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Olympic boxing controversy sparks fierce debate over inclusivity in women's sports

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Olympic boxing controversy sparks fierce debate over inclusivity in women's sports

A Summer Olympics that hoped to champion inclusivity — choosing “Games Wide Open” as its slogan — has become embroiled in loud, angry debates over who should and should not be allowed to compete as a woman.

The dispute has triggered conflicting official statements, pointed comments and unhinged social media posts, all whirling around two athletes in the women’s boxing competition at Arena Paris Nord.

This isn’t about how Imane Khelif of Algeria and Lin Yu Ting of Taiwan identify. By all accounts, they were born as women but appear to have unusual body chemistry that triggered gender tests and caused them to be disqualified from last year’s world championships.

The Olympics, however, have broader eligibility rules.

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“I think we all have a responsibility to dial down this and not turn it into some kind of witch hunt,” International Olympic Committee spokesman Mark Adams told reporters. “These are regular athletes who have competed for many years in boxing, they are entirely eligible and they are women on their passports.”

His plea has been overshadowed by a Thursday afternoon bout in which Khelif punched an opponent hard enough to make her quit after 46 seconds. Paris has been lumped in the same category as previous controversies involving South African runner Caster Semenya and U.S. collegiate swimmer Lia Thomas.

This case might be more incendiary because, instead of running or swimming fast, Khelif and Lin are delivering potentially lethal blows. Italian boxer Angela Carini said she conceded to Khelif because “I had to safeguard my life.”

Experts wonder if the sports world has reached an inflection point.

“We really have not come up with a consensus on how we define sex,” said Jaime Schultz, author of a new book titled “Regulating Bodies: Elite Sport Policies and Their Unintended Consequences.” “People have to learn how to talk about this.”

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Over the last 24 hours, much of the public discourse has inaccurately described Khelif and Lin as transgender. Former President Donald Trump posted on Truth Social: “I WILL KEEP MEN OUT OF WOMEN’S SPORTS!”

Taipei’s Lin Yu Ting, red, takes a punch from Uzbekistan’s Sitora Turdibekova in the Women’s 57kg boxing match.

(Wally Skalij/Los Angeles Times)

There is no evidence that either boxer is transgender or has chromosomal abnormalities. Though purposefully vague, officials have described what appear to be “differences of sex development,” a designation that applies to women who are androgen-sensitive or have naturally occurring testosterone levels in the male range.

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The international track federation used this standard to demand that 800-meter star Semenya either take medication to alter her body chemistry or race against men. She fought the decision, losing in the Federal Supreme Court of Switzerland.

Sports have a long and troubled history with gender testing.

Early on, female athletes were forced to disrobe for physical inspections. Chromosome tests came into fashion for a while but were successfully challenged by Spanish runner Maria Jose Martinez-Patino in the 1980s because they could not account for rare conditions.

Though testosterone is now a common measure, there is continued disagreement over its validity.

Italy's Angela Carini, left, cries after her loss to Algeria's Imane Khelif at the Paris Olympics on Thursday.

Italy’s Angela Carini, left, cries after her loss to Algeria’s Imane Khelif at the Paris Olympics on Thursday.

(John Locher / Associated Press)

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“These criteria keep folding under the weight of closer scrutiny,” said Schultz, who is also a kinesiology professor at Penn State. “None of them have held up over time.”

Veterans on the amateur scene, Khelif finished fifth in the 60 kilogram event and Lin finished ninth at 57 kilograms in the Tokyo Olympics in 2021. The Algerian won silver at the International Boxing Assn.’s 2022 world championships. The Taiwanese athlete earned gold at that tournament in 2018 and 2022.

But last year, the IBA took action against both women.

Khelif was disqualified shortly before her gold-medal bout and Lin after her bronze-medal victory. The IBA stated the boxers did not “undergo a testosterone examination but were subject to a separate and recognized test, whereby the specifics remain confidential.”

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The situation grew more complicated when the IOC suspended its recognition of the IBA after years of dispute between the organizations. With the IOC temporarily in control of boxing at the Games, Khelif and Lin have had their eligibility restored.

It came as no surprise when Khelif’s bout on Thursday prompted dueling responses.

First the IBA condemned Olympic officials for letting Khelif and Lin compete, stating: “We absolutely do not understand why any organization would put a boxer at risk with what could bring a potential serious injury.”

The IOC fired back by saying: “Every person has the right to practice sport without discrimination.” It further noted the IBA disqualifications were “based entirely on this arbitrary decision, which was taken without any proper procedure.”

Algeria's Imane Khelif, right, walks beside Italy's Angela Carini after their women's 66kg preliminary boxing match.

Algeria’s Imane Khelif, right, walks beside Italy’s Angela Carini after their women’s 66kg preliminary boxing match.

(John Locher / Associated Press)

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On Friday morning, when questioned about the Olympics’ apparent struggle with gender rules, Adams said: “There is still neither scientific nor political consensus on this issue. It’s not a black and white issue. And we at the IOC would be very interested to hear of such a solution, such a consensus on this, and we would be the first to act on this should a common understanding be reached.”

Hours later, the media descended on a bout between Lin and Sitora Turdibekova of Uzbekistan. No devastating blows were landed during Lin’s victory, by unanimous decision, after which both athletes walked through the mixed zone without responding to questions.

Khelif’s next bout — against Anna Luca Hamori of Hungary — figures to attract similar attention on Saturday. The Hungarian Boxing Assn. has reportedly protested Khelif’s participation but Hamori did not seem as concerned. “I am not scared,” the boxer said. “If she or he is a man, it will be a bigger victory for me if I win. So let’s do it.”

Even Carini, who fell to her knees and cried after losing to Khelif, has been magnanimous. Her comments reflect the complexity of the issue.

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“I am not in the position of saying this is right or wrong,” she told reporters. “I did my job as a boxer, entering the ring and fighting.”

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After contentious tenure atop sacred Hawaiian summit, Caltech observatory gets dismantled

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After contentious tenure atop sacred Hawaiian summit, Caltech observatory gets dismantled

After decades of mounting tension between scientists and native Hawaiians, Caltech has completed its removal of a telescope from the summit of Maunakea, a dormant volcano that is revered by the island’s Indigenous population.

The decommissioning of the Caltech Submillimeter Observatory in July follows the removal of a University of Hawaii observatory a month earlier, and comes amid a cultural resurgence among native Hawaiians.

“Nothing is forever,” said Gregory Chun, the executive director of the Center for Maunakea Stewardship at the University of Hawaii and a native Hawaiian.

“It was important for these two facilities to come down, not just because they were not productive anymore but because it’s an acknowledgment of the privilege of being up there. You were pau — you were done. So, you can go home now.”

Prized for its altitude, dark skies and low humidity, Maunakea still hosts 11 other telescopes. Although the facilities have brought Hawaii international acclaim in astronomy and have helped to boost the local economy, native Hawaiians have long regarded the summit as their spiritual connection to the heavens.

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Protests erupted at the base of the mountain in 2019, when Caletch and the University of California proposed construction of another observatory called the Thirty Meter Telescope. The outcry led the state to shift oversight responsibilities from the University of Hawaii — which leased the land to Caltech — to the new Maunakea Stewardship Oversight Authority, which is composed of local, environmental and scientific stakeholders.

The closure of the Caltech observatory marks the end of a contentious era, as locals and the new authority debate what’s next for the mountain.

“I have incredible respect for the people at the University of Hawaii, who can audit their own actions,” said John De Fries, the executive director of the new authority. “If this authority can begin to pioneer a new model of leadership, that’s reason to be grateful, but the task of that remains ahead of us.”

The Caltech Submillimeter Observatory’s telescope will now move to Chile. With new upgraded instruments, the observatory will continue doing science under a new name, the Leighton Chajnantor Telescope.

(Sayer Houseal / Caltech)

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In response to public criticism, the University of Hawaii created the Center for Maunakea Stewardship in 2020 to oversee operations on the mountain. It worked closely with Caltech to decommission the observatory.

Throughout the process, cultural observers were present to ensure deconstruction was done in a respectful way, and while the new authority was not involved in the decommissioning process, Caltech invited members to perform cultural ceremonies at its conclusion.

A senior member from the authority also inspected the site for final sign-off of completion, and reported that “the site had been restored to as near a pristine level that you can expect,” De Fries said.

Over its roughly three decades of observations, the Caltech Submillimeter Observatory has played a key role in several scientific breakthroughs in astrophysics.

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The observatory was first designed to detect some of the most unexplored wavelengths of light, between a third of a millimeter and one millimeter — much longer than visible light.

The telescope, with its fellow Maunakea resident the James Clerk Maxwell Telescope, discovered that Earth is basking in light from excited molecules living quietly in interstellar space.

A rainbow rises behind a gleaming observatory on a mountain summit.

Since the Caltech Submillimeter Observatory started looking at the night sky in 1987, the telescope has played a key role in several scientific breakthroughs. It helped identify molecules in interstellar space and created maps of cosmic dust and galaxy clusters.

(Caltech Submillimeter Observatory)

Toward the turn of the century, an upgraded Caltech Submillimeter Observatory started making maps of the sky. It was a “quantum leap in capability,” said Sunil Golwala, director of the observatory and a physics professor at Caltech.

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This allowed scientists to map everything from dust in the interstellar medium to the largest scale of structure in the universe, galaxy clusters.

Now, the Caltech telescope moves to Chile with a new name (the Leighton Chajnantor Telescope), new instruments and the opportunity to reestablish itself on the cutting edge of astronomy.

Golwala said the team has learned from their time on Maunakea and that the Chile site is farther from population centers and not regarded as sacred. They’ll also build near other observatories to reduce their environmental footprint.

In the aftermath of the observatory protests, finding the right balance between astronomy and preservation of the Maunakea sacred site remains a challenge.

Despite criticisms, the telescopes do help the state economically, and they support science and engineering on the islands as many of Hawaii’s young people are leaving to pursue degrees in these fields.

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“You don’t have a unified consensus in the community — much less the Hawaiian community — about [Thirty Meter Telescope] or astronomy,” Chun said. “So, balance is not going to be something that’s easily found, but I think if the authority can come up with a vision where people see themselves in it, we have a better chance.”

Over his time heading the center, Chun has come to think empathy is the path toward reconciliation, and the authority is an opportunity to find it.

“We certainly have a lot of lessons learned and scars that we’ve accumulated over the years,” Chun said.

“I also think, however, that it’s not by happenstance that one of the most sacred lands here in Hawaii to native Hawaiians is also the premier place, certainly in the northern hemisphere if not in the world, for astronomy.”

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This Scientist Has a Risky Plan to Cool Earth. There’s Growing Interest.

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This Scientist Has a Risky Plan to Cool Earth. There’s Growing Interest.

David Keith was a graduate student in 1991 when a volcano erupted in the Philippines, sending a cloud of ash toward the edge of space.

Seventeen million tons of sulfur dioxide released from Mount Pinatubo spread across the stratosphere, reflecting some of the sun’s energy away from Earth. The result was a drop in average temperatures in the Northern Hemisphere by roughly one degree Fahrenheit in the year that followed.

Today, Dr. Keith cites that event as validation of an idea that has become his life’s work: He believes that by intentionally releasing sulfur dioxide into the stratosphere, it would be possible to lower temperatures worldwide, blunting global warming.

Such radical interventions are increasingly being taken seriously as the effects of climate change grow more intense. Global temperatures have hit record highs for 13 months in a row, unleashing violent weather, deadly heat waves and raising sea levels. Scientists expect the heat to keep climbing for decades. The main driver of the warming, the burning of fossil fuels, continues more or less unabated.

Against this backdrop, there is growing interest in efforts to intentionally alter the Earth’s climate, a field known as geoengineering.

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Already, major corporations are operating enormous facilities to vacuum up the carbon dioxide that’s heating up the atmosphere and bury it underground. Some scientists are performing experiments designed to brighten clouds, another way to bounce some solar radiation back to space. Others are working on efforts to make oceans and plants absorb more carbon dioxide.

But of all these ideas, it is stratospheric solar geoengineering that elicits the greatest hope and the greatest fear.

Proponents see it as a relatively cheap and fast way to reduce temperatures well before the world has stopped burning fossil fuels. Harvard University has a solar geoengineering program that has received grants from the Microsoft co-founder Bill Gates, the Alfred P. Sloan Foundation and the William and Flora Hewlett Foundation. It’s being studied by the Environmental Defense Fund along with the World Climate Research Program, an international scientific effort. The European Union last year called for a thorough analysis of the risks of geoengineering and said countries should discuss how to regulate an eventual deployment of the technology.

But many scientists and environmentalists fear that it could result in unpredictable calamities.

Because it would be used in the stratosphere and not limited to a particular area, solar geoengineering could affect the whole world, possibly scrambling natural systems, like creating rain in one arid region while drying out the monsoon season elsewhere. Opponents worry it would distract from the urgent work of transitioning away from fossil fuels. They object to intentionally releasing sulfur dioxide, a pollutant that would eventually move from the stratosphere to ground level, where it can irritate the skin, eyes, nose and throat and can cause respiratory problems. And they fear that once begun, a solar geoengineering program would be difficult to stop.

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“The whole notion of spraying sulfur compounds to reflect sunlight is arrogant and simplistic,” the Canadian environmentalist David Suzuki said. “There are unintended consequences of powerful technologies like these, and we have no idea what they will be.”

Raymond Pierrehumbert, an atmospheric physicist at the University of Oxford, said he considered solar geoengineering a grave threat to human civilization.

“It’s not only a bad idea in terms of something that would never be safe to deploy,” he said. “But even doing research on it is not just a waste of money, but actively dangerous.”

Shuchi Talati, the founder of a nonprofit organization called the Alliance for Just Deliberation on Solar Geoengineering, called the technology “a double-edged sword.”

“It could be a way to limit human suffering,” she said. “At the same time, I think it can also exacerbate suffering if used in a bad way.”

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In a series of interviews, Dr. Keith, a professor in the University of Chicago’s department of geophysical sciences, countered that the risks posed by solar geoengineering are well understood, not as severe as portrayed by critics and dwarfed by the potential benefits.

If the technique slowed the warming of the planet by even just one degree Celsius, or 1.8 degrees Fahrenheit, over the next century, Dr. Keith said, it could help prevent millions of heat-related deaths each decade.

A planet transformed by solar geoengineering would not be noticeably dimmer during the daytime, according to his calculations. But it could produce a different kind of twilight, one with an orange hue.

He agrees that nations should stop burning coal, oil and gas, period. But Dr. Keith believes in going further.

Lean and athletic at 60, with glacier-blue eyes, Dr. Keith has spent his life outside the lab rock climbing, sea kayaking and skiing in the Arctic. He is deeply troubled by the myriad ways climate change is disrupting the natural world.

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By lowering global temperatures, solar geoengineering could help restore the planet to its preindustrial state, recreating conditions that existed before enormous amounts of carbon dioxide were pumped into the atmosphere and began to cook the Earth, he said.

If there were a global referendum tomorrow on whether to begin solar geoengineering, he said he would vote in favor.

“There certainly are risks, and there certainly are uncertainties,” he said. “But there’s really a lot of evidence that the risks are quantitatively small compared to the benefits, and the uncertainties just aren’t that big.”

The only thing more dangerous than his solution, he suggested, may be not using it at all.

To understand just how contentious Dr. Keith’s work can be, consider what happened when he tried to perform an initial test in preparation for a solar geoengineering experiment known as Scopex.

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Then a professor at Harvard, Dr. Keith wanted to release a few pounds of mineral dust at an altitude of roughly 20 kilometers and track how the dust behaved as it floated across the sky.

A test was planned in 2018, possibly over Arizona, but Dr. Keith couldn’t find a partner to launch a high-altitude balloon. When details of that plan became public, a group of Indigenous people objected and issued a manifesto against geoengineering.

Three years later, Harvard hired the Swedish space corporation to launch a balloon that would carry the equipment for the test. But before it took place, local groups once again rose up in protest.

The Saami Council, an organization representing Indigenous peoples, said it viewed solar geoengineering “to be the direct opposite of the respect we as Indigenous Peoples are taught to treat nature with.”

Greta Thunberg, the Swedish climate activist, joined the chorus. “Nature is doing everything it can,” she said. “It’s screaming at us to back off, to stop — and we are doing the exact opposite.”

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Within months, the experiment was called off.

“A lesson I’ve learned from this is that if we do this again, we won’t be open in the same way,” Dr. Keith said.

Behind the scenes, the Harvard team and its advisory committee became mired in finger pointing over who was to blame for the collapse of the project. Dr. Talati, a member of the Scopex advisory board, said it was “the moment of peak chaos.”

It didn’t help that there were personality conflicts. Several committee members said Dr. Keith could be ornery and headstrong, correcting colleagues in casual conversation and belittling those with whom he disagreed.

“I can be abrasive and difficult,” Dr. Keith acknowledged. “I am sometimes inappropriately forceful in making my point. I’m intense.”

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Opponents of solar geoengineering cite several main risks.

They say it could create a “moral hazard,” mistakenly giving people the impression that it is not necessary to rapidly reduce fossil fuel emissions.

“The fundamental problem is that we think we’re so smart that we don’t have to pay attention to nature’s boundaries,” Dr. Suzuki said. “But we haven’t dealt with the root cause of the problem, which is us.”

The second main concern has to do with unintended consequences.

“This is a really dangerous path to go down,” said Beatrice Rindevall, the chairwoman of the Swedish Society for Nature Conservation, which opposed the experiment. “It could shock the climate system, could alter hydrological cycles and could exacerbate extreme weather and climate instability.”

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And once solar geoengineering began to cool the planet, stopping the effort abruptly could result in a sudden rise in temperatures, a phenomenon known as “termination shock.” The planet could experience “potentially massive temperature rise in an unprepared world over a matter of five to 10 years, hitting the Earth’s climate with something that it probably hasn’t seen since the dinosaur-killing impactor,” Dr. Pierrehumbert said.

On top of all this, there are fears about rogue actors using solar geoengineering and concerns that the technology could be weaponized. Not to mention the fact that sulfur dioxide can harm human health.

Dr. Keith is adamant that those fears are overblown. And while there would be some additional air pollution, he claims the risk is negligible compared to the benefits.

“There’s plenty of uncertainty about climate responses,” he said. “But it’s pretty hard to imagine if you do a limited amount of hemispherically balanced solar geo that you don’t reduce temperatures everywhere.”

Last year, after the failure to launch the Scopex experiment in Sweden, Dr. Keith made a move that stunned his colleagues. He announced he was closing the door on 13 years at Harvard and taking his ambitions to the University of Chicago, where he would build a new program around climate interventions, including solar geoengineering.

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“I don’t know whether that stuff will ever get used,” said Mr. Gates, a major investor in climate technology. “I do believe that doing the research and understanding it makes sense.

Dr. Keith’s career can be traced to his father, Tony Keith, a wildlife biologist who attended the first global gathering to address threats to nature, the 1972 United Nations Conference on the Human Environment in Stockholm.

Dyslexia prevented him from learning to read until late in 4th grade, but when he was finally able to make sense of written words, he became a voracious reader. He also loved camping and, at 17, hiked a stretch of the Appalachian Trail solo.

After graduating from the University of Toronto, he spent months rock climbing. Looking for a way to get paid to live in the wilderness, he got a job studying walruses in the Canadian Arctic.

Dr. Keith eventually enrolled in a doctoral program at the Massachusetts Institute of Technology to study experimental physics.

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In 1992, he published an academic paper, “A Serious Look at Geoengineering,” that raised the questions that would shape his career: Who should authorize the use of these technologies? Who is liable if something goes wrong?

His academic career took him from Carnegie Mellon University to the University of Calgary, where he began investigating ways to capture and store carbon dioxide. The next stop was Harvard, where he got serious about solar geoengineering.

In 2006, a mutual acquaintance introduced him to Mr. Gates, who wanted to learn more about technologies that might help fight global warming. The two men discussed climate and technology in a series of meetings over the next 10 years.

Then in 2009, Dr. Keith founded Carbon Engineering, a company that developed a process for pulling carbon dioxide from the atmosphere. Investors included Mr. Gates, Chevron and N. Murray Edwards, who made billions pumping oil from the Canadian oil sands.

Last year Carbon Engineering was acquired by Occidental Petroleum, a major oil and gas producer based in Texas, for $1.1 billion. Dr. Keith owned about 4 percent of the company at the time of the sale, delivering him a personal windfall of about $72 million.

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Occidental is now building a series of enormous carbon capture plants. It plans to sell carbon credits to big companies like Amazon and AT&T that want to offset their emissions. Critics say that will only delay the phaseout of fossil fuels while allowing an oil company to profit.

“Of course I’m uncomfortable about it being sold to an oil company, no question,” Dr. Keith said, adding that he plans to give away most of his profits from the sale of Carbon Engineering, perhaps to a conservation group.

On a summer Monday in Cambridge, Mass., the Harvard campus was mostly quiet. But inside one classroom, a standing-room-only crowd listened as experts discussed the merits and risks of solar geoengineering.

Among those featured was Frank Keutsch, Dr. Keith’s former collaborator on the Scopex experiment.

Dr. Keutsch is less sanguine than Dr. Keith when considering its potential risks.

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“I compare stratospheric solar geoengineering with opiates,” he said on the panel. “They only treat the symptom and not the actual cause. You can get addicted to it if you don’t actually address the cause. In addition, like any painkiller, you’re going to have side effects. And then there are withdrawal symptoms, and that’s termination shock.”

Dr. Keutsch is now investigating whether calcium carbonate or diamond dust might be a better material than sulfur, and pondering issues around how a deployment might one day be governed. There are no current plans for a field experiment.

Academic energy in the field has followed Dr. Keith to the University of Chicago, which is allowing him to hire 10 full-time faculty members and build a new program focused on various types of geoengineering. The total cost could reach as much as $100 million.

The move has puzzled some. Dr. Pierrehumbert, who recently departed the University of Chicago for Oxford, said he was “flabbergasted” and contended that those research dollars could be better spent investigating ways to reduce the use of fossil fuels.

To celebrate his 60th birthday in October, Dr. Keith went hiking in the Canadian Rockies and came across a glacier that had shrunk dramatically in recent years. It was a visual reminder that global warming is upending the natural world, and it confirmed his central, controversial belief: Humans have already altered the planet, heating the climate with greenhouse gases. To repair the climate and return it to a more pristine state, we may need to take even more drastic action and engineer the stratosphere.

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“I’m more motivated even now to push on solar geo because the rationalist case for it is looking stronger,” Dr. Keith said. “While there are still lots of strong individual voices of opposition, there are a lot of people in serious policy positions that are taking it seriously, and that’s really exciting.”

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Secret shoppers find long waits and scarce openings in L.A. for psychiatric care with Medicaid

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Secret shoppers find long waits and scarce openings in L.A. for psychiatric care with Medicaid

Only 15% of phone calls seeking psychiatric appointments for Medicaid patients resulted in an appointment in Los Angeles, the lowest percentage out of four cities in a “secret shopper” audit, researchers found.

Los Angeles also had the longest wait times, with the median wait stretching 64 days — more than twice as long as in New York City or Chicago and nearly six times the median wait in Phoenix, secret shoppers found.

The findings, published Wednesday in a research letter in JAMA, underscore long-standing concerns about Medicaid recipients being unable to access psychiatric care when they need it.

Earlier research has found that psychiatrists are less likely than other physicians to accept Medicaid, a public insurance program serving people with low incomes. The headaches for would-be patients are exacerbated by what critics refer to as “ghost networks,” in which health insurers list medical providers in their directories who aren’t accepting new patients, don’t take their insurance or are otherwise inaccessible to patients.

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As a medical student at Weill Cornell Medical College trying to ensure follow-up for patients leaving the hospital, “one area in which I consistently was coming up against a wall was making outpatient mental health appointments,” said Dr. Diksha Brahmbhatt, who helped spearhead the audit and is now a resident physician at Brigham and Women’s Hospital in Boston.

For one young man on Medicaid, “it took about an hour and a half to try to get any appointment for him at all” — and it was scheduled about 40 days after his discharge, Brahmbhatt said.

Such experiences left her wondering, “What is the extent of this issue, especially in urban areas where we might expect access to actually be better for patients?”

To see what Medicaid patients might encounter when seeking psychiatric care, researchers from Weill Cornell Medical College randomly chose scores of “psychiatric prescribing clinicians” — psychiatrists, nurse practitioners and physician assistants — who were listed as accepting new patients by the biggest managed care plans for Medicaid patients in each city, then phoned to ask for the soonest available appointment.

They found that less than 18% of the listed clinicians they tried to contact were reachable, accepted Medicaid and could offer an appointment for a new patient on the insurance program. Even among those psychiatric providers able to schedule an appointment, waits could stretch up to six months.

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All in all, only 27.2% of offices they phoned had an appointment available for a Medicaid patient with either the intended provider or another one at the same practice. In L.A., that rate was only 15%, compared with 27.5% in Chicago, 30% in Phoenix and 36.3% in New York City. The typical waits were much longer in L.A. as well.

The JAMA letter did not speculate on why such appointments might be scarcer or waits longer in L.A. Brahmbhatt said that the study wasn’t designed to examine those differences and that the number of offices they called — 320 total — limited their ability to draw conclusions.

Health economist William L. Schpero, one of the researchers who performed the audit, said that “the access challenges we identified are likely the product of multiple factors,” including “inaccuracies in plan directories, clinician reluctance to participate in Medicaid, and an under-supply of psychiatric clinicians in some areas.”

“Which of those factors — among others — is primarily driving the relatively low appointment availability we found in L.A. requires additional research,” Schpero said.

Schpero and Brahmbhatt found that among the psychiatric providers with whom they could not make an appointment, 15.2% had phone numbers listed that were incorrect or out of service, and 35% didn’t answer the phone after two attempts.

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This is a patient population that “already faces a lot of barriers to getting the care that they need” and may already be grappling with mental health symptoms when they seek an appointment, Brahmbhatt said.

If they hit roadblocks, they are “that much more likely to then disengage from the healthcare system.”

In California, lawmakers are weighing a bill that would mandate that health insurers keep accurate listings or face fines. The bill, AB 236, would gradually phase in requirements for increasing accuracy in provider directories, starting with at least 60% next summer and increasing to at least 95% by July 2028. Fines for faulty listings could range up to $10,000 for every 1,000 people insured by a health plan, and those penalties could be adjusted upward with time.

“When Californians can’t find a provider, it leads to delayed or more expensive care,” said Katie Van Deynze, policy and legislative advocate at the consumer advocacy group Health Access California, which sponsored the legislation. “AB 236 puts health plans on a path of improvement, so patients no longer have to call through lists of outdated providers that have moved, retired, or are not accepting new patients.”

The California Department of Managed Health Care estimated in January that implementing the bill could cost up to $12 million annually for additional staffers, but a department spokesman said it was updating its estimate based on the latest version of the bill ahead of a Monday hearing.

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The January estimate was based on “additional workload to promulgate regulations and guidance, develop methodology and review plan documents for compliance” and other needed tasks to carry out requirements under the bill, department spokesperson Kevin Durawa said in an email.

As of June, AB 236 was backed by the National Union of Healthcare Workers and the National Multiple Sclerosis Society, among others, but opposed by industry groups including the California Assn. of Health Plans and the California Medical Assn.

Mary Ellen Grant, vice president of communications for the California Assn. of Health Plans, said its members understand the frustration that arises from inaccurate listings, but “AB 236 does nothing to address the root cause of the issue” and “simply places the full responsibility of provider directory accuracy onto health plans.”

Their accuracy is “largely reliant upon providers and medical groups maintaining their own accurate records and providing that information to health plans in a timely manner,” the group said. “The bill fails to acknowledge this shared responsibility” and is “unfairly punitive against health plans.”

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