weight

Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight

OBJECTIVE

We evaluated the effect of optimizing metformin dosing on glycemia and body weight in type 2 diabetes.

RESEARCH DESIGN AND METHODS

This was a prespecified analysis of 6,823 participants in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) taking metformin as the sole glucose-lowering drug who completed a 4- to 14-week (mean ± SD 7.9 ± 2.4) run-in in which metformin was adjusted to 2,000 mg/day or a maximally tolerated lower dose. Participants had type 2 diabetes for <10 years and an HbA1c ≥6.8% (51 mmol/mol) while taking ≥500 mg of metformin/day. Participants also received diet and exercise counseling. The primary outcome was the change in HbA1c during run-in.

RESULTS

Adjusted for duration of run-in, the mean ± SD change in HbA1c was –0.65 ± 0.02% (–7.1 ± 0.2 mmol/mol) when the dose was increased by ≥1,000 mg/day, –0.48 ± 0.02% (–5.2 ± 0.2 mmol/mol) when the dose was unchanged, and –0.23 ± 0.07% (–2.5 ± 0.8 mmol/mol) when the dose was decreased (n = 2,169, 3,548, and 192, respectively). Higher HbA1c at entry predicted greater reduction in HbA1c (P < 0.001) in univariate and multivariate analyses. Weight loss adjusted for duration of run-in averaged 0.91 ± 0.05 kg in participants who increased metformin by ≥1,000 mg/day (n = 1,894).

CONCLUSIONS

Optimizing metformin to 2,000 mg/day or a maximally tolerated lower dose combined with emphasis on medication adherence and lifestyle can improve glycemia in type 2 diabetes and HbA1c values ≥6.8% (51 mmol/mol). These findings may help guide efforts to optimize metformin therapy among persons with type 2 diabetes and suboptimal glycemic control.




weight

Brief interventions for obesity when patients are asked to pay for weight loss treatment: an observational study in primary care with an embedded randomised trial

BackgroundA brief intervention whereby GPs opportunistically facilitate an NHS-funded referral to a weight loss programme is clinically and cost-effective.AimTo test the acceptability of a brief intervention and attendance at a weight loss programme when GPs facilitate a referral that requires patients to pay for the service.Design and settingAn observational study of the effect of a GP encouraging attendance at a weight loss programme requiring self-payment in the West Midlands from 16 October 2018 to 30 November 2018, to compare with a previous trial in England in which the service was NHS-funded.MethodSixty patients with obesity who consecutively attended primary care appointments received an opportunistic brief intervention by a GP to endorse and offer a referral to a weight loss programme at the patient’s own expense. Participants were randomised to GPs who either stated the weekly monetary cost of the programme (basic cost) or who compared the weekly cost to an everyday discretionary item (cost comparison). Participants were subsequently asked to report whether they had attended a weight loss programme.ResultsOverall, 47% of participants (n = 28) accepted the referral; 50% (n = 15) in the basic cost group and 43% (n = 13) in the cost comparison group. This was significantly less than in a previous study when the programme was NHS-funded (77%, n = 722/940; P<0.0001). Most participants reported the intervention to be helpful/very helpful and appropriate/very appropriate (78%, n = 46/59 and 85%, n = 50/59, respectively) but scores were significantly lower than when the programme was NHS-funded (92% n = 851/922 and 88% n = 813/922, respectively; P = 0.004). One person (2%) attended the weight loss programme, which is significantly lower than the 40% of participants who attended when the programme was NHS-funded (P<0.0001).ConclusionGP referral to a weight loss programme that requires patients to pay rather than offering an NHS-funded programme is acceptable; however, it results in almost no attendance.




weight

Suspected Metallic Embolization Distal to Coiled Intracranial Aneurysms Detectable by Susceptibility-Weighted MR Imaging [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

After endovascular coiling of intracranial aneurysms, round dark parenchymal lesions believed to be particulate metal are sometimes encountered in MR imaging studies of the brain. We used SWI to assess the frequency of such occurrences, in addition to exploring likely causes and clinical implications.

MATERIALS AND METHODS:

We reviewed 700 MR imaging studies performed between September 2018 and March 2019 at our institution as follow-up monitoring of coiled intracranial aneurysms. Any sizeable (>5 mm) rounded dark-signal lesions encountered were presumed to be metallic. The magnitudes and locations of such lesions were recorded. In patients with these lesions, pertinent procedural documentation was screened for devices used, including coils, microcatheters, microguidewires, and stents. Medical records were also examined to determine whether any related symptoms ensued.

RESULTS:

Twenty patients (2.8%) exhibited a total of 25 lesions on SWI. Diameters ranged from 5 to 11 mm (median, 8 mm). All except 2 lesions were located in brain regions downstream from aneurysms, but all lesions occupied vascular territories of vessels used to place guiding catheters. Other than the Synchro 14, which was routinely deployed, no device was regularly used in patients with SWI-detectable lesions; and none of the affected patients developed focal neurologic symptoms as a consequence.

CONCLUSIONS:

Although the origins remain unclear, distal embolization of particulate metal distal to coiled cerebral aneurysms is occasionally observed on follow-up MR imaging studies. Such lesions, however, seem to have no apparent clinical impact.




weight

Bill Maher Has the Worst Take on Adele’s Weight Loss: ‘The Old Adele Would Not Fare as Well With COVID-19’

HBO

Adele posted a message to her social media channels this week thanking those on the front lines fighting COVID-19. In the process, the celebrated singer unveiled a thinner frame—and the internet had a lot of thoughts about it, almost all trash.

Enter Bill Maher, noted #MeToo skeptic, with perhaps the most garbage take of them all.

On Friday night, during the interview portion of his HBO show Real Time, the comedian began by placing the bulk of the blame for the high amount of COVID-19 deaths in the U.S. compared to other countries on America’s obesity problem—not, say, the fact that the Trump administration didn’t do a single thing during the month of February to contain the spread of the virus.

Read more at The Daily Beast.

Got a tip? Send it to The Daily Beast here




weight

Diets do help you lose weight - but the benefits usually don't last

Atkins, Paleo or Zone – whichever diet you follow, you’ll probably only lose a bit of weight, and improvements to your cholesterol may disappear within a year




weight

It's time to give the pedometer a break and embrace lifting weights

The incredible benefits of strength training are only just becoming apparent. That's good timing, when working out indoors is beneficial to everyone's health




weight

Men are worse than women at estimating their height and weight

We tend to overestimate our height and underestimate our weight to fit society’s ideals, or because we think we're still the same as our younger selves




weight

Adele reveals her incredible weight loss in new birthday picture

The 'Hello' singer turned 32 on Tuesday (05.05.20) and when she took to Instagram to thank fans for their well-wishes on her special day




weight

Food For London Now: Pret A Manger opens 10 shops close to hospitals and throws weight behind Standard appeal

You can donate at virginmoneygiving.com/fund/FoodforLondonNOW




weight

Line of Duty star Adrian Dunbar jokes that he is &apos;worried&apos; about cast&apos;s weight gain while series 6 filming is suspended

'I'm kind of worried about what's going to happen because a lot of us are eating quite a lot'




weight

Courteney Cox &apos;loved playing overweight Monica&apos; in Friends because she &apos;felt free&apos;

Actor also revealed her favourite episodes of the sitcom




weight

Gogglebox&apos;s Jonathan Tapper says weight loss helped him beat coronavirus

Jonathan Tapper says he "couldn't move at one point" and was "really struggling for breath"




weight

Sport TikTok challenges this week: World records, stay-at-home weightlifting and Dele Alli

With sport in lockdown across the globe , more and more sports stars are turning to social media to entertain themselves - and their fans.




weight

Adrienne Bailon Shows Off 20 Lb. Weight Loss In Black Bikini



She credits her fitness to one lifestyle change.




weight

Kym Whitley Is Weight Watchers' New Brand Ambassador



The “Twenties” star made the big announcement today.




weight

THIS was Rithvik Dhanjani's weight before he became an actor




weight

Stress eating and coronavirus: Weight Watchers rolls out Zoom virtual workshops


In mid-March, WW International, also known as Weight Watchers, decided to close its 3,000 physical locations but didn’t want to leave members to fend for themselves in these trying times.




weight

Adele's former personal trainer speaks about star's dramatic weight loss

The singer shared a post on Instagram to mark her 32nd birthday, revealing her slimmer frame




weight

Corrie star Colson Smith almost unrecognisable after incredible weight loss

The Corrie favourite has stunned fans with his new look after taking up running




weight

Recent Weight Management Ingredient Research Reflects Emerging Trends

Emphasis on fat and protein intake, reduced carbohydrate intake and gut health for managing weight are trends affecting the global weight management category.




weight

I'm gaining weight in quarantine and I couldn't be more thrilled about it

If the worst thing that happens to me during this global pandemic is that I have to buy new pants, I will weep with gratitude.




weight

Age influences structural brain restoration during weight gain therapy in anorexia nervosa




weight

Author Correction: “Dysfunctions” induced by Roux-en-Y gastric bypass surgery are concomitant with metabolic improvement independent of weight loss




weight

Comments on “The role of appetite-related hormones, adaptive thermogenesis, perceived hunger and stress in long-term weight-loss maintenance: a mixed-methods study”




weight

Predictors of weight loss after bariatric surgery—a cross-disciplinary approach combining physiological, social, and psychological measures




weight

Punching Below Its Weight: The U.S. Government Approach to Education in the Developing World

Summary

Global education plays an important role in contributing to U.S. foreign policy objectives. In a recent speech, Secretary of State Hillary Clinton highlighted education, along with health, agriculture, security, and local governance as the core areas for U.S. international development investment. She emphasized the importance of education, particularly of girls and youth, in improving global stability, speeding economic growth, and helping global health, all of which advance U.S. interests in the world.

But how effective has the U.S. government been in supporting global education? Unfortunately, its many good education activities and programs are not leveraged for maximum impact on the ground, especially in situations of armed conflict and state fragility. Challenges of U.S. foreign assistance—for example, fragmentation across multiple agencies, lack of policy coherence, diminished multilateral engagement—generally affects its work in education. Luckily some of the core strengths of U.S. assistance have an impact as well, specifically the large amount of resources (in total terms, if not relative terms) devoted to education and the vast breadth and depth of American academic, philanthropic and NGO partners engaged in pioneering work on education in the developing world.

This report analyzes the effectiveness of U.S. government education work specifically in relation to conflict-affected and fragile states. Findings across five domains—global reach, resources, technical expertise, policy and multilateral partnerships—show that U.S. education aid falls critically short of what it is capable of achieving. The U.S. government has substantial strengths in this area, especially in global reach, resources, and technical expertise, demonstrating a real comparative advantage in the field of education in situations of conflict and fragility. However, its fragmented policy across agencies and its limited multilateral engagement prevent it from maximizing its strengths, leaving it punching below its weight on this important issue. In this sense, the U.S. government is a classic underachiever, failing to efficiently deploy its many capabilities and potential for maximum impact.

There has never been a better time for looking at the aid-effectiveness of U.S. government education work. The Obama administration is bringing increased focus on the Paris Principles for Aid Effectiveness to its development initiatives. The U.S. Congress is actively engaged with pending legislative action to modernize foreign assistance and improve U.S. support for universal education. Two major reviews of foreign assistance are underway: the Quadrennial Diplomacy and Development Review led by the Department of State and USAID, and the Presidential Study Directive on U.S. Global Development Policy led by the White House.

Questions about foreign assistance reform asked in these two reviews can be applied to the education sector. For example, how can the U.S. government improve its education assistance by using a “whole-of-government” approach, by focusing on comparative advantages and strengths, and by improving coordination and by increasing multilateral engagement?

Careful analysis and answers to these questions can help propel the U.S. from its current position as an underachiever to being a leader in global education, specifically in contexts of conflict and state fragility.

This report makes nine specific recommendations, many of which could be achieved without any substantial increase in funding, that would enable the U.S. government to greatly increase the effectiveness of its education aid to populations living in contexts of conflict and state fragility.

Downloads

      
 
 




weight

Is Democracy in Decline? The Weight of Geopolitics


Politics follows geopolitics, or so it has often seemed throughout history. When the Athenian democracy’s empire rose in the fifth century B.C.E., the number of Greek city-states ruled by democrats proliferated; Sparta’s power was reflected in the spread of Spartan-style oligarchies. When the Soviet Union’s power rose in the early Cold War years, communism spread. In the later Cold War years, when the United States and Western Europe gained the advantage and ultimately triumphed, democracies proliferated and communism collapsed. Was this all just the outcome of the battle of ideas, as Francis Fukuyama and others argue, with the better idea of liberal capitalism triumphing over the worse ideas of communism and fascism? Or did liberal ideas triumph in part because of real battles and shifts that occurred less in the realm of thought than in the realm of power?

These are relevant questions again. We live in a time when democratic nations are in retreat in the realm of geopolitics, and when democracy itself is also in retreat. The latter phenomenon has been well documented by Freedom House, which has recorded declines in freedom in the world for nine straight years. At the level of geopolitics, the shifting tectonic plates have yet to produce a seismic rearrangement of power, but rumblings are audible. The United States has been in a state of retrenchment since President Barack Obama took office in 2009. The democratic nations of Europe, which some might have expected to pick up the slack, have instead turned inward and all but abandoned earlier dreams of reshaping the international system in their image. As for such rising democracies as Brazil, India, Turkey, and South Africa, they are neither rising as fast as once anticipated nor yet behaving as democracies in world affairs. Their focus remains narrow and regional. Their national identities remain shaped by postcolonial and nonaligned sensibilities—by old but carefully nursed resentments—which lead them, for instance, to shield rather than condemn autocratic Russia’s invasion of democratic Ukraine, or, in the case of Brazil, to prefer the company of Venezuelan dictators to that of North American democratic presidents.

Meanwhile, insofar as there is energy in the international system, it comes from the great-power autocracies, China and Russia, and from would-be theocrats pursuing their dream of a new caliphate in the Middle East. For all their many problems and weaknesses, it is still these autocracies and these aspiring religious totalitarians that push forward while the democracies draw back, that act while the democracies react, and that seem increasingly unleashed while the democracies feel increasingly constrained.

It should not be surprising that one of the side effects of these circumstances has been the weakening and in some cases collapse of democracy in those places where it was newest and weakest. Geopolitical shifts among the reigning great powers, often but not always the result of wars, can have significant effects on the domestic politics of the smaller and weaker nations of the world. Global democratizing trends have been stopped and reversed before.

Consider the interwar years. In 1920, when the number of democracies in the world had doubled in the aftermath of the First World War, contemporaries such as the British historian James Bryce believed that they were witnessing “a natural trend, due to a general law of social progress.”[1] Yet almost immediately the new democracies in Estonia, Latvia, Lithuania, and Poland began to fall. Europe’s democratic great powers, France and Britain, were suffering the effects of the recent devastating war, while the one rich and healthy democratic power, the United States, had retreated to the safety of its distant shores. In the vacuum came Mussolini’s rise to power in Italy in 1922, the crumbling of Germany’s Weimar Republic, and the broader triumph of European fascism. Greek democracy fell in 1936. Spanish democracy fell to Franco that same year. Military coups overthrew democratic governments in Portugal, Brazil, Uruguay, and Argentina. Japan’s shaky democracy succumbed to military rule and then to a form of fascism.

Across three continents, fragile democracies gave way to authoritarian forces exploiting the vulnerabilities of the democratic system, while other democracies fell prey to the worldwide economic depression. There was a ripple effect, too—the success of fascism in one country strengthened similar movements elsewhere, sometimes directly. Spanish fascists received military assistance from the fascist regimes in Germany and Italy. The result was that by 1939 the democratic gains of the previous forty years had been wiped out.

The period after the First World War showed not only that democratic gains could be reversed, but that democracy need not always triumph even in the competition of ideas. For it was not just that democracies had been overthrown. The very idea of democracy had been “discredited,” as John A. Hobson observed.[2] Democracy’s aura of inevitability vanished as great numbers of people rejected the idea that it was a better form of government. Human beings, after all, do not yearn only for freedom, autonomy, individuality, and recognition. Especially in times of difficulty, they yearn also for comfort, security, order, and, importantly, a sense of belonging to something larger than themselves, something that submerges autonomy and individuality—all of which autocracies can sometimes provide, or at least appear to provide, better than democracies. 

In the 1920s and 1930s, the fascist governments looked stronger, more energetic and efficient, and more capable of providing reassurance in troubled times. They appealed effectively to nationalist, ethnic, and tribal sentiments. The many weaknesses of Germany’s Weimar democracy, inadequately supported by the democratic great powers, and of the fragile and short-lived democracies of Italy and Spain made their people susceptible to the appeals of the Nazis, Mussolini, and Franco, just as the weaknesses of Russian democracy in the 1990s made a more authoritarian government under Vladimir Putin attractive to many Russians. People tend to follow winners, and between the wars the democratic-capitalist countries looked weak and in retreat compared with the apparently vigorous fascist regimes and with Stalin’s Soviet Union.

It took a second world war and another military victory by the Allied democracies (plus the Soviet Union) to reverse the trend again. The United States imposed democracy by force and through prolonged occupations in West Germany, Italy, Japan, Austria, and South Korea. With the victory of the democracies and the discrediting of fascism—chiefly on the battlefield—many other countries followed suit. Greece and Turkey both moved in a democratic direction, as did Brazil, Argentina, Peru, Ecuador, Venezuela, and Colombia. Some of the new nations born as Europe shed its colonies also experimented with democratic government, the most prominent example being India. By 1950, the number of democracies had grown to between twenty and thirty, and they governed close to 40 percent of the world’s population.

Was this the victory of an idea or the victory of arms? Was it the product of an inevitable human evolution or, as Samuel P. Huntington later observed, of “historically discrete events”?[3] We would prefer to believe the former, but evidence suggests the latter, for it turned out that even the great wave of democracy following World War II was not irreversible. Another “reverse wave” hit from the late 1950s through the early 1970s. Peru, Brazil, Argentina, Bolivia, Chile, Uruguay, Ecuador, South Korea, the Philippines, Pakistan, Indonesia, and Greece all fell back under authoritarian rule. In Africa, Nigeria was the most prominent of the newly decolonized nations where democracy failed. By 1975, more than three-dozen governments around the world had been installed by military coups.[4] Few spoke of democracy’s inevitability in the 1970s or even in the early 1980s. As late as 1984, Huntington himself believed that “the limits of democratic development in the world” had been reached, noting the “unreceptivity to democracy of several major cultural traditions,” as well as “the substantial power of antidemocratic governments (particularly the Soviet Union).”[5]

But then, unexpectedly, came the “third wave.” From the mid-1970s through the early 1990s, the number of democracies in the world rose to an astonishing 120, representing well over half the world’s population. What explained the prolonged success of democratization over the last quarter of the twentieth century? It could not have been merely the steady rise of the global economy and the general yearning for freedom, autonomy, and recognition. Neither economic growth nor human yearnings had prevented the democratic reversals of the 1960s and early 1970s. Until the third wave, many nations around the world careened back and forth between democracy and authoritarianism in a cyclical, almost predictable manner. What was most notable about the third wave was that this cyclical alternation between democracy and autocracy was interrupted. Nations moved into a democratic phase and stayed there. But why?

The International Climate Improves

The answer is related to the configuration of power and ideas in the world. The international climate from the mid-1970s onward was simply more hospitable to democracies and more challenging to autocratic governments than had been the case in past eras. In his study, Huntington emphasized the change, following the Second Vatican Council, in the Catholic Church’s doctrine regarding order and revolution, which tended to weaken the legitimacy of authoritarian governments in Catholic countries. The growing success and attractiveness of the European Community (EC), meanwhile, had an impact on the internal policies of nations such as Portugal, Greece, and Spain, which sought the economic benefits of membership in the EC and therefore felt pressure to conform to its democratic norms. These norms increasingly became international norms. But they did not appear out of nowhere or as the result of some natural evolution of the human species. As Huntington noted, “The pervasiveness of democratic norms rested in large part on the commitment to those norms of the most powerful country in the world.[6]

The United States, in fact, played a critical role in making the explosion of democracy possible. This was not because U.S. policy makers consistently promoted democracy around the world. They did not. At various times throughout the Cold War, U.S. policy often supported dictatorships as part of the battle against communism or simply out of indifference. It even permitted or was complicit in the overthrow of democratic regimes deemed unreliable—those of Mohammad Mossadegh in Iran in 1953, Jacobo Arbenz in Guatemala in 1954, and Salvador Allende in Chile in 1973. At times, U.S. foreign policy was almost hostile to democracy. President Richard Nixon regarded it as “not necessarily the best form of government for people in Asia, Africa, and Latin America.”[7] 

Nor, when the United States did support democracy, was it purely out of fealty to principle. Often it was for strategic reasons. Officials in President Ronald Reagan’s administration came to believe that democratic governments might actually be better than autocracies at fending off communist insurgencies, for instance. And often it was popular local demands that compelled the United States to make a choice that it would otherwise have preferred to avoid, between supporting an unpopular and possibly faltering dictatorship and “getting on the side of the people.” Reagan would have preferred to support the dictatorship of Ferdinand Marcos in the 1980s had he not been confronted by the moral challenge of Filipino “people power.” Rarely if ever did the United States seek a change of regime primarily out of devotion to democratic principles.

Beginning in the mid-1970s, however, the general inclination of the United States did begin to shift toward a more critical view of dictatorship. The U.S. Congress, led by human-rights advocates, began to condition or cut off U.S. aid to authoritarian allies, which weakened their hold on power. In the Helsinki Accords of 1975, a reference to human-rights issues drew greater attention to the cause of dissidents and other opponents of dictatorship in the Eastern bloc. President Jimmy Carter focused attention on the human-rights abuses of the Soviet Union as well as of right-wing governments in Latin America and elsewhere. The U.S. government’s international information services, including the Voice of America and Radio Free Europe/Radio Liberty, put greater emphasis on democracy and human rights in their programming. The Reagan administration, after first trying to roll back Carter’s human-rights agenda, eventually embraced it and made the promotion of democracy part of its stated (if not always its actual) policy. Even during this period, U.S. policy was far from consistent. Many allied dictatorships, especially in the Middle East, were not only tolerated but actively supported with U.S. economic and military aid. But the net effect of the shift in U.S. policy, joined with the efforts of Europe, was significant.

The third wave began in 1974 in Portugal, where the Carnation Revolution put an end to a half-century of dictatorship. As Larry Diamond notes, this revolution did not just happen. The United States and the European democracies played a key role, making a “heavy investment . . . in support of the democratic parties.”[8] Over the next decade and a half, the United States used a variety of tools, including direct military intervention, to aid democratic transitions and prevent the undermining of existing fragile democracies all across the globe. In 1978, Carter threatened military action in the Dominican Republic when long-serving president Joaquín Balaguer refused to give up power after losing an election. In 1983, Reagan’s invasion of Grenada restored a democratic government after a military coup. In 1986, the United States threatened military action to prevent Marcos from forcibly annulling an election that he had lost. In 1989, President George H.W. Bush invaded Panama to help install democracy after military strongman Manuel Noriega had annulled his nation’s elections. 

Throughout this period, too, the United States used its influence to block military coups in Honduras, Bolivia, El Salvador, Peru, and South Korea. Elsewhere it urged presidents not to try staying in office beyond constitutional limits. Huntington estimated that over the course of about a decade and a half, U.S. support had been “critical to democratization in the Dominican Republic, Grenada, El Salvador, Guatemala, Honduras, Uruguay, Peru, Ecuador, Panama, and the Philippines” and was “a contributing factor to democratization in Portugal, Chile, Poland, Korea, Bolivia, and Taiwan.”[9]

Many developments both global and local helped to produce the democratizing trend of the late 1970s and the 1980s, and there might have been a democratic wave even if the United States had not been so influential. The question is whether the wave would have been as large and as lasting. The stable zones of democracy in Europe and Japan proved to be powerful magnets. The liberal free-market and free-trade system increasingly outperformed the stagnating economies of the socialist bloc, especially at the dawn of the information revolution. The greater activism of the United States, together with that of other successful democracies, helped to build a broad, if not universal, consensus that was more sympathetic to democratic forms of government and less sympathetic to authoritarian forms.

Diamond and others have noted how important it was that these “global democratic norms” came to be “reflected in regional and international institutions and agreements as never before.”[10] Those norms had an impact on the internal political processes of countries, making it harder for authoritarians to weather political and economic storms and easier for democratic movements to gain legitimacy. But “norms” are transient as well. In the 1930s, the trendsetting nations were fascist dictatorships. In the 1950s and 1960s, variants of socialism were in vogue. But from the 1970s until recently, the United States and a handful of other democratic powers set the fashion trend. They pushed—some might even say imposed—democratic principles and embedded them in international institutions and agreements.

Equally important was the role that the United States played in preventing backsliding away from democracy where it had barely taken root. Perhaps the most significant U.S. contribution was simply to prevent military coups against fledgling democratic governments. In a sense, the United States was interfering in what might have been a natural cycle, preventing nations that ordinarily would have been “due” for an authoritarian phase from following the usual pattern. It was not that the United States was exporting democracy everywhere. More often, it played the role of “catcher in the rye”—preventing young democracies from falling off the cliff—in places such as the Philippines, Colombia, and Panama. This helped to give the third wave unprecedented breadth and durability.

Finally, there was the collapse of the Soviet Union and with it the fall of Central and Eastern Europe’s communist regimes and their replacement by democracies. What role the United States played in hastening the Soviet downfall may be in dispute, but surely it played some part, both by containing the Soviet empire militarily and by outperforming it economically and technologically. And at the heart of the struggle were the peoples of the former Warsaw Pact countries themselves. They had long yearned to achieve the liberation of their respective nations from the Soviet Union, which also meant liberation from communism. These peoples wanted to join the rest of Europe, which offered an economic and social model that was even more attractive than that of the United States. 

That Central and East Europeans uniformly chose democratic forms of government, however, was not simply the fruit of aspirations for freedom or comfort. It also reflected the desires of these peoples to place themselves under the U.S. security umbrella. The strategic, the economic, the political, and the ideological were thus inseparable. Those nations that wanted to be part of NATO, and later of the European Union, knew that they would stand no chance of admission without democratic credentials. These democratic transitions, which turned the third wave into a democratic tsunami, need not have occurred had the world been configured differently. That a democratic, united, and prosperous Western Europe was even there to exert a powerful magnetic pull on its eastern neighbors was due to U.S. actions after World War II.

The Lost Future of 1848

Contrast the fate of democratic movements in the late twentieth century with that of the liberal revolutions that swept Europe in 1848. Beginning in France, the “Springtime of the Peoples,” as it was known, included liberal reformers and constitutionalists, nationalists, and representatives of the rising middle class as well as radical workers and socialists. In a matter of weeks, they toppled kings and princes and shook thrones in France, Poland, Austria, and Romania, as well as the Italian peninsula and the German principalities. In the end, however, the liberal movements failed, partly because they lacked cohesion, but also because the autocratic powers forcibly crushed them. The Prussian army helped to defeat liberal movements in the German lands, while the Russian czar sent his troops into Romania and Hungary. Tens of thousands of protesters were killed in the streets of Europe. The sword proved mightier than the pen.

It mattered that the more liberal powers, Britain and France, adopted a neutral posture throughout the liberal ferment, even though France’s own revolution had sparked and inspired the pan-European movement. The British monarchy and aristocracy were afraid of radicalism at home. Both France and Britain were more concerned with preserving peace among the great powers than with providing assistance to fellow liberals. The preservation of the European balance among the five great powers benefited the forces of counterrevolution everywhere, and the Springtime of the Peoples was suppressed.[11] As a result, for several decades the forces of reaction in Europe were strengthened against the forces of liberalism.

Scholars have speculated about how differently Europe and the world might have evolved had the liberal revolutions of 1848 succeeded: How might German history have unfolded had national unification been achieved under a liberal parliamentary system rather than under the leadership of Otto von Bismarck? The “Iron Chancellor” unified the nation not through elections and debates, but through military victories won by the great power of the conservative Prussian army under the Hohenzollern dynasty. As the historian A.J.P. Taylor observed, history reached a turning point in 1848, but Germany “failed to turn.”[12] Might Germans have learned a different lesson from the one that Bismarck taught—namely, that “the great questions of the age are not decided by speeches and majority decisions . . . but by blood and iron”?[13] Yet the international system of the day was not configured in such a way as to encourage liberal and democratic change. The European balance of power in the mid-nineteenth century did not favor democracy, and so it is not surprising that democracy failed to triumph anywhere.[14] 

We can also speculate about how differently today’s world might have evolved without the U.S. role in shaping an international environment favorable to democracy, and how it might evolve should the United States find itself no longer strong enough to play that role. Democratic transitions are not inevitable, even where the conditions may be ripe. Nations may enter a transition zone—economically, socially, and politically—where the probability of moving in a democratic direction increases or decreases. But foreign influences, usually exerted by the reigning great powers, often determine which direction change takes. Strong authoritarian powers willing to support conservative forces against liberal movements can undo what might otherwise have been a “natural” evolution to democracy, just as powerful democratic nations can help liberal forces that, left to their own devices, might otherwise fail. 

In the 1980s as in the 1840s, liberal movements arose for their own reasons in different countries, but their success or failure was influenced by the balance of power at the international level. In the era of U.S. predominance, the balance was generally favorable to democracy, which helps to explain why the liberal revolutions of that later era succeeded. Had the United States not been so powerful, there would have been fewer transitions to democracy, and those that occurred might have been short-lived. It might have meant a shallower and more easily reversed third wave.[15] 

Democracy, Autocracy, and Power

What about today? With the democratic superpower curtailing its global influence, regional powers are setting the tone in their respective regions. Not surprisingly, dictatorships are more common in the environs of Russia, along the borders of China (North Korea, Burma, and Thailand), and in the Middle East, where long dictatorial traditions have so far mostly withstood the challenge of popular uprisings.

But even in regions where democracies remain strong, authoritarians have been able to make a determined stand while their democratic neighbors passively stand by. Thus Hungary’s leaders, in the heart of an indifferent Europe, proclaim their love of illiberalism and crack down on press and political freedoms while the rest of the European Union, supposedly a club for democracies only, looks away. In South America, democracy is engaged in a contest with dictatorship, but an indifferent Brazil looks on, thinking only of trade and of North American imperialism. Meanwhile in Central America, next door to an indifferent Mexico, democracy collapses under the weight of drugs and crime and the resurgence of the caudillos. Yet it may be unfair to blame regional powers for not doing what they have never done. Insofar as the shift in the geopolitical equation has affected the fate of democracies worldwide, it is probably the change in the democratic superpower’s behavior that bears most of the responsibility.

If that superpower does not change its course, we are likely to see democracy around the world rolled back further. There is nothing inevitable about democracy. The liberal world order we have been living in these past decades was not bequeathed by “the Laws of Nature and of Nature’s God.” It is not the endpoint of human progress.

There are those who would prefer a world order different from the liberal one. Until now, however, they have not been able to have their way, but not because their ideas of governance are impossible to enact. Who is to say that Putinism in Russia or China’s particular brand of authoritarianism will not survive as far into the future as European democracy, which, after all, is less than a century old on most of the continent? Autocracy in Russia and China has certainly been around longer than any Western democracy. Indeed, it is autocracy, not democracy, that has been the norm in human history—only in recent decades have the democracies, led by the United States, had the power to shape the world.

Skeptics of U.S. “democracy promotion” have long argued that many of the places where the democratic experiment has been tried over the past few decades are not a natural fit for that form of government, and that the United States has tried to plant democracy in some very infertile soils. Given that democratic governments have taken deep root in widely varying circumstances, from impoverished India to “Confucian” East Asia to Islamic Indonesia, we ought to have some modesty about asserting where the soil is right or not right for democracy. Yet it should be clear that the prospects for democracy have been much better under the protection of a liberal world order, supported and defended by a democratic superpower or by a collection of democratic great powers. Today, as always, democracy is a fragile flower. It requires constant support, constant tending, and the plucking of weeds and fencing-off of the jungle that threaten it both from within and without. In the absence of such efforts, the jungle and the weeds may sooner or later come back to reclaim the land.


[1] Quoted in Samuel P. Huntington, The Third Wave: Democratization in the Late Twentieth Century (Norman: University of Oklahoma Press, 1991), 17.

[2] Quoted in John Keane, The Life and Death of Democracy (New York: W.W. Norton, 2009), 573.

[3] Huntington, Third Wave, 40.

[4] Huntington, Third Wave, 21.

[5] Samuel P. Huntington, “Will More Countries Become Democratic?” Political Science Quarterly 99 (Summer 1984): 193–218; quoted in Larry Diamond, The Spirit of Democracy: The Struggle to Build Free Societies Throughout the World (New York: Times Books, 2008), 10.

[6] Huntington, Third Wave, 47.

[7] Odd Arne Westad, The Global Cold War: Third World Interventions and the Making of Our Times (Cambridge: Cambridge University Press, 2005), 196.

[8] Diamond, Spirit of Democracy, 5.

[9] Huntington, Third Wave, 98.

[10] Diamond, Spirit of Democracy, 13.

[11] Mike Rapport, 1848: Year of Revolution (New York: Basic Books, 2009), 409.

[12] A.J.P. Taylor, The Course of German History: A Survey of the Development of German History Since 1815 (London: Routledge, 2001; orig. publ. 1945), 71.

[13] Rapport, 1848, 401–402.

[14] As Huntington paraphrased the findings of Jonathan Sunshine: “External influences in Europe before 1830 were fundamentally antidemocratic and hence held up democratization. Between 1830 and 1930 . . . the external environment was neutral . . . hence democratization proceeded in different countries more or less at the pace set by economic and social development.” Huntington, Third Wave, 86.

[15] As Huntington observed, “The absence of the United States from the process would have meant fewer and later transitions to democracy.” Huntington, Third Wave, 98.

Downloads

Authors

Publication: Journal of Democracy
Image Source: © POOL New / Reuters
     
 
 




weight

Lightweight prefab wood framing system goes together without nails

Forget about 3D printing houses; digital fabrication using sustainable materials is a much bigger deal.




weight

Lightweight thin-film solar charger is rollable, and includes a battery bank

These ultra-thin solar charging devices use amorphous silicon technology, which is said to be effective even in shady or lower-light conditions.




weight

Freedom UV Water Purifier from SteriPen is Lightweight, Rechargeable and Simple to Use

Making sure the water you're about to drink is free from pathogens is a snap with this portable UV Purifier.




weight

Solavore Sport solar oven offers zero-carbon cooking in a lightweight package (review)

Simmer like a crock pot and bake like an oven, using the clean energy of sunlight.




weight

Beautifully simple corrugated plywood furniture is lightweight, strong & user-friendly (Video)

Made with a patented energy- and wood-saving technique, this Corelam collection is perfect for those who move a lot.




weight

The Weight of the Evidence: How We Know the Planet is Warming

In this excerpt from the latest book by the Union of Concerned Scientists, the authors explain why we're standing at a climate crossroads&dmash;and how serious the next decision really is.




weight

Earthworms lose weight in plastic-filled soil

When the earthworms are in trouble, we all are.




weight

Does size and weight matter in an electric car?

The new all-electric Porsche Taycan weighs in at about three tons. That means a lot of upfront carbon emissions.






weight

Sundaram Smart Nifty 100 Equal Weight Fund - Regular Plan - Growth

Category Other Scheme - Index Funds
NAV 9.1294
Repurchase Price
Sale Price
Date 08-May-2020




weight

Sundaram Smart Nifty 100 Equal Weight Fund - Regular Plan - Dividend Reinvestment

Category Other Scheme - Index Funds
NAV 8.7354
Repurchase Price
Sale Price
Date 08-May-2020




weight

Sundaram Smart Nifty 100 Equal Weight Fund - Regular Plan - Dividend Payout

Category Other Scheme - Index Funds
NAV 8.7354
Repurchase Price
Sale Price
Date 08-May-2020




weight

Sundaram Smart Nifty 100 Equal Weight Fund - Direct Plan - Growth

Category Other Scheme - Index Funds
NAV 9.3555
Repurchase Price
Sale Price
Date 08-May-2020




weight

Sundaram Smart Nifty 100 Equal Weight Fund - Direct Plan - Dividend Reinvestment

Category Other Scheme - Index Funds
NAV 8.9552
Repurchase Price
Sale Price
Date 08-May-2020




weight

Sundaram Smart Nifty 100 Equal Weight Fund - Direct Plan - Dividend Payout

Category Other Scheme - Index Funds
NAV 8.9552
Repurchase Price
Sale Price
Date 08-May-2020




weight

Principal Nifty 100 Equal Weight Fund-Growth

Category Other Scheme - Index Funds
NAV 55.0858
Repurchase Price
Sale Price
Date 08-May-2020




weight

Principal Nifty 100 Equal Weight Fund-Dividend

Category Other Scheme - Index Funds
NAV 32.3750
Repurchase Price
Sale Price
Date 08-May-2020




weight

Principal Nifty 100 Equal Weight Fund- Direct Plan - Dividend Option

Category Other Scheme - Index Funds
NAV 33.3884
Repurchase Price
Sale Price
Date 08-May-2020




weight

Principal Nifty 100 Equal Weight Fund - Direct Plan - Growth Option

Category Other Scheme - Index Funds
NAV 56.8133
Repurchase Price
Sale Price
Date 08-May-2020