The predominant gambling policy to respond to the adverse consequences of excessive gambling has been the Reno Model, which places the responsibility for gambling-caused problems on gamblers themselves. The newly implemented Japanese gambling policy, which shares basic premises with the Reno Model, focuses on the individual pathology of gamblers. However, this model lacks other critical perspectives: environmental and structural factors. To fully understand the harms caused by gambling; it is important to also pay attention to the negative consequences for affected others. In this brief report, we explore family members’ experiences of gambling problems within the specific context of the Japanese gambling policy. Interviews with family members reveal self-stigma of being bad parents which elicits shame and efforts to maintain secrecy, as well as public stigma involving labeling, isolation, risks of status loss, social exclusion and discrimination. The focus on individual pathology in Japanese legislation as well as in public and professional perception, reinforces self-blame, anxiety, and remorse on the part of affected family members. When contrasted with the lived experiences of gamblers’ family members, the inconsistencies and unreasonableness of the individual pathology paradigm in Japanese gambling policy become evident. It is necessary to shift the focus of gambling policies from individual to socio-political-cultural factors, investigating how these factors influence gambling-caused harm, especially in the Japanese context. Excessive gambling affects various domains of the lives of gamblers, their family members and the general public, producing harm such as multiple debts, job loss, marital conflict, domestic violence, child abuse, poor health, homelessness, attempted suicide, and crime –3. Negatpachinko and pachislot.1Gambling is legally banned in Japan, and could according to the penal code be punished with fines or imprisonment . HoweverPachinko and pachislot parlors are ubiquitous across Japan: near train stations, along bustling streets, in urban suburbs and rural towns. Conspicuous glittering signs enticed over seven million gamblers in 2020, even though most parlors were closed for more than 1 month due to COVID-19  for their winnings, which they can exchange for cash at a location outside the parlor. The parlor has nothing to do with this exchange. Using this loophole, the pachinko and pachislot is not regulated as gambling  in the upcoming years, despite the strong opposition from the public  with fe2 .The most general policy to address gambling problems is based on the Reno Model, which places the responsibility for gambling-caused harm primarily on gamblers themselves . RecentlThis particular Japanese gambling policy does not explicitly promote the concept of responsible gambling; however, the policy can be identified as a type of the Reno Model . The poltekidoni. However, no helpful information is offered to inform gamblers on whether or not they are playing in a tekidoni-like manner , B , C , D , and E . D’s husband was in treatment for gambling, but the gamblers of the other family members refused to seek help. In addition, an individual interview with participant F  was included in the study. She did not participate in the group interviews but has been a regular participant in the psycho-educational seminars conducted by the first author. Therefore, the authors asked for her permission. She read the accounts and consented to this description by mail. All participants were informed about the aims, methods, voluntariness of participation, confidentiality and right not to answer specific questions and withdraw their consent without reprisal, how the data will be analyzed and published, possible negative consequences from participation, and contact information. All of the approached family members agreed to participate and gave their informed consent.In the interviews, the first author strived to generate detailed accounts from the family members by using open ended questions and probes to build stories through conversations . The firThe family members bear witness of secrecy to keep up appearances and avoid the public stigma of being disqualified from social acceptance in society. The situation involves psychological distress with high levels of anxiety. The burden thus not only involves financial hardships, but also consequences for mental health and family relations.A: I was worried about my son’s debts. I didn’t talk to anyone, not even my parents or siblings. I didn’t want anyone to ask about my son. I was scared if someone would ask about him; What should I say? My siblings never asked anything about my son; they probably knew something was wrong with my son. Sometimes, they would ask, “Is he all right?” I would then reply, “Yes, fine.” That’s all.E: I feel isolated. I think my sisters probably don’t feel obliged to feel this way. Ordinary people would never understand how I felt about my son. I once wished my son were dead. Ordinary parents would not think this way.As revealed in Mother A’s and Mother E’s accounts above, keeping their sons’ gambling problems hidden is a heavy burden, involving lies to avoid being judged or labeled, and crucial also within the extensive family. To talk to their siblings about their children’s predicaments is not an option, which puts the women in isolated and alienated positions. Mother E even distinguish herself from “ordinary parents,” differentiating between “us” and “them,” when admitting that she once wished her son was dead.Despite staying abstinent for as long as a decade, gamblers can still feel ashamed for having done “stupid” things and harmed their family members. The family members, especially mothers, in turn blame themselves for having enabled their children’s gambling for a long time. Gamblers’ family members often criticize and label other family members who cannot stop bailing out their relatives, saying: “That mother is no good.”Family members are advised not to bail out gamblers’ debts because it perpetuates the gambling. However, if debts are not paid, gamblers may lose their own families, friends or jobs. Gamblers’ family members must make the difficult choice between bailing out their family members or subjecting them to social exclusion.A: For five or six years, I repeatedly paid his debts, 10 million yen (75 000 USD) in total. I didn’t know where I could get help. I didn’t want to talk to anyone. I tried to do everything I could do within the family boundary. Keeping up appearances was most important.B: About 10 years ago, my son borrowed money from my mother. Last year, another debt was discovered. The debt my mother repaid was small. This time, big money was borrowed from his cousin for other debts as well. I thought I had to pay it back as soon as possible. This cousin is very close to us.In everyday life, parents also encounter social pressure to bail out their children, as is revealed by Mother F. The gambler left home, angry with his mother, who refused to give him money. His mother received a notice of his tax arrears. She brought the notice to the city office, informing the staff that she was unaware of her son’s whereabouts. She asked the staff to make contact with him. The city officer asked her, “You are his mother, aren’t you?” At first, she was embarrassed, thinking that other people in the office had heard this. “I don’t want people in this office to hear this. Should I pay his taxes? That would be easier.” However, Mother F was determined not to bail out her gambling son. She repeated, “I don’t know my son’s whereabouts.” Mounted debts and uncertainty are part of the burden families carry. In addition, they risk facing frequent embarrassment in public offices.The high expectations of taking care of family members in Japanese society is also revealed in Wife D’s case. The burden of not only taking care of her children with Autism spectrum disorders and her old mother, but also her own husband with gambling problems, becomes heavy. But Wife D believes it is expected of her and that it has been her responsibility, her “calling,” and now takes care of her gambling husband as if he were her son.D: I have lived my life taking care of these people (husband and children with Autism spectrum disorder). “This is my calling.” In those days, I used to believe that. (…) I now take care of my old mother, and my husband is another child—the most troublesome one.Non-gambling family members suffer from the results of excessive gambling by their loved ones. However, the family members do not even question the industry’s responsibility and instead blame themselves for not being good parents. Confined to the framework of individual pathology, the participants cannot relate to how gamblers’ problems are generated in the socio-political-cultural environment. Parents instead feel guilty and inadequate for failing to nurture or protect their children. When the first author asked how family members experience and perceive gambling-caused harm, Mother A responded:A: When I bailed out my son repeatedly, I thought I wasn’t wrong, not me, not my responsibility; my wayward son caused this mess. I have been attending meetings (at a self-help group for family members of gamblers) for a decade, and now I know I did something wrong.The first author probed further, “Have you ever thought the gambling industry was in the wrong?” “No,” the mother replied. The responsibility for the gambling problem is thus turned from her son to including also her own behavior as a mother, but placing any blame on the industry is not an alternative in her framework.Father C believes his alcoholism led to his son’s gambling problem. He labels himself as a “worn-out and sloppy father,” which is a strong stigma to carry as a parent.C: I am an alcoholic, and my son inherited this predisposition. I blame myself for my alcoholism, which drove my son to gamble. This is the cycle of addiction, I believe. When my son was two years old, my wife and I divorced. When my son was in the 4th year of elementary school, my wife and I re-married. Two years after this, I relapsed. I started drinking again. When my son was a freshman in high school, I stopped drinking. During this period, my son was in a susceptible period of his life. He was exposed to a worn-out and sloppy father, me, which caused my son to gamble.Mother E feels guilty for failing to protect her son and remaining unaware of his gambling problems.E: I thought something had been wrong with my son. He didn’t pay rent or college tuition. Something was wrong, but I wasn’t aware that my son suffered from a gambling addiction. My son said, “I know what I’m doing, but I can’t stop.” I couldn’t understand him at that time. (…) The police came to us, asking about my son’s whereabouts. There was a case of theft at my son’s school. I thought I shouldn’t let my son commit another crime. I looked for my son, searching from one pachinko parlor to another, looking for my son’s bicycle. Finally, I found my son’s bicycle at an internet café. I called my husband, who told me to inform the police of my son’s whereabouts. Then the police came to the internet café. I was shocked to see my son handcuffed in front of me. On the other hand, I was relieved that my son wouldn’t commit another crime. However, even now, I’m not sure if I made the right decision.Mother E talks about how she still feels uncertainty and guilt after having turned her son in to the policy many years ago. The parents struggle with finding ways to relate to and handle their children’s problems. In doing so they blame themselves for being bad parents, rather than framing the problem as taking place within a broader socioeconomic context where restrictions of gambling opportunities essentially is lacking.This brief report adds to the literature by showing how family members of gamblers, primarily mothers, relate to their situation within the specific individual pathology-framework as the Japanese legislation as well as public and professional perceptions adhere to. The family members experience felt stigma of being bad parents which elicits shame and efforts to maintain secrecy, as well as public stigma involving labeling, risks of status loss, social exclusion and discrimination . People By framing gambling problems as an individual pathology, the national gambling policies divert the attention of the Japanese public from the external gambling environment to the pathology of gamblers and their family members. The public perceives gamblers as problematic and troublesome people who have caused their predicaments on themselves . Thus, aThe gamblers’ families, especially the parents, feel responsible for the gamblers’ problems; therefore, they bail out their gambling loved ones so they will not be excluded from society. Furthermore, Japanese social values and practices reinforce a sense of guilt and shame on the part of family members who feel obliged to take responsibility for the wrongdoing of another family member. As sociologist Sakuta explains: “The household has been the important institution to foster conformity to the societal demand”  p. 15. JOur findings are consistent with results from a recent survey conducted in Macau  showing Measures to respond to gambling-related problems have been implemented recently at the municipal level in Japan, e.g., by providing group therapy for gamblers. Treatment for gamblers is included in the public health insurance since 2020 , but stitekidoni-like manner (moderate-like manner) without disclosing any information regarding the monetary amount that gamblers can lose for particular EGM machines per hour (4 There is thus a need for clear regulations concerning both online casinos and EGM parlors in Japan.The Japanese government claims that gambling addiction is a treatable disease, and anyone can become addicted to gambling. If gambling is so addictive, gambling products would also contribute to the addiction and thus be inherently risky. However, the research and discussion on risky gambling products and how they are provided are not included in gambling policy agendas , 49–51. per hour . Online per hour .4 There Treatment-seeking gamblers and their family members in Japan do not talk about prevention. The family members feel that they are “too late” for prevention. They also have no illusions of expecting the government to regulate the industry practice. The most immediate solution for treatment-seeking gamblers and their family members is to stop gambling and regain ordinary daily lives. As Orford  p. 1195 Numerous gambling-caused problems are framed as the problem of gamblers and their family members, consequently provoking the public to focus on the pathology of gamblers and their family members. Socio-political-cultural factors are excluded from the public’s perspective. Gamblers and their families are ashamed to disclose their problems and, thus, do not seek help. Recently, growing criticism has emerged for this narrow perspective , 49, 51 In this report, the focus on individual pathology in Japanese legislation and public and professional perception has been illustrated and contrasted with the lived experiences of gamblers’ family members. It brings insights into the inconsistencies and unreasonableness of the “responsible gambling” paradigm originating from the Reno model. However, the report is preliminary in nature since interviewing more family members could have offered more robust findings. Furthermore, in future research, the discourses adopted in psychological aspects of individuals and inter-personal relations such as “distorted thinking” and “co-dependency” must be examined as to how the treatment methods and practices influence the perception of gambling-caused problems on the part of gamblers, family members, treatment, welfare service providers and the general public.The datasets presented in this article are not readily available because due to the sensitive nature of this research, participants of this study did not agree for their data to be shared publicly.This study was reviewed and approved by the Otani University Research Ethics Committee. The participants provided their written informed consent to participate in this study.NT conducted interviews with family members. All authors contributed equally to the analysis and writing of this report.


Many studies published in other countries have identified certain perceived benefits of and barriers to physical activity among patients with coronary heart disease. Nevertheless, there is no data about the issue relating to Jordanian patients with coronary heart disease.This study aimed to describe the prevalence of levels of physical activity, the benefits of and barriers to physical activity as perceived by Jordanian patients with coronary heart disease, and the relationship between physical activity and perceived benefits of and barriers to physical activity. In addition, it focused on examining the influence of selected sociodemographic and health characteristics on physical activity and the perceived benefits of and barriers to physical activity.A cross-sectional design was performed on a sample of 400 patients with coronary heart disease. They were given a list of perceived benefits of and barriers to physical activity and asked to what extent they disagreed or agreed with each.Jordanian patients with coronary heart disease perceived various benefits of and barriers to physical activity. Most of these benefits were physiologically related . The most substantial barriers to physical activity as perceived by the patients were “feeling anxiety,” “not enough time,” “lack of interest,” “bad weather,” and “feeling of being uncomfortable.” Sociodemographic and health characteristics that significantly influenced perceived barriers to physical activity were age, gender, health perception, chest pain frequency, education, job, caring responsibilities, ability to travel alone, smoking, and previous and current physical activity behavior.This study demonstrates that patients with coronary heart disease have perceived physiological benefits of physical activity and have perceived motivational, physical health, and environmental barriers to physical activity, which is significant in developing intervention strategies that aim to maximize patients' participation in physical activity and overcome barriers to physical activity. Physical activity is essential in preventing and treating coronary heart disease (CHD) –3. The sAlthough the significant benefits of PA are well-known in the treatment of CHD, the vast majority of patients with CHD do not achieve PA following recommendations, even when they engage in a structured PA program or cardiac rehabilitation program . The perThe contributing factors of low performance and adherence to PA that have been consistently reported in the literature include individual characteristics, such as motivation and self-efficacy. Perceived barriers to PA, such as time and access, and characteristics of PA behavior, such as PA type, intensity, and duration . In addiThe health promotion model (HPM) identifies perceived benefits of and barriers to action as influencing factors for health-promoting behavior, such as participation in PA. In this model, health-promoting behavior is the desired outcome , 24. TheThe significant aspect of the success of programs and interventions that aim to promote PA in patients with CHD is the recognition of factors that limit participation in these programs . InformaThis study aimed to describe the prevalence of PA levels in patients with CHD and the benefits of and barriers to PA as perceived by Jordanian patients with CH and describe the relationship between perceived benefits of and barriers to PA and the participation of these patients in PA. Furthermore, it aimed to describe the influence of selected sociodemographic and health characteristics on perceived benefits of and barriers to PA and the participation of PA.First, approval from the Institutional Review Board at King Abdullah University Hospital (KAUH) and Jordan University Hospital administration to interview the patients was secured. Then, the researcher reviewed patients' files who visited the cardiac clinic between 1 July 2019 and 1 October 2019. Those who met the inclusion criteria were identified and invited to participate in the study. A structured interview technique to collect the required data was used.The sample size was 400 patients with CHD, determined based on the prevalence of PA among CHD in the previous study by determining 40% at a 95% CI, 5% margin of error and adding 37 patients considering dropouts among participants . Two uniThe participants were administered the International Physical Activity Questionnaire (IPAQ), which assesses physical activity status. The instrument asks questions about the performance of 30 min of moderate-intensity activity 5 days per week (150 min per week) or a combination of walking and moderate-intensity activities amounting to a minimum of at least 600 METs-minutes/week. The IPAQ is a reliable and valid tool for assessing PA .Since there are no clinical tools for the reliable evaluation of perceived benefits of and barriers to PA among patients with CHD, the researcher developed a scale consisting of two lists of perceived benefits of and barriers to PA based on the literature. The first list contains 22 items that reflect PA's physical, psychological, and social benefits. The second list contains 41 items that reflect PA's physical, psychological, social, and environmental barriers. The response for each item was on a 6-point Likert scale ranging from (1) strongly disagree to (6) strongly agree. In addition, two open-ended questions asked participants' opinions about additional benefits of and barriers to PA. Items of perceived benefits and barriers demonstrated a high level of internal consistency; Cronbach's alpha was calculated: 0.87 for perceived benefits of PA and 0.92 for perceived barriers to PA. Also, test-retest reliability for the total instrument was 0.89 for the Exercise Benefits Scale and 0.77 for the Exercise Barriers Scale.To evaluate the clarity and understandability of the perceived benefits of and barriers to PA, the researcher interviewed ten patients with CHD in the cardiac clinics of both hospitals before starting data collection using structured interviews. The patients were six males and four females. In total, seven patients were diagnosed with MI, and three patients with angina. Results showed that all participants reported that all items were clear, understandable, and at the level of the patient's comprehension.t-test, chi-square test, and Fisher's exact test were used to examine differences in perceived benefits of and barriers to PA and individual and health characteristics concerning PA behavior that was measured on a continuous and dichotomous level. A one-way analysis of variance was used to compare the means of two or more independent groups.Descriptive statistical analysis was used to describe the sample. The Pearson correlation was used to describe the relationship between the benefits of and barriers to PA and the continuously measured sociodemographic and health characteristics. The same test was used to describe the relationship between individual and health characteristics, and PA was measured continuously. In addition, the The participants were 400 patients with CHD between 36 and 70 years old, with two-thirds being male. There were no significant differences between the two groups ,2.According to the International Physical Activity Questionnaire (IPAQ), 24% of the patients are classified as physically active. According to IPAQ, participants were recognized as physically active when they met the PA guidelines of 30 min of moderate-intensity activity 5 days/week (150 min/week) or engaged in a combination of walking and moderate-intensity activities for a minimum of at least 600 METs-min/week.It was found that male respondents and laborers were significantly more engaged in PA than females and office workers. Also, there was a statistically significant difference between physically active and non-physically active participants regarding physical activity advice, chest pain frequency, and perception of health. Patients with weak PA advice perceive their health as poor and have more chest pain frequency. They also have low PA levels. However, other factors such as marital status and smoking showed no statistically significant relationship with PA engagement , 4.There was a significant difference between physically active and non-physically active participants regarding PA's psychological and social benefits. Physically active patients perceive these benefits more than non-physically active patients. However, no significant difference between the two groups of patients was detected as regards the physical benefits of PA, such as “preventing overweight,” “decreasing the risk of coronary artery disease,” and “decreasing triglycerides.” Improving knowledge about the physiological benefits of PA is an essential element that should be included in the PA programs provided to patients with CHD.While regarding perceived barriers items about performing PA, physically active and non-physically active participants were significantly different regarding most of the perceived barriers to PA. Physically active patients exhibited fewer physical, psychological, social, and environmental barriers to the perception of PA than non-physically active participants.M = 5.81, SD = 0.53) “improves body muscle's flexibility” , “improves strength” , “prevents overweight” , “decreases risk of CHD” , “decreases triglycerides” , and “improves cardiovascular fitness”   .M = 4.53, SD = 1.81), “not enough time” , “feeling of being too lazy” , “busy at work” , “lack of interest” , “bad weather” , “don't like to do PA alone” , “not frequently seeing others perform PA” , “feeling of being uncomfortable” , and “PA causes shortness of breath”  (The biggest barriers to PA as perceived by the patients were as follows: “feeling with anxiety” ( = 1.82) .Job type significantly influenced the perceived benefits of “decreasing triglycerides” and “giving enjoyment.” Laborer workers perceived this PA benefits more than office workers. Physically active participants perceived all physiological benefits more than non-physically active participants.This study demonstrated the importance of sociodemographic and health characteristics of patients with CHD in influencing their perception of barriers to PA, including (1) health perception, (2) chest pain, (3) the ability to travel alone, (4) education, (5) age, (6) gender, (7) caring responsibilities, (8) job status, (9) current PA behavior, (10) smoking, and (1) PA advice. Health perception had a significant negative relationship with the barriers “feeling with anxiety” and “PA causes shortness of breath”. Patients with poor health were more likely to perceive “feeling with anxiety” and “PA causes shortness of breath” as solid barriers to PA. Chest pain frequency had a significant positive relationship with “feeling uncomfortable” barriers and “PA causes shortness of breath.” Participants who reported more chest pain frequency were more likely to perceive “feeling uncomfortable” and “PA causes shortness of breath” as solid barriers to PA. Age is negatively related to “busy at work” and “not enough time” barriers. Young participants were more likely to perceive “busy at work” and “not enough time” as solid barriers to PA. No significant relationships with other barriers were found.Females, illiterate, patients who could not travel alone, smokers, and non-regular physically active perceived “feeling uncomfortable” and “not enough time” as barriers to PA more than their counterparts. Illiterates and individuals who are unable to travel alone perceived “feeling anxiety” as a barrier to PA more than educated individuals who were able to travel alone. Illiterate and non-regular physically active perceived “PA causes shortness of breath” as a barrier to PA more than educated and regular physically active. Individuals who had caring responsibilities perceived being busy at work as a barrier to PA more than those who were not employed and did not have caring responsibilities. Office workers perceived bad weather as a barrier to PA more than laborers workers. PA advice had a significant negative relationship with barriers such as “not enough time,” “feeling of being uncomfortable,” “lack of advice,” and “feeling too boring.”Although physical activity is widely reported as a principal factor in improving health, it is viewed as a significant challenge for patients with CHD worldwide. This study found that patients were mainly physically inactive (76%). Perceived benefits of and barriers to PA are vital elements influencing PA participation in this study. The physically active patients perceive more benefits of and fewer barriers to PA than non-physically participants. However, no study documented the perceived benefits of and barriers to PA in Jordan among patients with CHD.All participants in this study reported substantial perceived benefits of PA that were mainly physiological benefits rather than psychosocial benefits, which may be related to the influence of media components that focus on the physiological benefits of PA. Therefore, patients may have more information about the physiological benefits of PA than the psychological benefits of PA. However, physically active patients perceived the physiological and psychosocial benefits of PA more than those who were not regularly physically active. In addition, it may be related that most participants (76%) were not regularly physically active to experience PA's physiological and psychosocial benefits. The role of healthcare providers in reinforcing the knowledge about the impact of physical and psychosocial benefits of PA is a crucial step to be considered in PA programs.A predominance of perceived psychosocial barriers to PA was observed were “anxiety,” “lack of interest,” “feeling of being too lazy,” “do not like to do PA alone,” and “not frequently seeing others doing PA.” These barriers were also identified in Myers and Roth's studies . AnxietyNot enough time was reported in the present study. As such, the need for positive reinforcement and reassurance from healthcare providers who advocate physical activity in CHD is considered necessary to overcome this barrier. The time barrier reflects that individuals are busy at work, which is also perceived as a barrier to PA. It reflects no motivation to do PA because time barriers and busyness at work excuse more than the cause of not participating in PA, which is congruent with the findings of other studies, which showed that time was the most significant barrier perceived by cardiac patients. It is the most prevalent self-reported reason for dropout from supervised clinical and community PA programs , 32. MotThis study demonstrated that most patients with CHD (74%) are non-physically active. The challenge of participation in PA was linked to perceived benefits and barriers to PA. The patients in this study perceived various physiological and psychosocial benefits of PA. Also, Jordanian patients with CHD perceived different physical and psychosocial barriers to PA. In addition, it was found that the sociodemographic and health characteristics of the patients with CHD influenced their participation in PA and their perception of PA benefits and barriers to PA. The factors such as age, gender, health perception, chest pain frequency, education, job, PA advice, caring responsibilities, ability to travel alone, smoking, and current PA behavior were considered. It seems that different groups with samples perceived different barriers to PA. The findings of this study suggest that it may be valuable to replicate this study using a more significant and heterogeneous randomly selected sample to increase the generalization of the findings. The findings also suggest investigating barriers to PA as perceived by different groups of people  to identify their specific perceived barriers to PA and investigate selected interventions that are appropriate to decrease barriers to PA among patients with CHD. Also, the findings of this study indicate the need for an influential role for nurses and other health team members who provide care to patients with CHD in Jordanian hospitals and clinics. This role should consider the benefits of and barriers to PA and the influence of sociodemographic and health characteristics on perceived barriers to PA in their interventions to motivate the patients to participate in regular PA.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by the Institutional Review Board at King Abdullah University Hospital (KAUH) and Jordan University Hospital Administration. The patients/participants provided their written informed consent to participate in this study.EA planned the research, carried out the data collection, analyzed the data, and wrote the manuscript. FB reviewed the paper for publication. All authors contributed to the article and approved the submitted version.


In the next decade, with the tools of cloning and sequencing, we were able to establish that the rate of flagellar tubulin synthesis in Naegleria is determined by the abundance of flagellar α- and β-tubulin mRNAs. These experiments also established that the tubulins for Naegleria mitosis were encoded by separate, divergent genes, candidates for which remain incompletely characterized. Meanwhile an unanticipated abundance of tubulin isotypes has been discovered by other researchers. Together with the surprises of genome complexity, these tubulin isotypes require us to rethink how we might utilize the opportunities and challenges offered by the evolutionary diversity of eukaryotes.The multi-tubulin hypothesis proposed in 1976 was motivated by finding that the tubulin to build the flagellar apparatus was synthesized  The multi-tubulin hypothesis  was presNaegleria, followed by what we have learned from our studies since then about multiple tubulin isotypes in this organism. This is followed by a discussion of what Naegleria and the multi-tubulins have taught us about the incredible diversity of eukaryotes, about how evolution has tinkered with basic building blocks of eukaryotes, and about what “far-out” organisms like Naegleria can contribute to biology.Here I summarize the results that led us to this hypothesis 45 years ago, based on our study of cell differentiation in the free-living, single-celled amoeboflagellate E. coli and in temperate bacteriophage λ were regulated, something about which virtually nothing was previously known, entirely by using classical genetics of mutants and crosses  came to mind. We obtained some Naegleria, domesticated the organism, and trained it to undergo a rapid, synchronous, and temporally reproducible differentiation on command (N. gruberi NEG have visible flagella at 60 min (the T50). Anticipating genetics, we began to isolate an array of mutants , the change of  command . The dif mutants , but to ears ago ].Naegleria has a remarkable microtubule wardrobe. The amoebae have microtubules only in their mitotic spindle. Interphase amoebae have no microtubules in their cytoplasm or nucleus . The onntamoeba , which intamoeba , and thuNaegleria amoebae appear to utilize actin-based motility machines almost entirely, and shut down the synthesis of actin and other components promptly during differentiation. As far as I am aware, Naegleria (and a few very close relatives) are unique in this combination: a primarily actin-based motility machine switching to a primarily tubulin-based motility machine—a dramatic switch which justifies its being referred to as a “yin-yang organism”  bias, it took us a while to hear her message.Our first look at microtubules came with a series of surprises: no microtubules in non-mitotic amoebae, no centrioles, no detection of chromosomes in electron microscopy of dividing cells, We assumed, based on prevailing knowledge, that the tubulin involved in assembling mitotic microtubules would provide a pool to be used in the assembly of the flagellar apparatus. For example, Inoué’s idea of the dynamic equilibrium between a tubulin pool and the reversible assembly of mitotic apparatus  was wide10 cells  we obtained a yield of 1.5 mg of tubulin that was 93% pure —the highly efficient “cloning by phone” approach. Cloning the Naegleria genes took us several years—both because of the extensive separate evolution of these DNAs (see below) and because Naegleria genes are AT-rich (averaging 65% AT). We eventually cloned and sequenced flagellar α-tubulin genes  α-tubulin for mitotic spindle fiber microtubules or is a specialized α-tubulin that accounts for a minor percentage of the microtubules.” Determining whether such divergent tubulin as α6 is able, on its own, to build Naegleria’s mitotic spindle, remains an important question that needs to be answered using protein- and immuno-chemistry.An exciting advance was made by Lee’s laboratory when they found an ain NB-1 . This geNaegleria gruberi NEG-M (the axenic derivative of strain NEG) was completed . They found strain NEG’s putative mitotic tubulin genes, a non-identical pair of α-tubulin genes similar to the α6 of strain NB-1, and in addition a pair of β-tubulin genes of similarly divergent nature which they deduced might be the mitotic β-tubulin genes. In addition, they reported a set of tubulins that I consider a “bonus,” highly divergent members of both families, with seven different α-tubulins and five β-tubulins. These are divergent not only in sequence, sharing at best about 60% encoded sequence with the flagellar tubulin genes, but also with gaps and additions which suggest they are unlikely to encode tubulins that would themselves assemble into microtubules. Finally, the genome was found to contain conserved, single, encoded gamma, epsilon and delta tubulins.In 2010 the draft genome of ompleted . Among mN. gruberi NEG-M are shown to be expressed in growing amoebae, and this finding is extended to both putative mitotic β-tubulin genes of NEG-M, with none of the four genes expressed during differentiation. This finding supports the hypothesis that these divergent tubulin subunits, both α and β, play some role in growing amoebae, but still leaves open the question of whether they are either necessary or sufficient to build the mitotic microtubules. We need more direct evidence. These putative mitotic tubulin subunits are among the most divergent sequences found. I estimated a 61–64% identity of the two mitotic α to Naegleria flagellar α-tubulin subunits and 62–66% identity of the two mitotic β to Naegleria flagellar β-tubulin subunits, while most tubulins are conserved in the vicinity of ≥90% identity. None of these four putative mitotic α- or β-subunits encode a C-terminal tyrosine. It would almost be surprising if they can assemble into microtubules on their own. So while it remains clear that the mitotic spindles are built of something other than flagellar tubulin, we cannot conclude that these divergent tubulins are sufficient to build the mitotic microtubules until this question is answered by experiment. I suspect this investigation is likely to yield results of interest. Walsh has even raised the intriguing suggestion that perhaps a protein of the nucleolus, which co-divides with the chromosomes in Naegleria, may be involved in the spindle fibers . Even if something works, evolution has no hesitation to break it, and it is then left to selection to determine what happens next. If evolution destroys a mitotic apparatus, for example, that clearly is the end for that cell’s ability to reproduce.When vertebrates and their cells, even human cells, became accessible to cloning and sequencing, the emphasis shifted from an interest in “all” eukaryotes as models to a narrow focus on our closer relations, and especially on mammals. This has been encouraged by the support mechanisms for science. Simultaneously, we are learning that the complexity of eukaryotes is far greater than anyone imagined in the 1960’s, or even a decade ago. And lest we become inclined to think that all we need to know will come from mammals and their ills, we should remind ourselves that about half the Nobel Prizes in Physiology and Medicine which have involved research that utilized organisms have gotten their insights based on research using non-vertebrate organisms, from bacteria  to yeasts (autophagy), from ciliates (telomeres) to flies .It was early, and correctly, recognized that all known eukaryotes arose from a single ancestral cell, a last eukaryotic common ancestor (LECA), beginning perhaps as long ago as 2,200 mya (million years ago) or more , when oxNaegleria appeared to be an early-branching eukaryote  branching off. ukaryote , but sucukaryote .Naegleria draft genome was completed  had begun their separate evolutionary journeys. When such generalizations are applied to all the groups of eukaryotic protists, the diversity is immense, as is our ignorance about them. Later separations from LECA include some of the best-known branches, including the one that led to plants and the one that led to the fungi-metazoa lineage.We focus here on a single group, the Heterolobosea, a part of the “excavate” subgroup . As of 2014, and still today, the excavates—a world of little-known beasts with many fascinating properties—were the least studied of all supergroups in terms of genome sequences and of publications . The Het,100 mya . At arouNaegleria, there are roughly 40 species, and these include organisms that appear to be themselves quite diverse (N. gruberi and the opportunistic human pathogen N. fowleri were long ago argued to be evolutionarily as distant from one another as are frogs and people (Even within the genus  diverse . For exad people , a strikN. fowleri genome has been expanded (N. gruberi, one finds similar, but somewhat divergent, homologous pairs in the N. fowleri genome, as well as homologs to both flagellar tubulin subunits.So far the divergent putative mitotic tubulins have only been found within the few sequenced Heterolobosea . Now thaexpanded , when onChlamydomonas, appear to utilize a common set α- and β-tubulins to assemble microtubules for these two functions. In a world of logic, this would imply that the common ancestor might have used its tubulin genes in this manner. The key question for Naegleria is: were separate tubulin isotypes originally used for mitosis and flagellar apparatus, or was an integrated set of specialized isotypes the “original” arrangement? If the original was a single set, then what event occurred that led to Naegleria’s having a set of flagellar tubulins and a set of very divergent mitotic tubulins? Naegleria’s system now works very well, allowing an amoeba to grow and divide rapidly. Indeed, for Naegleria, with only one cell type that reproduces, the fastest growing amoebae will “win” the evolutionary race at every generation, and the genus is common globally wherever there is fresh water. But how, from an engineer’s viewpoint, could this situation arise? At some point evolution had to switch over either from a single tubulin set that did both or from two specific sets. Tinkering with events as complex as the separation of a cell’s genes and the assembly of its flagellar apparatus is dangerous. Somehow we must invoke gene duplication and divergence, but this does not explain what happened. I think that when we understand how this occurred in the midst of early evolution, we will have grasped something important both about tubulins and the evolution of organisms that use it. In a broader sense, this single example makes it clear that continuing study of diverse eukaryotes is going to enhance our understanding in ways that focusing simply on mammals never will.LECA had to assemble tubulins for a mitotic spindle and for a flagellar apparatus. Some organisms, such as Naegleria genome that the organism has a capacity for both aerobic respiration and anaerobic metabolism (Naegleria to switch modules quickly. Whatever the reason, changing one’s mitotic machinery seems like a very dangerous activity, even for an investigator as bold as evolution.One conjecture is that Heterolobosea evolved at a time when oxygen was very limiting, and having a specialized tubulin allowed them to manage division under anoxic conditions. We know from the tabolism . Green aNaegleria is gone. We can expect to learn much in the coming decades. But we have certainly learned not to think of eukaryotes as a uniform group, but instead as a group whose diversity has much to teach us that our own small group, the mammals, cannot. The “far-out organism” Naegleria showed us multi-tubulins, as it demonstrated the capacity of centrioles to assemble de novo; these surprises subsequently have been extended to mammals and changed our ways of thinking. Naegleria has more to contribute, as do numerous other neglected protists.The vastness of this 2200-million-year global experiment takes one’s breath away. Genomics are just beginning to reveal the complexity and subtleties of eukaryotes, as more species and groups are analyzed. The day when what’s good for the elephant is good for Animal Farm: “all tubulins are equal, but some tubulins are more equal than others” (In the meantime, the more we know about tubulins, the more it seems true that, paraphrasing George Orwell about the pigs in  others” . Tubulin


This article argues that in a Janus-faced Liberal International Order, American grand strategy faces an economy-security conundrum. Tensions between transnational economic networks and national security concerns require different administrations to square a balance between important yet competing interests. This conundrum is especially challenging for Washington, D.C., when dealing with China. Indeed, while the Chinese and the American economies are interdependent, China continues to rise, with revisionist demands, and outside of the US-led system of alliances. The economy-security conundrum is managed by different presidents who pursue similar long-term objectives but through different approaches, leading to both strategic continuity and policy changes between one administration and the next. Former US President Barack Obama’s Trans-Pacific Partnership, subsequent President Donald Trump’s trade war, and President Joe Biden’s Build Back Better World (B3W)—most recently rebranded as Partnership for Global Infrastructure and Investment (PGII)—are indeed different policies, but all are aimed at either compelling China to abide the free-market rule of law or to separate from the West, especially regarding strategic and future industries. This article provides an analysis of the economy-security conundrum in US foreign policy toward China. It advances a twofold argument. The economic interdependence of the United States with a geopolitical rival like China requires effort to strike a balance between the economic interests of private companies and the national security interests of the state. This balance is addressed by different presidents and administrations who pursue similar long-term, strategic goals but through different policies: while American grand strategy does not change, one can see different ways in which it is operationalized. Former US President Barack Obama’s Trans-Pacific Partnership, subsequent former President Donald Trump’s trade war, and President Joe Biden’s Build Back Better World (B3W)—most recently rebranded as Partnership for Global Infrastructure and Investment (PGII)—and Indo-Pacific Economic Framework (IPEF) are policies that have sought to implement the same long-term goal—compelling China to abide the free-market rule of law. That said, each administration has pursued this goal with a different approach.This conclusion is achieved by building on recent neorealist contributions to literature on American grand strategy and the flaws of liberal hegemony identified by Barry Posen , StephenThe rest of this article is organized in four sections. The first defines the economy-security conundrum while engaging with the literature on the LIO. The LIO, indeed, is riddled with tensions between its two structural pillars, such as an aspatial network of flows of capital, goods, people, ideas, and a territorial order made of sovereign states. The second section continues to reflect on the economy-security conundrum but through the lens of American grand strategy. Here, it is discussed how the US, for the sake of economic interests, has contributed to the rise of a geopolitical rival. Furthermore, it is demonstrated how recent US administrations have struggled to find a balance between economic and security interests. The third section contains a comparison of Obama’s, Trump’s, and Biden’s foreign economic policies toward China. In the fourth section, the conclusion is drawn that, while there was discontinuity in the policies used—possibly caused by differences in their worldviews—the ultimate objectives of the three leaders’ strategies were aligned; they all aimed to discipline or isolate China, especially by intervening in supply chains of critical technology and industries Porter , 204. ThThe economy-security conundrum concept captures the competing nature of economic and security interests and the challenge of coordinating these in foreign policy. It is particularly useful at a time of deep globalization and rising political systems that are competing with the Western model. While some of the academic literature implicitly acknowledges the existence of such a conundrum, the label “economy-security conundrum” is not used explicitly. The latter represents a more focused interpretation of the concept of “economy-security nexus,” applied as a broad umbrella that covers the realist-liberal dichotomy; this concept is defined as “how well or how poorly states interact with one another in geopolitics and how this is (or is not) affected by their economic relations” Pempel , 17. Howcomplexio oppositorum of exceptionalism and universalism” (6The economy-security conundrum can be further deconstructed. First, while one can artificially separate economic and security interests, they are in fact more interdependent than the concept suggests. Colin Flint explained that the state-network dichotomy is not a simple one, because states—or sections of them—have been “active agents in promoting [or shaping] transnational networks” (Ibid, p. 180; Farrell and Newman rsalism” , 6.5 Simrsalism” , 218.6From these accounts of American grand strategists, one can infer two points of both conceptual and historical value. First, the economy-security conundrum is a spectrum, and in different historical periods US administrations will position on different sides of it. During the Cold War, security interests dominated in foreign policy, as compared to the 1990s, when the philosophy of hyperglobalism found many advocates in Washington, D.C. Second, US strategy-makers in the long-term have set the conditions for the US to become entangled in the inner contradictions of its own strategy and, more broadly, of the type of world order that it has designed since the end of WWII. This is especially the case when dealing with a commercial partner that operates through different values and institutions. The challenge for Washington, D.C. is to contain the rise of China while benefiting from its performance as a crucial locomotive of the global economy.Observing American grand strategy in a post-unipolar era, prominent neorealist scholars advocated for the US to disengage from global commitments. Stephen Walt stated that a grand strategy of liberal hegemony entails that “the United States must remain much more powerful than any other country,” and that “it should use its position of primacy to defend, spread, and deepen liberal values around the world” , 54. SimIn contrast with Japan and Germany—which remain tied to the US through formal diplomatic agreements—the rise of China has made managing the economy-security conundrum highly challenging, due to the magnitude of the Chinese economy, its depth of integration within the LIO, and the diplomatic-military isolation of the PRC. As China’s military power increased after the Cold War, Washington, D.C. was struggling to keep “the world open enough” for American and global business while “prevent[ing] the rise of any grand challenge” to American power Harvey , 84. YetThe rise of China and tensions between economic and security interests have been especially felt in the Indo-Pacific—while not so much in the MENA region, for instance. In 2011 the Obama administration announced that it intended to make the Asia–Pacific a geopolitical priority Clinton . The PenWhile the economy-security conundrum continued to affect US strategy-makers, the Trump administration was able to pursue rebalancing economic and security interests—also thanks to a bipartisan anti-China mood in Washington, D.C. Zhao , 372–373The Obama administration’s foreign economic policy toward China reflected Obama’s commitment to regionalism. The president’s policy manifested elements of pragmatism and selective engagement with the world’s problems, but the worldview was a Wilsonian one. Obama stated that “power is no longer a zero-sum game;” that “[n]o balance of power among nations will hold;” and that the post-WWII “international order … brought about diplomatic cooperation between the world’s major powers” , 2009b. While Obama’s worldview depicted an interconnected global system, former president Trump manifested a Hobbesian, disarticulated worldview where “social and political organization are defined in terms of this or that state” Agnew , 98. In vis-à-vis diplomatic tensions and disruptions. This objective has been set out in the executive order titled America’s Supply Chains, which demanded a review of US supply chains resilience (Biden Contrary to recent presidents like George W. Bush, Obama, and Trump, whose worldviews were clearcut, President Biden has not yet left an ideological legacy in US foreign policy. Nonetheless, it is evident that two structural factors have influenced his approach. First, in contrast to his two predecessors, Biden has been a member of the political establishment throughout his career; his foreign policy has not derailed from the pillars of American grand strategy—in the way Trump’s policy did. But, Biden inherited from Obama and Trump the strategy of “pivot to Asia” and a domestic environment increasingly sceptical of China. Considering this, his foreign economic policy toward China has sought to tackle the economy-security conundrum with features that resembled both Obama’s and Trump’s approaches. Like in Obama’s and Trump’s foreign policy, the underlying theme of Biden’s policy has been one of growing dissatisfaction with the LIO, and an effort to reform it in a more US-friendly way. While Biden’s strategy remains undeveloped, the primary theme is pursuing geo-economic re-engineering of the LIO by leveraging US alliances. From an operational viewpoint, Biden has sought to bridge the gap between supply chains and geopolitical objectives; that is, to make trading networks more resilient ce Biden . The repce Biden , 7. Two ce Biden . This wace Biden , 857–858ce Biden . This coce Biden .A second important move, in keeping with the overarching logic of the B3W, was the launch of IPEF, Biden’s attempt at replacing the defunct TPP—which currently the US does not intend to re-join (Barns-Graham Biden’s economic policy, aimed at keeping China out of a US-led sphere of influence, represents a development in the commitment to decoupling within US policy circles. That said, for the GPII and IPEF, the road is not without obstacles. Regarding the GPII, at Carbis Bay G7, the communiqué confirmed that members “will cooperate to address the challenge posed by China” but only “where it is in our mutual interest” (Carbis Bay G7 Summit Communiqué Nonetheless, these two frameworks are informed by strategic thinking and represent a sophisticated evolution in US foreign economic policy toward China. More to the point, the comparison between Obama’s, Trump’s, and Biden’s foreign economic policy toward China, provides evidence about two dynamics central to American grand strategy in the post-2008 era. First, tensions between economic and security interests have great influence on US economic policy toward China. In a liberal order made of an international system of states and a spaceless economy, the foreign policy of the hegemon will be in tension with developing a coherent policy toward one of the locomotives of the global economy, namely China. Second, in hindsight and following from the previous point, the trend of US foreign economic policy toward China has been and will continue to be one of decoupling. To balance the economy-security conundrum, it appears logical to assume that this decoupling will be highly selective and is likely to affect only some strategic industries—as in the case of semiconductors—and, above all, next-generation technology, and the green economy.This article sought to advance a contribution to the debate on US foreign policy after 2008 and US–China relations by unpacking the tension between national and global interests endemic to US grand strategy. This intervention was necessary to bring fresh insights into the debate stimulated by arguments laid out by neo-realist scholarship. Neorealists such as Posen, Walt, and Mearsheimer pointed out that American grand strategy, especially since the end of the Cold War, has been flawed by its constant attempt at engineering a liberal international order based on international rule of law, liberal democracy, and human rights, among several other principles. They correctly maintained that enforcing such order has undermined American national interests and power. This article, indeed, agreed that the American grand strategy of liberal hegemony has drained the relative power of the hegemon. Yet, it maintained that the main structural flaw of a strategy of liberal hegemony is the intentional integration into the LIO of countries that can become geopolitical rivals of the United States. While American grand strategy represents a synthesis of two self-reinforcing but also contradictory elements—nationalism and globalism—this strategy has contributed to causing the rise of economic competitors, such as Japan and Germany, and systemic rivals, such as China. Managing the economy-security conundrum in a post-American order, furthermore, has become an increasingly challenging task, especially when confronting China. The latter’s strategic interlocking between political power and key—state-owned—industries allows China to leverage on whole-of-government cooperation for the sake of geopolitical objectives. The latest developments in American foreign policy, from the B3W and PGII to IPEF and, more broadly, to calls for decoupling and whole-of-government approaches against security challenges, are a testament to the fact that the US, like other Western governments, is taking a page from China’s book. Cooperation between government and industries, and between close allies, is a key element for facing a competitor like China that can pull different levers of power at once.


In this article, we show that voluntarily inserting devices inside the body is contested and seek to understand why. This article discusses insertables as a source of contestation. To describe and understand the social acceptability, reactions toward, and rhetoric surrounding insertable devices, we examine (i) the technical capabilities of insertable devices , (ii) human reactions toward insertables , and (iii) the regulatory environment. The paper offers explanations to the misperceptions about insertables. The emerging HCI field of inbodied interaction seeks to align our body’s physiology with design to optimize human performance , p. 885.insertables – voluntarily, non-medical, devices inserted in, through, and underneath the skin  the technical capabilities of insertable devices , (ii) the reactions toward insertables , and (iii) the regulatory environment. While ethics, governance, and trust are briefly discussed, they are not the main focus of the paper and are an area for future inquiry.Opposition to insertable devices is multi-faceted – from misperceptions regarding how the devices work to religious and moral objections. A misperception is not necessarily borne out of ignorance. People may hold a misperception to be true with a high degree of certainty, and use it as evidence of being well-informed , p. 2. TThe ways in which insertable devices are spoken about influence the understanding of, and response to, them. While the concept of non-medical devices inside the body is not new, the practice is a more recent phenomenon. The earliest recorded prediction of devices being inserted is from Dr. Alan Westin in 1976 . HoweverOver two decades later, the use of devices inside the body for non-medical purposes remains novel and is generally not well understood. On occasions, the media report on an instance of insertable use e.g.,  after whOver a decade after Warwick’s experiment, a now-defunct American company, VeriChip, created an FDA-approved insertable RFID microchip. This was used for patient identification and retrieval of medical records in hospitals . While VSince 2006, hobbyists have been able to purchase RFID and NFC microchips from the online retailer Dangerous Things . Now theMicrochips are used for amenity-based purposes of access and authentication , storing and sharing information, and triggering actions when scanned by a smartphone . MicrochSome participants in One workaround to creating a payment system is by converting physical credit cards into a large custom insertable which are more invasive to insert and cannot be inserted via a needle. Dangerous Things offers a service to convert a micro-bankcard into an insertable. Micro-cards are provided by some banks to be placed in wristbands or other wearable-devices and are similar to older (larger) SIM cards . DangeroNewer insertable devices from Dangerous Things are using the more sophisticated and proprietary Walletmor payment microchip. This purpose-built device can be linked with a Walletmor account and used for payments (EU only) . This deIn terms of sensing and measuring body physiology, some microchips can be used to read body temperature when scanned with a reader  and a bespoke device reported by It will be demonstrated that some opponents fear that insertable devices can be used for tracking and controlling (see section “Tracking and controlling fears”). It is thus important to understand how data are transmitted from insertables and the read ranges.RFID and NFC use radio waves to transmit data from transponders (tags) to an external reader . The twoThere are two types of tags – active and passive. The differences between the two are summarized in The “Opponents and detractors (negative)” section will demonstrate concerns regarding the safety of RFID and NFC from opponents.Microchips have safely been inserted into pets since the 1980s with many jurisdictions requiring this by law . There iConversely, a human study suggested that RFID microchips in tumors could be a promising cancer treatment with three types of cancer cells being killed by the frequencies . The WorNew technologies face social challenges ; the sucWhile insertables use is growing , few proeveryone should).Proponents who are interested in transhumanism highlight “a future where humanity has progressed toward an upgraded version of itself” , p. 18. While not everyone will choose to insert a device, public sentiment seems to be shifting with acceptability on the rise. Given that younger people are more open to insertable devices, this may speak to the continued rise in their acceptability of them. While participants in 1.Personal narrative – self-expression to show identity.2.Individuality – body modifications signal being “special” and distinctive.3.No specific reason – not categorized, e.g., the result of impulse over reasoned decision-making or under the influence of illicit substances.These motivators may be important to young people as they grow and express themselves as individuals. Another reason that the younger generation may be more open to insertables is that they are more familiar with and accepting of all forms of technological innovation within a digital society. Once insertable devices have greater utility, there may be less social stigma preventing up-and-coming generations from inserting them.A 2002 study  showed tAs people begin to do things more and more (like using a new device), society begins to accept them . Once thA large reason for this neutral sentiment is that insertable devices are not (currently) useful or compelling enough . The curDue to the perceived low utility of insertable devices, many may prefer to continue using wearables. Predicting the future is inevitably difficult; current low utility does not necessarily mean that insertables will not continue to gain in adoption and popularity. For example, complaints that new technologies are not useful enough or unnecessary have not stopped technological progress before with regard to the PC revolution. “There is no reason anyone would want a computer in his home,” Ken Olson infamously claimed. This sentiment was echoed by Thomas J Watson’s similarly well-known comment: “I think there is a world market for maybe five computers.” Even Microsoft founder Bill Gates issued a 16-page memo in 1994 dismissing the Internet as merely “hype” of “hobbyists” . These pOpponents are concerned about microchips encroaching on “civil liberties and individual autonomy” , p. 1. SSkeptics use “sci-fi associations and references…to warn about dystopian developments” catalyzed through insertables , p. 18. But who is this omnipresent mysterious they? Ronson explores this question, describing the beliefs of one family:“the world was being secretly ruled by a clique of primarily Zionist international banker, global elites who want to establish a genocidal New World Order and implant microchips bearing the mark of Satan into everyone’s head” , p. 50.While these people may be “paranoid radical conspiracy theorists” , p. xii,There is also religious opposition to these technologies . The deb“He causes all, both small and great, rich and poor, free and slave, to receive a mark on their right hand or on their foreheads, and that no-one may buy or sell except one who has the mark or the name of the beast, or the number of his name.” (Revelation 13:16–17).Some fundamentalist Christians believe that those inserting microchips are receiving “the mark of the beast” . It is nInterestingly, even Dangerous Things founder Amal Graafstra was initially against the idea of microchips. He reflects: “basically everyone I grew up around, thought these things were evil and they would end up controlling humanity via satellite. I did not doubt that point-of-view or those technological misperceptions for quite some time” , p. 502.Some people find insertable devices morally repugnant and offensive. Offensive, however, can be a synonym for unusual, and reflective of attitudes of the time. The stigma associated with some emerging technologies has historically neutralized with time. For example, eyeglasses were “hotly debated in their time” but are now accepted , p. 95. Technologies perceived to violate the sanctity of the body can trigger disgust . Some arHomo sapiens behind. Homo sapiens poorly. Some opponents argue that insertable devices will create, or widen, a digital divide  to other devices (such as smartphones). While minds are extended through smartphones, and they What makes humans change over time, and insertables (for the near-term at least) do not seem to have implications that will drastically change how people live their lives. This is not a so-called watershed moment as the technology itself does not change humanity – the Amish are, after all, just as human as a technophile.Currently, as demonstrated above, insertables use is contested and it is easy for opponents to conjure concerns of Orwellian government tracking despite this being incongruent with the current technological realities of RFID and NFC. Privacy concerns surrounding insertable devices are perhaps not surprising as we, as a society, have become more aware of the privacy infringements of some companies, how much data they have, and how much control they can exert with this . But theInterestingly, the ethics of RFID badges given to employees do not appear to be discussed or even considered to be an issue, yet they are using the same technology as insertables (arguably they are more advanced because they have greater read ranges due to their larger size). A difference is you can leave badges at home, but they are still required in the office. It is clear there is more to insertables opposition than just tracking and privacy concerns.The creators of insertable devices are not large companies creating mass-produced objects. They are small-scale innovators who first began to experiment with insertables to reduce friction in their lives, for fun or learning or as a creative outlet, rather than for profit. These “makers and tinkerers”  were, unOver time they have become established insertable companies, heralding a consumer market in insertable devices that previously did not exist. Regulatory oversight to ensure consumer protection is not yet a feature of this emerging market. Further research is required to understand how these companies can or do work with regulatory bodies for safe paths to market and device safety. One insertables company, Grindhouse Wetware, no longer sells products due to these questions while another, BioHax, only inserts their devices themselves to mitigate risks and prevent accidents which would result in further opposition to insertables.While Verichips were FDA-approved , currentIn the absence of regulation, the Human Augmentation Institute (HAI) is interested in upholding the bodily autonomy of individuals whilst ensuring augmentations are conducted ethically, safely, and responsibly. They developed a Human Augmentation Code of Ethics, similar to DSruptive (a company manufacturing insertable devices) , based o® implant, Mirena® IUD, and Depo-Provera® are purchased from pharmacists, with the intention that they will be taken to a medical professional for insertion or injection  have contributed to misperceptions regarding insertables. The next subsection explores why this is so.It is not simply that people believe what they see in the movies as truth. Few would state that their beliefs about insertables are based on fiction, yet sci-fi associations may influence the understanding of insertable device uses and capabilities without conscious awareness. This may occur as assumptions are made about emerging devices because one believes they know about the category to which they belong , p. 248;When a new statement is encountered, related information is involuntarily retrieved from memory , p. 127 Furthermore, when there is limited knowledge regarding a particular topic, it is constructed from prior experiences and related knowledge – constructivist learning . Where tTechnologies in sci-fi are pervasive and becoming indistinguishable from real technologies  contribuStories are “attractive to our minds” , p. 98 aNarratives aid in understanding cause and effect and learning how to respond to future events. Science fiction may have prepared people for how to act, i.e., one should be fearful of insertables because it is known how this will end (in a dystopian future). Conclusions can be jumped to without considering alternatives or even being aware of the alternatives to consider; insertables must be the same as those seen in sci-fi and few other considerations are made as ideas about this technology are settled. The ease of recalling sci-fi images likely influences this , p. 58. The conflation of fiction with what real insertable devices can do it not conscious; it is not done using slow and deliberate thinking, what As mentioned, there are conspiracy theories surrounding insertables, that powerful and malicious groups are currently inserting devices, often without knowledge, for alleged nefarious, purposes of tracking and controlling. Some believe devices are inserted without consent or knowledge such as through eye exams, vaccinations, or at birth. This section explores why these, and other misperceptions, may exist.The above influences of science fiction and conspiracy theories can lead to misperceptions about what inserted microchips can do. This is not only confined to human microchips; Speaking of RFID generally, Misperceptions are also influenced by religious and ideological beliefs , p. 7. FAs stated earlier, misperceptions are not ignorance – people both hold them to be true and themselves to be well-informed . InsteadConspiracy theories can be considered fake news. In the past, conspiracy theories have been attributed to irrationality, paranoia, delusions, and “schizotypy,” however, The salience of concerns and fears of insertables being used for tracking and controlling shows people are worried about this possible future. Society reflects the fears and values of the population as well as the trust it holds. While enforced microchipping and tracking are fanciful and unlikely to occur in the near future, the fears are still legitimate. The acceptance and future uses of insertable devices are dependent on the influence of society. It is, therefore, important to understand the reasons behind the current constructions of knowledge about insertable devices.Rather than simply dismissing misperceptions as a result of one falling prey to a conspiracy theory, or conflating fact and fiction, this section aims to find models that may explain beliefs about insertables.Emotion and intuition influence reactions to technologies . These aFollowing this theory, when insertables are next mentioned, these judgments come to mind quickly and confidently, without being aware they were created through biases. The world in one’s mind is not a precise facsimile of reality; views are distorted by the prevalence and intensity of emotions felt.The ease at which ideas come to mind is also impacted by emotional reactions to them. Frightening thoughts and images can occur easily. These feelings and inclinations can become beliefs and attitudes, without critical examination. In order to explain beliefs about insertables, including the misperceptions and fears described earlier, literature regarding cognitive biases was explored. The studies of Based on the cognitive biases in The possibility that a device will be developed that is small enough to insert and can track without requiring charging seems unlikely, especially any time soon. Despite the improbability, the public still has a fear-based response over a rational one. Where vivid constructions representing such an eventuality are easy to conjure, influenced by affect-laden imagery , undue wInsertable fears, while technologically unfounded, are a result of real concerns. Similarly, while what is thought and felt about insertables may be influenced by biases, the availability of such thoughts is influenced by these concerns. Misperceptions and emotional reactions reflect what people are most worried about. The public has lost trust in technology companies, academics, and the government . They arPublic discourse impacts the construction of insertables’ knowledge. Given the possible impact of cognitive biases, whenever there is a discussion of insertables online, it is largely ideologically driven and influenced by the mythology discussed. Moral feelings further impact discourse , p. 370.Once claims of one being microchipped against one’s will drew scoffs of derision and accusations of schizophrenia, psychosis, or altered reality. Now that similar devices are becoming a reality, there is a fear of the unknown. Furthermore, disinformation spreads up to 10-times faster, further, “deeper and more broadly than the truth” . This isPublic discourse largely follows confirmation biases. Information that accords with existing beliefs is paid attention to, reinforcing knowledge. The ease of finding communities of like-minded people has increased with the proliferation of the internet. Groups can form around topics that do not listen to “outsiders”; the in-group’s thinking, even if it may be illogical or inaccurate, is reinforced , p. 217.This often strengthens resolve as people are resistant to changing their opinions. Facts that challenge these are simply ignored , p. 126,New technologies are societally deemed good or bad , and insvoluntary insertion, based on (unfounded) tracking fears (Moral panics can lead to societal-actors “like editors, policymakers [and] religious leaders” speaking out against new technologies and possible solutions , p. 1147ng fears . Such boPublic opinion is shaped by the press. However, it is important to examine how media information is reacted to rather than simply blaming the media. There is distrust in claims insertables cannot do what people believe they can. As previously argued, there is a bias toward information confirming what one already believes , p. 13, The media plays an important role in helping the public understand technology and research. They are a “significant means by which knowledge… generated by ‘experts”’ is handed over to the public , p. 331.Some are critical of the media. Rather than simply blaming the media, Even with accurate reporting, imagery influences the way text-based information is understood as images are processed faster than words and without engaging critical reasoning , p. 196.The media should not act as a scapegoat for the state of misperception and misinformation. This article has argued that the media is not the only cause of misperceptions. Emotions, cognitive biases, and identity impact how reality is viewed , p. 178.Misinformation is also perpetuated in published literature. For example, Additionally, Gauttier claimed microchips can be used to “pay” and replace credit cards . CurrentThere are also several examples of published research speculating about the future of insertable devices. This article has been concerned with understanding the socio-technical context within which insertable devices reside. The technical capabilities of insertable devices and the views of insertable device opponents were presented. These are largely incongruous with each other.The way technology is talked about shapes the way it is understood. The volume of misinformation and disinformation surrounding insertables is an issue. First, it makes the work of finding the truth more difficult in a deluge of conflicting stories. Second, due to the illusory truth effect, the repetition of such stories can increase the belief they are true. The more these are repeated, the more likely it is for people to believe them as fact. Conspiracy theories and general distrust are rife yet contradicting insertable device capabilities. Considerable time was spent exploring possible explanations for why people think and feel the way they do about insertables.While the truth alone does not change misperceptions, and this is not the intention of this research, it adds to a stock of knowledge about insertables. With anti-intellectualism  and “misAs there are large amounts of misinformation and misperceptions regarding devices inside the body any researchers exploring such devices will need to work to address these. However, this would need to be very carefully managed so as not to amplify and ultimately spread disinformation in “myth-busting” campaigns. Similarly, simply telling one to “listen to the facts” of technology does not build trust as per , particubefore they are exposed to a conspiracy theory reduced their likelihood of believing it; while conspiracy theories are difficult to correct, one can be “inoculated” against them. “Inoculating” the public against the conspiracies may be a way for inbodied interaction researchers to move forward. Transparency into researchers’ actions and intentions will also help address some of the opposition while preventing unwanted futures.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by the Office of Research Ethics and Integrity, University of Melbourne. The patients/participants provided their written informed consent to participate in this study.FV and SC supervised the research. All authors contributed to the article and approved the submitted version.