved within a state’s borders.

4.Source of profits – in smuggling cases profits are derived from the transportation of facilitation of the illegal entry or stay of a person into another county, while in trafficking cases profits are derived from exploitation.

The distinctions between smuggling and trafficking are often very subtle and sometimes they overlap. Identifying whether a case is one of human trafficking or migrant smuggling and related crimes can be very difficult for a number of reasons:

Some trafficked persons might start their journey by agreeing to be smuggled into a country illegally, but find themselves deceived, coerced or forced into an exploitative situation later in the process (by e.g. being forced to work for extraordinary low wages to pay for the transportation).Traffickers may present an ‘opportunity’ that sounds more like smuggling to potential victims. They could be asked to pay a fee in common with other people who are smuggled. However, the intention of the trafficker from the outset is the exploitation of the victim. The ‘fee’ was part of the fraud and deception and a way to make a bit more money. Smuggling may be the planned intention at the outset but a ‘too good to miss’ opportunity to traffic people presents itself to the smugglers/traffickers at some point in the process. Criminals may both smuggle and traffic people, employing the same routes and methods of transporting them. The relationship between these two crimes is often oversimplified and misunderstood; both are allowed to prosper and opportunities to combat both are missed. It is important to understand that the work of migrant smugglers often results in benefit for human traffickers. Smuggled migrants may be victimized by traffickers and have no guarantee that those who smuggle them are not in fact traffickers. In short, smuggled migrants are particularly vulnerable to being trafficked – combating trafficking in persons requires that migrant smuggling be addressed as a priority.

Figure above shows reported profile of victims and the purpose of human trafficking at the global level. Human trafficking for sexual exploitation is reported more frequently than trafficking for forced labor at the global level. Eighty percent of those sold into sexual slavery are under 24, and some are as young as six years old.

What is the most commonly identified form of human trafficking? Sex trafficking.

In UNODC’s Global Report on Trafficking in Persons, sexual exploitation was noted as by far the most commonly identified form of human trafficking (79%) followed by forced labor (18%). This may be the result of statistical bias. By and large, the exploitation of women tends to be visible, in city centers or along highways. Because it is more frequently reported, sexual exploitation has become the most documented type of trafficking, in aggregate statistics. In comparison, other forms of exploitation are under-reported: forced or bonded labor; domestic servitude and forced marriage; organ removal; and the exploitation of children in begging, the sex trade and warfare. There is a high global demand for women and children for sexual exploitation. Traffickers use their victims as “products” for sale. The average age of a young girl first being trafficked is 12-14 years old. Often girls and young women are lured in by promises of good jobs and opportunities in other countries, only to find themselves trapped by ruthless criminals in a foreign land. Their passports are taken away from them when they arrive, and these helpless victims are often forced to work in strip clubs, massage parlours and as prostitutes. The chance of escape is very slim, but some eventually do manage to find help. Others are not so lucky.

Sex trafficking versus prostitution:

Sex trafficking isn’t prostitution, which is engaging in sex with someone for payment. The crime of sex trafficking has three parties: one person holding the victim, while using “force, fraud or coercion” to make the victim engage in sex acts for payment, and the third party paying for the sex. The underage victims are often runaways and victims of sexual abuse who are vulnerable to pimps promising modeling jobs, money, food and drugs. Of course, when we differentiate prostitution between voluntary (victimless) prostitution and forced prostitution, sex trafficking becomes a type of forced prostitution.

Are prostitution and sex trafficking inextricably linked?

Activists in this crusade insist that prostitution must be targeted, because it is prostitution more than anything else that is the root cause of trafficking. Opposing trafficking without simultaneously fighting prostitution is seen as treating the symptom instead of the disease. The conflation of trafficking and prostitution is motivated by the crusade’s ultimate goal of eliminating the entire sex trade, a goal that is frequently articulated. Donna Hughes, for example, calls for “re-linking trafficking and prostitution, and combating the commercial sex trade as a whole.” Not only does she equate the two (“sex trafficking of women and children—what’s commonly called prostitution”), but also claims that most ‘sex workers’ are – or originally started out as – trafficked women and girls. The research literature does not support this claim. There is no evidence that most or even the majority of prostitutes have been trafficked. Moreover, prostitution and trafficking differ substantively; the former is a type of work, and the latter is a means of accessing a new market. Both empirically and conceptually, it is inappropriate to fuse prostitution and trafficking.

The issue, however, gets mired in controversy and confusion when prostitution too is considered as a violation of the basic human rights of both adult women and minors, and equal to sexual exploitation per se. Trafficking and prostitution become conflated with each other. …. On account of the historical conflation of trafficking and prostitution both legally and in popular understanding, an overwhelming degree of effort and interventions of anti-trafficking groups are concentrated on trafficking into prostitution. The line between forced and voluntary prostitution is very thin, and prostitution in and on itself is seen by many as an abusive practice and a form of violence against women. In Sweden, Norway and Iceland it is illegal to pay for sex (the client commits a crime, but not the prostitute) [vide infra].

Prostitution:

Prostitution is the act or practice of providing sexual services to another person in return for payment. The term prostitution means engaging or offering or agreeing to engage for hire in sexual penetration or sexual contact. The person who receives payment for sexual services is called a prostitute. Prostitution is one of the branches of the sex industry. The legal status of prostitution varies from country to country, from being a punishable crime to a regulated profession. Many people believe prostitution is a choice and/or that it is a victimless crime. Both of these beliefs are incorrect. Women and girls are, with few exceptions, forced into prostitution. Estimates place the annual revenue generated from the global prostitution industry to be over $100 billion. Prostitution is sometimes referred to as “the world’s oldest profession”. If prostitution in general is legal, there is usually a minimum age requirement for legal prostitution that is higher than the general age of consent. Prostitution occurs in a variety of forms. Brothels are establishments specifically dedicated to prostitution. In escort prostitution, the act may take place at the customer’s residence or hotel room (referred to as out-call), or at the escort’s residence or in a hotel room rented for the occasion by the escort (called in-call). Another form is street prostitution. It is interesting to note that due to their high desirability, Indian actresses – and women claiming to be actresses – can command high prices for sexual services. Prostitution is a significant issue in feminist thought and activism. Many feminists are opposed to prostitution, which they see as a form of exploitation of women and male dominance over women, and as a practice which is the result of the existing patriarchal societal order. These feminists argue that prostitution has a very negative effect, both on the prostitutes themselves and on society as a whole, as it reinforces stereotypical views about women, who are seen as sex objects which can be used and abused by men. Other feminists hold that prostitution can be a valid choice for the women who choose to engage in it; in this view, prostitution must be differentiated from forced prostitution, and feminists should support sex worker activism against abuses by both the sex industry and the legal system. Most of the research done by Sanlaap indicates that the majority of sex workers in India work as prostitutes due to lacking resources to support themselves or their children. Most do not choose this profession out of preference, but out of necessity, often after the breakup of a marriage or after being disowned and thrown out of their homes by their families. The children of sex workers are much more likely to get involved in this kind of work as well.

Over the last few decades, most of the countries have experienced a phenomenal growth of prostitution especially for the countries of the ex-USSR and Eastern Europe. Millions of women, teenagers, and children thus live in the red-light districts of the urban metropolises of their own countries or in those of the nearby countries. Two million women prostitute themselves in Thailand (Barry 122), 400,000 to 500,000 in the Philippines (CATW), 650,000 in Indonesia (CATW), about ten million in India (of whom 200,000 are Nepalese) (CATW), 142,000 in Malaysia (CATW), between 60,000 and 70,000 in Vietnam (CATW), one million in the United States, between 50,000 and 70,000 in Italy (of whom half are foreigners, most notably from Nigeria), 30,000 in the Netherlands (CATW), 200,000 in Poland (Opperman), and between 60,000 (Guéricolas) and, more credibly, 200,000 (Opperman) in Germany. German prostitutes sell sexual services to 1.2 million “customers” per day (Opperman ; Ackermann and Filter).

In India and Southeast Asia almost everybody seems to have entered prostitution involuntarily (although some, after having been trafficked, choose to stay in the industry). One of the ironies is that sex trafficking often arises in particularly sexually repressed countries, such as India, Pakistan and the Arab world. “Young American men sleep with their girlfriends while Indian men with prostitutes”. And just as much of American society accepts promiscuity as the unfortunate but inevitable consequence of sex drive, so India accepts the trafficking of 14-year-olds in the same way. On the balance, I think that it would be better off with more promiscuity and less trafficking rather than with less promiscuity and more trafficking. Of course, controlling your sex drive is the best option but how many men can do it?

Sex tourism:

Sex tourism refers to travelling, typically from developed to under-developed nations, to engage in sexual activity with prostitutes. Sex tourism is travel for sexual intercourse with prostitutes or to engage in other sexual activity. The World Tourism Organization, a specialized agency of the United Nations defines sex tourism as “trips organized from within the tourism sector, or from outside this sector but using its structures and networks, with the primary purpose of effecting a commercial sexual relationship by the tourist with residents at the destination”. The growth of sexual tourism over the last 30 years has entailed the “prostitutionalization” of the societies involved. In Thailand, with 5.1 million sexual tourists a year, 450,000 local customers buy sex every day. Government policies favorable to sex tourism contributed to the explosion of this industry. So sex tourism is a type of prostitution and should not be confused with sex trafficking.

Child sex tourism:

Child sex tourism is a travel to a foreign country for the purpose of engaging in commercially facilitated child sexual abuse. Child sex tourism results in both mental and physical consequences for the exploited children that may include disease (including HIV/AIDS), drug addiction, pregnancy, malnutrition, social ostracism, and possibly death. Thailand, Cambodia, India, Brazil and Mexico have been identified as leading hotspots of child sexual exploitation. Child sex tourism is a criminal (in most countries) multi-billion-dollar industry believed to involve as many as 2 million children around the world. In an effort to eradicate the practice, many countries have enacted laws to allow prosecution of its citizens for child abuse that occurs outside their home country, even if it is not against the law in the country where the child abuse took place, for example, the US Protect Act.

Legality of prostitution:

The figure below shows legal status of prostitution in various countries.

Countries around the world have taken one of four approaches to prostitution laws: prohibition, regulation, abolition, and decriminalization. The prohibitionist approach is characterized by criminalization of all prostitution-related activities: soliciting, procuring, pimping, and brothel keeping. The regulation approach is characterized by the legalization and regulation of the sex industry. The abolitionist approach is characterized by the treatment of women and children used in prostitution as victims in need of services and the treatment of the buyers and traffickers as perpetrators. In this scheme, those who sell sex acts are decriminalized, whereas those who buy others for sex are criminalized. The decriminalization approach is a strategy to achieve either the abolitionist approach or the regulation approach. In some countries, like New Zealand and Thailand, decriminalization was a means to regulation. In New Zealand, all offenses including prostitution, brothel keeping and other related offenses were decriminalized by the national parliament, which then tasked local governments with promulgating regulations of the sex industry. In other countries like Sweden, decriminalization is a means to abolition. Those who buy other human beings for sex or promote their sexual exploitation such as pimps and traffickers face criminal penalties. Those who sell sex do not face such penalties. In the United Kingdom and Germany, the definitions of prostitution and sex trafficking are linked. In Sweden, the definition of human trafficking is linked with sexual exploitation.

Do women choose sex work?

Women and girls are seen as actively choosing “sex work” as legitimate work. The reality is that the act of being prostituted is sexually exploitative in itself; regardless of the alleged or actual degree of power, control or safety women can exercise in different situations and at different times in their lives. There are different degrees, levels and extent of coercion, abuse and violence perpetrated against any one woman or girl at any particular time but most women who are in the sex industry are violated and sexually exploited. The sex industry is an inherently unsafe and dangerous environment.

The fundamental question:

Is prostitution a form of violence and exploitation of women, which should be banned, or a job like any other, which should be regulated? The question has divided Europe. Spain has been dubbed the “brothel of Europe,” with up to 500,000 women working as prostitutes. Every day, 1.5 million men buy sex in Spain. Ninety per cent of the prostitutes are immigrants – mainly from Latin America, Eastern Europe and Africa – coerced into the trade by criminal rings. There are exceptions to coerced sex trade. Margarita Carreras has worked as a prostitute for 24 years “because I want to, because this is a free country, because it is very lucrative and because I prefer it to a cleaning job,” she explained. However, she is in minority league of sex workers as compared to majority league who sell sex not out of choice.

With regard to prostitution, three worldviews exist: abolitionism (where the prostitute is considered a victim), regulation (where the prostitute is considered a worker) and prohibitionism (where the prostitute is considered a criminal). Currently in the Western World, two main tendencies oppose each other: abolitionism and regulation.

For the proponents of the abolitionist view, prostitution is always a coercive practice, and the prostitute is seen as a victim. They argue that most prostitutes are forced into the practice either directly by pimps and traffickers or indirectly through poverty, drug addiction and other personal problems, or, as it has been argued in recent decades by radical feminists such as Andrea Dworkin, Melissa Farley and Catharine MacKinnon, merely by patriarchal social structures and power relations between men and women. William D. Angel finds that “most” prostitutes have been forced into the profession through poverty, lack of education and employment possibilities. Kathleen Barry argues that there should be no distinction between “free” and “coerced”, “voluntary” and “involuntary prostitution “since any form of prostitution is a human rights violation, an affront to womanhood that cannot be considered dignified “labor”. France’s Green Party argues: The concept of “free choice” of the prostitute is indeed relative, in a society where gender inequality is institutionalized. The proponents of the abolitionist view hold that prostitution is a practice which ultimately leads to the mental, emotional and physical destruction of the women who engage in it, and, as such, it should be abolished. As a result of such views on prostitution, Sweden, Norway and Iceland have enacted laws which criminalize the clients of the prostitutes, but not the prostitutes themselves.

In contrast to the abolitionist view, those who are in favor of legalization do not consider the women who practice prostitution as victims, but as independent adult women who had made a choice which should be respected. Mariska Majoor, former prostitute and founder of the Prostitution Information Center from Amsterdam holds that: “In our [sex worker's] eyes, it’s a profession, a way of making money; it’s important that we are realistic about this (…) Prostitution is not bad; it’s only bad if done against one’s will. Most women make this decision themselves.” Indeed, many consider prostitution as a legitimate activity, which must be recognized and regulated, in order to protect the workers’ rights and to prevent abuse. They believe that prostitutes must be treated as sex workers to enjoy benefits similar to other professions. The World Charter for Prostitutes Rights (1985), drafted by the International Committee for Prostitutes’ Rights, calls for the decriminalization of all aspects of adult prostitution resulting from individual decision. Since the mid-1970s, sex workers across the world have organized, demanding the decriminalization of prostitution, equal protection under the law, improved working conditions and the right to pay taxes, travel and receive social benefits such as pensions. As a result of such views on prostitution, countries such as Germany, the Netherlands and New Zealand have fully legalized prostitution.

In trying to understand the varied views of prostitution and female sex trafficking, it is important to recognize that the two opposing sides of the issue, those opposed to prostitution and those in support of it, come at the issue with a different question in mind. To those opposed to prostitution, the belief is: a woman’s body is not a commodity for men’s pleasure. To those in favor of prostitution, the belief is: no one should interfere with a woman utilizing her body as a resource for financial gain. One common view within these readings is the feminist perspective that declares that women deserve equal treatment with men in all societies simply because they are human beings. The view that I believe is most important is the view of the survivors of trafficking and prostitution themselves. In a press release titled Survivors of Prostitution and Trafficking Manifesto (2005), women who consider themselves victims of prostitution and sex trafficking ask for the sake of their own lives and the lives of women in similar situations, not to legalize or condone the prostituting of women or children. These women do not represent every woman who has been a prostitute or victim of sex trafficking, but based on the growing amount of work on this subject, it would seem that they may represent a vast majority of victims.

To its victims, sexual exploitation is neither sex nor sexy. Many progressives who state that globalized capitalism promotes gender, race and class inequality have a strange reluctance to criticize the sex industry for doing exactly that. They are out of touch with the majority of women in prostitution who want not “better working conditions” but a better life. Prostitution is not “sex work;” it is violence against women. It exists because significant numbers of men are given social, moral and legal permission to buy women on demand. It exists because pimps and traffickers prey on women’s poverty and inequality. It exists because it is a last ditch survival strategy, not a choice, for millions of the world’s women.

Field research from nine countries shows the great harm suffered by people used in prostitution: 89 percent of people being used in prostitution want to escape. 60 to 75 percent of women in prostitution have been raped, 70 to 95 percent have been physically assaulted, and 68 percent met the clinical criteria for post-traumatic stress disorder.

Forced prostitution:

“Forced prostitution” generally refers to conditions of control over a person who is coerced by another to engage in sexual activity. Forced prostitution, also known as involuntary prostitution, is the act of performing sexual activity in exchange for money on a non-voluntary basis. There are a wide range of entry routes into prostitution, ranging from “voluntary and deliberate” entry, “semi-voluntary” based on pressure of circumstances, and “involuntary” recruitment via outright force or coercion. Sexual slavery encompasses most, if not all, forms of forced prostitution. All forms of involuntary prostitution are regarded as an offence under customary law in all countries. This is different from voluntary prostitution which has different legal statuses in different countries, which range from being fully illegal and punishable by death to being fully legal and regulated as an occupation in countries such as Germany, the Netherlands and New Zealand. The issue of consent in prostitution is a hotly debated issue. Opinion in places like Europe has been divided over the question of whether prostitution itself should be considered as a free choice or as inherently exploitative of women. The law in Sweden, Norway and Iceland – where it is illegal to pay for sex, but not to sell sexual services – is based on the notion that all forms of prostitution are inherently exploitative; opposing the notion that prostitution can be voluntary. In contrast, prostitution is a recognized profession in countries such as Netherlands and Germany.

Victimless prostitution versus forced prostitution vis-à-vis sex trafficking:

There is a “call girl” image, where lovely, apparently educated women choose to become prostitutes, almost as a career choice. This is “clean” prostitution, prostitution as a profession — where men always use condoms and women get tested for HIV as a matter of course. This is almost always portrayed as somehow empowering (and even fun) for women and the image is of high-class call girls getting paid a lot of money to have non-abusive, non-violent sex with wealthy, powerful but still “gentlemanly” (and usually attractive) men. This image seems to be the closest to the kind of prostitution that most people can feel comfortable with. This is the type that is viewed as “victimless” and “consensual”. This is the type that people think should be legalized, regulated and taxed. There is another case of women who are over 18, with no education, living in poverty with no work experience, who found the only way to make money was to go into the streets and who did not have a pimp, and they may fall in the category of voluntary prostitution. However, these cases are rare as compared to so called forced prostitution where women who perhaps came from an abusive childhood, who perhaps have a drug problem, who may have a pimp, but who still are adults making “choices”. In this view, the image is of not-so-attractive women having cheap sex in motel rooms or cars with traveling salesmen or suburban husbands. This is the most common type of prostitution where research indicates that most prostitutes were sexually abused as girls, and they typically enter “the life” between the ages of 12 and 14. The majority have drug dependencies or mental illnesses, and one third have been threatened with death by pimps, who often use violence to keep them in line. Sex trafficking leads to this kind of forced prostitution and therefore must be distinguished from victimless prostitution. Trafficking in women for the purpose of sexual exploitation is an extreme form of sexual violence against women, usually in the context of migration, which has nothing in common with prostitution as a consensual service. A study found that 89% of 785 people in prostitution from nine countries wanted to escape prostitution. 75% of those in prostitution have been homeless at some point in their lives.

Violence vis-à-vis sex worker:

A study report showed that violence is very much a part of the lives of the women who were prostituted and sex trafficked. Not only did most of the women (92 percent) say they had been raped, and physically assaulted in prostitution, 79 percent had been physically abused as children, by an average of 4 perpetrators, with more than half (56 percent) abused by caregivers. Additionally, the report states that 72 percent of the women suffered head injuries (described as traumatic brain injury) including broken jaws, fractured cheekbones, missing teeth, punched lips, black eyes, blood clots in the head, hearing loss, memory loss, headaches and neck problems. Violence was an intrinsic part of the prostitution and sexual exploitation used to control and intimidate the women. Another study compared violence against sex workers in the U.S. with international sex workers. Eighty-six percent of U.S. women and 53 percent of the international women reported being physically abused by pimps and traffickers. One half of the U.S. women and 1/3 of the international women described frequent, sometimes daily assaults. Eighty-eight percent of U.S. women and 50 percent of international women reported psychological abuse. Ninety percent of the U.S. women and 47 percent of international women reported verbal threats. Seventy percent of U.S. women and 40 percent of international women reported being sexually assaulted in prostitution at the hands of the pimps and traffickers. As evidenced from the context of interviews with women, the research team believes that these findings represent underreporting of the actual violence perpetrated, especially against international women by pimps and buyers. There may be many reasons for this underreporting including normalization or non-naming of the violence in their lives. Women were isolated, confined and guarded to prevent them from leaving. Thirty-five percent of international women, and 64 percent of U.S. women were held in isolation and under guard in brothels or compounds. Prostitution is ontologically a form of violence. It feeds on violence and in turn amplifies it. Abduction, rape, submission – there are submission camps in a number of European countries, not only in the Balkans and in Central Europe, but also in Italy, where submission is called “schooling” – terror and murder are still the midwives and outriders of this industry; they are essentially not only for market development, but also for the “manufacture” of the “goods” as they contribute to making prostituted people “functional” – this industry demands total availability of the body. A study of street prostituted people in England established that 87% of them had been victims of violence during the past 12 months; 43% were suffering the consequences of serious physical abuse. A research study in Chicago showed that 21.4% of women working as escorts and exotic dancers had been raped more than 10 times. An American study in Minneapolis showed that 78% of prostituted people had been victims of rape by pimps and customers, on average, 49 times a year. 49% had been the victims of abduction and had been transported from one state to another and 27% had been mutilated. I want to emphasize that women and girls who are the objects of sex trafficking as well as the vast majority of prostituted women, have very often been subjected to violence.

Is prostitution consensual sex or rape?

If rape is defined as any unwanted sex act, then prostitution has an extremely high rate of rape because many survivors view prostitution as almost always entirely consisting of unwanted sex acts or even in one woman’s words, paid rape… prostitution is like rape. I will narrate story of a commercial sex worker in her own words. “It’s like when I was 15 years old and I was raped. I used to experience leaving my body. I mean that’s what I did when that man raped me. I went to the ceiling and I numbed myself because I did not want to feel what I was feeling. I was very frightened. And while I was in prostitution I used to do that all the time. I would numb my feelings. I wouldn’t even feel like I was in my body. I would actually leave my body and go somewhere else with my thoughts and with my feelings until he got off, and it was over with. I don’t know how else to explain it except that it felt like rape. It was rape to me.” Are you moved by paid rape? If you aren’t then you have no conscience.

Would prostitution legal or illegal reduce rape rates?

Kirby R. Cundiff, PhD, Associate Professor of Finance at Northeastern State University, wrote the Apr. 8, 2004 working paper entitled “Prostitution and Sex Crimes,” for the Independent Institute that stated: “It is estimated that if prostitution were legalized in the United States, the rape rate would decrease by roughly 25% for a decrease of approximately 25,000 rapes per year…The analysis seems to support the hypothesis that the rape rate could be lowered if prostitution was more readily available. This would be accomplished in most countries by its legalization. A study conducted in Queensland… showed a 149% increase in the rate of rape when legal brothels were closed in 1959, while other offenses against the person by males increased only 49%.

However, there are contradictory studies which challenge above mentioned studies. Safer Society Foundation, Inc. (then known as Prison Research Education Action Project), in the 1976 Instead of Prisons: A Handbook for Abolitionists, wrote: Three cities which allowed open prostitution experienced a decline in rape after prostitution was again prohibited. Rapists include men who do not patronize prostitutes. Rapists include men who have ‘girlfriends,’ or are married, or living with women. Statistical studies of reported rapes show that the majority of rapists are well below the age of males who most frequently use prostitutes. Also, statistics show that most rapes are executed on women whom rapist already know or have acquaintance with them rather than strangers. Finally, in Vietnam, brothels for the American military were officially sanctioned and incorporated into the base-camp recreation areas and yet G.I. rape and sexual abuse of Vietnamese women and girls is one of the most atrocious chapters of violence in U.S. history.

So there is no evidence to suggest that prostitution indeed reduce rape rates. Rapist would rape even if alternative sex subject is easily available. Rapist is raping a woman not because he is sex starved but because he wants to dominate woman by having sex with her without her consent. Coalition Against Trafficking in Women (CATW) Australia branch posted on their website “Frequently Asked Questions About Prostitution” (accessed Mar. 8, 2007) that stated: ..In cases of gang rape by sportsmen in Australia in 2004, it has become clear that the use of prostituted women and strip clubs is integral to the woman hating and male bonding which led to the sexual violence. The argument also suggests that women who are not prostituted are safer because some other women are set aside to be commercially raped on their behalf. Women’s equality requires that all women should be free from sexual exploitation. Prostitution cannot eliminate rape when it is itself bought rape. The connection between prostitution and rape is that women are turned into objects for men’s sexual use; they can be either bought or stolen. A culture in which women can be bought for use is one in which rape flourishes. In fact, legal sex businesses provide locations where sexual harassment, sexual exploitation, and violence against women are perpetrated with impunity. State-sponsored prostitution endangers all women and girls, in that acts of sexual predation are normalized…

Sexual slavery:

Sexual slavery is when unwilling people are coerced into slavery for sexual exploitation. The Rome Statute’s definition of sexual slavery includes situations where persons are forced into domestic servitude, marriage or any other forced labor that involves sexual activity, as well as the trafficking of persons for sexual purposes, frequently women and children. Sex trafficking, commercial sexual exploitation of children, child prostitution, child pornography, child sex tourism, forced prostitution, white slavery, and sexual slavery during armed conflict & war including comfort women etc are various types of sexual slavery.

Comfort women:

The term “comfort women” was a euphemism used to describe 200,000 women forced into sexual slavery by the Japanese military during World War II. A majority of the women were from Korea, China, Japan and the Philippines, although women from Thailand, Vietnam, Malaysia, Taiwan, Indonesia and other Japanese-occupied territories were used for military “comfort stations”. Young women from countries under Japanese Imperial control were abducted from their homes. In many cases, women were also lured with promises of work in factories or restaurants. Once recruited, the women were incarcerated in “comfort stations” in foreign lands. “Comfort women” are a widely publicized example of sexual slavery. Each slave was reportedly raped “an average of 10 rapes per day (considered by some to be a low estimate), for a five day work week; this figure can be extrapolated to estimate that each ‘comfort girl’ was raped around 50 times per week or 2,500 times per year. For three years of service – the average – a comfort girl would have been raped 7,500 times.

Mail-order brides:

Mail-order brides means ordering and paying for exotic women from overseas to be a man’s wife; men can order their brides online and even take “tours” of a country’s women. The women often come from countries such as China, the Ukraine, the Philippines, Peru, Costa Rica, and various areas throughout Russia.

White slavery:

In English-speaking countries in the 19th and early 20th centuries, the phrase “white slavery” was used to refer to sexual enslavement of white women. It was particularly associated with orientalist accounts of women enslaved in Middle Eastern harems. The phrase gradually came to be used as a euphemism for prostitution. In the United States in the early twentieth century, peaking in 1910, when Chicago’s U.S. attorney announced (without giving details) that an international crime ring was abducting young girls in Europe, importing them, and forcing them to work in Chicago brothels. These claims, and the panic they inflamed, led to the passage of the United States White-Slave Traffic Act of 1910. It also banned the interstate transport of females for immoral purposes.

Other types of sex slavery are discussed elsewhere in the article.

Pimp:

Pimp is a person who procures a commercial sex worker. Pimp is a link between the customer and the sex worker. Pimps are generally males and any woman who is doing a job of a pimp is called a madam. Traffickers are also known as pimps or madams, exploit vulnerabilities and lack of opportunities, while offering promises of marriage, employment, education, and/or an overall better life. However, in the end, traffickers force the victims to become prostitutes or work in the sex industry. Various works in the sex industry includes prostitution, dancing in strip clubs, performing in pornographic films and pornography, and other forms of involuntary servitude. To stay in business, pimps and traffickers need a steady supply of victims. A pimp can only use a woman or girl for a limited period of time before she needs to be replaced usually because of poor physical or mental health or addiction. Russian police said that a woman lasts only one year with a pimp before her “quality decreases.” The pimp-prostitute relationship can be abusive and possessive, with the pimp / madam using techniques such as psychological intimidation, manipulation, starvation, rape and/or gang rape, beating, confinement, threats of violence toward the victim’s family, forced drug use and the shame from these acts. A large percentage of pimps are also documented gang members, which causes concerns for police agencies in jurisdictions where prostitution is a significant problem as they are also involved in other crimes including narcotics. The use of the Internet for prostitution as well as other changes in the sex industry has resulted in the disintermediation of prostitution, allowing prostitutes to deal with clients directly. This has rendered pimps largely superfluous in many developed nations but pimps do have significant roles in sex trafficking. It must be understood that sex trafficking is not trafficking of a prostitute to another state/area.

Even though the terms pimp and trafficker are used interchangeably, a person who traffics a sex slave inter-country is called trafficker while a person who traffics a sex slave intra-country is called pimp.

The pimps who are trafficking young women and girls on the street have a great marketing tool: the media. You can turn on the TV now and see pimps glamorized in TV shows, music videos, and movies. Young people use “pimp” in everyday conversation: “my ride is pimped out,” “your clothes are pimping.” They do not understand the reality behind the term. Pimps prey on young women and girls by finding their weakness and then exploiting it. It is easier to manipulate children, and by the time children become adults, they are broken down and dependent on a pimp. After the pimp gets into your mind, it’s easy for him to maintain control, much like a domestic abuser. From then now on you have to call him “daddy” and he will punish you if he feels like you have stepped out of line. You are required to bring him $500-$2,000 every night. You are not a woman, you are always a “bitch” or a “ho” and are reminded of that daily. You are part of his “stable.” If you do not want to follow the rules, then he may sell you at anytime to another pimp.

Few women and girls in prostitution are willing to acknowledge that they have or are controlled by a pimp. The pimp has convinced her that he is a boyfriend or someone who cares about and looks after her. Acknowledging that he is a pimp violates the characterization of the relationship that the pimp has worked to create and can be psychologically devastating to the woman or girl to admit what he is really doing to her. Pimps also instruct victims to keep his role a secret because he knows that he is engaging in criminal activity and wants to remain hidden. Also, men who purchase sex like to believe that the woman or girl is acting independently; they don’t want to know that she has a pimp. It interferes with their fantasy of their interaction.

Traffickers/pimps make it their business to understand the psychology of youth and to practice and hone their tactics of manipulation. The trafficker’s goal is to exploit and create vulnerabilities and remove the credibility the minor holds in the eyes of their families, the public, and law enforcement. The trafficker’s ultimate goal is profit. The figure below shows Sex Trafficking Power and Control Wheel.

The researchers identified four stages through which young women and girls are subjected to manipulation and eventual domination by pimps:

1) Ensnaring of vulnerable, socially isolated teenagers;

2) Establishing victim dependency by displays of affection and generosity;

3) Taking control of victims by establishing a sexual relationship and introducing the idea of sex work; and

4) Total dominance of victims sustained by physical coercion.

Researchers identified following characteristics of pimps in a study:

1. Pimps running street workers tended to be men with diverse offending styles.

2. They had long criminal histories and did not necessarily define themselves as pimps. Many of them had started criminal activity in their teens.

3. The majority had pimped juveniles at some time.

4. Pimps routinely used violence, often using or threatening the use of guns. In interviews, they admitted using considerable degree of control over the lives of victims, deciding almost every aspect of their lives and work. In the previous six months, two-thirds were in possession of illegal firearms; three-quarters were dealing drugs; two-thirds had committed one robbery; two-thirds had committed assaults with actual bodily harm, and half had committed assaults with grievous bodily harm.

5. Many pimps were heavily involved in drug dealing, and most had significant drug habits.

6. Drug dependence often substituted for violence as the means of coercing compliance from victims.

7. Even though pimps had extensive contact with the criminal justice system, only a very small proportion of their offending came to police attention.

8. Pimps of off-street prostitution establishments, such as massage parlors or escort services, tended to be women, without significant involvement in other forms of crime.

9. The off-street “managers” relationships with women and girls were contractual rather than coercive.

10. There were pressures on off-street exploiters to avoid working with juveniles and to minimize drug use on their premises.

Once a woman is under the control of a trafficker or pimp, she can be exploited to make a large profit. Pimps can make 5 to 20 times as much from a woman as they paid for her. An International Organization for Migration study of women trafficked into Germany found that the trafficker or pimp requires a payment of US $3,000 to $30,000 from a woman for her travel expenses and her purchase price. Then she must pay for her room and board in the brothel as well as the pimp’s fees, lawyer’s fees, doctor’s fees, and sometimes private living expenses. Even after a woman has paid off her debt, she must turn over 50 to 75 percent of her earnings to pimps. The money from the sale of commercial sex acts enriches pimps and traffickers at the cost of the freedom, health, and well-being of victims. Victims are often compelled to earn money by force, fraud, and coercion. In addition to physical and sexual abuse, psychological control methods include manipulation of emotionally vulnerable teen girls, threats and withholding of identification papers of undocumented immigrants, and the use of debts, drug, and alcohol dependence.

Sex trafficking:

Sex Trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for the purpose of a commercial sex act in which a commercial sex act is induced by force, deception, taking advantage of vulnerability, fraud, or coercion. The elements of force, fraud and coercion are not relevant in cases involving persons under age of 18 years due to the fact that they are minors. Sex trafficking is the exploitation of women and children, either within national borders or across international borders, for the purposes of forced /coerced sex work. It is characterized as a human being that is sexually exploited in exchange for goods or money. Each year, an estimated 800,000 women and children are trafficked across international borders—and unknown numbers are trafficked within countries. The American Trafficking Victims Protection Act (TVPA) makes no mention of force, fraud or coercion even for adults above 18 years – simple trafficking in contrast to severe trafficking where force, fraud and coercion is used but different countries have different laws. The term “commercial sex act” means any sex act on account of which anything of value is given to or received by any person. Furthermore, some victims of sex trafficking may have a notion that they will be involved in the sex industry when they accept the sex trafficker’s offer. However, such pre-knowledge does not mean they are not a victim. Usually they have some concept or idea, but the reality is much worse than what they anticipated. They may have thought they would only have to have sex with 5 men a day but are forced to have sex with 10. They may have thought condoms would be used, but they are coerced to have sex without condoms. Such a person is as much a victim of sex trafficking as someone who did not have any idea they would be involved in the sex trade. So the emphasis on whether a person is knowing or unknowing is irrelevant. By definition, sex trafficking is a type of forced prostitution. Sex trafficking and prostitution are a part of the same continuum of criminal activity, that is, the sexual exploitation of women and girls. Sex trafficking is a form of slavery and involuntary servitude resulting in grave human rights violations.

A world map showing the legislative framework (or lack thereof) in place in different countries to prevent female trafficking:

Force, fraud and coercion are the methods used by traffickers to press victims into lives of servitude and abuse:

1. Force – Rape, beatings, confinement

2. Fraud – False offers of employment, marriage, better life

3. Coercion – Threats, debt-bondage, psychological abuse

Not all sex trafficking victims are coerced under false pretenses. Many women and children are simply stolen- kidnapped off the streets. In many countries, police are paid off by traffickers to ‘look the other way’. This is an effective tactic. Meanwhile, the girls are locked in dark rooms with no windows. They are violated horrendously. Their bodies are used as disposable pleasure for many years. When they are finally released, because their youthfulness is jaded and they have become terribly diseased, they are fully broken. They know no other way of life. They often then turn into street prostitutes.

Several countries rank high as source countries for human trafficking, including Belarus, the Republic of Moldova, the Russian Federation, Ukraine, Albania, Bulgaria, Lithuania, Romania, China, Thailand, and Nigeria (origin countries). Belgium, Germany, Greece, Israel, Italy, Japan, the Netherlands, Thailand, Turkey, and the U.S. are ranked very high as destination countries of trafficked victims. According to the United Nations Office on Drugs and Crime (UNODC) Thailand, China, Nigeria, Albania, Bulgaria, Belarus, Moldova and Ukraine are among the countries that are the greatest sources of trafficked persons. The UNODC further cites Thailand, Japan, Israel, Belgium, the Netherlands, Germany, Italy and the United States as being common destination countries of trafficked women and girls.

Destination western nations and originating countries both are complicit and complacent, and rife with corruption, all of which contribute to the growth of a new criminal industry – the illegal trafficking of women for sex. So says author Victor Malarek, whose riveting book titled “The Natashas – Inside The New Global Sex Trade” has proved conclusively that complicity, complacency, corruption drive global trafficking trade. The author passionately describes the deplorable conditions under which women are forced to work and live. That they are victims and not willing participants remains crystal clear in his mind no matter how many times he hears from government officials or men who avail themselves of such services that “the women knew what they were getting into” or “they do it for the money.” He knows that not a single one of the victims would willingly submit to be “raped by a fat, ugly, doughy pervert”, especially when most of the time it’s the pimp who gets the money, not the woman being used for sex. People find it hard to believe that women could be duped so easily. “They can’t be that stupid” is a phrase the author hears over and over again. Poverty and despair are the main reasons why women fall into the trap of being trafficked. Faced with few prospects for earning a living and feeding their children & abusive husbands, women choose what they perceive to be their only way out. Because of indifferent societies and left with few if any legal alternatives, the women remain stuck with the choices they made, often branded for life.

The United Nations estimates that some 80% of persons trafficked are trafficked for sexual exploitation. They are mostly women and children (UN 2003). An estimated 120,000 women and children are trafficked into Western Europe each year (European Commission, 2001). The US Department of State considers that globally some 600,000 to 800,000 people are trafficked within and across borders annually, of whom some 80% are women & girls and some 50% are minors (US Dept of State, 2005). Some European estimates suggest that, in 1990-1998, more than 253,000 women and girls were trafficked into the sex industry of the then 12 EU countries.

Just as the development of local prostitution is tied up with rural migration towards cities, hundreds of thousands of young women are moving internationally towards the urban areas of Japan, Western Europe, and North America. These rural migrations towards close or distant urban areas show no sign of slowing down (Santos). On the contrary, everything indicates that it is continuing and that traffic in women and children is widespread. The women and children of South and Southeast Asia constitute the most important group: 400,000 persons a year are objects of the aforementioned traffic. Russia and independent states from the ex-USSR constitute the second most important group (175,000 persons a year) followed by Latin America and the Caribbean (about 100,000 persons) and Africa (50,000 persons).The number of prostitutes from the Philippines, Taiwan, Thailand, and Russia installed in Japan is estimated at 150,000 (CATW). About 50,000 Dominicans prostitute themselves abroad, notably in the Netherlands, where they were found to make up 70 per cent of the occupants of 400 Amsterdam sex-shop “windows” (Guéricolas 31). About 500,000 women of Eastern Europe and between 150,000 and 200,000 women of the countries of the ex-USSR prostitute themselves in Western Europe. Of these, it is estimated that 150,000 are in the red-light districts of Germany-a country where 75 per cent of the prostitutes are foreign (Oppermann). About 40 per cent of Zurich’s prostitutes are from a Third World country (Oppermann). About 50,000 foreigners arrive each year in the United States to supply the prostitution networks (O’Neill). Each year, nearly a quarter million women and children of Southeast Asia (Burma, Yunnan province in China, Laos and Cambodia) are bought in Thailand, a transit country, for a price varying between 6,000 and 10,000 U.S. dollars (CATW). In Canada, the intermediaries pay 8,000 dollars for a young Asiatic from the Philippines, Thailand or Malaysia whom they resell for 15,000 dollars to a pimp (CATW). In Western Europe, the current price of a European woman from the former “socialist” countries is between 15,000 and 30,000 $ (CATW). On their arrival in Japan, Thai women have a debt of 25,000 $ (CATW). These bought women have to work for years to pay off “expenses” incurred by the pimps. In countries that have legalized prostitution or where it is tolerated, prostitution has become an important tourist draw.

The picture below shows scale of sex service in Europe:

Official estimates of individuals in sex trafficking worldwide vary. In 2001 the International Organization for Migration estimated 400,000, the Federal Bureau of Investigation estimated 700,000 and UNICEF estimated 1.75 million. In Western Europe alone, the International Organization for Migration estimates that around 500,000 women per year are trafficked from poorer regions in the world. Several factors lead women to look for working possibilities in other countries. In Eastern Europe, women have been the victims of the political and economic changes of the 90s with the dismantlement of the former Soviet Union social security structures and are today highly represented in unemployment statistics. In Netherlands, the Bureau of the Dutch Rapporteur on Trafficking in Human Beings in 2005 estimated that there are from 1,000 to 7,000 trafficking victims a year and most police investigations relate to sex businesses. In Germany, the trafficking of women from Eastern Europe is often organized by people from that same region. German authorities identified 676 sex-trafficking victims in 2008. In Greece, according to NGO estimates in 2008, there may be a total 13,000–14,000 trafficking victims of all types in the country at any given time. Major countries of origin for trafficking victims brought into Greece include Nigeria, Ukraine, Russia, Bulgaria, Albania, Moldova, Romania, and Belarus. In Switzerland, the police estimated in 2006 that there may be between 1,500 and 3,000 victims of all types of human trafficking. One news article states that an estimated 200,000 Nepalese girls have been trafficked to red light areas of India. Nepalese women and girls, especially virgins, are reportedly favored in India because of their fair skin and young looks. One report estimates that every year between 5,000 and 7,000 Nepalese girls are trafficked into the red light districts in Indian cities, and that many of the girls may only be 9 or 10 years old. Eighty percent of North Koreans who escape into China are women. Nine out of 10 of those women become victims of human trafficking, often for sex. If the women complain, they are deported back to North Korea, where they are thrown into gulags or are executed. The trafficking in Persons Report of 2007 from the US Department of State says that sexual slavery exists in the Arab states of the Persian Gulf, where women and children may be trafficked from the post-Soviet states, Eastern Europe, Far East, Africa, South Asia or other parts of the Middle East. In 2001 the United States State Department estimated that 50,000 to 100,000 women and girls are trafficked each year into the United States. The San Francisco Chronicle reported in 2006 that in the 21st century, women mostly from South America, Southeast Asia, and the former Soviet Union, are trafficked into the United States for the purposes of sexual slavery. Sex trafficking in the United States may be present in Asian massage parlors, Mexican cantina bars, residential brothels, or street-based pimp-controlled prostitution. In 2000 the U.S. Congress legislated the Trafficking Victims Protection Act with tougher punishments for sex traffickers and also the creation of the possibility for former sex slaves to obtain a T-1 visa. To obtain the visa women must prove they were enslaved by ‘force, fraud or coercion’. The visa allows former victims of sex trafficking to stay in the United States for 3 years and then apply for a green card.

Sex trafficking is a type of human trafficking involving the recruitment, transportation, transfer, harbor or receipt of persons, by coercive or abusive means for the purpose of sexual exploitation. So sex trafficking is basically human trafficking involved in sexual slavery. Traffickers use psychological and well as physical coercion and bondage, and it defines coercion to include: threats of serious harm to or physical restraint against any person; any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or the abuse or threatened abuse of the legal process. Although not all sex slaves are trafficked, all sex trafficking victims are victims of sexual slavery. Trafficking is a particularly cruel type of slavery because it removes the victim from all that is familiar, renders her completely isolated and alone, often unable to converse in the language of her fellow victims or captors.

One of today’s biggest human rights crises is the international trafficking of women and girls into sex slavery. Human trafficking is the third largest criminal industry in the world, outranked only by arms and drug dealing. The number of people trafficked each year is estimated by most experts to be in the millions. Given its current growth rate, which is fuelled by its high profitability, low investigation rate and low prosecution rate, human trafficking is expected by some to take over drug trafficking as the second largest criminal industry in the world within the next decades.

The figure above shows human trafficking to the United States as an example of trafficking networks. Traffickers acquire their victims primarily from developing countries where poverty is rampant, commonly through some means of force or deception. Victims are typically very young, most ranging in age from eight to 18 years old. Some are as young as four or five years old. A common scenario involves a poor Asian or Eastern European girl who is offered a “better life” as a housemaid, restaurant server or dancer in a wealthy country such as the United States, Great Britain, or Italy. When she arrives at her destination, her passport is taken away, she is physically and sexually abused, and she is forced into prostitution in a country where she neither speaks the language nor has any a friend, relatives or means of support. She is forced to service 8-15 clients a day and does not receive any pay. Rather, the money is used to pay off her “debt” to the trafficker and brothel owners for transportation, food, lodging and so on. After some period of time, she will be resold to another brothel owner, often in another country, and the cycle will continue all over again. She is likely to acquire HIV/AIDS, and to pass it on to her clients and their wives, all around the world. She has a greater chance than most of dying early, and is certain to live a horrible existence in whatever short years she has. Even if she is eventually rescued and repatriated to her country and community, she is likely to be ostracized as a result of her involvement in prostitution.

This sexual exploitation is not dependent on nationality, race or religion. It is also not dependent on economic or social standing. For example, a working man from Cambodia may purchase the use of a child sex slave trafficked from Vietnam for $1. Another Vietnamese girl of the same age will be charged out at $200 – often more if she is still a virgin – to a European businessman in Hong Kong. Both girls will be forced to service countless American and local military men. A South American girl will be trafficked into Canada under an “exotic dancer” visa and forced into prostitution. A desperately poor Romanian child will be used as a sex slave in the lucrative and depraved child pornography business, the reach and growth of which has become unlimited since the advent of the Internet. The one substantial difference is that it is the wealthy countries – through their military, businessmen, expatriates, tourists, and Internet pornography subscribers, all of whom pay significantly more for the use of a sex slave – that keep this criminal industry extremely profitable for traffickers.

Migration patterns of trafficking tend to flow from East to West, but trafficking victims exist everywhere. Women may be trafficked from any country to another country at any given time; many of the poorest and most unstable countries have the highest incidences of trafficking, and trafficking victims share a common bond in extreme poverty where there are no economic alternatives and so women and girls are more vulnerable to being deceived and coerced into sexual service. Higher unemployment and lower job security have undermined women’s economic positions and incomes. A stalled gender wage gap combined with an increase in women’s informal sector and part-time work push women into poorly-paid jobs as well as long-term and often hidden unemployment, leaving women vulnerable to traffickers.

Shocking Sex Trafficking Facts:

1) 1.2 million children are trafficked every year; this is in addition to the millions already held captive by trafficking.

2) Every 2 minutes a child is being prepared for sexual exploitation.

3) The average victim is forced to have sex up to 40 times a day.

4) The average age of a trafficked victim is 14 years old.

5) Approximately 30 million children have lost their childhood through sexual exploitation over the past 30 years.

6) Sex trafficking is an engine of the global AIDS epidemic.

7) People are trafficked from 127 countries to be exploited in 137 countries.

8) Between 14,500 and 17,500 victims are trafficked into the USA each year.

9) The total market value of illicit Sex Trafficking is estimated to be in excess of $32 billion.

10) Trafficking in women is the second largest global organized crime today.

11) Over 25% of victims are trafficked from Southern and Eastern Europe.

12) Tragically, only 1-2 percent of victims are rescued, and only 1 in 100,000 Europeans involved in trafficking are convicted.

13) 30,000 victims of sex trafficking die each year as a result of sexual abuse, disease, torture.

14) A 2003 study in the Netherlands found that a single sex slave could earn her pimp at least $250,000 a year.

Types of Sex Trafficking:

Victims of trafficking are forced into various forms of commercial sexual exploitation including prostitution, pornography, stripping, live-sex shows, mail-order brides, military prostitution and sex tourism. Victims trafficked into prostitution and pornography are usually involved in the most exploitive forms of commercial sex operations. Sex trafficking operations can be found in highly-visible venues such as street prostitution, as well as more underground systems such as closed-brothels that operate out of residential homes. Sex trafficking also takes place in a variety of public and private locations such as massage parlors, spas, strip clubs and other fronts for prostitution. Victims may start off dancing or stripping in clubs and then be coerced into situations of prostitution and pornography.

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Sex trafficking of girls from Nepal into India:

Dr. Govinda Prasad Kusum, then Secretary for Ministry of Home Affairs in Nepal, said that approximately 7,000 to 10,000 girls are being trafficked into India every year. “We have a large number of Nepalese girls in India’s red light areas and controlling traffickers is proving troublesome because we share open borders with India and traffickers have a dozen ways to cross borders without being noticed,” said Kusum at the launch of “the Global Report on Trafficking in Persons”. In Nepal, trafficking has become a highly profitable business, with high profile political connections. Nepali, Bangaldeshi and Pakistani women are trafficked to India, and through India they are trafficked to Eastern Europe and Saudi Arabia. The trafficking of girls from Nepal into India for the purpose of prostitution is probably the busiest ‘slave traffic’ of its kind anywhere in the world. More than 200,000 Nepalese girls are involved in the Indian sex trade. In Nepal child marriage is accepted, and considered the best method to procure girls for prostitution. Many of the girls are barely 9 or 10 years old. The girls are sold by poor parents, tricked into fraudulent marriages, or promised employment in towns only to find themselves in India’s brothels. They’re locked up for days, starved, beaten, and burned with cigarettes until they learn how to service up to 25 clients a day. Some girls go through ‘training’ before being initiated into prostitution, which can include constant exposure to pornographic films, tutorials in how to ‘please’ customers and repeated rapes. Trafficking in women and girls is easy along the 1,740 mile-long open border between India and Nepal. Trafficking in Nepalese women and girls is less risky than smuggling narcotics and electronic equipment into India. Traffickers ferry large groups of girls at a time without the hassle of paperwork or threats of police checks. The procurer-pimp-police network makes the process even smoother. Bought for as little as Rs (Nepalese) 1,000, girls have been known to fetch up to Rs 30,000 in later transactions. Police are paid by brothel owners to ignore the situation. Girls may not leave the brothels until they have repaid their debt, at which time they are sick, with HIV and/or tuberculosis, and often have children of their own.

The picture below shows a rescued Nepalese sex trafficking victim reunited with her father who came searching for her in India.

Sex trafficking and largest democracy India:

Director of Central Bureau of Investigation (CBI) told a seminar on human trafficking that India occupied a “unique position” as what he called a source, transit nation and destination of this trade. India’s home secretary remarked that at least 100 million people were involved in human trafficking in India. The number of trafficked persons is difficult to determine due to the secrecy and clandestine nature of the crime. However, studies and surveys sponsored by the ministry of women and child development estimate that there are about three million prostitutes in the country, of which an estimated 40 percent are children, a CBI statement said. Prostitution in pilgrim towns, exploitation through sex tourism and pedophilia are some of the “alarming trends” that have emerged in recent years in India. Authorities believe 90 percent of human trafficking in India is “intra-country.” As far as inter-country sex trafficking is concerned, Women and children from India are sent to nations of the Middle East daily. India is “becoming a hub” for large scale child prostitution rackets, the Indian Supreme Court said and suggested the setting up of a special investigating agency to tackle the menace. “It’s happening because of abject poverty in the country. This is also because of the very high and large scale unemployment. All our cultural ethos are going down the drain. India is becoming a hub of such activities,” the apex court said while dealing with a PIL filed by an NGO. The brothels of India hold between 100,000 and 160,000 Nepalese women and girls, 35 percent were taken on the false pretext of marriage or a good job. In India, Karnataka, Andhra Pradesh, Maharashtra, and Tamil Nadu are considered “high supply zones” for women in prostitution. Bijapur, Belgaum and Kolhapur are common districts from which women migrate to the big cities, as part of an organized trafficking network. Districts bordering Maharashtra and Karnataka, known as the “devadasi belt,” have trafficking structures operating at various levels. The women here are in prostitution either because their husbands deserted them, or they are trafficked through coercion and deception. Many are devadasi dedicated into prostitution for the goddess Yellamma. In one Karnataka brothel, all 15 girls are devadasi. Sexual slavery and political corruption are leading to an AIDS catastrophe in India. Indian leaders and media are oblivious of the fact that India had indeed become a center of sex trafficking leading to AIDS epidemic. I have yet to see a single discussion on Indian TV about sex slavery in India. The so called ancient civilization has become brothel civilization. In a small town Daman where I live, every weekend women are trafficked into Daman for providing sexual services to the tourists. So sex trafficking is ubiquitous in India.

Older Women:

A recent trafficking case in Russia, in which a woman in her 50s was trafficked to Greece, indicates that a market exists for middle-aged women. Older men are seeking housekeepers, as well as someone for sex acts, and have a preference for older women instead of young women or teens who are seen as too difficult to control. In the U.S., there appears to a market for older Asian women to be used in massage parlors. These women are expected to perform masturbation massage.

Traffickers:

At a global level, the largest number of reported references is to nationals of Asia (comprising several sub-regions) followed by Central and South Eastern Europe.

Figure above shows reported nationality of offenders (% of total sources reporting the profile of the offender).

Who traffics women and girls?

Organized crime is largely responsible for spreading international human trafficking. Although sex trafficking—along with its correlative elements such as kidnapping, rape, physical abuse, and prostitution—is illegal in nearly every country in the world, widespread greed and corruption make it possible for sex trafficking to proliferate. While national and international institutions attempt to regulate and enforce anti-trafficking legislation, local police forces and governments may in fact be participating in the very sex trafficking rings they are charged in preventing. Potential traffickers can include gangs and criminal networks, pimps, small business owners, factory owners, corporations, brothel and massage parlour managers, or employers of domestic servants. Both men and women are involved in trafficking operations, and they all profit from the control, exploitation and misery of others. Human traffickers often use a Sudanese phrase “use a slave to catch slaves,” meaning traffickers send “broken-in girls” to recruit younger girls into the sex trade. Sex traffickers often train girls themselves, raping them and teaching them sex acts.

Traffickers can be international organized crime syndicates or ‘mom and pop’ family-run operations. Traffickers include independent business owners. Many times they are members of the victim’s own ethnic or national community. These predators can include individuals who are prominent in their communities, adult men, including married men who take advantage of girls. Traffickers may include family members. Traffickers use legal businesses including massage parlors and strip clubs as fronts for trafficking.

In approximately 54% of human trafficking cases, the recruiter is a stranger, and in 46% of the cases, the recruiters know the victim. Fifty-two percent of human trafficking recruiters are men, 42% are women, and 6% are both men and women.

As for the traffickers, they are not respecters of international borders, the rule of law, democracy, or multi-lateral treaties guaranteeing universal human rights. They have no regard for the economic status of victims or their level of education. They do not discriminate against their victims based on the color of their skin, their nationality, or their religion. For all those among the innocent, the weak, the desperate, the hungry, the abandoned, and the vulnerable, sexual traffickers are equal opportunity exploiters.

The average age that a pimp/trafficker recruits a girl into prostitution is 12 to 14 years old. They know how to target the girls who are the most vulnerable. Her greatest vulnerability is her age. 12- to 14-year-olds are still naive about the world. So the danger is compounded for girls who have an unstable home life and those who are already victims of sexual abuse. It is not surprising that young children and adolescents are the primary targets of traffickers/ pimps, given their operational methods. Youth have less life experience, fewer coping mechanisms, and smaller social support mechanisms to draw from. Also traffickers like all those seeking to expand a business, respond to the preferences of the market – in this case, the buyers of sexual activities.

Victims of sex trafficking can be women or men, girls or boys, but the majority are women and girls. There are a number of common patterns for luring victims into situations of sex trafficking including:

1. A promise of a good job in another country

2. A false marriage proposal turned into a bondage situation

3. Being sold into the sex trade by parents, husbands, boyfriends

4. Being kidnapped by traffickers

5. Agents who scout for potential victims in source regions, sometimes representing themselves as a potential sponsor or love interest

6. Misleading advertisements promising jobs and opportunity in western nations

As shown in figure below, the victims IOM assisted often were enticed by traffickers’ promise of a job, most believed they would be working in various legitimate professions, and were subjected to physical violence.

Traffickers use various techniques to keep victims enslaved. Some traffickers keep their victims under lock and key. However, the more frequent practice is to use less obvious techniques including:

1. Debt bondage – financial obligations, honor-bound to satisfy debt

2. Isolation from the public – limiting contact with outsiders and making sure that any contact is monitored or superficial in nature

3. Isolation from family members and members of their ethnic and religious community

4. Confiscation of passports, visas and/or identification documents

5. Use or threat of violence toward victims and/or families of victims

6. The threat of shaming victims by exposing circumstances to family

7. Telling victims they will be imprisoned or deported for immigration violations if they contact authorities

8. Control of the victims’ money, e.g., holding their money for “safe-keeping”

The result of such techniques is to instill fear in victims. The victims’ isolation is further exacerbated because many do not speak language of destination country and are from countries where law enforcement is corrupt and feared.

How are women trafficked?

Women and girls are ensnared in sex trafficking in a variety of ways. Some are offered legitimate and legal work in positions such as shop assistants or waitresses. Others are promised education, marriage, and the promise of a better life. Still others are sold into trafficking by friends, neighbors, acquaintances, boyfriends, and sometimes parents. Trafficking victims are often passed among multiple traffickers as they are moved further and further from their home countries. Women often travel through multiple countries before they arrive at their final destination, becoming confused and disoriented along the way. For example, a woman from the Ukraine may be sold to a trafficker in Turkey, who passes her on to a trafficker located in Thailand. Typically, once a woman is in the custody of traffickers, her official papers and passport are confiscated. Victims are told they are in the country of destination illegally, increasing the victims’ dependence on their traffickers. Women are often kept in captivity and are also trapped into debt bondage, meaning they are obligated to pay back large recruitment and transportation fees before they will be released from their captors. Many victims are charged additional fines or fees while being held under bondage, requiring them to work longer periods in order to pay off their fees. Trafficking victims go through several stages of degradation, physical, and psychological torture. They are often deprived of sleep and food, not allowed to move about freely, and endure physical torture. In order to keep women captive, they are told their families and children will be harmed or murdered if the women try to escape or if they tell anyone about their captivity. Because victims rarely understand the culture and language of the country into which they have been trafficked, they experience an additional layer of psychological stress, isolation, and frustration. Often before servicing clients women are forcibly raped by the traffickers in order to initiate the cycle of abuse and degradation. Some women are drugged in order to prevent escape. Once “broken in,” sex traffic victims often service up to 30 men a day and are vulnerable to sexually transmitted diseases, HIV infection, and pregnancy. Sex traffickers use a variety of ways to “condition” their victims, including subjecting them to starvation, rape, gang rape, physical abuse, beating, confinement, threats of violence toward the victim and victim’s family, forced drug use and the threat of shaming their victims by revealing their activities to their family and their families’ friends.

Sex trafficking victims are generally found in dire circumstances and easily targeted by traffickers. Individuals, circumstances, and situations vulnerable to traffickers include homeless individuals, runaway teens, displaced homemakers, refugees, job seekers, tourists, kidnap victims and drug addicts. While it may seem like trafficked people are the most vulnerable and powerless minorities in a region, victims are consistently exploited from any ethnic and social background. The Russian Mafia promises unemployed women a job in the United States. Upon arrival in United States, they take the passport from her, show her photos of her family back home and threaten her family if she runs. She is forced into prostitution with the threat that her children, parents, grandparents, siblings, aunts, uncles and cousins will all be killed if she says no. This is how the organized crime get the cooperation of the women all around the world. They threaten the female’s family. This is how they make the woman compliant and take a professional female who is seeking a job and turn her into a prostitute. Fake job offers are a common way to obtain women in Asia, the Former Soviet Block Nations and Latin America. Female tourists can be targeted as they are far from home and not likely to be missed quickly.

There is no universally accepted definition of trafficking for sexual exploitation. The term encompasses the organized movement of people, usually women, between countries and within countries for sex work with the use of physical coercion, deception and bondage through forced debt. However, the issue becomes contentious when the element of coercion is removed from the definition to incorporate facilitating the willing involvement in prostitution. For example, in the United Kingdom, The Sexual Offenses Act, 2003 incorporated trafficking for sexual exploitation but did not require those committing the offence to use coercion, deception or force, so that it also includes any person who enters the UK to carry out sex work with consent as having been trafficked. In addition, any minor involved in a commercial sex act in the United States while under the age of 18 qualifies as a trafficking victim, even if no movement is involved, under the definition of Severe Forms of Trafficking in Persons, in the U.S. Trafficking Victims Protection Act of 2000.

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What happens while in captivity?

Sex traffickers have to scare their victims into doing what they want. They use a variety of tactics which is called “conditioning” their victims. Such tactics are:

Forced drug and alcohol use

Beatings

Rape

Gang rape

Confinement

Starvation

Threats of violence to the victims and their families

Threatening to tell their families to shame the victims

Threatening deportation to victims who are not legal residents of the country

Profile of men who buy sex (also called johns or customers):

Listen to the story of Amira Birger, a 15-year-old girl who had been forced into the sex trafficking trade. She was raped by a family member when she was 6; a traumatic experience she says conditioned her to accept her miserable fate. In her eight months on the Phoenix streets, Amira Birger serviced four to five men a day, pulling in between $4,000 and $5,000 a week. Some hadn’t reached legal drinking age. Some were pushing 70. Some would take their wedding rings off and lay them on the nightstand while Birger earned her pimp a daily wage. “We worked down the street from the courthouse, and I swear we had judges and lawyers coming in,” Birger says. “Other times, it was painters or construction workers who had saved up their money. But there was no one profile. It was a huge, wide walk of life.”

There is no one profile of men who purchase sex. Men who purchase women are both rich and poor, Eastern and Western. Often they are married and have children, and in some cases as reported in the New York Times, men have sex with trafficked girls instead of abusing their own young children. A study in the United States found that the average age of men at the time they first purchase sex ranged from 9 to 62. A similar Canadian study found that age at time of first purchasing sex ranged from 12 to 57.34 Men who demand purchased sex are not limited to any one race, education level, socioeconomic status or religion. A study of men who purchase sex in Chicago found that 40 percent were African American, 36 percent were white, 14 percent were Latino, 5 percent were Asian/Pacific Islander, and 5 percent were multicultural or “other”. Their education levels ranged from a few years of high school to graduate degrees. The yearly income levels amongst these men ranged from less than $20,000 to more than $140,000. Of these men, 44 percent were not religiously affiliated and 56 percent were—and of these, they were divided between Catholic, Protestant, Muslim, and Jewish. Sixty-two percent of these men had a partner (girlfriend or wife), and 38 percent were unattached. A study of men who purchase sex in London also found that the men are highly varied. In this study, 47 percent of men were white, 11 percent were black or African, 10 percent were Asian, 10 percent were Indian or Pakistani, 4 percent were Eastern European, 4 percent were multicultural, and another 14 percent included Afghan, Australian, Brazilian, Central American, Portuguese, Spanish, Italian, Western European, South African, and African American. Their incomes ranged between less than $32,000 and more than $80,000. Half of these men were politically moderate and the other half were split between right-leaning and left-leaning. Fifty-four percent of these men were in a relationship, and 44 percent were not.These numbers do not necessarily represent exact breakdowns of all men who purchase sex, but they illustrate a critical point: men who purchase sex and thereby create demand for victims are incredibly varied. It is impossible to dismiss any type of man as being innocent of purchasing sex or to claim that any one group of men is solely responsible for purchasing sex. Men of all kinds engage in this practice. One of the things that all of the men who purchase sex share is a belief that the bodies of women and girls are available for their sexual pleasure for a price. And that once the price has been paid, those women and girls will do what the men want. These men can turn a blind eye to the reality of these women & girls and believe the faked smiles and come-ons. Without men, there would be no demand. There would be no supply, either: it would not be profitable for pimps and criminals to stay in this business if platoons of men weren’t prowling side streets in search of purchased sex—male buyers who are willing to close their eyes and shell out $50 or $100 for a few minutes of physical bliss while deepening the misery of countless women and children.
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Do customers insist on sex without condom?

Another study found that buyers came from all ages (15-90) and socio-economic classes. The majority of men were married. The majority of international (82%) and U.S. (58%) women said that men expected them to comply with all their requests. Almost half of the international and U.S. women (47% each) reported that men expected sex without condoms. Fifty percent of the international women, and 73 percent of U.S. women reported that men would pay more for sex without a condom. A significant portion of the international (29%) and U.S. (45%) women said that men became abusive if women tried to insist that they use condoms. Buyers subjected women to physical violence (international women–28%, U.S. women–86%), sexual assault (international women–36%, U.S. women–80%) and other forms threats and violence.

Research on customers (johns): Comparing Sex Buyers with Men Who Don’t Buy Sex:

Ninety-nine percent of the research in this field has been done on prostitutes, and only one percent has been done on johns. A landmark study was done on men who buy sex and compared it with men who don’t buy sex. Men of all ages, races, religions, and backgrounds do it. Rich men do it, and poor men do it, in forms so varied and ubiquitous that they can be summoned at a moment’s notice. No one even knows what proportion of the male population does it; estimates range from 16 percent to 80 percent. Are all study findings true of just sex buyers, or are they true of men in general? How men who buy sex differ from those who don’t buy? Although the two groups share many attitudes about women and sex, they differ in significant ways. One man in the study explained why he likes to buy prostitutes: “You can have a good time with the servitude,” he said. A contrasting view was expressed by another man as the reason he doesn’t buy sex: “You’re supporting a system of degradation,” he said. Overall, the attitudes and habits of sex buyers reveal them as men who dehumanize and commodify women, view them with anger and contempt, lack empathy for their suffering, and relish their own ability to inflict pain and degradation. The study found that sex buyers were more likely to view sex as divorced from personal relationships than non-buyers, and they enjoyed the absence of emotional involvement with prostitutes, whom they saw as commodities. “Prostitution treats women as objects and not … humans,” said one john interviewed for the study. In their interviews, the sex buyers often voiced aggression toward women, and were nearly eight times as likely as non-buyers to say they would rape a woman if they could get away with it. Asked why he bought sex, one man said he liked “to beat women up.” Sex buyers in the study committed more crimes of every kind than non-buyers, and all the crimes associated with violence against women were committed by the johns. Sex buyers in the study used significantly more pornography than non-buyers, and three quarters of them said they received their sex education from pornography, compared with slightly more than half of the non-buyers. Over time, as a result of their prostitution and pornography use, sex buyers reported that their sexual preferences changed and they sought more sadomasochistic and anal sex. Many johns view their payment as giving them unfettered permission to degrade and assault women. “You have to treat a whore like a whore,” one john said. “You can find a whore for any type of need—slapping, choking, aggressive sex beyond what your girlfriend will do”, said another john. Johns prefer to view prostitutes as loving sex and enjoying their customers. “The sex buyers were way off in their estimates of the women’s feelings,” study reports. In reality, the bottom line is that prostituted women are not enjoying sex, and the longer she’s in it, the less she enjoys sex acts—even in her real life, because she has to shut down in order to perform sex acts with 10 strangers a day, and she can’t turn it back on. What happens is called somatic dissociation; this also happens to incest survivors and people who are tortured.

Sex trafficking industry:

Trafficking and exploitation of women and children for the sex trade can be analyzed as money making criminal businesses. It is known that trafficking is a low risk, high profit criminal enterprise. When traffickers are caught, the penalties are relatively low compared to the amount of profit made and the harm done to victims. Organized criminals are involved in this illicit enterprise because it is low risk and enormously profitable. Our goal is to increase the risk and eliminate the profitability.

The sex industry has the capacity to include all forms of adult and child sexual exploitation in what it offers to the buyer; it does not discriminate against anyone including children of either gender, the young woman, the adult woman, the prostituted woman or child, the trafficked woman or child. The industry rejects no act of exploitation demanded by customers. It ensures that the needs of the consumers are always met. The sex industry is not concerned about acts of violence perpetrated against the victims, or the health of the victims. The pro-legalization lobby bases its arguments on a series of false distinctions that are not reflected in the reality of the lives of women and children in the sex industry. It promotes the ideas that: prostitution and trafficking are not connected; we must distinguish between forced and free prostitution; women and girls can only be protected by legal indoor prostitution; adult and child prostitution are distinct; those opposing legalization are denying women agency; there are “soft and harmless” sides to the pornography industry and so on.

The cost of doing business is a consideration for traffickers. They make decisions on where to traffic victims and set up business based on profit margins, as well as risk of arrest and prosecution. According to Russian police, because of the high cost of visas, documents and travel, it is not profitable to send victims to the US. Consequently, traffickers more often send victims to other countries. Intelligence gathered by Swedish police indicates that since the new anti-prostitution law came into effect in 1999, it is more difficult and risky to operate in Sweden. Therefore, the traffickers and pimps take victims to other markets where the costs and the risks are lower.

Sex trafficking can be extremely lucrative, especially in areas where education and employment opportunities may be limited. According to the United Nations Office on Drugs and Crime (UNODC), the greatest numbers of traffickers are from Asia, followed by Central, Southeastern, and Western Europe. Crime groups that are involved in the sex trafficking of women and girls often are also involved in the transnational trafficking of guns and drugs, and frequently use violence in order to carry out their activities. Victims of human trafficking suffer devastating physical and psychological harm. However, due to language barriers, lack of knowledge about available services, and the frequency with which traffickers move victims, human trafficking victims and their perpetrators are difficult to catch. Many times, if a sex slave is arrested, she is imprisoned while her trafficker is able to buy his way out of trouble. Human trafficking is one of the fastest growing criminal enterprises because it holds relatively low risk with high profit potential. Criminal organizations are increasingly attracted to human trafficking because, unlike drugs, humans can be sold repeatedly. Human trafficking affects an estimated 2.5 million victims around the world yearly, more than half of whom are women and girls. Trafficking is driven by profit and may involve sexual exploitation or forced labor. Globally, trafficked workers generate US$ 32 billion each year. Yet in spite of the large scale of trafficking, most victims are never identified and few offenders – less than 1 in 10 – are ever convicted.

The exploiters are in business to make money. Manipulating and coercing a woman or girl into prostitution and other forms of sexual exploitation, such as production of pornography and stripping is very profitable. According to Interpol depending on the market, a woman can bring in from $75,000 to $250,000 per year. The higher the standard of living in the destination country, the more money that can be made from each victim. Although traffickers and pimps can make more money in wealthier countries, buying sex is not less frequent in poorer countries. Poverty has never prevented men from frequenting prostitutes, whose fees are geared to the purchasing power of their customers. A few estimates of the amount of money generated by the sex industry reveals how much profit there is in operating businesses that are often based on the exploitation of victims of trafficking.

Trafficking is a lucrative industry. It has been identified as the fastest growing criminal industry in the world. It is second only to drug trafficking as the most profitable illegal industry in the world. In 2005, Patrick Belser of ILO estimated a global annual profit of $31.6 billion. In 2008, the United Nations estimated nearly 2.5 million people from 127 different countries are being trafficked into 137 countries around the world. Sex tourism is a major economic factor in many of these regions, and inside of certain circles particular areas may be well-known as sex-tourism destinations. In one report, the International Labor Organization estimated that between 2-14% of the gross domestic product of Indonesia, Colombia, Malaysia, the Philippines, and Thailand may be derived from sex tourism. According to the U.N., trafficking is a $32 billion annual industry that traps about 2.5 million people around the world at any given time. The average age of a young girl first being trafficked is 12-14 years old. Sex trafficking is a lucrative business and a trafficker can earn up to 20 times what he or she paid for a young girl. Ludwig “Tarzan” Fainberg, a convicted trafficker said, “You can buy a woman for $10,000 and make your money back in a week if she is pretty and young. Then everything else is profit”. A human trafficker can earn 20 times what he or she paid for a girl. Provided the girl was not physically brutalized to the point of ruining her beauty, the pimp could sell her again for a greater price because he had trained her and broken her spirit, which saves future buyers the hassle. A 2003 study in the Netherlands found that, on average, a single sex slave earned her pimp at least $250,000 a year. Another study found that, on average, a good looking sex slave purchased for $10,000 from east European market could end up making her owner $160,000 in profits before she dies or runs away. However, a child in Vietnam can be bought for as little as $400.

In the last 30 years, the rapidly growing sex trade has been massively “industrialized” worldwide (Barry; Jeffreys). This process of industrialization, in both its legal and its illegal forms, generates profits amounting to billions of dollars. It has created a market of sexual exchanges in which millions of women and children have been converted into sexual commodities. This sex market has been generated through the massive deployment of prostitution, one of the effects of the presence of military forces engaged in wars and/or territorial occupation (Strudevant and Stolzfus) in particular in the emerging economies, the unprecedented expansion of the tourist industry (Truong), the growth and normalization of pornography (Poulin 2000), and the internationalization of arranged marriages (Hughes).

The sex industry, previously considered marginal, has come to occupy a strategic and central position in the development of international capitalism. For this reason it is increasingly taking on the guise of an ordinary sector of the economy. This particular aspect of globalization involves an entire range of issues crucial to understanding the world we live in. These include such processes as economic exploitation, sexual oppression, capital accumulation, international migration, and unequal development and such related conditions as racism and poverty.

The industrialization of the sex trade has involved the mass production of sexual goods and services structured around a regional and international division of labor. These “goods” are human beings who sell sexual services. The international market in these “goods” simultaneously encompasses local and regional levels, making its economic imperatives impossible to avoid. Prostitution and related sexual industries – bars, dancing clubs, massage parlors, pornography producers etc. – depend on a massive subterranean economy controlled by pimps connected to organized crime. At the same time, businesses such as international hotel chains, airline companies, and the tourist industry benefit greatly from the sex industry. In Thailand, trafficking is a 500 billion Bahts annual business (equivalent to approximately 124 million U.S. dollars), which represents a value equal to around 60 per cent of the government budget (CATW). In 1998, the International Labor Organization (ILO) estimated that prostitution represented between two and 14 per cent of the economic activities of Thailand, Indonesia, Malaysia, and Philippines (Jeffreys). According to a study conducted by Ryan Bishop and Lilian Robinson, the tourist industry brings four billion dollars a year to Thailand. It is not without reason, then, that in 1987 the Thai government promoted sexual tourism through advertising. “The one fruit of Thailand more delicious than durian (a local fruit) is its young women” (Hechler).

The industrialization of the sex trade and its globalization are fundamental factors that make contemporary prostitution qualitatively different from the prostitution of yesterday. “Consumers” in the economic North now have access to “exotic” and young, very young bodies worldwide, notably in Brazil, Cuba, Russia, Kenya, Sri Lanka, Philippines, Vietnam, Nicaragua, and, given the trafficking of children, in their own countries. The sex industry is diversified, sophisticated, and specialized: it can meet all types of demands. Another factor, which confers a qualitatively different character on the current sex trade, is the fact that prostitution has become a development strategy for some countries. Under obligations of debt repayment, numerous Asian, Latin American, and African States were encouraged by international organizations such as the International Monetary Fund (IMF) and the World Bank (WB) to develop their tourism and entertainment industries. In each case, the development of these sectors inspired the development of the sex trade (Hechler). In certain cases, as in Nepal, women and children were put directly on regional or international markets (notably in India and in Hong-Kong) without the country experiencing a significant expansion of local prostitution. In other cases, as in Thailand, local, regional, and international markets developed simultaneously (Barry). We can see that, in every case, the “goods” in this market move transcontinentaly and transnationally from regions with weak concentrations of capital toward regions with stronger concentrations. For example, over ten years, 200,000 Bangladeshi women and girls were the object of trafficking to Pakistan (CATW), and we find that between 20,000 to 30,000 Thai prostitutes are from Burma (CATW). A good part of the migratory stream makes its way towards industrialized countries. Foreign women in these Asian countries are generally at the bottom of the prostitution hierarchy, are socially and culturally isolated, and work in the worst possible conditions.

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In 1998, the International Labor Organization (ILO) released a report entitled The Sex Sector: The Economic and Social Bases of Prostitution in Southeast Asia. Based on research of the sex industries in Malaysia, Indonesia, Thailand, and the Philippines, the ILO gave an overall favorable review of the business of sex: The sex sector is a significant source of foreign exchange earnings, with links between the growth of prostitution as a highly structures transnational business and the expansion of the tourist industry in these countries, as well as labor exports from these countries. The ILO report called for prostitution and sex industries to be officially recognized as a legitimate economic sector because they are already “integrated into the economic, social and political life” of countries and “contribute in no small measure to employment, national income, and economic growth.”

State sex economy:

The State facilitates and regulates on behalf of the client and operates as a facilitator / pimp in ensuring the supply is continued under the guise of protecting the rights and health and safety of the victims. The State profits from the industry. Legal and illegal collusion of State and State officials continues. The State cannot be ‘neutral’ in this matter. If it legalizes and regulates prostitution, it promotes prostitution and protects the consumer not the victims. The State as regulator does not concern itself with the health and safety of the women in prostitution because the reality of women’s exploitation has disappeared and is replaced by the concept of “choice” and “sex work”.

Kidnapping, rape, and violence continue to act as midwives of this industry. They are fundamental not only for the development of markets, but also for the “manufacturing” of these “goods,” as they contribute to making them “functional” for an industry that requires a constant supply of bodies. Research has shown that between 75 and 80 per cent of prostitutes were sexually abused in their childhood (Satterfield; Chaleil). More than 90 per cent of prostitutes are controlled by a pimp (Silbert and Pines 1982 ; Barry). A study of street prostitutes in England established that 87 per cent had been victims of violence during the last 12 months and 43 per cent suffered from grave physical consequences of abuse (Raymond). An American study showed that 78 per cent of prostitutes had been victims of rape by pimps and customers, on average 49 times a year ; 49 per cent had been victims of removal and transported from one state to another and 27 per cent had been mutilated (Raymond). The average age of entrance into prostitution in the United States is 14 years (Silbert and Pines 1981; Giobbe).

The Liberalization of the Sex Industry:

In 1995 during the United Nation’s Fourth World Women’s Congress in Beijing, the principle of “forced” prostitution appeared (UN). This was the first time the term “forced prostitution” was used in a UN document. This created a special (presumed minority) category of prostitution that could be opposed without opposing the sex industry as such. Constraint/force was identified as the problem rather than the sex trade itself. The way was opened for the normalization and legalization of the industry. In 1997 at the Hague Ministerial Conference on Private International Law, when the European ministers attempted to draw up guidelines harmonizing the European Union’s fight against trafficking for the purposes of sexual exploitation, their definition of trafficked women included only those women who were being trafficked against their will. In 1998, the International Labor Organization (ILO) called for the economic recognition of the sex industry on the grounds that prostitutes would then benefit from workers’ rights and protections and improved working conditions that it presumed would follow. This is the first time in an international text that sex work is presented as simply a job. All these statements and agreements tend to undermine the struggle against the growing sex industry and the system of prostitution which is at its heart, for they shift opposition from the system itself, to the use of force/constraint within the system. They aim to protect only women who have not agreed to their exploitation and can prove this placing the burden of proof on already vulnerable women.

Over 30 years, we have seen an extremely profitable “sexualization” of many societies based on social domination. We have witnessed the industrialization of prostitution, of the traffic in women and children, of pornography, and of sexual tourism. This once marginal market is an increasingly central aspect of current capitalist globalization. Sex multinationals have become independent economic forces (Barry) quoted on the stock exchange. Sexual exploitation is more and more considered to be an entertainment industry (Oppermann), and prostitution a legitimate job (Kempadoo ; Dorais). The increasing size and centrality of the global sex industry helps explain why so many groups and agencies are adopting normalizing regulatory approaches in their attempts to address its harms. However, this strategy is deeply flawed. The rapidly expanding international sex market exploits above all women and children, especially members of marginal and minority groups in the Third World and in the former “socialist” countries. This “leisure industry” is based on the systematic violation of human rights, for it requires a market in commodified human beings and the complicity of pimps and clients who are prepared to buy and sell women and children. Resisting or struggling against the commodification of women and children in the sex industry becomes a central element in the struggle against capitalist globalization. Anything less is complicity.

Humankind is witnessing the industrialization of prostitution, trafficking in women and children, pornography and sex tourism. The various sectors of the sex industry are flourishing; they are organized and managed by networks of pimps and organized crime. The liberalization of the laws governing prostitution in some countries has allowed the pimps involved in organized crime to acquire, emerging from the underground, the status of entrepreneurs and respected business partners. The criminal markets are naturally integrated into the legal markets where they are able to launder money with complete impunity. They now play a major role in the world economy. The United Nations Development Program (UNDP) estimates that gross criminal product makes up 15% of world trade. The sex markets account for a sizeable share of this. It is estimated that the profits from trafficking women for the purpose of prostitution alone now generate more money than trafficking in firearms or drugs. The sex trade industry increasingly regarded as an entertainment industry and prostitution as “legitimate work”.

My conscience burns:

So in a nutshell, sexual exploitation of women and girls have created a large industry which contributes to economy of many developing nations and which has blessing of various governments, ILO, world bank, international monetary fund, all in the name of globalization of sex industry and accepting sex industry as legitimate economic sector with pimps and traffickers as entrepreneurs and sex victims as commodities. I hold my head in shame as I write this article. I wish I never came to the world where mothers, sisters and daughters are sold forcibly in market to rent their private parts to be abused daily by many customers in the name of supporting nation’s economy. In my view, pimps and traffickers must be given death penalty after due process of law. I really don’t care whether you agree with me or not.

Liberalization of Markets for Commercial Sex Acts and Sexually Explicit Performances:

Increasingly, the various markets for commercial sex acts and sexually explicit performances are more openly advertised. Euphemisms and coded terms are used to openly advertise illegal activity. This has the effect of normalizing the acts and increasing the demand for them among men. As these commercial sex acts and performances become visible, they become more accepted. In Las Vegas, there are 120 pages of advertisements for sexual services under the heading of “entertainment services” in the yellow pages phone book. Even some mainstream newspapers accept advertisements from escort services, massage parlors, and “spas.” With the proliferation of public advertising, people are less likely to suspect that women and girls are being coerced into the activity. In the U.S., two women trafficked from Asia to the Washington, DC area were forced into prostitution in a brothel that advertised in a local newspaper. Exploiters have been allowed to openly advertise illegal activity as long as they use euphemisms for prostitution. As commercial sexual activity is more openly advertised and laws against illegal activity are not enforced, the standards become unclear. A report on strip clubs in Canada concluded that: “There is no clear idea in Canada between judges, police officers, politicians, strip-club owners, strippers and patrons about what is and is not illegal…” The sex industry has become so liberal that the question of legalizing prostitution in Toronto may already be moot. In this kind of environment, the trafficking of women and girls is likely increase and to escape everyone’s attention.

Markets for Virgins and Young Girls:

In some regions of the world, particularly in Asia, there is a market for virgins or young girls. Virgins are an elite commodity sought by high ranking or wealthy individuals who can afford to buy a rare human commodity that is forever changed after the man is finished with her. In Cambodia, a virgin is considered the most expensive commodity. In the late 1990s, the average price for a virgin girl was US$300 to $700.68 – Being sold as a virgin is often a girl’s entry into prostitution. She may be resold as a virgin or girl with little experience a few times, but then her value falls and she joins the other thousands of girls in prostitution. In some cultures the beliefs that having sex with a young girl will cure men of sexually transmitted diseases or restore youth creates a demand for young women or girls. Men’s fear of contracting HIV also creates a market for younger women or girls because they think a younger victim is less likely to be already infected with HIV.

Root causes of sex trafficking:

As discussed earlier, sex trafficking has become part of sex industry or sex business, and as per norms of any business, the price is fixed as per demand and supply.

Analyzed as a market, human trafficking includes both supply and demand forces. On the supply side, poverty, corruption, lack of education, and the eternal human yearning for improving one’s life make people vulnerable to the lures of trafficking. We are, and must continue, making significant efforts to address these “push” factors. At the same time, we cannot ignore the demand side of the equation. Market demand – especially from male sex buyers – creates a strong profit incentive for traffickers to entrap more victims, fueling the growth of trafficking in persons. Demand is at the root of sex trafficking; to eradicate sex trafficking, demand must first be eradicated. This is because sex trafficking, prostitution and commercial sexual exploitation follow the laws of economics. Without demand for purchased sex, there would be no need for supply (women and girls) and sex trafficking would diminish rapidly. Demand fuels both domestic and international trafficking.

Demand for sex trafficking:

The transnational sex trafficking of women and children is based on a balance between the supply of victims from sending countries and the demand for victims in receiving countries. Sending countries are those from which victims can be relatively easily recruited, usually with false promises of jobs. Receiving or destination countries are those with sex industries that create the demand for victims. Where prostitution is flourishing, pimps cannot recruit enough local women to fill up the brothels, so they have to bring in victims from other places. Until recently, the supply side of trafficking and the conditions in sending countries have received most of the attention of researchers, NGOs, and policy makers, and little attention was paid to the demand side of trafficking. The crucial factor in determining where trafficking will occur is the presence and activity of traffickers, pimps, and collaborating officials running criminal operations. Poverty, unemployment, and lack of opportunities are compelling factors that facilitate the ease with which traffickers recruit women, but they are not the sole cause of trafficking. Many regions of the world are poor and chaotic, but not every region becomes a center for the recruitment or exploitation of women and children. Trafficking occurs because criminals take advantage of poverty, unemployment, and a desire for better opportunities. To date, discussion of the “demand side” of sex trafficking has focused on the men who purchase sex acts. This report will expand the conceptualization of “the demand” to include two additional components: the exploiters – the traffickers and pimps – and the state. The purpose is to bring a better understanding to the factors that lead to the exploitation and sexual enslavement of women and children around the world. A focus on the demand side of sex trafficking means making men personally responsible and accountable for their behavior that contributes to the sex trade. An expansion of the conceptualization of the demand for victims of sex trafficking calls for accountability from governments and law enforcement agencies to suppress the markets in which women and children are bought and sold for sex acts and curtail the means by which traffickers and pimps recruit, transport, and exploit women and children . Although trafficking is usually associated with poverty, it is often the wealthier countries that create the demand for victims for their sex industries. To fully understand and combat sex trafficking, it is important to identify what is meant by “the demand” and to define and characterize each component so that policies and laws can be created to address it. Demand fuels the purchase of human beings for sex. Demand is comprised of a culture that tolerates or promotes sexual exploitation; men who buy commercial sex; exploiters who make up the sex industry; and states that are complicit in providing safe haven for pimps and traffickers either as source or destination countries. There are four components that make-up the demand:

1) The men who buy commercial sex acts,

2) The exploiters who make up the sex industry,

3) The states that are destination countries, and

4) The culture that tolerates or promotes sexual exploitation.

1. The Men (vide supra):

Typically, when prostitution and sex trafficking are discussed, the focus is on the women and children victims. The men who purchase the sex acts are usually faceless and nameless. The men, the buyers of commercial sex acts, are the ultimate consumers of trafficked and prostituted women and children. They use them for entertainment, sexual gratification, and acts of violence. Research on men who purchase sex acts has found that many of the assumptions we make about them are myths. Seldom are the men lonely or have sexually unsatisfying relationships. In fact, men who purchase sex acts are more likely to have more sexual partners than those who do not purchase sex acts. They often report that they are satisfied with their wives or partners. They say that they are searching for more – sex acts that their wives will not do or the excitement that comes with the hunt for a woman they can buy for a short time. They are seeking sex without relationship responsibilities. Men who purchase sex acts do not respect women, nor do they want to respect women. They are seeking control and sex in contexts in which they are not required to be polite or nice, and where they can humiliate, degrade, and hurt the woman or child, if they want.

2. The Exploiters (vide supra):

The exploiters, including traffickers, pimps, and brothel owners make-up what is known as the sex industry. Traffickers and organized crime groups are the perpetrators that have received most of the attention in discussions about the sex trafficking. They operate the business of sexual exploitation. They make money from the sale of sex as a commodity. The exploiters include individual perpetrators, organized crime networks, and corrupt officials. Secondary profiteers include hotels, restaurants, taxi services, and other businesses that provide support services to the sex industry.

3. The State:

By tolerating or legalizing prostitution, the state, at least passively, is contributing to the demand for victims. The more states regulate prostitution and derive tax revenue from it, the more actively they become part of the demand for victims. If we consider that the demand is the driving force of trafficking, it is important to analyze the destination countries’ laws and policies. Officials in destination countries do not want to admit responsibility for the problem of sex trafficking or be held accountable for creating the demand for victims. In destination countries, strategies are often devised to protect the sex industries that generate millions, even billions, of dollars per year for the economy. When prostitution is legal, governments expect to collect tax revenue. Where prostitution is illegal, criminals, organized crime groups and corrupt officials profit. In the destination countries, exploiters exert pressure on the lawmakers and officials to create conditions that allow them to operate. They use power and influence to shape laws and policies that maintain the flow of women to their sex industries. They do this through the normalization of prostitution.

4. The Culture:

The culture, particular mass media, is playing a large role in normalizing prostitution by portraying prostitution as glamorous, empowering, or a fast, easy way to make money. The Internet and other types of new information and communications technologies are increasing the global sexual exploitation of women and children. Sex industry sites on the Internet are popular and highly profitable. The growth and expansion of the sex industry is closely intertwined with new technologies. Although trafficking for prostitution is widely recognized, trafficking of women and children for the production of pornography receives less attention. Increasingly, the pornographers are traveling to poor countries where they can abuse and exploit women and children with fewer risks. They use new information technologies to transmit the live images around the world.

Male demand for a supply of women and children is the root cause of prostitution and trafficking. Gender inequality, globalization, poverty, racism, migration and the collapse of women’s economic stability are global factors, which create the conditions in which women are driven into the sex industry. The majority of trafficked persons are women and girls, in particular from developing countries and countries with economies in transition. Multiple forms of discrimination and conditions of disadvantage contribute to the vulnerability of women and girls driven into prostitution. Prostitution and the sex industry promote the myth that male sexuality must be satisfied by a supply of women and children who can be bought. This demands the creation of a group of women who are legitimate targets for rape and sexual exploitation. Male abusers can act with impunity because they know that women in prostitution will not be believed or taken seriously by the criminal justice system.

One overriding factor in the proliferation of sex trafficking is the fundamental belief that the women and girls are expendable. In societies where women and girls are undervalued or not valued at all in comparison to men, women are at greater risk for being abused, trafficked, and coerced into sex slavery. If women experience improved economic and social status, a large part of trafficking would be eradicated.

One reason for the proliferation of sex trafficking is that in many parts of the world there is little or no stigma attached to purchasing sexual favors for money, and prostitution is considered a victimless crime. Because women and girls are culturally and socially devalued in so many societies, there is little conflict involved with the purchasing of women and girls for prostitution. Further, few realize the explicit connection between the commercial sex trade, the trafficking of women and girls, and the slave trade. In western society in particular, there is a commonly held perception that women enter into the commercial sex trade by choice. However, for the majority of women in the sex trade, and specifically in the case of trafficked women and girls who are coerced or forced into servitude, this is simply not true.

In addition, the sex tourism business—that is the practice of traveling or vacationing for the specific purpose of having sex – is a billion dollar industry that encourages the sexual exploitation of women and girls. Many sex tours explicitly feature young girls because the tours are marketed specifically to pedophiles who prey on young children and to men who believe that having sex with virgins or young girls will cure sexually transmitted diseases (STDs). Often, these men spread HIV and other STDs to their young victims and create localized disease epidemics.

We need to urge all governments, NGOs, and faith communities to focus on reducing the demand for victims of sex trafficking and prostitution. All the components of the demand need to be penalized – the men who purchase sex acts, the traffickers, the pimps, and others who profit, states that fund deceptive messages and act as pimp, and the culture that lies about the nature of prostitution.

Gender inequality vis-à-vis sex trafficking;

Gender inequality is inherent in the promotion and normalization of prostitution. Enshrined within state legislation, men’s right to buy women is a direct contradiction to a society based on gender equality. Promoting the idea that some women must be available for sale to satisfy men’s sexual needs is to create a group of women who are excluded from the protection afforded under national and international human rights law. Prostitution and trafficking promotes sexism and racism as men are encouraged to see women from poorer foreign countries as less, as “other” and as legitimate targets for exploitation. Maiti Nepal foundation has rescued 12,000 Nepali girls and young women from sex trafficking, many of them were sold across the border to brothels in India. The stories I heard were chilling; trafficked girls were forced to service as many as 35 men a day. Girls as young as 13 were living with full-blown AIDS. Those who resisted were tortured and punished. However, poverty was the lowest common denominator in this equation. But the real push factor to the sex trafficking trade was gender inequality. Girls continue to be uneducated in the villages of Nepal, and sexual exploitation persists as men try to exert their power over these impoverished, imprisoned girls. I realized that the problem was not about rich versus poor, or about developed versus developing countries. The real issue was global: How women are continually treated as second rate. Sex trafficking may not be a problem in your part of the world, but gender inequality persists everywhere.

Corruption and sex trafficking:

Corruption is increasingly cited as a key reason for why trafficking continues and traffickers remain free. Corruption both facilitates trafficking and feeds the flow of people by destabilizing democracies, weakening a country’s rule of law and stalling a nation’s development. At the same time, trafficking, which can involve global or regional networks, contributes to a country’s corruption. To function, trafficking relies on pay-offs to police, judges and ministers at all levels. Broader attention needs to be paid to this nexus between corruption and human trafficking.

Corruption plays a role in every stage of the human trafficking process right from recruitment, transport and exploitation. Each phase is vulnerable to corruption and enables victimization. Many experts indicate that if it were not for corruption, human trafficking would not have expanded so rapidly in the wake of globalization. Corruption allows the trafficking process to remain protected from prosecution and facilitates the victimization of innocent people. Corruption assists the victim’s movements within a country and across borders. When trafficking is discovered, corruption results in laws and judicial processes being disregarded. Corruption undoes institutional safeguards, rooted in basic human rights and other international norms, which should legally protect the victim. Corruption also helps criminals and their accomplices to hide the profits generated by human trafficking.

In recent decades, the growth of public sector corruption has correlated closely with the rise in human trafficking. Numerous countries that are ranked poorly on Transparency International’s Corruption Perceptions Index also tend to be among the largest source countries for human trafficking victims, including Indonesia, Thailand, Nigeria, the Philippines and Pakistan. Strong correlations have been found between a country’s tolerance towards trafficking (both within and across its borders) and its own level of public sector corruption. Why India has become a hub of child prostitution? Besides gender inequality, it is the widespread corruption that is responsible for ancient civilization to become uncivilized.

Corruption of government officials and police is necessary for trafficking and exploitation of large numbers of women and children. In sending countries, large-scale operations require the collaboration of officials to obtain travel documents and facilitate the exit of women from the country. In destination countries, corruption is an enabler for prostitution and trafficking. The operation of brothels requires the collaboration of officials and police, who must be willing to ignore or work with pimps and traffickers. Prostitution operations depend on attracting men. Pimps and brothel owners have to advertise to men that women and children are available for commercial sex acts. Officials have to ignore this blatant advertising. I believe that only by going to the root causes, which are corruption and the demand in destination countries, will we end the trafficking of women and children.

Actors that have roles in victimizing sex trafficked person:

Some experts have argued that a trafficked person suffers four forms of victimization on the part of different actors – each of which is facilitated by corruption. Victimization can occur by:

1. Corrupt officials:

These individuals may lead trafficking networks, use trafficked prostitutes, or employ cheap domestic help who have been trafficked;

2. Private or individual groups:

These groups include criminals, their families, friends and extended networks;

3. The media:

While the media plays an important role in society, practices of showing trafficked persons without protecting their identities leads to their further exploitation. In contrast, some media outlets may obscure stories about trafficking, due to connections with the networks involved.

4. States and international organizations:

When officials and staff in these bodies do not behave with ethics and integrity, they can lead to distorted actions. This can include providing support to corrupt officials, treating victims as criminals, and not adequately educating their staff and officers about how to handle trafficking victims.

In looking at how victimization occurs by these different actors, the role and roots of corruption become clearer. Drawing on this knowledge is essential if policies are to effectively target trafficking and corruption simultaneously.

Poverty and sex trafficking:

There is evidence to suggest that incidence of human trafficking high in poverty-stricken areas. It also implies, on some level, that poverty can be equated with a lack of virtue or a loss of humanity. It is sad but true that poor man’s good looking wife is hunted by rich man for sexual exploitation. Often, trafficked women are sold for paltry sum into slavery by their parents, husbands or close family members. It’s an economics decision. These are often the poorest people in the country, living without basic services like electricity, clean water and certainly no education for young girls. The family’s poor, and they can’t afford to keep raising a girl. Maybe they have a large debt to pay off. They sell their daughter to pay off the debt, or maybe a recruiter comes and promises a job in a big city. Maybe the family knows this means prostitution, maybe they don’t. Maybe they think that their daughter will actually be better off. The point is, when a girl comes from a very poor family, she’s at a high risk of being trafficked. It’s just too easy for recruiters to convince, or bribe, or blackmail, or outright kidnap her and funnel her into the sex trade. However, blaming poverty alone for human trafficking is disheartening; it’s also misleading and inaccurate. There may be a correlation between the two phenomena, and poverty almost certainly increases an individual’s vulnerability to trafficking, but so many other factors come into play too. For example, the approach taken by law enforcement authorities to the issue; the legislative measures taken by national governments; global gender inequalities; the level of access to education; falling in love with the wrong guy… Most of these things can be shaped and influenced, and it’s up to us to do so. Many parents in the countryside of Africa, Asia and South America will sell one of their children to traffickers so that they can purchase food to feed their other children. They [unnecessarily] sacrifice one for the sake of many. Being aware of this, human traffickers flock to poverty-stricken areas and exploit the poor for their own malicious benefit. Unfortunately, it’s a story repeated all throughout the world in some of the most poverty-stricken areas. If 26% of the world’s population (7 billion) still lives in extreme poverty, that means that 1.8 billion of the world’s poor are at high risk for human trafficking. Poverty is a root cause of international human trafficking, according to analysis conducted by the Institute for Trafficked, Exploited & Missing Persons (ITEMP).

Contributing factors:
One major element fueling human trafficking is pornography (vide infra). It is like a drug fueling sexual addiction and it is never satisfied. The porn high wears off, then demands a stronger high, then yet a stronger high – a process which often leads to acting out the fantasies. Other factors that contribute to human trafficking include illegal immigration, terrorist activity, gang activity and Internet abuse.

Are women/girls of ethnic/racial minorities more vulnerable to sex trafficking?

Any political economic analysis of prostitution and trafficking in women and children must take into account structural discrimination, uneven development, and the hierarchical relationships between imperialist and dependent countries, and between men and women. In recent years under the impact of structural adjustment and economic liberalization policies in numerous countries of the Third World, as well as in the ex-USSR and Eastern Europe, women and children have become “new raw resources” within the framework of national and international business development. Capitalist globalization is more and more characterized by a feminization of migration (Santos). Women of ethnic minorities and other relatively powerless groups are particularly exploited. So, the internal traffic of Thai females consists mostly of 12-16 year olds from hill tribes of the North and the Northeast. In Taiwan, 40 per cent of young prostitutes in the main red light district are aboriginal girls (Barry 139). At the world level, the customers of the North abuse women of the South and of the East as well as local women from disadvantaged groups. From an economic point of view, these “goods” are doubly valuable because bodies are both a good and a service. More precisely, we have seen a commodification not only of the body, but also of women and children as human beings. This has led many to see this trafficking in women and children as a form of slavery (CATW).

Factors Promoting Sex Trafficking:

Many factors are implicated in the rise of sex trafficking worldwide. Among the more influential are:

1. Gender-based social and economic inequality in all areas of the globe (United Nations, 1995), assuring a supply of women, especially from developing and new independent states (NIS) in Eastern Europe.

2. Male demand for the sex of prostitution and related sexual entertainment (Barry, 1995; Thanh-Dam Truong, 1990; Bishop and Robinson, 1998: 67).

3.Macro-economic policies, promoted by international lending organizations that mandate “structural adjustments” in many developing regions of the world, pushing certain countries (e.g. the Philippines) to export women for labor, making them vulnerable to trafficking; or to develop economies based on tourism (e.g. Thailand), including sex tourism (Daguno, 1998; Bishop and Robinson, 1998).

4. Expansion of transnational sex industries and increasingly sophisticated predatory recruitment techniques and networks (Kaihla, 1991; Gutner and Corben, 1996; Vatikiotis, 1995).

5. Globalization of capital and information technology (Santos, 1999; Hughes, 1999).

6. Armed conflict, military occupation and concentration of military and militia bases in various parts of the world (Sturdevant and Stoltzfus, 1992; Moon, 1997).

The interplay of demand and supply in commercial sex:

There are different means through which demand and supply are found to influence each other. First, demand can create its own supply. The picture below shows how demand can create its own supply.

There are situations in which, the supply can create its own demand within the setup of commercial sex work. The picture below shows how supply can create its own demand.

Would legalizing prostitution reduce sex trafficking or worsen sex trafficking:

Legalization promotes the sex industry as a legitimate business and an acceptable career for girls and women. Pimps can ensure the supply of women and girls for the purpose of sexual exploitation with the approval of the State. Legalization removes every legal impediment to pimping, procuring and brothels. Traffickers can use work permits to bring foreign women into the prostitution industry, masking the fact that women have been trafficked, by coaching them to describe themselves as independent “ migrant sex workers.” Legalization promotes the expansion of all forms of sexual exploitation of both children and adult women: including tabletop dancing, bondage and discipline centers, peep shows, phone sex, and pornography. Claims that legalization is necessary to safeguard the health of women are used to disguise the reality that it is the health and safety of the customer which the industry seeks to protect. There are no “safe zones” for women in the sex industry. When legal barriers disappear so too do the social and ethical barriers to treating women as sexual merchandise. Legalization of prostitution sends the message to new generations of men and boys that women are sexual commodities and that prostitution is harmless fun. However, many people believe the sex trade will exist regardless of its lawfulness and should therefore be made legal, as regulation will bring it within government control, helping to minimize the negative effects of sex work like exploitation, drug addiction and physical abuse. In most circumstances, this logic is sound. If the illegality of something does not curb behaviour, the effective harm reduction strategy may be to integrate that behaviour into the legal system. However, with regards to sex work, this could produce more harm than good.

Those to favor legalization of commercial sex would argue as follows:

No law has ever succeeded in stopping prostitution. Prostitution is the provision of sexual services for negotiated payment between consenting adults. So defined, prostitution is a service industry like any other in which people exchange skills for money or other reward. Non-consenting adults and all children forced into sexual activity (commercial or otherwise) deserve the full protection of the law and perpetrators deserve full punishment by the law. Prostitution laws are also a violation of the right of individual privacy because they impose penal sanctions for the private sexual conduct of consenting adults. Whether a person chooses to engage in sexual activity for purposes of recreation, or in exchange for something of value, is a matter of individual choice, not for governmental interference. We need to distinguish between victims and independent sex workers, and clients will not play a role as a potential source of information on trafficking practices. They argue that the legalization of prostitution will improve working and safety conditions for sex workers, allowing sex businesses to recruit among domestic women who choose prostitution as their free choice of occupation. This, in turn, makes resorting to trafficked women less attractive (Bureau of the Dutch National Rapporteur on Trafficking 2005; Segrave 2009; Limoncelli 2009). The view that the legalization of prostitution may reduce trafficking is typically held by those who believe that the choice to sell one’s sexual services for money need not always be forced, but can be a voluntary occupational choice. Criminalizing the sex industry creates ideal conditions for rampant exploitation and abuse of sex workers. It is believed that trafficking in women, coercion and exploitation can only be stopped if the existence of prostitution is recognized, and the legal and social rights of prostitutes are guaranteed. Prohibition gives cover to traffickers. It allows them to use the laws against prostitution to intimidate, especially when it comes to children. Women and girls being held against their will are afraid to go to police because they will be treated as criminals. Criminalization forces prostitution into the underworld. Legalization would bring it into the open, where abuses such as trafficking and under-age prostitution can be more easily tackled. Brothels would develop reputations worth protecting.

Those who oppose legalization of commercial sex would argue as follows:

Sex trafficking would not exist without the demand for commercial sex flourishing around the world. Prostitution is inherently harmful and dehumanizing and fuels trafficking in persons. Those who call for combating prostitution with the force of the law typically subscribe to the belief that prostitution is almost always forced and rarely truly voluntary. Prostitution and related activities—including pimping and patronizing or maintaining brothels—encourage the growth of modern-day slavery by providing a façade behind which traffickers for sexual exploitation operate. Where prostitution is tolerated, there is a greater demand for human trafficking victims and nearly always an increase in the number of women and children trafficked into commercial sex slavery. Few women seek out or choose to be in prostitution, and most are desperate to leave it. Most victims of international human trafficking are women and girls. The vast majority end up being sexually exploited through prostitution (UNODC 2006). Many authors therefore believe that trafficking is caused by prostitution and combating prostitution with the force of the law would reduce trafficking (Outshoorn 2005). For example, Hughes (2000: 651) maintains that “evidence seems to show that legalized sex industries actually result in increased trafficking to meet the demand for women to be used in the legal sex industries.” Farley (2009: 313) suggests that “wherever prostitution is legalized, trafficking to sex industry marketplaces in that region increases.” In its Trafficking in Persons report, the U.S. State Department (2007: 27) states the official U.S. Government position is “that prostitution is inherently harmful & dehumanizing and fuels trafficking in persons.” The idea that combating human trafficking requires combating prostitution is, in fact, anything but new. As Outshoorn (2005: 142) points out, the UN International Convention for the Suppression of the Traffic in Persons from 1949 had already called on all states to suppress prostitution. “You don’t legalize organized rape. You just don’t do that. What we have found is that legalization has caused an increase in the trafficking into the area where the legalization exists. The state then becomes the pimp… Legalizing prostitution creates more demand and mainstreams abuse of women and children… It also makes it difficult to hold traffickers accountable.”

Summary of arguments for not legalizing prostitution:

1. Legalization of prostitution is a gift to pimps, traffickers and the sex industry.

Legalization of the sex industry also converts brothels, sex clubs, massage parlors and other sites of prostitution activities into legitimate venues where commercial sexual acts are allowed to flourish legally with few restraints. No woman should be punished for her own exploitation but States should never decriminalize pimps, buyers, procurers, brothels or other sex establishments.

2. Legalization of prostitution and the sex industry promotes sex trafficking.

Legalized prostitution industries are one of the root causes of sex trafficking. In the one year since lifting the ban on brothels in the Netherlands, NGOs report that there has been an increase of victims of trafficking. In January, 2002, prostitution in Germany was fully established as a legitimate job after years of being legalized in so-called tolerance zones. Promotion of prostitution, pimping and brothels are now legal in Germany. As early as 1993, after the first steps towards legalization had been taken, it was recognized (even by pro-prostitution advocates) that 75 per cent of the women in Germany’s prostitution industry were foreigners from Uruguay, Argentina, Paraguay and other countries in South America (Altink, 1993: 33). After the fall of the Berlin wall, brothel owners reported that 9 out of every 10 women in the German sex industry were from Eastern Europe (Altink, 1993: 43) and other former Soviet countries. The sheer volume of foreign women who are in the prostitution industry in Germany, by some NGO estimates now up to 85 per cent, casts further doubt on the fact that these numbers of women could have entered Germany without facilitation. As in the Netherlands, NGOs report that most of the foreign women have been trafficked into Germany since it is almost impossible for poor women to facilitate their own migration, underwrite the costs of travel and travel documents, and set themselves up in business without outside help. The link between legalization of prostitution and trafficking in Australia was recognized in the U.S. State Department’s 1999 Country Report on Human Rights Practices, released by the Bureau of Democracy, Human Rights and Labor. In the country report on Australia, it was noted that in the State of Victoria which legalized prostitution in the 1980s, trafficking in East Asian women for the sex trade is a growing problem in Australia.

3. Legalization of prostitution does not control the sex industry. It expands it.

Contrary to claims that legalization and decriminalization would regulate the expansion of the sex industry and bring it under control, the sex industry now accounts for 5 percent of the Netherlands economy (Daley, 2001: 4). Legalization of prostitution in the State of Victoria, Australia, has led to massive expansion of the sex industry. Whereas there were 40 legal brothels in Victoria in 1989, in 1999 there were 94, along with 84 escort services. Other forms of sexual exploitation, such as tabletop dancing, bondage and discipline centers, peep shows, phone sex, and pornography have all developed in much more profitable ways than before (Sullivan and Jeffreys: 2001). Brothels in Switzerland have doubled several years after partial legalization of prostitution. Most of these brothels go untaxed, and many are illegal. Switzerland had the highest brothel density of any country in Europe, with residents feeling overrun with prostitution venues, as well as experiencing constant encroachment into areas not zoned for prostitution activities.

4. Legalization of prostitution increases clandestine, hidden, illegal and street prostitution.

Legalization was supposed to get prostituted women off the street. Many women don’t want to register and undergo health checks, as required by law in certain countries legalizing prostitution, so legalization often drives them into street prostitution. And many women choose street prostitution because they want to avoid being controlled and exploited by the new sex businessmen. The argument that legalization was supposed to take the criminal elements out of sex businesses by strict regulation of the industry has failed. The real growth in prostitution in Australia since legalization took effect has been in the illegal sector. Since the onset of legalization in Victoria, brothels have tripled in number and expanded in size; the vast majority having no licenses but advertising and operating with impunity (Sullivan and Jeffreys: 2001). In New South Wales, brothels were decriminalized in 1995. In 1999, the numbers of brothels in Sydney had increased exponentially to 400-500. The vast majority have no license to operate.

5. Legalization of prostitution and decriminalization of the sex industry increases child prostitution.

Another argument for legalizing prostitution was that it would help end child prostitution. In reality, however, child prostitution in the Netherlands has increased dramatically during the 1990s. The Amsterdam-based ChildRight organization estimates that the number has gone from 4,000 children in 1996 to 15,000 in 2001. The group estimates that at least 5,000 of the children in prostitution are from other countries, with a large segment being Nigerian girls (Tiggeloven: 2001). Child prostitution has dramatically risen in Victoria compared to other Australian states where prostitution has not been legalized. Of all the states and territories in Australia, the highest number of reported incidences of child prostitution came from Victoria. In a 1998 study undertaken by ECPAT (End Child Prostitution and Trafficking) who conducted research for the Australian National Inquiry on Child Prostitution, there was increased evidence of organized commercial exploitation of children.

6. Legalization of prostitution does not protect the women in prostitution.

The Coalition Against Trafficking in Women International (CATW) has conducted 2 major studies on sex trafficking and prostitution, interviewing almost 200 victims of commercial sexual exploitation. In these studies, women in prostitution indicated that prostitution establishments did little to protect them, regardless of whether they were in legal or illegal establishments. The only time they protect anyone is to protect the customers. In a CATW 5-country study that interviewed 146 victims of international trafficking and local prostitution, 80% of all women interviewed suffered physical violence from pimps and buyers, and endured similar and multiple health effects from the violence and sexual exploitation (Raymond et al: 2002). The violence that women were subjected to was an intrinsic part of the prostitution and sexual exploitation. Pimps used violence for many different reasons and purposes. Violence was used to initiate some women into prostitution and to break them down so that they would do the sexual acts. After initiation, at every step of the way, violence was used for sexual gratification of the pimps, as a form of punishment, to threaten and intimidate women, to exert the pimp’s dominance, to exact compliance, to punish women for alleged violations, to humiliate women, and to isolate and confine women. Of the women who did report that sex establishments gave some protection, they qualified it by pointing out that no protector was ever in the room with them, where anything could occur. CATW’s studies found that even surveillance cameras in prostitution establishments are used to protect the establishment. Protection of the women from abuse is of secondary or no importance.

7. Legalization of prostitution increases the demand for prostitution. It boosts the motivation of men to buy women for sex in a much wider and more permissible range of socially acceptable settings.

With the advent of legalization in countries that have decriminalized the sex industry, many men who would not risk buying women for sex now see prostitution as acceptable. “When the legal barriers disappear, so too do the social and ethical barriers to treating women as sexual commodities”. Legalization of prostitution sends the message to new generations of men and boys that women are sexual commodities and that prostitution is harmless fun. As men have an excess of sexual services that are offered to them, women must compete to provide services by engaging in anal sex, sex without condoms, bondage and domination and other proclivities demanded by the clients. Once prostitution is legalized, all holds are barred. Women’s reproductive capacities are sellable products. For example, a whole new group of clients find pregnancy a sexual turn-on and demand breast milk in their sexual encounters with pregnant women. Specialty brothels are provided for disabled men, and State-employed caretakers who are mostly women must take these men to the brothels if they wish to go (Sullivan and Jeffreys: 2001). Advertisements line the highways of Victoria offering women as objects for sexual use and teaching new generations of men and boys to treat women as subordinates. Businessmen are encouraged to hold their corporate meetings in these clubs where owners supply naked women on the table at tea breaks and lunchtime.

8. Legalization of prostitution does not promote women’s health.

A legalized system of prostitution that mandates health checks and certification only for women and not for clients is blatantly discriminatory to women. Women only health checks make no public health sense because monitoring prostituted women does not protect them from HIV/AIDS or STDs, since male clients can and do originally transmit disease to the women. It is argued that legalized brothels or other controlled prostitution establishments protect women through enforceable condom policies. In one of CATW’s studies, U.S. women in prostitution interviewed reported the following: 47% stated that men expected sex without a condom; 73% reported that men offered to pay more for sex without a condom; 45% of women said they were abused if they insisted that men use condoms. Some women said that certain establishments may have rules that men wear condoms but, in reality, men still try to have sex without them. One woman stated: It’s regulation to wear a condom at the sauna, but negotiable between parties on the side. Most guys expected blow jobs without a condom (Raymond and Hughes: 2001). In reality, the enforcement of condom policy was left to the individual women in prostitution, and the offer of extra money was an insistent pressure. Many factors militate against condom use: the need of women to make money; older women’s decline in attractiveness to men; competition from places that do not require condoms; pimp pressure on women to have sex with no condom for more money; money needed for a drug habit or to pay off the pimp; and the general lack of control that prostituted women have over their bodies in prostitution venues.

9. Legalization of prostitution does not enhance women’s choice.

Most women in prostitution did not make a rational choice to enter prostitution. They did not sit down one day and decide that they wanted to be prostitutes. Rather, such choices are better termed survival strategies. Rather than consent, a prostituted woman more accurately complies to the only options available to her. Her compliance is required by the very fact of having to adapt to conditions of inequality that are set by the customer who pays her to do what he wants her to do. Most of the women interviewed in CATW studies reported that choice in entering the sex industry could only be discussed in the context of the lack of other options. Most emphasized that women in prostitution had few other options. Many spoke about prostitution as the last option, or as an involuntary way of making ends meet. 72 % of the social service providers that CATW interviewed did not believe that women voluntarily choose to enter the sex industry (Raymond and Hughes: 2001). The distinction between forced and voluntary prostitution is precisely what the sex industry is promoting because it will give the industry more security and legal stability if these distinctions can be utilized to legalize prostitution, pimping and brothels. Women who bring charges against pimps and perpetrators will bear the burden of proving that they were forced. How will marginalized women ever be able to prove coercion? If prostituted women must prove that force was used in recruitment or in their working conditions, very few women in prostitution will have legal recourse and very few offenders will be prosecuted. Women in prostitution must continually lie about their lives, their bodies, and their sexual responses. Lying is part of the job definition when the customer asks, did you enjoy it? The very edifice of prostitution is built on the lie that women like it. Some prostitution survivors have stated that it took them years after leaving prostitution to acknowledge that prostitution wasn’t a free choice because to deny their own capacity to choose was to deny themselves. There is no doubt that a small number of women say they choose to be in prostitution, especially in public contexts orchestrated by the sex industry. When a woman remains in an abusive relationship with a partner who batters her, or even when she defends his actions, concerned people don’t say she is there voluntarily. They recognize the complexity of her compliance. Like battered women, women in prostitution often deny their abuse if provided with no meaningful alternatives. So the issue is complexity of compliance for prostituted women/girls and not merely a matter of voluntary choice.

10. Women in systems of prostitution do not want the sex industry legalized or decriminalized.

In a 5-country study on sex trafficking done by the Coalition Against Trafficking in Women and funded by the Ford Foundation, most of the 146 women interviewed strongly stated that prostitution should not be legalized and considered legitimate work, warning that legalization would create more risks and harm for women from already violent customer and pimps (Raymond et al, 2002). They all say that “It’s not a profession. It is humiliation and violence from the men’s side”.

Prostitution violates the right to physical and moral integrity by the alienation of women’s sexuality that is appropriated, debased and reduced to a commodity to be bought and sold. It violates the prohibition of torture and of cruel, inhuman or degrading treatment or punishment because clients’ acts and practices of sexual “entertainment” and pornography are acts of power and violence over the female body. It violates the right to liberty and security, and the prohibition of slavery, of forced labor and of trafficking in persons because millions of women and girls all over the world are held in sexual slavery to meet the demand of even more millions of male buyers of sex, and to generate profits for the capitalists of sex. It violates the right to enjoy the highest standard of physical and mental health because violence, disease, unwanted pregnancies, unsafe abortions, and AIDS stalk, presenting constant and grave risks for women and girls in prostitution, and militating against a healthy sense of and relationship with their own bodies. Prostitution will happen anyway but legalization and regulation will help stem the abuses. Using the same logic, slavery (which still exists in many places) should be legalized so underground slaves can be given some measure of human rights. There are not enough women in your country who have been raped as a child, are homeless, or have a drug addiction, to be prostitutes, because in reality these are the women who end up in this situation. In this case, you have to deceive or kidnap women and children from other countries, take their passport, beat them up and put them into sex slavery. The concept that ‘mom’s job’ is having sex with strangers sets the wrong tone for family life. It hurts the woman; it hurts the children; that is an exploitative situation. If prostitution is legal it affords men the ‘excuse’ to go find sex outside of marriage, when things in the marriage are difficult. That does nothing to enhance the relationship between a man and a woman. Prostitution runs opposite to what relationships are supposed to be. Intimacy and love are not involved; it’s just a purely physical act. It lowers both people to the lowest common denominator. We no longer remain human and humane but become animals who have random sex on the road.

Today’s appeasers fail to understand that legalizing prostitution always increases illegal prostitution. They fail to understand that the emotional capture of victims by brutal and experienced traffickers makes it certain that the victims will almost never feel free to testify about the lives they are forced to endure. They fail to understand that ‘Pretty Woman’ story is a lie, that the Academy Award electors who awarded Oscar to the profoundly infamous song ‘It’s Hard Out Here for a Pimp’ provide cover and protection for the real world of slavery. The Hollywood and Bollywood movies indirectly promote sex trafficking by glamorizing romance between a poor pretty woman and a rich gentleman. No, life is not as simple as portrayed in movies. In reality, the poor pretty woman will be sexually exploited by rich gentleman and thrown into the dark world of sex industry because that rich gentleman is nothing but a pimp masquerading as a boyfriend.

A study at Courant Research Centre investigated the impact of legalized prostitution on human trafficking inflows. According to economic theory, there are two opposing effects of unknown magnitude. The scale effect of legalizing prostitution leads to an expansion of the prostitution market, increasing human trafficking, while the substitution effect reduces demand for trafficked women as legal prostitutes are favored over trafficked ones. The empirical analysis for a cross-section of up to 150 countries showed that the scale effect dominates the substitution effect. On average, legalized prostitution increases human trafficking inflows.

No country has successfully legalized prostitution without substantial growth of human trafficking, organized crime, and underage prostitution. The National Dutch Police estimated that between 50–90 per cent of women in the legal brothels in Holland were working involuntarily. The sex trade is a very lucrative industry that perpetuates gender inequalities that will not be solved if prostitution is legalized. The sex trade will not become safer or easier to regulate. Legalization will only validate women (primarily) as commodities, which dehumanizes sexual interactions. Furthermore, legalization could perpetuate socioeconomic inequalities. For example, people applying for welfare are usually expected to complete an in-depth job search before they will be awarded government aid. In 2002, the German government legalized prostitution as a legitimate profession. In 2005, women applying for welfare in Germany who were having difficulty finding work in traditional industries were being advised to apply to brothels. If they refused, benefits could be denied. In this circumstance, legalized prostitution could actually result in an influx of impoverished women participating in the sex trade. Of course, this would be contrary to the legalization objective, which is to minimize women’s non-consensual participation in the industry. Sadly, the probability that financially disadvantaged women will be forced to sell sex as a means for providing for themselves and their families will likely increase.

So what is the solution? If prostitution isn’t legalized and regulated, then sex trade workers will be more susceptible to violence, disease and drug addiction. If it is, the government is responsible for propagating inequity with little evidence the policy will be socially beneficial.

Nordic model:

There are two major consequences of the legalization of prostitution. First, the institutional officialization (legalization) of sex markets strengthens the activities of organized pimping and organized crime. Secondly, such strengthening, accompanied by a significant increase in prostitution-related activities and in trafficking, brings with it a deterioration not only in the general condition of women and children, but also, in particular, that of prostituted people and the victims of trafficking for the purpose of prostitution. While the total decriminalization of prostitution – equivalent of the law of the jungle – is not regarded favorably by any country, the legalization of prostitution brings with it a number of problems that I have already examined. The alternative is the policy adopted by Sweden, which criminalizes those who benefit from prostitution – the pimps and the customers – and decriminalizes the activities of the prostituted people, who are regarded as the prey and the victims of organized pimping. So there is a third option: the Nordic model. The Nordic model decriminalizes the sale of sex but criminalizes the act of buying sex. Across Scandinavia, countries including Sweden, Norway and Iceland have implemented this policy and seen positive results. By making the demand for paid sex illegal without punishing sex workers, the law recognizes prostitution as a form of exploitation and places the participation risk of hefty fines, incarceration and public shame on the buyer, not the seller, of sex. This legislation, in tandem with subsidized housing, job training programs and drug rehabilitation, has helped many women exit the industry. Since the law was implemented in 1999, street prostitution [in Sweden] has decreased by 50 per cent with no increase in indoor prostitution. Also, there’s been a “considerable decline of human trafficking into Sweden.

Criminalizing the purchase of sexual acts, such as has been proven to work in the Nordic European states, will help tackle sex trafficking in a number of ways:

1. It gives a clear message that the exploitation of women is unacceptable.

2. It destroys the market for sex trafficking.

3. It allows the prosecution service to use the testimony of punters to prosecute sex traffickers and so takes the burden of truth away from the sex trafficking survivor.

4. It makes those causing harm accountable for their actions.

5. It decriminalizes those who sell sex acts whilst offering support services to exit prostitution.

Success of Nordic model:

The government of Sweden published an evaluation of the law’s first ten years and how it has actually worked in practice. The findings are strikingly positive: street prostitution has been cut in half; there is no evidence that the reduction in street prostitution has led to an increase in prostitution elsewhere, whether indoors or on the Internet. The ban has had a chilling effect on traffickers who find Sweden an unattractive market to sell women and children for sex. Police now confirm it works well and has had a deterrent effect on other organizers and promoters of prostitution. Sweden appears to be the only country in Europe where prostitution and sex trafficking has not increased. The Swedish results should be contrasted to neighboring countries such as Denmark where there are no legal prohibitions against the purchase of persons in prostitution. Denmark has a smaller population than Sweden (roughly 5.5 million to Sweden’s 9 million), yet the scale of street prostitution in Denmark is three times higher than in Sweden. The failure of the legalization model in Europe helped the Swedish model to become the Nordic model in 2009 when Norway outlawed the purchase of women and children for sexual activities. One year after the Norwegian law came into force, a Bergen municipality survey estimated that the number of women in street prostitution had decreased by 20 percent with indoor prostitution also down by 16 percent. Bergen police report that advertisements for sexual activities have dropped 60 percent. The success of the Nordic model is not so much in penalizing the men (the penalties are modest) as in removing the invisibility of men who are outed when they get caught. This, in turn, makes it less appealing for pimps and traffickers to set up shop in countries where the customer base fears the loss of its anonymity and is declining. Legalization of prostitution is a failed policy in practice. The prostitution policy tide is turning from legalization of prostitution to targeting the demand for prostitution without penalizing the victims. Countries who want to be effective in the fight against trafficking and not havens of sexual exploitation are beginning to understand that they cannot sanction pimps as legitimate sexual entrepreneurs and must take legal action against the buyers.

Arrest johns and not prostitutes:

Most johns (men who buy sex) know that they cause harm when they support the sex trade, but they continue to buy sex because they face very few consequences. Researcher has conducted a study that interviewed 113 johns in Chicago, and only 7 percent of those interviewed had ever been arrested for buying sex. When men are targeted by law enforcement it’s called a “reverse sting.” Why is it a reversal to arrest purchasers? It’s a reversal for our culture because purchasers are men, and as a society we have always blamed women for prostitution. This needs to change. If there were no demand, there would be no prostitution. The aim is to criminalize Johns for buying sex and decriminalizing prostituted women who want to get out of the industry. Several studies have concluded that trafficking increases in countries where prostitution is legalized, so giving sex workers ‘rights’ comes at the expense of the trafficking victims that are funneled into the country to fill demand. The goal is to abolish human sex trafficking – and if the end of the sex trade is to be a by-product of that, so be it.

How would I recognize a sex trafficked victim? (Usually includes a combination of indicators):

They may be controlled or intimated by someone else (i.e. being escorted or watched).

They may not speak on their own behalf and may not be speaking language of destination country.

They may not have a passport or other I.D.

They may not be familiar with the neighborhood they live/work in.

They may be moved frequently by their traffickers.

They may have injuries/bruises from beating and/or weapons.

They may show visible signs of torture i.e. cigarette burns, cuts.

They may show visible signs of branding or scarring (indicating ownership by the trafficker).

They may show signs of malnourishment.

They may express fear and intimidation through facial expressions and/or body language.

There are very few clear black and white indicators of human trafficking. The best general indicator is to look for someone doing something that a normal person would not do of their own free will. Many victims do not self-identify as victims. They also do not see themselves as people who are homeless or drug addicts who rely on shelters or assistance. Victims may not appear to need social services because they have a place to live, food to eat, medical care and what they think is a paying job.

The Mindset of a Human Sex Trafficking Victim:

When interacting with and providing assistance to potential trafficking victims, it is important to understand their mindset so you can provide them the best care and help them begin the process of restoring their lives.

1. Many trafficking victims do not speak language of destination country. Preying upon the poor and destitute from countries in Eastern Europe, Asia, Latin America and Africa, traffickers lure their victims into the west with promises of marriage, a good job so they can provide for their families back home, and a better life.

2. These promises and dreams quickly turn to nightmares as victims find themselves trapped in the sex industry living daily with inhumane treatment, physical and mental abuse, and threats to themselves or their families back home. Sometimes victims do not even know what city or country they are in because they are moved frequently to escape detection.

3. Victims of trafficking have a fear or distrust of the government and police because they are afraid of being deported or because they come from countries where law enforcement is corrupt and feared. Sometimes they feel that it is their fault that they are in this situation. As a coping or survival skill, they may even develop loyalties and positive feelings toward their trafficker and try to protect them from authorities.

4. Confidentiality is vital for victims of human trafficking. Their lives and the lives of their families are often at great risk if they try to escape their servitude or initiate criminal investigations against their captors.

Where would I find a victim who has been trafficked for sexual exploitation?

Nightclubs/bars

Modeling studios

Hospitals

Escort services

Massage parlors

Shelters

Internet

Private residences

Hotel/motel rooms

What is the impact of sex trafficking?

Trafficking has a harrowing effect on the mental, emotional and physical wellbeing of the women and girls ensnared in its web. Trafficked women suffer extreme emotional stress including shame, grief, fear, distrust, and suicidal thoughts as well as the repercussions of physical abuse. Victims often experience post-traumatic stress disorder and the ensuing acute anxiety, depression and insomnia. Victims often turn to drugs and alcohol to numb the pain. Sex trafficking promotes societal breakdown by removing women and girls from their families and communities. Trafficking also finances organized crime groups that usually participate in many other illegal activities such as drug and weapons trafficking and money laundering. It negatively impacts local and national labor markets due to the loss of human resources. Sex trafficking also burdens public health systems and erodes government authority, encourages widespread corruption, and threatens the overall security of vulnerable populations.

Victims suffer from host of physical and psychological problems stemming from:

Inhumane living conditions

Poor sanitation

Inadequate nutrition

Poor personal hygiene

Brutal physical and emotional abuse

Dangerous workplace conditions

General lack of quality medical care

Physical and Mental Health issues associated with victims of sex trafficking:

1. Sexually transmitted diseases, HIV/AIDS, pelvic pain, rectal trauma and urinary difficulties

2. Unwanted pregnancy, resulting from rape or prostitution

3. Infertility from chronic untreated sexually transmitted infections or botched or unsafe abortions

4. Infections or mutilations caused by unsanitary and dangerous medical procedures performed by unqualified individuals

5. Malnourishment and serious dental problems. These are especially acute with child trafficking victims who often suffer from retarded growth and poorly formed or rotted teeth.

6. Infectious diseases like tuberculosis

7. Undetected or untreated diseases, such as diabetes or cancer

8. Bruises, scars and other signs of physical abuse and torture. Sex-industry victims often beaten in areas that will not damage their outward appearance like lower back.

9. Substance abuse problems or addictions

10. Psychological trauma from daily mental abuse and torture, including depression, stress-related disorders, disorientation, confusion, phobias and panic attacks

11. Feelings of helplessness, shame, humiliation, shock, denial or disbelief

12. Cultural shock from finding themselves in strange country

A medical study of women and girls entering care after having been trafficked found that:
95% reported physical and/or sexual violence.
56% suffered post-traumatic stress disorder.
57% had 12-23 concurrent physical health problems.
60% suffered pelvic pain, vaginal discharge and gynecological infection.
38% had suicidal thoughts, 95% depression – most showing little reduction after 90 days in care.

Sexual violence vis-à-vis HIV among sex trafficked victims:

A community-based cross-sectional study was conducted among brothel-based sex workers of West Bengal, eastern India, to understand sex-trafficking, violence, negotiating skills, and HIV infection in them. In total, 580 sex workers from brothels of four districts participated in the study. Results of the study revealed that a sizeable number of the participants were from Nepal (9%) and Bangladesh (7%). The seroprevalence of HIV was strikingly higher among Nepalese (43%) than among Bangladeshis (7%) and Indians (9%). Almost one in every four sex workers (24%) had joined the profession by being trafficked. Violence at the beginning of this profession was more among the trafficked victims, including those sold by their family members (57%) compared to those who joined the profession voluntarily (15%). The overall condom negotiation rate with most recent two clients was 38%. By multivariate analysis, HIV was significantly associated with sexual violence (odds ratio=2.3; 95% confidence interval 1.2–4.5). The study has documented that the trafficked victims faced violence, including sexual violence, to a greater magnitude, and sexual violence was associated with acquiring HIV in them.

Sex trafficking of young girls and HIV:

A study was published in JAMA regarding HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women. In this study, repatriated Nepalese sex-trafficked girls and women were found to have a high prevalence of HIV infection, with increased risk among those trafficked prior to age 15 years. A high rate of HIV infection (38.0%) was found among this sample of repatriated Nepalese sex-trafficked girls and women. Within this high-risk group, risk for HIV was further increased among girls trafficked at 14 years or younger (60.6% HIV-positive), those trafficked to Mumbai (49.6% HIV positive), and those reporting longer duration in brothels. The observation that 1 in 7 (14.7%) survivors of sex trafficking were 14 years or younger at the time of trafficking, coupled with the high rates of HIV infection seen among these youngest survivors, indicates a need for greater attention from the public health community to this population and to prevention of this violent gender-based crime and human rights violation.

Sex trafficking and HIV:

With approximately 40 million people living with HIV globally, there is an immediate need to address the causes that heighten the vulnerability of women and girls to trafficking and HIV. The twin problems of trafficking and HIV are influenced by the same set of factors – such as poverty, discrimination and unsafe mobility, especially in the context of gender and human rights. Sex trafficking and HIV are linked in two important ways: sex trafficking victims are more vulnerable to HIV than many other groups and sex trafficking spreads and exacerbate HIV and AIDS. While all people in the commercial sex industry are vulnerable to HIV infection, sex trafficking victims are often at the highest risk. Since trafficking victims — by definition — cannot control their situation, they cannot insist on safer sex practices, like condoms. Even if condoms are available in the brothel where a trafficking victim is held, she may not have the power to insist upon, or even suggest their usage. Trafficking victims are frequently raped and exposed to violent sexual behavior, which can cause tissue tears that make HIV transmission more likely. And once a trafficking victim contracts HIV, it is highly unlikely she will be tested, diagnosed, and treated for the disease, thus allowing the AIDS to develop. Additionally, women and children widowed or orphaned by AIDS are at increased risk for trafficking. Victims may also receive medical and/or surgical treatment which may have included forced or voluntary pregnancy terminations, in unsanitary conditions, by unqualified practitioners, using contaminated instruments and/or unscreened blood supplies. Sex trafficking also proliferates the global AIDS epidemic. Since trafficking victims are rarely tested and treated for HIV infections, they may continue to be forced to have unprotected sex with hundreds or thousands of men before exhibiting any symptoms. The cross-border transportation which sometimes accompanies sex trafficking operations also spreads the disease, as one infected victim can infect the men who buy her in several different regions or countries. Those men may go on and infect other partners, both in and out of the commercial sex industry. Furthermore, some cultural myths about AIDS, like the idea that sex with a virgin will cure an HIV infection, cause infected men to seek out unprotected sex with young trafficked women. Because of these deep connections, a reduction in global HIV infections means a reduction in people vulnerable to trafficking and one less harm experienced by sex trafficked women and children. And a reduction in global sex trafficking means one fewer way HIV can be spread across the globe. Also, children who have lost at least one parent to HIV/AIDS are more susceptible to traffickers’ manipulations. For example, older children trying to feed their siblings are most likely to be lured by a trafficker’s fraudulent job offer. Also, HIV and AIDS increases the number of children trafficked because there is an increased demand for sex with young girls, since they are perceived to be HIV negative (despite the fact that they are in fact more vulnerable to HIV and AIDS, both biologically and because of their lack of power to negotiate the use of condoms). One of the reasons customers give for sexually exploiting children is to avoid sexually transmitted diseases. But the data show this is no protection. For example, in Cambodia there are between 50,000 and 70,000 prostitutes. More than a third of them are less than 18 years old and about 50 per cent of these young people are HIV positive (Véran).

Only 15 per cent of the prostitutes in the United States have never contracted a venereal disease (Leidholdt). Fifty-eight per cent of the prostitutes of Burkina Faso have AIDS, as have, 52 per cent in Kenya, about 50 per cent in Cambodia and 34 per cent in the North of Thailand. In Italy, in 1988, two per cent of the prostitutes had AIDS, compared to 16 per cent ten years later (Leidholdt ; see also, Mechtild). In the industrialized countries, 70 per cent of female infertility is caused by venereal diseases caught from husbands and partners (Raymond). Given such conditions, it is hard to understand how some researchers can continue to treat “sex work” as a predominantly and simply a freely chosen occupation/activity.

According to Policing the National Body: Sex, Race, and Criminalization, A Project of the Committee on Women, Population, and the Environment, 2002, numerous case studies have found that women in prostitution have significantly higher rates of sexually transmitted diseases (STDs) and infections (STIs), hepatitis, HIV/AIDS, and other sexual health problems. STDs of the upper and lower reproductive tracts, including syphilis, genital herpes, chanchroid, trichomoniasis, chlamydia, and gonorrhea increase the HIV transmission rate in women two to ten times. The report states, “HIV/AIDS is both a stark disease burden and also a biomarker of the gendered condition of women and of male sexual consumption. The highest rates in the world today exist in centers of sex tourism, in the military, and in societies and subcultures that condone male sexual exploitation, male sexual promiscuity, and female subordination. When the landscapes of sexual politics are further driven by economic collapse and conflict we see – as in Africa, South and East Asia, and the Newly Independent States of the former Soviet Union – the rise of trafficking in women and girls for prostitution and the emergence of new and the re-emergence of ‘old’ sexually transmitted diseases.” Countries such as Ukraine, Russia, and Belarus, where the spread of HIV/AIDS is rising the most quickly, also have the highest numbers of trafficked women and girls.

A study analyzed Syphilis and Hepatitis B Co-infection among HIV-Infected, Sex-Trafficked women and girls from Nepal. Its findings demonstrate that HIV-infected sex-trafficking victims are more likely to be infected with other STIs, specifically syphilis and hepatitis B, than those not infected with HIV.

A study found that 68% of 827 people in several different types of prostitution in 9 countries met criteria for post traumatic stress disorder (PTSD). The severity of PTSD symptoms of participants in this study were in the same range as treatment-seeking combat veterans, battered women seeking shelter, rape survivors, and refugees from state-organized torture.

More than 2/3 of sex trafficked children suffer abuse at the hands of their traffickers. Trafficked children are significantly more likely to develop mental health problems, abuse substances, engage in prostitution as adults, and either commit or be victimized by violent crimes later in life. Over 71% of trafficked children show suicidal tendencies.

Sex work and death:

An estimated 30,000 victims of sex trafficking die each year from abuse, disease, torture, and neglect. Foremost among the health risks of prostitution is premature death. In a recent US study of almost 2,000 prostitutes followed over a 30-year period, by far the most common causes of death were homicide, suicide, drug and alcohol related problems, HIV infection and accidents – in that order. The homicide rate among active female prostitutes was 17 times higher than that of the age-matched general population. Canadian Commission Special Committee on Pornography and Prostitution (1985) found that the death rate of women in prostitution was 40 times higher than the general population. A mortality survey of 1600 women in U.S. prostitution noted that “no population of women studied previously had the percentage of deaths due to murder even approximating those observed in our cohort”. In this survey murder accounted for 50% of the deaths of women in prostitution. (Farley, 2004).

Human rights violations and trafficking:

Trafficking in women and girls for the purpose of sexual exploitation is an open and flagrant human rights violation occurring around the world. When a woman or child is trafficked or sexually exploited, they are denied the most basic human rights, and in the worst case, they are denied their right to life. Prostitution and sexual exploitation have devastating health and quality of life effects on its victims.

Methods of Coping and Resistance:

Although women were severely victimized while in the sex industry, they were not simply victims. They found many ways to cope, resist and survive the exploitation and violence. The vast majority of international (87%) and U.S. (92%) women used drugs or alcohol to cope while they were in the sex industry. Half of the women began using drugs and alcohol after they entered the sex industry to numb themselves to the trauma of unwanted sex. Many women (international women—50%, U.S. women—43%) tried, sometimes multiple times, to leave the sex industry. Twenty-seven percent of the international women and 52 percent of the U.S. women said economic necessity, drug dependencies and pimps who beat, kidnapped, and/or threatened them or their children prevented them from leaving.

Commercial sexual exploitation of children (CSEC):

The commercial sexual exploitation of children is perhaps the most heinous of all human trafficking situations. The Declaration and Action Agenda of the World Congress Against Commercial Sexual Exploitation of Children (1996) offers the following definition: “The commercial sexual exploitation of children is a fundamental violation of children’s rights. It comprises sexual abuse by the adult and remuneration in cash or kind to the child or a third person or persons. The child is treated as a sexual object and as a commercial object. The commercial sexual exploitation of children constitutes a form of coercion and violence against children, and amounts to forced labor and a contemporary form of slavery.” Children can be sexually exploited for financial gain in a number of ways. Prostitution, pornography, and child trafficking for sexual purposes are three of the primary and overlapping ways that such exploitation occurs. That is not to say that these are the only mechanisms of abuse, however they are most primary. Two examples of additional forms include early marriages, sale of children for marriage and reproduction, and sex tourism. Sex tourists, seeking anonymity and impunity in foreign lands, exploit many of these children in child sex tourism. The commercial sexual exploitation of children clearly impinges on the child’s right to autonomy, health, and psychological well-being. Children who are trafficked for sexual exploitation often face horrifying physical violence that can result in injury or death. Children are hit, beaten with fists and with objects, and raped in order to ensure their compliance with the expectations of their captors. It is not uncommon for children who have been trafficked into sex slavery to be forced into sex acts with up to 20 men daily (O’Connell, 2005). Often, protective measures against sexually transmitted disease are not taken, and therefore children are vulnerable to a wide range of dangerous illnesses, many of which are likely to shorten their lifespan. Such threats to physical safety also play a role in the psychological trauma of being trafficked. In addition to physical violence and rape, trafficked children face painful separation from their caregivers and the ongoing threat of harm. Reactions to this and any type of abusive situation vary from person to person. Children who have been trafficked have reported feelings of worthlessness and shame. Another common reaction to an abusive and dangerous situation is to identify with the abuser. This creates a false sense of safety that can sometimes help the victim make it through terrifying circumstances. Clearly there should be no room in our world for any type of mistreatment of children. However, hundreds of thousands of children endure the most vile and inhumane conditions on a daily basis. With regard to protecting children from being trafficked, there is a need to strengthen the criminal justice response to trafficking through education, training, and legislative reform. In addition, strong psychosocial support must be in place in communities worldwide in order to meet the needs of survivors. A step in the direction toward rectification of the abuse and neglect of children through trafficking is education and volunteerism.

Every 2 minutes a child is being prepared for sexual exploitation (UNICEF). The average age of a trafficked victim is 12-14 years old. According to United Nations Children’s Fund (UNICEF), over the past 30 years, over 30 million children have been sexually exploited through human trafficking. Sex traffickers often recruit children because not only are children are more unsuspecting and vulnerable than adults, but there is also a high market demand for young victims. Traffickers target victims on the telephone, on the Internet, through friends, at the mall, and in after-school programs. An estimated 2 million children, the majority of them girls, are sexually exploited in the multibillion dollar commercial sex industry (UNICEF). An estimated 1.2 million children are trafficked each year (UNICEF). Around the world between 50 and 60 percent of the children who are trafficked into sexual slavery are under age 16. The National Center for Missing & Exploited Children (NCMEC) estimates that at least 100,000 American children are the victims of commercial sexual trafficking and prostitution each year. The industry of child prostitution exploits 400,000 children in India (UNICEF 2003), 100,000 children in the Philippines (CATW), between 200,000 and 300,000 in Thailand (Oppermann), 100,000 in Taiwan (UNICEF 2001) and in Nepal (ECPAT), 500,000 children in Latin America, and from 244,000 to 325,000 children in the United States. If one includes children in all the sex industries, the U.S. figures climb to 2.4 million (UNICEF 2001). In the People’s Republic of China, there are between 200,000 and 500,000 prostituted children. In Brazil, estimates vary between 500,000 and two million (UNICEF 2001). About 35 per cent of the prostitutes of Cambodia are less than 17 years old (CATW). Certain studies estimate that during one year, the prostituted “sexual services” of one child are sold to 2,000 men (Robinson).

Prostitution of children under the age of 18 years, child pornography and the (often related) sale and trafficking of children are often considered to be crimes of violence against children. They are considered to be forms of economic exploitation akin to forced labor or slavery. Such children often suffer irreparable damage to their physical and mental health. They face early pregnancy and risk sexually transmitted diseases, particularly AIDS. They are often inadequately protected by the law and may be treated as criminals. Child trafficking and CSEC sometimes overlap. On the one hand, children who are trafficked are often trafficked for the purposes of CSEC. However, not all trafficked children are trafficked for these purposes. CSEC is also part of, but distinct from, child abuse, or even child sexual abuse. Child rape, for example, will not usually constitute CSEC. Neither will domestic violence.

Did you know that one in seven kids between the ages of 10 and 18 run away at some point in their lives? Estimates of runaway children are between 1 million and 3 million. Where do so many children go? Many wind up on the streets and many of those end up being trafficked. Girls represent 80 to 90% of the victims, although in some places boys predominate. severe poverty, the possibility of relatively high earnings, low value attached to education, family dysfunction, a cultural obligation to help support the family or the need to earn money to simply survive are all factors that make children vulnerable to CSEC. In order to make a living, children are sold into the sex trade to provide food and shelter and in some cases money to satisfy the addiction of a family member or themselves. There are other non-economic factors that also push children into commercial sexual exploitation. Children who are at greatest risk of becoming victims of CSEC are those that have previously experienced physical or sexual abuse. A family environment of little protection, where caregivers are absent or where there is a high level of violence or alcohol or drug consumption, induces boys and girls to run away from home, making them highly susceptible to abuse. Gender discrimination and low educational levels of caregivers are also risk factors. Children with extreme poverty and marginalized families in coastal areas also become victims of CSEC. Child trafficking can occur when children are abducted from the streets, sold into sexual slavery and forced marriage by relatives, or in any place where traffickers, pimps and recruiters prey upon a child’s vulnerabilities. Poverty is the pre-condition that makes it easier for traffickers to operate. The greatest factor in promoting child sex trafficking and child sexual exploitation is the demand for younger and younger victims worldwide. This demand comes from the mostly male buyers who become the customers in the growing global sex industry. Children are often trafficked, employed and exploited because, compared to adults, they are more vulnerable, cheaper to hire and are less likely to demand higher wages or better working conditions. Client preferences for young children, particularly in the context of the HIV/AIDS epidemic, pull in additional children. Additionally, the expansion of the Internet has facilitated the growth of child pornography. Experience has shown that certain socio-economic characteristics, such as population density, concentration of night entertainment (bars and discos), high poverty and unemployment levels, movement of people, and access to highways, ports, or borders are also associated with CSEC.

Child grooming:

Child grooming refers to actions deliberately undertaken with the aim of befriending and establishing an emotional connection with a child, in order to lower the child’s inhibitions in preparation for sexual activity with the child, or exploitation. Child grooming may be used to lure minors into illicit businesses such as child prostitution or the production of child pornography.

Child prostitution:

Child prostitution is considered inherently nonconsensual and exploitative, as children, because of their age, are not legally able to consent to sex. The prostitution of children is a form of commercial sexual exploitation of children in which a child performs the services of prostitution, usually for the financial benefit of an adult. In many countries, especially poorer countries, child prostitution remains a very serious problem, and numerous tourists from the Western World travel to these countries to engage in child sex tourism. Thailand, Cambodia, India, Brazil and Mexico have been identified as leading hotspots of child sexual exploitation. The surveys sponsored by the Ministry of Women and Child Development estimated about 40% of India’s prostitutes to be children. Thailand’s Health System Research Institute reported that children in prostitution make up 40% of prostitutes in Thailand.

Child pornography:

Child pornography – which some have called ‘child abuse images’ – refers to images or films depicting sexually explicit activities involving a child; as such, child pornography is a visual record of child sexual abuse. Abuse of the child occurs during the sexual acts which are photographed in the production of child pornography, and the effects of the abuse on the child (and continuing into maturity) are compounded by the wide distribution and lasting availability of the photographs of the abuse.

Sex Trafficking in children:

Sex trafficking of children is the recruitment, transportation, transfer, harboring, or receipt of children for the purpose of sexual exploitation. Trafficking and commercial sexual exploitation of children can take many forms and include forcing a child into prostitution or other forms of sexual activity or child pornography. It was reported in 2010 that Thailand and Brazil were considered to have the worst child sex trafficking records. Trafficking in children often involves exploitation of the parents’ extreme poverty. Parents may sell children to traffickers in order to pay off debts or gain income, or they may be deceived concerning the prospects of training and a better life for their children. They may sell their children for labor, sex trafficking, or illegal adoptions. Thousands of children from Asia, Europe, North America and South America are sold into the global sex trade every year. Often they are kidnapped or orphaned, and sometimes they are actually sold by their own families. In the U.S. Department of Justice study, more than 30 percent of the total numbers of trafficking cases for that year were children coerced into the sex industry.

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Listed in the order of frequency with which they have been identified in the scholarly literature, child sexual exploitation appears to be fueled by:

1) The use of prostitution by runaway and thrown away children to provide for their subsistence needs;

2) The presence of pre-existing adult prostitution markets in the communities where large numbers of street youth are concentrated;

3) Prior history of child sexual abuse and child sexual assault;

4) Poverty;

5) The presence of large numbers of unattached and transient males in communities–including military personnel, truckers, conventioneers, sex tourists, among others;

6) For some girls, membership in gangs;

7) The promotion of juvenile prostitution by parents, older siblings and boyfriends;

8) The recruitment of children by organized crime units for prostitution; and, increasingly,

9) Illegal trafficking of children for sexual purposes to the U.S. from developing countries located in developing Asia, Africa, Central and South America, and Central and Eastern Europe.

It is estimated that there are 100,000 to 150,000 under-aged sex workers in the U.S. (the average age of girls who enter into street prostitution is between 12 and 14 years old, with some as young as nine years old), not including those who entered the “trade” as minors and have since come of age. Rarely do these girls enter into prostitution voluntarily. Many started out as runaways or throwaways, only to be snatched up by pimps or larger sex rings. Others persuaded to meet up with a stranger after interacting online through one of the many social networking sites, find themselves quickly initiated into their new lives as sex slaves. Debbie, a straight-student who belonged to a close-knit Air Force family living in Phoenix, Ariz., is an example of this trading of flesh. Debbie was 15 when she was snatched from her driveway by an acquaintance-friend. Forced into a car, Debbie was bound and taken to an unknown location, held at gunpoint and raped by multiple men. She was then crammed into a small dog kennel and forced to eat dog biscuits. Debbie’s captors advertised her services on Craigslist. Those who responded were often married with children and the money that Debbie “earned” for sex was given to her kidnappers. The gang raping continued. After searching the apartment where Debbie was held captive, police finally found Debbie stuffed in a drawer under a bed. Her harrowing ordeal lasted for 40 days. While Debbie was fortunate enough to be rescued, others are not so lucky. According to Shared Hope International, an under-aged prostitute, working five nights a week, could over the course of five years find herself “raped” by 6,000 men. That quota increases dramatically during sporting events such as the Super Bowl, which is considered a magnet for prostitution. As Shared Hope reports, “Children exploited through prostitution typically are given a quota by their trafficker/pimp of 10-15 buyers per night…though some service providers report girls having been sold to as many as 45 buyers in a night at peak demand times, such as a sporting event or convention.”

The U.S. and sex trafficking:

No discussion on sex trafficking is comprehensive without mention of the U.S. because it is the biggest destination country for victims of sex trafficking due to its great demand, large economy and also belief among non-Americans that life in America is better than rest of the world and so they are easily lured into working in the U.S. In 2005, the Department of Justice reported there have been an estimated 100,000 to 150,000 sex slaves in the U.S. since 2001. The U.S. government estimates that 600,000 to 800,000 persons are trafficked across international borders annually. The four organizations with databases on global trafficking in persons are the U.S. government, International Labor Organization (ILO), IOM, and UNODC. The U.S. government and ILO estimate the number of victims worldwide, IOM collects data on victims it assists in the countries where it has a presence, and UNODC traces the major international trafficking routes of the victims. The databases provide information on different aspects of human trafficking since each organization analyzes the problem based on its own mandate. For example, IOM looks at trafficking from a migration and rights point of view and ILO from the point of view of forced labor. Despite the fact that the databases use different methodologies for data collection and analysis and have various limitations, some common themes emerge. For example, the largest percentage of estimated victims is trafficked for sexual exploitation. In addition, women constitute the majority of estimated victims. However, the estimated percentage of victims those are children ranges from 13 to 50 percent. Table below describes the victim profiles that emerge from the data.

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In 2000, the U.S. Congress enacted the Trafficking Victims Protection Act (TVPA) to combat trafficking and reauthorized this act twice. The table below shows Minimum Standards for the elimination of Human Trafficking to be complied by various governments as per TVPA.

Figure below shows principal U.S. Government Agencies with responsibilities for Antitrafficking activities and associated coordination entities:

The government has also created several coordinating mechanisms for these antitrafficking efforts, as shown in figure above.

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The TVPA classifies countries that are origin, transit, or destination countries for significant number of victims of severe forms of trafficking in one of three tiers.

Tier 1: Countries which fully comply with the TVPA’s minimum standards for the elimination of trafficking
Tier 2: Countries which do not fully comply with the TVPA’s minimum standards but are making significant efforts
Tier 2 watch list: as Tier 2 but the number of victims is increasing, or the countries do not provide evidence of increased efforts to tackle the problem or the country if making efforts to improve
Tier 3: Countries which do not fully comply with the minimum standards and are not making significant efforts to do so.

The world map below shows various countries as per “tier” definition discussed above.

Countries which ignore Human Trafficking:

The annual U.S. State Department Trafficking in Persons Report on 175 countries is the most comprehensive worldwide report on the efforts of governments to combat human trafficking. In 2011, 23 countries failed to meet the Trafficking Victims Protection Act’s (TVPA) minimum standards, and were classified as Tier 3 countries. That’s up from 13 countries in 2010. Countries making the list in 2011 included many habitual offenders, headed by Cuba, Iran, North Korea, Papua New Guinea, Saudi Arabia, Sudan, Burma, Congo (DRC), Mauritania, Eritrea, Zimbabwe and Kuwait.

The Anti-trafficking Policy Index:

The “3P Anti-trafficking Policy Index” measures the effectiveness of government policies to fight human trafficking based on an evaluation of policy requirements prescribed by the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children (2000). The policy level is evaluated using a five-point scale, where a score of five indicates the best policy practice, while score 1 is the worst. This scale is used to analyze the three main anti-trafficking policy areas: (1) prosecuting (criminalizing) traffickers, (2) protecting victims, and (3) preventing the crime of human trafficking. The outcome of the Index shows that anti-trafficking policy has overall improved over the 2000-2009 period. Improvement is most prevalent in the prosecution and prevention areas worldwide. An exception is protection policy, which shows a modest deterioration in recent years.

Statistical fallacies:

It is argued that many of these sex trafficking statistics are grossly inflated to aid advocacy of anti-trafficking NGOs and the anti-trafficking policies of governments. Due to the definition of trafficking being a process (not a single defined act) and the fact that it is a dynamic phenomenon with constantly shifting patterns relating to economic circumstances, much of the statistical evaluation is flawed and estimates of global human trafficking are questionable. The accuracy of the estimates is in doubt because of methodological weaknesses, gaps in data, and numerical discrepancies. There is also a considerable discrepancy between the numbers of observed and estimated victims of human trafficking. Numerous NGOs and governmental agencies produce estimates and specific statistics on the numbers of potential and actual victims of trafficking. According to the critics, these figures rarely have identifiable sources or transparent methodologies behind them and in most (if not all) instances, they are mere guesses. Scholars argue that this is a result of the fact that it is impossible to produce any meaningful statistics on a reportedly illegal and covert phenomenon happening in the shadow economy.

The quality of existing country level data varies due to limited availability, reliability, and comparability. Table below summarizes the main limitations of trafficking data, identified in the review of literature on human trafficking.

If sex slaves were so abundant, why weren’t they being found? The “discrepancy” between the estimated numbers of victims and the number of cases actually brought to court suggests that this problem is being blown way out of proportion. Is it so? Well, I think sex trafficking is clandestine trade and like all clandestine trade, you always see only tip of the ice berg. The United Nations notes that “the lack of accurate statistics is due only in part to the hidden nature of the crime, and that the lack of systematic reporting is the real problem.” In other words, the number of those trafficked worldwide might be far greater than what is estimated. In 2006 there were 5,808 trafficking prosecutions and 3,160 convictions worldwide, which would mean that one person is convicted for every 800 people trafficked. So statistics has to be viewed in this context.

The other side of the story:

Regarding sex trafficking, it is impossible to measure the ratio of agency to victimization—i.e., voluntary versus involuntary migration. But several studies suggest that a significant number of migrants have made conscious and informed decisions to relocate. A study of Vietnamese migrants in Cambodia, who had been assisted by intermediaries, reported that out of 100 women studied, only six had been duped, and the rest knew prior to leaving Vietnam that they would work in a brothel in Cambodia. Their motivations consisted of “economic incentives, desire for an independent lifestyle, and dissatisfaction with rural life and agricultural labor.” After raids on the brothels by “rescue” organizations, the women “usually returned to their brothel as quickly as possible.” The researchers argue that criminalizing the sex industry “forces [the workers] underground, making them more difficult to reach with appropriate services and increasing the likelihood of exploitation.” Similar findings have been reported in Europe, where the women are “often aware of the sexual nature of the work. . . . Many migrants do know what is ahead of them, do earn a large amount of money in a short time selling sex, and do have control over their working conditions.” One investigation of trafficking from Eastern Europe to Holland, based on interviews with seventy-two women, found that few of the women were coercively trafficked, and that a “large number” had previously worked as prostitutes. For most of the women, economic motives were decisive. The opportunity to earn a considerable amount of money in a short period of time was found to be irresistible. . . . In most cases recruiting was done by friends, acquaintances, or even family members. The facilitators made travel arrangements, obtained necessary documents, and provided money to the women. In Australia “the majority of women know they will be working in the sex industry and often decide to come to Australia in the belief that they will be able to make a substantial amount of money. . . . Few of the women would ever consider themselves sex slaves.” These are not isolated studies; others have shown that a proportion of migrants sold sex prior to relocating or were well aware that they would be working in the sex industry in their new home.

Chinese prostitutes resist effort to rescue them from Africa:

Police from China flew to the Democratic Republic of Congo in November 2010 in the country’s first operation to rescue women trafficked to Africa. They found 11 Chinese women who had been promised decent jobs in Paris by traffickers but ended up working in a Chinese-owned karaoke bar in the country’s capital Kinshasa. After a joint raid by Chinese and Congolese police on the karaoke bar, however, the women decided to stay in the country, saying it was easier to make good money there than in China. Chinese police official told the media, “They make 100 $ for receiving one guest – half of the money goes to their boss and they keep the other half.”

Thailand’s Burmese sex workers don’t want to be ‘rescued’:

Being a sex worker these days isn’t what it used to be. Much has improved – no more pimps or mama-sans, and fewer punches thrown their way. Being “rescued”, though, causes them all sorts of problem. A point is reached in history where there are more women in the Thai sex industry being abused by anti-trafficking practices than there are women exploited by traffickers. “We came to build new lives for our families, not to be sent home empty-handed and ashamed,” explained Dang Moo, Burmese sex worker in Mae Sot. But the anti-trafficking law regards sex workers as victims, so those who enforce it believe they are “rescuing” the prostitutes. That just makes things worse, say the sex workers. Once “rescued” and after a period of detainment, the foreign workers are deported (only to return at the first chance) and the Thais usually have to undergo vocational training. Gone are the days of pimps, prostitution mafia and the “green harvest”, when girls are recruited upcountry. In their place are helpful “older brothers” – the motorcycle-taxi driver and the bar manager. Sex workers now have hi-tech tools like smart phones and the Internet, and they’re also skilled at using them. So most Burmese sex workers in Thailand refuse to be “rescued”.

The picture below shows rescued sex trafficked Bangladeshi women/girls in India.

When police raided Budhwar Peth in Pune, India, which is the red light district of the city in October 2010, they found sex workers from Bangladesh. The police suspected the sex workers were illegally brought into the country and forced into prostitution. However, next day, all 21(including 6 minor) sex workers stomped out and created a ruckus. They broke off the grill and engaged in a fight with the management for a return ticket to brothel life. The photograph above shows these rescued sex workers in apparently good health. So this is the other side of the sex trafficking and it has been my endeavor to present both sides of the story and let audience decide the truth themselves. You cannot divide the world between white & black, truth & lies and good & evil. We all live in “gray areas” and we have to decide on which side of gray shall we live. I have decided to oppose sex trafficking notwithstanding the other side of the story. You can make your own judgment.

Complicity of saviors:

There was enslavement and rape in Bosnia, not only during wartime 20 years ago but during the peace. Worse, not only were the enslaved women’s “clients” soldiers and police officers – so too were the traffickers, protected at the top of the United Nations operation in Bosnia. Bosnian women were raped not only by Serbian militia but later on by UN soldiers. A damning dossier sent by Kathryn Bolkovac to her employers, detailing UN workers’ involvement in the sex trade in Bosnia, cost the American her job with the international police force. During her time in Bosnia as an investigator, Ms Bolkovac, 41, uncovered evidence of girls who refused to have sex being beaten and raped in bars by their pimps while UN peacekeepers stood and watched. She discovered that one UN policeman who was supposed to be investigating the sex trade paid £700 to a bar owner for an underage girl who he kept captive in his apartment to use in his own prostitution racket. She was sacked after disclosing that UN peacekeepers went to nightclubs where girls as young as 15 were forced to dance naked and have sex with customers, and that UN personnel and international aid workers were linked to prostitution rings in the Balkans. Liberated Kosovo is filled with sex slaves. NATO soldiers, UN police, Western aid workers were all exploiting these sex trafficked women. It’s not enough for the UN to say, “There are a few rotten apples that need to be got rid of.” They have to understand that this outrageous practice is endemic in the male hegemony of a militarized environment – its part of locker-room bravado and the high levels of testosterone in fighting armies. These crimes are perpetrated by individual men who rape and torture girls on mission, and then go home to their wives as war heroes.

Wired trafficking:

The Internet has become the latest place for promoting the global trafficking and sexual exploitation of women. The information superhighway is used to actively engage in the buying and selling of women and children. Catalogs of mail order brides, commercial sex tours, and video-conferencing bringing live strip shows to the Internet: it is all there and worse because there is still scant regulation of the Internet, the traffickers and promoters of sexual exploitation have virtual carte blanche. If expressions of concern or condemnation of forms of sexual exploitation of women and children on the Internet are minimized by claims of the need for internet freedom and free speech, it is imperative that we must define sexual exploitation as human rights violations and crimes against women, which we will not allow in our communities or on the Internet. The technology has changed the playing field. Offenders don’t just parade children on city streets any more. Today, a customer can shop online for a girl child from the privacy of his home or hotel room. Online classified advertising services, like Craigslist, Backpage and dozens of others have made it possible for pimps and operators to offer these kids to prospective customers with little or no risk. However, to be fair to internet, I must state that it is the demand of men that is responsible for sexual exploitation of women/girls on internet and had there been no demand, who would have used internet for sex trafficking and pornography. So don’t blame the technology, blame yourself. Who told Karnataka ministers to watch pornography on mobile phone during assembly session? You cannot blame mobile phones for spreading pornography. However, pornography and sex trafficking are intimately linked as discussed below.

Pornography and sex trafficking:

The common denominator in pornography, prostitution, and sex trafficking is ―demand. People who buy sex or pornography are supporting sex trafficking because they create the demand that fuels the commercial sex industry. Help end the demand by asking your local law enforcement to enforce obscenity and vice crimes laws. Pornography is used to train sex slaves, especially children, showing what is expected of them when they are prostituted. By showing pornography to young children, they not only tell them they will have to perform or submit to the acts shown, but by repeatedly showing the victims porno-graphic films, they desensitize the children to it. Pimps and traffickers take pornographic pictures of victims to coerce them into making films and/or prostituting by threatening to show their family the pictures. Sometimes pimps film their victims performing sex acts on johns and sell it as pornography. In 2007, a man and woman were convicted in New York of forcing an 18-year-old girl to pose for pictures which they posted on Craigslist and of forcing her into prostitution. Customers view pornography and then use prostitutes to perform those sex acts. Many people are unaware of the change of focus in today’s pornography –– much of it is extremely violent and dehumanizing. Some of those who view it want to reenact what they see, but few wives or girlfriends will agree to such degradation. In other instances, the customer is unwilling to ask for the acts that he prefers, so he seeks out a prostitute. In a 2009 British study, twenty-seven percent of the men interviewed who admitted buying sex said, ―once he pays, the customer is entitled to engage in any act he chooses with women he buys. Fifty-eight percent of the men in the study used pornographic films and/or videos at least once a month. Pimps and traffickers cater to the demands of customers and will force their victims to perform whatever act the customers demand after viewing degrading acts on pornography.

Production of pornography and Internet sex shows are markets which often rely on trafficked victims. Some pornography is produced for private consumption or it is traded among trusted offenders, but a large amount of adult and child pornography is produced for commercial distribution. The value of it depends on if it is illegal and the extremeness of the abuse to the victim. The pornography markets for victims of trafficking have not received the attention that prostitution has. Yet, approximately one third of the victims of prostitution at Breaking Free in St. Paul Minnesota have been used in the production of pornography. In some parts of the world, centers of trafficking are also centers for the production of pornography. Budapest, Hungary is a destination and transit city for women trafficked from central and eastern Europe. Budapest has also become the pornography production capital of Europe. American and European pornography producers moved to Budapest because of the cheap, available victims. Budapest provides low production costs and lax government regulations and attitudes. There are hundreds of pornography films produced each year in Budapest. In only eight years, Budapest has become probably the biggest center for pornography production in Europe, even greater than Amsterdam and Copenhagen. Most West European producers of pornography use East European actors wherever possible. “They cost less and do more,” an executive at Germany’s Silwa production company explains. It is likely that at least some of the women used in the production of these videos are victims of trafficking, yet few people think of production of pornography as a way that victims of trafficking are exploited. There have been reports of young children–usually homeless or neglected teenagers–being recruited for pornography with promises of glamorous careers in modeling. The production pornography is often, and when children are used, always, an act of sexual abuse and exploitation. Experts agree that each time that image is viewed, the victim is revictimized. Once an offender uploads an image to the Internet, it quickly spreads all over the world. As a result of the development of new software that can trace the distribution of material on the Internet, a video of a four-year-old being abused was traced around the Internet. The video was found to have been downloaded to thousands of personal computers worldwide, and it just a few months time, was offered 40,000 times to offenders seeking child pornography. When images are made of victims of sex trafficking and distributed on the Internet, the abuse never ends because all of the images or videos can never be traced or destroyed. Someone can forever be viewing that act of sexual abuse.

Celebrities, pornography and pimps:

Celebrities too have become amateur porn stars. They show up in sex tapes (Colin Farrell, Kim Kardashian), hire porn producers to shoot their videos (Britney Spears) or produce porn outright (Snoop Dogg). Actual porn stars and call girls meanwhile have become celebrities. Ron Jeremy regularly takes cameos in movies and on TV, while adult star Jenna Jameson is a best-selling author. This veritable culture of pornography has also lent an air of glamour to the sex industry. As Tina Frundt, who was forced into prostitution when she was 14 years old, pointed out: “You can turn on the TV now and see pimps glamorized in TV shows, music videos, and movies.” Moreover, the use of such pejorative terms as “whore,” “slut” or “bitch” has largely become commonplace today and, especially when used by young people, connotes a certain amount of affection. Porn star Sunny Leone, the newest and perhaps ‘sexiest’ entrant to the “Big Boss” house on Indian TV says that ‘porn star’ doesn’t automatically mean ‘prostitute’. I have already discussed earlier that pornography, prostitution and sex trafficking are intimately linked and people who support pornography are indirectly supporting sex trafficking.

Sexually Explicit Performances:

Women and girls are trafficked for sexually explicit performances, such as stripping and lap dancing. The standards for what is considering “dancing” have changed over the past decade and now involve physical contact. Previously, many strip clubs had “no contact” rules, which meant that men were not allowed to touch the women. But increased demand from male clients has led to more tolerance for physical touching. Lap dancing involves a naked or scantily clothed woman dancing around and eventually sitting on a man’s lap and rubbing until he ejaculates. The introduction of “lap dancing” has almost eliminated the distinction between dancing and prostitution. A study of strip clubs in Canada found that as soon as a new, more sexually explicit activity is introduced at a club, customers patronize that club. If other clubs don’t do the same thing to compete, they are left out of the market. The sex industry constantly pushes the limit and creates new scenarios and presentations for forms of sexual exploitation. Recruiting women for stripping and lap dancing is often not that difficult because women assume they will just be “dancing,” and are often given assurances that they don’t have to take off all their clothes. But after the women arrive, the exploiter’s expectations are imposed on the victims. Since 1998 in the U.S., there have been six federal cases of trafficking involving victims being coerced into stripping and the amount of coercion and force used against victims is no less than that used to coerce victims into prostitution. These markets have become attractive to some criminals because they assume that since stripping is legal they will be less likely to be caught trafficking women into these markets.

Modeling and sex trafficking:

A word of caution as a girl can be recruited by dubious model agencies for sexual exploitation and made a call girl or trafficked into another nation as sex worker. We must regulate modeling agencies to help prevent Child Sex Trafficking. There are growing numbers of modeling agencies that transport underage teenagers from developing countries or Eastern Europe into developed countries (Western nation) by falsifying their age. Many of these teenage girls come from economically disadvantaged families and are offered none to very limited protection while traveling and working as “models.” Many of these young “models” are kidnapped and forced into brothels of Europe and North America. Parents who send their daughters for modeling career must ensure that she is working with reputed modeling agency otherwise she can become victim of sex trafficking.

Soldiers, sexual exploitation and sex trafficking:

Where military forces gather, there has been an historical risk of sexual exploitation, especially of local women. A decade ago there were 18,000 prostitutes in the service of the 43,000 U.S. servicemen stationed in South Korea (Barry 139). Between 1937 and 1945 the Japanese army of occupation exploited between 100,000 and 200,000 Korean women imprisoned in “comfort stations”. Over the last year, the U.S Department of Defense made new strides in addressing this phenomenon. UN peacekeeping operations were rocked by a sex abuse scandal in the Congo that caused the organization to reexamine current training policy. And NATO grappled with a wide range of attitudes—and laws covering prostitution—among member countries. Sex trafficking and sex abuse are not synonymous but to satisfy the lust of soldiers, women/girls have been trafficked in the area of military camps.

Sports and sex trafficking:

Some experts say there is evidence that sex trafficking and prostitution might increase at sporting events that draw hundreds of thousands of men away from their homes. Sex trafficking and sex tourism flourish when a large sporting event is hosted because fans and players want to celebrate when they win, and indulging in sexual activities is the leading way to celebrate victory. However, the reality of what actually happens and how people really behave has not lived up to such degraded visions, but in fact far worse than that, where girls/women are sexually abused. It no longer remains celebration or enjoyment but sexual assault. The increase in forced prostitution and sex trafficking for the purpose of sexual exploitation during various FIFA World cups bear testimony to the claim that sporting events promote sex trafficking. When India hosted commonwealth games recently, many women were trafficked in from other countries for sex work. In the U.S.; there is undeniably sex trafficking during Super Bowl. Large sporting events like the Super Bowl are prime targets for sex traffickers because of the high demand generated by thousands of men pouring into an area for a weekend of fun. The 2010 Super Bowl saw an estimated 10,000 sex workers brought into Miami. Despite efforts to crack down on sex trafficking at the 2011 Super Bowl in Dallas, there were still a tremendous number of women and children sexually exploited. In the past, attempted crackdowns by law enforcement have misfired by treating prostitutes as criminals to be locked up rather than victims to be rescued. However, there is exaggeration of figures of sex trafficking during sporting events by media. Nonetheless, sports and sex trafficking are linked.

Drug abuse and sex trafficking:

Traffickers frequently will encourage drug addictions as a means of controlling trafficked persons. This stratagem binds the trafficked person to the trafficker because the trafficked person feels compelled to work in order to maintain the feeling from drug usage. In cases where use becomes dependency, women are further tied to their trafficker to work in order to support their addiction. Moreover, trafficked persons under the influence of drugs or alcohol might be able to work longer hours, perform otherwise risky or objectionable acts with clients, and work with more clients than usual. Occasionally trafficked persons will use alcohol and drugs as a way to tolerate abuse. In order to numb themselves, trafficked persons will use drugs or alcohol to make themselves ‘be able to do’ what they were being made to do. Some trafficked persons will self-medicate using drugs as a form of stress relief.

Drug cartel in sex trafficking:

Cartels will kidnap children and young people, demand ransom, but in many cases never return the victims. The person held in captivity can be filmed doing sex acts and can be sold on the Internet throughout the world and make 10 times that amount of money. A young girl with a certain complexion — blond hair, blue eyes – will dramatically increase the value of the potential victim. Kidnappers are using social media to target victims, by creating a false profile, engages you, talks about you. This person now sounds familiar to you, and your defenses are going to come down, increasing your vulnerability.

Do abortion clinics help sex trafficking?

In the U.S. the Planned Parenthood clinics are offering abortion services to young girls aged 13-14 years involved in sex trafficking when brought by her pimp to the clinic. If a young girl has been enslaved by sex traffickers, shouldn’t we be able to count on the abortion clinic (a facility which claims to care about women) to help rescue her? However, Planned Parenthood clinics in America have been found conniving with sex traffickers. Listen to the story of “Rosa” who was smuggled into the United States from Mexico when she was 14: “And so my nightmare began. Because I was a virgin, the men decided to initiate me by raping me again and again, to teach me how to have sex. Over the next three months, I was taken to a different trailer every 15 days. Every night I had to sleep in the same bed in which I had been forced to service customers all day. I couldn’t do anything to stop it. I wasn’t allowed to go outside without a guard. Many of the bosses had guns. I was constantly afraid. One of the bosses carried me off to a hotel one night, where he raped me. I could do nothing to stop him. Because I was so young, I was always in demand with the customers. It was awful. Although the men were supposed to wear condoms, some didn’t, so eventually I became pregnant and was forced to have an abortion. They sent me back to the brothel almost immediately.” Planned Parenthood and abortion services are an integral part of facilitating the human trafficking/sex trafficking business. Much like abortion, human trafficking thrives because of society’s general lack of respect and value for the inherent dignity of human life. Just as the abortion industry uses the unborn child for profit, the trafficker also profits off of the vulnerable woman who he sees as disposable. It is assumed that abortion is a good way to help women and girls who are victims of trafficking. However, a closer look below the surface shows that abortion is likely to harm, not help, victims of trafficking – and, in the words of one expert, could even be a death sentence. Abortion is usually unwanted and often traumatic, used as a tool by sex traffickers and puts women and girls at further risk for more trauma and continued abuse.

Can widespread contraceptive use lead to sex trafficking?

I believe many of our societal issues are directly related to the use of contraceptives because they allow the sexual act to be performed without accountability. It reinforces personal gratification detached from natural law, which states that sex between a man and a woman can produce a child during fertile days if all is well physiologically. By circumventing this law, people are objectified because it takes the person out of the equation; it becomes solely an act of gratification. If a particular act produces something as significant as creating another human being, doesn’t it seem logical that there would be responsibility attached to that act? Married couples often have the most issues surrounding sex. Women often feel unappreciated and men often struggle with pornography. Could there be a direct correlation between this and sex without responsibility? We may think so due to this objectification. Single people struggle with sexual issues as well. Women will involve themselves in sexual encounters/relationships often in an effort to feel loved and valued. Men will participate in the same type of relationship mostly for physical gratification. This may not always be true, but most will agree they do not feel a sense of responsibility when it comes to sex. Why should they? Contraceptives take accountability out of the situation. Women are fertile a few days out of each month. If instead of using contraceptives, people did not have sex for those few days, value would be restored to the people rather than the sexual act. Since contraceptives have taken out accountability and responsibility from sexual acts, it would promote perversions including rape, sex trafficking, child pornography, abortion and single parent households. However, to be fair to contraception, I would state that prostitution has existed for hundreds of years much before invention of contraceptives and therefore one cannot squarely blame contraceptives for sexual exploitation.

How hotel/motel rooms are used for sex trafficking:

The picture below shows sex trafficking victim in a motel room.

After a pimp and customer make a deal, usually online or over the phone, hotels are an obvious place where the sex can take place. There’s privacy, a neutral place for a customer to come to, certain amount of anonymity and you don’t have to stay long term. Hotel managers may never spot the signs of sex trafficking, but housekeeping and room service employees often know something isn’t right. A pimp might hold up one or two girls in a room and might run traffic out of a room. They’ll post ads on a website and send a girl to the room next door. Red flags to watch for: Someone besides the guest rents a room, checks in without luggage and leaves the hotel. The girl left in the room may seem confused about her own name; may appear helpless, ashamed, nervous or disoriented; may show signs of abuse such as bruising in various stages of healing; or may have tattoos that reflect money or ownership. The girl usually doesn’t have any spending money or identification; cannot make eye contact; and wears clothes printed with slogans such as “Daddy’s Girl” or inappropriate clothes for the weather. Sometimes, the girl will come on to various men during the check-in process. Hotel guests can also keep their eyes open for those red flags. Guests who see the red flags can simply call the national hotline to report their suspicions, without ever leaving their names.

The 2004 Tsunami and sex trafficking:

In the aftermath of the December 26, 2004 Indian Ocean tsunami, there were sporadic reports of rape, sexual abuse, kidnapping, and trafficking in persons in the countries devastated by the tsunami. Thousands of orphaned children were vulnerable to exploitation by criminal elements seeking profit from their misery. In response, governments, international organizations, and NGOs made the prevention of human trafficking, particularly child trafficking, an integral component of disaster-relief planning. The tsunami-affected countries immediately alerted the public about the danger of human trafficking and worked with police and community officials to detect and deter trafficking cases. In particular, the Indonesian Government moved swiftly to halt international adoptions in the face of potential abuse. The Sri Lankan and Indonesian Governments also posted additional police at camps for internally displaced persons to prevent abuses of women and children.

Inter-country adoption and sex trafficking:

Inter-country adoption has pressed into the public consciousness in two contradictory ways. On the one hand, inter-country adoption is presented as a heart-warming act of good will that benefits both child and adoptive family. The child is characterized as a bereft orphan doomed to a dismal future within a poor country. All the child needs is a chance and a home. The adoptive family’s simple act of love in bringing the child to the Promised Land (western nation) brings to the adoptive parents a harvest of love from the child while also enriching the nation with a dynamic diversity. Contrasted with the positive face of adoption are numerous scandals and horror stories concerning inter-country adoption. The adoption process, legal or illegal, when abused can sometimes result in cases of trafficking of babies and pregnant women between the West and the developing world. In David M. Smolin’s papers on child trafficking and adoption scandals between India and the United States, he presents the systemic vulnerabilities in the inter-country adoption system that makes adoption scandals predictable. Adoption is portrayed as child trafficking or baby selling. Shadowy figures buy, steal, or kidnap children from poor families in developing nations for sale to adoptive families in rich nations. Such inter-country adoption may be involved in child sex trafficking from poor nation to wealthy nation.

Sex trafficking and media:

The media plays an indispensable role in educating people about the many manifestations of global human trafficking, presenting the problem in human terms and in all its painful detail. Yet media coverage is weak in many parts of the world. Some news media outlets are not yet aware of the trafficking phenomenon, or confuse it with other issues such as illegal migration and alien smuggling. The media has a large role to play in mobilizing public support and involvement to help prevent and combat trafficking. Due to its reach and ability to mould public opinion, it is a powerful tool of social change. Investigative journalism on trafficking needs to be promoted. However, media publicity should take into consideration the rights approach and ensure that there is no violation of the rights of the victims and survivors. So, there is a need to develop minimum standards for the media.

DO’S for media:

Tell the truth.

Be accurate and objective and, above all, fair.

Use masking techniques to avoid revealing the identities of the victims.

The victims can do with some empathy from the journalists. Try to feel what they feel.

Do not expose them, but take up their cause.

Investigate the reasons behind trafficking.

Help track down perpetrators.

Visit source areas and see the reality in all its complexity.

Highlight the problems the survivors face, not their trauma.

Cover the story at court – focusing on the law, its lacunae, its enforcement, delays, etc.

Choose your words carefully.

DON’TS for media:

When you want to do such a story – be a little more human.

Do not treat the survivor as an object.

Refrain from treating them as ‘victims’ as well.

Try and avoid taking pictures of faces of the survivors.

Try not to ask questions to victims that violate their dignity. (How many times were you raped? How many clients a day?)

Try not to take them (on a mental recap of their actual journey) to the brothel.

Try not being patronizing, compassionate or even sympathetic.

Do not distort facts to sensationalize even with blurbs, captions and visuals.

Avoid tabloid-like, sensational headlines.

Avoid an “us-versus-them” attitude.

Be objective. There is no need for a trial by media.

How do you tackle & manage sex trafficking?

The picture below shows the “disconnect” between prevalence and knowledge of sex trafficking.

Human sex Trafficking is an organized crime and one of the gravest violations of Human Rights transgressing boundaries of official jurisdictions and other man made restrictions of time and space. The list of traffickers and exploiters is endless. It is indeed a “high profit – low risk business”. Very often, victims remain un-noticed, un-cared for and their concerns not addressed. People are often not concerned because they are unaware of the extent, dimensions and implications of Human Trafficking. The prevailing ‘culture of silence’, ‘culture of tolerance’ and the ‘culture of non-concern’ not only permits but, promotes and perpetuates Human Trafficking and gives a free hand to the traffickers to continue with impunity, the merchandising of human beings. Law Enforcement Agencies are mandated to respond to the challenges of this trans-national organized crime. However, the very complex nature and manifold dimensions of human trafficking requires concerted and synergic response especially in the context of rehabilitation of the trafficked persons. Therefore, the anti-human trafficking response cannot be exclusively left to the domain of a police official at the police station. What is appropriate is an integrated and holistic response by a host of agencies including law enforcement officials, agencies concerned with justice delivery, social welfare and development, as well as civil society organizations, the media, academicians etc. A synergy of efforts is therefore indispensable during the ’3 Ps’ of anti human trafficking, namely, Prevention, Prosecution and Protection.

Prevention:

A multi-pronged prevention strategy for creating awareness, sensitization and dealing with vulnerability factors of specific areas/communities can be effectively implemented with the involvement of the concerned government departments, law enforcement agencies, NGOs, media and corporate/business houses. Preventing re-trafficking is an area where NGOs along with the assistance of corporate/business houses can play a stellar role by ensuring the economic rehabilitation of rescued victims/survivors. Prevention also calls for addressing the demand factors, which includes demand for child labor, demand for children in sex tourism, etc. Captains of industry and the tourism sector can play a substantial role in this area.

Prosecution:
An effective and successful prosecution is not the responsibility of law enforcement agencies alone, but can be brought about by the combined endeavors of NGOs (for e.g. by preparing a victim to face a court room situation, etc.) and the media (for e.g. by a continuous follow-up on the progress of the trial, by being vigilant to ensure that justice is delivered with celerity, certainty and surety). The number of convictions is increasing, but unfortunately not proportionately to the growing awareness and extent of the problem. There are several likely reasons for the low number of convictions of human traffickers. One of the reasons is the absence of anti-trafficking legislation in some countries. Alternatively, there may be legislation addressing human trafficking but law enforcement officials and prosecutors might not be properly trained to utilize it. Sometimes situations of human trafficking are mistaken for situations of migrant smuggling; this can result in inappropriate and inadequate sentences applied to crimes. Another potential obstacle to securing convictions may also be corruption. Further to this, sometimes prosecutions are not successful because of the unwillingness of victims to cooperate with the criminal justice system where they have been threatened and intimidated by traffickers.

Protection:
Protection of the rights of the victim during the criminal justice system processes (investigation and trial) can be effectively undertaken by all the stakeholders involved. The care and attention of the rescued person can be broadly classified into two; firstly, counseling, de-dramatization and psychosocial and medical attention. Secondly, empowerment programs and providing sustainable livelihood options. In these areas, everyone can be a stakeholder, with a specific role to play; this includes law enforcement agencies, civil society organizations, media, political personalities, celebrities, business houses, academics, and every citizen who is concerned with human rights issues.

Partnerships and Inter-Agency Cooperation:

Experts in the field of human trafficking emphasize the need to work in partnership or in a coordinated international, national and local response to effectively combat sex trafficking. Law enforcement, prosecutors, judges, service providers and the public must work together to use the full extent of the community’s legal system to protect victims, hold perpetrators accountable, and enforce the community’s intolerance of the sale of human beings for sex. Coordinated community response programs should engage the entire community in efforts to change the social norms and attitudes that contribute to sex trafficking. Civil society organizations are critical partners particularly in prevention and protection efforts, but can also be key in assisting the government in the area of prosecution, starting with their role in the identification of victims of trafficking, support and care for victims of trafficking throughout court proceedings, including the provision of legal assistance, medical and psychological aid, as well as in contributing to a dignified process of repatriation (if such is desired by the victim) and reintegration, or the process of integration into society if a residency status is granted.

It should not happen that remedy is worse than disease. If the ‘victim of trafficking’ be eventually sent home to be reunited with her misery once again, then she will choose not to identify herself as a ‘victim of trafficking’ – in order not to become a victim of anti-trafficking.

The picture below shows how sex trafficking can be reduced by concerted efforts of various agencies, organizations and individuals.

Prosecution of pimps:

Throughout the world, most prostitution-related arrests are of the women and girls, who are most likely to be victims, followed by the purchasers of sex acts, and finally, the exploiters. Although they are the profiteers and most serious perpetrators of harm to victims, they are the least arrested and prosecuted. The Barnardos report on pimping in the UK notes: “‘Pimping’ is an offence which rarely attracts the attention of the criminal justice system… [although pimps] do…play a large part in locking sex workers into sex work.” In interviews, the police said that they rarely charge an individual with pimping unless the woman or girl files a complaint.

In the UK, police gave following reasons for the low number of arrests and convictions of pimps:

1) Evidential problems of proving living off immoral earnings;

2) A lack of resources and manpower needed to secure successful prosecutions;

3) Inadequate court sentences;

4) Witnesses are fearful and unprotected by the criminal justice system;

5) Variations in police practice across areas.

Raising awareness:

This can take three forms. First, in raising awareness amongst potential victims, particularly in countries where human traffickers are active. Second, raising awareness amongst police, social welfare workers and immigration officers to equip them to deal appropriately with the problem. And finally, in countries where prostitution is legal or semi-legal, raising awareness amongst the clients of prostitution to watch for signs of human trafficking victims. Raising awareness can take on different forms. One method is through the use of awareness films or through posters.

What can individuals do?

Learn, read, report, and stop burying your heads in the sand. Many of the people involved in these crimes could be your next door neighbor. Get local law enforcement initiatives started, and ask your local police chief question regarding sex trafficking. Try to find out whether local hotel/motel/guest house have non-native young females working, who do not speak local language, have no documents and do not know what wage they are being paid. Individuals have a crucial part to play. First, they can support grassroots anti-slavery organizations, either through volunteer efforts or financial contribution. Second, they can demand that their governments take the steps required to abolish slavery once and for all. Third, and perhaps most important, they can serve as the frontlines of a new abolitionist movement, by forming a system of anti-slavery community vigilance committees. Opposing sex trafficking, the system of prostitution and the sex industry doesn’t make you a conservative, a moralist, or an apologist for some political party or group. It helps make you a feminist and a human rights advocate.

Sex education must be included in curricula of high schools which have chapters that introduce child sexual abuse, its effects, measures to be taken to protect children from child sexual abuse, and also elaborates on reasons for child trafficking.

Tips to protect children from sex trafficking:

1. Make sure your children are with you, or with a trusted adult at all times.

2. Strictly monitor computer use. Sex traffickers can toy with children over the Internet at their leisure, until they have them emotionally entrapped.

3. Educate your children going off to college or travel about the deception used by sex traffickers. If someone seemingly needy asks for assistance, girls should get a policeman or a security guard to help.

4. Teach kids never to lose themselves in alcohol or drugs.

5. Warn young people to avoid stairwells, elevators, clubs, bars, and deserted streets where they can be whisked out of sight.

6. Teach youngsters to beware of offers of modeling and dancing careers that seem too good to be true. Millions of girls have lost their lives believing they were going to be famous, or have better opportunities.

Can biology of sex bail out men for creating demand of sex trafficking?

Let us understand basic biological fact. Sex is not easy for men. Sex is a complicated process for men. Men need to have a hard erection in order to have sex. Getting an erection is a complicated process. Getting a rock hard erection is not necessarily easy for men. In order for a man to have a hard erection, he must be sexually aroused by the woman, feel comfortable, and continue to be aroused or he will lose the erection and have a soft flaccid penis. Can a woman or a girl who is crying, kicking, and screaming because she does not want to have sex with him turn on men? Does this make men sexually excited? Does this give men a rock hard erection when the woman they are trying to have sex with hates them, and is doing everything she can to prevent sex with him? Does this always turn men on sexually? For most men the answer is no. Most men will never get an erection raping a woman who hates him, and does not want to have sex with him, or they will lose the erection quickly and have a soft flaccid penis. Men, when they see a prostitute are looking for a sexy woman and want a “girlfriend experience” and want the woman to like them and want to have sex with them. The man needs to feel comfortable with the woman. If the woman does not want to have sex with them, that is a big turn off and the man will not get an erection. The man will have a soft flaccid penis. Of course, there will always be a few men who are perverts. Those are not turned on sexually in the normal way but in abnormal way (e.g. rapists). Barring these exceptions, it can be assumed that most normal men will not get hard erection while having sex with sex trafficked woman/girl who is resisting. However, the truth lies somewhere in between rape and consensual sex. Most victims of sex trafficking are “broken girls” who have been tortured, raped and blackmailed by pimps, and so while encountering customers, they do not resist or scream and in fact, during sexual act, their conscience is out of their body so that they do not feel anything; and therefore biology of sex cannot bail out men for creating demand of sex trafficking. Also, as discussed earlier, most men who buy sex do not buy sex to get orgasm, but to sexually abuse a woman/girl in a way they could not do with their wives or girlfriends.

Can this happen to you or your loved one?

Our instinct is to start listing the reasons this couldn’t happen to us or those we love. There must be some inherent issue with the victims that separates us. No, nobody is invulnerable to sex trafficking. When traffickers pick up a girl who has some fight in her, she has to be broken. Often, she’s shut in a room on a nasty mattress, her clothes are taken away, and a series of men—drunk, fat, ugly, stoned, and otherwise—come in, one after the other, twenty-four hours a day for several days and keeps on raping her. She can’t get out. She can’t eat. She can’t even sleep. She gives in and becomes a forced prostitute. She is forced to service more than a dozen clients a day—business men, locals, and tourists—interested in quick sex for cash. After several months of sexual abuse and physical violence, she is mentally and emotionally destroyed and is resigned to her situation. She no longer dreams of going home. She is broken. Any woman can be broken in and turned into a prostitute. There is another way to manipulate victims, that is by controlling them with drugs. Can she run away? Her trafficker has threatened to steal a younger brother or sister or kill her parents. She is so weak she can’t get up. She knows that cops cannot be trusted, and she’s seen that played out. The good cop will send her to jail for the night, take all her clothes as evidence, and release her to the streets in the morning with nothing but a prison uniform. The bad cop will threaten her with jail if she doesn’t continue with commercial sex. The bad cop may also use sexual services from victim. She has no other marketable skills. She has no money and no place to live. She would go from a skanky shelter-home with a life of abuse to the streets, where she’d still be vulnerable to abuse, but also to weather and starvation. This is the bleak picture. For those of you who think it cannot happen to you, I want to let you know that the dragnet of the traffickers is so wide that only God knows who is safe. I cannot remain silent to this bleak picture. The least I can do is to create awareness among people about sex trafficking and remind people that it can happen to your daughter, your sister or your girl friend who could be sex trafficked into some distant place where you cannot help her. So fight for the victims of sex trafficking socially, legally and culturally.

“We, the survivors of prostitution and trafficking gathered at this press conference today, declare that prostitution is violence against women. Women in prostitution do not wake up one day and “choose” to be prostitutes. It is chosen for us by poverty, past sexual abuse, the pimps who take advantage of our vulnerabilities, and the men who buy us for the sex of prostitution.” (Manifesto, Joint CATW-EWL Press Conference, 2005).

Contrary to the old cliché, prostitution is almost certainly not the world’s oldest profession–that would be hunting and gathering, perhaps followed by subsistence farming–but it has been found in nearly every civilization on Earth stretching back throughout all recorded human history. We can say with some confidence that wherever there have been money, goods, or services to be bartered, somebody has bartered them for sex. Everybody, both men and women, has a responsibility for the society we live in, and for what kind of society we want our daughters and sons to grow up in. We want the future daughters to have all possibilities in society, so that they won’t have to sell their bodies. And we do not want a society where boys are taught that women can be bought. Sale of the female body is contrary to an equal society. Female sexual slavery is present in all situations where women or girls cannot change the immediate conditions of their existence; where regardless of how they got into those conditions they cannot get out; and where they are subjected to sexual violence and exploitation. It is impossible to combat trafficking where prostitution is legally sanctioned. As long as prostitution is tolerated, and governments permit it to be practiced as a legal and valid employment alternative, trafficking in and violence against women will continue.

Myths of sex trafficking:

Myth 1: Sex trafficked persons can only be foreign nationals or are only immigrants from other countries.

Fact: Sex trafficking encompasses both transnational trafficking that crosses borders and domestic or internal trafficking that occurs within a country. Statistics on the scope of trafficking are most thorough and accurate if they include both transnational and internal trafficking of native citizens as well as foreign nationals.

Myth 2: Human trafficking is another term for human smuggling.

Fact: In human smuggling, people voluntarily request or hire an individual, known as a smuggler, to covertly transport them from one location to another. This generally involves transportation from one country to another, where legal entry would be denied upon arrival at the international border. There may be no deception involved in the (illegal) agreement. After entry into the country and arrival at their ultimate destination, the smuggled person is usually free to find their own way. In human trafficking, deception, coercion or fraud is used to traffic a person and upon arrival at destination, a trafficked person is not free but enslaved.

Myth 3: There must be elements of physical restraint, physical force, or sexual assault when identifying a sex trafficking situation.

Fact: The legal definition of sex trafficking does not require physical restraint, bodily harm, or physical force or rape. Psychological means of control such as threats, fraud, or abuse of the legal process are sufficient elements of the crime.

Myth 4: Sex trafficking victims always come from situations of poverty or from small rural villages.

Fact: Although poverty can be a factor in human trafficking because it is often an indicator of vulnerability, poverty alone is not a single causal factor or universal indicator of a human trafficking victim. Trafficking victims can come from a range of income levels, and many may come from families with higher socioeconomic status especially when her family members or boyfriend is involved in selling her to pimp.

Myth 5: If the sex trafficked person consented to be in their initial situation or was informed about what type of sex work they would be doing or that commercial sex would be involved, then it cannot be sex trafficking or against their will because they “knew better.”

Fact: A victim cannot consent to be in a situation of sex trafficking. Initial consent to commercial sex prior to acts of force, fraud, or coercion (or if the victim is a minor in a sex trafficking situation) is not relevant to the crime, nor is payment.

Myth 6: Foreign national trafficking victims are always undocumented immigrants coming to destination country illegally.

Fact: Foreign national trafficked persons can be in the destination country through either legal or illegal means. Although some foreign national victims are undocumented, a significant percentage may have legitimate visas for various purposes. Not all foreign national victims are undocumented.

Myth 7: Victims of sex trafficking will immediately ask for help or assistance and will self-identify as a victim of a crime.

Fact: Victims of sex trafficking often do not immediately seek help or self-identify as victims of a crime due to a variety of factors, including lack of trust, self-blame, or specific instructions by the traffickers regarding how to behave when talking to law enforcement or social services. It is important to avoid making a snap judgment about who is or who is not a trafficking victim based on first encounters. Trust often takes time to develop. Continued trust-building and patient interviewing is often required to get to the whole story and uncover the full experience of what a victim has gone through.

Myth 8: Prostitution is a victimless crime.

Fact: Prostitution creates a setting whereby crimes against women and girls become a commercial enterprise…. It is an assault when he forces a prostitute to engage in sadomasochistic sex scenes. When a pimp compels a prostitute to submit to sexual demands as a condition of employment, it is exploitation, sexual harassment, or rape — acts that are based on the prostitute’s compliance rather than her consent. The fact that a pimp or customer gives money to a prostitute for submitting to these acts does not alter the fact that child sexual abuse, rape, and/or battery occurs; it merely redefines these crimes as prostitution.

Myth 9: Legalization would better protect people in the sex industry from violence and abuse.

Fact: Regardless of prostitution’s status (legal, illegal or decriminalized) or its physical location (strip club, massage parlor, street, escort/home/hotel), prostitution is extremely dangerous for women. Homicide is a frequent cause of death…. It is a cruel lie to suggest that legalization will protect anyone in prostitution. It is not possible to protect someone whose source of income exposes them to the likelihood of being raped repeatedly, have sexual compliance to 10 to 15 buyers everyday and suffer from STDs including HIV.

Myth 10: For HIV/AIDS prevention to succeed; legal, social, economics – of sex work has to change, with repeal of criminal laws.

Fact: Even if a prostitute is being tested every week for HIV, she will test negative for at least the first 4-6 weeks and possibly the first 12 weeks after being infected…. This means that while the test is becoming positive and the results are becoming known, that prostitute may expose hundreds clients to HIV. This is under the best of circumstances with testing every week and a four-week window period. It also assumes that the prostitute will quit working as soon as she finds out the test is HIV positive, which is highly unlikely. So this is not the best approach for actually reducing harm. Also, no law forces clients to test for HIV before they approach sex worker and many clients bring HIV to sex workers who then transmit it to other clients. Instead, in order to slow the global spread of HIV/AIDS we should focus our efforts on abolishing prostitution.

Myth 11: It is estimated that if prostitution were legalized, the rape rate would decrease by roughly 25%.

Fact: Prostitution cannot eliminate rape when it itself bought rape. The connection between rape and prostitution is that women are turned into objects for men’s sexual use; they can either be bought or stolen. A culture in which women can be bought for use is one in which rape flourishes.

Myth 12: Prostitution is the oldest profession in the world – you will never end it.

Fact: Just because something has been around for a long time does not mean it’s a good thing. Slavery was a legal trade for many years, but the international community took a stand against it. Sex trafficking is a modern day form of slavery that must also be stopped. Sex trafficking exists because prostitution exists.

Myth 13: How will these women earn a living if men stop paying for sex with them? She will starve to death.

Fact: Trafficked women don’t receive the money that exchanges hands for their sexual services. This money goes directly to their traffickers, pimps and exploiters. The women themselves are kept as prisoners, their passports are confiscated and they are forced to sleep with as many as 25 men a day for nothing as they have to clear their debt.

Myth 14: Prostitution is a choice by women.

Fact: I understand that some women will and do choose to work in prostitution. However, for the vast majority of women working in prostitution, and particularly trafficked women who are coerced, deceived or forced; they do not have a choice.

Myth 15: If teenagers are voluntarily engaging in prostitution to earn money, they should not be called victims of sex crime.

Fact: As far as sex trafficking is concerned, anybody below the age of 18 years is a child. For example, a girl can have consensual sex with her boyfriend if she is above the age of 16 years but if she is lured into sex trafficking by a pimp, she becomes a victim of crime. Child prostitution is illegal in most countries and minors who take money for sex are usually taking part in that illegal activity; nevertheless they are also victims of crime. The majority of minors who become involved in prostitution are runaway or thrown away children from abusive or otherwise dysfunctional homes. They are often lured into prostitution by sophisticated criminals who convince them not only that they will earn money to survive but also that they will be taken care of and have the secure loving environment that they lacked at home. These promises are never honored and pimps take the money a child earns on the streets and pimps engage in severe physical abuse to build a relationship of dependency.

Myth 16: All women working in prostitution, strip clubs, escort agencies and sex massage parlors choose their profession for the lifestyle and money. They are living the “Pretty Woman” dream by setting their own terms of work and keeping all the money they earn.

Fact: There is evidence that many workers in the sex trade are trapped in modern sex slavery. They are lured by a boyfriend or recruiter posing as a friend or potential employer. Some are sold into the industry by their fathers, brothers or husbands. After recruitment, these women are trapped by drug addiction and debt bondage to a pimp, gang or sex trade ring.

Myth 17: Sex workers cannot be raped.

Fact: This belief justifies violence against sex workers. Sexual transactions are for consensual activities and thus sex workers must give their permission. Sex workers have just as much of a right to give consent as does the rest of society.

The moral of the story:

1. Human trafficking is the second-largest organized crime in the world and 80 % of it is sex trafficking.

2. Every 30 seconds, one woman/girl is trafficked for sexual exploitation. Every 2 minutes, one girl child is being prepared for sexual exploitation. Only 1 to 2 percent of victims are rescued.

3.The prevailing ‘culture of silence’, ‘culture of tolerance’ and the ‘culture of non-concern’ not only permits but, promotes and perpetuates sex trafficking and gives a free hand to the traffickers to continue with impunity.

4. Complicity, complacency and corruption of the state drives global sex trafficking trade.

5. The demand for sex by men and gender inequality propagated by society are the root causes of sex trafficking besides host of other factors.

6. Humans have reached lowest level of morality by accepting sex industry as legitimate economic sector with pimps & traffickers as entrepreneurs and sex victims as commodities.

7. Sex trafficking is the leading cause of HIV epidemic worldwide.

8. There is evidence to link pornography with sex trafficking.

9. Sexual promiscuity is an inevitable consequence of biological sex drive but there are better way to deal with it including masturbation or consensual sex with willing partner (wife or girl friend or acquaintance). Prostitution and sex trafficking are certainly not the way to deal with biological sex drive.

10. Prostitution and sex trafficking are violence against women. Barring some exceptions, all sexual relationship during commercial sex work is a paid rape where alleged consent is obtained by paying money. Under no circumstances, such sexual relation be termed as consensual sex. By labeling sexual relations in sex industry as consensual sex, you are denigrating consensual sex between two adults outside sex industry. When a man and woman have consensual sex (either premarital or extramarital or marital or casual), it is implied that they are attracted towards each other. During commercial sex, man is sexually exploiting a woman and the woman is reluctantly consenting as she is getting money for survival.

11. Prostitution is not a desirable social phenomenon and is an obstacle to the ongoing development towards equality between men and women.

12. Legalization of prostitution is a failed policy and leads to increased sex trafficking. When the legal barriers disappear, so too do the social and the ethical barriers to treating women as sexual commodities.

13. As far as criminalization of sex industry is concerned, buying sex must be criminalized and selling sex must be decriminalized. That means all customers, pimps and traffickers must be prosecuted but all girls/women who are trafficked into sex industry must be considered as victims.

14. I support death penalty for pimps/traffickers through due process of law.

Dr. Rajiv Desai. MD.

March 8, 2011

Postscript:

Trafficking in humans for sexual exploitation has been practiced for centuries. What is new is the scale of the trade, the ages of those involved and the organization applied to the marketing. When I went into the details of sex trafficking, I heard voices of some of the world’s most silent and abused women – women who have been forced into prostitution by the men they trust. This is their story about the journey from home to captivity, from love to abuse and from honor to disgrace. I am also a victim of child trafficking during infancy traveling through various hands and various countries and I know that nobody helped me in my difficult days because traffickers have no compassion, no remorse and no faith. This is the most passionate article I have ever written and I hope that it will be appreciated by all regardless whether they agree with me or not.

Tags: abortion and sex trafficking, adoption and sex trafficking, causes of sex trafficking, child sex tourism, comfort women, CSEC, forced prostitution, gender inequality, HIV and sex trafficking, Human trafficking, impact of sex trafficking, johns, legalization of prostitution, male demand, migrant smuggling, myths of sex trafficking, pimp, pornography and sex trafficking, prostitution, sex industry, sex service, sex tourism, sex victim, sex work, sexual slavery, traffickers, TVPA, victimless prostitution, violence in prostitution, white slavery
Posted in CRIME AND LAW, EDUCATION, PUBLIC AWARENESS, SOCIAL/CULTURAL/CIVILISATION | 21 Comments »

CAREER GUIDANCE AND CAREER EDUCATION

February 9th, 2012

CAREER GUIDANCE AND CAREER EDUCATION:

Note: Even though the word ‘career’ and the word ‘vocation’ are used interchangeably, the term career guidance & career education is more inclusive than the term vocational guidance & vocational education but these terms are often used interchangeably despite delicate difference between them (vide infra). Vocational education is also known as VET (vocational education and training) or CTE (career and technical education).
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Prologue:

The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddiness in philosophy because it is an exalted activity will have neither good plumbing nor good philosophies. Neither its pipes nor its theories will hold water. Education is not the filling of a bucket, but the lighting of a fire. Popular misconceptions about the labor market and college, including the widespread beliefs among parents that a three to four-year college degree will guarantee their children a place in the middle class and that every child has the aptitude and interests to succeed in an academic three to four-year college degree program result in mad rush for college admissions. When I was in high school, nobody gave me any career guidance including parents, teachers, friends, neighbors or society in general. I became doctor because I had high marks in higher secondary exam without ever knowing whether I had attitude and/or aptitude to become a doctor. No wonder, I discovered mathematical formula of Pi when I was a medical student. Everybody is not as blessed as me and therefore waste their entire life in a career which is a perfect mismatch with their abilities. More than one billion young people will reach working age within the next decade. Providing them with the opportunity to secure productive employment and decent work is a societal, national and global challenge. The International Labor Organization estimates that around 85.3 million young women and men were unemployed throughout the world in 2006, accounting for 44 per cent of all unemployed persons globally. I see thousands of unemployed college degree holders in India because they cannot do any skilled work like plumber, welder, electrician or mechanic. It is not just the level of education achieved, but the quality and relevance of education and training that is important. Providing young women and men with formal and non-formal educational possibilities, including career guidance & vocational training would lead to their empowerment. Action has to be taken in order to avert the growing youth unemployment crisis. The expected inflow of young people into the labor market, rather than being viewed as a problem, should be recognized as presenting an enormous opportunity and potential for economic and social development. Governments, employers’ & workers’ organizations, international development partners and civil society need to tap into this vast productive potential of men and women.

Education:

Education is the process by which people’s abilities and talents are developed. Education, in this broad sense, is also everything that is learned and acquired in a lifetime: habits, knowledge, skills, interests, attitudes, and personality. From this standpoint, people become educated not merely by attending schools but by the total experiences of life. They learn through direct experience, imitation, and self-teaching. They learn from parents and friends, from such institutions as churches and libraries, from recreational and social agencies such as clubs, and from the press, motion pictures, radio, television, internet, and the like. In the narrow sense, education is the formal process by which society deliberately transmits its accumulated knowledge, skills, customs and values from one generation to another, e.g., instruction in schools. It is with this definition of education that the remainder of this article deals. A right to education has been created and recognized in many countries. In many European countries and Japan, almost all children between 6 and 16 are compelled by law to attend school. In many countries of Africa, Latin America, and Asia, however, a large percentage of school-age children are not able to go to school. Systems of schooling involve institutionalized teaching and learning in relation to a curriculum, which itself is established according to a predetermined purpose of the schools in the system. In formal education, a curriculum is the set of courses and their content, offered at a school or university. As an idea, curriculum stems from the Latin word for race course, referring to the course of deeds and experiences through which children grow to become mature adults. A curriculum is prescriptive, and is based on a more general syllabus which merely specifies what topics must be understood and to what level to achieve a particular grade or standard. Examples of the purpose of schools include: develop reasoning about perennial questions, master the methods of scientific inquiry, cultivate the intellect, create positive change agents, develop spirituality, and model a democratic society. Schooling is usually divided into stages or levels: primary (elementary), secondary (usually called high school), and higher education (colleges, universities, and professional schools). Adult education is often considered a fourth level.

Preschool education (or infant education) is the provision of learning to children before the commencement of statutory and obligatory education, usually between the ages of zero and three or five, depending on the jurisdiction. Primary education is the first stage of compulsory education. It is preceded by pre-school or nursery education and is followed by secondary education. In North America, this stage of education is usually known as elementary education and is generally followed by middle school. The major goals of primary education are achieving basic literacy and numeracy amongst all pupils, as well as establishing foundations in science, mathematics, geography, history and other social sciences. The relative priority of various areas, and the methods used to teach them, are an area of considerable political debate. Secondary education is the stage of education following primary education. Secondary education includes the final stage of compulsory education and in many countries it is entirely compulsory. The next stage of education is usually college or university. Secondary education is characterized by transition from primary education for minors to tertiary, “post-secondary”, or “higher” education (e.g., university, vocational school) for adults. Higher, post-secondary, tertiary, or third level education refers to the stage of learning that occurs at universities, academies, colleges, seminaries, and institutes of technology. Higher education also includes certain collegiate-level institutions, such as vocational schools, trade schools, and career colleges that award academic degrees or professional certifications. Higher education is taken to include undergraduate and postgraduate education, while vocational education and training beyond secondary education is known as further education in the United Kingdom, or continuing education in the United States. An academic discipline is a branch of knowledge which is formally taught, either at the university, or via some other such method. Each discipline usually has several sub-disciplines or branches, and distinguishing lines are often both arbitrary and ambiguous. Examples of broad areas of academic disciplines include the natural sciences, mathematics, computer science, social sciences, humanities and applied sciences.

Education benefits the individual and the society in which the individual lives. A person without an adequate education may have difficulty finding a job and earning a living. The economic well-being of a country can be undermined by lack of a skilled work force, and the more technologically advanced a nation is the more acute is its need for educated workers. Every group, no matter how primitive, makes at least some effort to train its youth in its way of life. As a society becomes more complex, education becomes more important. Schools and other institutions play a vital role in preserving and extending a nation’s cultural heritage. Education has acquired great importance in all societies. It helps to prepare the men and women who direct and carry out the varied activities required in a modern society. Education is considered to be essential in all democratic societies. People who govern themselves must learn to recognize and preserve their freedoms, form intelligent opinions about public affairs, vote thoughtfully, and hold office effectively. Education is a major component of well-being and is used in the measure of economic development and quality of life, which is a key factor determining whether a country is a developed, developing, or underdeveloped country. Countries differ widely in the rate of literacy—the ability to read and write—among the adult population. Levels of literacy range from more than 95 per cent of the adult population in northern, western, & central Europe and Japan to less than 20 per cent in many of the countries of Africa and Asia. The United Nations publishes a Human Development Index every year, which consists of the Education index, GDP Index and Life Expectancy Index. These three components measure the educational attainment, GDP per capita and life expectancy respectively. The Education Index is measured by the adult literacy rate (with two-thirds weighting) and the combined primary, secondary, and tertiary gross enrollment ratio (with one-third weighting). The adult literacy rate gives an indication of the ability to read and write, while the gross enrollment ratio gives an indication of the level of education from kindergarten to postgraduate education.

The image above shows World Map indicating Education Index based on the UN Human Development Report in October 2009. All countries considered to be developed countries possess a minimum score of 0.8 or above, although the great majorities have a score of 0.9 or above.

Comparison of education between India and China:

Few weeks back, in the ACER PISA test — the OECD’s annual global assessment of students’ skills (for South and South East Asia) — India came second from the bottom defeating Kyrgyzstan while China topped the list. This acts as the final nail in the coffin of India’s dented education system. China today has installed key schools meant for highly academically inclined students. China has adopted a policy of providing nine-year compulsory education to all with a special emphasis on vocational training and higher education. Contrast this with India, where a high-school student is unable to solve a basic mathematical problem or frame a sentence on his own. Moreover, Indian rural schools are mired with problems of infrastructure and above all suffer largely from the curse of teachers’ absenteeism. On an average, more than 30 per cent of teachers are found absent in rural schools in India. In 2003, the Academic Ranking of World Universities (ARWU) ranking showed that there were 23 Chinese universities amongst 35 featured in total. In comparison, India did not figure anywhere in ARWU. There are 545 universities in India compared to 2,236 in China. India has only 5,100 ITIs and 1,745 polytechnics compared to China’s 500,000 VETs (Vocational Education and Training institutions). Clearly, not only is India far behind in the number of quality institutions, but India is decades behind in framing the right kind of policies. How can education policy of largest democracy far worse than that of authoritarian regime? Indian leaders & media have to answer this question. Oh, they are busy discussing cricket & bollywood and whether cricket star or movie star should be given highest civilian honor. When you do not respect education, the education does not respect you and you become a country of fake icons.

There are two main types of education:

(1) General education (academic education)—the nonspecialized education that is concerned with activities that all people have in common regardless of occupation;

(2) Vocational and Professional education — the training that prepares persons for specific jobs or professions. Vocational education means training designed to advance individuals’ general proficiency, especially in relation to their present or future occupations. The term does not normally include training for the professions. While a general education strives to give students a broad range of cross-disciplinary knowledge and at the same time a single focus (the student’s choice of major), vocational education operates under the theory that only information pertinent to a specific trade is necessary for a person to enter the work force. Within the trade that is chosen, a student of a vocational program may learn less theory than his or her counterpart at a general education school, but will probably obtain more direct experience and be well suited to enter the workforce upon graduation. Professional education courses like doctor, engineer, scientist etc do not come under preview of vocational education.

The figure below shows how general education (academic), vocational education and professional education are connected to working life.

Life Skills:

Life skills are problem solving behaviors used appropriately and responsibly in the management of personal affairs. They are a set of human skills acquired via teaching or direct experience that are used to handle problems and questions commonly encountered in daily human life. The subject varies greatly depending on societal norms and community expectations. The term “life skills” refers to the various psychosocial and interpersonal skills that lead people to a healthy and productive life. These skills include the ability to make informed decisions, communicate effectively, cope with life situations, and manage oneself. Life skills can vary from financial literacy, substance abuse prevention, to therapeutic techniques to deal with disabilities, such as autism. Life skills may include actions for oneself or towards others, as well as actions to change the surrounding environment in order to make it more conducive to good health. Life skills competencies are necessary for the total development of children and youth. These competencies are the knowledge, skills, attitudes, and types of behavior that children and youth need to become healthy, happy, and well-balanced individuals. Children who have these competencies will be able to meet the challenges of work and life in a complex and fast-paced world. Life skills are often taught in the domain of parenting, either indirectly through the observation and experience of the child, or directly with the purpose of teaching a specific skill.

Life skills ought to be taught to students in schools are narrated below:

Life skills are incorporated in education curricula of developed nations while life skills are ignored in education curricula of developing nations. The cause-effect relationship between life skills and development is unclear. That means whether incorporation of life skills in education curricula resulted in producing a developed nation or whether developed nation incorporated life skills as a consequence of their development is a matter of debate. I got educated in India but nobody taught me any life skill. My entire school education was based on memorizing concepts rather than applying concepts in practice.

Aptitude and attitude:

Aptitude is variously defined as innate learning ability, the specific ability needed to facilitate learning a job, aptness, knack, suitability, readiness, tendency, natural or acquired disposition or capacity for a particular activity, or innate component of a competency. It is the sum total of innate abilities plus acquired skills and abilities. The first component of aptitude is beyond a person’s control – we are just born that way – and the second one is dependent attitude! Aptitude is something over which none of us have any control whatsoever (except when we acquire learned skills).

Aptitude:

Attitude is the manner, disposition, feeling or position, etc. with regard to a person or thing – tendency or orientation especially of the mind (positive/negative attitude); also the position or posture of the body appropriate to or expressive of an action, emotion, etc. e.g. a threatening attitude or a relaxed attitude. Simply put, I’d say it is our mental / emotional response to people or events in life. Attitude is something over which all of us have total control.

Attitude:

Aptitude Assessment for career and educational guidance:

Suppose that two persons of equal intelligence have the same opportunities to learn a job or develop a skill. They attend the same on-the-job training or classes, study the same material, and practice the same length of time. One of them acquires the knowledge or skill easily; the other has difficulty and takes more time, if they ever master the skill. These two people differ in aptitude for this type of work or skill acquisition. Aptitude assessments are used to predict success or failure in an undertaking. For vocational/career guidance and planning, they are used to measure different aptitudes such as general learning ability, numerical ability, verbal ability, spatial perception, and clerical perception. Objective aptitude tests are based on timed sub-tests whose results are compared to age-group norms or other criteria – as opposed to self-report inventories of abilities often found in computerized career exploration systems. For helping a person find and pursue a career, course of study, or work experience program; aptitude assessment should logically precede achievement testing or skills assessment.

Aptitude Tests:

The aptitude tests can be of two types: general and vocational. A general aptitude test reports only on some main elements of your aptitudes. But, if you want to know some concrete and specific details, you have to take vocational aptitude test. The last can be of different types: language, dental, management, accounting, differential, electrical, programmer, fire fighter, writing, military, police, computer, clerical, nursing, flight, sales, music, etc. Most students have had to take several standardized tests throughout their academic careers. Some gauge students solely on their knowledge and expertise, while others assess students on their aptitude. Standardized aptitude tests have been utilized in a variety of ways, from identifying children with learning difficulties as early as in elementary school, to conversely distinguishing gifted students with higher propensities for scholastic success. One of the most notable and notorious examples of an aptitude test, taken by millions of high school students each year to determine their readiness for college, is the Scholastic Aptitude Test (SAT). On the surface, the SAT evaluates students’ achievement in basic algebra, geometry, reading and writing. However, in deeper ways, the exam is also similar to an IQ test in measuring students’ abilities to interpret and analyze presented information and solve problems. Nevertheless, the validity and usefulness of employing aptitude tests to establish the paths in which students proceed in their academic careers still remains controversial.

Aptitude versus IQ Testing:

Aptitudes might be thought of as separate types of intelligence, each perhaps having relative strength or weakness in an individual. This can be of high value for determining what training or career to pursue. Intelligence Quotient (IQ) is one score summarizing a person’s overall intelligence based on a broad range of abilities. An IQ score will indicate that you are smart, average, or not smart, but it is not a precise tool for career guidance. Two people with the same IQ might have very different scores for their individual aptitudes.

Attitude (motivation) versus aptitude (ability/intelligence):

Is Intelligence or Motivation more important for positive Higher-Educational outcomes?

A longitudinal study at University of Western Ontario explored the relationships among a set of student input and environmental throughput variables in predicting output human capital skills acquisition and academic achievement at a large Canadian university. The framework for exploring these relationships is referred to as the integrated paradigm of student development. Surprisingly, input intelligence quotient was negatively related to output human capital skills and to various adjustment measures. Input motivation best predicted output skills acquisition and achievement, independent of intelligence quotient. Although these counterintuitive findings may be sample- and university-specific, the instrument package representing the integrated paradigm of student development appears to provide a useful diagnostic battery for evaluating how well different types of students make the transition to different types of university settings.

Can a hotel employee with great aptitude, but a poor attitude provide superior guest service? Absolutely. The more pertinent question is: will that employee consistently provide the level of service you want and you deserve? Probably not. Can the poor attitude sometimes adversely affect job performance? Absolutely. What about the opposite? Can a positive attitude compensate for less aptitude? At least partially. As a “professional guest,” you are far more tolerant of a genuinely cordial and guest-oriented employee who may not be a technical wizard rather than someone super efficient desk clerk who does not smile, or even look at you during check in. Surveys indicate that many hotel guests share similar tolerance. A prospective employee’s aptitude is often tested as part of the recruitment and hiring process. What about attitude of the applicant who deals with hotel guests every day?

Although it might sound counterintuitive to some, there are indications that attitude can outweigh aptitude in determining whether skills are attained. While marketing skills assessment to the business community, many educators have heard employers say something to the equivalent of, “just give me a person with the right attitude, who will show up and stay on the job, and we’ll train them.” A study entitled Attitude versus Aptitude, by Côté and Levine, published in the Journal of Adolescent Research, found that motivation was a better predictor than IQ for skills acquisition.

Attitude and aptitude both contribute to a person’s success but attitude drives aptitude rather than the other way round. Attitude helps an individual connect with his/her inner yearnings, enjoy the process or journey rather than elate or despair at the end result and this perspective on life leads to satisfaction and success. Look at the lives of all these people –Einstein, Bill Gates, Steve Jobs – what did they have in common? Attitude! An unrelenting attitude, a perspective to see things the way other people did not see! And even as I write this, I do not mean to say that they needed no aptitude, they did have great aptitude also. What made them different from the rest of the world was their attitude of subscribing seriously and strictly to their own beliefs rather than to the world’s expectations of them. This led them to develop aptitudes that were aligned to their respective beliefs. For instance, if Steve Jobs, the brain behind Apple and Pixar, did not have that attitude of non-conformation to societal or parental expectations, he would have been just another graduate that his foster parents so desired him to be or people of his age aspired to become. His attitude to explore the aptitudes and skills that interested him helped him learn calligraphy even as he had no idea on how he might use it ever; but his creative attitude stimulated him to use it beautifully in creating a typography that most operating systems use today. The same is true of the Einstein and Gates of this world. Not doing well in academics did not have any bearing on their lives because they had a more powerful tool, better designed for success and that was their attitude!

Basically attitude is about how we view our world, and aptitude means the talent or ability we possess whether it is natural or learned. One would think that if you possess the right skills and abilities, you will succeed in life. Why would we think this way? We have spent many years going to school to develop our skills and abilities. The logical conclusion of our education is that we would be qualified to get a job, right? People, who make decisions about employment, just don’t look at only your aptitude. Given that everyone has the aptitude for the job, what really differentiates you? An experienced hiring manager looks beyond aptitude (provided you meet the requirement and experience). Attitude is what makes a key distinction. You need both, but attitude is more important then you may realize.

Positive attitude:

A father had twin sons. One was an incurable pessimist, the other an eternal optimist. On Christmas day, father decided to conduct an experiment. He put the pessimist son in one room surrounded by every gift a youngster could ever imagine and the optimist in another room full of horse manure. After a time, he looked in on his pessimist son and found him sitting amidst all these toys, clothes and sporting goods frowning, worried and deep in thought. When asked “What is wrong?”, this son said, “Dad, I can’t figure out the catch behind all this good stuff, but I am determined to do so and I need to be left alone now so I can work on it harder”. Next, the father looked in on his optimist son who was waist-deep in all that horse manure, but was sweating profusely from quickly shoveling it into a big pile over his shoulder. When asked what he was doing, the optimist son said, “Dad, I figure with all this crap around me, there must be a pony in here somewhere!” A positive attitude is the best attitude. Although it is not possible to be 100% positive and cheery all the time, it is important to remember that attitude shapes our thinking and mindset. Attitude also rubs of onto others, which is why we tend to stay away from negative people with bad attitudes.

Here some thoughts about attitude that are important.

1. Attitudes influence your outcomes: attitude projects your future or speaks to your potential and the results you are looking for before they happen. (e.g. can do attitude finds solutions vs. we are bound to fail)
2. Attitude is the one thing you have control over where as aptitude is given (natural gifts and talents) and can be developed.
3. Attitude is a choice: you can choose to think differently about how you view your world.
4. Repeatedly choosing the right attitude will develop into a habit which in turn will develop your character over time.
5. Attitude will determine the level of your personal and professional development.
6. People can see and sense a good or bad attitude.
7. Attitude will determine the level of your success provided you continuously cultivate your aptitude.
8. Decision makers (hiring managers, executives, leaders) measure the results people produce as well as their attitude. Great results with a bad attitude that sours an organization is typically less desirable than getting lesser results with a good attitude.
9. Having the right attitude will eliminate stress in life, and likely enhance your health.
10. Attitudes are contagious and influence the atmosphere around you. It can advance an organization or be toxic.

Aptitude is governed by cerebral cortex primarily under genetic control but can be learned through mirror neurons (acquired skills). Attitude is governed by limbic system of brain responsible for emotions and memory. As there are connection between cortex and limbic system, attitudes can be changed by human with due process of learning and counseling but innate ability cannot be changed by training. However, a portion of aptitude which is acquired skill can be obtained by learning.

Altitude (success) 100 % = attitude (motivation) 60 % + aptitude (ability) 40 %

If you have zero aptitude, you cannot succeed no matter how great is your attitude. If you have zero attitude, you will not succeed no matter how great is your aptitude. We need both attitude and aptitude. Also, positive attitude can help improvise aptitude but vice versa is unlikely.

Myers-Briggs Type Indicator: Psychological Types vis-à-vis career choice:

The Myers-Briggs Type Indicator (MBTI) assessment is a psychometric questionnaire designed to measure psychological preferences in how people perceive the world and make decisions. The original developers of the personality inventory were Katharine Cook Briggs and her daughter Isabel Briggs Myers. They began creating the indicator during World War II, believing that knowledge of personality preferences would help women who were entering the industrial workforce for the first time to identify the sort of war-time jobs where they would be “most comfortable and effective”. The initial questionnaire grew into the Myers-Briggs Type Indicator, which was first published in 1962. The MBTI focuses on normal populations and emphasizes the value of naturally occurring differences.

The four pairs of preferences or dichotomies are shown in the table below:

Dichotomies
Extraversion (E) -	(I) Introversion
Sensing (S) -	(N) Intuition
Thinking (T) -	(F) Feeling
Judgment (J) -	(P) Perception

Typological model regards psychological type as similar to left or right handedness: individuals are either born with, or develop, certain preferred ways of thinking and acting. The MBTI sorts some of these psychological differences into four opposite pairs, or dichotomies, with a resulting 16 possible psychological types. None of these types are better or worse; however, Briggs and Myers theorized that individuals naturally prefer one overall combination of type differences. In the same way that writing with the left hand is hard work for a right-hander, so people tend to find using their opposite psychological preferences more difficult, even if they can become more proficient (and therefore behaviorally flexible) with practice and development. Note that the terms used for each dichotomy have specific technical meanings relating to the MBTI which differ from their everyday usage. For example, people who prefer judgment over perception are not necessarily more judgmental or less perceptive. Nor does the MBTI instrument measure aptitude; it simply indicates for one preference over another. In her research, Isabel Myers found that the proportion of different personality types varied by choice of career or course of study. However, some researchers examining the proportions of each type within varying professions report that the proportion of MBTI types within each occupation is close to that within a random sample of the population. Some researchers have expressed reservations about the relevance of type to job satisfaction, as well as concerns about the potential misuse of the instrument in labeling individuals. Studies suggest that the MBTI is not a useful predictor of job performance.

Career:

The word “career” is used to refer to one’s progress through his/her working life, particularly in a certain profession or line of work. When we talk about a “career in teaching” or a “career in technology” we mean that a person will study and then work in teaching or in technology, perhaps changing jobs from time to time in the interests of advancement. The goals that one has for one’s working life are called “career goals,” and planning how we will reach them is called setting a “career path.” Carpentry, engineering, nursing, hospitality, social work, banking, and farming are just a few of the many possible careers people might choose. Generally, vocation and career are used interchangeably. A vocation is a career or calling and the word is derived from the Latin vocare, which means “to call.” Vocational guidance means helping someone find his or her calling or at least a suitable career choice. Vocations or careers can be loosely categorized into areas such as service, technical, mechanical, creative, health and business.

Selecting a career is an uphill task and most crucial decision in one’s life. Occupation of a profession of a person determines his mode of living and economic prospects. Moreover, a particular working atmosphere and service structure influences attitude and behavior of an individual. A particular line of work is the focal way to accomplish goals, materialize ambitions and realize dreams in the twisting and meandering life course. Therefore, appropriate information and guidelines are mandatory to select a vocation according to ones aptitude. Lack of awareness about career planning has grave implications for the future of the candidates. The changing of a profession results in experience gained for one profession become useless after changing the row of employment. Changing of vocation also generates frustration in the educated people because of comparison with previous professions and looking for future avenues in the new service.

Holland’s Theory of Career Choice:

The career key is based on John Holland’s theory of career choice. The theory explains work-related behavior – such as, which career choices are likely to lead to job success and satisfaction. It also explains other human actions, like success and satisfaction in school and training programs. It is the best known and most widely researched theory on this topic and is used by most career counselors. In our culture, most people are one of six personality types: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional. People of the same personality type working together in a job create a work environment that fits their type. For example, when Artistic persons are together on a job, they create a work environment that rewards creative thinking and behavior — an Artistic environment. There are six basic types of work environments: Realistic, Investigative, Artistic, Social, Enterprising and Conventional. People search for environments where they can use their skills and abilities and express their values and attitudes. For example, Investigative types search for Investigative environments; Artistic types look for Artistic environments, and so forth. People who choose to work in an environment similar to their personality type are more likely to be successful and satisfied. For example, Artistic persons are more likely to be successful and satisfied if they choose a job that has an Artistic environment like choosing to be a dance teacher in a dancing school. How you act and feel at work depends to a large extent on your workplace (or school) environment. If you are working with people who have a personality type like yours, you will be able to do many of the things they can do, and you will feel most comfortable with them.

According to this theory, you should choose an occupation whose personality type is the same as, or similar to yours. This is most likely to lead to your job satisfaction and success.

Parent’s role:

The most important influences in a student’s life should be reflected through parental influences. However, many parents do not have all the information needed to make educated decision about a child’s future career plan. However, all parents should be involved in their child’s future planning, not just financially. The parents know just as much if not more about their children than the child does. Parents should play four key roles in children’s learning as depicted below:

However, we all have prejudices. The problem is that prejudices come out of personal experience and, while we are happy to learn from others, we should not allow someone else’s personal experience to completely cloud our own decisions and good judgment. So parents can have their own prejudices resulting in biased career advice. Also, some of the careers that exist today did not exist 10 years ago – your parents may not know about them. Under such circumstances, it’s best to obtain career advice from someone who specializes in career guidance. We depend on family to provide emotional and financial support, so it is important to take cognizance of their advice, and at the same time to get them to believe in us and our choices.

The table below shows various factors influencing career choice of Indian MBA students:

A survey was done to find whether students received careers advice or not?

A survey published by the Panel on Fair Access to Professions reveals that young people feel they are not given the careers advice they need but have a thirst for a professional career. Young people have been a vital part of the Fair Access Panel’s work and over 1,500 young people from all parts of U.K. took part in the survey. Nearly two-thirds of the respondents to the survey commissioned by the panel want more careers support, highlighting work experience opportunities as key to getting a foot in the door. Over a third of 13-19 year olds want a career in the key professions – with teaching, medicine and law the favored occupations. However:

1) 70% of under 14s have had no careers advice.

2) 45% over 14 have had no or very poor/limited advice.

3) Girls rate the advice somewhat worse than boys.

4) Girls more likely to do personal research and make more use of external opportunities (role model visits etc.).

The same survey analyzed what sort of career students want to pursue.

Ideas and suggestions put forward by young people (in the same survey) to tackle the challenges of entering a professional career include:

-Open days for the professions with placements for those interesting in pursuing a career.

-An expansion in good quality work placements in careers where experience and contacts are the key.

-Providing role models of people who actually get into top professions.

The table below shows most favored occupations among students:

The table above also shows marked difference in career choice between boys and girls. Why? Discussed below.

Gender difference vis-à-vis career: various studies:

Study-1

Gender difference and career interest among Undergraduates: Implications for career choices:

A study was conducted to determine the career interests of university students. Two hundred and thirty-eight undergraduates were involved in the study. They consisted of 101male and 137 female students attending three public universities in Malaysia. The findings of the study suggested that the career interest patterns of university students vary across gender. The study showed that male students constituted the larger group in the realistic career interest patterns (70%) compared to females (30%). Another researcher, Van Burren et al. (1993) also found that more males than female students preferred realistic and investigative occupations. Researchers like Bem (1981) and Betz (1994) have tried to reason out the factors relevant to the development of gender differences in vocational interest. They suggested that the development of gender difference in vocational interests as well as vocational choices is a result of multitudes of factors, some which are internally related, and some are environmentally related. In a study by Betz (1994), it was found that occupational stereotype is one of the factors affecting the vocational interest of genders. On this basis, people believed that occupations are designed to be appropriate for one gender and not for the other gender. Self-concepts, self-efficacy, personality and even the environment could also influence the career interest pattern where students grew-up. For instance, the perceptions of many students that subjects such as mathematics and physics are difficult could affect one’s career interest.

Study-2

Impact of a career planning course on academic performance and graduation rate:

A study was conducted to assess the impact of a career-planning course in terms of time taken to graduate, graduation rate, credit hours taken, number of course withdrawals, and cumulative GPAs. Student course participants (N = 544) were compared to a matched sample of non-course participants (N = 544) after 5 years. Results showed that the 2 groups differed with respect to hours taken to graduation and number of course withdrawals. Women participants graduated in less time than nonparticipants but had more course withdrawals. Men took longer to graduate but had fewer course withdrawals and higher GPAs.

Study-3

Gender differences for optimism, self-esteem, expectations and goals in predicting career planning and exploration in adolescents:

An Australian sample (N=467) of high school students was administered scales tapping optimism, self-esteem, career expectations, career goals, career planning and career exploration. The study tested a career mediational model based on social cognitive career theory (SCCT) and cognitive–motivational–relational theory (CMR). It was hypothesized that the stable person inputs of optimism and self-esteem would predict career planning and career exploration through the variables of career expectations and career goals differentially for young males and females. For males, optimism and self-esteem influenced career expectations, sequentially predicting career goals, career planning and career exploration. A different pathway was identified for females, with optimism directly influencing career goals, which subsequently predicted career planning and career exploration. Self-esteem predicted career expectations, which then directly influenced career planning and career exploration by bypassing career goals.

Study-4

Gender differences in vocational education: an international perspective:

A study uses distributional analysis applied to cross-country data from UNESCO to examine shares of secondary school students enrolled in the vocational track, by gender. The emphasis on vocational education and access to different types of training across demographic groups varies considerably around the world. European countries in particular, long known for their heavy emphasis on specialized vocational schooling, have relatively high vocational school shares in secondary school. At the other end of the distribution, almost 30 countries in the sample, most of them low-income, have vocational school shares below 4 percent. In the majority of countries, a higher share of male secondary school students enroll in the vocational track compared with female students. Latin American countries stand out for having a high female representation among vocational school students. In the USA, male students cluster in trade and industrial courses, while female students cluster in business preparation courses.

Study-5

Men and Things, Women and People: A Meta-Analysis of Sex Differences in Interests:

The magnitude and variability of sex differences in vocational interests were examined in the meta-analysis for Holland’s (1959, 1997) categories (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional), Prediger’s (1982) Things–People and Data–Ideas dimensions, and the STEM (science, technology, engineering, and mathematics) interest areas. Technical manuals for 47 interest inventories were used, yielding 503,188 respondents. Results showed that men prefer working with things and women prefer working with people, producing a large effect size (d – 0.93) on the Things–People dimension. Men showed stronger Realistic (d – 0.84) and Investigative (d – 0.26) interests, and women showed stronger Artistic (d – 0.35), Social (d – 0.68), and Conventional (d – 0.33) interests. Sex differences favoring men were also found for more specific measures of engineering (d – 1.11), science (d – 0.36), and mathematics (d – 0.34) interests. Average effect sizes varied across interest inventories, ranging from 0.08 to 0.79. The quality of interest inventories, based on professional reputation, was not differentially related to the magnitude of sex differences. Moderators of the effect sizes included interest inventory item development strategy, scoring method, theoretical framework, and sample variables of age and cohort. Application of some item development strategies can substantially reduce sex differences. The present study suggests that interests may play a critical role in gendered occupational choices and gender disparity in the STEM fields.

Study-6

Gender differences in financial risk aversion and career choices are affected by testosterone:

Women are generally more risk averse than men. Researchers investigated whether between- and within-gender variation in financial risk aversion was accounted for by variation in salivary concentrations of testosterone and in markers of prenatal testosterone exposure in a sample of >500 MBA students. Higher levels of circulating testosterone were associated with lower risk aversion among women, but not among men. At comparably low concentrations of salivary testosterone, however, the gender difference in risk aversion disappeared, suggesting that testosterone has nonlinear effects on risk aversion regardless of gender. A similar relationship between risk aversion and testosterone was also found using markers of prenatal testosterone exposure. Finally, both testosterone levels and risk aversion predicted career choices after graduation: Individuals high in testosterone and low in risk aversion were more likely to choose risky careers in finance. These results suggest that testosterone has both organizational and activational effects on risk-sensitive financial decisions and long-term career choices.

Research has demonstrated that parental perceptions, beliefs, and attitudes in turn influence their children’s development and interests; and also cultural factors affect difference in career choices among boys and girls. Gender-based differences in parental attitudes and practices and in experiences with and perceptions of science may contribute to enhanced scientific literacy skills among boys relative to girls. By the time they reach adolescence, girls and boys report having different experiences with science-related activities. Boys report experiences such as making catapults, changing a car battery, playing with electric toys, or using a microscope; girls report experiences such as making bread or pastries, watching a bird make its nest, observing the stars, or planting seeds. When asked about their interests, boys prefer learning about planes, cars, atom bombs, nuclear power plants, or electricity; girls prefer learning about rainbows, healthy eating, animal communication, or AIDS. The dearth of women in scientific fields of study is reflected by a similar underrepresentation of women in science and engineering occupations. Over the past three decades, women in Canada have joined the labor force in ever-increasing numbers: as of 2006, women accounted for 47% of all workers in Canada. Over the same period, women have accounted for a steadily increasing proportion of workers in health care and social assistance and educational services, but the relative proportion of women in professional, scientific and technical services has declined compared to the overall proportion of women in the labor force as seen in the figure below:

Career test:

You can take online/offline career test that is aimed at determination of you professional preferences. The career test will be interesting for pupils and students; it will help select future profession. It also will help anyone who wants to learn as to what professions they like the best. The free career test can make you reconsider your future plans and gave you a deeper vocational insight. It can make you change the direction of your future education away from your original plan. The fact that you are sure you know everything about your abilities is completely wrong, as your hidden possibilities may be revealed with time. Career test gives you an opportunity to do it sooner.

The figure below depicts various factors that join up into choosing a career.

Guidance:

Guidance is defined as the application of mental health, psychological or human development principles; through cognitive, affective, behavioral or systemic intervention strategies; that addresses wellness, personal growth or career development as well as pathology.

Guidance and counseling is a concept that institutions especially schools, should promote the efficient and happy lives of individuals by helping them adjust to social realities. The disruption of community and family life by industrial civilization convinced many that guidance experts should be trained to handle problems of individual adjustment. Though the need for attention to the whole individual had been recognized by educators since the time of Socrates, it was only during the 20th century that researchers actually began to study and accumulate information about guidance.

Perspectives on guidance and social inclusion in a global society:

In most countries there is a widening gap between rich and poor, those with opportunity and those who are marginalized, those with education and those without, and those who struggle for survival and those for whom survival generates barely a passing thought. In most countries, women continue to earn less than men. Equal pay for work of equal value is a commonly expressed goal, but most evidence indicates that the goal is far from being met, even in so-called developed countries. In many (perhaps even most) countries, status is attached to a university education, and young people (and their parents) seek career paths in the so-called professional occupations, even though unemployment for university graduates is chronically high. Vocational education and training (VET) is often regarded as an inferior second, regardless of a student’s interests, passions, or abilities, and despite the fact that many jobs in the trades go unfilled. Thus, many (perhaps most) countries import workers to fill blue-collar jobs while their own young people seek training in professions for which there are few employment opportunities. Many young people dismiss promising and meaningful career paths in areas where employment demand is great, simply because of the stigma attached to working in technical and vocational occupations. Frequently, investment in training goes unrealized, because young people drop out of training, or complete training, but then do not enter the occupational field for which they have been trained. Educational systems continue to be directed primarily towards preparation for university education, even though the majority of students end up making transitions directly into the labor force. These are phenomena that are experienced in many countries, regardless of whether they are thought of as developing or developed countries. Think of contradictions. There are many areas in many developing countries where soft drinks are available but clean drinking water is not available. I am sure that most people have similar stories that they could share, of situations where the good intentions of people from “more developed” countries create a plan for helping those in “developing” countries fall into substantial frustration. At a cognitive level, we are aware that ideas and approaches often do not translate well from one country to another or from one culture to another. Many people are encountering that lesson again at a practical level. If guidance is going to have a meaningful impact on social inclusion, guidance experts likely will need to dramatically change the way they think about their mission, their mandate, and the scope of their practice. They may even need to revise the way in which they view the role of guidance in society. Society today is on a roller coaster ride for many. The prosperity and abundance enjoyed by a few are not shared by most. Models for guidance and counseling have for the most part been developed with middle class populations in developed countries. Even in the so called developed countries, large portions of the population are not well served by existing approaches. If we are to realize the dream of maximizing the world’s potential though guidance, we will need to expand our mission, mandate, and scope of practice to include an explicit and substantial component focused on a social inclusion agenda, implemented in partnership with all stakeholders, and incorporating specific steps to demonstrate the added value that guidance brings to attempts to provide a more meaningful and fulfilling life for the citizens of our countries.

Father of guidance:

Frank Parsons is often considered as the “Father of Guidance”. He was trained in multiple disciplines, being a lawyer, an engineer, a college teacher, and a social worker before becoming a social reformer and working with youth. He was characterised as a broad scholar, a persuasive writer, a tireless activist, and a great intellect. Frank Persons defines vocational guidance as “the choice of a vocation, adequate preparation for it and the success” He also said that ideal career choices are based on matching personal traits (aptitude, abilities, resources, personality) with job fact (wages, environment, etc) to produce the best condition implement their own education and of vocational success. He is best known for founding the Boston Vocational Bureau in 1908, a major step in the institutionalization of vocational guidance. At the Bureau, he worked with young people who were making decisions about their career. In his book, Choosing a Vocation, which was published in 1909 (one year after his death), he developed a framework to help individuals decide on a career. According to Parsons, an ideal career choice should be based on matching personal traits such as abilities and personality, with job characteristics such as wages, requirements, prospects and so forth, through true reasoning. This is more likely to ensure vocational success. His framework later became the popular “Trait-Factor Theory” in career guidance (which is still used today). Parsons created procedures to help his clients learn more about themselves and the world of work. He designed an extensive questionnaire that asked about clients’ experiences, preferences and moral values. The idea of having vocational counsellors was implemented in many primary and secondary schools in the Boston area and it gradually spread to other major cities in the United States. By 1910, 35 cities had followed Boston’s steps.

Career guidance is a better term than vocational guidance:

According to Kagan and Havemann, vocational guidance is “the technique of helping a person selects the right lifetime occupation, often through test of attitudes and interests”. Vocational guidance is assistance in choosing a career or profession or in making employment or training decisions. An example of vocational guidance is a meeting with a consultant who helps people figure out what a good job would be for them based on their skills and qualifications. The term career guidance is replacing the term vocational guidance. Vocational guidance is focused upon the choice of occupation, and is distinguished from educational guidance, which focuses upon choices of courses of study. Career guidance brings the two together and stresses the interaction between learning and work. Career guidance can be defined as “services and activities intended to assist individuals of any age and at any point throughout their lives, to make educational, training and occupational choices and to manage their careers” (OECD & EC, 2004). Such services may be found in schools, universities and colleges, in training institutions, in public employment services, in the workplace, in the voluntary or community sector and in the private sector. The activities may take place on an individual or group basis, and may be face-to-face or at a distance (including help lines and web-based services). They include career information provision (in print, ICT-based and other forms), assessment and self-assessment tools, counseling interviews, career education programs (to help individuals develop their self awareness, opportunity awareness, and career management skills), taster programs (to sample options before choosing them), work search programs, and transition services.

As defined earlier, career guidance is services intended to assist people, of any age and at any point throughout their lives, to make educational, training and occupational choices and to manage their careers. Career guidance includes career education, career counseling, employment counseling, job placement and career information. Career guidance consists of services that help people successfully manage their career development. Although this aspect of human development occurs on its own as we mature, everyone can benefit from assistance navigating through this process. Career guidance often involves assisting students and adults who are trying to choose a career. Career development professionals may administer self assessment instruments or teach their clients how to use self-administered tools, to help them learn about their interests, values, skills and personality type. They can educate individuals about how to explore occupations that are most suitable based on that information and then ultimately teach them how to decide which one is the best choice. Helping you choose a career would be pointless if you didn’t know how to find a job in your field of choice. Therefore career guidance also consists of providing job search assistance.

Career guidance helps people to reflect on their ambitions, interests, qualifications and abilities. It helps them to understand the labor market and education systems, and to relate this to what they know about themselves. Comprehensive career guidance tries to teach people to plan and make decisions about work and learning. Career guidance makes information about the labor market and about educational opportunities more accessible by organizing it, systematizing it, and making it available when and where people need it. In its contemporary forms, career guidance draws upon a number of disciplines: psychology; education; sociology; and labor economics. Historically, psychology is the major discipline that has under-pinned its theories and methodologies. In particular differential psychology and developmental psychology have had an important influence. One-to-one interviews and psychological testing for many years were seen as its central tools. There are many countries where psychology remains the major entry route. However in most countries career guidance is now provided by people with a very wide range of training and qualifications. Some are specialists; some are not. Some have had extensive, and expensive, training; others have had very little. Training programs are still heavily based upon developing skills in providing help in one to-one interviews. On the other hand, psychological testing now receives a reduced emphasis in many countries as counseling theories have moved from an emphasis upon the practitioner as expert to seeing practitioners as facilitators of individual choice and development. While personal interviews are still the dominant tool, career guidance includes a wide range of other services: group discussions; printed and electronic information; school lessons; structured experience; telephone advice; on-line help. Career guidance is provided to people in a very wide range of settings: schools and tertiary institutions; public employment services; private guidance providers; enterprises; and community settings.

The term vocational guidance means assistance given to an individual in solving problems related to occupational choice and progress with due regard for the individual’s characteristics and their relation to occupational opportunity. Vocational guidance is based on the free and voluntary choice of the individual; its primary object is to give him full opportunity for personal development and satisfaction from work, with due regard for the most effective use of national manpower resources. Vocational guidance is a continuous process, the fundamental principles of which are the same irrespective of the age of the individuals being counseled. These principles have an immediate importance for the welfare of individuals everywhere and for the prosperity of all countries. Facilities for vocational guidance should be adapted to the peculiar needs of each country and be adopted progressively. Their development within each country should proceed from a widespread understanding of the purpose of vocational guidance, the establishment of an adequate administrative structure and the provision of technically qualified personnel.

Vocational guidance and counseling is widely accepted as a powerful and effective method of helping to bridge the gap between education and the world of work, as well as between school and society. It is a means of assisting young people to make appropriate and judicious educational choices that will enable them to develop their potential and to have access to work opportunities that are compatible with their interests and abilities. It can also help to instill confidence and positive attitudes, to derive fulfillment from their chosen areas of learning and work and, most importantly, to inculcate an eagerness for lifelong learning.

Vocational guidance is often started in high school although some high schools also have vocational training programs. Vocational exploration courses offer students the opportunity to research different career possibilities as well as learn which vocational areas they have aptitude or talent in. For instance, many vocational guidance classes give tests to the students that test their ability with experimental numbers, words, mechanical concepts and many more subjects. Tests designed to measure an individual’s personality traits, intelligence quotient (IQ) as well as his or her main values and interests are administered and analyzed by career counselors. Vocational guidance is a service to help other find appropriate jobs. The core components of a vocational guidance program are: an appraisal service, an informational service, a counseling service and a planning, placement and follow-up service. The vocational guidance service is provided in educational institutions like school, colleges and universities and non-educational settings like government and non-government employment exchange services.

The need for vocational guidance has grown as a result of the greater variety of jobs and skills required in modern society, and greater awareness of how widely people differ in interests and abilities. Whatever a person’s work, a high degree of efficiency is usually important. To achieve this, individuals have to be satisfied with their jobs. The choice of a vocation affects not only the quality of their work but also their relationships with others and their usefulness to the community. Young people need help in finding their real interests and capabilities. They need help in making a realistic, as opposed to fanciful, choice of a career. And they need guidance in planning for a well-rounded education as well as for specific training for a particular vocation. For young people, vocational guidance may be spread over a period of years. Specific guidance may start in the seventh or eighth grade, where students may read books and watch films and videotapes that deal with careers. They may visit factories, farms, stores, or other places of work such as hospitals, courtrooms, and airports. Adults, too, are often in need of vocational guidance. A person may realize, after months or even years in a particular occupation, that he or she is unsuited to the work and unhappy in it. Circumstances may force a person to leave one kind of job and seek another. After retirement from a job, older persons often find they still need to work. Women who leave work to have children often need or want to reenter the job market when their children reach school age. Immigrants need help in adjusting to jobs in their new homeland. Disabled persons require help in training for and adjusting to jobs.

Vocational Guidance Programs:

Vocational guidance is one of the basic pillars in the life of contemporary societies as this process continues throughout the individual life, starting as he joins kindergarten and continues throughout his shift to the stages of general education, graduation in higher education stages, embarking on practical life till his pension. Guidance process has an important and constructive impact on the individual life as it helps him achieve harmony between the various factors of his personality, tendencies and preparedness and the reality of life. This helps him develop and grow in various psychological, social and economic aspects and consequently assist in achieving prosperity and progress of the society in which he lives. Vocational guidance usually covers six areas:

(1) Studying or surveying the various kinds of occupations;

(2) Determining aptitudes;

(3) Choosing a vocation;

(4) Preparing for work in the chosen vocation;

(5) Finding a job;

(6) Adjusting to and gaining competence in the job.

Policy makers and career guidance:

Support by public policy-makers for career guidance has traditionally rested upon a belief that it can improve the efficiency and effectiveness of labor markets and educational systems, as well as contribute to social equity. Indeed formal career guidance has its origins in a concern in the early parts of the 20th century to use systematic methods to help underprivileged young people to choose an occupation when they were leaving school and about to look for a job (Parsons, 1909). Some of the policy challenges that career guidance must respond to in OECD countries are long-standing: to improve the knowledge and skills base of the population; to keep unemployment low and ensure that labor supply and demand are in harmony; and to ensure that education and employment opportunities are distributed equitably. Some countries – Denmark and Norway are examples – made it clear that they expected the goals of career guidance to be centered on the individual: for instance by increasing personal satisfaction, improving career decision-making, or increasing personal development. All countries made it clear that they also expected career guidance to serve a number of important public objectives. And all indicated that their career guidance services are being strongly influenced by current issues and developments in public policy. These public policy goals, issues and developments fall into three broad categories: learning goals; labor market goals; and social equity goals.

Learning goals:

In some cases, countries expressed the significance of career guidance for education, training and skills development in quite broad terms. For example, Australia, Austria, Canada, Finland, Germany, Ireland, the Netherlands and the United Kingdom made it clear that career guidance is an important part of their approach to lifelong learning. Canada and Korea saw it as one way in which public policy can support the development of human resources. More broadly, it is very common for countries to see career guidance as a tool that can help to improve the efficiency of their education systems. Countries also saw career guidance as a way to improve the interface between education and the labor market. Finally, three European countries – Austria, Finland and Germany – saw career guidance as growing in importance as education becomes increasingly internationalized: for example by helping to provide information and advice on international study opportunities. A similar motivation under-pinned the creation in 2003 by the European Commission of a web site portal to provide information on learning opportunities throughout Europe.

Labor market goals:

As with learning goals, countries often expressed the importance of career guidance for labor market policies in quite general terms. For example, Australia, Canada, Denmark, Germany and the United Kingdom argued that it is important in helping to improve labor market outcomes or labor market efficiency. Denmark argued that it can help to reduce the effects of labor market destabilization. Austria, Denmark, Finland, Germany, Korea and Spain indicated that it can help to prevent or reduce unemployment. Some countries also argued that career guidance is an important part of policies that support adjustments to the broad changes that are occurring in labor markets. Denmark, Finland, Germany and the Netherlands saw it as important in helping to deal with the effects of an ageing society, or in reducing early retirement. Korea and the United Kingdom saw career guidance as important in helping to support the notion of a lifelong career, as opposed to a lifelong job. Austria, Finland, Germany and Norway argued that it can support the growing internationalization of the labor market. Canada believed that career guidance can help address the impact of migration on the labor market.

Social equity goals:

Somewhat less frequently, countries argued that career guidance can help to achieve a number of social equity goals: both within the education and the labor market. Australia and the United Kingdom argued that it can help to promote greater social inclusion. Denmark and Spain argued that it can address the needs of marginalized groups and of the disadvantaged. Finland, Germany and Norway believed that career guidance is important in supporting the social integration of migrants and ethnic minorities.

Labor market benefits of career guidance:

Many of the ways that career guidance could help to improve the efficiency and effectiveness of the labor market are similar to the ways it might help to achieve learning goals. For example, career guidance commonly:

1. Helps people to understand their interests, abilities and qualifications so that they seek jobs that they are likely to have a chance of obtaining, will enjoy and will do well: and to avoid looking for ones that they might not be able to get, would not enjoy or would not be good at;

2. Helps people to find out about what is involved in occupations, so that they are more likely to know which ones they might like and be good at;

3. Helps people to find out about particular jobs that are available and how they can apply for them;

4. Teaches people how to assess the short- and long-term consequences of particular types of occupational choices;

5. Makes information about the labor market, and education systems, more accessible by organizing it, systematizing it, and making it available when and where people need it;

6. Teaches people how to search for, understand and evaluate information about occupations.

Unemployment:

Career guidance could help to improve the match between supply and demand by helping people to search for a better fit between their talents & qualifications and available work opportunities. Unemployment could be reduced if such interventions helped to reduce the incidence of voluntary employment terminations or periods of job search (thus reducing frictional unemployment); or if they encouraged those made redundant to improve their qualifications or to seek new types of work in different regions (thus addressing structural unemployment).

Social Equity benefits:

There are also strong conceptual arguments in support of the contribution that career guidance can make to social equity. Many career guidance activities attempt to maximize the use that people make of their talents, regardless of their gender, social background or ethnic origin. Disadvantaged groups are likely to be less familiar with educational and labor market information than more advantaged groups. They may be more under-confident in, unskilled in, or unused to negotiating access to complex learning systems. They may need more help in finding opportunities that can maximize their talents, and in overcoming barriers to accessing these opportunities.

Human capital benefits:

People’s knowledge and skills play a strong role in economic growth of a country. The importance of human capital as a source of economic growth appears to be increasing. Traditionally human capital has been defined largely in terms of people’s productive capacity and characteristics: in other words in terms of “skills”, broadly defined. Newer and wider ways of thinking about human capital point out that less than half of earnings variation in OECD countries can be accounted for by educational qualifications and readily measurable skills. It argues that a significant part of the remainder may be explained by people’s ability to build, and to manage their skills. The characteristics that are important in the development of human capital include the ability to acquire skills: in other words, to learn, to identify one’s learning needs, and to manage one’s learning. They also include the ability to understand how best to use these skills. Included in this category are career planning, job search and career-management skills. There is a close harmony between this wider view of human capital and some notions of employability. Seen in this wider context, it seems that many aspects of career guidance have the potential to contribute significantly to national policies for the development of human capital.

Career guidance as personal service:

Traditionally, career guidance in schools has been viewed largely as a personal service, provided at key decision points, and a support to the curriculum rather than part of it. It has mainly been delivered through personal interviews, sometimes supported by psychometric testing. This has made it expensive to provide to large numbers, and so has limited its availability. Personal career guidance services in schools have commonly suffered from further constraints. The focus has tended to be on educational decision making, often with little attention to the occupational and longer-term career choices that flow from particular educational pathways. In particular, where career guidance services are wholly school-based, links with the labor market can be weak. And those who are planning to enter tertiary education may receive greater attention than the job-bound.

Outside agency based career guidance:

A response in some countries to the above mentioned issues has been for personal career guidance to be provided by an agency based outside the school. The potential advantages of this include the possibility of career guidance having closer links to the labor market, the likelihood that career guidance will have a clear identity, separate from other forms of guidance, and the increased possibility that guidance will be independent of the interests of the educational institution. A strong example of career guidance in schools that is provided by an external agency is Germany. Strong external support to schools is also provided in the United Kingdom through Connexions, formerly the Careers Service, and in the Czech Republic where the public employment service plays a strong role in providing career guidance to schools as part of the national strategy to address youth unemployment. There, research by the National Institute of Vocational Education has shown that students rely more heavily upon the employment service for assistance than they do upon in-school services. Some involvement by the public employment service in school career guidance services can also be observed in Luxembourg.

Career guidance in curriculum:

In recent years there has been a trend for career guidance based upon personal interviews to be supplemented with a curriculum-based approach. An emphasis upon lifelong learning and sustained employability greatly enhances the case for such an approach. Most countries now include programs of career education within the curriculum. These vary in content. Some (in Germany, for example) focus mainly on understanding the world of work and its demands. Most, however, also include attention to self awareness and the development of skills for making decisions and managing transitions. In a lifelong context, this broader approach is highly desirable.

Public employment service:

Traditionally, career guidance services for adults have been largely concentrated in public employment services. The major users of such services have been the unemployed, as well as other groups on the edge of the labor market such as disabled people. Services for such groups tend to focus on getting them a job as quickly as possible in order to reduce unemployment levels and income-security payments (and, in cases where there are concerns about overall labor shortages, to increase labor force participation rates). Sometimes help with job placement is offered on a self-service basis. Sometimes training is required before people can be placed in jobs. This can be in job-seeking skills, in basic skills, or in specific vocational skills. Training is frequently preceded by some employment counseling, partly to advise people, but also to decide how much training the state is prepared to provide. This commonly leads to a case-managed action plan which is required in order to maintain eligibility for income support. In other words, the counseling often performs gatekeeping and policing functions in relation to public resources. It is not just to help the individual make decisions, but also to make institutional decisions about the individual.

Planning career paths for gifted and talented youth:

Multipotentiality and early emergers:

Although parents and teachers may be concerned about academic planning for gifted and talented young people, they often assume that career planning will take care of itself. Students may have many choices available because of multiple gifts or a particular talent, and a career choice in that area seems inevitable. The perception is that there is no need for career planning and the student is simply expected to make an occupational decision around the sophomore year of college and then follow through on the steps necessary to attain that goal. Unfortunately, evidence is mounting that youthful brilliance in one or more areas does not always translate into adult satisfaction and accomplishment in working life. Studies with such diverse groups as National Merit Scholars (Watley, 1969), Presidential Scholars (Kaufmann, 1981), and graduates of gifted education programs (Kerr, 1985) have shown that the path from education to career is not always smooth, and it may be complicated by social-emotional problems and needs of gifted students that differ from those of more typical students. Multipotentiality is the ability to select and develop any number of career options because of a wide variety of interests, aptitudes, and abilities. The broad range of opportunities available tends to increase the complexity of decision making and goal setting, and it may actually delay career selection. Multipotentiality is most commonly a concern of students with moderately high IQs (120-140), those who are academically talented, and those who have two or more outstanding but very different abilities such as violin virtuosity and mathematics precocity. As opposed to multipotentiality, early emergers are children who have extremely focused career interests. A passion for an idea and an early commitment to a career area are common childhood characteristics of eminent individuals in a wide variety of professions; thus, early emergence should not be thought of as a problem of career development, but rather as an opportunity that may be acted upon, neglected, or, unfortunately, sometimes destroyed. Acting upon early emergence means noticing an unusually strong talent or enthusiasm, providing training in skills necessary to exercise that talent, providing resources, and keeping an open mind about the future of the talent or interest. Neglecting early emergence means overlooking the talent or interest or failing to provide education and resources. Destroying the early emerger’s passion may not be easy, but belittling the talent or interest (“What makes you think you can become an anthropologist?”) may easily extinguish the flame. Insisting on well-roundedness or disallowing needed training (e.g., refusing to allow a mathematically precocious child to accelerate in math) may diminish the passion. Overly enthusiastic encouragement and pressure may also remove the intrinsic pleasure the child feels in the interest or talent area. The multipotential student seems unfocused, delaying, and indecisive, whereas the early emerger is focused, driven, and almost too decisive. Both types carry with them dangers and opportunities. Skillful career education and guidance can help ensure that neither multipotentiality nor early emergence leads to difficulty in career planning and development.

Career planning for Minority Gifted Students:

Ethnic or religious minority gifted students have special career planning needs as well as needs related to multipotentiality or early emergence. Minority students are less likely to have been selected for gifted education programs and less likely to perform well on standardized achievement tests than their nonminority peers. In addition, they may have lower career aspirations because of lower societal expectations. Nevertheless, the patterns of leadership and out-of-class accomplishments of gifted minority students are very similar to those of nonminority gifted students. Minority gifted students are active leaders in other communities. Therefore, career counseling for these students may be most effective when it focuses on raising career aspirations and emphasizes out-of-class accomplishments as indicators of possible career directions. Career planning must also go hand in hand with building a strong ethnic identity if later conflict between ethnic identity and achievement in majority society is to be avoided.

Career planning for Gifted Girls and Women:

Persisting sex role stereotypes and the continued socialization of girls for secondary roles means that, despite great gains in certain fields such as medicine and law, gifted girls are less likely than gifted boys to achieve their full potential. Although gifted girls outperform gifted boys in terms of grades, gifted boys achieve higher scores on college admission examinations. Compared to gifted boys, gifted girls are underprepared academically, having taken fewer mathematics and science courses and less challenging courses in social studies. As a result, they have fewer options for college majors and career goals. Bright women apparently let go of career aspirations gradually, first through underpreparation and later through decisions that may put the needs of husbands and families before their own. Gifted women fall behind gifted men in salary, status, and promotions throughout their working lives. In order to ensure that gifted girls have the greatest possible chance to fulfill their potential, career planning should emphasize rigorous academic preparation, particularly in mathematics and science; maintaining high career aspirations; and identifying both internal and external barriers to the achievement of career goals.

The system theory framework (STF), a theory of career development:

The Systems Theory Framework (STF; McMahon, 2002; McMahon & Patton, 1995; Patton, 1997; Patton & McMahon, 1999, 2006) is not designed to be a theory of career development; rather it is construed as an overarching framework within which all concepts of career development described in the plethora of career theories can be usefully positioned and utilized in theory and practice. Central to the STF is the individual system within which is depicted a range of intrapersonal influences on career development, such as personality, ability, gender, and sexual orientation. Some of these influences have received considerable attention by career theorists and others have not. As individuals do not live in isolation, the individual system is connected with influences that comprise the individual’s social system as well as the broader environmental/societal system. While the influence of many factors, such as geographic location and political decisions, on career development is less well understood within the theoretical literature, their influence on career development may be profound. The STF presents career development as a dynamic process, depicted through its process influences and recursiveness change over time and chance as seen in the figure below.

Fundamental to understanding the STF is the notion that career development system is an open system. An open system is subject to influence from outside and may also influence that which is beyond its boundaries. Such interaction is termed recursiveness in the STF, which in diagrammatic form is depicted by broken lines that represent the permeability of the boundaries of each system. It is well acknowledged that influences on an individual may change over time. The final process influence, chance, is depicted on the STF diagram as lightning flashes, reflecting an increased recognition of the part chance plays in career development. All of the systems of influence are located within the context of time – past, present and future – all of which are inextricably linked; past influences the present, and together past and present influence the future.

The relationship between guidance and counseling:

There is considerable similarity and overlap between guidance and counseling since “counseling skills underpin good guidance practice” (Watts & Kidd, 2000). However, the two concepts are not the same. Hui (2002) describes ‘guidance’ as helping students in their whole-person development and ‘counseling’ as helping students to cope with distress and confusion. Counseling in fact denotes a more therapeutic and personalized intervention, whereas guidance “embraces a larger range of activities” (Herr, Cramer & Niles, 2004).

Career counseling can be seen as very much an evolving profession. In reality it has emerged as a profession in its own right only comparatively recently. Herr (1997) explains that for much of its history, career counseling was rarely differentiated from vocational or career guidance, and that it was not until the 1960s and 1970s that the term ‘career guidance and counseling’ sufficiently differentiated the two elements.. It is only in the last twenty years that calls have been made for expanded views of career counseling in response to changes in society, and increasing attention is being paid to changing definitions of career counseling.

Herr (1997) distinguishes five observations about the changes in career counseling. They are that:

1. Its principal content is the perceptions, anxieties, information deficits, work personalities, competencies, and motives that persons experience in their interactions with their external environment;

2. Career counseling is not a singular process, but a term used to summarize a range of interventions;

3. Career counseling is no longer conceived as a process principally focused on ensuring that adolescents make a wise choice of an initial job;

4. Career counseling may be considered the preferred intervention of choice, but may be one of a program of interventions … to deal with emotional or behavioral disorders that accompany or confound the career problem;

5. Career counseling may best be thought of as a continuum of intervention processes. Herr notes that these changes in the content and processes of career counseling have not occurred in a vacuum; rather they are in response to the prevailing conditions in society.

The use of a System Theory in career counseling:

Framework for understanding career development has implications for the practice of career counseling as it requires career counselors to make the difficult move from a comfortable traditional worldview to the emerging worldview with its different account of causality (Patton & McMahon, 1999). In using the approach, career counselors need to combine traditional approaches with the ability to think in circular rather than linear terms as seen in the figure below. The notion of circular feedback processes shaping and reshaping systems through subtle feedback is common in some fields of counseling (such as family therapy), yet comparatively new in the field of career counseling. The interaction between the client and the counselor, that is, the counseling relationship itself, can be conceptualized as a system in its own right. In fact counselors become an element of the system of influences on the career development of the individual, and the individual becomes an element of the system of influences on the counselor. In this system of interaction, the counselor and the individual use language to co-construct the meaning of career for the individual in counseling. The career counseling process centers on meaning, with language as the medium (Patton & McMahon, 1999; Peavy, 2004).

The figure above portrays the complexity of the career counseling process and its place in the social and environmental-societal systems. Just as the career counselor exists within his/her own ever-changing system of influences, so too does the client. Thus, part of the career counselor’s role is to understand the influences relevant to his/her own career story; that is, his/her own system of career influences. Career counseling constitutes the meeting of two separate systems and the formation of a new system, the therapeutic system as seen in the figure above. The boundaries of each system must be permeable enough to allow a relationship to develop and dialogue and resulting meaning to occur, yet impermeable enough for both parties to maintain their individuality. Thus, the boundary between the counselor system and the client system needs to be maintained However, as the relationship between members of the therapeutic system develops, the boundary between the client system and the counselor system may become less clear. Counselors who lose sight of this are in danger of imposing their own values on clients or manipulating them, or, alternatively, being manipulated by the client. Thus, the career counselor need a clear understanding of their own stories formed through interaction with their own system of influences, past, present, and future, before they can facilitate exploration of the client’s life narratives, including the meaning of career and work in their lives. It is recognized that all individuals belong to and interrelate with multiple groups, and the counselor must be aware of the unique pattern of these social system influences in each client if counseling is to be successful (Peavy, 1998). At a broader level, career counseling takes place within the environmental-societal system and represents a recursive interaction between the counselor and a range of systems. The figure above illustrates the interconnections between two systems of influences and the positioning of the interconnections between broader systems of influences shared by each individual system (that of the counselor and the client). Systems theory encourages interventions at levels of the system other than that of the individual, and raises the potential for career counselors to be more proactive at this broader systems level. For example, career counselors may work with a family or an organization in the belief that interventions anywhere in the system will interact with other elements of the system to bring about change. In addition they may become advocates for clients with particular needs; for example, individuals of low socioeconomic and/or minority status.

Vocational Counselors (career counselors):

Career counseling is the process of helping the candidates to select a course of study that may help them to get into job or make them employable. A career counselor helps candidates to get into a career that is suited to their aptitude, personality, interest and skills. So it is the process of making an effective correlation between the internal psychology of a candidate with the external factors of employability and courses. Career counselors work with people from various walks of life, such as adolescents seeking to explore career options, or experienced professionals contemplating a career change. Career counselors typically have a background in vocational psychology or industrial/organizational psychology.

In a broad sense, anyone who helps a person with a career problem is a counselor. Parents, religious leaders, teachers, employers and supervisors—all help direct vocational choice and performance. However, vocational counselor is applied more strictly to a person who has had training in psychology with emphasis on vocational problems and may have an M.A. or Ph.D. degree. Counselors may be employed by schools, religious organizations, government agencies, charitable and correctional institutions, or private counseling agencies. In some states a counselor is required to have a license in order to practice. Career counselors usually provide career counseling outside the school setting. Their chief focus is helping individuals with career decisions. Vocational counselors explore and evaluate the client’s education, training, work history, interests, skills, and personality traits. They may arrange for aptitude and achievement tests to help the client make career decisions. They also work with individuals to develop their job-search skills and assist clients in locating and applying for jobs. In addition, career counselors provide support to people experiencing job loss, job stress, or other career transition issues.

School counselor:

A school counselor is a counselor and an educator who works in elementary (primary), middle, and high schools to provide academic, career, college access, and personal/social competencies to students. In some countries, school counseling is provided by educational specialists (for example, Botswana, China, Finland, Israel, Malta, Nigeria, Romania, Taiwan, Turkey and United States). In other cases, school counseling is provided by classroom teachers who either have such duties added to their typical teaching load or teach only a limited load that also includes school counseling activities (for example- India, Japan, Mexico, South Korea, Zambia). School counselors provide pupils with career, personal, social and educational counseling. School counselors assist students of all levels, from elementary school to postsecondary education. They advocate for students and work with other individuals and organizations to promote the academic, career, personal, and social development of children and youth. School counselors help students evaluate their abilities, interests, talents, and personalities to develop realistic academic and career goals. Counselors use interviews, counseling sessions, interest and aptitude assessment tests, and other methods to evaluate and advise students. They also operate career information centers and career education programs. Often, counselors work with students who have academic and social development problems or other special needs.

Vocational guidance work can be accomplished in three phases, namely, (1) Collecting of information or data (2) Rendering guidance on the bases of this information and (3) Follow-up programme. First of all, necessary information regarding the nature of the child like his abilities, interests, aptitudes, personality characteristics and circumstances of life has to be obtained carefully. On the other side, the guidance worker also tries to get all the adequate and relevant information regarding the world of work and job opportunities. He makes himself well informed by having living contacts- with all the current literature and publications. He has contacts with the employment bureau, state and central Bureaus of Guidance & Counselling and is well acquainted with the current trends of employment market and the demand & supply position. Equipped with all such information and knowledge, he may engage himself in the actual guidance work. For this purpose, he may utilize both Individual Guidance and Group Guidance methods. Pupils are informed about the world of work and Job opportunities through lecture, display of literature and pamphlets of library readings. They are now helped to match their individual characteristics with the requirement of different Jobs or occupations and thus helped to make adequate vocational choices. Further, they are helped to select courses and activities related to their vocational choices.

Vocational Guidance activities target individuals who are:

1. About to make a choice with respect to their education and vocation,

2. In search of new fields of study/training,

3. Already employed but dissatisfied with their current occupation, hence in search of new areas of training and professional development,

4. Unemployed or have lost their jobs for whatever reason and wish to resume employment and

5. Threatened with social exclusion owing to personal circumstances or misfortune

Career guidance and Mentor:

I think mentors are very important at every stage of a career. A mentor would see you in ways your co-workers might not, and they were more likely to be completely honest. The more successful you become, the more you need someone to sit you down and say, “Hey, you have a blind spot in this. Here’s what you need to do”. What mentors do is they let you see yourself as others see you, and report that back to you so there’s a clear idea of how you’re perceived. There’s a big difference between a consultant, who is a paid expert who tells you how to do the right thing the best way, and a mentor, who is someone you seek out when you want something and you need guidance. Your mentor is someone who holds you accountable to what you say you want.

Students can get information regarding career guidance through various sources:

School counselor

Internet

Periodicals

Peers

Life-skill training

Simulations

Work visits (on-site observations)

Guidance sources

VET School

Business/marketing education teachers

Outside the classroom, students and their success coaches should:

1. Use the Family Connection web portal and toolkit to engage students in planning for academic success.

2. Have access to information customized to include local information.

3. Receive communications at critical stages and milestones.

4. Collaborate online with the ability for parents to make suggestions or approve academic plans.

5. Reflect on tasks and programs.

6. Be provided with a mechanism to ask for help when completing tasks or programs.

What to look for when choosing a college:

Choosing a college can be a daunting and stressful decision in any young person’s life. Deciding what you are going to study, and where, is your first step to ensuring you will graduate with the right skills to find that all-important job and build your career. It is vital to do your research and find the college that is the right match for you, in terms of cost, options, accessibility, quality and reputation. The process of researching and selecting a college should be done early, as making a rushed or ill-informed choice can result in a costly mistake. Even with a limited budget, you need to get the best quality you can afford and make sure you don’t waste precious money and time being taken for a ride by a fly-by-night college. Choosing a college is a major decision. Explore your interests and take the time to find the college that is right for you and puts you on a path to a brighter future.

When evaluating your options, the following should be considered:

1. Does the college offer degrees, certificates as well as diplomas?

2. What is the accreditation status of the degrees, certificates, diplomas and courses on offer? Ensure that proof can be provided on request.

3. What are the cost implications? Consider registration, study material and tuition fees. What are the hidden costs?

4. Does the college offer flexible payment plan options?

5. Does the college offer late registration options?

6. Are you able to take a short break in studies and pick up on further modules as you may need to?

7. What study resources are freely available to the students? Libraries, computer facilities and internet are important factors.

8. Does the college offer extracurricular activities and other social clubs that will enhance your student life?

9. Does the campus location suit you?

10. Are students uploaded to the National Learner’s Records Database (NLRD)?

11. What level of support services are provided to students?

Websites for students to get proper career advice:

Students need to learn about themselves, develop a vision of their future and collaborate with adults who can provide a support system for overcoming challenges. A critical factor in any student graduating college and career ready is his or her support network. This network of peers and adults provide ongoing encouragement, direction, feedback, and accountability to their student’s plan and resulting progress outcomes. There are many websites helpful to future college students. Naviance is specifically designed to enhance and extend the power of student support networks. Not only do students and their parents have access to the student’s plan and results, so does the student’s counselor and teachers. Schools and districts can leverage this network by requiring student plan reviews by a student’s network – a virtual student-parent-teachers-counselors conference, which can be a particularly effective way to engage key stakeholders at all stages of the student’s college readiness journey. Many schools in America use Naviance for college and career planning. The tool is open to students and parents 24 hours per day, seven days per week. Naviance is a comprehensive website that students and parents can use to help in making plans about courses, colleges and careers. Naviance empowers parents to assist their children in the career and college preparation process – from early goal setting to critical transitions, Naviance supports the students in and out of the classroom.

The Relationship of Career Guidance to vocational education & training (VET):

The case for closer attention to these issues is particularly strong for two reasons. First, the terminology tends to confuse the relationship between the two concepts. It is not uncommon to find “vocational guidance” being subsumed within, or blurred with, “vocational training”, and for “career education” to be confused with “vocational education”. Second, there is a tendency to think that career guidance is largely irrelevant to VET, which is based on the supposition that career decisions have already been made. However, this supposition is flawed, in a number of important respects, and that career guidance is relevant to some of the key policy issues relating to the development of VET.

Are career education and vocational education the same?

People often use the term career and vocation interchangeably. Does that mean that career education and vocational education are synonymous? For the sake of explanation, career education is described by adjective ‘broad’ while vocational education is described by adjective ‘narrow’. However, broad is not necessarily good and narrow is not necessarily bad. Career education is broad in its coverage of occupations to achieve the goal of providing sufficient information and experience for career decision making. Vocational education is narrow in that its goal is to provide skill, knowledge, training and social interaction competencies to prepare individuals for entry into paid employment in a specific job. Career education seeks to remove the assumed distinction between the academic and the vocational learning programs, blending them to serve all learners at all levels of instructions in their quest for productive careers and rewarding life. The primary goal in career education is to enable every person to make informed choices as he/she develops his/her own career. Career education extends the academic world to the world of works. Career education is all inclusive in that it encompasses vocational education, academic education and professional education as well as career awareness, exploration and selection. Career education is for all students; vocational education is for students who wish to acquire skills for a particular job. Career education spans early childhood and adulthood; vocational education usually begins no sooner than upper secondary school. Career education emphasizes unpaid and paid employment; vocational education emphasizes paid employment in jobs that require training at less than the bachelor’s degree. Career education concepts are integrated into the ongoing curriculum; vocational education curriculum has as its core substantive content in a trade area.

Career guidance is effectively acting as bridge between VET programs and the world of work, viewing the student as an active agent in the relationship. Its role is to make sure that student demand is well-informed in terms of the labor market. This means that it needs to be supported by high-quality information. Career guidance is relevant to the quality and effectiveness of VET prior to entering a VET program and within the VET program. In some respects, career guidance is more important for students considering VET options than for those entering general education options, because their choices can carry tighter career implications. However, general education choices have career implications too; and both groups should have access to the full range of choices. This is particularly important where efforts are being made to secure greater parity of esteem between academic/general and VET pathways, including greater flexibility between them. Accordingly, career guidance provision for those considering VET should be integrated into provision for all. If career guidance services are to play a strong role in relation to VET, this has implications for the training of career guidance practitioners. This is a complex area, because such practitioners cover a range of roles, with different professional affiliations. In some cases they define themselves primarily as psychologists, as teachers, or as labor market administrators, with any career guidance training being subsumed within, or added to, their core professional training; in other cases they represent a distinctive professional group of their own, with their own professional training. One of the problems in securing adequate attention to VET in careers programs prior to entry to VET is that most career practitioners have been trained not within the VET system but within academic programs, often within psychology. The move towards more competence-based approaches to training of career practitioners may be helpful in this respect. In the UK, such practitioners may now be trained through National Vocational Qualifications instead of, or alongside, academic qualifications. It is also important that training of career practitioners should include significant attention to the gathering, interpretation and use of labor market information which will make career practitioners credible to clients. Yet within psychology-based programs, this area has often been neglected. We must provide career guidance accessible to all, informed by knowledge of labor market outcomes.

It is generally agreed that in contemporary society children and young adults are in need of guidance and counseling on a very wide range of issues. Too often, young people find the period of transition from school to work to be a time of crisis. They may perhaps have looked forward to leaving school but frequently find themselves quite unprepared to face the realities of the transition, ignorant of the choice and nature of the occupations available to them and bewildered by the thought of the ordeal that lies ahead of them. In addition, they sometimes find that they have read subjects that are unrelated to the requirements of the occupation they wish to follow. Careful long-term preparation for this challenging phase of their lives could transform adolescence from a time of crisis into a period of planned transition that is fulfilling and exciting. Such a systematic preparation could greatly assist young adults in their task of adapting to a new environment and help to ensure that they find opportunities for personal fulfillment in their future occupations. Surveys of educational and vocational guidance systems have led to broad agreement on the social and psychological factors that form the basis of this process. It is generally agreed that, to be of maximum value, vocational guidance should be accompanied by counseling which is made available to all pupils throughout their schooling and forms a carefully planned program of career orientation. In some countries a program of long-term preparation for career choice is an integral part of the framework of secondary education. Most career orientation courses present work as an important part of an individual’s life. These courses attempt to help pupils make a realistic assessment of their own potential and of future occupational choices both by theoretical study and practical experimentation. The main function of guidance and counseling in career orientation program may be considered as forming a bridge between the world of school and the world of work.

World’s wealth is its people, their skills and knowledge and their potential. Lifelong learning, full development of individual competences and the maintenance of employability are crucial in this respect. Therefore, it is necessary not only to integrate unemployed people into the labor market through learning and better training but also to promote the potential of employed people and support and accompany them in managing their education and career. To achieve these goals, people need to be supported by high quality guidance in general & in continuing education as well as in vocational education & training and in the labor market. In the context of lifelong learning, educational and career guidance is a connecting link between the needs of the citizens and the demands of the educational and labor market.

Career guidance plays a key role in helping labor markets work and education systems meet their goals. It also promotes social equity: recent evidence suggests that social mobility relies on wider acquisition not just of knowledge and skills, but of an understanding about how to use them. In this context, the mission of career guidance is widening, to become part of lifelong learning. Already, services are starting to adapt, departing from a traditional model of a psychology-led occupation interviewing students about to leave school. One key challenge for this changing service is to move from helping students decide on a job or a course, to the broader development of career management skills. For schools, this means building career education into the curriculum and linking it to students’ overall development. A number of countries have integrated it into school subjects. However, career education remains concentrated around the end of compulsory schooling. In upper secondary and tertiary education, services focus on immediate choices rather than personal development and wider decision making, although this too is starting to change in some countries. A second challenge is to make career guidance more widely available throughout adulthood. Such provision is underdeveloped, and used mainly by unemployed people accessing public employment services. Some new services are being linked to adult education institutions, but these are not always capable of offering wide and impartial advice. Efforts to create private markets have enjoyed limited success, yet public provision lacks sufficient funding. Thus creation of career services capable of serving all adults remains a daunting task. Web-based services may help with supply, but these cannot fully substitute for tailored help to individuals.

The advancement of education, training and vocational guidance in various fields must endeavor:

1. To take quality education to the weaker economic sections of the society.

2. To bring all the children of age 5-14 working as the child labor, beggar or house servants to the school with special attention to the girl child.

3. To impart the kind of education that gives them a broad vision of life and creates a sense of belongingness with the whole world.

4. To spread Smile, Education, Self Reliance, and Self Esteem to everyone who has been deprived from it.

Realities of labor market:

The reality of the labor market is quite different. Gray (1997) gives this analysis:

1. Among college students who graduate with a three to four-year degree, only two of three will find employment related to their field of study.

2. Among college students who graduate with a professional credential (e.g., for teaching, engineering, or accounting), only one in two will find related employment.

3. A three to four-year degree does not guarantee a high income.

4.Although college graduates have higher average earnings than high school graduates, only some of the variation in earnings can be attributed to education; supply and demand are the most important factors.

5. The U.S. Department of Labor’s Managerial/Professional job grouping is indeed at the top of the salary ladder. But the next rung down on the ladder is Craft, Precision Metal, and Specialized Repair occupations in virtually every industry and every work environment like construction drafter, medical lab technician, manufacturing systems operator, computer repairperson, and paralegal that pay well but require specific occupational skills available in secondary and postsecondary vocational-technical programs or apprenticeship programs.

History of vocational education:

The idea of vocational education can be traced to apprenticeships. Blacksmiths carpenters, merchants, and other trades have existed almost since the advent of civilization, and there have always been apprenticeship-style relationships where specific techniques and trades have been passed down to members of the younger generation. Prior to the Industrial Revolution, the apprenticeship system and the home were the principal sources of vocational education. Since then society has been forced by the decline of handwork and the specialization of occupational functions to develop institutions of vocational education. Manual training, involving general instruction in the use of hand tools, developed initially in Scandinavia (1866) in response to the doctrines of Friedrich Froebel and Johann Pestalozzi. It became popular in the elementary schools of the United States after 1880. Vocational education as we understand it today started in the early twentieth century. The industrialized countries of the West were the first to notice the benefits of having a specialized skilled work force and diverted funds to institutions that taught such skills. For most of the twentieth century, vocational education focused on specific trades such as an automobile mechanic or welder, and was therefore associated with the activities of lower social classes. As a consequence, it attracted a level of stigma, and is often looked down upon as being of inferior quality to standard post-secondary education. Towards the end of the twentieth century a new trend helped the appreciation of vocational education. Community colleges soon started to offer vocational education courses granting certificates and associate degrees in specialized fields, usually at a lower cost and with comparable, if not better, curricula. Good quality careers advice is needed more than ever to help young people navigate what is an ever more complex labor market. At the post-secondary level vocational education is typically provided by an institute of technology, or by a local community college.

Definition:

There are many legal definitions of vocational education (i.e., how vocational education is defined by law). These legal definitions are critical since they specify how, for what purpose, and to what extent federal monies may be spent for vocational education. All too often this legal definition is interpreted by state and local officials as the only definition of vocational education.

Defining VET as a sector within the education system poses a number of difficulties. For the most part, general and academic education is seen as that which builds analytical skills, knowledge and critical thinking, while VET develops craftsmanship, practical experience and practical problem-solving. However, this simple distinction does not hold up to scrutiny. Critical thinking and analytical skills are needed in the case of a good plumber or electrician who must routinely make judgments in order to solve problems. Equally, a good surgeon needs a large set of practical skills to masterfully operate a patient. These simple distinctions can also lead to confusion, and academic drift of vocational institution or a vocationalisation of higher education. Vocational education may be classified as teaching procedural knowledge. This can be contrasted with declarative knowledge, as used in education in a usually broader scientific field, which might concentrate on theory and abstract conceptual knowledge, characteristic of tertiary education.

Vocational education is defined as training for a specific vocation in industry or agriculture or trade. Vocational education [or Vocational Education and Training (VET), also called Career and Technical Education (CTE)] prepares learners for careers that are based in manual or practical activities, traditionally non-academic and totally related to a specific trade, occupation or vocation; hence the term, in which the learner participates. It is sometimes referred to as technical education, as the learner directly develops expertise in a particular group of techniques or technology. Vocational Education and Career Education are terms used interchangeably but their difference is already discussed vide supra. Vocational education can be acquired at the secondary (high school) level or postsecondary (after high school) level and can interact with the apprenticeship system. At the postsecondary level, vocational education is typically provided by an institute of technology, a local community college, a career training college, or a trade school. Increasingly, vocational education is recognized in terms of prior learning and partial academic credit towards an associate’s degree; however, VET alone does not generally require a bachelor’s degree and is not usually considered to fall under the traditional definition of an academic higher education. Increasingly, vocational education can be recognized in terms of recognition of prior learning and partial academic credit towards tertiary education (e.g., at a university) as credit; however, it is rarely considered in its own form to fall under the traditional definition of a higher education. Until the end of the 20th century, vocational education focused on specific trades such as automobile mechanics, a plumbing, welding, or carpentry. However, as the 21st-century labor market becomes more specialized and economies demand higher levels of skill, governments and businesses are investing in the future of vocational education through publicly funded training organizations and subsidized apprenticeship or trainee programs. Vocational education has diversified and now exists in industries such as retail, tourism, information technology, funeral services, and cosmetics, as well as in the traditional crafts and cottage industries. Many trades are highly paid and always in demand.

Moodie (2002) analyses existing definitions in four dimensions – epistemological, teleological, hierarchical and pragmatic. He argues that a definition is needed on all four levels, stating that ‘one may consider vocational education and training to be the development and application of knowledge and skills for middle-level occupations needed by society from time to time’. Such a pragmatic definition seems to match the approach of UNESCO in its Revised Recommendation on Technical and Vocational Education and Training (TVET), giving preference to the term ‘technical and vocational education and training’ over the term ‘vocational education and training’. The mentioned recommendation states that ‘technical and vocational education’ is ‘used as a comprehensive term referring to those aspects of the educational process involving, in addition to general education, the study of technologies and related sciences, and the acquisition of practical skills, attitudes, understanding and knowledge relating to occupations in various sectors of economic and social life (UNESCO, 2001).

Vocation means a particular occupation, business, or profession; calling or a strong impulse or inclination to follow a particular career. Vocational education means educational training that provides practical experience in a particular occupational field, as agriculture, home economics, or industry. Vocational education prepares learners for careers in manual or practical activities, traditionally non-academic and only related to a specific trade, occupation, or “vocation”. In the past, such education was in the form of apprenticeships, in which young people learned from the master the skills necessary for particular trades. Thus, it was associated with the lower social classes as compared to the classical education that was received by gentlemen. Following the industrialization of the nineteenth century, however, vocational education began to be introduced into the school educational system. Vocational Exploration Training is through assessments such as interest inventories and/or counseling, a process of identifying occupations or occupational areas in which a person may find satisfaction and potential, and for which his or her aptitudes and other qualifications may be appropriate.

Vocational education is defined as a practically illustrated and attempted job or career skill instruction. As such, a variety of components fall under the vocational education umbrella: agricultural education, business education, family and consumer sciences, health occupations education, marketing education, technical education, technology education, and trade and industrial education. The vocational curriculum can be identified as a combination of classroom instruction, hands-on laboratory work and on-the-job training; augmented by an active network of student organizations. Vocational preparation must always be viewed against the backdrop of the needs of society and of the individual. While meeting the demands of the economy, the abilities of individuals must be utilized to the fullest. Meeting the internalized job needs of individuals is a crucial objective of vocational education.

Vocationalism:

Vocationalism is defined as the method used by schools, particularly high schools, to organize their curricula so the students may develop skills, both vocational and academic, that will give them the strategic labor market advantages needed to compete for good jobs. Overall enrollment in vocational courses has fallen. However, an incoming current has brought a growing number of participants into new programs and curricula. While traditional vocational offerings have been geared toward immediate entry into specific occupations, new programs and course sequences are intended to prepare students for both colleges and careers, by combining a challenging academic curriculum with development of work-related knowledge skill.

Stevenson (2005) researching on VET in Australia remarks that wherever one looks, the place for the vocational appears to be similar – the vocational is at the bottom of a hierarchy of knowledge and value, it is a stream of learning available to the “lower achiever”, it is governed in a paternalistic way with highly circumscribed degrees of freedom over content and process, it is legitimated solely in industrial and other utilitarian terms, rather than in the connections among different kinds of meaning making, and it is preserved for occupations of lower status. Instead, Stevenson adopts a view from John Dewey in that a ‘vocation means nothing but such a direction of life activities as renders them perceptibly significant to a person, because of the consequences they accomplish, and also useful to his associates’. However, while such a definition does raise the status of what ‘vocational’ is, it does not solve the practical problem of difficulties in being able to identify VET provision in certain institutions. In such an approach, vocationalism is important for all types of studies. Indeed, even for academics, meaning to their own work often arises in application.

Training:

The term training refers to the acquisition of knowledge, skills, and competencies as a result of the teaching of vocational or practical skills and knowledge that relate to specific useful competencies. It forms the core of apprenticeships and provides the backbone of content at institutes of technology (also known as technical colleges or polytechnics). In addition to the basic training required for a trade, occupation or profession, observers of the labor-market recognize as of 2008 the need to continue training beyond initial qualifications: to maintain, upgrade and update skills throughout working life. One can generally categorize such training as on-the-job or off-the-job:

1. On-the-job training takes place in a normal working situation, using the actual tools, equipment, documents or materials that trainees will use when fully trained. On-the-job training has a general reputation as most effective for vocational work.

2. Off-the-job training takes place away from normal work situations — implying that the employee does not count as a directly productive worker while such training takes place. Off-the-job training has the advantage that it allows people to get away from work and concentrate more thoroughly on the training itself. This type of training has proven more effective in inculcating concepts and ideas.

Vocational training is training for a specific career or trade, excluding the professions. Vocational training focuses on practical applications of skills learned, and is generally unconcerned with theory or traditional academic skills. A large part of the education in vocational schools is hands-on training. Vocational training thus provides a link between education and the working world. Traditionally, it is usually provided either at the high school level or in a postsecondary trade school. Besides traditional vocational education, other excellent alternatives include apprenticeships, community college programs, the education and training offered by the military services, and distance learning courses.

Subtle difference between vocational training and technical training:

While the major difference between technical and vocational training may seem somewhat semantic in nature, it is mostly related to the subjects each focuses on. Vocational training often refers to education and training that focuses more on practical skills and being able to perform tasks related to working in a particular industry. Vocational training is a form of training and education that is more practical than academic and often focuses on skills and abilities a person needs to perform a job. Much of this training has often been aimed at preparing students for work in construction, manufacturing, and similar jobs that require skilled labor. Technical training is similar in nature, but the focus is on technology and developments made in computers and digital information. While both technical and vocational training are less academic and more practical, vocational training often focuses on manufacturing and construction while technical training is more computer-oriented. The other major difference between technical and vocational training is the outlook for each type of training in different countries. In countries like the U.S., for example, a great deal of effort has been expended to reduce the focus on vocational training in schools as manufacturing jobs have largely been outsourced outside of the country. Technical training, on the other hand, has become increasingly important as more and more jobs involve using computers for numerous tasks and training for such positions has become more specialized. In other countries, however, both technical and vocational training have expanded as greater opportunities for construction and manufacturing work have developed alongside computer-based work.

Two types of vocational trainings are available: a) Formal and; b) Non-formal. Formal vocational training follows a structured training program and leads to certificates, diplomas or degrees, recognized by State/Central Government, Public Sector and other reputed concerns. Non-formal vocational training helps in acquiring some marketable expertise, which enables a person to carry out her/his ancestral trade or occupation. In a way through such non-formal vocational training, a person receives vocational training through ‘hereditary’ sources. Often ‘Non-formal’ vocational trainings are also received through ‘other sources’. In such cases training received by a person to pursue a vocation, is not ancestral and is different from the trade or occupation of his/her ancestors.

The vocational education sector has changed considerably over the last fifteen years. The increased involvement of employers in designing competency-based programs, the reconfiguration of the list of available programs, and the major investments made in buildings and material resources at vocational education centers are some examples of the changes made. They were implemented to offer a better response to the needs of the labor market and to prepare a qualified work force able to find and keep employment in a constantly-evolving working environment. Given this context, it is important to ensure that vocational education teachers have an expert understanding of the trade they teach, and continue to update their knowledge. Their expertise must be supported by training in teaching methods that takes into account the special features of the vocational education sector.

Pre-vocational education:

Pre-vocational education means schools combine general education with some specific subjects related to career (vocation). Pupils follow a general curriculum along with a learning pathway to various sectors including care and welfare; engineering and technology; business and agriculture etc. Different countries have different methods of introduction of pre-vocational education. In some countries, it is introduced at primary school level while most countries introduce at secondary school level. After passing examination of pre-vocational education in secondary school, the successful pupils go for vocational schools/institutes at higher secondary level or college level.

Vocational education is a type of education, after completion of which a person is practically and theoretically prepared for work in a certain profession. It means that a certain professional qualifications have been mastered and there is possibility for further improvement in the relevant professional area. There are three grades of vocational education:

1. Vocational basic education,

2. Vocational secondary education,

3. Vocational higher (tertiary) education.

Vocational basic education is offered by primary schools in some countries. Vocational secondary education is offered by the following: Vocational secondary school, professional secondary schools, trade secondary schools, choreography, arts and music secondary schools, technical schools and some colleges. Tertiary vocational education is an alternative to higher education and is based on upper secondary education and training or equivalent informal and nonformal competence. Tertiary vocational education consists of vocational courses lasting for two to three years. Apart from the traditional colleges of technical management and maritime subjects which are publicly financed (by the county authorities), most of the colleges offering this kind of education are private ones.

A classification of VET:

From a theoretical perspective, VET can be classified in the following categories (Grubb and Ryan, 1999):

1.Pre-employment VET: prepares individuals for the initial entry into employment; in most countries these are traditional programs of vocational and educational training in schools; they are found both in schools and workplaces as dual systems and are often operated by national ministries of education;

2. Upgrade training: provides additional training for individuals who are already employed, as their jobs change, as the technology and work environment become more complex, or as they advance within the company;

3.Retraining: provides training for individuals who have lost their jobs so that they can find new ones, or for individuals who seek new careers to develop the necessary competences for employment; individuals in retraining programs, by definition have already had a labor-market experience; therefore, retraining may not have a direct connection with the occupation they already have;

4. Remedial VET: provides education and training for individuals who are in some way marginal or out of the mainstream labor force; typically those who have not been employed for a long period of time or who do not have any labor-market experience; usually people depending on public income.

Cedefop (2008) offered a distinction which encompasses the previous ones: initial and continuous educational training (IVET and CVET)

1. IVET refers to general or vocational education and training carried out in the initial education system, usually before entering working life. Some training undertaken after entry into working life may be considered as initial training (e.g. retraining). Initial education and training can be carried out at any level in general or vocational education (full-time school-based or alternate training) pathways or apprenticeship;

2. CVET is defined by the area of education or training that comes in after entry into working life and aims to help people to (a) improve or update their knowledge and/or skills; (b) acquire new skills for a career move or retraining; (c) continue their personal or professional development; continuing education and training is part of lifelong learning and may encompass any kind of education: general, specialized or vocational, formal or non-formal, etc.

A study was conducted to find students’ reasons for participating in vocational education.

There’s a growing backlash against the idea that every citizen should aspire to get a three to four-year, general-education college degree, a backlash driven by record-high student debt and the dismal youth employment rate. According to the Bureau of Labor Statistics, about 17 million Americans with bachelor’s degrees were doing menial work in 2010 that doesn’t require anything close to that level of education. A new paper from the National Bureau of Economic Research, examining 18 industrialized nations, confirms that young people who receive vocational education have a higher employment rate than those who receive general education.

But, the researchers conclude, those advantages erode over time, as vocationally educated workers can’t adapt nearly as well to structural changes in the economy and labor market.

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Different countries have different methods & different systems of vocational guidance/vocational education and therefore it will be difficult to generalize one system for all. A universal singular VET model which can guarantee the maximum benefits may not exist. Countries differ substantially in the orientation of their education programs. Some countries, in particular in Europe, stress vocational education that develops specific job-related skills in order to prepare students to work in specific occupations. Other countries, like the US, emphasize general education that provides students with broad knowledge and basic skills in mathematics and communication, and serves as the foundation for further learning on the job. Context and effectiveness are interrelated and VET systems have strong roots in the national culture of each country. The effects of VET occur at micro, meso and macro level, but these levels are strongly interdependent and often difficult to disentangle: positive effects at micro level can generate effects at meso & macro levels and vice versa. Consequently, VET benefits are outcomes occurring at individual, organizational and societal level that must be understood as intertwined and complex.

The figure below shows education and training systems around the world.

The education and training system in India:

The flowchart above shows parallel academic and vocational education system in India. ITI means Industrial Training Institute. According to the Planning commission report for the 11th Five year plan, there are about 5,114 Industrial Training Institutes (ITIs) imparting training in 57 engineering and 50 non-engineering trades. Of these, 1,896 are State Government-run ITIs while 3,218 are private. The total seating capacity in these ITIs is 742,000. Vocational education consists basically of practical courses through which one gains skills and experience directly linked to a career in future. It helps students to be skilled and in turn, offers better employment opportunities. These trainings are parallel to the other conventional courses of study (like B. Sc., M. Sc. etc.). Vocational trainings in a way give students some work related experiences that many employers look for. While 54% of the Indian population is under 25 years, the average age in China, Europe and Japan is between 30 and 41 years. In India, out of 26.5 million, 10.5 million candidates are unable to clear their class X boards; out of 10.5 million, 8 million fail to clear the class XII boards; out of 8 million, 5 million join higher education, while 3 million disappear. The need for vocational education can no longer be ignored. The biggest problem in India is that Indians tend to prefer degrees to vocational skills. The industry too, does not go by mandates such as certification. Besides, both skilled and unskilled people are hired. So learners don’t see why they need a certification. Compare this with the UK, the largest in vocational education, where certification is a must and you need a license to work. If Indians do not convert their human asset, it will become a liability. The only way to do it is through vocational education — a blend of both theoretical and hands-on learning, which equips one with skills required for a specific job or profession. Traditionally, imparting vocational skills has been the forte of government-run Industrial Training Institutes (ITIs), though there are many private players in this space. India is unveiling National Vocational Education Qualification Framework (NVEQF) that will allow seeking a degree from a school or a college while on work. The new framework to be jointly adopted by the Central Board of Secondary Education and All India Council for Technical Education will help school students who are unable to complete higher education or the students who are not academically bright but have other skill sets. The government plans to run the program in 25% secondary schools and half of the technical education institutions in India with the help of private sector, which will have an important role in curriculum development. Apart from enhancing skills of youth, the program is aimed at increasing the higher education Gross Enrollment Ratio to 30% by 2020 from about 17% in 2009-10. About 220 million children go to school, but only 14 million reach college.

The education and training system in Germany:

The figure above provides a highly simplified overview of the basic structure of the education/training sector in the Federal Republic of Germany, divided by training areas/types of schools. After the four-year primary-school period, which all pupils complete, educational pathways diverge within Germany’s divided school system, which consists of secondary modern schools (Hauptschule), secondary schools (Realschule), grammar schools (Gymnasium) and comprehensive schools (Gesamtschule). The different pathways often reconverge within the dual system, which accepts graduates of special schools, secondary-modern schools, secondary schools, comprehensive schools, vocational schools and grammar schools.

Germany’s dual system:

The dual training principle means periods in school alternating with periods of training in an enterprise. This principle ensures that the trainees acquire theoretical, practical, general and personal skills which are in demand by the labor market. The dual system does not have any formal admission prerequisites: by law, all schoolleavers, regardless of what school-leaving certificates they have, can learn any recognized occupation requiring formal training. In actual fact, however, opportunities for admission, and the actual numbers of people who enter certain occupations, depend on pre-qualification. In the dual system, a combination of learning and working provides the basis for teaching vocational stills. The system seeks to teach theory and practice, and to impart structured knowledge and active competence, in their proper context. The different learning sites involved, the company and the vocational school, interact in keeping with their different emphases, but their tasks are not rigidly divided: school is not reserved solely for teaching theory, and in-company training involves more than simply practice. Under the dual system, vocational schools and companies have a joint educational responsibility. Trainees spend one or two days in vocational school and three or four days in their company.

Chinese vocational guidance:

Vocational education started in China more than 130 years ago. After the founding of the People’s Republic of China, vocational education underwent a process of adjustment, rectification, substantiation, reform, improvement and steady development. China’s first Vocational Education Law was promulgated and implemented in 1996, which provides legal guarantee for development and improvement of vocational education. According to China Statistics Yearbook, there were 11,570 secondary vocational schools around the nation with over 3 million students in 2003. The number of schools rose to 11,813 and that of students crossed 14 million in 2006. At the same time, the number of schools for skilled workers stood at 2,884, while that of students jumped from 2.35 million in 2003 to 3.21 million in 2006. More than a government push, the development of vocational education in China needs corporate support, which may involve cooperation with schools to increase the practical skills of students, offering internship opportunities as well as providing on-the-job training for existing workers. And more important than that is an improvement in salary levels and social status, which will automatically attract more urban youth to the factory floor.

American disdain for VET and new name CTE:

America has a unique disdain for vocational education. It has supported such training since 1917; money now comes from the Perkins Act, which is reauthorized every six years. However, many Americans hate the idea of schoolchildren setting out on career paths—such predetermination, they think, threatens the ethos of opportunity. As wages have risen for those with college degrees, skepticism of VTE has grown too. The overall decline in high school vocational enrollment is evident from student transcript data of the U.S. Between 1982 and 1994 the average number of vocational credits completed by high school graduates declined from 4.7 to 4.0, or from 22 percent to 16 percent of total credits earned in all subjects. The number of students who completed three or more courses in a single vocational program area slipped from 34 percent to 25 percent. Furthermore, students with disabilities, or with low grades, accounted for a growing proportion of vocational course-taking in high schools during this period. By 2005 only one-fifth of high-school students specialized in an industry, compared with one-third in 1982. The share of 17-year-olds aspiring to four-year college, meanwhile, reached 69% in 2003, double the level of 1981. But the fact remains that not every student will graduate from university. Vocational education has been so disparaged that its few advocates have resorted to giving it a new name: “career and technical education” (CTE). Vocational education in general is trying to move on from its past. Educators no longer want it viewed, as one puts it, as “shop class for boys with cigarettes rolled up in their sleeves” –- a lesser diploma aimed at failing students. It is not even called vocational education anymore; now the official term is career and technical education. The curriculum focuses on newer careers, such as computers and information technology. Students must get hands-on experience and pass certification exams devised at least partly by the industries that will employ them. For today’s high school students, computer related fields are hot – about 22,660 students are enrolled in CTE computer courses, while less than 70 are preparing to be plumbers. A lot of the old trade skills are viewed as old fashioned and obsolete. But they’re things we all need to survive and we need to do to keep the city going. You can survive without computer but cannot survive without water. Everybody needs plumber. Americans must understand it.

A more demanding Labor Market in the U.S.:

In 1973, nearly a third of the U.S.’s 91 million workers were high-school dropouts, while another 40 percent had not progressed beyond a high school degree. Thus, people with a high-school education or less made up 72 percent of the nation’s workforce. In an economy in which manufacturing was still dominant, it was possible for those with less education but a strong work ethic to earn a middleclass wage, as 60 percent of high school graduates did. In effect, a high school diploma was a passport to the American Dream for millions of Americans. By 2007, this picture had changed beyond recognition. While the workforce had exploded nearly 70 percent to 154 million workers, those with a high school education or less had shrunk to just 41 percent of the workforce. Put another way, while the total number of jobs in America had grown by 63 million, the number of jobs held by people with no post-secondary education had actually fallen by some 2 million jobs. Thus, over the past of a century, all of the net job growth in America has been generated by positions that require at least some post-secondary education. Figure below shows that since 1973, jobs that require at least some college education have exploded while opportunities for those with just a high school education have shrunk dramatically.

Of course, labor markets in rest of the world are different than the U.S. as far as demand for some post-secondary education is concerned.

Vocational Guidance Education in Full-Time Compulsory Education in Europe:

Vocational guidance education is part of the National Core Curriculum at all levels of education (primary included) as a cross-cutting approach called ‘learning about daily life and practical skills’. The objectives of this approach are to allow pupils to self-evaluate skills and become familiarized with the professional world and to impart knowledge to them about the different professional areas. All teachers at all levels of education have the role of preparing pupils for their future career choices. In all types of educational institution, a separate subject called ‘career counseling’ exists for pupils aged 13-14. It is taught in the framework of the cross-cutting approach ‘learning about daily life and practical skills’. The objective of this subject is to facilitate pupils’ future school and career choices. Pupils receive assistance in formulating and defining their individual interests, in establishing their career objectives and in planning their educational pathways. In upper secondary education, courses are offered which consist of presentations of different trades and careers, aimed at helping pupils to take decisions in terms of their choice of future educational pathways and careers. So there is a striking difference in education systems between America and Europe.

Until the recent past, educational and vocational guidance was perceived simply as the process of giving students some information about their abilities and the needs of the labor markets, so as to enable them to make appropriate decisions and occupational choices. Nowadays, as the reports of many countries show, the emphasis has shifted towards providing students with generic development competencies to cope more effectively with their continuing development as students, workers and citizens. While most of the countries responses revealed a certain uniformity in the definition of the basic concept and general objectives of vocational guidance, in some countries vocational guidance is still considered merely as a system whereby candidates are selected for various occupations. In many countries the vocational guidance covers a wide range of activities designed to help students while attending school to make a vocational choice, and furthermore to assist adults in seeking employment, career development and their further education and training. Throughout the countries, the nature of guidance services is more or less universal, however, the methods differ from level to level and the age groups involved. At lower secondary level, the vocational guidance is usually integrated into subjects such as polytechnical studies or general technical studies or technical orientation, practical arts, initiation to technology, etc. At the upper secondary level it exists as a separate subject with visits to industries, career planning, etc. At both levels this is supported by mass media and concentrates not only on students, but includes parents as well – because of the decisive role they play in the decision of their children. In a number of countries, there is a growing trend to provide educational and vocational counseling and guidance aimed at directing students to appropriate learning opportunities within such flexible systems as bridging courses, modularization and self-study, and the students counseling continues throughout the program of study. Further advice is offered on career opportunities, retraining necessitated by emerging new technological changes in particular enterprises, and career changes related to community or family requirements.

General or vocational education?

This is a “tough choice” in many developing countries. In the human capital framework, general education creates ‘general human capital’ and vocational and technical education ‘specific human capital’. The former is portable across one’s life and from job to job, while the later one is not and hence many advocate general education, as more suitable to the flexible labor force that can change task and even the type of work; but the later one has an advantage, imbibing specific job-relevant skills, that can make the worker more readily suitable for a given job and would make him/her thus more productive. Hence both are important, and education systems in many countries therefore include both general and vocational streams of education in varying proportions. Leading social scientists have lent strong support for vocational education. For instance, Thomas Balogh (1969) was emphatic in arguing: “As a purposive factor for rural socio-economic prosperity and progress, education must be technical, vocational and democratic.” He in fact suggested that even “elementary education must impart technical knowledge to rural youth in an eminently practical way …” The case for VET received much support in the context of the global educational crisis. VET was viewed as the solution to the educational problems in the developing economies. It was believed that many educational problems could be solved by diversifying the secondary education curriculum: the unbridled demand for higher education could be controlled, the financial crisis in education would be eased by reducing pressures on higher education budgets, and unemployment among college and secondary school graduates would be reduced. Since both general and specific human capital contribute to economic growth, a balance has to be struck between size of general education and vocational education. Further, vocational education need not necessarily be purely vocational and technical. It should also include, like in Japan and Korea, general skills and attributes that are useful across a wide variety of occupations. This is particularly important in the rapidly changing economic systems.

Education has a tremendous impact on individuals and on society, so much so that entire industries have been built on the development and execution of meaningful education in this country and many others. Most people agree that education is a positive thing. The legal requirement of basic education in all developed nations supports this fact. However, the role that education plays in society and in individual lives is sometimes debated. There are those who think that people should primarily be educated to perform a skilled job, otherwise known as vocational education. Others feel that the whole mind should be expanded using a broad body of general knowledge. This is considered general education (academic education). Each of these educational ideals have their own advantages and disadvantages, as well as influences on society. Considered carefully, these ideals can create the foundation of an educational experience that enables a student to reach his or her highest potential in the workplace and in life. The academic courses are concerned with developing students’ knowledge, while vocational courses are concerned with developing students’ abilities to perform particular tasks. The structure of the academic strand was determined primarily by sets of examinations. In the vocational strand, there was (as one might expect) much less emphasis on examinations, but the structure was still very much built round the delivery of different types of courses.

Critical thinking and analysis are the most valuable parts of general education. When joined with humanities and the arts, the student acquires a broad base of knowledge that can be drawn from for making important decisions throughout their lifetime. The result of general education is the student who can see fallacies of argument, has the ability to look beyond the rhetoric of a well-written speech, and can identify trends that are potentially harmful. The more broadly people are able to think; the more likely they are to reach their full potential and contribute their talents to society. That should be the motivation and goal of any educational program. The arts, literature, and history represent not only who we are, but who we have been and who we are becoming. A culture that limits itself to the business of the here and now often forgets the greatness of what it was and tends to repeat past mistakes. General education is more complete but can be out of reach to many people. It takes significantly longer and is more expensive than vocational education. A student who concentrates on general education classes at the undergraduate level and professional training at the Master’s and PhD level commits themselves to years more study, tuition, and part-time or non-employment.

Vocational education is as old as humanity itself. Any time young people are handed down essential skills for accomplishing important tasks, vocational education is occurring. From hunting and gathering to engine repair, and from grinding wheat to nuclear medicine, vocational training is, and has always been, the backbone of culture. We all must know a skill to survive. Currently, vocational education accomplishes several goals within a relatively short period of time. It readies people to become productive taxpaying citizens that will strengthen the community and tax base. This can be done in 2-4 years, depending on the degree, and involves less of a financial commitment than a general education degree. People who finish their degree can immediately enter the job market and, with periodic continuing educational courses in their field, can stay on the cutting edge of technology and trends. This is an important aspect of vocational education when technology changes quickly and affects almost every aspect of life and career. Personal and cultural competitiveness often relies on the ability to understand and integrate technology in work and life. However, there are drawbacks to vocational education. It does little to educate people in analytical or critical thinking, nor does it instruct students in humanities or arts. Another often overlooked consideration in vocational education is the need of government, especially democratic republics, to draw legislators, leaders, and judicial officials straight from the general population. If the majority of people have only a vocational education, then that society might have a difficult time finding qualified people to govern and legislate.

Education provides the basic knowledge, skills and attitudes to make adult and youth people literate. Education programs also prepare adults and youth for meaningful and satisfying roles as working and contributing members of society.

Academic education prepares:

1. To read, write and compute.

2. To pass the competitive exam.

3. To acquire critical thinking and analysis.

4. To provide social education.

Vocational education prepares:

1. For employment with job skills training.

2. To increase productivity.

3. To acquire survival skills.

Pros and Cons of Vocational Education and Training:

Weighing the pros and cons of vocational education and training may help determine if this type of training program is right for a particular situation. For people who want to acquire training and get a job as soon as possible, a vocational training and education program may be just right. Vocational education and training institutions are typically cheaper to attend than a traditional colleges or universities. There are, however, some negative aspects to acquiring this type of training, such as the stigma of attending these schools, non-transferrable credits, and limitation of career or job opportunities. Before making a decision, there are many things to consider, such as tuition costs, transfer of credits, time of completion, and future employment options. Some of the positive aspects of vocational education and training are the lower cost of courses offered and the shorter period of time needed to complete the required courses and graduate. The cost of a traditional college education may be out of reach for some people, so vocational school may be the only affordable option for acquiring some kind of occupational training, finding a job and making a living. Vocational courses require much less time to complete than a three to four year degree. Some can be completed in a few months, and graduates can start looking for a paying job relatively quickly. Vocational training also allows a more flexible schedule for those students needing to take classes while working or raising a family. One of the negative aspects of vocational training and education is it that it may limit future employment and career opportunities. If your future career plans include moving into higher-ranking positions or even into management, the training received at a vocational school may not provide much help. Vocational training and education also limit the wages and types of companies for which one may work. Those wanting to remain in a particular area of work and who have no desire to move into higher paying managerial or executive positions will benefit from this type of training and education. There is sometimes a stigma attached to vocational training and education. This may be a negative aspect of this type of training for some people, while others do not seem to be bothered by it. While more expensive and requiring more time to complete, a college degree is considered by some to be better than any sort of training or education received at a vocational school. One final negative aspect is that some vocational training and education credits may only transfer to another vocational or training school and may not transfer to a traditional college or university.

Criticism of vocational education:

1. Vocational subjects are desirable on general education grounds, as part of a wellrounded education intended for everyone but they should not detract from efforts to improve the quality of core subjects. No study has shown that vocational courses offered as a minor part of a student’s total curriculum give an advantage in finding work (let alone self-employment) within the first few years after leaving school. This is particularly so when the labor market conditions for youth are severely depressed. Vocational subjects may foster an interest in the types of work for which the subjects are broadly intended and the skills learned may have private uses but tracer studies have found no positive impact on access to work after students leave school and no strong effect on access to relevant further technical training.

2. Vocationalization is costly. Most variants are more costly per student class period than general education subjects, primarily because of smaller classes and the greater cost of facilities, equipment, and consumables. Unless a course can be taught to a full class of students (few can), operating costs will be more than twice that of non-laboratory academic subjects.

3. Enrollment in some types of vocational courses is often strongly gender biased. Many skills taught are culturally identified with one gender only; for example, domestic science and secretarial skills with girls, industrial arts skills with boys.

4. Vocationalization is hard to implement well. It requires specially trained instructors, preferably with work experience in the types of skills being taught. Teachers with these qualifications are hard to recruit and retain. Time spent on vocational skills training can detract from the teaching of basic academic skills, which are badly in need of improvement and also essential for labor market purposes.

One can treat the spectrum of theory and practice as a dimension in a space of possible course aims, where the two endpoints of the dimension correspond to boundaries of this space that are structured in terms of the models of knowledge and of skills. This space of knowledge and skills is illustrated in the figure below and provide the principal ways in which knowledge underpins the skills where it is applied.

The traditional view of the distinction between academic and vocational courses is simply not adequate to describe the actual relationships that exist between them, particularly in the context of informatics courses in higher education. We must move on from the “tired and outdated” academic versus vocational debate and focus on creating a new pedagogy.

Integration of vocational and academic curricula:

The idea of combining vocational and academic coursework is also central to ‘High Schools That Work’, a network of more of more than 800 schools engaged in raising academic curriculum with modern vocational studies. It is also a key component of the New American High Schools identified by the U.S. Department of Education. Research has shown that schools bring academic and vocational education together in a number of different ways, which comprise eight different models of integration at the secondary level. These models are summarized as follows:

1. More academic content is incorporated in vocational courses.

2. Academic courses are made more vocationally relevant.

3. Academic and vocational teachers cooperate to incorporate academic content into vocational programs.

4. Curricular alignment is accomplished by modifying or coordinating both academic and vocational curricula across courses.

5. Seminar projects are done in lieu of elective courses and require students to complete a project that integrates knowledge and skills learned in both academic and vocational courses.

6. The academy model is a school-within-a-school that aligns courses with each other and to an occupational focus.

7. Vocational high schools and magnet schools align courses with each other and to an occupational focus for all students.

8. Occupational clusters, career paths, and occupational majors feature a coherent sequence of courses and alignment among courses within clusters.

The benefits of completing vocational and technical education programs are excellent for those who want to seek continuing education and increase their job skills. With the ever changing job market and the need for additional education, vocational and technical education provides opportunities for those who do want to attend academic college for a bachelor’s degree. So vocational education can be acquired by students of academic education as an additional education.

Vocational assessment:

One of the more important challenges facing educational and vocational institutions is be the attainment of a more open, flexible and effective system to recognize skills and competence, able to recognize the real skills of individuals whatever acquired. There is therefore the need to make clear and understandable the individuals abilities to help them in improving their employment situation or to give them access to higher education or training recognizing their credits. The need to recognize and evaluate non formal and informal learning is part of the broader approach to lifelong learning. In Europe there are various systems and methodologies for the recognition and evaluation of non formal and informal learning. The process to evaluate skills includes three stages: introduction and guidance, evaluation and recognition.

What is school to work transition and why focus on it?

School-to-work transition generally refers to the critical socio-economic life changing period between approximately 15 to 24 years of age – a period when young individuals develop and build skills, based on their initial education and training that helps them become productive members of the society. Some of the most immediate economic considerations of this period in a young person’s life include issues related to education and skills development, unemployment and inactivity, job search, labor market entry and segmentation, occupational matches, stable employment and adequate income. Analyzing the transition from school to work is quite intricate because many young people begin employment while in school, migrate out of their communities, perform casual or unpaid work, or are easily discouraged from job searching. In addition there are multiple pathways for acquiring skills and furthering education including different institutional set ups, such as age of compulsory education, tracking into general and technical streams and formal and informal mechanisms of skills development.

The statistics below shows school dropout rate in India.

Why do students dropout?

Examining the reasons why students drop out, Willis (1986) discusses the following correlates of educational risk: family structure and poverty, race and ethnicity, language, residence, economic displacement, and gender. Indicators of educational risk, according to Willis, are student attendance, school continuation rates, academic performance, involvement in school activities, student behavior, attitudes toward school, need for employment, nature of family support, involvement in out-of-school activities, and involvement with the juvenile justice system. This does not mean, however, that dropping out is just a minority or urban problem. Noting that since 1970 the dropout rate for blacks has decreased nationally, whereas that for whites has edged up steadily in the U.S., Brown (1985) prefers to categorize high risk youth as either alienated (“uninterested in or dissatisfied with the values represented by school and work” and lacking in “motivation to succeed in expected ways”), disadvantaged and alienated, or simply disadvantaged.

Costs of student dropout:

The social, economic, and political costs of the dropout problem have been well documented. According to Brown (1985), the loss to national exchequer in lost tax revenues and payments to welfare recipients incurred as a result of the dropout problem amount to $20 billion annually. Willis (1986) cites figures stating that, based on estimates that the lifetime earnings loss of a single male dropout is $187,000 and that of a single female dropout are $122,000, the lost lifetime earnings from a high school with a 40 percent dropout rate amounts to $3.2 billion. These are American statistics and you can extrapolate costs of dropout in other developing nations form these figures.

VET in dropout prevention:

Historically, vocational education has been expected to serve the needs of students who do not expect to go to college, as well as those with low academic achievement—subgroups that are at risk of dropping out. It has been argued that vocational education may reduce dropping out among these students because they may find it more engaging or relevant than academic subjects. Typically, most of the courses students take until they reach high school are in academic subjects. This could be frustrating for students who do not perform well in academic courses, or for students who do not see the relevance of these courses for the activities they want to pursue after leaving high school. This frustration could cause these students to become disengaged from, which, as previous research suggests, could result in their dropping out (Finn 1989; Alexander et al. 2000). Vocational education may reengage these students because occupational courses are often fundamentally different from academic ones. Many academic courses focus on providing students with the skills needed to enter and succeed in postsecondary education. In contrast, many occupational courses focus on preparing students to succeed in the labor market. Students who are frustrated by academic courses may find occupational courses more interesting. Because of this interest, vocational education could, in fact, reduce dropping out. Vocational education may be particularly effective in reducing dropping out among students who plan to work immediately after high school.

The key to reducing the dropout rate is helping youth to overcome their sense of disconnection. Miller and Imel (1987) attest that students with low motivation to attend school have shown improvement in school attendance and retention after participating in career education and those vocational students who have participated in career education are more likely to complete the vocational program they have selected. An analysis performed by Mertens, Seitz, and Cox (1982) on data obtained in 1979 and 1980 interviews with the New Youth Cohort of the National Longitudinal Surveys of Labor Force Behavior, confirmed that, all else being equal, the more vocational classes students took, the less likely they were to drop out of school. Two frequently cited studies that examined the relationship between vocational education and dropping out have concluded that vocational education reduces dropping out. The first study was conducted by Rasinski and Pedlow (1994) and found that vocational education indirectly reduces dropping out—that is, vocational education increases a student’s class rank, which, in turn, reduces dropping out. The second study was conducted by Plank (2001) and found that vocational education directly reduces dropping out, and that its effect is greatest when a student earns three vocational credits for every four academic credits.

However other studies found that, the average high school student’s chance of dropping out is the same when following the vocational concentrator or the basic academic program but for students who want to pursue vocational education, dropping out is less likely when they concentrate in vocational education than when they explore. It is also possible that vocational education does not affect dropping out, or that it even increases dropping out. Vocational education may have no effect on dropping out because the lateness of vocational education in a student’s educational career may make it difficult for vocational education alone to reengage students. Vocational education may even increase dropping out, because students who take occupational courses early in high school may develop skills that are valued in the labor market before they are scheduled to graduate, which may encourage some students to drop out because they want to work (Agodini and Dynarski 1998). This may be especially true of students who do not plan to seek postsecondary education.

VET costs and benefits:

The question ‘Is it worthwhile to invest in VET as VET is costly compared to general education. It is difficult to carry out an aggregate cost-benefit assessment or to come up with general conclusions. VET systems are embedded in national economic structures which add to their heterogeneity. Flexibility or rigidity of the labor market has an impact on employee turnover and on employers’ capacity to protect themselves against free-riding and poaching. Regulations such as minimum wages as well as the impact of unions and involvement of employers are crucial in shaping the wage structure and hence training costs and benefits. In the standard theoretical model of human capital with perfect labor markets, workers capture all the returns to their general human capital and employers have no incentive to pay for general training. However, when labor market frictions compress wages (increasing the wages of less skilled workers), firms may invest in the general skills of their employees. The reason according to Acemoglu and Pischke (1998) is that labor market imperfections restrict mobility of workers. This implies that trained workers do not get paid their full marginal product when they change jobs and general skills are turned into de facto specific skills. Other factors adding to the complexity of cost-benefit analysis include the nature of vocational education and training (in vocational schools or work-based) and the specific occupation or industry. Characteristics of the students, their age and level of prior schooling, the time it takes them to complete a VET program and to find an apprenticeship place are also relevant. Various direct and indirect costs to different stakeholders have to be taken into account as depicted in the table below.

Benefits may be difficult to quantify and hard to disentangle from other variables affecting performance and productivity.

The European research review of the benefits of vocational education and training (VET) presents the results of research carried out from 2005 to 2009 in 21 European countries. It relies on contributions from members of the ReferNet, who were asked to provide research-based information on the theme. Countries in this study include the Czech Republic, Denmark, Germany, Spain, France, Italy, Cyprus, Lithuania, Hungary, the Netherlands, Austria, Poland, Portugal, Romania, Slovenia, Slovakia, Finland, Sweden and the UK, plus Norway and Iceland. VET benefits can be grouped using a classical typology based on the nature of results. Two main categories can be identified: economic benefits and social benefits. Both can be analyzed on three different levels: the micro level (the benefits for individuals); the meso level (benefits for enterprises/groups); and the macro level (benefits for society as a whole). Figure below gives examples of VET benefits according to the dimension (economic and social) and the level of analysis (micro, meso and macro).

Vocational and Technical School Benefits:

Typically vocational and technical schools are designed for those who need or like to work with their hands or prefer work skills that require active engagement. These same people do not like to sit behind a desk and enjoy jobs which have changing experiences. The following are examples of other benefits of Vocational Education which include:

1. Higher hourly wages compared with those who have only a high school degree

2. Actively engaged in problem solving in the working environment

3. Hands-on work activities that allow application of knowledge

4. Employment opportunities which involve the outdoors

5. Leading to employment opportunities which offer greater responsibilities

6. Learning new work skills to meet requirements in an ever changing work place

7. Learning new skills for changing careers

8. Typical 97% employment rate after graduation, with over 80% in the field of their certificate (U.S. Department of Education, 2006)

9. Increased job skill transfer ability

10. Increased job stability

11. The ability to transfer to a four year college for a Bachelors Degree, if desired

12. The ability to earn a two year Associates Degree, if desired

VET survey:

A survey found that:

1)76 percent said that all students would benefit from vocational education.

2)90 percent agreed or strongly agreed that vocational education prepared students for good-paying jobs.

3)92 percent agreed or strongly agreed that vocational education can lead students to go to college.

4) Only 4 percent agreed that vocational education led to low-skill jobs.

5)98 percent said that internships or apprenticeships in different career fields were appropriate for high school juniors and seniors.

6)90 percent said that real work-based problems or career-related projects were a good way to teach subjects like math and English.

These survey results present a curious contradiction. On one hand, there is a raft of common misconceptions about vocational education, the labor market; in particular the name “vocational education” often invokes an automatic negative response. On the other hand, however, people often reveal very favorable attitudes toward many of the elements that are a traditional part of vocational education. The great majority of people have a very positive reaction to the elements that are the very foundation of vocational education: a focus on career preparation; knowledge and skills that are relevant for the job market; the possibility of challenging careers, good-paying jobs, and college. Such favorable attitudes toward the foundation elements of vocational education may represent a new trend for the new millennium.

VET and economic growth:

VET is important for economic growth. Growth of economy depends on availability of skilled workers and VTE helps development of skilled labor force and thereby strengthens economy. But the relationship is not linear. So each country has to decide the extent of VET that has to be developed, depending upon the level of development and demand for skills. As Foster (1965) observed, “in the initial stages, technical and vocational instruction is the cart rather than the horse in economic growth, and its development depends upon real and perceived opportunities in the economy”. The provision of vocational education must be directly related to those points at which some development is already apparent and where demand for skills is beginning to be manifested.

VET and Development:

The industrialized world invests more in vocational schooling than the developing world. The UNESCO Institute of Statistics (UIS) finds a simple correlation between the two, as ‘the greater a country’s Gross Domestic Product per capita, the greater its secondary Percentage of Technical/Vocational Enrollment’ (UIS, 2006). However, surprisingly, there is little in the relevant literature to support the link between VET and development. With a few exceptions, the standard conclusion is that it is wiser for governments to invest in general education than in VET. This line of reasoning has been set on the pretext of ‘the vocational school fallacy’ – a term coined by Foster when researching the externalities of Western education reform in Ghana in 1965.

The Vocational School ‘Fallacy’:

Vocational and technical education is not necessarily favored by all. There are strong opponents as well. In a seminal often quoted work, Philip Foster (1965) exploded the vocational school myth and called it “vocational school fallacy.” Foster and later Mark Blaug (1973) clearly argued that vocationalisation cannot be a remedy for educated unemployment: it cannot prepare students for specific occupations and reduce mismatches between education and the labor market; academic streams promise higher wages than vocational streams; accordingly demand for vocational education might not exist, and Say’s law that supply creates its own demand might not work. Furthermore, vocational schooling may create “a sense of second class citizenship among both teachers and taught which militates against effective learning” (Blaug, 1973). King and Martin (2002) explain the VET ‘fallacy’ as a challenge between planning and reality. Foster’s main message was that youth in Africa had already quite rationally decided in the sixties – despite all types of attempts to change their attitude – that an academic education would be better for achieving their goals and improving their position than vocational schooling. Thus while policy could have had many noble goals in trying to improve the situation of socially and economically disadvantaged people, the actual attitudes and behavior of young people may not match these goals, as was the case in Africa, according to Foster. Foster’s conclusions were based on a study of perceptions of young Ghanaian males on their future prospects and education opportunities. Although several methodological points are made and the mitigating effects of schools on society are recognized, King and Martin’s (2002) survey still concludes that ‘Foster’s message today as in 1963 remains relevant for any attempts to use schools to deliver massive changes in attitude and aspiration in the absence of any parallel initiatives in the larger economic environment’ (King and Martin, 2002). Oketch (2007) is more critical of the fallacy, claiming that it does not have to apply today, as vocational education is seen as training which forms the basis for future training, not as a way to facilitate job entry, but as a way to facilitate vocational-specific skill over a lifetime. He argues that VET in Africa needs to be reformed to train for what he calls ‘higher skills’ linking better with the informal sector (Oketch, 2007). It is however clear that the ‘fallacy’ continues to influence policymakers today, making them skeptical about the need for VET.

Rejuvenation of VET from being labeled fallacious:

With the succinct, clear and powerful arguments of Foster, Blaug and others, it was hoped that the issue was buried. But it refuses to stay buried. Few countries have given up their efforts in developing elaborate systems of VET. After all, it has inherently a powerful appeal. Many countries have set ambitious targets as well. For example, China had a goal of expanding vocational education so that at least fifty per cent of the enrolments in secondary education would be in vocational education in near future; India has a similar target of reaching 25 per cent; and Bangladesh twenty per cent. As Psacharopoulos (1987) aptly stated, “because of the inherently logical and simplistic appeal, vocationalism will be with us for years to come, and more countries will attempt to tune their formal educational systems to the world of work.” Organizations such as UNESCO and the World Bank have played a leading role in reviving and furthering the cause of vocational or diversified secondary education. UNESCO adopted in 1974 an important detailed recommendation concerning technical and vocational education, and argued for provision of technical and vocational education as “an integral part of general education,” as “a means of preparing for an occupational field,” and as an instrument to reduce the mismatches between education & employment, and between school & society at large. The World Bank’s sector policy paper on education (World Bank, 1974) attacked school curricula as excessively theoretical and abstract, insufficiently oriented to local conditions, and insufficiently concerned with attitudes and with manual, social & leadership skills; and accordingly the Bank also suggested increasing vocationalisation of the curricula of academic schools.

Wolf report regarding vocational education in UK:

Professor Wolf is the Sir Roy Griffiths Professor of Public Sector Management at King’s College London, and specializes in the relationship between education and the labor market. She has a particular interest in training and skills policy, universities, and the medical workforce. Vocational education not good enough, says Wolf report. Hundreds of thousands of young people are doing vocational courses which do not lead to university or a job, a report says. Many 14 to 16 year olds are on courses which the league table systems encourage but which lead children into dead-ends. Many young people have not been told the truth about the consequences of their choice of qualification. A quarter to a third (300,000 – 400,000) of 16 to 19 year olds are on courses which do not lead to higher education or good jobs. High-quality apprenticeships are too rare and an increasing proportion is being offered to older people not teenagers. It says all pupils should study a core of academic subjects until they are 16. Professor Wolf recommends a radical change of direction.

Key disadvantage of VET:

Virtually all discussion of vocational education emphasizes its potential advantages in easing entry into the labor market by youth. But there is the other end of the market. If people receive skills that are finely tuned to employment opportunities, they might not be particularly prepared to adjust to new technologies. Thus, with higher growth rates and faster technological and structural change, people with vocational training may be more likely to be out of the labor market later in the life cycle. So Vocational education facilitates entry into the labor market but hurts employment at older ages. The skills students learn from a vocational education may ease their transition into the labor market, according to a new study from the National Bureau of Economic Research. However, those initial labor-market advantages fade as workers age. The study found that individuals with a general education are more likely to be employed at age 50 than are those with a vocational education. A general education was particularly helpful in countries that experienced faster economic growth and larger technological change.

Employment rates are higher for youth with vocational education, but this turns around by the age of 50. The employment patterns are most pronounced in the “apprenticeship countries” with combined school and work-based education programs (Denmark, Germany, and Switzerland) and least noticeable in the countries with no formal system of vocational education such as the United States. The figure above displays the employment patterns for these three “apprenticeship countries,” and the lower employment at older ages is very apparent.

Key reforms that must be undertaken in different areas to make the vocational education and vocational training systems more responsive to the needs of the labor market – and these have been summarized below. The first phase focuses on reforms aimed at improving the quality and labor market relevance of the existing system, while the medium-term agenda also includes moving forward on mobilizing additional resources for the system, especially once the quality has improved. The table below highlights the key reforms that need to be undertaken in the 1st phase and over the medium term, the advantages of undertaking these reforms and the potential challenges that need to be addressed to ensure successful implementation of reforms.

Poor progress of VET in Asian countries vis-à-vis Europe:

Why several countries have made remarkable progress in vocational education (European) and many others could not (Asian)? This depends upon social, economic and political factors, which also mutually interact with each other. First, the social factors. Social attitudes to vocational education are not encouraging in many Asian countries. Negative attitudes to manual work severely dampen the demand for vocational education. Further, VET is conceived as a system of education for the poor, and for the educationally backward sections that are not eligible for admission into higher education. This is viewed as one that perpetuates inequalities in the system. For example, the experiment of providing a rural curriculum in Tamil Nadu in India, familiarly known as the Rajaji experiment, and the Handessa Rural Education Scheme in the 1930s in Sri Lanka, were abandoned not only because there was no demand for such education, but also because they came to be viewed as a Brahmincal conspiracy and as “a ruse designed to keep the under-privileged away from the prestigious academic curriculum” (Wijemanne, 1978). In rural areas it is mostly considered as the second-class education against the expectations of pupils and parents. Low prestige attached to vocational education and its inherent inequities are somewhat a common phenomenon in many countries including India, Indonesia, Philippines and Sri Lanka and to some extent in Korea and Taiwan. This suspicion that vocational curricula provide a second-class education to individuals belonging to lower class or lower caste, racial minorities and women; away from academic education and access to jobs of the highest pay and status; became quite strong over the years and some public polices of ill-treatment of vocational education in educational planning and resource allocation contributed to strengthening this belief. As a result, vocational education in countries like India did not take off on a sound footing. Secondly, enrolments in vocational education and level of economic development are related. Demand for vocational education seemed to exist in industrially developing societies, with growth and diversification of industrial structure. The lower the overall level of a country’s development, the weaker is the case for introducing vocational curriculum and diversifies it. But it is in these countries the need for vocational education is felt. Emphasis on diversified industrial production emphasizes the need for labor force with vocational skills. Much growth in vocational education took place in countries like Korea during early industrialization processes, when employment opportunities could increase. So vocational education becomes more popular in regions where jobs can be guaranteed. The other way can also be augured: unemployment rates may diminish, if people have vocational skills. For instance, Haq and Haq (1998) observed, unemployment rates in the East Asian economies remained low essentially because the population possessed employable vocational and technical skills. However, the relationship between demand for vocational education and economic development may not be linear. When the economies move away from reliance on its agricultural and manufacturing sectors and in favor of service sector, the demand for VET may indeed decline.

How to improve VET in developing nations akin to developed nations:

The training courses lack focus on the changing job market in developing nations. As a result it was seen from various reports that the number of students is declining for long term vocational courses. The training policy should be focused on the changing job market in order to attract young people. Funding for the public VET institutes is very low in developing countries as compared to developed countries which have restructuring-funds, whose share goes for improvement of vocational training systems in order to achieve international quality. In developing nations, vocational institutes must focus on low-literate youth and provide new vocational qualifications/training programs and also on unorganized sector, otherwise it will cause long term losses. Lack of accountability and training/supply management are also major problems for ITI institutes. A central vocational training standardization system, accredited nationally and globally, for maintaining the quality of the vocational education can enhance credibility of vocationally trained persons in the industry. To attract more students from school level, reorientation of vocational courses is needed. There should be a bridge organization to relate R&D institutes and vocational education system. It would help the vocationally trained person to get the benefits of R&D.

Table 4 Social Rates of Return to Vocational versus General Secondary Education
Country	Year	General	Vocational/ Technical
Cyprus	1975	10.5	7.4
Cyprus	1979	6.8	5.5
Taiwan	1970	26.0	27.4
South Korea	1981	9.0	8.1
Thailand	1970	10.0	8.0
	1990	11.4	6.7
Philippines	1960s	21.0	11.0
Indonesia	1978	19.0	23.6
	1978	32.0	18.0
	1982	23.0	19.0
	1986	19.0	6.0
	1986	12.0	14.0
	1986	11.0	9.0
Jordan	1960s	6.7	1.6
Source: Psacharopoulos (1994); Tilak (1994, 2001); Bennell (1995, 1998)

The table above presents estimates of social rates of return to VET versus general education in seven Asian countries. Though they are somewhat out-of-date, it can be noted that except in Taiwan where the difference is small, in general, vocational education does not pay as much as general secondary education. After all, costs of vocational education are extremely high, but the labor market benefits are not so high as to compensate for the huge costs. However, if productivity is measured not in earnings, but in physical terms, and not in relation to costs, sometimes it is found that workers with VET may be more productive than those with general academic education (e.g., Min and Tsang, 1990).

Appropriate role of the Public Sector in vocational training:

There has always been an extensive debate regarding the appropriate role of government in the provision and financing of training. While the debate is by no means resolved, international experience points towards some guiding principles in this regard. No government today can afford to provide and finance all the skills needed by a modern economy. Finding the appropriate balance in government and non-government provision and financing of skills is essential. The highest priority for government is in getting the policies right to facilitate skills development that encourages each of the partners to pursue its comparative advantage in a market context. The balance in the partnership may vary from country to country given the economic context and will need to be informed by analysis of this context. Some rather clear roles for government emerge where ensuring equity of access to training is concerned and where markets fail to provide the right signals to guide training decisions. Encouraging cost recovery for training can improve the efficiency with which training resources are used but reduce access to training for those without a capacity to pay. The state has a clear role to promote equity in access and can use its financing in a targeted fashion to achieve this goal in state-sponsored and nongovernment sources of skills training. Where markets fail to send the right signals to guide training decisions, governments can also justify financing interventions. The presence of social benefits to training that are not captured in increased earnings for the trainee or higher profits for the enterprise will lead to lower levels of private investment in skills development than needed from a social perspective. Targeting public financing to those who would invest in these skills can improve the performance of the market. State-sponsored provision of training can also be used to address equity and market failures, but it is not a necessary condition in an environment where non-government capacity for skills development exists. Determining the role for the public sector in the provision of training therefore requires carefully assessing what the non-government sector is willing to do and whether, with appropriate incentives, it can be encouraged to fill training gaps. There are many things the non-government sector does not or cannot do. These include overall policy development and guidance, standard setting, the provision of information about the benefits and location of training, preparing teaching materials, training instructors, and running standardized examinations of graduates. Here, the state’s role is clear and positive.

Apprenticeships:

Apprenticeship is a system of training a new generation of practitioners of a skill. Apprentices build their careers from apprenticeships. Most of their training is done while working for an employer who helps the apprentices learn their trade, in exchange for their continuing labor for an agreed period after they become skilled. Theoretical education may also be involved, informally via the workplace and/or by attending vocational schools while still being paid by the employer. The system of apprenticeship first developed in the later middle Ages and came to be supervised by craft guilds and town governments.

‘Apprenticeship’ can mean very different things. For the World Bank for example, the ‘traditional’ apprenticeship is offered by a small business owner, which is willing, for a fee, to teach a skill or trade that is in demand. The training period varies in length, depending upon the technical difficulty of the trade and how quickly apprentices master the body of skills. Such apprenticeships are still found in North and West Africa and to a lesser extent in Latin America (Middleton et al, 1993). Such an apprenticeship is quite the opposite of more regulated ‘transitions’. In the latter situation, it is in the interest of the company to provide the apprenticeship when it employing and giving a (modest) salary to the apprentice. The word ‘apprenticeship’ is therefore quite ambiguous. Ryan (1998), in an attempt to calculate the economic merits of apprenticeship, explains that the category ranges from the informal purely work-based learning-by-doing – which still predominates in developing countries – to formal structured programs of general education and vocational preparation sponsored by large industrial firms in some advanced economies. Completing an apprenticeship is an alternative to traditional vocational training. Apprenticeships are most common for highly skilled manufacturing or construction jobs, but are available for more than 850 occupations in many industries. Common programs train people to be boilermakers, bricklayers, carpenters, electricians, firefighters, machinists, millwrights, plumbers, roofers, telecommunications technicians, and tool and die makers. Less common programs train people to be stage technicians and actors, cooks, designers, paralegals, environmental technicians, computer programmers, and landscapers. Apprenticeships combine on-the-job training with classroom instruction. Apprenticeships typically take four to six years to complete, although some can be completed in as little as one year. Because apprenticeships are paid programs, competition for available slots is often fierce. About twenty-nine thousand apprenticeship programs exist nationwide.

The modern concept of an internship is similar to an apprenticeship. Internship is a system of on-the-job training for white-collar jobs, similar to an apprenticeship. Interns are usually college or university students, but they can also be high school students or post graduate adults seeking skills for a new career. They may also be as young as middle school or in some cases elementary students. Student internships provide opportunities for students to gain experience in their field, determine if they have an interest in a particular career, create a network of contacts, or gain school credit. Internships provide employers with cheap or free labor for (typically) low-level tasks. Some interns find permanent, paid employment with the companies in which they interned. Their value to the company may be increased by the fact that they need little to no training. An internship may be paid, unpaid or partially paid (in the form of a stipend). Paid internships are most common in the medical, architecture, science, engineering, law, business (especially accounting and finance), technology and advertising fields. Internships in non-profit organizations such as charities and think tanks are often unpaid, volunteer positions. Internships may be part-time or full-time – typically they are part-time during the university year and full-time in the summer. They usually last 6–12 weeks, but can be shorter or longer, depending on the company involved. The act of job shadowing may also constitute interning. Internship positions are available from businesses, government departments, non-profit groups and organizations.

World Bank and VET:

The position of the World Bank is interesting, as it has funded many VET projects in the past. From 1963 to 1976, more than half of World Bank-assisted investments in the educational systems of developing countries supported vocational education or training. Two-thirds of this investment was made in middle income countries. Similar patterns persisted well into the 1980s, not only for the World Bank, but also for the investment programs of the Asian, African, and Inter-American Development Banks. The dilemma mentioned in the World Bank study is that developing nations are faced with a dual problem while developing strategies for increasing the access to ‘middle-level skills’. This dual problem is to improve productivity under severe resource constraints and respond to high demands of public education and training resources, including improving access to, and quality of, basic education. Therefore, the results of VET should be seen in the context of other investments as well. The authors take note of the above-mentioned problems of definition, combined with a lack of data, concluded that due to such problems ‘it is not surprising that the attempts to examine VET’s contribution to economic growth have been unsuccessful’. However this does not stop them from drawing far-reaching conclusions.

The World Development Report (WDR) 2007:

Development and the Next Generation (WDR 2007) presents a comprehensive approach of life transitions into the challenges of adulthood, it focuses on the five major transition faced by youth including, learning for life, transitioning to work, healthy adolescence, forming families, and exercising citizenship. Of the five transitions outlined in the WDR, the education sector mainly focuses on the first two – learning for life and the school-to-work transition. These two issues are intricately intertwined with the other issues of healthy adolescence, family life and the avoidance of risk-taking behaviors. Developing countries which invest in better education, healthcare, and job training for their record numbers of young people between the ages of 12 and 24 years of age, could produce surging economic growth and sharply reduced poverty. With 1.3 billion young people now living in the developing world-the largest-ever youth group in history-the report says there has never been a better time to invest in youth because they are healthier and better educated than previous generations, and they will join the workforce with fewer dependents because of changing demographics. The report says that young people make up nearly half of the ranks of the world’s unemployed, and, for example, that the Middle East and North Africa region alone must create 100 million jobs by 2020 in order to stabilize its employment situation. Moreover, surveys of young people in East Asia and Eastern Europe and Central Asia-carried out as research for the report-indicate that access to jobs, along with physical security, is their biggest concern. Far too many young people–some 130 million 15-24 year olds–cannot read or write. Secondary education and skill acquisition make sense only if primary schooling has been successful. This is still far from being the case and efforts have to be reinforced in this area. In addition, more than 20 percent of firms in countries such as Algeria, Bangladesh, Brazil, China, Estonia, and Zambia, rate poor education & work skills among their workforce as ‘a major or severe obstacle to their operations.’ Overcoming this handicap starts with more and better investments in youth. Most developing countries have a short window of opportunity to get this right before their record numbers of youth become middle-aged, and they lose their demographic dividend. This isn’t just enlightened social policy. This may be one of the profound decisions a developing country will ever make to banish poverty and galvanize its economy. One study attributes more than 40 percent of the higher growth in East Asia over Latin America in 1965-1990 to progressive policies on macro-economics, trade, education, healthcare, and vocational training, and the faster growth of its working-age population. Countries that miss this demographic window will find themselves lagging increasingly further behind in the global economy. The report says that most policymakers know that their young people will greatly influence their national social and economic fortunes, but nonetheless face acute dilemmas in how to invest more effectively in their youth. The World Development Report identifies three strategic policies that may enhance investment in young people: (1) Expanding opportunities, (2) improving capabilities, and (3) offering second chances for young people who have fallen behind due to difficult circumstances or poor choices. These address five fundamental transitions facing young people and affecting their whole economic, social and family life, namely getting an education, finding work, staying healthy, forming families, and exercising citizenship.

Adult Education:

Adult education is a broad field where people whose major social roles are characteristic of adult status undertake systematic and sustained learning activities for the purposes of bringing about changes in knowledge, attitudes, values, or skills. Many adult educators are involved directly or indirectly in activities or programs that educate, train, or develop workers for present or future employment because they have expertise and/or experience in teaching adults. These activities or programs include basic adult education, continuing professional education, adult literacy training, Job Training Partnership Act (JTPA) programs, and business and industry training.

Social exclusion and vocational guidance:

Learning in its widest, truest sense can raise self-confidence and provide an enjoyable, interesting experience and enhance life. The guidance process itself provides ‘learning experiences to enable clients to acquire knowledge, skills and competencies related to making personal, educational and career decisions’ (Clark, 1999). Furthermore, for those who do choose to return to learning, good quality guidance is extremely important in the negotiation of the maze of learning opportunities currently on offer and their costs. For people at risk of social exclusion such guidance may be indispensable. A range of factors contributes to social exclusion, and people of all ages may be excluded from participating in the normal social and economic life of the country in which they live. In a modern economy, the single greatest symptom of social exclusion is likely to be low income, arising from unemployment or precarious or low-paid employment. Poverty and social exclusion are not, however, synonyms. Other attributes of social exclusion include lack of access to employment, education and the kind of social life regarded as normal; lack of access to informal networks that provide information such as the availability of jobs or courses; lack of contact with officialdom apart from welfare and policing agencies; and vulnerability to crime either as victims or perpetrators. Furthermore, ‘social exclusion’ means that processes are at work without the control of the individual. People rarely, if ever, ‘exclude themselves’; and the popular myth of the ‘socially excluded’ or the ‘underclass’ as young, male and feckless is far from the reality. In fact, the excluded are heterogeneous. For the majority of disadvantaged groups, however, the issue is not access to higher education but access to any form of lifelong learning. There are three kinds of barriers commonly referred to as institutional, situational and dispositional.

1. Institutional barriers:

For groups at risk of social exclusion, including older adults, less affluent and well-educated people, women with dependent children, ethnic minorities and rural populations, participation is low where: institutions do not provide appropriate courses; a middle-class, ethnocentric ethos is pervasive; timetabling and lack of child-care provision do not recognise the needs of women; courses are located far from home; fees are high; disabled access is poor (including access for the visually and hearing disabled); and there are few support structures, including the provision of information and advice (McGivney 1993; Park 1994). Thus the difficulty of access arising from institutional barriers on the part of learning providers is one reason for non-participation. The blame for some of these barriers, however, lies not with the providers themselves but with the rules under which they operate.

2. Situational barriers:

Those most in need of education and training to enhance their life-chances are the least likely to participate in it, and often because their situation prevents them from doing so. Examples of such situations are life in rural or other remote areas; disability; low-paid, low-skilled employment; lone parenthood; and homelessness.

3. Dispositional barriers:

For some education is felt to be ‘a waste of time’ or ‘not for the likes of me’, although job-related training, if offered, may be a more attractive, because more obviously relevant and useful proposition. It would be a mistake, however, to equate all non-participants with the socially excluded. Some people simply choose not to participate in courses, preferring to spend their free time in other ways, including informal or self-directed learning which is not recognised as such (Tough 1993); but the patterns that emerge on analysis of participants suggests that wider cultural, social and economic factors play an important part in influencing and constraining personal choice. Participation ‘is not merely a function of socio-demographic variables … Rather it has something more to do with perceptions of power and self-worth mediated through the instrumentality of these variables’ (McGivney 1993, citing Courtney). What appear to be dispositional barriers, then, may often be essentially institutional or situational, or a mixture of both which is hard to disentangle.

Social exclusion vis-à-vis education in India:

India is a unique country where large sections of Hindu lower caste people were socially excluded to acquire education for centuries and reservation policy in post-independent era is trying to bring back these socially backward people into the mainstream of education. However, the method they have adopted to give reservation in educational institutions purely on the basis of birth bypassing merit is counter-productive. What we need is affirmative action in which every socially backward child/youth is given a flat 10 % marks in addition to his/her marks obtained by merit to make a level playing field while competing with Hindu upper class students. You cannot allow a youth from socially backward caste with 40 % marks to become a doctor/engineer under pretext of stamping out social exclusion. Sadly, reservation policy in India has become party to vote-bank politics and it is unlikely for such a nation to excel in educational achievements.

Vocational guidance and lifelong learning:

In an ideal world, everyone who needed it would have free access to a vocational guidance and counselling service, which in turn would be at the centre of a network of agencies and organisations with the resources to offer lifelong learning to those who most need it but find it difficult to access. This would enable guidance services to move beyond working to remove dispositional barriers into collaboration to remove institutional barriers and ameliorate the effects of situational barriers.

Disabled people and VET:

Employment is a means through which one is able to use his/her potential to further develop his/her skills and interests, to feel part of a community, to contribute to society, and to have access to financial independence in the process. Indeed, employment is one of the pillars on which the whole concept of independent living stands. Whereas independent living can often be taken for granted by nondisabled people, disabled people due to barriers created by society, have to struggle to have access to what is ultimately their right, that is, to live their own life, deciding what they want to do and make it happen. Very often, disabled people find themselves in situations where other non-disabled people, explicitly or implicitly, make decisions on their behalf, perhaps out of overprotection and often out of sheer paternalism. This, of course, happens with respect to the choice of employment. Thus, the need for a study about career guidance for disabled people has long been felt. Such a study needs to contemplate that what this minority requires is support to be able to access a career. Career guidance needs to take into consideration personal circumstances, but which are truly congruent to the person’s interests and potential rather than leading them to a ‘career’ which ‘fits the mould’ of low expectations.

The evidence that disabled people experience severe economic deprivation and social disadvantage is overwhelming and no longer in dispute, whether it is from the Government’s own commissioned research, from research institutes, academics or disabled people themselves. For example, after over a century of state-provided education, disabled children and young people are still not entitled to the same kind of schooling as their able bodied peers and nor do they leave with equivalent qualifications. The majority of British schools, colleges and universities remain unprepared to accommodate disabled students within a mainstream setting. Thus, many young disabled people have little choice but to accept a particular form of segregated ‘special’ education which is both educationally and socially divisive.

The life of a student can be referred to as a lifelong journey. The Career Guidance teacher has a role to accompany any student, who for some reason or other encounters difficulties along this passage. A person with a disability, like any other student, requires a positive experience and needs to answer questions related to Who am I? and What can I become? However, in this experience called ‘life’, these individuals do not come across the normal pitfalls, but have a number of barriers they need to overcome to ensure that they will make it through. There are many elements which will affect the way students will prevail over these challenges, namely; their personality, their sense of pliability and the support imparted by society to overcome these barriers. Resilience is improved when community leaders, educators, therapists, parents, youth and community workers, mentors, priests, coaches, provide as many supports in the environment as can be garnered. More than 9 out of 10 secondary students with autism (92 percent) take at least one academic subject in a given semester as seen in figure below:

Distance Learning Vocational Programs:

Many programs offered by vocational and technical schools are offered through distance learning. This allows adult students to complete a program when it is more convenient for them due to the work schedule, life commitments, or distance to school. Examples of vocational and technical school programs offered through distance learning include:

1. Computers – computer technician, web designer, website developer, network administrator, information technology, and more.

2. Business – buying and selling, travel and tourism, library assistants, recreation careers, and more.

3. Heating, Air Conditioning and Plumbing – installers, repair mechanics, building inspectors, and more.

4. Nursing – medical assistants, dental assistants, pharmacy technicians, physical therapists, and more.

5. Culinary – chefs, line cooks, and food preparation workers.

6. Landscape Design – principals of design, irrigation systems, horticulture, and more.

7. Telecommunications – electronics repair, communication systems, power line technicians, and more.

These are samples of the vocational and technical education programs that are available through distance learning. These programs and more are also offered through traditional classroom settings for those who do not want to complete distance learning programs.

Future vocational guidance via mobile phones:

One of the ways to improve young people’s career guidance is through mobile phone applications. What I think we will see in schools and colleges in the future, is analyzed and organized data released by social enterprises in the format that young people can use and available on mobile phone as direct personal communication. By creating mobile phone apps that enable young people to check out organized material on line, it will provide career guidance to young people and at some point, they will be motivated to contact someone who has direct experience.

Brain Scans may help guide Career Choice:

General aptitude tests and specific mental ability tests are important tools for vocational guidance. Researchers are now asking whether performance on such tests is based on differences in brain structure, and if so, can brain scans be helpful in choosing a career? Using MRI, the researchers correlated gray matter with independent ability factors (general intelligence, speed of reasoning, numerical, spatial, memory) and with individual test scores from a battery of cognitive tests completed by 40 individuals seeking vocational guidance. They found that, in general, the grey matter correlates for the broad and narrow test types were different. Researchers concluded that a person’s pattern of cognitive strengths and weaknesses is related to their brain structure, so there is a possibility that brain scans could provide unique information that would be helpful for vocational choice. This result forms a basis to investigate this further.

Difference between America and Europe vis-à-vis VET:

By “middle class” I mean people who are neither at the top nor the bottom of their societies in terms of income. Aristotle was only the first of a long line of commentators to point out that stable democracies depend on the presence of a broad middle class. Without a broad middle class, countries from the beginning of time have descended into oligarchy, with a small elite getting all the goodies and lording it over the impoverished others, or been consumed by populist revolution. Democracy withers in such situations.

In 2006 report, Tough Choices or Tough Times, NCEE documented the decline of that middle class in the U.S. The triangle-shaped distribution of the American income up to about 20 years ago is now contrasted with the emerging hour-glass shape of today. The fat middle of that triangle was the middle-class. The thing that gives the new hour-glass shape of American income distribution its singular pattern is the rapid disappearance of the middle class. Increasingly, those who used to be in the middle are dividing their destinations; a few are rising into the realm of the upper classes and many more are descending into the lower class. Many global economic forces are at work contributing to inequality of incomes in the liberal democracies, but none is more important than differences in education levels within and among nations. Few Americans are aware of the extent to which their economy used to depend on the breadth and quality of the vocational education system. It was as if the United States felt that it had to choose between making improvements in students’ academic skills and maintaining a system to provide robust vocational skills. Americans chose the former, and, with the inauguration of career academies in their high schools, substituted programs intended to motivate students to stay in school for serious vocational educational programs. Americans solved the problem of the low prestige of vocational program by renaming it, calling it career and technical education instead.

Japan, Singapore, the Netherlands, Denmark and other leading industrial countries lived in the midst of the same global economic forces Americans did, but they did not do what Americans did in response. They doubled down to improve both their academic and their vocational programs. They built education systems designed to support the middle class as well as an elite. They built vocational education programs that require high academic skills. And they designed programs that could deliver those skills. They did not sever the connections between employers and their high schools; they strengthened them. They made sure their high school vocational students had first-rate instructors and equipment. Their reward is a work force that is balanced between managers and workers, scientists and technicians. No one tells an individual student what he or she will do with their life. But those students have a range of attractive choices. So death of vocational education in America resulted in demise of American middle class while strengthening vocational programs with academic skills by Europeans resulted in development of broad middle class. So too much academic education at the cost of vocational education result in creating either elite or poor class at the cost of middle class.

Myths about vocational education:

Myth 1: Vocational education is only seen as the acceptable route for those people who weren’t ‘academics’ and dropouts.

Fact: This is definitely a myth. The term ‘vocational’ actually means ‘work-related’. So if you are doing a vocational qualification it means you are learning skills that will help you to get, and do, a job. That’s it. Vocational education is not an ‘easier’ alternative to academic hard work, it is something that provides people with practical skills and the underpinning knowledge people need to understand how to use these skills. Some people are not aware that you can actually get vocational qualifications that will take you up to the same level as a degree, so the opportunities for continued personal development are still there, even if you don’t choose the conventional route. While it used to be very strongly believed that vocational education was really only suitable for those who weren’t rich or clever enough to go to college (and not just by students but parents, teachers and policymakers were often of the same opinion). There have been studies about this sort of thing you know (Kober and Rentner in 2000; Stone in 1993) and they found that 80% of all high school students take at least one vocational course, and one in eight students take more vocational courses than vocational students do. So, the college grads are actually taking more vocational courses than the dummies and dropouts. Vocational students in applied academic subjects like math are actually just as good at it as college students are.

Myth 2: Vocational education doesn’t pay.

Fact: Studies have shown that vocational graduates are actually more likely to be employed than their non-vocational peers, and they earn more money, especially if they worked part time during high school. Generic technical and occupationally specific skills provided in vocational education can not only increase worker productivity, but also job access, job stability and skill transfer, so they find it easier to find training-related jobs. With a vocational qualification, you’re more likely to be able to start working sooner, giving you the experience you need to back up what you’re learning – and you get to earn money at the same time. And the money earning doesn’t stop there. For the last five years, City & Guilds has produced the Vocational Rich List – a barometer that charts the fames and fortunes of the UK’s self-made millionaires and entrepreneurs from a vocational background. Last year’s results revealed that the 25 wealthiest people across all industries had tripled their fortunes from £2.7bn to £9.3bn since 2003. And 68% of them are still in the same industry they took their qualification in, illustrating how the hands-on route can lead to a lifetime of success.

Myth 3: Without a college graduate degree, you have no future.

Fact: Take a look at these facts. Out of all the college graduates who graduate with a three to four-year degree, around 66% will find a job in their related field of study. College students who graduate with a professional credential (accounting, engineering, teaching etc) only 50% will find a job in that field. There is no guarantee of a higher income if you have a college degree. A closer look at supply and demand in the labor market uncovers another reality to contradict the belief that a college degree is the ticket to success. That fact is that professional occupations make up only 20 percent of all jobs. Technical employment is the fastest-growing segment of the labor market. Most technical work will not require a college degree. Only 25 percent of all technical work requires a graduate degree. The fastest-growing piece of the high-skill, high-wage technical workplace is occupations that require an associate’s degree.

Myth 4: A popular misconception is that vocational and academic routes are binding – if you start in one or the other, you have to follow the same one for the length of your career.

Fact: Vocational education and conventional qualifications should be seen as complementary, not mutually exclusive. A top surgeon who goes on a course to get up to speed on the latest techniques is learning skills that they will use in their work. It’s no different to someone taking a vocational qualification.

Myth 5: Vocational education is still viewed by many to be a narrow route.

Fact: There are over 500 different qualifications – and they’re not all for plumbers, hairdressers and chefs. For example, we have teaching, healthcare, travel and tourism, journalism and even law qualifications. We know that despite what the media might like to say about young people, these are the same career areas they put at the top of their wish list.

Myth 6: Another common belief among parents is that every child has the aptitude and interests to succeed in an academic college degree program.

Fact: According to some estimates, only about 30 percent of high school graduates possess the aptitude and receive the academic preparation needed for success in college academic courses. In 1996 in the U.S., 27 percent of college freshmen dropped out-an all-time high. The best estimates are that about half of the students in college degree programs graduate within six years; the worst estimates, as low as 30 percent. Every parent believes that their child is bright enough to acquire a bachelor’s degree but the fact is quite contrary. Don’t push your child too much in academic career and spoil his/her life.

The moral of the story:

1. Parents must understand that all children do not have aptitude to obtain bachelor’s degree and a bachelor’s degree from an academic college is not a panacea for success in life.

2. If you are sure that you know all your abilities, then you are wrong, and only time will tell deficiency and variability in your abilities, but unfortunately it will be too late as you will be pursuing a wrong career by then. So obtain proper career guidance to determine your true aptitude.

3. Each person – regardless of gender, education, economic status, race, religion, age or occupational status – should have free and easy access to career guidance so that their individual capabilities and skills can be identified and developed to enable them to undertake adequate education, vocational training and employment, to adapt to changing individual & social life situations and to participate fully in the social & economic life of their community.

4. Careers are unique to each person and created by what one chooses or does not choose. They are dynamic and unfold throughout life.

5. Good career advising may be the single most underestimated characteristic of a school or college experience.

6. All students need career advising, even those who enter college already decided on an academic major.

7. Biological and environmental (familial, societal, cultural & religious) differences between boys and girls make their career choices different despite having similar aptitude.

8. In order to be successful in career, you need positive attitude besides aptitude.

9. All of us need to connect academic world with world of work, connect knowledge with skill and connect education with employment to live a successful life. Career guidance & career education is the best way to make that connection.

10. Vocational education has important short- and medium-run earning benefits for most students at both the secondary and postsecondary levels, and these benefits extend especially to those who are economically disadvantaged.

11. Vocational education as a policy is fundamentally sound but its implementation has been fundamentally flawed in most developing nations.

12. Growth of economy depends on availability of skilled workers and vocational education helps development of skilled labor force and thereby strengthens economy. The greater a country’s Gross Domestic Product per capita, the greater is its percentage of Technical & Vocational Enrollment, and vice versa is also true. Weaker the economy, lesser is the need for skilled labor. However, the relationship between economy and vocational education is not linear. Every country must develop its vocational education infrastructure not only dependent on demand of labor market & economic growth but also considering its social and political climate.

13.Too much academic education at the cost of vocational education results in creating few elite ruling majority poor class with wearing away of middle class. The stronger the vocational guidance & education in a country, broader will be its middle class and better will be democracy. The stronger the academic education disregarding vocational education in a country, narrower will be its middle class and weaker will be democracy.

14. Instead of general (academic) or vocational education, what we need is vocationalization of general education and academization of vocational education. We need fine balance between doctors and health care workers, between scientists and technicians and between managers and workers. This is possible only if there is integration and balance between academic education and vocational education. Integration and balance are different but not mutually exclusive and coexist simultaneously according to my theory of duality of existence which can be widened to include education. Just as light exists in dual form, wave & particle simultaneously; education also exists in dual form, academic & vocational. It is ‘out of box’ idea but I am sure that it will work.

Dr. Rajiv Desai. MD.

February 9, 2012

Postscript:

I wish I had received proper career guidance in my school days. I always felt that I should not have become a practicing doctor. I am best at being a teacher and all my college buddies know how many lectures and clinics I have taken for them when they appeared for their MD exams.

Tags: academic education, apprenticeship, aptitude, attitude, career choice, career counseling, career counselor, career test, CTE, early emergers, education, general education, human capital, internship, labor market, life skills, MBTI, multipotentiality, pre-vocational education, professional education, social equity, social exclusion, STF, student dropout, VET, VET benefits, VET fallacy, Vocation, vocational counseling, vocational counselor, vocational education, vocational guidance, vocationalism
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INTERNET CENSORSHIP

January 12th, 2012

INTERNET CENSORSHIP:

Caveat:

Please do read my previous article on ‘The computer and internet” before you read this article as it will make basics of computer & internet easy. Various circumvention techniques discussed in this article are purely for educational purpose and cannot evade existing laws of land. All court orders by competent court must be respected regarding viewing and/or publishing objectionable content on Internet. In many jurisdictions, accessing blocked content is a serious crime, particularly content that is considered child pornography, a threat to national security, or an incitement of violence. Thus it is important to understand the circumvention technologies and the protections they do or do not provide and to use only tools that are appropriate in a particular context. Great care must be taken to install, configure, and use circumvention tools properly. I am not expert on computers, internet or information technology; and therefore technical inaccuracies are inevitable.

Prologue:

Type the keywords “Internet censorship” into Google News and you will immediately understand to what degree the World Wide Web is under assault from attempts by governments globally to regulate and stifle free speech. From Australia to Belarus, from Turkey to Vietnam, from Pakistan to Egypt, from Afghanistan to Iran, huge chunks of the Internet are going dark as the Chinese model of Internet regulation is adopted worldwide. China’s 485 million web users are the world’s largest online population. And the Chinese government has developed the world’s most advanced Internet censorship and surveillance system to police their activity. Yet the days of Americans piously condemning China’s “Great Firewall” and hoping for a technological silver bullet that would pierce it are over. China’s system is a potent, vast and sophisticated network of computer, legal and human censorship. The Chinese model is spreading to other authoritarian regimes. Even though America and India are democratic nations with free society, their media were involved in blocking my comments on Internet curtailing my fundamental human right of freedom of expression. So tendency to censor bona fide comments/speech/picture on Internet exists even in free society and not necessarily among authoritarian regimes.

Censorship:

According to Merriam-Webster.com, to censor can be defined as “to examine in order to suppress or delete anything considered objectionable.” Censorship is the suppression of speech or deletion of communicative material which may be considered objectionable, harmful or sensitive as determined by the censor. Censorship has existed since people first organized into societies. First censorship law in china was introduced in 300 AD. It can be used as a method of governance and control, but can also be used as a form of civil protection, such as protecting young children from graphic or sexual images. Historic examples of censorship include the execution of Socrates in ancient Greece and the Index Librorum Prohibitorum (banned books) created by the Catholic Church in the 1600s. Both were authoritative attempts to suppress opposing religious, philosophical and scientific ideas. Today, censorship is generally discussed in the context of mass media. The Federal Communications Commission (FCC) enforces regulations on what can and can’t be shown in U.S. broadcast media such as radio and television. As of yet, attempts to censor and regulate Internet content have been largely unsuccessful. Still, a person may be prosecuted for posting illegal Internet content.

No Internet censorship discussion can start without Chinese model:

With more than half a billion Chinese now online, authorities in Beijing are concerned about the power of the Internet to influence public opinion in a country that maintains tight controls on its traditional media outlets. China has an advanced filtering system known internationally as the Great Firewall of China. It can search new Web pages and restrict access in real time. It can also search blogs for subversive content and block Internet users from visiting them.

The following diagram illustrates the current Internet censorship mechanisms used by China:

The following table illustrates various methods used by Chinese government to censor Internet:

Method	Description
IP blocking	The access to a certain IP address is denied. If the target Web site is hosted in a shared hosting server, all Web sites on the same server will be blocked. This affects all IP protocols (mostly TCP) such as HTTP, FTP or POP. A typical circumvention method is to find proxies that have access to the target Web sites, but proxies may be jammed or blocked. Some large Web sites allocated additional IP addresses to circumvent the block, but later the block was extended to cover the new address.
DNS filtering and redirection	Doesn’t resolve domain names, or returns incorrect IP addresses. This affects all IP protocols such as HTTP, FTP or POP. A typical circumvention method is to find a domain name server that resolves domain names correctly, but domain name servers are subject to blockage as well, especially IP blocking. Another workaround is to bypass DNS if the IP address is obtainable from other sources and is not blocked. Examples are modifying the Hosts file or typing the IP address instead of the domain name in a Web browser.
URL filtering	Scan the requested Uniform Resource Locator (URL) string for target keywords regardless of the domain name specified in the URL. This affects the Hypertext Transfer Protocol. Typical circumvention methods are to use escaped characters in the URL, or to use encrypted protocols such as VPN and SSL.
Packet filtering	Terminate TCP packet transmissions when a certain number of controversial keywords are detected. This affects all TCP protocols such as HTTP, FTP or POP, but Search engine pages are more likely to be censored. Typical circumvention methods are to use encrypted protocols such as VPN and SSL, to escape the HTML content, or reducing the TCP/IPstack’s MTU, thus reducing the amount of text contained in a given packet.
Connection reset	If a previous TCP connection is blocked by the filter, future connection attempts from both sides will also be blocked for up to 30 minutes. Depending on the location of the block, other users or Web sites may be also blocked if the communications are routed to the location of the block. A circumvention method is to ignore the reset packet sent by the firewall.

History of Internet:

According to Internet historians, the first inklings of the Internet began in the United States in 1969 as a network of four servers called the APRANET. ARPA (the Advanced Research Projects Agency), a division of the Department of Defense, created the ARPANET for military research so that the information on the network would be decentralized and could survive a nuclear strike. The network continued to grow in size and speed as technology increased over the next two decades. Standards began to set in such as the TCP/IP protocol for network transmission of data. By 1990 the Hypertext Transfer Protocol (HTTP) had been created to standardize the way in which Internet documents are sent and received. By 1994, the APRANET was disbanded, and the internet became a public network connecting more than 3,000,000 computers together worldwide. Commercial organizations began to offer services over the internet such as online ordering of pizzas. At present, millions of companies are now online offering products and services such as software, hardware, books, games and adult oriented photographs. Though estimates vary, the consensus is that the amount of providers and users of the internet has nearly doubled each year since 1987. Since the Internet grew into the public eye so fast, many people were caught off guard and concerns began to mount. The unregulated flow of information that the internet provides created concerns with parents and politicians beginning in the early and middle 1990’s.

Who owns Internet?

The greatest thing about the internet is that neither one individual nor one organization nor one country can own internet. It is a global collection of networks, both big and small. Thousands of people and organizations own the internet. The internet consists of lots of different bits and pieces, each of which has an owner. Some of these owners can control the quality and level of access you have to the Internet. They might not own the entire system, but they can impact your internet experience. The physical network that carries internet traffic between different computer systems is the Internet Backbone. In the early days of the internet, ARPANET served as the system’s backbone. Today, several large corporations provide the routers and cable that make up the Internet Backbone. These companies are upstream Internet Service Providers (ISPs). That means that anyone who wants to access the Internet must ultimately work with these companies. Many individual consumers and businesses subscribe to local/regional ISPs that aren’t part of the Internet Backbone. These ISPs negotiate with the upstream ISPs for Internet access.

Internet basics:

Every computer that is connected to the Internet is part of a network, even the one in your home. For example, you may use a modem and dial a local number to connect to an Internet Service Provider (ISP). Internet service provider (ISP) is defined as an organization/company that provides internet access services to the public. The ISP may then connect to a larger network (upstream ISP) and become part of their network. The internet is simply a network of networks.

Every computer on the Internet has a unique identifying number, called an IP Address. The IP stands for Internet Protocol, which is the language that computers use to communicate over the Internet. If we had to remember the IP addresses of all our favorite Web sites, we’d probably go nuts! Human beings are just not that good at remembering strings of numbers. We are good at remembering words, however, and that is where domain names come in. Since IP address was difficult to remember, domain name system (DNS) was invented which gave each IP address a domain name. For example, domain name of my website is drrajivdesaimd.com having IP address 208.91.198.23 which is the IP address of the sever cp-19.webhostbox.net on which my website is hosted. Every time you use a domain name, you use the internet’s DNS servers to translate the human-readable domain name into the machine-readable IP address. The Uniform Resource Locator (URL) http://www.drrajivdesaimd.com contains the domain name drrajivdesaimd.com and so does its e-mail address: info@drrajivdesaimd.com– however it must be understood that the server cp-19.webhostbox.net also hosts many other websites and therefore their IP addresses will be same as my website 208.91.198.23

Internet servers make the Internet possible. All of the machines on the Internet are either servers or clients. The machines that provide services to other machines are servers. And the machines that are used to connect to those services are clients. A server is a computer dedicated to running one or more such services as a host to serve the needs of users of the other computers on the network. Depending on the computing service that it offers it could be a database server, file server, mail server, print server, web server, or other. A DNS server is a special type of computer on the internet used to support the Domain Name System. The primary job of a domain name server, or DNS server, is to resolve (translate) a domain name into an IP address. Most of the time, your ISP automatically assigns a primary and secondary DNS server when your computer requests network information. All DNS servers are organized in a hierarchy. At the top level of the hierarchy, so-called root servers store the complete database of internet domain names and their corresponding IP addresses. The internet employs 13 root servers that have become somewhat famous for their special role. Ten of these servers reside in the United States, one in Japan, one in London, UK and one in Stockholm, Sweden. Basically DNS server convents domain name into IP address.

A server has a static IP address that does not change very often. A home machine that is dialing up through a modem, on the other hand, typically has an IP address assigned by the ISP every time you dial in. That IP address is unique for your session — it may be different the next time you dial in. This way, an ISP only needs one IP address for each modem it supports, rather than one for each customer. If any computer is behind a firewall or uses a proxy server, the IP address shown will be that of the firewall computer or proxy server. Many ISPs route internet traffic via a proxy server to reduce network traffic.

Any server machine makes its services available using numbered ports — one for each service that is available on the server. For example, if a server machine is running a Web server and a file transfer protocol (FTP) server, the Web server would typically be available on port 80, and the FTP server would be available on port 21. Clients connect to a service at a specific IP address and on a specific port number. Once a client has connected to a service on a particular port, it accesses the service using a specific protocol. Protocols are often text and simply describe how the client and server will have their conversation. Every Web server on the internet conforms to the hypertext transfer protocol (HTTP).

When you type URL in your web browser on Internet, your request goes to DNS server which can do one of four things with it:

1) It can answer the request with an IP address because it already knows the IP address for the requested domain.

2) It can contact another DNS server and try to find the IP address for the name requested. It may have to do this multiple times.

When the DNS server returns the IP address of your URL to your browser, then your browser contacts the server hosting the website to get a Web page.

3) It can say, “I don’t know the IP address for the domain you requested, but here’s the IP address for a DNS server that knows more than I do.”

4) It can return an error message because the requested domain name is invalid or does not exist.

When a file is sent from one computer to another, it is broken into small pieces called packets. The packets are labeled individually with origin, destination and place in the original file. Now the packets are sent sequentially over network. When a packet get on a router, the router looks at the packet to see where it needs to go. The routers determine where to send information from one computer to another. Routers are specialized computers that send your messages and those of every other Internet user speeding to their destinations along thousands of pathways. Using “pure” IP, a computer first breaks down the message to be sent into small packets, each labeled with the address of the destination machine; the computer then passes those packets along to the next connected Internet machine (router), which looks at the destination address and then passes it along to the next connected internet machine, which looks the destination address and pass it along, and so forth, until the packets (we hope) reach the destination machine. IP is thus a “best efforts” communication service, meaning that it does its best to deliver the sender’s packets to the intended destination, but it cannot make any guarantees. If, for some reason, one of the intermediate computers “drops” (i.e., deletes) some of the packets, the dropped packets will not reach the destination and the sending computer will not know whether or why they were dropped. By itself, IP can’t ensure that the packets arrived in the correct order, or even that they arrived at all. That’s the job of another protocol: TCP (Transmission Control Protocol). TCP sits “on top” of IP and ensures that all the packets sent from one machine to another are received and assembled in the correct order. Should any of the packets get dropped during transmission, the destination machine uses TCP to request that the sending machine resend the lost packets, and to acknowledge them when they arrive. TCP’s job is to make sure that transmissions get received in full, and to notify the sender that everything arrived OK.

In order to understand how Internet communication looks, feels, and actually works in between countries, we’re going to look closely at the path of an email exchange between Andrew is in Ulaanbaatar (Mongolia) to Ethan in Accra (Ghana) — a case study of TCP/IP in action.

Andrew’s packets go through the Ethernet connection to the cybercafe gateway machine, then through a modem and phone line to the Magicnet server, and then through a gateway machine at Magicnet. In the next seven tenths of a second, they take an epic journey through 23 machines in Mongolia, China, Hong Kong, San Jose, New York, Washington DC and Boston. These are twenty-three computers which work as routers.

Basics of internet censorship:

In a nutshell I describe a typical Internet search. I type www.google.com on web browser on my PC. The information (packets) will go to my ISP (Tata Docomo) server. My ISP server will resolve domain name google.com into IP address 209.85.229.147 through contacting DNS servers. Once IP address is found, the information will be sent via plenty of router computers in many countries to the server of google.com in the U.S which will return webpage of google.com to my ISP and thence to my PC. All these things in a fraction of a second. Now if somebody wants to censor google.com, he can block transfer of information (packets) at my PC, at my ISP server, at DNS server, at various router computers, at upstream ISP server and at the server of google.com—all will result in me not getting webpage of google.com –it is as simple as that and it also quite simple to circumvent the block. All you need to know is the basics of Internet technology. For example, try to type http://209.85.229.147 in your web browser and you will reach google.com—if somebody was blocking domain name google.com, you can still reach google.com by directly typing IP address in web browser. Of course, Google has many IP addresses of google.com besides the one narrated by me. You can also type alternative IP address of google.com to access webpage.

Internet spread:

Over the first decade of the 21st century, the Internet and its convergence with mobile communications has enabled greater access to information and communication resources. In the last 10 years the Internet grew very, very fast. It is a bunch of thousands of little networks put together. Billion computers are connected and it is basically not controlled or even owned by a government or company. Everybody can put his web pages online which can be accessed by everybody on the world who is sitting in front of a computer with Internet access. I believe that this can and will change the world as we know it today. In 2010, nearly 2 billion people worldwide – over one quarter of the world’s population – use the Internet. During the same period, defenders of digital rights have raised growing concerns over how legal and regulatory trends might be constraining online freedom of expression. The continuing reinvention and worldwide diffusion of the Internet has made it an increasingly central medium of expression of the 21st century, challenging the role of more traditional mass media including radio, television, and newspapers.

Africa has the lowest level of Internet penetration at about 11 per cent, followed by Asia, the Middle East, Latin America and the Caribbean, Europe, Oceania and Australia, and finally North America, which has the highest proportion of its population online at over three-quarters (77 per cent) of the population.

The impact of these regional changes in Internet adoption is best summarized by the figure below, which shows North America declining from the largest plurality of the Internet population to a number below Europe and Asia. Europe is now also declining in its throw weight online, relative to Asia. These figures dramatically illustrate a global shift in the centre of the Internet’s gravity. Asia is replacing North America and Europe as the dominant presence on the Internet, constituting an increasingly large proportion of the world Internet population, and the implications of this development for freedom of expression online have yet to become clear.

Finally, while the growth in Internet penetration appears gradual on a global scale, compared for example with that of mobile telephony, content continues to expand at a fast pace. The number of active websites increased significantly after 2006 and appears to be growing steadily, creating a virtuous cycle of more content generating more use and more use generating more content.

This could have major societal implications, as the use of the Internet has the potential to reshape global access to information, communication, services, and technologies. Enduring issues, ranging from freedom of the press to the balance of world information flows in all sectors, and from the media to the sciences, will be tied to the Internet as a ‘network of networks’ – an interface between individuals and the news, information, stories, research, cultures and entertainment following worldwide. By 2010, mobile communication reached nearly 80 per cent of the world’s population, and is converging rapidly with Internet communication.

Internet as medium of communication:

The Internet is unlike any information medium in history. Though there are many similarities between the Internet and other means of communications, the free flow of information that the Internet provides makes it a completely unprecedented information medium. Unlike television and radio, the Internet affords users the capacity to access a breadth of information beyond just a channel-changer with only a limited number of stations. The capacity of the Internet is only limited by those who use it. Unlike traditional print media like the newspaper, the Internet is relatively cheap and widely accessible with no red tape. With a computer, network connection, and the proper software, anybody can become a web publisher. There is virtually no limit to how much content can be published on the Internet, whereas newspapers are limited by physical costs such as the cost of paper. The Internet is truly unprecedented information medium and should be treated like one.

Internet revolution:

The largest public response to the terrorist attacks in Mumbai was launched by a 13-year-old boy. He used social networks to organize blood drives and a massive interfaith book of condolence. In Colombia, an unemployed engineer brought together more than 12 million people in 190 cities around the world to demonstrate against the FARC terrorist movement. The protests were the largest antiterrorist demonstrations in history. And in the weeks that followed, the FARC saw more demobilizations and desertions than it had during a decade of military action. And in Mexico, a single email from a private citizen who was fed up with drug-related violence snowballed into huge demonstrations in all of the country’s 32 states. In Mexico City alone, 150,000 people took to the streets in protest. So the internet can help humanity push back against those who promote violence and crime and extremism. In Iran and Moldova and other countries, online organizing has been a critical tool for advancing democracy and enabling citizens to protest suspicious election results. And even in established democracies like the United States, we’ve seen the power of these tools to change history. Some of you may still remember the 2008 presidential election here. The freedom to connect to these technologies can help transform societies, but it is also critically important to individuals. There is a story of a doctor who was desperately trying to diagnose his daughter’s rare medical condition. He consulted with two dozen specialists, but he still didn’t have an answer. But he finally identified the condition, and found a cure, by using an internet search engine. That’s one of the reasons why unfettered access to search engine technology is so important in individuals’ lives.

Internet and freedom of expression:

Representatives of global institutions and national governments around the world have endorsed freedom of expression as a basic human right. While most often associated with freedom of the press and the First Amendment in the United States, freedom of expression is not only an American value. It has been upheld as a basic human right for decades by a number of international organizations, having been endorsed since 1948 in the United Nations Universal Declaration of Human Rights. In many states, the right to free expression is augmented by rights to freedom of information, providing citizens with a legal right to request and access government held information, and imposing duties on states to publish open records. The close connection between these rights is obvious, namely that the value of free expression is significantly weakened if it cannot be exercised in consideration of key political information relating to how citizens are governed and taxes spent. RTI act in India is classical example of right to information. “Freedom of expression is one of the most fundamental rights of our democracies … but that without freedom of information, freedom of expression often remains meaningless”. However, freedom of information should not result in breach in privacy or release of material related to nation’s security.

Clearly, freedom of expression is not absolute in any cultural setting, and this applies equally whether considering expression online or of offline. Contrary to popular belief, free speech is not an absolute right, as all countries establish some limitations to free speech. Certain limitations, such as criminal speech consisting of death threats or defamatory speech, are relatively unconventional. Other forms such as hate speech or obscenity are subject to differing rules in different countries. At the one end of the spectrum, the United States has adopted perhaps the most permissive free speech legal framework, with even the most hateful material enjoying constitutional protection. By contrast, Canada and many European countries have set limitations on hate speech, rendering certain forms illegal.

On the one hand, the global diffusion of the Internet, along with a continuing stream of innovations, such as the ease with which users can create as well as consume text and video, are making the Internet increasingly pivotal to the communicative power of individuals, groups and institutions with access to networks and the skills to use them effectively. On the other hand, this very shift in communicative power has spawned greater efforts to restrict and control the use of the Internet for information and communication on political, moral, cultural, security, and other grounds. It is leading also to legal and regulatory initiatives to mitigate risks associated with this new medium, ranging from risks to children, to privacy, to intellectual property rights, to national security, which might more indirectly, and often unintentionally, enhance or curtail freedom of expression. In some cases, limits on expression are intentional, but they are often unintended, such as when regulatory instruments, that might have been appropriate for newspapers, broadcasting or the press, are used inappropriately to control the Internet. As a consequence, defenders of freedom of expression have raised growing concerns over how legal and regulatory trends might be constraining freedom of expression at the very time that the Internet has become more widely recognized as a major medium for fostering global communication. These concerns are reinforced by surveys that provide evidence of encroachments on freedom of expression, such as through the filtering of Internet content. At the same time, despite Internet censorship and filtering, this network of networks continues to bring more information to increasing numbers of individuals around the world.

If you believe that progress of human civilization depends on individual expression of new ideas, especially unpopular ideas, then the principle of freedom of speech is the most important value society can uphold. The more experience someone has with the Internet, the more strongly they generally believe in the importance of freedom of speech, usually because their personal experience has convinced them of the benefits of open expression. The Internet not only provides universal access to free speech, it also promotes the basic concept of freedom of speech. If you believe that there is an inherent value in truth, that human beings on average and over time recognize and value truth, and that truth is best decided in a free marketplace of ideas, then the ability of the Internet to promote freedom of speech is very important indeed. “Truth” is a foundation of bedrock, consistent from day to day. Information is correct (absolute truth), incorrect (absolute falsehood) or somewhere in between (pertinent information is unknown or, in part, enough wrong so as to be misleading). It is only further defined by “more facts”. Genuine “truth” does not change. To such extent as “truth” is partially known, further definition (additional facts both relevant and also “true”) complete the puzzle as pieces are added. If you want to know truths about my life, then read my posts on my facebook page on Internet. If anybody in the world feels that my truths are untruths, then he/she can post his/her truth below my posts. So freedom of expression on internet can be regulated without censorship.

The Internet, though heralded as the modern medium of communication through which the entire world can be reached in a matter of seconds and which has demystified the hassles related with distance in the world, the same Internet that can be used for cyber democracy and freedom of expression; can be very harmful and indeed kill through the spread of hate speech. It should therefore be regulated to the extent it is harmful and be unregulated to the extent it is not harmful and not be used by the governments to suppress opposing/divergent views.

Freedom of expression on the Internet or in any other media is very helpful in building a culture of tolerance to divergent views and acceptance of opposing ideas. It is also asserted that the best way to fight prejudices is through freedom of expression through which people of different cultures and backgrounds exchange views and ideas in a more human and tolerant way especially on the borderless Internet. The right to freedom of expression is a fundamental right that safeguards the exercise of all other rights and is a critical underpinning of democracy.

BBC World Service global public opinion poll:

A poll of 27,973 adults in 26 countries, including 14,306 Internet users was conducted for the BBC World Service by the international polling firm GlobeScan using telephone and in-person interviews between 30 November 2009 and 7 February 2010. Overall the poll showed that despite worries about privacy and fraud, people around the world see access to the internet as their fundamental right. They think the web is a force for good, and most don’t want governments to regulate it.

Findings from the poll include:

1) Four in five adults (79%) regard internet access as their fundamental right. The poll of more than 27,000 adults conducted by GlobeScan found that 87 per cent of those who used the internet felt that internet access should be “the fundamental right of all people.” More than seven in ten (71%) non-internet users also felt that they should have the right to access the web. Countries where very high proportions regarded internet access as their fundamental right included South Korea (96%), Mexico (94%), and China (87%). Most web users are very positive about the changes the internet has brought to their lives, with strong support for the information available, the greater freedom it brings and social networking. Nearly four in five (78%) Internet users felt that the Internet had brought them greater freedom.

2) Most Internet users (53%) felt that “the internet should never be regulated by any level of government anywhere”.

3) Opinion was evenly split between Internet users who felt that “the internet is a safe place to express my opinions” (48%) and those who disagreed (49%). Somewhat surprisingly users in Germany and France agreed the least, followed by users in highly filtered countries such as China and South Korea, while users in Egypt, India and Kenya agreed more strongly.

4) The aspects of the Internet that cause the most concern include: fraud (32%), violent and explicit content (27%), threats to privacy (20%), state censorship of content (6%), and the extent of corporate presence (3%).

Definition of Internet censorship:

Internet censorship is defined as the control or suppression of, access to information on the Internet and/or publishing on internet. It may be carried out by governments, or by private organizations either at the behest of government or on their own initiative, or individuals (parents). Individuals and organizations may engage in self-censorship on their own or due to intimidation and fear. The concept of Internet censorship revolves around administrative control or suppression of publishing information on the Internet or accessing it. Under this concept, the reception of those web pages which are deemed unfit by the administrative body of the said country are blocked by government sanctions.

Internet censorship refers to technical and non-technical measures taken by repressive regimes to limit a user’s freedom to access information on the Internet. Such measures include, but are not limited to: monitoring of users Internet activities, denying users access to certain websites (blocking), tracking and filtering users’ data flow, and disciplining website operators to tailor their content to comply with censorship regulations. Sometimes the Internet censorship is also referred to as Internet blocking or jamming.

Internet censorship is the limiting of access to the internet based on the content of the sites or information blocked. It can be done by parents wishing to limit a child’s access to adult or subject matter that the parents find objectionable. This would be end user censorship. It can be done at the governmental level to block people from accessing information which the government deems to be detrimental or off limits for whatever reason. If you are in the United States, there is very little that is censored. If you are in Cuba or China, almost everything that happens on the internet in those countries is monitored and restricted.

Internet Censorship refers to the controlling of publishing and accessing the contents of the internet, in order to prevent citizens under a particular law from viewing or publishing socially unacceptable content. Websites can be blocked in a number of different ways by governments to prevent their citizens from accessing specific sites. However, the United States exercises the right to free speech allowing its citizens to view and post anything on the internet that does not infringe on other’s rights. The content within the internet remains free and available, yet inaccessible if there have been limitations on that content by an individual’s government. It is ultimately limited to a citizen’s location and their governmental laws as to what content is available and what gets censored or becomes unavailable.

Many different actors can restrict freedom of expression online. Individuals decide what to read, and what to delete or filter such as by installing spam filters on their personal computer. Parents, corporate information technology (IT) departments, and many other actors have a role in deciding what content is available to users in different social contexts. In general, however, studies of censorship and filtering and freedom of expression are most often concerned with governmental censorship. Governments can directly, or indirectly (through formal and informal agreements with ISPs) restrict freedom of expression by regulating access to the Internet or to particular Internet content. Many civil society advocates of freedom of expression are concerned that state-supported restrictions on Internet access and information are increasing and thereby threatening freedom of expression online.

Content related to Nazism or Holocaust denial is blocked in France and Germany. Child pornography, hate speech, and sites that encourage the theft of intellectual property are blocked in many countries throughout the world. In fact, most countries throughout the world, including many democracies with long traditions of strong support for freedom of expression and freedom of the press, are engaged in some amount of online censorship, often with substantial public support. The countries engaged in state-mandated filtering are clustered in three main regions of the world: East Asia, central Asia, and the Middle East/North Africa. A few countries in other regions also practice certain forms of filtering.

The legal issues are similar to offline censorship. One difference is that national borders are more permeable online: residents of a country that bans certain information can find it on websites hosted outside the country. Conversely, attempts by one government to prevent its citizens from seeing certain material can have the effect of restricting foreigners, because the government may take action against Internet sites anywhere in the world, if they host objectionable material. One of the early nicknames for the Internet was the “information superhighway” because it was supposed to provide the average person with fast access to a practically limitless amount of data. For many users, that’s exactly what accessing the Internet is like. For others, it’s as if the information superhighway has some major roadblocks in the form of Internet censorship.

Internet and repressive regime:

The Internet has become a revolutionary force in repressive regimes. The free flow of information and idea exchange has been perceived as a threat, rather than a blessing, by the authorities in these countries. In response, they have imposed strong censorship on Internet usage by monitoring, filtering, tracing and blocking data flows using advanced technologies. Confined to a tailored and distorted cyberspace, innocent citizens face constant threats when they read, write or speak on the Internet, as their privacy is exposed under the authorities’ watchful eyes. The consequences can be life-threatening. In this environment, the service and content providers practice a great deal of self-censorship.

This graph below contains the results of an analysis of internet censorship news articles from 1993-2010 and shows trend of greater media coverage and greater importance over the years.

Levels of control:

The control of internet can be discussed as three levels:

A) First-generation controls that systematically and explicitly “focus on denying access to specific Internet resources by directly blocking access to servers, domains, keywords, and UP addresses. More sophisticated “second-generation” and “third-generation” controls are being developed by States to affect “information denial” and “access shaping.

B) Second-generation controls refer to the practice of creating “a legal and normative environment and technical capabilities that enable state actors to deny access to information resources as and when needed, while reducing the possibility of blowback or discovery. Common second-generation practices include the following in particular:

1) Compelling internet sites to register with authorities and to use noncompliance as grounds for taking down or filtering “illegal” content, and possibly revoking service providers’ licenses.

2) Strict criteria pertaining to what is “acceptable” within the national media space, leading to the de-registration of sites that do not comply.

3)Expanded use of defamation, slander, and “veracity” laws, to deter bloggers and independent media from posting material critical of the government or specific government officials, however benignly (including humor).

4) Evoking national security concerns, especially at times of civic unrest, as the justification for blocking specific Internet content and services.

5) Shutting down Internet access, as well as selected telecommunications services such as cell phone services and especially short message services (SMS).

6) Extensive use of computer network attacks especially the use of distributed denial of service (DDos) attacks, which can overwhelm ISPs and selected sites.

C)Third-generation controls on the other hand is less interested in “denying access than successfully competing with potential threats through effective counterinformation campaigns that overwhelm, discredit, or demoralize opponents.” In particular, it includes “warrantless monitoring of Internet users and usage,” employment of ‘Internet Brigades’ to engage, confuse, or discredit individuals or sources” through “the posting of prepackaged propaganda…, and disinformation through mass blogging and participation in Internet polls, or harassment of individual users, including the posting of personal information.” The intent of these highly sophisticated and multidimensional use of “surveillance, interaction, and direct physical action to achieve a disruption of target groups or networks” is the effecting of “cognitive change rather than to deny access to online information or services.”

Categories subject to Internet filtering:

Free expression and media freedom

Political transformation and opposition parties

Political reform, legal reform, and governance

Militants, extremists, and separatists

Human rights

Foreign relations and military

Minority rights and ethnic content

Women’s rights

Environmental issues

Economic development

Sensitive or controversial history, arts, and literature

Hate speech

Sex education and family planning

Public health

Gay/lesbian content

Pornography

Provocative attire

Dating

Gambling

Gaming

Alcohol and drugs

Minority faiths

Religious conversion, commentary, and criticism

Anonymizers and circumvention

Hacking

Blogging domains and blogging services

Web hosting sites and portals

Voice over Internet Protocol (VOIP)

Free e-mail

Search engines

Translation

Multimedia sharing

P2P

Groups and social networking

Commercial sites

One example is sufficient. The diagram below shows items that are censored in Kuwait.

The picture below shows what you see on internet in Bahrain if the site you are visiting is censored.

Size of blocking units:

There are several governments who think that unlimited access to information is dangerous for their citizens. So they established blocking units to censor internet. This ranks from DNS blocking of Nazi sites in parts of Germany to a government office with 30.000 employees only working in blocking thousands of websites, services and ports in China.

Worldwide distribution of internet censorship:

The magnitude or level of censorship is classified as follows:

Pervasive: A large portion of content in several categories is blocked.

Substantial: A number of categories are subject to a medium level of filtering or many categories are subject to a low level of filtering.

Selective: A small number of specific sites are blocked or filtering targets a small number of categories or issues.

Suspected: It is suspected, but not confirmed, that Web sites are being blocked.

No evidence: No evidence of blocked Web sites, although other forms of controls may exist

In terms of severity, the most pervasive Internet censorship is applied in: Burma, Cuba, Egypt, Iran, North Korea, China, Syria, Tunisia, Turkmenistan, Uzbekistan and Vietnam. Substantial censorship in: Bahrain, South Korea, Saudi Arabia, United Arab Emirates and Yemen. Nominal and other types of censorship are applied in: Australia, Belgium, Brazil, Canada, Chile, Colombia, Czech Republic, Denmark, Fiji, Finland, France, Germany, Ghana, Ireland, India, Israel, Italy, Jordan, Mexico, Morocco, Netherlands, Norway, Pakistan, Poland, Russia, Singapore, Sweden, Thailand, Turkey, United Kingdom and USA.

The largest democracy India and Internet censorship:

The growing Chinese belligerence seems to have motivated India to follow suit, but perhaps in the wrong context. China was recently rated as the most restricted country in terms of Internet censorship. And, if India’s new censorship laws are enforced, India could be right be in the league of countries with most restricted Internet usage policies. The new Information Technology Rules, 2011 lists down all the content restrictions that an ISP, cloud provider or a hosting provider needs to impose on bloggers, online news websites and individuals. It also defines the time frame within which the ‘intermediary’ needs to pull down a website or a blog in case any violation of the rules is observed. The new rules not only define censorship laws but also allows the government to abuse terms such as ‘invasion of another’s privacy’, ‘defamation’, ‘harassment’ and ‘threat to the nation’. China has already been prosecuting people exercising free speech by terming the content as ‘threat to nation’ etc. According to IT Rules 2011, Sub Rule 2, “Users shall not host, display, upload, modify, publish, transmit, update or share any information that is grossly harmful, harassing, blasphemous, defamatory, obscene, pornographic, pedophilic, libelous, invasive of another’s privacy, hateful, or racially, ethnically objectionable, disparaging, relating or encouraging money laundering or gambling, or otherwise unlawful in any manner whatever;” Additionally, Sub Rule 2 also states that users may not publish anything that threatens the unity, integrity, defense, security or sovereignty of India, friendly relations with foreign states, or public order or causes incitement to the commission of any cognizable offence or prevents investigation of any offence or is insulting any other nation. Leaving so much power in the hands of the ISPs may not be a good idea for a country like India where there are highest number of complaints to shut down Facebook pages and profile as ‘someone’ finds them offensive. Now, instead of first battling out a complaint in the court of law, the ISP would straight away block your website in case your content seems offensive to someone. However, ISP is not a regulatory body to enforce moral codes as portrayed by Indian IT rules. Role of ISP in Internet censorship is discussed later on in this article. Indian regime does not seem to have any respect for freedom of expression but bent on displaying moral policing to prevent adulteration of Indian culture by western culture. Indian regime and Indian courts are concerned about religious sentiments hurt by some comment/picture on Internet. I deplore any comment/picture that hurt religious sentiments but that does not mean that Internet should be censored. No religion is so narrow minded that it cannot tolerate offensive intimidation.

Unless the censor has total control over all Internet-connected computers, such as in North Korea or Cuba, total censorship of information is very difficult or impossible to achieve due to the underlying distributed technology of the Internet. Pseudonymity and data havens (such as Freenet) protect free speech using technologies that guarantee material cannot be removed and prevents the identification of authors. Technologically savvy users can often find ways to access blocked content. Nevertheless, blocking remains an effective means of limiting access to sensitive information for most users when censors, such as those in China, are able to devote significant resources to building and maintaining a comprehensive censorship system.

Freedom on the Net reports:

In the 2011 edition of Freedom House’s report Freedom on the Net, of the 37 countries surveyed, 8 were rated as “free” (22%), 18 as “partly free” (49%), and 11 as “not free” (30%). In their 2009 report, of the 15 countries surveyed, 4 were rated as “free” (27%), 7 as “partly free” (47%), and 4 as “not free” (27%). And of the 15 countries surveyed in both 2009 and 2011, 5 were seen to be moving in the direction of more network freedom (33%), 9 moved toward less freedom (60%), and one was unchanged (7%).

A green-colored bar represents status of “Free,” a yellow-colored one represents status of “Partly Free,” and a purple-colored one represents status of “Not Free” on the Freedom of the Net Index.

OpenNet Initiative reports:

Through 2010 the OpenNet Initiative had documented Internet filtering by governments in over forty countries worldwide. The level of filtering in 26 countries in 2007 and in 25 countries in 2009 was classified in the political, social, and security areas. Of the 41 separate countries classified, seven were found to show no evidence of filtering in all three areas (Egypt, France, Germany, India, the Ukraine, the United Kingdom, and the United States), while one was found to engage in pervasive filtering in all three areas (China), 13 were found to engage in pervasive filtering in one or more areas, and 34 were found to engage in some level of filtering in one or more areas. Of the 10 countries classified in both 2007 and 2009, one reduced its level of filtering (Pakistan), five increased their level of filtering (Azerbaijan, Belarus, Kazakhstan, South Korea, and Uzbekistan), and four maintained the same level of filtering (China, Iran, Myanmar, and Tajikistan.

The OpenNet Initiative (ONI), an organization dedicated to informing the public about Web filtering and surveillance policies around the world, classifies Web filtering into four categories:

1) Political: Content that includes views contrary to the respective country’s policies. The political category also includes content related to human rights, religious movements and other social causes,

2) Social: Web pages that focus on sexuality, gambling, drugs and other subjects that a nation might deem offensive.

3) Conflict/Security: Pages that relate to wars, skirmishes, dissent and other conflicts.

4) Internet tools: Web sites that offer tools like e-mail, instant messaging, language translation applications and ways to circumvent censorship.

Internet enemies:

In 2006, Reporters without Borders (Reporters sans frontières, RSF), a Paris-based international non-governmental organization that advocates freedom of the press, started publishing a list of “Enemies of the Internet”. The organization classifies a country as an enemy of the internet because “all of these countries mark themselves out not just for their capacity to censor news and information online but also for their almost systematic repression of Internet users.” In 2007 a second list of countries “Under Surveillance” (originally “Under Watch”) was added. Both lists are updated annually.

Enemies of the Internet:

Burma: The Burmese government’s Internet policies are even more repressive than those of its Chinese and Vietnamese neighbors. The military junta clearly filters opposition websites. It keeps a very close eye on Internet cafes, in which the computers automatically execute screen captures every five minutes, in order to monitor user activity.

China (excluding Hong Kong and Macau): China unquestionably continues to be the world’s most advanced country in Internet filtering. The authorities carefully monitor technological progress to ensure that no new window of free expression opens up. After initially targeting websites and chat forums, they nowadays concentrate on blogs and video exchange sites. In a country in which hundreds of people are currently in prison for expressing themselves too freely online, self-censorship is obviously in full force.

Cuba: With less than 2 per cent of its population online, Cuba is one of the most backward Internet countries. An investigation carried out by Reporters Without Borders in 2007-October revealed that the Cuban government uses several levers to ensure that this medium is not used in a “counter-revolutionary” way. Cuba has banned private Internet access completely — to get on the Internet, you have to go to a public access point.

Iran: Internet filtering has stepped up and Iran today boasts of filtering 10 million “immoral” websites. Pornographic sites, political sites and those dealing with religion are usually the ones most targeted.

North Korea: Till 2006, North Korea continues to be the world’s worst Internet black hole. Only a few officials are able to access the web, using connections rented from China. The country’s domain name – .nk – has still not been launched and the few websites created by the North Korean government are hosted on servers in Japan or South Korea. It is hard to believe this is simply the result of economic difficulties in a country which today is capable of manufacturing nuclear warheads.

Saudi Arabia: Saudi Arabia does not hide its online censorship. Unlike China, where website blocking is disguised as technical problems, Saudi Arabia’s filters clearly tell Internet users that certain websites are banned. Censorship concentrates on pornographic content, but it also targets opposition websites, Israeli publications, or sites dealing with homosexuality.

Syria: Syria’s existing Internet surveillance systems, which include hardware from Silicon Valley-based Blue Coat, have aided President Bashar al-Assad’s regime in his crackdown on protest. More than 100 Syrians have died in detention, and information gathered through Area SpA’s Internet surveillance system would have been used against people being detained and tortured, according a researcher for the Middle East and North Africa.

Turkmenistan: With less than 1 per cent of the population online, this is one of the world’s least connected countries.

Uzbekistan: Official censorship seems to have become even tougher since the bloody crackdown on the pro-democracy protests in Andidjan in May 2005.

Vietnam: Good news finally arrives from Vietnam this week, as a Vietnamese court reduced the jail sentence of blogger and human rights activist Professor Pham Minh Hoang from three years to 17 months. He’ll be released from jail in soon.

Bahrain: This fall, 63 Bahraini students were expelled from school for “participating in unlicensed gatherings and marches,” the evidence of which was pulled from their Facebook accounts which they reportedly used to organize pro-democracy protests in February.

Thailand: Clicking “like” on Facebook in Thailand can potentially land you in prison. The Thai Minister of Information and Communication Technology declared that they will begin charging Facebook users for “liking” or sharing content that could be deemed offensive to the Thai throne, the sentence for which could run anywhere between three to 15 years in prison.

Other names in list of internet enemies include

Belarus

Egypt

Eritrea

France

Libya

Malaysia

Russia

Australia

South Korea

Sri Lanka

Tunisia

Turkey

United Arab Emirates

Venezuela

Cyber dissident:

A cyber-dissident is an individual who could be professional journalist, an activist or citizen journalist who posts news, information, or commentary on the internet that implies criticism of a government or regime. Mohamad Reza Nasab Abdolahi was imprisoned in Iran for published an open letter to Ayatollah Ali Khamenei. His pregnant wife and other bloggers who commented on the arrest were imprisoned too. Several bloggers in Egypt were arrested for allegedly defaming then president Hosni Mubarak or expressing critical views about Islam. Blogger Karim Amer has been convicted to four years of prison. When Russian president Vladimir Putin in 2006 called on his nation’s women to have more children, journalist Vladimir Rakhmankov published a satiric article on the Internet calling Putin “the nation’s phallic symbol”. Rakhmankov was found guilty of offending Vladimir Putin, and fined by the court of the region he lived in to the sum equal of 680 US dollar. The overall story served as a good advertising for Rakhmanov’s article that was republished by numerous Russian sources afterwards.

The figure below shows how dissidents can communicate through internet when the state has blocked internet access.

Wikileaks:

The website Wikileaks is dedicated to providing access to information by protecting ‘whistleblowers, journalists and activists who have sensitive material to communicate to the public’. The site leads with a quote from Time Magazine that the site ‘… could become as important a journalistic tool as the Freedom of Information Act.’ It was founded and led by Julian Assange on the notion that ‘principled leaking’ of key documents can support greater public accountability, invoking the spirit of Daniel Ellsberg and the Pentagon Papers. The site was supported primarily by individual volunteers, but the release of notable documents led to some funding through donations.

Paid commentators in China:

China has growing army of paid internet commentators often referred to as the “50 Cent Party” for the alleged fee they collect for each posted comment. This is an effort by the Chinese Communist Party (CCP) to manipulate public debate. These private citizens are paid by the government to pretend to be “ordinary” netizens while in fact promoting the CCP line and seeking, in a nontransparent fashion, to guide public opinion in a particular direction. Though politicians around the world are increasingly using internet to reach their constituents, the kind of deceptive measures employed by the “50 Cent Party” would not be tolerated in a democracy. They would also be unnecessary for a democratic government, since elected leaders have genuine supporters willing to defend them on the internet free of charge, and the population can turn to a free press, rather than self-proclaimed “fellow citizens,” to verify officials’ public statements. There are about over 560,000 private citizens being paid by the government to manipulate discussions on the Chinese internet.

China’s Internet censorship as trade barrier:

China’s Internet filtering and censorship are causing real economic harm, and how these practices violate some of China’s formal trade commitments under the World Trade Organization. While the WTO allows exceptions to its rules for matters of public morals and national security, the boundaries of such exceptions need to be tested. The WTO also requires that all restrictions be transparent, provide due process, be minimally restrictive and apply equally to foreign and domestic entities. As of today, China complies with none of these requirements. In repeatedly blocking sites like Facebook, Twitter, Google, Flickr, YouTube and others, China is singling out U.S. companies for censorship even when Chinese-owned services carry some of the same, supposedly “banned” content. This double standard strongly suggests that protectionism is one of the motivations for that country’s aggressive censorship. The economic threat is real. Internet related commerce is already in the trillions and growing rapidly. Restricting the free flow of information has especially serious repercussions in the U.S. – home to the world’s leading companies involved in online communication, information exchange, and digital commerce. Besides Chinese Internet censorship as a trade barrier, it also causes considerable harm to fundamental human rights.

Arab spring:

The Arab Spring is a revolutionary wave of demonstrations and protests occurring in the Arab world that began on Saturday, 18 December 2010. To date, there have been revolutions in Tunisia and Egypt; a civil war in Libya resulting in the fall of its government; civil uprisings in Bahrain, Syria and Yemen; major protests in Algeria, Iraq, Jordan, Kuwait, Morocco, and Oman; and minor protests in Lebanon, Mauritania, Saudi Arabia, Sudan, and Western Sahara. During the Arab Spring media jihad (media struggle) was extensive. Most observers believe that the Internet and mobile technologies, particularly social networks such as Facebook and Twitter, played and are playing important new and unique roles in organizing and spreading the protests and making them visible to the rest of the world. An activist in Egypt tweeted, “we use Facebook to schedule the protests, Twitter to coordinate, and to tell the world”. This successful use of digital media in turn leads to increased censorship including the complete loss of Internet access for periods of time in Egypt and Libya in 2011. In Syria, the Syrian Electronic Army (SEA), an organization that operates with at least tacit support of the government, claims responsibility for defacing or otherwise compromising scores of websites that it contends spread news hostile to the Syrian regime. The success of several Arab Spring revolutions offers a chance to establish greater freedom of expression in countries that were previously subject to very strict censorship, especially online. At the same time success in this effort is not certain. In response to these dramatic events and opportunities, in March 2011, Reporters Without Borders moved Tunisia and Egypt from its “Internet enemies” list to its list of countries “under surveillance”. At the same time there are warnings that Internet censorship might increase following the events of the Arab Spring.

The success of the Tunisian and Egyptian protest movements inspired demonstrations throughout the Middle East including large-scale social media coordinated protests in Libya, Iran, Bahrain, Algeria, Jordan and Yemen. In several of countries, governments responded to the calls for reform with arrests and violent suppression of public demonstrations. Increasingly, several Middle Eastern governments also may be disrupting phone and Internet communication to contain the spread of unrest. These new Internet filtering efforts come a week after Egypt returned to the Internet following an abortive effort to block protests demanding the then president, Hosni Mubarak, resign. While other countries, including Iran and Myanmar, disrupted telecommunication following social unrest in the past, the Egyptian outage represents a new Internet milestone — the first highly connected telecommunication dependent society to intentionally disconnect from the Internet.

In an action unprecedented in Internet history, the Egyptian government appears to have ordered service providers to shut down all international connections to the Internet. At 22:34 UTC (00:34am local time) on January 27, 2011; there was virtually simultaneous withdrawal of all routes to Egyptian networks in the Internet’s global routing table. Approximately 3,500 individual BGP routes were withdrawn, leaving no valid paths by which the rest of the world could continue to exchange Internet traffic with Egypt’s service providers. Virtually all of Egypt’s Internet addresses were unreachable worldwide.

In the above chart of February 2011, the “normal” traffic in and out of each country averaged over the preceding three weeks is shown in green. The dotted red line in each graph shows the traffic over the last seven days. Orange shaded areas indicated periods of statistically abnormal traffic either last week or the week of February 14. Abnormal traffic volumes may represent network failures or periods of intentional traffic manipulation. Due to the near complete block of all Internet traffic (January 27 — February 2), the Egyptian graph shows orange for most of last week as traffic levels climbed to normal. Yemen Internet traffic also exhibited brief, though unusual dips, during the prior week (February 7-11) and also includes an orange period. While the Internet has proven a powerful tool for rallying social and political change, so too have governments recognized their regulatory and technical capability to disrupt communications. There is a major contest going between the continued evolution of the Internet as a vehicle for political change and authoritarian government’s continued assertion of control.

___

Since the beginning of the popular uprisings and protests in the Middle East and North Africa, events in the region have been characterized by increased contestation in cyberspace among regime sympathizers, governments, and opposition movements. One component of this contestation is the tendency among governments and networks of citizens supportive of the state to use offensive computer network attacks. Such tactics are supplements to legal, regulatory, and other controls, and technical forms of Internet censorship. For example, a group known as the Iranian Cyber Army has defaced Twitter and Iranian opposition websites. Also, Tunisian political activists and Yemeni oppositional websites have both accused their government security organizations of launching attacks on their sites in an attempt to silence their message and deny access to their content. The activities of the Syrian Electronic Army (SEA), which appears to be a case of an open and organized pro-government computer attack group that is actively targeting political opposition and Western websites. It is documented that how Syria has become the first Arab country to have a public Internet Army hosted on its national networks to openly launch cyber attacks on its enemies. The SEA continues to claim responsibility for defacing or otherwise compromising scores of websites that it contends spread news hostile to the Syrian regime. After a 4-day countdown meant to build anticipation, the SEA announced the defacement of over 130 websites and has continued to release the URLs of more defaced pages every few days. Although most of the websites were indeed defaced, the vast majority of the affected pages were online businesses and blogs with no apparent political content. SEA disseminates denial of service (DoS) software designed to target media websites including those of Al Jazeera, BBC News, Syrian satellite broadcaster Orient TV, and Dubai-based al-Arabia TV.

Twitter in the Iranian 2009 Election Protests:

In the midst of protests surrounding the contested 2009 election results in Iran, the Internet, and Twitter in particular, was claimed to have played an important role in organizing and supporting the protests on the streets of Tehran. Overall, there is little doubt that Twitter and videos posted on the Web played a significant role in providing a means for individuals in Iran to communicate with one another, but most often via the world outside Iran. The main role of Twitter was as a tool for the Iranian diaspora to relay protest news to the international media, which in turn became a significant factor in shaping and informing developments on the ground. The counter-measures used to break this cycle were quite effective. On important protest days, Iranian authorities effectively pulled the plug on the Internet, introducing 60 to 70 per cent packet loss into the network and closing all the major ports used by circumvention tools, making it nearly impossible for ordinary users to do anything online. On normal and non-critical days, Iran appeared to be doing deep packet inspection.

Success of Arab Spring:

The protesters openly acknowledge the role of Internet as a fundamental infrastructure for their work. Libya’s dictator Gadhafi’s former aides have advised him to submit his resignation through Twitter before his death. Just as the fall of Suharto in Indonesia is a story that involves the creative use of mobile phones by student activists, the falls of Zine El Abidine Ben Ali in Tunisia and Mubarak in Egypt will be recorded as a process of Internet-enabled social mobilization.

There are three possible ways in which freedom on the Internet can be limited:

1. Obstacles to access, including restrictions imposed by governmental policy or economic conditions, such as a lack of infrastructure;

2. Limits to content, such as through self- or government-censorship, when self-censorship includes that imposed by the Internet industry;

3. Restrictions on the rights of users, such as (un)lawful disconnection.

Table below summarizes the current state of Internet censorship in the world:

Who Censors	What	Why	How
Government	Pornography; hate speech; terrorist information, e.g., directions for how to make bombs; information from/ about regimes felt to be threat	Protect children and citizens; decrease foreign influence; protect political stability; maintain security	Legislation; licensing/controlling telecommunication; labeling;
Academic institutions	Hate speech; criticism of administration/ faculty; expression judged to be in conflict with institutional policy, good taste, etc.	Institutional responsibility for setting high cultural/social standards, maintaining civility and security	Prevent publication; threaten suspension/ dismissal;
Religious groups, institutions	Pornography; in general, expressions thought to deny, contradict, or mock the particular religion espoused	Responsibility for maintaining moral standards and respect for religious teachings and institutions	Law suits; working to eliminate publication and use of information they deem objectionable
Corporations	Information thought to be harmful to company; employee use of electronic resources for “unauthorized” communication	Protect trade secrets; preserve image; guard against unproductive or damaging employee behavior	Law suits; counterintelligence or disinformation; dismissal/sanctions against offending employees
Media	Information that threatens advertisers	Preserve relationships with sponsors	Refrain from publishing
Libraries	Pornography, other information thought to be harmful to children	Respond to community pressure; avoid need to “police” terminals	Filters; contracts specifying online conduct;

Motives for internet censorship:

There are five primary motives or rationales for Internet censorship: politics and power, social norms and morals, security concerns, protecting intellectual property rights and existing economic interests. In addition, networking tools and applications that allow the sharing of information related to these motives are often targeted.

1) Politics and power:

Censorship directed at political opposition to the ruling government is common in authoritarian and repressive regimes. Some countries block Web sites related to religion and minority groups, often when these movements represent a threat to the ruling regimes. Examples include: Political blogs and Web sites, sites with content that offends the dignity of or challenges the authority of a reigning sovereign or of a state, Tibetan exile group sites in China, indigenous hill tribes’ sites in Vietnam and Sites aimed at religious conversion from Islam to Christianity. The list of countries that engage in substantial political blocking includes Bahrain, China, Libya, Iran, Myanmar, Pakistan, Saudi Arabia, Syria, Tunisia, Uzbekistan, and Vietnam. Thailand and Ethiopia are the most recent additions to this group of countries that filter Web sites associated with political opposition groups. Yet in other countries with an authoritarian bent, such as Russia and Algeria, filtering of the Internet is not yet uncovered.

2) Social norms and morals:

Social filtering is censorship of topics that are held to be antithetical to accepted societal norms. In particular censorship of child pornography and to protect children enjoys very widespread public support and such content is subject to censorship and other restrictions in most countries. Examples include: Sex and erotic, fetishism, prostitution & pornographic sites; child pornography & pedophile related sites; Gay & Lesbian sites; sites seen as promoting illegal drug use; gambling sites; sites encouraging or inciting violence and sites promoting criminal activity. Sites that contain blasphemous content, particularly when directed at a majority or state supported religion; sites that contain defamatory, slanderous, or libelous content; and sites that include political satire are also censored. Web sites that deny the Holocaust or promote Nazism are blocked in France and Germany. Web sites that provide unflattering details related of the life of the king of Thailand are censored in that country.

Child pornography is defined as a material that visually depicts:

A. a minor engaged in sexually explicit conduct;

B. a person appearing to be a minor engaged in sexually explicit conduct;

C. realistic images representing a minor engaged in sexually explicit conduct.

Child Protection:

The Internet is an increasingly central component in the lives of children and young people in the developed world. It cannot be seen as an ‘adults-only’ environment. It is in this context that some of the most emotive debates around freedom of expression online arise, at the point where the crucial regulatory goal of preventing harm to minors pushes up against the noble ideal of free speech for all. Many, possibly even most states, have introduced some regulatory tools to protect children online, at least in terms of prohibiting illegal activity; the question remains as to how much regulation is enough, and how much is too much. In many jurisdictions, this debate hinges in large part on the distinction between activities that are illegal and those that are harmful. In attempting to combat activity that is clearly illegal, many countries have expressed revulsion at the production, dissemination and consumption of child sexual abuse images. In most countries, the removal of these images is deemed to be a justified limitation to freedom of expression. As far as child abuse is concerned; should Internet content be controlled by law enforcement agencies or should it rather be a responsibility undertaken by ISPs and search engines? If so, should this occur with or without government support and mandates?

What harm pornography does?

Pornography is defined in Webster’s Dictionary as pictures, film, or writing which deliberately arouse sexual excitement. One thing might sexually excite one person but not another. So by this definition, one can understand why there is a lot of room for discrepancy. Pornography demeans and degrades women, victimizes children and ruins men. It contributes to domestic and spouse abuse, rape, incest and child molestation. And a great share of it is not protected speech, any more than libel, slander or false advertising are protected speech; therefore, it is not a freedom of expression issue. It is not legal material. Many people do not realize this fact.

Child pornography laws that exist on the federal, state and local levels also apply to the Internet. Thus creating a new set of laws for the Internet are unnecessary because federal, state and local laws already apply to users of the Internet if they are in the jurisdiction of said laws. Also, Software Systems which allow parental control of Internet material are already widely available on the Internet. Many parents turn to software and hardware solutions to this problem. They can purchase Web filtering programs like Net Nanny or CYBERsitter to block access to undesirable Web sites. These programs usually have a series of options parents can select to limit the sites their children can access. These options tell the program which filters to enable. For example, CYBERsitter has 35 filter categories, including pornography and social networking sites. Net Nanny’s software system allows parents to “monitor, screen and block access to anything residing on, or running in, out or through your PC, online or off”. There are many other parental control software systems that are similar to Net Nanny including SurfWatch and Cyber Patrol. Another option for parents is to install a firewall. Tech-savvy parents might not have a problem installing and maintaining a firewall. Others prefer to use Web filters, which do most of the work for them.

3) Security concerns:

Internet filtering related to threats to national security that targets the Web sites of insurgents, extremists, and terrorists often enjoys wide public support. Examples include: Blocking of pro–North Korean sites by South Korea, Blocking sites of groups that encourage domestic conflict in India, Blocking of sites devoted to the Balochi independence movement by Pakistan, Blocking of sites of the Muslim Brotherhood in some countries in the Middle East and Blocking Wikileaks. The perceived threat to national security is a common rationale used for blocking content. Internet filtering that targets the Web sites of insurgents, extremists, terrorists, and other threats generally garners wide public support. This is best typified by South Korea where pro–North Korean sites are blocked, or by India where militant and extremist sites associated with groups that encourage domestic conflict are censored.

4) Protection of intellectual property rights:

Sites that share content that violates copyright or other intellectual property rights are often blocked, particularly in Western Europe and North America.

5) Existing economic interests:

The protection of existing economic interests is sometimes the motivation for blocking new Internet services such as low-cost telephone services that use Voice over Internet Protocol (VoIP). These services can reduce the customer base of telecommunications companies, many of which enjoy entrenched monopoly positions and some of which are government sponsored or controlled.

Libel for Defamation:

Most nations’ courts seek to protect the reputations of individuals and companies from irresponsible accusations of libel. However, restrictions on spoken or written expression that are meant to prevent defamation vary widely. In Asia, governments have enacted laws which deter acts of online defamation and frequently impose serious sanctions such as imprisonment. These measures are often seen as stifling freedom of expression and freedom of the press on the Internet. In the United States, Australia and United Kingdom, libel cases for online defamation have tested the limits of legal jurisdiction in the online world. United Kingdom is widely perceived to have some of the greatest restrictions on the publication of defamatory information, and is said to have spawned libel tourism in the country. Nonetheless, everybody must understand that the truth cannot be libel.

Hate speech:

Hate speech is defined as: “racist and xenophobic material” meaning any written material, any image or any other representation of ideas or theories which advocates, promotes or incites hatred, discrimination or violence; against any individual or group of individuals; based on race, color, descent, religion or national / ethnic origin; or any material used as a pretext for any of these factors. As much as the Internet is a mechanism for spreading democracy it is also a breeding ground for hate speech by groups who have used it to promote their cause. While most people tend to agree that this is a negative consequence of the Internet, some think that inappropriate regulation of online hate speech can lead to the suppression of the right to freedom of expression. Others believe that prohibiting hate speech altogether may further proliferate its discourse in society. Moreover, active censorship usually tends to backfire in a democracy, especially when filtering and online monitoring are used. So how can a balance be found between both, in order to avoid online censorship? There are two major approaches to this issue. The first is to encourage free and open exchange of ideas online (mainly a US approach). The second is to directly block hate speech on the Internet, which has been the approach adopted by Germany, amongst other countries. It is difficult and highly unlikely that an international consensus will be found on how to deal with this problem. Some suggest establishing an ombudsman bureau and using exposure as an effective means to reduce hate speech online. Others argue that the solution lies in public education and the teaching of tolerance and acceptance of diverse values.

Illegal Content:

A useful starting point in addressing problematic Internet content is to differentiate between controversial or offensive or harmful content and illegal content. Illegal content is defined objectively, in the sense that existing laws determine which content is illegal — whether it is in cyberspace or in the physical world. More precisely, illegal content is defined as content that is in violation of country’s laws of general application. Illegal content includes child pornography; online solicitation of children for sexual acts; hate propaganda; obscenity; online harassment; and communicating threats. It is wrong to consider the Internet a “lawless place” and the law of the land also applies to the Internet in theory. This is also true regarding the availability of illegal content over the Internet. The most common and most frequently cited example of illegal content is the availability of child pornography over the Internet. Consequently, the whole issue of illegal content and how to deal with this has revolved around child pornography, even though child pornography and pedophilia are not necessarily Internet specific problems. Another concern for content-related criminal activity by law enforcement agencies is the possibility of using the Internet for harassment and threats. As Table below illustrates, it is not always easy to categorize certain types of content as illegal even though these may sometimes be regarded as objectionable or harmful and that categorization of content is not straightforward and is often problematic.

Child pornography

Hate speech

Pornography

Society sees it as a problem.

•Child pornography is not a new problem.

• Digital child pornography is

not a new problem – it can be

traced back to the mid-1980s.

• Clear cut example of “illegal

content”.

• Criminalized by the CoE

Cybercrime Convention, the

UN Optional Protocol to the

Convention on the Rights of

the Child on the sale of children,

child prostitution and

child pornography, and the EU

Council Framework Decision

on combating the sexual

exploitation of children and

child pornography (not

adopted yet).

• UN Optional Protocol: 108

signatories, 71 parties as of

February 2004.

• Society sees it as a problem.

• Racism and xenophobia are not new problems.

• Digital hate is not a new

problem – it can be traced

back to the mid-1980s.

• Difficult to categorize:

Depending upon its nature and

the laws of a specific State it

could be considered illegal or

harmful/offensive (BUT legal).

• Harm criteria are different in

different European States.

• CoE Additional Protocol to

the Cybercrime Convention

on the criminalization of acts

of a racist and xenophobic

nature committed through

computer systems:

23 signatories so far

but no ratifications

• Society does not always see it as a problem.

• Pornography is certainly not new.

• Difficult to categorize:

Depending upon its nature and

the laws of a specific State it

could be considered illegal or

harmful/offensive (BUT legal).

• Harm criteria are different in

different European States.

• UK approach is rather different

to the German or Scandinavian

approaches to sexually

explicit content.

• No international attempt

to regulate “sexually explicit

content”.

Illegal universally

In between

Legal in many nations

Harmful Content (offensive content). The difference between illegal and harmful content is that the former is criminalized by national laws, while the latter is considered offensive, objectionable, unwanted, or disgusting by some people but is generally not criminalized by national laws. Controversial or offensive content is for the most part defined subjectively in the sense that, while it is not illegal under country law, it is deemed to be controversial or offensive according to individual, community, or culturally based standards. In some cases, this type of content may be considered to be harmful to children. Offensive content includes such things as legal pornography; violence; alcohol and tobacco advertising aimed at minors; and other content that may be considered to be objectionable on social, religious, cultural, or other grounds. Internet content that may also be labeled “harmful” includes sexually explicit material, political opinions, religious beliefs, views on racial matters, and sexuality. But it should be noted that in the Handyside case, the European Court of Human Rights confirmed that freedom of expression extends not only to ideas and information generally regarded as inoffensive but even to those that might offend, shock, or disturb, and this sort of information legally exists over the Internet as well as in other media. The governance of this sort of Internet content may differ from country to country. This is certainly the case within Europe where there are different approaches to sexually explicit content, hate speech, or Holocaust denial. For example, under the Obscene Publications Act in the UK, it is illegal to publish and distribute obscene publications. Yet possessing or browsing through sexually explicit and obscene content on the Internet is not an illegal activity for consenting adults. Furthermore, there are no UK laws making it illegal for a child to view such content in a magazine or on the Internet. The laws normally deal with the provision of such content to children. Therefore, harm is a criterion which depends upon cultural differences and this is accepted within the jurisprudence of the European Court of Human Rights. Nevertheless, the availability of harmful Internet content is a politically sensitive area and a cause for concern for European regulators.

Pros and cons of internet censorship:

The series of events related to Internet censorship in various parts of the world over the last year or so has brought this issue back to the debating table. This has, in turn, left the entire world divided into two groups – those advocating Internet censorship and those opposing it. While those who advocate it argue that such regulations are necessary to keep certain problems, such as sexual exploitation of children and spread of drug cartels, at bay; its critics are of the opinion that this is a mere authoritative practice which questions the fundamental principles of democracy.

The internet is the fastest growing and largest tool for mass communication and information distribution in the world. It can be used to distribute large amounts of information anywhere in the world at a minimal cost. In the last ten years there has been increasing concern about damaging internet content right from violence & sexual content to bomb-making instructions, terrorist activity and child pornography. Irrespective of whether it is on the television or on Internet, racial comments and pornography can never be justified. It may be easier to trace a person who uses television as a medium to spread hatred or porn, but it is very difficult to do so on the Internet with no boundaries whatsoever. The fact that the chances of being traced are very rare makes many resort to various criminal activities, right from sexual exploitation of children to running drug cartels from a particular part of the world, on the Internet. While laws pertaining to various Internet crimes do exist, it is very difficult to book a person on such charges – especially if he is not from the same country. The rising number of crimes validates this very fact, and advocates of Internet censorship cite this as one of the most prominent reason in their justification of Internet regulation. According to the critics of Internet censorship, it is a blatant violation of Internet privacy and freedom of press – which is used by authoritative administration to suppress the effectiveness of this means of mass media. The critics also question the idea of Internet Service Providers deciding what to put on the Internet and what to omit, as the chances of these service providers being biased cannot be ruled out. As far as government regulation is concerned, the government can only regulate what is going on in their country, but it is very difficult to regulate web pages which are generated from other countries. On the legal front, the owners of these websites can sue the administration over blocking their websites as well. While that may seldom work in non-democratic countries, it is an effective tool for such companies in democratic countries. At the same time, such censorship is also bound to come heavy on taxpayers pocket because the government will have to put in more funds to tackle new concepts of Internet technology, such as proxy server, which keep on changing every now and then.

Pros of Internet Censorship:

1. Censorship of pornographic material prevents the corrupting of the children.

2. Religious conflicts are avoided by the censorship of material deemed insulting or offensive to a particular religious community.

3. Censorship is necessary to preserve the secrets of a nation.

4. Censorship is useful in hiding sensitive military information, which could be used by an enemy state.

5. It keeps the internet safe for the kids (even though it’s a parent’s responsibility to do that).

6. Makes the internet a more useful tool for people, instead of a porn filled toy.

7. Internet may be used to portray wrong information about individuals or groups that could incite violence against them.

8. It can be used to prevent politically motivated propaganda.

9. It protects the privacy of people.

10. Breach of copyright is prevented.

11. Crazy disturbing ideas wouldn’t have a chance to reach the ears of the public.

12. It protects indigenous cultures from the bad influence of foreign cultures.

13. It prevents companies from spreading inaccurate or grossly exaggerated claims about their products.

14. Censoring sensitive information can stop unsuitable people gaining access to potentially harmful information.

15. Terrorists are prevented from learning about dangerous technology like the atom bomb.

16. Children are prevented from learning things that could harm them and others.

17. It can protect the safety of the public and can prevent disturbing the social order.

18. It shields the morals of society.

19. It restrains vulgarity and obscenity.

20. It prevents the public display of disrespect to any particular individual or community.

21. It also helps prevent hate groups and other similar organizations aiming to spread hate speech or related propaganda.

Cons of Internet Censorship:

1. Dictators and dictatorship use it to promote a flattering image of them and for removing any information that is negative to them. In some countries, dictators use censorship to further their own agendas while squashing those of the opposition.

2. Unscrupulous governments and individuals are apt to take advantage of censorship and use it to hide their own misdeeds from scrutiny of the world. Censorship has often been used by dictators to prevent the media reporting unsavory events in war torn and politically unstable countries.

3. Why should someone else decide what I can watch, or read, or play on the internet, I’m an adult, allow me to do what I want.

4. There is a very fine line between censorship and protectiveness—removing some types of information from the eyes and ears of children can lead to a lack of informative information on vital subjects like sex, drugs, and alcohol.

5. People should have the freedom to choose the type of information and ideas they wish to be exposed to rather than be told what they can and cannot do by a higher body.

6.Censorship can be used to prevent the public finding out what immoral and illegal activities certain individuals have been up to in their private lives—information that the public has a right to know.

7. Not everyone has the same idea of what images and ideas are appropriate for dissemination.

8. Freedom of speech/expression is compromised.

9. It prevents the free flow of ideas.

10. Withholding of information only leads to ignorance in the society.

11. Censoring of information may lead to a wrong image perceived by the public.

12. It is generally associated with dictatorship.

13. We live in a country of freedom. Censorship is against that freedom (for those who live in democratic nations).

14. It is a force against globalization.

15. It works against creativity.

16. If you hide something from people they will become extra curious about it.

17. It has no place in a truly democratic society.

18. It gives rise to and hides human rights abuses.

19. It is used to control people.

20. There can be different standards of morals among different societies quite different from the imposed ones by the censorship.

21. It may be used to block legitimate criticism.

22. Governments and media conglomerates can use censorship to distort facts or hide truths from ordinary citizens.

23. Governments should not control people. It should be the other way around.

24. It stifles the opposition, broadcasting only a particular point of view.

25. People have a right to know.

26. Censorship can prevent people who have an emergency from getting help.

27. Censorship can lead to ignorance of the world and other cultures.

28. Extreme censorship can lead to social upheaval.

29. Extreme censorship can lead to an oppressed and uneducated society.

30. It leads to international trade barriers lead to a further gap between the rich and the poor.

31. Some adult people want to view porn, and it’s their right to watch it.

32. Sites that are likely to be censored are billion dollar industries, and it would harm the economy.

33. Internet censorship harms communication during calamities like earthquakes and hurricanes when other modes of communications are disrupted.

In my view, cons have better & superior point of view than pros of Internet censorship. Besides child pornography, copy right/intellectual property right infringement and incitement of violence, I see no reason for Internet censorship.

Firewall:

A computer firewall provides protection from dangerous or undesirable content. Firewalls can be software or hardware. They act as a barrier between the Internet and your computer network. They only let safe content through and keep everything else out. Firewalls have helped protect computers in large companies for years. Now, they’re a critical component of home networks, as well. A firewall is simply a program or hardware device that filters the information coming through the Internet connection into your private network or computer system. Firewalls are customizable. This means that you can add or remove filters based on several conditions. Some common protocols that you can set firewall filters for include: IP (Internet Protocol) – the main delivery system for information over the Internet; TCP (Transmission Control Protocol) – used to break apart and rebuild information that travels over the Internet; HTTP (Hyper Text Transfer Protocol) – used for Web pages; FTP (File Transfer Protocol) – used to download and upload files; UDP (User Datagram Protocol) – used for information that requires no response, such as streaming audio and video; ICMP (Internet Control Message Protocol) – used by a router to exchange the information with other routers; SMTP (Simple Mail Transport Protocol) – used to send text-based information (e-mail); SNMP (Simple Network Management Protocol) – used to collect system information from a remote computer and Telnet – used to perform commands on a remote computer. Firewalls use one or more of three methods to control traffic flowing in and out of the network.

1) Packet filtering – Packets (small chunks of data) are analyzed against a set of filters. Packets that make it through the filters are sent to the requesting system and all others are discarded.

2) Proxy service – Information from the Internet is retrieved by the firewall and then sent to the requesting system and vice versa.

3) Stateful inspection – A newer method that doesn’t examine the contents of each packet but instead compares certain key parts of the packet to a database of trusted information. Information traveling from inside the firewall to the outside is monitored for specific defining characteristics, then incoming information is compared to these characteristics. If the comparison yields a reasonable match, the information is allowed through. Otherwise it is discarded.

Concept of filtering information on Internet:

Filtering consists of social, political, and technical methods, all of which interact in ways that can strongly reinforce one another. In most filtered countries, the social pressure not to visit forbidden information is the most effective form of filtering (and applies equally well to on- and off-line information). Unfiltered Internet access increases the diversity of information and opinions users see. This increased diversity not only provides users with the new information and viewpoints but also, in itself, exerts a counteracting social pressure in favor of free information. Unfortunately, all of the tools used by social pressure lead to explicit aware actions, discouraging users from ever entering the positive feedback loop of free information. The combination of the social pressure to filter information and the initial hurdle of using circumvention technology reinforce one another. When social pressure fails, political pressures apply. In practice, the arrest of users for accessing blocked information is rare, but laws regulate at a higher level as well. For example, China has implemented regulations on Internet cafes that place Internet cafe users under increasingly strong surveillance, including requiring credentialing for access to the Internet. These sorts of measures both make clear the threat of the application of political force and reinforce the social pressures to filter. Also, laws are most likely to be enforced against known political dissidents, who are some of the key early users of circumvention technology. Technical filters are both the first and last line of defense against the dissemination of unwanted information. In the first place, technology allows the filtering country easily to designate which pieces of information it wants its citizens to avoid; this mere designation enables the social pressures to function. Technical filters only need to apply force (by actually blocking rather than merely designating offensive material) when social and political forces fail. It is the combination of social, political, and technical filtering methods that proves very difficult to break through and explains why circumvention tool use remains very small in proportion to the total number of Internet users in filtered countries.

Non-technical censorship:

Internet content is subject to censorship methods similar to those used with more traditional media. For example:

Laws and regulations may prohibit various types of content and/or require that content be removed or blocked either proactively or in response to requests.

Publishers, authors, and ISPs may receive formal and informal requests to remove, alter, slant, or block access to specific sites or content.

Publishers and authors may accept bribes to include, withdraw, or slant the information they present.

Publishers, authors, and ISPs may be subject to arrest, criminal prosecution, fines, and imprisonment.

Publishers, authors, and ISPs may be subject to civil lawsuits.

Equipment may be confiscated and/or destroyed.

Publishers and ISPs may be closed or required licenses may be withheld or revoked.

Publishers, authors, and ISPs may be subject to boycotts.

Publishers, authors, and their families may be subject to threats, attacks, beatings, and even murder.

Publishers, authors, and their families may be threatened with or actually lose their jobs.

Individuals may be paid to write articles and comments in support of particular positions or attacking opposition positions, usually without acknowledging the payments to readers and viewers.

Censors may create their own online publications and Web sites to guide online opinion.

Access to the Internet may be limited due to restrictive licensing policies or high costs.

Access to the Internet may be limited due to a lack of the necessary infrastructure, deliberate or not.

Technical Internet filter (filter):

Internet filter is any hardware or software installed intentionally to disallow/restrict retrieval of information/text/picture/video on internet. Content-control software, also known as censorware or web filtering software is a term for software designed and optimized for controlling what content is permitted to a reader, especially when it is used to restrict material delivered over the Web. Companies that make products that selectively block Web sites do not refer to these products as censorware, and prefer terms such as “Internet filter” or “URL Filter”. Content-control software determines what content will be available. Internet filters are setup by a System Administrator to prevent user access to sites that could be either inappropriate, or a potential security risk to the network. The restrictions can be applied at various levels: a government can attempt to apply them nationwide, or they can, for example, be applied by an ISP to its clients, by an employer to its personnel, by a school to its students, by a library to its visitors, by a parent to a child’s computer, or by an individual user to his or her own computer. The motive is often to prevent persons from viewing content which the computer’s owner(s) or other authorities may consider objectionable; when imposed without the consent of the user, content control can constitute censorship. Some content-control software includes time control functions that empowers parents to set the amount of time that child may spend accessing the Internet or playing games or other computer activities.

Almost all data on the Internet is exchanged in a client server model, meaning simply that a client requests some data over the network that a server then returns over the same network. A filter can operate in three places in such a system – on the client requesting the data, on the server returning the data, or on the network between, during either the request or the response. Perhaps the most straightforward way to filter the Internet is to install software on a client machine that prevents the client from requesting offensive information in the first place. Many Internet accessible computer labs, including those at schools and libraries, use this sort of filtering because they have easy control over a small number of computers to be filtered. Parents can also install filter in home computer to prevent children from accessing pornographic sites. As with client side filtering, the technology of server side filtering is simple in practice – you need either remove the offending content from the server or prevent the server from sending a response with the offending content. In practice, most Internet servers are located in non-filtering countries, so filtering countries need the participation of either the hosting content owner or the hosting country. Another possible mode of server side filtering is to engage in hostile attacks on offending servers, for example via machine intrusions or denial of service attacks. Such attacks are expensive, however, and only temporarily effective and so have not been used widely to date. Internet traffic aggregates onto a small number of huge backbone data pipes and then disaggregates back out to the individual local networks. Filtering the vast majority of traffic on a large network requires only filtering the traffic on this small number of pipes (only regional traffic that never hits a backbone avoids such filtering). Specialized computers called routers control all Internet traffic, including that on the backbones. Filters can be installed on routers to block a site. All filtering countries use a combination of social, political, and technical filtering methods, and most filtering countries use a combination of technical filtering methods including client, server, and router filtering. Many countries use only a single router filtering method, such as IP blocking or DNS blocking. China has the most sophisticated technical filtering infrastructure, consisting of overlapping implementations of IP blocking, DNS blocking, and Keyword blocking.

Types of filter:

1) PC-based (end user) Filters: This type of filter is installed as software on your computer. This filter can be customized to meet a family’s needs. The parents can restrict child’s access to objectionable content. This filter can be disabled only by someone with the password. Client-side filters usually work well in places like libraries, because only some access points need to be filtered, for instance, the computers in the children’s playing and reading section.

2) PC-based Filter Product with Server-Based Filtering

3) Server-based Filters (installed on ISP server, DNS server, host server or any router computer between origin and destination of web request): Content limited ISPs are intended for both children & adults to allow access to almost everything, except what the ISP considers inappropriate.

4) Search-engine filters: Many search engines, such as Google and Alta Vista offer users the option of turning on a safety filter. When this safety filter is activated, it filters out the inappropriate links from all of the search results.

Most Web filters use two main techniques to block content: Blacklists and keyword blocking. A blacklist is a list of Web sites that the Web filter’s creators have designated as undesirable. Blacklists change over time, and most companies offer updated lists for free. Any attempt to visit a site on a blacklist fails. With keyword blocking, the software scans a Web page as the user tries to visit it. The program analyzes the page to see if it contains certain keywords. If the program determines the Web page isn’t appropriate, it blocks access to the page. Many filtering programs allow blocking to be configured based on dozens of categories and sub-categories such as these from Websense: “abortion” (pro-life, pro-choice), “adult material” (adult content, lingerie and swimsuit, nudity, sex, sex education), “advocacy groups” (sites that promote change or reform in public policy, public opinion, social practice, economic activities, and relationships), “drugs” (abused drugs, marijuana, prescribed medications, supplements and unregulated compounds), “religion” (non-traditional religions occult and folklore, traditional religions), …. The blocking categories used by the filtering programs may contain errors leading to the unintended blocking of websites. The blocking of DailyMotion in early 2007 by Tunisian authorities was, according to the OpenNet Initiative, due to Secure Computing wrongly categorizing DailyMotion as pornography for its SmartFilter filtering software. It was initially thought that Tunisia had blocked DailyMotion due to satirical videos about human rights violations in Tunisia, but after Secure Computing corrected the mistake access to DailyMotion was gradually restored in Tunisia. No matter what the censors’ reasons are, the end result is the same: They block access to the Web pages they identify as undesirable. Internet censorship isn’t just a parental or governmental tool. There are several software products on the consumer market that can limit or block access to specific Web sites. Most people know these programs as Web filters. Regulations and accountability related to the use of commercial filters and services are typically non-existent, and there is no or little oversight from civil society or other independent groups. Vendors often consider information about what sites and content is blocked valuable intellectual property that is not made available outside the company, sometimes not even to the organizations purchasing the filters. Thus by relying upon out-of-the-box filtering systems, the detailed task of deciding what is or is not acceptable speech has been outsourced to the commercial vendors.

White-list:

Most Internet filters works with a blacklist, which means that access to all sites is allowed, except some special sites (well, sometimes there are a lot of exceptions…). A white-list works the other way around: Access to all sites is blocked, except some special ones. For a normal ISP it is almost impossible to offer – because the Internet is nearly worthless. The white-list scheme is used by free Internet terminals that are sponsored by a company which allows users the free access to their e-commerce site. This filter scheme is the most difficult to circumvent.

Governments, Internet Service Providers (ISPs), Internet access providers, companies, parents or individuals can install software that restricts content to users. This software can be installed on an individual personal computer, but may also be installed ‘upstream’ on a home, company or ISP network server. In some cases, it is installed at a national ‘backbone’ level. A filter can screen particular words, email addresses, websites or other addresses and be used for example, if the installer wishes to prevent users within its borders from seeing particular content or a particular site. When used by governments, it is often branded as ‘censorship’, particularly if aimed at political speech. But in the case of ISPs, where filters are used for example to combat spam, it can be viewed as an essential service to users. In the household, parents might use a filter as a means of ‘child protection. These examples underscore the need to assess the social and political context in which filtering is conducted.

The most common points at which filtering can be applied include:

1. Internet Service Providers: ISPs are often mandated, encouraged, or incentivized to filter illegal or immoral content, or prevent search results from specified websites, by a regulator or other agency authorized by a government with jurisdiction over their activities. They also routinely filter spam and attempt to prevent infection by malware for reasons of stability and user protection.

2. Gateways to the Internet backbone: State-directed implementation of national content filtering schemes and blocking technologies may be carried out at the backbone level, often with filtering systems set up at links to the Internet backbone, such as international gateways in order to eliminate access to content throughout an entire country.

3. Institutions: Companies, schools, libraries and households can filter on the basis of their own criteria or on behalf of state authorities.

4. Individual computers: Filtering software can be installed on individual computers, such as a personal computer, to restrict the ability to access certain sites or use certain applications.

5. Law enforcement: Actions can be taken against users who engage in unlawful file sharing of music, malicious hacking, fraud, etc

The table below shows different technical methods of Internet filtering in various countries.

Various Internet censorship techniques include:

1. Internet Protocol (IP) address blocking: The most straightforward way to block traffic on a router is to block the IP addresses of servers hosting offensive material. The IP address is the number used to uniquely identify every computer (server or client) on the Internet, so blocking the IP address of a given machine makes it inaccessible. A router already needs to examine the destination IP of every bit of data it handles, so the only extra cost of filtering based on the destination (or origin) IP is the cost to lookup the destination IP address in a table of blocked IP addresses. Such lookups require relatively little computing power even at the scale required for a country level backbone router, making IP blocking a cheap method of filtering traffic on a large scale. Access to a certain IP address is denied. If the target Web site is hosted in a shared hosting server, all websites on the same server will be blocked. This affects IP-based protocols such as HTTP, FTP and POP. A typical circumvention method is to find proxies that have access to the target websites, but proxies may be jammed or blocked, and some Web sites, such as Wikipedia (when editing) also block proxies. Some large websites such as Google have allocated additional IP addresses to circumvent the block, but later the block was extended to cover the new addresses.

2. Domain name system (DNS) filtering and redirection: Another way to filter traffic on the network is to block the lookup of DNS names of offensive sites. The DNS name is the plain text name generally used by end users to lookup a site (e.g., google.com). These DNS names are translated into IP addresses by DNS servers. To block specific DNS name lookups requires only removing those DNS zones from all of a country’s DNS servers. There are more DNS servers than backbone routers, but the number is still relatively small, and the work of maintaining DNS block lists can be outsourced to individual ISPs simply by distributing the list to the participating ISPs. Blocked domain names are not resolved or an incorrect IP address is returned. This affects all IP-based protocols such as HTTP, FTP and POP. A typical circumvention method is to find an alternative DNS root that resolves domain names correctly, but domain name servers are subject to blockage as well, especially IP address blocking. Another workaround is to bypass DNS if the IP address is obtainable from other sources and is not itself blocked. Examples are modifying the Hosts file or typing the IP address instead of the domain name as part of a URL given to a Web browser.

3. Uniform Resource Locator filtering: URL strings are scanned for target keywords regardless of the domain name specified in the URL. This affects the HTTP protocol. Typical circumvention methods are to use escaped characters in the URL, or to use encrypted protocols such as VPN and TLS/SSL.

4. Keyword blocking which denies access to websites based on the words found in pages or URIs, or blocks searches involving blacklisted terms. Advances are enabling increasingly dynamic, real-time analysis of content, but this is not yet in wide use. Keyword block filtering examines the content of the traffic, rather than merely the destination and can examine content in any part of a request, including a specific URL in a web request or an offending keyword in an email. As such, keyword blocks can be much more precise than IP or DNS blocks, blocking only specific pages with a complete URL (http://hrw.org/china but not http://hrw.org/usa) or only specific pages with an offensive keyword (“Taiwan independence”). Keyword based blocking can be used for any Internet application that uses text, including web pages, email, and most instant messaging. Keyword blocking can be circumvented by encrypting all data sent over a connection, since encryption renders content into a form the filter cannot read. So a request that is blocked by a keyword filter as an HTTP request will not be blocked as an HTTPS request. Likewise, non-text data is generally impossible to filter by simple keyword filtering, since most such data must be interpreted as entire files, rather than as individual packets.

5. Packet filtering: Terminate TCP packet transmissions when a certain number of controversial keywords are detected. This affects all TCP-based protocols such as HTTP, FTP and POP, but Search engine results pages are more likely to be censored. Typical circumvention methods are to use encrypted connections – such as VPN and TLS/SSL – to escape the HTML content, or by reducing the TCP/IPstack’s MTU/MSS to reduce the amount of text contained in a given packet.

6. Connection reset: If a previous TCP connection is blocked by the filter, future connection attempts from both sides can also be blocked for some variable amount of time. Depending on the location of the block, other users or websites may also be blocked, if the communication is routed through the blocking location. A circumvention method is to ignore the reset packet sent by the firewall.

7. Full block: A technically simpler method of Internet censorship is to completely cut off all routers, either by software or by hardware (turning off machines, pulling out cables). This appears to have been the case on 27/28 January 2011 during the 2011 Egyptian protests, in what has been widely described as an “unprecedented” internet block. About 3500 Border Gateway Protocol (BGP) routes to Egyptian networks were shut down from about 22:10 to 22:35 UTC 27 January. This full block was implemented without cutting off major intercontinental fiber-optic links. Full blocks also occurred in Myanmar/Burma in 2007 and Libya in 2011.

8. Portal censorship and search result removal: Major portals, including search engines, may exclude web sites that they would ordinarily include. This renders a site invisible to people who do not know where to find it. When a major portal does this, it has a similar effect as censorship. Sometimes this exclusion is done to satisfy a legal or other requirement, other times it is purely at the discretion of the portal. For example Google.de (http://www.google.de/) and Google.fr (http://www.google.fr/) remove Neo-Nazi and other listings in compliance with German and French law.

9. Computer network attacks: Denial-of-service attacks and attacks that deface opposition websites can produce the same result as other blocking techniques, preventing or limiting access to certain websites or other online services, although only for a limited period of time. This technique might be used during the lead up to an election or some other sensitive period. It is more frequently used by non-state actors seeking to disrupt services.

10. Forced proxy server / transparent proxy: You have to specify a proxy server in your ‘Internet Explorer’ settings in order to get a connection to the Internet. Sometimes, the ISP is using a transparent proxy. With these you can’t see easily if there is a proxy or not. Every request you send to or receive from the Internet is checked at this server and redirected to you. Filtering can occur at forced proxy or transparent proxy.

11. Blocked ports: Ports are like doors for a special service to a server or PC. They rank from 0 to 65535. The standard ports are from 0 to 1024; these are the well known ports. If a censor blocks a port, every traffic on this port is dropped, so it’s useless for you. Most censors block the ports 80, 1080, 3128 and 8080, because these are the common proxy ports. Because all of the proxies on common ports are useless for you, you have to find proxies that are listening on an uncommon port. These are very difficult to find.

___

12. Deep packet inspection (DPI): Most forms of filtering require some inspection of the content of a message, which could be derived from the identity of the source, header information, for example, or the actual content of the message, such as the words, strings of words or images in the message or on the website. Increasingly this involves what is called ‘deep packet inspection’. Deep packet inspection is the use of computer systems that can inspect packets sent over networks using the Internet Protocol suite in ways that enable a third party, not the sender or receiver, to identify particular aspects of the communication. Inspection is done by a ‘middle-man’, not an endpoint of a communication, using the actual content of the message. For example, ISPs can apply this technology for the lawful intercept of messages on public networks to determine if customers are using the network for unlawful purposes or purposes that violate their user agreements. Governments in North America, Asia and Africa use DPI for various purposes such as surveillance and censorship. DPI can serve as a ‘one for all’ solution to monitor or regulate traffic and communication elements: e.g. the interception and logging of Internet traffic, enforcement of copyright, prioritizing limited bandwidth, and tracking users’ behavior.

Over- and under-blocking:

Technical censorship techniques are subject to both over- and under-blocking since it is often impossible to always block exactly the targeted content without blocking other permissible material or allowing some access to targeted material and so providing more or less protection than desired. An example is that automatic censorship against sexual words in matter for children, set to block the word “cunt”, has been known to block the Lincolnshire (UK) placename Scunthorpe. Another example is blocking an IP-address of a server that hosts multiple websites, which prevents access to all of the websites rather than just those that contain content deemed offensive. Internet filtering is almost impossible to accomplish with any degree of precision. Some filtering software blocks hate group sites. If a student is trying to research about skinheads or neoNazis, that information will be blocked on the Internet. Some software programs block any mention of the word “sex” and will therefore block out sites dealing with biological and botanical issues involving procreation. Filtering programs will block the word “breast” and therefore block information about breast cancer. Early Web filters would often block access to chicken breast recipes. The programs couldn’t tell the difference between an innocent site about cooking and a pornographic site, so they blocked all of them indiscriminately. A country that is deciding to filter the Internet must make an ‘‘overbroad’’or ‘‘underbroad’’ decision at the outset. The filtering regime will either block access to too much or too little Internet content. Very often, this decision is tied to whether the state opts to use a home-grown system or whether to adopt a commercial software product, such as SmartFilter or Websense, two products made in the United States and licensed to some states that filter the Internet. Bahrain, for instance, has opted for an underbroad solution for pornography; its ISPs appear to block access to a small and essentially fixed number of blacklisted sites. Bahrain may seek to indicate disapproval of access to pornographic material online, while actually blocking only token access to such material, much as Singapore does. United Arab Emirates, by contrast, seems to have made the opposite decision by attempting to block much more extensively in similar categories, thereby sweeping into its filtering basket a number of sites that appear to have innocuous content by any metric. Censorship opponents have some big problems with Web filtering software. Many Web filtering programs encrypt their blacklists, claiming that it helps minimize abuse. Opponents point out that the encrypted blacklist could also include Web pages that aren’t inappropriate at all, including pages that criticize the creators of the Web filter. Even if the programs’ creators aren’t blocking these sites on purpose, it’s easy for a Web filter to restrict access to the wrong sites. That’s because programs that search for keywords can’t detect context.

Transparency of filtering or blocking activities:

Among the countries that filter or block online content, few openly admit to or fully disclose their filtering and blocking activities. States are frequently opaque and/or deceptive about the blocking of access to political information. For example: Saudi Arabia and the United Arab Emirates (UAE) are among the few states that publish detailed information about their filtering practices and display an acknowledgment to the user when accessing a blocked website. In contrast, countries such as China and Tunisia send users a false error indication. China blocks requests by users for a banned website at the router level and an error message is sent, effectively preventing the user’s IP address from making further http requests for a varying time, which appears to the user as “time-out” error with no explanation. Tunisia has altered the block page functionality of SmartFilter so that users attempting to access blocked websites receive a fake “File not found” error page. In Uzbekistan users are frequently sent block pages stating that the website is blocked because of pornography, even when the page contains no pornography. Uzbeki ISPs may also redirect users’ request for blocked websites to unrelated websites, or sites similar to the banned websites, but with different information. When media was blocking my views on internet, it never admitted before people that they were blocking my views for whatever reason they have. I believe that if anybody is blocking internet content, he/she ought to have courage to tell the reason for blocking rather than hiding cowardly. Also, not giving reason for blocking amount to mala fide intention.

Internet circumvention technology:

Internet censorship circumvention is the processes used by technologically savvy Internet users to bypass the technical aspects of Internet filtering and gain access to otherwise censored material. Circumvention is an inherent problem for those wishing to censor the Internet, because filtering and blocking do not remove content from the Internet and as long as there is at least one publicly accessible uncensored system, it will often be possible to gain access to otherwise censored material. However, circumvention may not be very useful to non tech-savvy users and so blocking and filtering remain effective means of censoring the Internet for many users. There is a vast amount of energy, from commercial, non-profit and volunteer groups, devoted to creating tools and techniques to bypass Internet censorship, resulting in a number of methods to bypass Internet filters. Collectively, these are called circumvention methods, and can range from simple work-arounds, protected pathways, to complex computer programs. Different techniques and resources are used to bypass Internet censorship, including proxy websites, virtual private networks (VPN), sneakernets, and circumvention software tools. Solutions have differing ease of use, speed, security, and risks. Most, however, rely on gaining access to an Internet connection that is not subject to filtering, often in a different jurisdiction not subject to the same censorship laws. There are risks to using circumvention software or other methods to bypass Internet censorship. In some countries individuals that gain access to otherwise restricted content may be violating the law and if caught can be expelled, fired, jailed, or subject to other punishments and loss of access.

Circumvention Users: Users are individuals who use circumvention technologies to bypass Internet content filtering.

Circumvention Providers: Install software on a computer in a non-filtered location and make connections to this computer available to those who access the Internet from a censored location. Circumvention providers can range from large commercial organizations offering circumvention services for a fee to individuals providing circumvention services for free.

Circumvention Technologies: These are any tools, software, or methods used to bypass Internet filtering. These can range from complex computer programs to relatively simple manual steps, such as accessing a banned website stored on a search engine’s cache, instead of trying to access it directly.

The decision to use circumvention technology should be taken seriously, carefully analyzing the specific needs, available resources, and security concerns of everyone involved. There is a wide variety of technologies available for users who want to circumvent Internet filtering. However, using them for successful and stable circumvention service depends on a variety of factors, including the user’s level of technical skill, potential security risk, and contacts available outside the censored jurisdiction.

Many technologically savvy users can find alternative methods to access blocked content. However, for most people, blocking is an effective means for preventing access. Nevertheless, as filtering or blocking content does not erase the original content, some users can still access the content by using other connections for which access has not been blocked, creating a cat and mouse game between actors seeking to gain or block access to particular content. The fact that websites are not removed, but blocked, can mean that, for example in the case of child protection, the content has not been destroyed, but it has been made invisible for most non tech-savvy users.

While there are some outspoken supporters and opponents of Internet censorship, it’s not always easy to divide everyone into one camp or another. Not everyone uses the same tactics to accomplish goals. Some opponents of censorship challenge government policies in court. Others take the role of information freedom fighters, providing people with clandestine ways to access information.

Circumvention sites and tools should be provided and operated by trusted third parties located outside the censoring jurisdiction that do not collect identities and other personal information. Best are trusted family and friends personally known to the circumventor, but when family and friends are not available, sites and tools provided by individuals or organizations that are only known by their reputations or through the recommendations and endorsement of others may need to be used. Commercial circumvention services may provide anonymity while surfing the Internet, but could be compelled by law to make their records and users’ personal information available to law enforcement.

There is no absolutely effective filtering or circumvention methods. The battle between those who would filter and those who would circumvent that filtering turns on the amount of resources each side expends and the effectiveness of those resources. So there are always ways to filter a piece of information if the filterer is willing expends enough resources, and there are always ways to circumvent a filter if the circumventor is willing to expend enough resources. The goal is to find tools that meet users’ needs cheaply, and require disproportionate resources to block.

Hiding your IP address, using a proxy, using the onion router & obtaining an IP address to a website so you won’t have to rely on a public DNS server – these seem like a very intimidating task for the unprepared or novice internet user. You have to choose to bypass the Internet censorship or not. I can only educate you about circumvention technology but I can’t take any responsibility for misuse/abuse by you. In several censor countries you will go to jail if they catch you, in a lot of companies you will get fired and some schools will ban you. Of course, the censors not only block Internet traffic, they are also looking at it (in countries/companies with a little Internet population) and try to find out who is bypassing their firewall and how. An easy way to find out who (and how) is bypassing the firewall is by just looking for some identicators in the logfiles.

Things to remember while using circumvention techniques:

1. There are a many ways to get access to a blocked site. Most methods do not allow you to do this securely. Find a method that provides you with both access and security.

2. The more private your circumvention solution the better. Regardless of the choice of technology, private solutions stand the best chance of not being discovered and blocked.

3. You increase your level of stable and secure circumvention if you are able to use a trusted out of country contact.

4. Never use an out of country contact you do not know and trust! Your contact can be your key to safety and your most important source of vulnerability.

5. Remember that your provider (ISP) can potentially see everything you are doing through a circumvention system.

6. Violating state laws regarding Internet censorship can be a major risk. Do not use any technology you do not fully understand or know how to operate.

7. Make a thorough threat assessment based on your country context, skill level, and social network.

8. Make sure to understand fully the technology you are using. Some services advertize security and anonymity, but do not actually provide them or require extra configuration or fees in order to activate such features.

The Berkman Center for Internet & Society’s 2007 Circumvention Landscape Report included the following observations: It is reassuring to discover that most [circumvention] tools function as intended. They allow users to circumvent Internet censorship, even in countries like China and Vietnam, which use sophisticated technology to filter. However, all tools slow down access to the Internet, that most tools featured serious security holes [some of which were patched during or shortly after the study], and that some tools were extremely difficult for a novice Internet user to use. …It is estimated that the number of people using circumvention tools is around two to five million users worldwide. This number is quite high in absolute terms but quite low relative to the total number of filtered Internet users (China alone has over 450 million Internet users). Even accepting likely high end estimates of the project developers, it is estimated that less than two percent of all filtered Internet users use circumvention tools. … Simple web proxies represent at least as great if not greater proportion of circumvention tool usage as do the more sophisticated tools.

Identity:

Is protecting your identity online of paramount importance to you?

Do you want to surf and/or publish anonymously?

What is the difference between circumvention and anonymous surfing?

Circumvention and anonymity are different. Anonymous systems protect your identity from the website you are connecting to and from the anonymity system itself. They can be used for circumvention, but are not designed for this purpose and thus can easily be blocked. Circumvention systems are designed to get around blocking but do not protect your identity from the circumvention provider. Do not mistake open public proxies for anonymous systems – they are not. Although they may not ask for personal information, they can view and record the location of the computer from which you are connecting and all of the websites you visit through them. Commercial services which advertize anonymous surfing may still record your connection information and the web sites you visit. There is an important distinction to be made between circumvention and anonymity technologies. Circumvention technologies focus, with varying degrees of security, on allowing users to bypass censorship, while anonymity technologies focus on protecting the users’ identity from outside observers, such as government surveillance, as well as from the anonymity system itself. Circumvention systems that use encryption can protect users in some surveillance scenarios, but are not anonymous because owners of the circumvention system can see everything that the user does. They also cannot protect users from traffic analysis attacks in the same way that anonymity systems can. Anonymity systems protect privacy by shielding the identity of the requesting user from the content provider. In addition, they employ routing techniques to ensure that the user’s identity is shielded from the anonymous communications system itself. In addition to providing anonymity, these technologies are also used in many countries to bypass Internet censorship. Anonymity systems are increasingly being recommended by privacy advocates. The most widely known anonymity system is Tor. Tor works by routing a user’s request through at least three Tor servers. As the request hops from one Tor server to another, a layer of encryption is removed, so no individual server knows both the original source and destination of the request. The last server in the chain of hops, known as a circuit, actually connects to the requested content and then sends that information back through the circuit to the user. However, anonymity technologies are currently not difficult to block. Tor’s developers are working on building in blocking resistance to the anonymity system.

Invisible (anonymous) browsing:

Anonymous web browsing is browsing the World Wide Web while hiding the user’s IP address and any other personally identifiable information from the websites that one is visiting. Anonymous web browsing is generally useful to internet users who want to ensure that their sessions cannot be monitored. For instance, it is used to circumvent traffic monitoring by organizations which want to find out or control which web sites employees visit.

Your IP———-Your location——

Invisible Browsing has following advantages:

1. Protect your online privacy! It is your right!

From the moment you connect to Internet you are exposed to multiple online privacy threats and challenges. Whether we like it or not, the Internet is for everybody, including bad persons, cyber thieves that might easily compromise your computer and steal your sensitive data. It is your right to protect your online privacy and to stop them following you. The hide IP software will let you surf anonymously and prevent your IP or other confidential information to be collected without your permission.

2. No discrimination – protect your right to free speech!

Even if you live in China, Saudi Arabia or any other corner of the world you have the right to read what news you want, to see what movie you want and to comment what blog post/forum discussion you want, even if it is in American “space”. You are free to present your opinion.

3. Access Restricted Websites & Blogs!

For many years, the web has been heavily censored in countries around the world. That censorship continues at this very moment and it is happening right now even in America. It did not happen overnight but slowly came to America’s shores from testing grounds in China and the Middle East. Get around blocked sites with Invisible Browsing.

4. Bypass Internet censorship and surf the web anonymously!

Government and other organizations set Internet restrictions in order to control the users’ habits. You need to go over the rules they set for you without ever asking your opinion. Invisible Browsing will help you bypass these restrictions by allowing you to change your real IP address according to your browsing needs.

Anonymous Communication Systems:

Anonymous technologies conceal a user’s IP address from the server hosting the web site visited by the user. Some, but not all, anonymous technologies conceal the user’s IP address from the anonymizing service itself and encrypt the traffic between the user and the service. Since users of anonymous technologies make requests for web content through a proxy service, instead of to the server hosting the content directly, anonymous technologies can be a useful way to bypass Internet censorship. However, some anonymous technologies require users to download software and can be easily blocked by authorities. It is possible to hide your real IP address on the Web by using an anonymous proxy server or a VPN server. A proxy acts as an intermediary, routing network packets between your computer and the Internet. When using a proxy for anonymous web surfing, an IP address of that proxy is relayed instead of your own helping you stay anonymous. And remember: “Privacy is not a crime and anonymity is not morally ambiguous or wrong, they are your right.”

With AnonymoX, a Firefox add-on (on Firefox browser), you can gain access to all such websites by browsing the web anonymously. With it, you can change your IP address, location and visit websites that are blocked or inaccessible in your country. You can change the IP and location with only a few simple clicks without having to use proxies. All you need to do is either click the blue button next to the search bar or in the add-on bar, or click Change Identity to get a new IP Address. Also, delete cookies by simply clicking the more option.

Anonymizers are not entirely secure. If an anonymizer keeps logs of incoming and outgoing connections and the anonymizer is physically located in a country where it is subjected to warrant searches then there is a potential risk that government officials can reverse trick and identify all users who used the anonymizer and how they used it. Most anonymizers state they do not keep logs but there is currently no way to confirm that. However, if the user used another anonymizer to connect to the exposed anonymizer, that user is still anonymous. This is sometimes called daisy-chaining. The safest way therefore is to use a chain of Proxy servers to make your requests or use a specialist service like TOR which is designed to make it hard to track internet usage.

Different ways to bypass Internet censorship:

Using a different ISP:

Well, it’s as easy as it sounds: Just change your Internet Service Provider! For example, only in ‘Nordrhein-Westfalen’ (a state of Germany) is there a censoring firewall, so you can just subscribe to an ISP outside that state. But normally the censorship counts for all the country. One possibility is to try out an ISP outside the country. That costs a lot, but that way you will have a normal Internet access and won’t have to worry about getting around filters. This could be a normal dialup provider in an neighbor country or even better, a 2-way Internet access via satellite like http://www.europeonline.com/, http://www.remoteworkcentral.com/, http://registrierung.tiscali.de/produkte/1400_satellit.php, http://www.gilat.de/, http://www.hns.com/, http://www.vsatnet.com/, http://www.starband.com/, http://www.wildblue.com/, http://www.skycasters.com/, http://www.directduo.com/, http://www.orbitsat.com/, http://www.ottawaonline.com/ and so on, just search with a search engine for ’2-way Internet via satellite [your country or neighbor country]‘ or something like that.

Using a non censoring DNS-server:

Normally, you would automatically would use the DNS-server of your ISP to resolve domain names. Internally, only these IP-addresses are used to send/receive data on the Internet. If your DNS-server is censoring, you simply can use another DNS-server. Under Windows, just right-click in your system panel on the ‘network’ icon and select properties of the TCP/IP-protocol. In Linux you have to edit the ‘/etc/resolv.conf’ file. Use the server that is (virtual) your nearest. If you want to setup your own DNS-server use Bind (http://www.isc.org/products/BIND/). Using DNS servers other than those supplied by default by an ISP may bypass DNS based blocking. OpenDNS and Google offer DNS services or see List of Publicly Available and Completely Free DNS Servers.

Using a non censoring proxy server:

You can put a proxy server between your Internet connection and the site you want to visit. You send your request for a special website to that proxy server, which request the page from the Internet and deliver it to you. Normally, those servers cache the requested pages, so that on the next request he can deliver the page directly from the cache. That would be faster and cheaper. For the eyes/computers of our ISP/Government we are only connecting to the proxy, they can’t easily see, that we are connecting to a “blocked site”. But sometimes the standard proxy ports (80, 1080, 3128 and 8080) are blocked. In that case you have to use the proxies that are listening on an uncommon port.

Instruct your Web browser to take a detour through an intermediary computer, called a proxy, that:

–is located somewhere that is not subject to Internet censorship.

–has not been blocked from your location.

–knows how to fetch and return content for users like you.

One of the most popular ways is to use proxy servers. You can get updated proxy information sent to you automatically by sending an e-mail to proxies@rfanews.org. Note: Send an email regularly to get currently working proxies. If you don’t know how to use a proxy server, learn it through any computer engineer about how to set up your own computer to use proxy or use a proxy on another Web site.

Open Proxies:

An open proxy is a proxy server which will accept client connections from any IP address and make connections to any Internet resource. It is not hard to find open proxy servers on the Web. Lists of open proxy servers can be found in seconds with a simple online search. These lists are frequently updated, and some even include bandwidth statistics info and where the server is hosted. Configure your Internet browser to access an open proxy. However, many open proxy servers are short-lived and you may have to repeat this process as necessary and open proxies may not work well if your ISP has installed content filters.

How to bypass the great firewall of china (GFW) or any such censorship mechanism?

The ultimate function of an anti-censorship system is to connect censored users to uncensored Internet securely and anonymously. This function requires a complex system with many components working together. Figure below shows the components of a typical anti-censorship system. Censored users (1) use circumvention client software (2) on their computers to connect to circumvention tunnels (4), usually with the help of a tunnel discovery agent (3). Once connected to a circumvention tunnel, a user’s network traffic will be encrypted by the tunnels and penetrate the GFW (7) without being detected by the censors (6). On the other side of the GFW, the network traffic will enter a circumvention support network (8) set up and operated by anti-censorship supporters (9). The computers, sometimes called nodes, in the circumvention support network act as proxies to access content from the unobstructed Internet (10) and send the information back, not necessarily taking the same route, to the censored user’s computer.

In fact, the most mysterious component in an anti-censorship system is the tunnel discovery agent (3). With such an agent, a user does not need to configure the software. The agent will automatically find circumvention tunnels for the user’s particular client software. Little public information is available from the most successful anti-censorship tools, because their technologies are proprietary and source code is not available. Some of the agent implementations may have exploited weaknesses in the GFW technologies and can blend the discovery traffic with regular traffic without being detected. The continual success of the leading anti-censorship tools (Garden, UltraSurf and DynaWeb, ) for so many years can be significantly attributed to their innovative tunnel discovery agent designs. _

Client side software:

Increasingly in China, people can access censored Web sites via special portal pages called “Client side software.” These are services provided by companies that specialize in offering free access to information. Experts recommend Freegate, Dynaweb, Fire Phoenix, UltraSurf, freenet, and several others. Client-side software enables users to browse the Internet freely. The experience is the same as while using the regular Internet Explorer browser but it automatically searches the highest speed proxy servers in the background or it uses a parallel network of servers maintained by a company that promotes freedom of information on the Internet.

Tunneling Software:

Tunneling encapsulates one form of traffic inside of other forms of traffic. Typically, insecure, unencrypted traffic is tunneled within an encrypted connection. The normal services on the user’s computer are available, but run through the tunnel to the non-filtered computer which forwards the user’s requests and their responses transparently. Users with contacts in a non-filtered country can set up private tunneling services while those without contacts can purchase commercial tunneling services. “Web” tunneling software restricts the tunneling to web traffic so that web browsers will function but not other applications. “Application” tunneling software allows one to tunnel multiple Internet applications, such as email clients and instant messengers.

Using a VPN (virtual private network) Service:

VPN is about creating a virtual private network or tunnel over the public network “internet”. Each VPN tunnel is totally anonymous on the public internet and it helps to keep your activities of internet users anonymous, private and secure. A VPN connection is an attractive option for people concerned about their security and privacy. It is not a web proxy and it is much more advanced and secure. A security tunnel that protects your data as it travels from your computer to the VPN server before letting it out on to the internet. As long as that VPN service is outside user’s country, it’ll be very difficult to stop users using such services to circumvent DNS censorship. Using VPN services, you can now surf the web anonymously & prevent your ISP from keeping logs on your online activities! If sites are blocked you can access Blocked websites … Unblock blocked websites by bypassing proxies & it works with Skype and other VoIP applications too! Unlike using a proxy site that is very limited constantly being blocked, VPN services are compatible with pretty much any internet application such as dreamweaver, Internet Explorer, FireFox, Skype, Google Talk, Net2Phone, MSN, ICQ, and many more! If you are concerned about your privacy on the web, a VPN will allow you to be anonymous on the web by hiding your real IP! Via an encrypted VPN tunnel you can secure your internet connection to the web, when using an unsecured wireless network. In the Middle East, Asia and around the world internet service providers are blocking websites and VoIP applications. Bypass Internet Censorship in China, Malaysia, UAE, Bahrain, Oman etc. using VPN services. You can unblock all blocked sites like Orkut, Myspace, YouTube, Photobucket, bebo etc.

Using TOR:

I have already discussed TOR earlier in anonymous surfing. TOR is more or less a network of proxies. One person accesses a proxy and that proxy forwards that access to another proxy, trying to erase the user’s tracks. That proxy sends that stream to another proxy and the stream keeps going through these steps until it finally reaches what is known as an “exit-node”. That exit node then accesses the internet on the user’s behalf and acts as an intermediary in the process. As long as that exit node exists outside of the user’s country, there is a very good chance that it won’t be affected by DNS censorship imposed by the ISPs onto their DNS servers. Tor is a network designed to protect privacy and security by making use of encrypted traffic tunneled through a collection of relays. In practical terms, Tor makes it possible for someone subject to Internet censorship to conceal the ultimate destination of any request for data and any data sent. It is far superior to the earlier method of swapping around lists of proxy servers since the Tor software handles for you the task of connecting to a growing and rapidly changing list of relays that carry traffic in not one but several jumps to its ultimate destination. To use Tor as a client, download and install the software as well as a browser plug-in such as the Torbutton for Firefox and activate it when you wish to connect through the Tor network. Depending on the number of relays available and your connection, traffic can be significantly slower than what you’re used to so turn it off when you don’t need it. If you are fortunate to be in a country without significant Internet censorship, consider installing Tor and then adding your own computer as a relay for traffic through its network. The more people run relays, the stronger the network becomes.

JAP:

JAP is a free and open source anonymity tool invented by a German university. It sends your traffic encrypted through different mixes, so that absolutely nobody, not even the owner of one of the mixes know who is accessing which site. This is also one of the best tools to circumvent censorship. Just follow the installation instructions on http://anon.inf.tu-dresden.de/index_en.html or http://www.anon-online.org/index_en.html on installing the Java client (available for Windows, Unix, Linux, OS/2, Macintosh and others).

Using a Web-2-phone service:

These are services which you dial into with a normal telephone. Then you request the website you want to visit and the operator/computer voice then reads the content to you.

CGI Web-Proxy:

A CGI proxy is a free script that can be found on many Web pages that acts as an HTTP or FTP proxy. What this means is that through a CGI proxy, you can access any Web site using the server of a different Web site. A CGI proxy allows the Web user to be anonymous and access Web sites that may be restricted. CGI proxy will help you get around blocking software. CGI Proxy is the engine that most web-based circumvention systems use. Private web-based circumvention systems turn a computer into a personal, encrypted server capable of retrieving and displaying web pages to users of the server connecting remotely. Private web-based circumventors include providers, who install and run circumvention software in an uncensored jurisdiction, and users, who access the service from a jurisdiction that censors the Internet. The circumvention provider grows his/her private network based on social relations of trust and private communications making it difficult for censors to find and block. CGI proxies use a script running on a web server to perform the proxying function. A CGI proxy client sends the requested URL embedded within the data portion of an HTTP request to the CGI proxy server. The CGI proxy server pulls the ultimate destination information from the data embedded in the HTTP request, sends out its own HTTP request to the ultimate destination, and then returns the result to the proxy client. A CGI proxy tool’s security can be trusted as far as the operator of the proxy server can be trusted. CGI proxy tools require no manual configuration of the browser or client software installation, but they do require that the user use an alternative, potentially confusing browser interface within the existing browser. Webproxies are CGI-scripts that you access with your browser. The addresses under CGI proxy are not really meant as proxies. They act as translators, html-checkers or as a web archive. You can use them as a kind of proxy anyway. These webproxies are good instruments for bypassing. You don’t have to configure your browser or anything, but it’s kind of slow and won’t work with all webpages. Only the proxies that are going over a secure connection can be used for phrase filtering, but the others are perfect for URL/IP filtering. Use them in your school, company or library when you have no privileges to install/change something on the machine. These links points to google.de because the site is very small, useful, always on, and does not contain the “.com” extension of DOS-Files that are filtered by some proxies.

HTTP proxies send HTTP requests through an intermediate proxying server. A client connecting through an HTTP proxy sends exactly the same HTTP request to the proxy as it would send to the destination server unproxied. The HTTP proxy parses the HTTP request; sends its own HTTP request to the ultimate destination server; and then returns the response back to the proxy client. An HTTP proxy tool’s security can be trusted as far as the operator of the proxy server can be trusted. HTTP proxy tools require either manual configuration of the browser or client side software that can configure the browser for the user. Once configured, an HTTP proxy tool allows the user transparently to use his normal browser interface.

Using steganography:

Hide content inside of images. More Info: http://en.wikipedia.org/wiki/Steganography

Camera/Shy is the only steganographic tool that automatically scans for and delivers decrypted content straight from the Web. It is a stand-alone, Internet Explorer-based browser that leaves no trace on the user’s system and has enhanced security. Camera/Shy is an application that enables stealth communications, such software can be useful in countries where Email communications are regularly monitored and censored, such as happens in China.

Using a special proxy like P2P program:

A peer-to-peer computer network relies primarily on the power and bandwidth of each of the participants in the network. It is a connection between equals and it is typically used to share audio or video files, or anything in digital format. There are different projects of peer-2-peer programs to bypass censorship. They work like Napster, Kazaa and eDonkey, which means that you have to download a little tool that contains a server and a client part. Freenet is the oldest and most widely spread P2P-program to beat censorship, so a lot of people use it and it has actually worked well for several years. Freenet works by storing small encrypted snippets of content distributed on the computers of its users and connecting only through intermediate computers which pass on requests for content and sending them back without knowing the full file, similar to routers in the internet which route packets without knowing anything about files – but with a layer of strong encryption, caching and without reliance on centralized structures. This allows users to anonymously publish or retrieve various kinds of information.

Peek a Booty:

The goal of the Peekabooty Project is to create a product that can bypass the nationwide censorship of the World Wide Web practiced by many countries. Peek a booty uses a complicated communications system to allow users to share information while revealing little about their identity. When a node receives a request for a web page it randomly decides whether to pass this on or access the page itself. It also only knows the address of its nearest partner. This makes it difficult to determine who requested what information and is designed to protect users from anyone trying to infiltrate the system from inside.

Usenet:

The normal port for newsservers 119 is usually blocked, so you have to access the Usenet via a different port. If you sometimes only want to read some very common newsgroups you can easily visit them via free web-based newsservers like http://groups.google.com/ and http://news.spaceports.com/ . A lot of newsserver companies offer their services on a non standard port. Just ask them before signup. If you need access to a newsserver with your newsclient you have to subscribe to one of these newsserver-companies which allow access to their newsservers on an uncommon port.

Instant Messenger:

Instant Messengers are very popular. You have to register your nickname at one of the companies and download their software. Then when you are on the Internet you can start the software and log onto their servers. You are then marked as “online” and all your friends who know your nickname and have the same Instant Messenger client can see that you are online and easily chat with you. Yahoo messenger and MSN messengers are very popular.

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Psiphon:

New software that helps Web users skirt Internet censorship and surveillance by connecting to the computers of family or friends in such countries as the U.S. and Canada. Psiphon relies on people in uncensored countries to install the software on their computers. By connecting to a Psiphon computer through the Internet, friends and family in such places as China or Iran can surf the Web as though they were in Canada or U.S.

Infranet:

An increasing number of countries and companies routinely block or monitor access to parts of the Internet. To counteract these measures, new system is proposed named Infranet, a system that enables clients to surreptitiously retrieve sensitive content via cooperating Web servers distributed across the global Internet. These Infranet servers provide clients access to censored sites while continuing to host normal uncensored content. Infranet uses a tunnel protocol that provides a covert communication channel between its clients and servers, modulated over standard HTTP transactions that resemble innocuous Web browsing. In the upstream direction, Infranet clients send covert messages to Infranet servers by associating meaning to the sequence of HTTP requests being made. In the downstream direction, Infranet servers return content by hiding censored data in uncensored images using steganographic techniques. A research paper described the design, a prototype implementation, security properties, and performance of Infranet. The security analysis shows that Infranet can successfully circumvent several sophisticated censoring technique.

Using a Web DNS Tool:

Just by using publicly available DNS look-up tools, one can easily obtain server IP addresses for later use. If a domain is censored, one can simply replace the domain name part of the URL with the IP address and still access the website.

Using Foxy Proxy:

It’s a simple plug-in for FireFox you can download and install. After getting a nice list of simple proxies that preside outside of your country, you have a better chance at accessing the website that has been censored by your government and/or corporate interests.

Using MAFIAAFire:

A simple plug-in for FireFox (or Chrome) you can download and install. If a website has had its domain seized, then you can be redirected to an alternate domain and still access the website.

How to publish information:

It is one thing is to access information that is already censored, but another challenge is to publish one’s own information that can’t easily be censored. Here you can see few ideas on how to avoid censorship while publishing on internet:

1) Publish with a lot of mirrors. Especially dynamic IP’s with a dyndns.org redirector are useful. Put your pages on so many different servers that the censor’s can’t successfully block all servers.

2) Fax Polling. You can either use a service on the Internet or provide that service on your own computer with a fax modem.

3) Use one-time-addresses. These are links/URLs that are only valid for 1 visit or 1 hour, they are often used for paid downloads.

4) Hide the ‘dangerous’ content. For example, save text as images. The users won’t notice it, but it is difficult for the censor-spiders to ‘read’ the content.

5) Host with a secure server in another country. For example, with http://www.havenco.com/ which is located at Sealand, an independent country on a little island in the North Sea near England?

6) Encrypt the content. Use .htaccess and/or SSL for your website and AES, Twofish or Rijndael for files.

7) Offer your data in P2P-Programs. Filesharing programs like Kazaa or eDonkey are very difficult to censor.

Send content via email. Create an autoresponder from which everyone with a hotmail account can receive your content.

9) Martus. It’s an encrypted bulletin service to post and view information. See: http://www.martus.org/

10) Individuals associated with high profile rights organizations, dissident, protest, or reform groups should take extra precautions to protect their online identities while publishing their views.

How do I Get Past Blocked Websites?

1) Using a Web Proxy:

Any internet search engine can direct you to an infinite number of proxy web sites. Systems Administrators add proxy sites to their block sites list all the time, but there are always new proxies opening, so there will never be a short supply. There are several webpages that you can go to, to bypass your ISP’s block on websites. Some of these websites are: www.ctunnel.com…, www.gtunnel.com…, www.backdoor.com…, www.proxyvan.com… and www.mirrorproxy.com…. All you have to do on these websites is type in the website that you want to go to in the space provided click Go and you’ve bypassed the ISP. However do keep in mind that if your ISP has the above mentioned websites blocked and others like them then there is no way around the block.

2) Use translation service:

Begin by going to a free translation web site, such as Google’s language tools, or freetranslation.com. Look for a link that says something along the lines of “web translator” or “web site translator.” Select your language. Select the language you want to “translate”. You should select that you are translating from a foreign language into English. English words on the website will remain in English, so you are basically making use of the translation engine without changing any of the words. Set your destination. Type in the URL of the web site that has been blocked by your ISP and click the translate button. You will arrive on a page that has the translation tools in a frame on the top of the page, with the blocked site appearing in the frame below it.

3) URL Redirection Service:

Begin by visiting a web site that provides URL redirection services. Two popular sites are tinyurl.com and shorturl.com, but you can easily find others by conducting a keyword search. Type in a new URL that will be your secret web address to get to the site that has been blocked. The system will check to see if your desired URL is available. If so, you may claim it to use. Fill out the required information about yourself (in case you ever want to edit your link) and the blocked site that you are trying to get access to. You will be offered a premium account, which costs money. Select the basic account, which is free, and you should now be able to access the blocked site by typing in your private URL.

Note:

Some administrators may have a number of popular web proxies and redirection services blocked as well. If this happens to you, simply look for another one to try. The more obscure and hard to find the web proxy or redirection site is, the less likely it will be that the administrator will find it to block.

4) An exact replica of the online story in print:

Create a free account at Adobe website and provide the URL address that you wish to convert. This service will create a nice PDF of the webpage and send that you as an attachment in an email.

5) Using Akamai to bypass Internet censorship:

Take the URL of the site you want to access, e.g. http://www.yahoo.com/, drop the “http://” at the beginning, and add the rest to the end of the akamaitech.net URL: http://a1.g.akamaitech.net/6/6/6/6/www.yahoo.com/ (Don’t forget the “/” on the end, or the trick won’t work.) Load the URL into your browser. You should be able to view the contents of the page — in this case, the contents of http://www.yahoo.com/.

6)”Cached” Pages:

Many search engines provide copies of web pages, known as cached pages, of the original pages they index. When searching for a web site, look for a small link labeled “cached” next to your search results. Since you are retrieving a copy of the blocked page from the search engine’s servers, and not from the blocked web site itself, you may be able to access the censored content. However, some countries have targeted caching services for blocking.

7) RSS Aggregators:

RSS Aggregators are web sites that allow you to bookmark and read your favorite RSS feeds. RSS Aggregator sites will connect to the blocked we sites and download the RSS feed and make it available to you. Since it is the aggregator connecting to the site, not you, you will be able to access the censored content.

Alternate Domain Names:

One of the most common ways to censor a website is to block access to its domain name, e.g. news.bbc.co.uk. However, sites are often accessible at other domain names such as newsrss. bbc.co.uk. Therefore if one domain name is blocked try to see if the content can be accessed at another domain. For example the following domain names refer to the same web site: http://www.wikimedia.org/ and http://text.pmtpa.wikimedia.org/. The alternative URLs may not be blocked. Entering an IP address rather than a domain name (http://208.80.152.2/) or a domain name rather than an IP address (http://wikimedia.org/) will sometimes allow access to a blocked site.

9) Web Accelerators:

Web Accelerators cache web pages and make it appear as if your Internet connection is faster. Since you are retrieving the website from the cache and not from the blocked website directly, you can access censored content.

Example: webaccelerator.google.com

10) Mirror and archive sites:

Copies of web sites or pages may be available at mirror or archive sites such as http://www.archive.org/ (http://www.archive.org/) and the alternate sites may not be blocked.

11) Web to E-mail services:

Web to e-mail services such as http://www.web2mail.com/ (http://www.web2mail.com/) will return the contents of web pages with or without images as an e-mail message and such access may not be blocked. Several years ago when the Internet connections where slow and the “www” was just invented, many people just got email restricted access to the Internet. That’s the origin of the “Agora” and “www4email” software. Some of these email robots are still available and we can use them to bypass Internet censorship.

12) Using Your HOSTs File:

For most users, there is actually a hosts file on their computer that can be used to connect domain name to server IP address without the use of a public DNS server. If a website is censored through a DNS server, one can simply use the HOSTs file so that a public DNS server isn’t even used in the first place. You just type in the domain name in your URL and the website would still appear.

Other tricks:

Pakistan Blogspot hack – pkblogs.com – is excellent but limited only to blogspot.com blogs. It won’t work for sites like typepad.com or geocities.com which are also blocked. Secondly, we sometimes don’t see images when accessing blogspot sites via pkblogs.com The anonymous proxy surfing services use different ports which may be blocked by your local firewall. Also, these services sometimes append their own ads to the visiting site.

Alternatives to Filtering:

Government agencies have used a number of techniques to deny access or censor particular types of content that differ from content filtering. These include:

1.Denial of service attacks, which produce the same end result as other technical blocking techniques – blocking access to certain websites – although only temporarily, and this is more often used by non-state actors seeking to disrupt services. A ‘denial of service’ attack disables servers hosting particular Web sites, either of opposition media outlets or of foreign governments;

2. Restricting access to domains or to the Internet, such as by installing high barriers (costs, personal requirements) to register a domain or even to get Internet access;

3. Search result removals, by which search engine providers can filter web content and exclude unwanted websites and web pages from search results. By using blacklists, parsing content and keywords of web pages, search engines are able to hinder access. This method makes circumventing the denial of access more difficult as search engines are not always transparent about the filtering of search results;

4. Take-down of websites, by removing illegal sites from servers, is one of the most effective ways of regulating content. To do so, regulators need to have direct access to content hosts, or legal jurisdiction over the content hosts, or an ability to force ISPs to take down particular sites. In several countries, where authorities have control of domain name servers, officials can deregister a domain that is hosting restricted content.

5. Type of ‘cyberwarfare’ that occurs more regularly is hacking into computers and stealing information, as well as planting Trojans or viruses.

Self-regulation of Internet content:

Most would agree that there is no single or absolute definition of self-regulation. Instead, the definition lies somewhere on a spectrum ranging from the formal delegation of regulatory powers to industry by government, to self-initiated, organized, and managed “regulation” by industry and other private sector players. In the current context, self-regulation is defined as a system of Internet governance that relies on the private sector — the market — to lead in the definition of the rules that such a system will follow, and in the development and implementation of a set of mechanisms and activities that will support these rules and govern behavior. In particular, we focus on market-based approaches to the management and control of controversial Internet content. It is widely accepted that the Internet is not conducive to traditional forms of content control such as broadcasting regulations. In the first instance, the Internet is not conducive to regulation due to its international nature and underlying packet-based communication mechanism. Any attempt to regulate the flow of content on the Internet at a national level would be immensely expensive, detrimental to the performance of the network, and easily circumvented (one can simply obtain Internet access in a jurisdiction that is not regulated), rendering such regulation impractical, if not technologically unfeasible. An equally important point is that regulation is not considered to be an effective means of addressing the challenge of offensive Internet content from a public policy point of view. Of fundamental importance to our discussion of Internet content is the “freedom of thought, belief, opinion, and expression, including freedom of the press and other media of communication.” This right is only subject to “such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.”

Voluntary rating systems:

Another viable solution to the problem of children viewing objectionable material on the Internet is the use of a voluntary rating system. Voluntary rating systems are increasingly viewed as a means of addressing controversial Internet content while, at the same time, strengthening freedom of expression on the Internet. Used in conjunction with both browser-based and stand-alone filtering technologies, rating systems are used to filter or block undesirable content and to direct users to desirable content. In voluntary systems, content providers label their Web sites according to the category in which the site’s content falls. Filtering or browser software then “read” the label and determine whether or not it will, based on the user’s predetermined criteria, provide access to the particular content. The RSACi (Recreational Software Advisory Council on the Internet rating system) is a completely voluntary rating system which allows web publishers to have their site rated by the Recreational Software Advisory Council. The ratings measure the web site’s content levels of sex, nudity, language and violence (Recreational Software Advisory Council Web Site). RSACi is being used in conjunction with Microsoft’s popular web browser, Internet Explorer, to allow parents to decide what rating is appropriate for their child. The parents needs only to follow a few simple steps in which they enter a security password and decide what ratings are appropriate for their child. After the rating system is enabled, the child user will be unable to browse web sites that have ratings above the standards set by the parents without knowledge of the password. Emerging from RSACi is a new organization called the Internet Content Rating Association (ICRA). ICRA was formed in mid-1999 by a variety of industry players and has set out to establish and implement an international, culturally neutral system that is based on the voluntary rating of Internet content by Web site and other content providers.

Content labeling:

Content labeling may be considered another form of content-control software. In 1994, the Internet Content Rating Association (ICRA) — now part of the Family Online Safety Institute — developed a content rating system for online content providers. Using an online questionnaire a webmaster describes the nature of his web content. A small file is generated that contains a condensed, computer readable digest of this description that can then be used by content filtering software to block or allow that site. ICRA labels come in a variety of formats. These include the World Wide Web Consortium’s Resource Description Framework (RDF) as well as Platform for Internet Content Selection (PICS) labels used by Microsoft’s Internet Explorer Content Advisor.

The World Wide Web Consortium has recently developed a set of technical standards called PICS (platform for internet content selection) that enable people to distribute electronic descriptions or ratings of digital works across the internet in a computer readable form. PICS was originally developed to support applications for filtering out pornography and other offensive material, to protect children. An information provider that wishes to offer descriptions of its own materials can directly embed labels in electronic documents or other items (such as images)—for example, such labels may indicate whether the content is appropriate for particular audiences such as minors, patients, etc.

PICS:

PICS, the Platform for Internet Content Selection, is designed to enable supervisors-whether parents, teachers, or administrators-to block access from their computers to certain Internet resources, without censoring what is distributed to other sites. It draws on two unique features of the Internet. First, publishing is instantaneous, world-wide, and very inexpensive, so it is easy to publish rating and advisory labels. Labels and ratings already help consumers choose many products, from movies to cars to computers. Such labels are provided by the producers or by independent third parties, such as consumer magazines. Similarly, labels for Internet resources could help users to select interesting, high-quality materials and could help supervisors to block access to inappropriate ones. Second, access to Internet resources is mediated by computers that can process far more labels than any person could. Thus, parents, teachers, and other supervisors need only configure software to selectively block access to resources based on the rating labels; they need not personally read them. The basic idea is to interpose selection software between the recipient and the on-line resources. Several selection software products were either under development or already on the market when work began on PICS, including SurfWatch, CyberPatrol, NewView, and Parental Guidance. Each product included labels indicating whether certain Internet sites were acceptable as well as software that blocked access to unacceptable sites. But none of them could process the labels provided by a competing product. It was clear to the on-line services and many of the filtering software vendors that some technical conventions would be needed to allow innovations in labeling systems and services to proceed independent of innovations in software that makes use of labels. PICS separates the selection software from the rating labels: any PICS-compliant selection software can read any PICS-compliant labels. In fact, a single site or document may have many labels, provided by different organizations. Consumers choose their selection software and label sources. Labels may come from many sources. Information publishers may self-label, just as manufacturers of children’s toys currently label products with text such as, “Fun for ages 5 and up.” Much as independent consumer magazines rate products, third-party ratings of information resources can also be useful. For example, the Wiesenthal Center, which is concerned about Nazi propaganda and other hate speech available on-line, could label materials that are historically inaccurate or promote hate. A teacher might label a set of NASA photographs and block access to everything else for the duration of an astronomy lesson. A service like Yahoo might rate everything, or at least the most popular resources. With multiple perspectives to choose from, parents and other supervisors can choose labeling sources that reflect their goals and values, and ignore all other labels. PICS also allows labels to use non-binary rating scales. Rather than being limited to permitted/prohibited labels, services can invent more complex scales. For example, Yahoo labels might include a “coolness” value and a subject category. Non-binary labels enable more flexible blocking rules. For example, if a rating service used the MPAA’s movie-rating scale, an eight-year-old might be permitted access only to G-rated sites while a fifteen-year-old might be permitted access to PG-rated sites as well. PICS provides a labeling infrastructure for the Internet. It is value-neutral-it can accommodate any set of labeling dimensions, and any criteria for assigning labels. Any PICS-compatible software can interpret labels from any source, because each source provides a machine-readable description of its labeling dimensions. A new labeling service can distribute labels directly to clients over the network, or arrange with information providers or on-line services to redistribute the labels. This system permits the implementation of context-specific rules rather than blanket rules. Around the world, governments are considering restrictions on on-line content. Since children differ, contexts of use differ, and parents’ values differ, such blanket restrictions can never meet everyone’s needs. PICS will enable labeling services and software to meet supervisors’ diverse needs, and the labels will also help users surf the Internet more efficiently.

Medical information on internet;

The principal dilemma of the internet is that, while its anarchic nature is desirable for fostering open debate without censorship, this raises questions about the quality of information available, which could inhibit its usefulness. While the internet allows “medical minority interest groups to access information of critical interest to them so that morbidity in these rare conditions can be lessened, it also gives quacks such as the “cancer healer” Ryke Geerd Hamer a platform. I have seen many CAM practitioners boasting cure from asthma to cancer on internet. The quality of medical information is particularly important because misinformation could be a matter of life or death. Thus, studies investigating the “quality of medical information” on the various internet venues—websites,mailing lists and newsgroups, and in email communication between patients and doctors—are mostly driven by the concern of possible endangerment for patients by low quality medical information. Thus, quality control measures should aim for the Hippocratic injunction “first, do no harm.” Labeling and filtering technologies such as PICS (platform for internet content selection) could supply professionals and consumers with labels to help them separate valuable health information from dubious information. Doctors, medical societies, and associations could critically appraise internet information and act as decentralized “label services” to rate the value and trustworthiness of information by putting electronic evaluative and descriptive “tags” on it.

What could be government policy and/or laws regarding Internet censorship in various countries around the world?

As in 2002, Government policies concerning censorship of the Internet may be broadly grouped into four categories:

1) Government policy to encourage Internet industry self-regulation and end-user voluntary use of filtering/blocking technologies:-

This approach is taken in the United Kingdom, Canada, and a considerable number of Western European countries. It also appears to be the current approach in New Zealand where applicability of offline classification/censorship laws to content on the Internet seems less than clear. In these countries laws of general application apply to illegal Internet content such as child pornography and incitement to racial hatred. Content “unsuitable for minors” is not illegal to make available on the Internet, nor must access to same be controlled by a restricted access system. Some (perhaps all) such governments encourage the voluntary use of, and ongoing development of, technologies that enable Internet users to control their own, and their children’s, access to content on the Internet.

2) Criminal law penalties (fines or jail terms) applicable to content providers who make content “unsuitable for minors” available online:-

This approach is taken in some Australian State jurisdictions and has been attempted in the USA (although no such US Federal law is presently enforceable, and to the best of EFA’s knowledge nor is any such US State law). In these countries, in addition, laws of general application apply to content that is illegal for reasons other than its unsuitability for children, such as child pornography.

3) Government mandated blocking of access to content deemed unsuitable for adults:-

This approach is taken in Australian Commonwealth law (although it has not been enforced in this manner to date) and also in, for example, China, Saudi Arabia, Singapore, the United Arab Emirates and Vietnam. Some countries require Internet access providers to block material while others only allow restricted access to the Internet through a government controlled access point.

4) Government prohibition of public access to the Internet:-

A number of countries either prohibit general public access to the Internet, or require Internet users to be registered/licensed by a government authority before permitting them restricted access as in (3) above. Information on countries in this category is available in the Reporters Without Borders report as Enemies of the Internet.

Arrest of Bloggers:

Control is not limited to filtering or censorship. Recent years have seen an increase in a wide variety of threats to freedom on the Internet, such as an increase in arrests of bloggers and Internet users. The Committee to Protect Journalists found that in 2008, there were, for the first time, more jailed ‘cyber-dissidents’, such as bloggers, than traditional media journalists. The arrest or detention of content producers, such as bloggers, or users, such as those who are accessing or consuming unlawful or otherwise targeted material, is one of the most traditional forms of content control. In doing so, surveillance and monitoring methods are often used to identify users or producers.

Digital rights:

Imposing indirect liability on private companies or threatening them with other legal issues has generated fears that industry self-regulation, driven by government policy, will lead to over-zealous censorship online and therefore will decrease or limit access to copyrighted material. In any case, a narrow governmental focus on law or direct regulation cannot deliver a comprehensive picture of the extent of limitations imposed on freedom of expression online. Table below illustrates the variety of goals and objectives which underlie explicit or implicit policies of content control within a larger ecology of evolving ‘digital rights’.

Net Neutrality:

Net neutrality is one of the more technical aspects of Internet regulation that has been viewed as a potential threat to freedom of expression online. There is no single definition for net neutrality but it usually means that ISPs do not discriminate against users through access fees, nor do they favor one type of content or content provider over another, or charge content providers for sending information to consumers over their broadband cables. In a nutshell, net neutrality refers to a level playing ground where Internet service providers (ISPs) allow access to all content without favoring any particular company or Web site. As digital media evolves with the creation of new technology, the need for bandwidth has made the net neutrality debate more prominent. It is attractive to many as a possible solution to managing existing bandwidth more efficiently as demands begin to exceed supply, rather than simply expanding available bandwidth. Without net neutrality, ISPs can charge content providers a fee for bandwidth usage. Content providers that pay the fee will get more broadband access, meaning their Web sites will load faster than competitors who didn’t pay the fee. For example, if Yahoo pays a fee to an ISP and Google didn’t, the ISP’s customers would discover that Yahoo’s search engine loads much faster than Google’s. Supporters of net neutrality argue that such preferential treatment amounts to censorship.

Intellectual property rights and copyright violations:

It’s wrong to steal a 30 cent pack of gum and it’s a felony to steal a 30 thousand dollar car but if a 30 million dollar movie is pirated and put up on the internet, people don’t blink an eye. Illegal downloading of music and films is on the rise. In many ways it has become socially acceptable to watch pirated material online. The issue of piracy is a significant problem for the entertainment industry. Millions of people have illegal access to movies and TV shows and these needs to be addressed. Something ought to be done to crackdown on sites that promote illegal streaming and downloading of films and shows. Rogue sites illegally upload content such as movies to sites which often look “authentic” because they do a really good job of pretending to be legal. Consumers watch films for free and in some cases even pay for the service with their credit cards.

A study examined approximately 100 rogue sites and found that these sites attracted more than 53 billion visits per year which average out to approximately nine visits for every man, woman, and child on Earth. Global sales of counterfeit goods via the Internet from illegitimate retailers reached $135 billion in 2010. No country can tolerate such criminal activity. Not only are jobs and consumers at risk, but rogue sites contribute absolutely nothing to the economy of a country from which they pirated out goods & services. The operators of rogue sites break laws, do not pay taxes, and skirt accountability.

Stop online piracy act (SOPA) and Internet:

SOPA is a legislation that would prevent Americans from visiting websites the government claims are violating copyright rules. Proponents of SOPA say that not only are online piracy and counterfeiting drains on their economy, they expose consumers to fraud, identity theft, confusion and to harm. It allows the Justice Department to obtain court orders demanding that American ISPs prevent users from visiting blacklisted websites. ISPs receiving such orders would have to alter records in the net’s system for looking up website names, known as DNS. It also allows the Justice Department to order search sites like Google to remove an allegedly “rogue” site from its search results. Both proposals amount to the holy grail of intellectual-property enforcement that the recording industry, movie studios and their union and guild workforces have been clamoring. SOPA is ostensibly designed to squelch pirate content sites by allowing the US Attorney General to get a court order forcing ISPs to block access, and by denying sites financial services like credit card or Paypal access. The Stop Online Piracy Act specifically targets foreign websites primarily dedicated to illegal activity or foreign websites that market themselves as such. The bill targets online criminals who profit from stolen American content and counterfeit goods and are a danger to American consumers. Under current practice, copyright owners such as TV networks and Hollywood studios reach out to websites to request that pirated videos be taken down. Under the new regime, they could ask banks, Internet service providers and domain name registrars to stop doing business with websites that they believed were devoted to piracy. They could, for instance, go straight to YouTube’s domain registration company and demand that the entire YouTube website be taken down. And if the registrar resisted, the copyright owners would have the legal ability to take the registrar to court.

“We support the bill’s stated goals,” says an open letter signed by nine Internet companies, including Google, Facebook, Twitter, Yahoo, AOL and eBay. “Unfortunately, the bills as drafted would expose law-abiding U.S. Internet and technology companies to new uncertain liabilities.” The companies believe the government should “consider more targeted ways to combat foreign ‘rogue’ websites dedicated to copyright infringement and trademark counterfeiting.” Requiring Internet-service providers and search engines to remove links to websites accused of trafficking in counterfeit movies and music would amount to “ Internet censorship” and set a bad example for other countries.

Are proponents of SOPA pirates themselves?

Major entertainment entities including NBCUniversal, CBS, Disney, Fox, Sony Pictures, Viacom and Warner Brothers are all lobbying for greater monitoring and punishment of what they term “content theft.” After all, they make the shows, and pirates (the consumers who download copyrighted content free of charge on the Internet) lift them without so much as watching an ad. These studios recently formed a coalition to support the Stop Online Piracy Act (SOPA), a proposed bill in American Congress that could lead to new levels of web censorship. However, according to data gathered by TorrentFreak via spy site YouHaveDownloaded, employees at Sony, Fox and Universal are a bunch of torrent-happy fiends just like the pirates. TorrentFreak used IP ranges for a handful of major Hollywood studios, entered that information into YouHaveDownloaded and saw a stream of TV shows, music and movies being downloaded by employees. At Sony, folks were downloading Conan the Barbarian and music by the Black Keys. Over at NBC’s Fort Lauderdale office, someone was pirating Cowboys and Aliens and new sitcom Two Broke Girls. And at Fox, downloads included the newly-released-on-DVD film Super 8. These are the same companies who want to disconnect people from the Internet after they’ve been caught sharing copyrighted material. So is there a double standard by proponents of SOPA?

SOPA is “Unconstitutional”:

Constitutional law experts at Harvard Law School, argues that SOPA violates the First Amendment of the U.S. constitution. The bill would empower the Justice Department and copyright holders to demand that search engines, Internet providers and payment processors cut ties with websites “dedicated” to copyright infringement. Experts argue that the bill amounts to illegal “prior restraint” because it would suppress speech without a judicial hearing. Additionally, the law’s definition of a rogue website is rather vague. Conceivably, an entire website containing tens of thousands of pages could be targeted if only a single page were accused of infringement. Such an approach would create severe practical problems for sites with substantial user-generated content, such as Facebook, Twitter, and YouTube, and for blogs that allow users to post videos, photos, and other materials.

Free speech concerns and SOPA:

Many proxy servers such as those used during the Arab Spring can also be used to thwart copyright enforcement and therefore may be made illegal by the act. Some US-funded “internet in a suitcase” projects allow users in China to circumvent the Chinese government’s control of DNS. The Chinese program is technically very similar to SOPA provisions. Communication problems during Hurricane Katrina, the Fukushima earthquake and the Arab Spring have led to proposals of technology changes to enable ad-hoc emergency networks. Whistleblowers already risk punitive copyright lawsuits, no less ruinous because they are eventually decided in favor of the whistleblowers. A bill that was to target only the ‘worst of the worst’ foreign Web sites committing blatant and systemic copyright and trademark infringement has morphed inexplicably into an unrestricted hunting license for media companies to harass anyone foreign or domestic—who questions their timetable for digital transformation.

Firefox add-on DeSopa circumvents internet blacklisting if SOPA becomes law:

DeSopa is a simple Firefox extension that allows internet users to revert to using a site’s IP (internet protocol) address, thereby bypassing DNS blockades of foreign websites such as The Pirate Bay. At the Firefox DeSopa download page, the add-on is described as such, “DNS Evasion to Stop Oppressive Policy in America.”

Technical problems with SOPA:

Internet security experts are concerned over ordering American internet service providers to stop giving out the correct DNS entry for an infringing website under the .com, .org and .net domains. Putting false information into the DNS system — the equivalent of the net’s phonebook — would be ineffective, frustrate security initiatives and lead to software workarounds. These actions would threaten the Domain Name System’s ability to provide universal naming, a primary source of the internet’s value as a single, unified, global communications network. In other words, the bill would break the internet’s universal character and hamper U.S. government-supported efforts to rollout out DNS-SEC, which is intended to prevent hackers from hijacking the net through fake DNS entries.

My view on SOPA and all such legislations:

I sincerely believe in preservation of intellectual property rights and copy rights. I condemn piracy of movies, videos and music. However, SOPA is not the best way to do it. Technically it will harm Internet’s universal character and may frustrate internet functioning during disasters like earthquakes & hurricanes when lifeline services and telecommunication structure is disrupted. Also, technical circumvention of SOPA is possible and feasible. Legally, it can be misused easily against any whistleblower, anybody who is critical of government and any dissident. The law can also be misused by competitors to blackmail genuine websites who are profiting from bona fide services. No government or investigative agency or company should have right to censor any website unilaterally. That decision must be taken by competent court after hearing both parties.

ISP treatment:

When the author or publisher of books cannot be traced or are insolvent, the printers can be sued or prosecuted in some circumstances and therefore some say that internet service providers (ISPs) should be made liable if they assist in the provision of dangerous and harmful information such as bomb making instructions, hard core pornography etc. I disagree. Internet Service Providers (ISPs) should be treated as carriers of data and not publishers of the data. ISPs are similar to telephone companies in that they allow the transport of data. Telephone companies are considered carriers and not publishers because they are not expected too, and furthermore, not allowed to regulate the content of private communications between individuals. ISPs should be treated in the same ways. Microsoft CEO and computer industry expert Bill Gates in his book on the future of the Internet, The Road Ahead, asserts that the idea of having Internet Service Providers act as censors would be absurd. Some critics have suggested that communications companies be made gatekeepers, charged with filtering the content of what they carry. This idea would put companies in the business of censoring all communication. It’s entirely unworkable, for one thing because the volume of communicated information is way too large. This idea is no more feasible or desirable than asking a telephone company to monitor and accept legal responsibility for everything that’s spoken or transmitted on its telephone wires. Indeed, it would be absurd to ask a telephone company to be legally responsible for their client’s content, just as it is absurd to ask an ISP to be legally liable for their client’s content.

A study of ISP:

A different approach to surveying the state of Internet censorship was taken by Westphal and Towell of Northern Illinois University, who queried companies that provide Internet services around the world about pressures to regulate and the source of the pressure. While the response rate to this survey was very low, 86 providers from 38 countries participated. A majority of 56% said that the pressure to regulate came from the government. However, about the same percent claimed that they, as providers, had the most control over the material transmitted, and that parents/users controlled 51%. Terrorism, pornography, and racism were the primary targets of regulation reported, but there were also countries that stated that astrology, religion, birth control, and politics needed to be regulated. The study concluded that the majority of the Internet providers indicated that the Internet needs regulating, but the degree of regulation is still unclear. Knowing that the Internet is a global network and countries all over the world operate under their own sets of laws, regulating the Internet on an international level may be impossible… If Internet participants cannot agree on who has control and what should be censored, then the reasons for discrepancies in all the other basic issues surrounding this topic become obvious. What is legal and acceptable in one country may be illegal or unacceptable in another.

The sliding scale toward “self-regulatory” censorship:

A new report suggests that nations are slowly turning ISPs into the off-duty information cops of the world. Eager to placate politicians in order to achieve their own goals (like the selective throttling of data), networks are cooperating with governments looking for easy, informal solutions to difficult problems like copyright infringement, dangerous speech, online vice, and child pornography. Network and content providers are ostensibly engaging in “self-regulation,” but that’s a deceptive phrase, warns the European Digital Rights group. It is not regulation—it is policing—and it is not ‘self’ because it is their consumers and not themselves that are being policed.

Big Businesses and Internet Censorship:

Corporations that restrict employee Internet access usually do so for a few reasons. One of the most common reasons is to increase productivity. While employees can use the Internet for research or communication, they may also use it as a distraction. Some companies restrict Internet access severely in order to prevent employees from wasting time online. Another corporate concern is harassment. Without restrictions, an employee could surf the Web for inappropriate content, such as pornography. If other employees see this material, they may feel that their work environment is a hostile one. Some companies resort to using Internet censorship in order to avoid lawsuits. While several companies use Web filtering software similar to the products available for home use, many also rely on firewalls. With a firewall, a company can pick and choose which Web pages or even entire domains to block. This way, the company is more likely to avoid blocking sites that employees may need to access legitimately.

Internet and democracy:

The Internet is a potential force for democracy by increasing means of citizen participation in the regimes in which they live. The Internet is increasingly a way to let sunlight fall upon the actions of those in power—and providing an effective disinfectant in the process. The Internet can give a megaphone to activists and to dissidents who can make their case to the public, either on the record or anonymously or pseudonymously. The Internet can help make new networks, within and across cultures, can be an important productivity tool for otherwise underfunded activists, and can foster the development of new communities built around ideas. The Internet can open the information environment to voices other than the organs of the state that have traditionally had a monopoly on the broadcast of important stories and facts, which in turn gives rise to what William Fisher refers to as ‘‘semiotic democracy.’’ Put another way, the Internet can place the control of cultural goods and the making of meaning in the hands of many rather than few. The Internet is increasingly an effective counterweight to the consolidation in big media, whether the Internet is controlled by a few capitalists or the state itself. Anybody who analyzed my life will say that Internet has strengthened democracy by exposing role of traditional media working as a proxy of their respective government in so called democratic countries like America & India.

Internet and economy:

The Internet also can be a force for economic development, which is most likely the factor holding back some states from filtering the Internet more extensively or from imposing outright bans on related technologies. The Internet is widely recognized as a tool that is helping to lead to the development of technologically sophisticated, empowered middle classes. Entrepreneurship in the information technology sector can lead to innovation, the growth of new firms, and more jobs. Internet without censorship leads to open information environment which can lead to a beneficial combination of greater access to information, more transparency, better governance, and faster economic growth. The Internet, in this sense, is a generative network in human terms. In the hands of the populace at large, the Internet can give rise to a more empowered, productive citizenry.

Hackers to launch satellites to block Internet censorship:

Hackers are rallying behind a new plan to launch satellites into space to prevent Internet censorship. It is a project that will involve setting up low-cost ground stations to track and communicate with the fast-moving satellites. However, there is a technical hitch. Low-Earth-orbit satellites, such as have been launched by amateurs so far, do not stay in a single place but rather orbit, typically every 90 minutes. That’s not to say they can’t be used for communications, but obviously only for the relatively brief periods that they are in your view. It’s difficult to see how such satellites could be used as a viable communications grid other than in bursts. Also, outer space is not governed by the countries beneath it, so any country could take the law into their own hands and disable the satellites.

U.S. bill targets exports of Web Censorship Tools:

One of the most popular filtering software programs is SmartFilter, owned by Secure Computing in California, a company that’s just been bought by McAffee for $465m (£311m). SmartFilter has been used by some of the world’s most authoritarian regimes: Tunisia, Saudi Arabia and Sudan. The list of sites that are blocked by the software is so secret that not even the countries that use the technology know what is actually being censored. It’s unconscionable that U.S. technology is putting democracy activists at risk. U.S. companies should not, knowingly or unwittingly, be providing the technology used by repressive regimes to hunt down and punish human rights activists. There is a criminal cooperation between Western hi-tech companies and authoritarian regimes. Every day we learn of more democratic activists being arrested through the use of a growing array of Internet censorship and surveillance tools, abused by the governments of China, Belarus, Egypt, Syria and many other countries. The surveillance tools sold by these companies are used all over the world by armed forces, intelligence agencies, democratic governments and repressive regimes. The leading exporters of these technologies include the United States, France, Germany, Italy, United Kingdom and Israel. The bill Global Online Freedom Act will stop the vicious merry-go-round of exporting Internet-restricting technologies from the U.S. and then the U.S. has to spend millions of dollars helping activists circumvent. The legislation would prohibit American companies from exporting hardware or software that could be used for online surveillance or censorship to nations that restrict the Internet. It would also require Internet companies listed on U.S. stock exchanges to disclose to American regulators their practices in collecting and sharing personally identifiable information and steps taken to notify users when removing content.

EU to Give Secret Anti-Censorship Software to Human Rights Activists:

Arab Spring had been the wake-up call to governments around the world to recognize the power of the Internet, and social networking in particular, in building freedom and democracy. When peaceful protests are being planned, connectivity is everything. Communications networks must stay switched on. Enabling citizens of authoritarian countries to bypass surveillance and censorship measures depends on two basic conditions: availability of appropriate technologies (in particular software programs that can be installed on one’s desktop computer, laptop, smart-phone or other device) and awareness, both of the techniques used by authoritarian regimes to spy on citizens and censor their communications, and of the appropriate counter-measures to use. The so-called Internet survival packs would include currently available technology as well as potential new software aimed specifically at allowing activists to use the Internet to get their message across while at the same time remaining safe from persecution. EU has recently announced the “No Disconnect Strategy” to provide support to Internet users, bloggers and cyberactivists living in countries with poor track records on human rights.

Internet and earthquake:

One of the attributes that makes the Internet so popular is the ability to withstand partial outages and still function as a medium for transferring video, audio and text simultaneously. Kobe, Japan, experienced an enormous earthquake on 17 January 1995, named the Hanshin-Awaji Earthquake. At that time, “lifeline” public services such as gas, electricity, and water service stopped. Many people outside of the afflicted area were anxious to know if their family and friends were safe, and so many telephone calls were made to the afflicted area that the local telephone system was paralyzed. From this experience, we learned that the Internet stayed alive because of its robustness even in disasters. It became clear that the information system on the Internet should be prepared for burst access. A major earthquake caught people off guard in Turkey, Izmit, on August 17, 1999, at 03:02AM while they were asleep. A second occurred on November 12, 1999, at 18:58PM in Duzce. Thousands died and thousands more were wounded. People lost their lives, homes, livelihoods and dreams. In the wake of this earthquake, many national and international communities offered help and assistance. However, it rapidly became apparent that one of the main obstacles to efficiency in conducting the rescue operation was the lack of coordination in the earthquake region. A significant contributing factor was the disruption to the telecommunications infrastructure. All the phone lines were overloaded; even the mobile phones were not working. It soon became apparent that the only reliable working telecommunication medium was the Internet. As a consequence, it became the medium of choice for informing volunteers and nongovernmental organizations (NGOs), both nationally and internationally, about the needs of the earthquake region.

Discussion on internet censorship:

Is Internet censorship right? That is the question millions of people around the world are asking themselves— people like you and me who freely surf the Web every day reading the latest news or simply checking our e-mail. This freedom that we exercise daily is in danger of becoming another government-regulated part of our lives. The Internet, a technological masterpiece, has become subject of great controversy. Certain individuals feel as though the Internet should be governmentally regulated and censored in order to protect the youth of the world. On the other hand, the regulation of material on the Internet would, in fact, violate the fundamental human right to free speech and expression. Thomas Emerson once stated “Those who seek to impose limitation on expression do so ordinarily in order to forestall some anticipated effect of expression in causing or influencing other conduct”.

Let me first present what American Supreme Court and the UN stated on this issue:

On June 26, 1997, the United States Supreme Court held that communications over the Internet deserve the highest level of constitutional protection and the Court’s most fundamental holding is that communications on the Internet deserve the same level of constitutional protection as books, magazines, newspapers, and speakers on a street corner soapbox. The Court found that the Internet “constitutes a vast platform from which to address and hear from a world-wide audience of millions of readers, viewers, researchers, and buyers,” and that “any person with internet access can become a town crier with a voice that resonates farther than it could from any soapbox”.

UN and Internet:

On 10 December 1948, the adoption by the United Nations General Assembly of the Universal Declaration of Human Rights launched a new era. One of the fundamental rights the Universal Declaration described, in Article 19, was the right to freedom of speech: “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive, and impart information and ideas through any media and regardless of frontiers”. When those words were written sixty three years ago, no one imagined how the global phenomenon of the Internet would expand people’s ability to “seek, receive and impart information”, not only across borders but at amazing speeds and in forms that can be copied, edited, manipulated, recombined and shared with small or large audiences in ways fundamentally different than the communications media available in 1948. The unbelievable growth in the past several years of what is on the Internet and where it is available has the effect of making an unimaginably vast portion of human knowledge and activities. But the Internet does not contain only relevant and helpful educational information, friendship and communication. Like the world itself, it is vast, complex and often scary. It is just as available to people who are malicious, greedy, unscrupulous, dishonest or merely rude. With all of the best and worst of human nature reflected on the Internet and certain kinds of deception and harassment made much easier by the technology, it should not surprise anyone that the growth of the Internet has been paralleled by attempts to control how people use it. For example, we use spam-filtering tools to prevent spam from being delivered to our own e-mail accounts. However, when our access to internet is blocked or filtered by other people’s concerns, and when we don’t agree that the blocking is appropriate or in our interest; it cause significant conflicts and disagreements.

UN report on freedom of expression vis-à-vis Internet:

The United Nations Special Reporter on the promotion and protection of the right to freedom of opinion and expression submitted his report to the seventeenth session of the Human Rights Council on 16 May 2011. This report explores key trends and challenges to the right of all individuals to seek, receive and impart information and ideas of all kinds through the Internet. The Special Reporter underscores the unique and transformative nature of the Internet not only to enable individuals to exercise their right to freedom of opinion and expression, but also a range of other human rights, and to promote the progress of society as a whole. It outlines some of the ways in which States are increasingly censoring information online, namely through: arbitrary blocking or filtering of content; criminalization of legitimate expression; imposition of intermediary liability; disconnecting users from Internet access, including on the basis of intellectual property rights law; cyber attacks; and inadequate protection of the right to privacy and data protection. The UN Special Reporter is cognizant of the fact that, like all technological inventions, the Internet can be misused to cause harm to others. As with offline content, when a restriction is imposed as an exceptional measure on online content, it must pass a three-part, cumulative test:

(1) It must be provided by law, which is clear and accessible to everyone (principles of predictability and transparency);

(2) it must pursue one of the purposes set out in article 19, paragraph 3, of the International Covenant on Civil and Political Rights , namely: (a) to protect the rights or reputations of others; (b) to protect national security or public order, or public health or morals (principle of legitimacy); and

(3) It must be proven as necessary and the least restrictive means required to achieve the purported aim (principles of necessity and proportionality).

In addition, any legislation restricting the right to freedom of expression must be applied by a body which is independent of any political, commercial, or other unwarranted influences in a manner that is neither arbitrary nor discriminatory. There should also be adequate safeguards against abuse, including the possibility of challenge and remedy against its abusive application.

The UN Special Reporter in his report to the Human Rights Council reiterates the call to all States to decriminalize defamation. Additionally, he underscores that protection of national security or countering terrorism cannot be used to justify restricting the right to expression unless it can be demonstrated that: (a) the expression is intended to incite imminent violence; (b) it is likely to incite such violence; and (c) there is a direct and immediate connection between the expression and the likelihood or occurrence of such violence.

UN and Internet censorship:

Amidst raging controversy over the government of India’s proposal to monitor content in cyber space, UN Secretary General Ban Ki Moon said access to the Internet and various social media must not be blocked as a way to prevent criticism and public debate. In his speech on the eve of the Human Rights Day which was released at the United Nations Information Centre here, Moon said, “Today, within their existing obligation to respect the rights of freedom of assemble and expression, governments must not block access to the internet and various forms of social media as a way to prevent criticism and public debate.” Emphasizing on the important role that the social networking sites played in global events, Moon said, “Many of the people seeking their legitimate aspirations were linked through social media.”

Freedom of speech is a right of the citizens of the world; on the other hand, this freedom is not absolute to the point that society thinks that it is. One person’s right to freedom of expression should not infringe upon rights of others. Some forms of speech are thoroughly outlawed in many democratic nations such as fraudulent advertising, child pornography, obscenity, fighting words, help-wanted ads that discriminate on the basis of race, words used in a criminal transaction, unlicensed broadcasts, libel, speech that infringes a copyright, and unauthorized disclosure of data used to make atomic weapons. Naturally, most of these forms of speech have a compelling government interest. Government may regulate, or censor speech if it has a compelling interest, is a public concern, or threatens national safety. In turn, this demonstrates that the ideas and expressions of private institutions cannot be regulated, unless one of the preceding requirements is met. William Turner writes that “Government may not restrict or penalize speech because of its content or its viewpoint. It must remain neutral in the marketplace of ideas”. Overall, government may not regulate speech, unless there is a major national or public concern.

Despite the generally prevailing principle of freedom of speech in democratic countries, it is widely accepted that certain types of speech are not given protection as they are deemed to be of insufficient value compared to the harm, they cause. Child pornography in the print or broadcast media for instance is never tolerated. The internet should be no exception to these basic standards. Truly offensive material such as hardcore pornography and extreme racial hatred are no different simply because they are published on the World Wide Web as opposed to a book or video. Censorship is tailored to the power of the medium. Accordingly there is a higher level of censorship attached to television, films and video than to newspapers and books. This is because we recognize that moving pictures and sound are more graphic and powerful then text and photographs or illustrations. There is also normally more regulation of videos then cinema films because the viewer of a video is a captive audience with the power to rewind, view again and distribute more widely. The internet, which increasingly uses video and sound should be attached the same level of power and regulated accordingly. Also, more relevant difficulty is the anonymity provided by the internet which gives pornographers and criminals the opportunity to abuse the medium. Asian countries have experimented with requiring citizens to provide identification before posting content on to the internet; such a system if universally adopted could be a relatively simple way of enforcing laws against truly offensive and harmful content. The issues at stake in this debate are protection of children, terrorist activity, crime, racial hatred etc. all of which are international problems. If a global solution is required then it can be achieved by international co-operation and treaties. It is acknowledged that it is justifiable to censor where harm is caused to others by the speech, words or art of an author, all the examples cited above are clearly causing harm to various groups in society.

Internet should be free, but not lawless:

Liberty, the ability to maximize one’s talents free from interference with respect for the rights of others, is not the same as lawlessness, the state in which the Internet property pirates find themselves. It is the function, indeed the obligation, of government to put an end to lawlessness, provided that it shows a decent respect for due process and the other constitutional protections we are all afforded. Protecting copyrights is in fact a property rights issue. We must distinguish between protected free speech and the outright theft of another’s property. They are not the same thing. It’s the difference between liberty and lawlessness. I am in favor of the former and opposed to the latter.

There is a common perception that the Internet is a ‘Wild West’ or lawless and unregulated territory. This ignores the fact that laws in the offline world also apply to the online world. In fact, user behavior is very much a focus of law and regulation in every nation. However there are many reasons why criminal behavior is (in practice) less well regulated online. Firstly, many of the simpler regulatory solutions that apply offline (zoning, age restrictions or proof of identity requirements) are harder to implement online. In addition, there is the problem of managing and deploying law enforcement resources online and also the complexity of reconciling cross-national differences in laws and sanctions. Harvard law professor Jonathan Zittrain (2003) argues that jurisdiction built upon the movement of information traveling across the Internet has proven too costly for governments. However, the extent to which offline laws and regulations targeting user behavior are also applied in the online world can be illustrated by the examples given in Table below.

Fear as basis of censorship:

Overall, one can say that the instinct to censor is quite universal, and that the stated aim is protection — of children, of cultural values, of government stability, and so on. The objective is to maintain control. But why is there this need to be protective, to be in control? Perhaps underlying this instinct is the more basic one of fear. It’s that the theocratic right is driven by an irrational fear — a fear that the citizens can’t be trusted to do the right thing if they’re presented with unvarnished, unmanufactured facts. Across the world, similar fears seem to drive the censors, suggesting a mistrust of free speech and people’s ability to deal with it rationally, and perhaps an unacknowledged lack of confidence on the part of the censor in their own infallibility.

Intellectual freedom vis-à-vis Internet:

As a society we want our young people to be literate, thoughtful, and caring human beings; but we also attempt to control what they read, think, and care about. We feel the need to “protect” children from dangerous or disturbing ideas and information. Of course, what is dangerous or disturbing to one person or segment of society may be exciting and innovative to others and perhaps just “the truth” to still others. This combination of multiplicity of values and concern for young people keeps censorship alive in school and public libraries. Current concerns for literacy and critical thinking in education may actually increase incidents of censorship. Literacy assumes the power of texts and encourages exposure to competing ideas and beliefs. Critical thinking implies questioning, the analysis and evaluation of those beliefs to come to a personal judgment that empowers young people to take ownership of ideas and control of their own intellectual and moral lives. New technologies are causing an increase in incidents of censorship. The history of communications technologies, from the written word to modern electronic media, has been written with fear as critics contemplate the most dire consequences of each move that takes us farther from the personal one-on-one interaction with another human being in real time and space. The internet and the World Wide Web are especially problematic. In the virtual world of these media, there is a potential for a kind of anonymous intimacy that can be very seductive in our often fragmented, disconnected lives. Young people, often very comfortable with and eager to explore these new media at the same time they are coping with the myriad problems of coming-of-age in our society, may be especially susceptible to such seduction. Like most things, this can be either good or bad. I am encouraged and impressed by students who have exhausted traditional school and library resources, who now discover new and more current material on the internet and the web. At times they even participate in dialogues that move knowledge to new dimensions. I am even more impressed to see previously unmotivated students, seduced by information and ideas, discovering the power of their own intellects through electronic exchange. For me, the question becomes: Are we willing to give up this potential (if we could) to “protect” young people from “dangerous” encounters? As concerned adults, we need to understand conflicts of intellectual freedom, not as something negative or practiced by those less enlightened than ourselves, but as a process in which we are all participants playing various roles based on age, family background, societal position, religious beliefs, and profession. Professional teachers who serve youth in school have a pivotal part to play in this ongoing intellectual and moral drama. In order to best serve young people, we need consciously to consider both the basic underpinnings of intellectual freedom in our society and the requirements of the professional roles we play. I invite others to read, question, think, criticize, and share their own interpretations to help keep this drama alive. Without this ongoing dialogue and challenge to ideas and beliefs, there is no intellectual freedom.

Censorship of the Internet, as evidenced by national filtering of online content, appears to be more widely acceptable, even within states with liberal democratic traditions. Concerns over issues such as child protection, online decency and fraud have been deemed significant enough to justify restrictions on freedom of expression. This is not to say that such considerations are not important to address in the digital age; the eradication of child abuse images online, for example, is almost universally accepted as a vital goal. Yet research indicates that disproportionate reliance on disconnecting users or filtering content could seriously undermine essential aspects of freedom of expression without resolving the policy problem at hand, unless the larger ecology of policies and regulations is taken into account in balancing conflicting objectives. Protecting certain human rights or freedoms often has a direct and immediate impact on other rights and freedoms. Thus, the preservation of one freedom can limit another. Balancing these conflicting values and interests is only likely to be a resolved through negotiation and legal-regulatory analyses. This will probably vary cross-nationally, if not locally. Resolution of these balancing issues requires a broad view of the larger ecology of policies and regulations shaping freedom of expression as seen in the figure below.

The benefits of open, free expression and freedom of connection are immense. There are many ways to mitigate the risks of an open society, and filtering or censorship is rarely the most effective of these. Should the Internet be regulated as if it were a newspaper, broadcaster or a common carrier network? Or should it follow a new regulatory framework, which could well be the most sensible way forward. Some have viewed content on the Internet as impossible or inappropriate to regulate; a position well developed and most influenced by Ithiel de Sola Pool (1983) in his discussion on videotext. Impossible, because control over content production and consumption on the Internet was thought to be inherently distributed and incapable of being centrally controlled or censored. Inappropriate, because computers were thought to become newspapers of the future and should therefore enjoy the same freedom as the press.

Should it be illegal to publish literature with “indecent” content on the Internet but perfectly legal to publish that same work in print? This question has spawned the debate over Internet censorship. The proponents of internet censorship suggest creating laws for the Internet similar to those now in place for television and radio. Those strongly opposing Internet regulations, such as the Citizens Internet Empowerment Coalition (CIEC), assert that the Internet is not like a television and should not be regulated like one. The issues associated with Internet censorship are similar to those for offline censorship of more traditional media such as newspapers, magazines, books, music, radio, television, and films. One difference is that national borders are more permeable online: residents of a country that bans certain information can find it on websites hosted outside the country. Thus censors must work to prevent access to information even though they lack physical or legal control over the websites themselves. This in turn requires the use of technical censorship methods that are unique to the Internet, such as site blocking and content filtering. Blocking and filtering can be based on relatively static blacklists or be determined dynamically based on an examination of the information being exchanged. Blacklists may be produced manually or automatically and are often not available to the public. Blocking or filtering can be done at a centralized national level, at a decentralized sub-national level, or at an institutional level, for example in libraries, universities or Internet cafes. Blocking and filtering may also vary within a country across different ISPs. Countries may filter sensitive content on an on-going basis and/or introduce temporary filtering during key time periods such as elections. In some cases the censoring authorities may block content while leading the public to believe that censorship has not been applied. This is done by causing a fake “Not Found” error message to be displayed when an attempt to access a blocked web page is made.

The ability to speak one’s mind has never been easier, thanks to the Internet and social media. The ability to publish has never been easier, thanks to the Internet and social media. The ability to defame has never been easier. The ability to be irresponsible in news coverage has never been easier. The ability to insult, provoke and incite has never been easier. If technology makes it frighteningly easy to publish, it’s clear that, while you have the freedom to publish and to speak, it’s a freedom that comes with conditions attached. The freedoms come with responsibility – and irresponsibility, we now learn, can be punished. Continued irresponsibility could lead to a curb on the freedoms in the form of regulation, perhaps even a slice of censorship

Internet censorship is the removal of material from open access by government authority. Those who endorse censorship say that it is to protect minors from access to harmful and objectionable material. This is a noble, but impractical point of view, as it raises too many unanswerable questions. Who will decide what is indecent or objectionable? How do you censor only the explicit material used as pornography versus explicit material used to educate? How can one country censor something that is global? Where does censorship stop-explicit material, political opinion, religious beliefs? Most people believe there is no way to partially censor the Internet, and are deeply disturbed by attempts to do so. Whether it is ethical or not to censor the Internet should be considered. Ethics are often a matter of social culture, what is ethical in one culture may be unethical in another. Since the Internet is global is would be nearly impossible to set one standard. People are taking the narrow view, that banning or controlling information is the only way to fight incorrect or harmful information. The best way to fight misinformation is with correct information. Non-factual truth is subjective and matter of personal perspective. Only by effectively debating your argument with contentious and logical discourse, can you persuade your audience to share your point of view. Censorship denies the people their right to decide for themselves. This denial implies a lack of trust in the people to know and do what is correct and it is an attempt to control people. This same lack of trust and desire to control people has existed for as long as humanity. “Knowledge is Power”, a common and ever more truthful phrase. Those in power have always tried to control knowledge in order to control people. With the Internet that is no longer a possibility. China is a classical example of regime trying to control people by controlling internet. Freedom of speech and expression in any form, has taken on a whole new meaning because of the Internet and other new technologies. Those who value freedom must act to protect this freedom of knowledge or it could be impaired or lost.

There is a more efficient way to control obscene material on the Internet. Through the use of special programs designed to filter obscene Internet material, parents can allow their children to enjoy the Internet without the risk of viewing inappropriate images or ideas. Parental regulation is the only way to allow unregulated Internet use and the expansion of knowledge. Our world is not perfect. We are a world filled with sex, drugs, racism, and violence. It would seem that those parents are just trying to protect their children from the outside world. But does it really help? These days, the average elementary school student is aware of many things that their parents would rather be oblivious to their knowledge of. A wide range of sources, from television and other forms of media, to their environment at home and school influence them. All of these things combined will help to shape their moral values and personality. In order for the youth to grow up to be productive, capable adults, we must start by teaching them to individually make responsible decisions. It is the responsibility of the parents to instilling these values early on, therefore making it that much easier to communicate with them later on in their lives. I understand that parents are trying to protect their children from the harsh realities of life, but are they really helping, or hindering?

The human faculties of perception, judgment, discriminative feeling, mental activities and moral preference are exercised only in making a choice and Internet censorship or for that matter any censorship takes away that choice. Censorship deprives us from the opportunity to evaluate, learn from, and choose what we want to see, read and hear. The argument that something is harmful to minors ignores so many other issues;

1) How such censorship of the Internet would also deprives adults of the same material and have the effect of making all Internet content only suitable for children,

2) How “minors” covers a broad range of intellectual abilities, from ages 0 to 18 or 21,

3) That all children do not develop the same way at the same age,

4) That these arguments ignore cultural differences,

5) That we set a bad example of how to deal with controversial issues,

6) And most particularly, it ignores the context within which the censored material is delivered.

The context within which all the “objectionable” material being censored exists is clearly important. Studies are reported where teaching critical viewing skills and media literacy eliminate the supposedly negative effects. Yet we reject teaching such skills, and allow ideas to be suppressed. Does this prepare young people for life in the real world, or does it stifle their ability to make intelligent choices? To quote Heins: “The ponderous, humorless overliteralism of so much censorship directed at youth not only takes the fun, ambiguity, cathartic function, and irony out of the world of imagination and creativity; it reduces the difficult, complicated, joyous, and sometimes tortured experience of growing up to a sanitized combination of adult moralizing and intellectual closed doors.” Intellectual protectionism frustrates rather than enhances young people’s mental agility and capacity to deal with the world. It inhibits straightforward discussion about sex. Indeed, like TV violence, censorship may also have “modeling effects,” teaching authoritarianism, intolerance for unpopular opinions, erotophobia, and sexual guilt. Censorship is an avoidance technique that addresses adult anxieties and satisfies symbolic concerns, but ultimately does nothing to resolve social problems or affirmatively help adolescents and children cope with their environments and impulses or navigate the dense and insistent media barrage that surrounds them.

Censorship is generally an evil and should be avoided where ever possible. Except child pornography, other forms of speech may well be truly offensive but the only way a society can deal with them is by being exposed to them and combating them. Otherwise these groups are driven underground and become martyrs. The reason why the print media is comparatively unregulated is because we recognize that this is the primary means of distributing information in society. For this reason the internet must be allowed at least the same protection as freedom of press. Even allowing for the extreme problems surrounding freedom of speech, internet censorship would be more or less impossible. Governments can attempt to regulate what is produced in their own country but it would be impossible to regulate material from abroad. What is the point in the USA removing all domestic reference to hardcore pornography when it is possible to access material from the United Kingdom or Sweden? It is also possible for citizens to produce material and store it in an overseas domain further complicating the issue. True freedom of speech requires anonymity in some cases to protect the author; the governments who have introduced ID requirements for internet use also deny many basic rights to their citizens. The internet allows citizens to criticize their government and distribute news and information without reprisal from the state and such a system clearly could not survive with ID requirements. Internet Service Providers are certainly the wrong people to decide what can and cannot be placed on the internet. There is already far too much control of this new technology by big business without also making them judge and jury of all internet content. In any case the sheer bulk of information ISPs allow to be published is such that vetting would be more or less impossible. Many ISPs have shown themselves to be responsible in immediately removing truly offensive content where they have been alerted to it. What is required is self regulation by the industry recognizing their responsibility to internet users but not imposing arbitrary and draconian restrictions upon its use.

Governmental censorship would primarily attempt to stop an unintentional effect of certain speech or expression on the Internet; in other words, the government would be opposing the idea of individualism in society. When controlling what people read or view, whether in a book or on a computer monitor, the government limits people’s ideas and their thought capacities. Frederick Schauer, a law professor at the College of William and Mary, stated “Freedom of speech meant not only freedom from any form of governmental control, but also freedom from private social pressures that could also inhibit thought and opinion”. As citizens of any country, individuals have the right to be free from governmental control that inhibits thoughts, ideas, and free expression. Every individual in democratic nations has the right to read or view whatever book or magazine they choose. How should this be different from viewing the same type of material on the Internet? The separation between the individual and government is central to the Free Speech Principle, and this feature is often lost when . . . we conflate social intolerance and governmental intolerance. Governmental regulation of thoughts and ideas results in less freedom, therefore condoning less wisdom; these, in turn, result in the absence of individualistic character which is necessary in a democratic society. Government believes that it knows what is best for society; however, this can also be seen as those who are in power know what is the best method to keep power. Censorship is a possible way for the powerful to terminate individualism, wisdom, and the marketplace of ideas; it not only facilitates less freedom, but also promotes governmental coercion, collectivism, and possibly totalitarianism. Preventing individuals from exploring others’ thoughts and ideas is a way to prevent the expansion of knowledge and power.

I support promoting the free flow of ideas by word and image. Part of this mission, therefore, is to promote freedom of expression and freedom of information as a central element in building strong democracies, contributing to good governance, promoting civic participation and the rule of law, and encouraging human development and security. I recognize that the principle of freedom of expression must apply not only to traditional media, but also to the Internet. Providing an unprecedented volume of resources for information and knowledge, the Internet opens up new opportunities for expression and participation and holds enormous potential for development. Freedom of expression vis-à-vis internet is not just a by-product of technical change; it must be protected by legal and regulatory measures that balance a variety of potentially conflicting values and interests in a complex global ecology of choices. Freedom of expression is not an inevitable outcome of technological innovation. It can be diminished or reinforced by the design of technologies, policies and practices – sometimes far removed from freedom of expression.

Impending fiasco:

You’re sitting at your PC and you log into your Internet access server to read your email. You’re expecting a message from a friend, who is sending you some information on breast cancer as your mother is suffering from breast cancer, but when you check your inbox, there is instead a message from the server. It says the message that was sent to you from the address of your friend has been intercepted because it contained indecent material that did not comply with FCC regulations of the Internet. You call your friend only to find that the police have come and taken him away, and he is now facing up to two years in prison and/or up to $100,000 in fines. The message sent by your friend contained the word “breast” which by current FCC standards is indecent, and thus not permitted to be transferred on the Internet. Due to this, your friend is now subject to criminal charges. Sound ridiculous, unreasonable or scary? It is all three together and further it is impending reality. This situation is very possible in the very near future. This will happen when the government censors the Internet, by any means it deems necessary in so called democratic nations. Imagine, what will happen to you if you live in non-democratic nation?

Why engineers oppose Internet censorship?

The internet is a result of the collaborative effort of tens of thousands of brilliant minds who understand how the underlying technologies work together. The people supporting internet censorship however, come from a non-technical background. As they try to change how these things work in order to fit with their business models, they will most certainly break something. Would you let a chiropractor “fix” the car that you drive to work every day, against the express recommendations of your mechanic and the engineers that built it? The internet is the car that many of us drive to work every day, and almost everyone who understands what goes on under the hood are opposed to internet censorship.

Internet censorship and science:

Turkish Government has censored Darwin & Evolution. Concerns about censorship have risen in Turkey since November 2011 when the Council of Information Technology and Communications (BTK) placed blocks on websites that contain the words “Darwin” and “Evolution.” This filtering system blocks websites about the theory of evolution, along with pornographic sites, to any Turkish computer user who has the children’s security profile activated on his or her computer. Websites that remain unprotected include those referencing the theory of creationism, Intelligent Design and anti-evolution sentiments. While Turkey is often considered one of the most secular Islamic countries, it also houses a significant population of Islamic creationism believers. It is the sentiments of this group that provided the impetus for the evolution website filtering. Denying evolution is equivalent to denying gravity, and that students sell themselves short if they believe otherwise. To me, the censorship of any scientific theory (unrelated to obscene or inappropriate content) is not only a cause for concern but it gives wrong education to students and make them live in fictitious world. Also, it destroys creativity in students. Everybody has right to adhere to his/her religious beliefs but not at a cost of genuine scientific education. Religion is a personal matter while education is enlightenment of an individual. Religious believers & followers who assert that religion is above science must stop using benefits of science including using computer/internet, cars, air-conditioners, TV etc.

Who is bad, Internet or you?

What exactly is censorship? Some feel censorship is a violation of their rights. Others say censorship is a must in the violent, abusive world we call “society.” Who has the right to censor? Who doesn’t? What needs to be censored, and what doesn’t? The fact of the matter is that there are many pros and cons about internet censorship. Internet is important for understanding contemporary social change and internet is also a mirror of contemporary social change. No webpage comes to your home/office on its own. You switch on computer, you connect to internet and you search for so called vulgar, derogatory and defamatory contents. Then you blame the pornographic sites, then you blame the sites which spread racist hatred, then you blame the sites which cause blasphemy. It makes no sense. Who is bad, Internet or you? It is akin to ask doctors not to do sex determination test on fetuses to prevent female feticide. In India, social structure is such that female child is having lesser worth than male child and so thousands of parents want to abort female fetuses. Now this social evil must be tackled as social level and not at doctor’s level. If all parents decide that male child and female child are same, nobody will go for sex determination test. Same thing about corruption in India. Corruption in India is established as a socially acceptable phenomenon. How can you eradicate corruption by laws when majority population is indulging in corrupt practices? Social evil ought to be corrected by social reformers and not by enforcing laws enacted by the elite whose moral standard is different from moral standard of ordinary people.

Who makes laws?

Society makes laws. Laws against rape and murder exist because society wants it that way. Whether it is leader’s daughter’s rape or businessman’s wife’s rape or a beggars’ sister’s rape, law is applied equally because everybody agrees that rape is a rape no matter who is the victim. When it comes to criminalize objectionable content on internet, who is the victim? Does society wants such laws? Who defines what objectionable content is? Yes, as far as child pornography or provocation of violence is concerned, everybody in society agrees to make laws against it and such laws will work. What about pirated movies or videos or music? I am sorry to say that most people do watch pirated stuff. When society itself has downgraded its morals, how laws will prevent piracy? People will use circumvention techniques and see pirated movies. Some of the content on Internet criticizes various governments or regimes. So government wants to enact laws to censor it because it harms its interest but society has nothing to do with it because criticism of government or regime on Internet does not affect anybody in society. In such case, such a law is a repressive weapon to destroy freedom of expression and eventually society will either change government or disobey such laws.

Internet as human right:

The lead scientist of internet Vinton Cerf argues that the Internet cannot be considered a human right. According to him, human rights must be among the things we as humans need in order to lead healthy, meaningful lives, like freedom from torture or freedom of conscience. Technology is an enabler of rights, not a right itself. Also, technology is often a point of differentiation between the “haves” and “have-nots,” that does not necessarily make any piece of technology a human right. I respectfully disagree with Cerf. Look at my life. Traditional media has conspired to kill my talent and my existence. Had there been no internet, I was destined to die in oblivion and my talent would go waste. I am internet child. The internet is the greatest facilitator of freedom of expression and freedom of information that the world has ever seen. If freedom of expression is human right, then, its greatest facilitator cannot be separated from it. What happened in my life can happen in your life too. I therefore urge the UN to declare Internet as fundamental human right.

Internet and future generation:

Please read my article on “The Stress”. Stress in biology is defined as a response to change. Exposure to internet is a major change in environment of humans. Stress induced changes in genetic code including the creation of novel genes, the alteration of gene expression in development, and the genesis of major genomic rearrangements are carried forward in next generation to help next generation to adapt to stress. So internet exposure will also bring about change in genetic code to adapt to it. Inherited intelligence improvises in subsequent generation due changes in genetic code caused by exposure to various environmental factors including internet. Internet censorship leads to stifling of free flow of ideas, free flow of information and suppression of creativity. Massive internet censorship in countries like China, Cuba and North Korea leads to very little change in genetic codes of their population as compared to free societies of Europe, America and India whose population would have significant change in genetic code due to exposure to free internet. So subsequent populations of China, Cuba and North Korea will have weaker inherited intelligence as compared to inherited intelligence of free societies. In other words, exposure to free Internet will lead to development of more intelligent future generation.

The moral of the story:

1. Internet is a fundamental human right akin to freedom of expression and freedom of information.

2. Freedom of expression must coexist with freedom of information for it to make sense.

3. The right to freedom of expression must not infringe on other’s rights. The right to freedom of information must not violate other’s right to privacy. No fundamental human right is absolute. What we need is balance of everybody’s rights.

4. Arab Spring has been the wake-up call to governments around the world to recognize the power of the Internet, and social networking in particular, in building freedom and democracy. Freedom of Internet strengthens democracy.

5. Freedom of Internet leads to augmentation of economic growth.

6. Freedom of Internet unites people by bridging gaps of cultural, social and religious divide.

7. Every medium has different power and different audience, and therefore you cannot apply same yardstick of regulation of traditional media to Internet.

8. Internet needs to be regulated but by whom and how are the unresolved issues. Since Internet permeates boundaries of nations; and different nations have different cultures having different parameters of obscenity, morality and legality in the sense that what is legal and acceptable in one country may be illegal or unacceptable in another country; suggests that self-regulation is the best way forward otherwise we risk losing freedom of expression, freedom of information and liberty under pretext of regulating Internet.

9. Except for child pornography, copy right/intellectual property right infringement and incitement of violence; I see no reason for Internet censorship.

10. It is the responsibility of parents to regulate internet access for their children according to the prevailing culture of the society, family values and social structure by installing suitable filtering software in the home computer or by teaching them to make responsible decisions.

11. The progression of human civilization depends on expression of new ideas (however unpopular) and this can be achieved only by freedom of expression. Internet censorship curtails freedom of expression and thereby curtails progression of human civilization.

12. Exposure to free Internet will lead to development of more intelligent future generation.

Dr. Rajiv Desai. MD.

January 12, 2012

Postscript:

Metaphorically, I am an internet child. Had there been no internet, I would have lived in oblivion and died in oblivion. I am grateful to the inventors of computer and internet for my existence. Between the two extremes of free internet on one side and censored internet on the other side, I will go for free internet because advantages of free internet far outweigh advantages of censored internet.

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