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Daily Archives: April 3, 2017
Goal of psoriasis care is symptom control with least toxic treatment … – Sarasota Herald-Tribune
Posted: April 3, 2017 at 7:49 pm
Dear Dr. Roach: I have psoriasis. I have used clobetasol for 22 years. The psoriasis is not severe, but its constant. Should I be concerned about using this treatment for so many years? The only time it cleared up (and that was for two years) was when I had to take steroids for poison ivy. The doctor would not put me on a low dose of steroid to see if the psoriasis would stop completely and will not use other treatments, because both my brother and sister died of cancer. Any suggestions? I had two co-workers with psoriasis that was much worse than mine, and for some reason it disappeared for both of them after 20 years. R.M.
Dear R.M.: For mild to moderate psoriasis, a skin disorder that most commonly manifests with scaly plaques, the goal of care is to control symptoms using the least toxic therapies available. That means topical therapies, like clobetasol cream or ointment, and other treatments for instance, vitamin D-like or vitamin A-like drugs. These are very safe to use long-term for most people, if used correctly under supervision (clobetasol, a powerful steroid, used in the wrong place, especially the face, can cause permanent atrophy). If you have had good response to these, they are your best choice. However, it sounds like you havent had as good a response as you want.
I am curious about your response to the oral steroids you took for poison ivy. Normally, we treat moderate to severe poison ivy with a week or so of oral steroids. If just that much gave you two years of freedom from psoriasis, then I dont understand why your doctor cant give you a short course of steroids on a very-infrequent basis.
For severe psoriasis, systemic treatments are essential; however, they do have risks. Steroids are not a usual systemic treatment for psoriasis. Methotrexate, a drug used for cancer and in serious autoimmune diseases, is well-studied and tolerated by most. Vitamin A relatives, like acitretin (Soriatane), are very effective. Biological therapies, like etanercept (Enbrel), also have a clear place in treating severe psoriasis, but all of these drugs have potential for harm, including an increased risk of certain types of cancer.
In your case, I would consider getting a second opinion from a dermatologist with expertise in psoriasis. If the advice is the same, you can feel confident in the advice; if not, you will need to decide which course to follow.
Dear Dr. Roach: You recently had a column where you did not recommend alprazolam (Xanax) as a long-term sleep aid. What are the negative effects of using it that way? A.T.
Dear A.T.: Alprazolam is in the class of drugs called benzodiazepines, which includes Valium, Klonopin and Halcyon. They are effective at getting people to sleep more quickly, and increase total sleep time by 30-60 minutes. Alprazolam is very short-acting (although there is a long-acting form now) and is not indicated for insomnia.
I dont recommend benzodiazepines because they increase the rate of falls, especially in the elderly, because they can cause memory loss and because they can cause confusion and dependence.
I try to avoid prescribing sleeping medications, and most people with occasional difficulty sleeping do well with sleep hygiene advice: Having a regular sleep schedule, not trying to force sleep, avoiding alcohol and caffeine near bedtime and not using bright lights or computer screens before bed are part of this. If I do prescribe a sleep medication, I recommend using it no more than every other day and for no more than two weeks. People who need more than that, I refer to a sleep specialist.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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Goal of psoriasis care is symptom control with least toxic treatment ... - Sarasota Herald-Tribune
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2017 Global Gene Medicine Therapy Market in North America … – Edition Time
Posted: at 7:48 pm
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1) Major key Manufacturers working in Gene Medicine Therapy industry is also mentioned. 2) 2017 Worldwide Gene Medicine Therapy market estimated at USD XXXX in 2016. 3) 2017 Global Gene Medicine Therapy industry projected to reach USD XXXX million at forecast period. 4) Worldwide Gene Medicine Therapy market projected to grow at CAGR XXXX % During forecast period. 5) Gene Medicine Therapy Market (in North America, Europe and Asia) expected to grow at CAGR of XXXX % over the forecast period.
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The Gene Medicine Therapy market research report consists of six sections, the first section includes about Gene Medicine Therapy basic product information; the second section includes the analysis of Asias Gene Medicine Therapy industry; in third section analysis of North American Gene Medicine Therapy industry is done; in the fourth section analysis of Europe Gene Medicine Therapy industry; in the fifth section the study related to Gene Medicine Therapy market entry and feasibility of investment study is done; in sixth section the valuable research conclusions related to Gene Medicine Therapy industry are listed.
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2017 Global Gene Medicine Therapy Market in North America ... - Edition Time
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Canopy acquires gene-editing technology license – St. Louis Business Journal
Posted: at 7:48 pm
Stunning Contemporary Gem
Dave Smoller co-founded Canopy Biosciences
Dilip Vishwanat
Canopy Biosciences, a young startup looking to accelerate the commercialization of life science medical tools and services, has exclusively licensed a gene-editing technology from Washington University in St. Louis and Johns Hopkins University.
The company, which raised$2 million from investors earlier this year, was co-founded by Dave Smoller and is led by CEO and President Edward Weinstein. Smoller and Weinstein worked together at Sigma-Aldrich before the company was sold to Merck KGaA in November 2015 for $17 billion.
Dave Smoller co-founded Canopy Biosciences
Dilip Vishwanat
Canopy looks to in-license essentially a collaboration agreement between two parties in which one company performs research and development technologies in the fields of genetic engineering and personalized medicine.
The licensed technology is called Tunr and it targets translation elongation by introducing consecutive adenosine nucleotides into a gene coding sequence of interest, according to a release.
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Canopy acquires gene-editing technology license - St. Louis Business Journal
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Toronto doctors identify new disease in children caused by defective gene – Medicine Hat News
Posted: at 7:48 pm
By Sheryl Ubelacker, The Canadian Press on April 3, 2017.
TORONTO Daniel Nevins-Selvadurais case had doctors at Torontos Hospital for Sick Children baffled. At age three, he had developed blood in his stool, a sign of possible hereditary inflammatory bowel disease. But testing for all the genetic mutations known to cause the condition came back negative.
As he grew older, Daniels symptoms became more diverse. He developed unusual rashes and painful lumps in his legs, as well as having an abnormally high white cell count and low platelets in his blood, pointing to an unidentified problem with his immune system.
A host of doctors at the hospital among them specialists in blood disorders, cancer, rheumatology, immunology and gastroenterology couldnt pin down the cause of the childs illness.
Nobody could give us a diagnosis, so he was passed from one specialist to another over the years and various people did various tests, said his mother, Christina Arulrajah. He showed signs of so many different diseases.
Still, Dr. Aleixo Muise, a gastroenterologist who had been seeing Daniel for his inflammatory bowel disease, or IBD, said that because of the boys wide-ranging symptoms all the doctors thought that he must have a genetic cause to his disease.
Then in 2014, a team led by Muise launched a project to explore the genetic basis of IBD, using an advanced technology for studying patients DNA. Daniels genome was among those investigated using a technique called whole-exome sequencing.
It was then that they had their eureka moment.
Testing of Daniels genome turned up a mutation never before seen. The defect was in a gene known as ARPC1B, which produces a protein the bodys cells need to change shape, move, divide and perform other vital functions.
His ARPC1B gene was expressing none of this critical protein.
ARPC1B, we know, plays a very important role in the immune system and how different cells in the body mostly found in the blood work, said Muise.
Sometimes its surprising that one defect causes such widespread different types of disease in one patient, but this one mutation explains all the problems Daniel had.
The Sick Kids team subsequently discovered two other patients who were related to each other but not to Daniel, who also had a mutation that left them with very little ARPC1B protein. Since then, about 20 children worldwide have been identified with the genetic mutation.
It gave us enough evidence to know that this was a brand new disease that hadnt been described before, said Muise.
The discovery of whats been dubbed ARPC1B syndrome is described in Mondays edition of the journal Nature Communications.
Daniel was over the moon to get a diagnosis, said his mother. When they found out what was wrong, it was a real relief.
In his mind, its all about the cure. Now that theres a diagnosis, theres now going to be a cure.
His doctors believe a bone-marrow transplant will give Daniel new blood cells including immune cells that wont carry the genetic mutation. A search is now on for an appropriate donor for the 10-year-old.
If you do a bone-marrow transplant or you replace his immune system, this should cure him of his disease, said Muise.
Daniels mother said shes still trying to get her head around the notion of a cure after watching her son deal with so many health issues since infancy, the worst of which was seeing him repeatedly in pain.
While we have never let his illness define him, and he remains a very positive and energetic boy, it was always on the back of his mind, Arulrajah said of her soccer-loving son.
She hopes a successful bone-marrow transplant will mean an end to all the medications Daniel has had to take to treat his various symptoms over the years, including long courses of a steroid that have affected his growth.
It would be absolutely fantastic.
-Follow @SherylUbelacker on Twitter.
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Screening genome’s ‘dark matter’ for risks – Durham Herald Sun
Posted: at 7:48 pm
Durham Herald Sun | Screening genome's 'dark matter' for risks Durham Herald Sun Researchers have developed a method to swiftly screen the non-coding DNA of the human genome for links to diseases that are driven by changes in gene regulation. The technique could revolutionize modern medicine's understanding of the genetically ... |
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UT researchers map genetic code to determine cancer risk – Toledo Blade
Posted: at 7:48 pm
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Do you know someone with cancer? If so, there is a strong chance that this person has lung cancer.
Lung cancer is the leading cause of cancer-related death in the United States and is the most common cancer worldwide. About 160,000 Americans were expected to die from lung cancer in 2016, accounting for 27 percent of all cancer-related deaths.
Rose Zolondek is a student pursuing her doctorate in philosophy at the University of Toledo college of medicine and life sciences biomedical science program.
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Identifying and then screening a person at high risk can reduce the likelihood of that person dying from lung cancer. Screening allows doctors to find tumors at an earlier stage when they are more responsive to treatment and potentially curable by surgical removal. About 9 million Americans are at high risk for lung cancer. Based on a large clinical trial, early screening of people at high risk reduced the risk of dying from lung cancer by 20 percent.
How do we identify who is at risk? The risk of lung cancer varies from person to person and depends on both a persons inherited genetics and on environmental exposures such as smoking, radon, asbestos, and many other toxins that can get into your lungs.
At the University of Toledo college of medicine and life sciences, formerly the Medical College of Ohio, we are investigating the differences in our risk of lung cancer by studying differences in inherited genetic code. Most of the cells in the body, including lung cells, contain chromosomes you inherited from ones parents. Each chromosome is composed of DNA building blocks in a sequence that defines an individuals unique genetic code, just like sequences of letters define a word, sequences of musical notes define a song, or sequences of symbols define a computer program.
We now know specific DNA sequences of each human genome that produce different hair and eye color. We also see differences in DNA sequences at certain genetic locations that increase the risk for human diseases such as lung cancer. For example, certain inherited DNA sequence differences can change the way cells in the lung react to environmental exposures such as tobacco smoke.
Differences in DNA sequence are called single nucleotide polymorphisms, or SNPs. Each SNP is a change in a single DNA building block, also called a nucleotide. SNPs are found every 300 nucleotides on average. This means that ones entire genome contains about 10 million SNPs total. Most SNPs do not have any effect on ones health. However, some SNPs are within DNA sequences that code for proteins and therefore can affect ones risk for a specific disease such as lung cancer.
Our research lab studies SNPs in genetic sequences that are responsible for the repair of damaged DNA. This is a very important function within ones cells. Damaged DNA, if not repaired properly, can result in a population of cells with a DNA mutation that may lead to cancer.
We now know that if certain SNPs occur in specific genetic sequences, they can inhibit DNA from being repaired properly, which increases the chance of lung cancer, especially if you smoke.
We now have machines that can rapidly sequence the entire human genome, which is 3 billion nucleotides long. Our research lab uses these machines to identify the nucleotide sequence of SNPs that are associated with increased risk for lung cancer. My research focus is based on our recent results with genes that are responsible for protecting DNA in lung cells from damage and other genes that repair damage when it occurs.
For example, we are studying genes such as glutathione peroxidase, or GPX1, that protect lung cells from certain toxic effects of cigarette smoke. We are also studying genes called TTC38 and TRMU. Very little is known about the function of TTC38, which makes it exciting to study. We know that TRMU helps to modify letters in the DNA code and SNPs in this gene are associated with deafness, but also appear to have a role in lung cancer.
Identifying the function of SNPs in these genes help us better identify high risk individuals who may have the best benefit from regular screenings in the clinic. This would increase early detection of lung cancer and allow patients to be treated earlier. Earlier treatment often means better outcomes especially for lung cancer.
We continue to increase our understanding of lung cancer risk and to fight against this devastating disease by our ongoing collaborative work with other researchers and pulmonary doctors at the University of Toledo, the Toledo Hospital, the University of Michigan, and many other centers of excellence in lung cancer research. Our research is supported by the National Institutes of Health and the George Isaac Cancer Research Fund.
Rose Zolondek is a student pursuing her doctorate of philosophy in the University of Toledo college of medicine and life sciences biomedical science program. Ms. Zolondek is doing her research in the laboratory of Dr. James Willey. For information, contact rose.zolondek@rockets.utoledo.edu or go to utoledo.edu/med/grad/biomedical.
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UT researchers map genetic code to determine cancer risk - Toledo Blade
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Instagram to alter censorship guidelines – UAA Northern Light
Posted: at 7:47 pm
Instagram is approaching updated censorship guidelines for all accounts. The update will blur out content that could be considered objectionable, letting the user choose if they would like to view the content.
In the past, Instagram has been accused of deleting sensitive content, which many users deemed unreasonable. The censorship update will allow users to decide what kind of content they wish to see.
The update is an approach to foster a safer, kinder community for the 500 million active users of the social outlet. Instagram will soon be censoring content such as animal testing, famine, humanitarian crises and nudity.
The blurring of certain content may affect a variety of users including brands, bloggers, photojournalists and photographers. Much of what popularly followed users share could be censored if found offensive by others.
Soon you may notice a screen over sensitive photos and videos when you scroll through your feed or visit a profile. While these posts dont violate our guidelines, someone in the community has reported them and our review team has confirmed they are sensitive. This change means you are less likely to have surprising or unwanted experiences in the app, Kevin Systrom, co-founder and CEO of Instagram, wrote in a company blog post.
Instagram will also be adding a new security feature, enabling a two-factor authentication that will require a code every time a user logs in.
Anchorage-based photographer Jovell Rennie does not doubt that the new guidelines will cause backlash, but thinks that many users wont necessarily be affected. Rennie is best known for a variety of local camera work, sharing Alaska and boudoir photography.
I cant imagine many photographers liking the fact that their images are blurred. I think it comes down to your motivations for using the platform. If you use it primarily for commercial exposure, reaching out to prospective clients, etc., then you might be pretty peeved about the blurring. If you use it for artistic expression, you might not feel as bothered, Rennie said.
Shayne Nuesca, UAA student and photojournalist, feels that Instagrams guidelines will result in feeds that are too curated.
I dont like the idea that I could be censored if I do decide to make a photograph about a more sensitive issue. When I see a photo thats blurred, I automatically think that the photo might be distasteful. But most of the time, it isnt and it actually adds a story to a larger narrative. I would hate to see organizations and photojournalists be labeled as distasteful because their photos are censored. Its really not fair, Nuesca said.
To Nuesca, expressing yourself safely is more suppressive than expressive.
Whether Instagrams new approach is successful or hurts a fraction of their users, letting consumers have the authority to choose what kind of content they wish to see could be a reasonable solution.
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The short path from censorship to violence – Spectator.co.uk (blog)
Posted: at 7:47 pm
The news that Ayaan Hirsi Ali has cancelled her speaking tour of Australia due to security concerns should concernanyone who believes in freedom. It is a dark day when a woman who fled to the West to escape the Islamist suffocations of Somalia, and precisely so that she might think and speak freely, feels she cannot say certain things in certain places. That even a Western, liberal, democratic nation like Australia cannot guarantee Hirsi Ali the freedom to speak her mind without suffering censorship or harm is deeply worrying. It points to the mainstreaming of intolerance, to the adoption by certain people in the West of the illiberalism that makes up the very Islamist outlook that Hirsi Ali and others have sought to escape.
Hirsi Alis Oz tour, Hero of Heresy, had been due to kick off this Thursday. She would have visited Brisbane, Sydney and Melbourne, hosted by Think Inc., an organisation devoted to the promotion of intellectual discourse. But today, citing, among other things, security concerns, Think Inc. announced the tour was off.
This isnt the first time Hirsi Ali has effectively been hounded out of even tolerant nations, made to feel unwelcome in the West because of her strong, critical take on Islam and its treatment of women. She had to leave her adopted home of Holland after receiving death threats for her involvement in the 2004 Islam-critical film Submission (the films director, Theo van Gogh, was stabbed to death by an Islamist). She still has heavy security whenever she speaks in public. Certain campuses in the US have made it clear she isnt welcome, because shes Islamophobic. That is, she criticises Islam, which today is treated as a species of mental illness. How perverse that even a woman who has suffered under extreme forms of Islam can be treated as dangerous for daring to ridicule that religion.
Hirsi Alis troubles in Australia are striking because they point to a really worrying interplay between the polite intolerance of Islamophobia and the more violent urge in certain sections of society to punish and maybe even kill critics of Islam.
So before this mornings reports of a security threat to Hirsi Ali, there had been a respectable campaign to keep her out of Oz. Four hundred Muslim women and other concerned citizens, including academics, a museum director and, hilariously, human-rights activists, signed a petition saying Hirsi Alis rhetoric poses a threat to social peace and the safety of Muslims Down Under. Against a backdrop of increasing global Islamophobia, Hirsi Alis divisive rhetoric simply serves to increase hostility and hatred towards women, the petition says. In short, her words are inflammatory, violent even, and they directly harm Muslims. So shut them down, shut her up, keep her out. Australia deserves better than this, the petition said.
In a video watched and shared tens of thousands of times by both Islamic and so-called liberal activists, Muslim women are shown denouncing Hirsi Ali, accusing her of repeat[ing] the language of our oppressors. The video says Hirsi Ali uses the same Islam-critical rhetoric that has been used in recent years to justify wars, invasion and genocide. So her words are warlike, evil, destructive. It also says she uses the language of patriarchy. This is perverse. Its patriarchal to criticise the Islamist repression of women? And, by extension, is it anti-patriarchal to defend the Islamist ideology from a womans divisive criticism?
Then came some kind of security threat, some promise of violence that caused her to cancel her tour. Its time we realised that these things are intimately related; that respectable societys creeping intolerance of critical thought fuels other, more extreme peoples conviction that such thought must be punished harshly, if necessary.
The more people depict certain ideas as unfit for public life, the more they send out a signal that the people who hold those ideas are dangerous and wicked, and possibly fair game for violence. They branded Hirsi Ali an enemy of public order and decency, no doubt making it easier for others to fantasise about punishing her. They said she would harm Australia and its Muslims, no doubt giving others the idea that she should therefore be kept out of Australia by any means necessary.
Where somewant to crush the likes of Hirsi Ali or Charlie Hebdo with laws and bans, others want to crush them with violence. Different means, yes; but these two sections of society, the chin-strokers and the gun-strokers, share the same aim: to silence people whose ideas they dislike. The bookish censor lends moral authority to the violent censor. From thefailure to stand up for Salman Rushdie to the No Platforming of the likes of Hirsi Ali today, too many thinkers in the supposedly tolerant West unwittingly give a nod of approval to efforts to shut down dangerous people.The signal we should be sending to society is not that some ideas are too dangerous for public life, but that no ideas, even ridicule of Islam, will ever be silenced or punished; that it is unacceptable ever to harm someone simply for what they think and say.
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The short path from censorship to violence - Spectator.co.uk (blog)
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Women’s Studies program condemns censorship – The New Hampshire
Posted: at 7:47 pm
UNH Women's Studies Program Faculty and Staff April 3, 2017 Filed under Opinions
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The Womens Studies Program strongly condemns the universitys recent censorship of the anti-sexual harassment exhibit posted in the MUB.
We stand in support of the students who worked with the Sexual Harassment and Rape Prevention Program (SHARPP) to stage this creative and brave response to sexual violence on university campuses. The students solicited actual epithets that have been hurled at members of our campus community, and replicated these on the wall outside the MUBs main offices. Within only hours of the exhibits appearance on March 17, the university took it down.
The administration justifies its decision by citing the MUB policy manual (section 8.03): Any poster with hate speech as defined in the Students Rights, Rules and Responsibilities will not be posted. Any poster/flyer containing profane/vulgar language is prohibited. But this was not a poster, it was an exhibit. And the language it contained is, indeed, much more than profane and vulgar: it is real, and it is violent.
By invoking, interpreting and enforcing the MUB policy manual in this way, the university has shut this conversation down, and has done great damage to student and staff attempts to address campus sexual harassment and violence. The university has invested a great deal of resources on public relations campaigns to present itself as taking action on this problem. It would do well to let the people who understand the issue bestSHARPP, and the students who live with and experience the harassment and violenceto have a voice.
The Faculty and Staff of the UNH Womens Studies Program
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Women's Studies program condemns censorship - The New Hampshire
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Documentary Follows Beauty Queen Who Fought Censorship – The Epoch Times
Posted: at 7:47 pm
When documentary filmmaker Kacey Cox heard that Anastasia Lin, an actress hed previously worked with, had won Miss World Canada based on a platform for human rightsand would have to enter China to compete in the finalshe knew he had to film her journey.
You couldnt have written a better story, Cox said.
Miss World is a U.K.-based pageant with the motto beauty with a purpose, and Lin brought a message of religious freedom to the stage. She was outspoken about human rights atrocities in China, like the persecution of practitioners of various faiths, and the Chinese regimes harvesting of organs from prisoners of conscience.
The ruling Chinese Communist Party (CCP) is not known for taking criticismthere have been many cases of foreign citizens being arrested in the country for speaking out about issues like Lin has. She was admittedly nervous when she first got the newsof where the finals would be held.
Cox and Lin met briefly soon after Lin won Miss World Canada, and Lin mentioned the finals venue had been moved from Australia to China. At first, the implications didnt register with Cox. He congratulated her, and they parted ways.
Then as he was walking away, it clickedLin was going to be walking into the lions mouth. He chased after her, all the way down to the parking lot, and told her they had to make a film about it.
The result was the documentary Anastasia Lin: The Crown, currently screening at film festivals internationally and soon to be shown at the Manhattan Film Festival, on April 25.
The film reveals a side of China that is still little known, one governed by a covert body that effectively silences dissent.
As every major media reported in the aftermath of the 2015 Miss World pageant, Lin was barred from entry by Chinese officials and received little assistance from the Miss World pageant organizers. In making the film, Cox followed Lin as she made multiple attempts to get answers and gain entry to the country. The film also succinctly illustrates her personal story.
At one point, Lin sheds light on why she became such a passionate advocate for human rights. She confesses that as a young child in China, she was considered a good student because she was the class organizer who made sure all the other students studied the CCPs propaganda and viewed the Partys enemies as their enemies. It wasnt until she left the country that she realized how misled people inside China still are. The realization led her to dig into the lies the Party asked others to repeat.
As Lin continued speaking out about human rights abuses while in the international spotlight as a beauty queen, she started getting pushback.
Inside China, articles about Lin were either blocked or completely altered to the point where they seemed to be written about another person entirely. Her name and her photo were changed to show another Chinese woman.
Then Lins father, who lives in China, started receiving threats. He called to advise her to back down, admonishing her for criticizing the Party. Then, as Cox documented while traveling with her, Lin started receiving threatening phone calls herself.
Cox filmed Lin as she took a flight from Canada to Hong Kong with plans to enter Sanya City, a resort town in China that has unique rules that dont require entrants to have visas until after they arrive.
The trip was an incredibly tense. It was the shortest 16-hour flight Ive ever been on, Cox said.
Chinadeclared Lin persona non grataan unwelcome person, or someone not allowed into the countryand when she landed, she was crowded by media. Interviews and media appearances continued on for the next eight days; Cox observed as Lin stayed up until 3 a.m. to give interviews to overseas media outlets. Her opportunity to competewas over, but her human rights platform and calls to hold China accountable were more relevant than ever.
I felt that a documentary could amplify her message, which is one of ending the persecution of groups like [the spiritual practice] Falun Gong in China, and religious freedom for people around the world, Cox said. Human rights and religious freedom are issues Cox has always also felt strongly about, and he felt personally invested in the story from the beginning.
While following Lin on this journey, he felt he was really seeing beauty with a purpose in action. On a trip to Geneva, Switzerland, where Lin spoke at a U.N. forum about human rights, young fans approached her and told her about how shed changed their perception of beauty queens.
Its a persons purpose that makes them beautiful, Cox said. The film doesnt talk much about pageant perceptions, but this message colored his making of the documentary. He made a film that he hoped would clearly explain Lins cause and purpose, and hopefully inspire others to act with similar conviction.
Anastasia Lin: The Crown will screen in New York at the Manhattan Film Festival on April 25 at 5 p.m.
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Documentary Follows Beauty Queen Who Fought Censorship - The Epoch Times
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