Wikipedia

Ice Bucket Challenge

For the book by Casey Sherman and Dave Wedge, seeIce Bucket Challenge: Pete Frates and the Fight Against ALS.

TheIce Bucket Challenge,sometimes called theALS Ice Bucket Challenge,was an activity involving the pouring of a bucket of ice water over a person's head, either by another person or self-administered, to promote awareness of the diseaseamyotrophic lateral sclerosis(ALS, also known asmotor neuron diseaseorLou Gehrig's disease) and encourage donations to research. The challenge was co-founded byPat QuinnandPete Frates;[1]itwent viralonsocial mediaduring July–August 2014.[2][3]In the United States, many people participated for theALS Association,and in the United Kingdom, many people participated for theMotor Neurone Disease Association,[4]although some individuals opted to donate their money from the Ice Bucket Challenge to other organizations.[5]

A person performing the ALS Ice Bucket Challenge

The challenge encourages nominated participants to be filmed having a bucket of ice water poured on their heads and then nominating others to do the same. A common stipulation is that nominated participants have 24 hours to comply or forfeit by way of a charitable financial donation.[6]

On August 1, 2015, a group of ALS organizations in the United States, including theALS Association,Les Turner ALS Foundation,andALS Therapy Development Institute,re-introduced the Ice Bucket Challenge for 2015 to raise further funds with the intention of establishing it as an annual occurrence. It failed to raise the same viral attention as the 2014 event, which raised over $115M[7]worldwide for the disease.[8]However some people—including celebrities and various government officials around the world—have followed through with the intention of a yearly event by continuing to perform the challenge again each subsequent summer.[9][10][11][12][13][14][15]

History

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Predecessors

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From 1991 to early 2014, a challenge of unknown origin often called the "Cold Water Challenge" became popular on social media in areas of theNorthern United StatesandNorthern Norway.The task usually involved the option of either donating money to cancer research or having to jump into cold water. In Norway the penalty for refusal could also be having to purchase alcoholic drinks for others.[16]According to theWall Street Journal,the Ice Bucket Challenge was begun by professional golfers as means to support various pet charities.[17][18]

One version of the challenge, which took place inSalem, Indiana,as early as May 15, 2014, involved dousing participants with cold water and then donating to a charity, for example a local child diagnosed with an inoperable brain tumor.[19]In another version, the Auckland Division of the Cancer Society of New Zealand was the beneficiary.[20]As with similar challenges, it was usually filmed so footage can be shared online.[21][22]

TheNational Fallen Firefighters Foundationpopularized the "Cold Water Challenge" in early 2014 to raise funds as an unsanctioned spin-off of thepolar plungemost widely used bySpecial Olympicsas a fundraiser.[23]

On May 20, 2014, theWashington Township, New Jersey,fire department posted a video onYouTubeparticipating in the "Cold Water Challenge" with fire hoses. Participating members of the department were subsequently punished for using fire department equipment without permission.[24]

Soon after, the challenge was brought to mainstream audiences when television anchorMatt Lauerdid what was called "the Ice Bucket Challenge" on July 15, 2014, onNBC'sThe Today ShowatGreg Norman's challenge. Lauer was raising money for the Hospice of Palm Beach County.[25][26][27]

Shifting focus to ALS

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Atlanta Falconsplayers, coaches, and staff take the Ice Bucket Challenge.

In the Summer 2015 edition of the ALS Association's internet magazine "Visions" (page 5) says that "It all started in Florida with a golfer named Chris Kennedy. When Kennedy took the challenge in mid-July last year, the then little-known stunt was not tied to a specific charity. Kennedy thought taking the challenge might bring some cheer to a family member with ALS, Anthony Senerchia." Next, Kennedy nominated Senerchia's wife. Soon, news of the stunt traveled toPat Quinn,of Yonkers, NY, according to "Visions".[28]Within two weeks, word then reached Quinn's friend Pete Frates and he took the challenge, making him the fourth person to complete the challenge for ALS. During a Boston TV interview on September 2, 2019, Frates' father implied that his family knew so much about the disease, that "he felt like he was the Nostradamus of ALS".[29] The challenge first received increased media attention in theUnited Stateson June 30, 2014, when personalities of theGolf ChannelprogramMorning Drivetelevised the social-media phenomenon, and performed a live, on-air Ice Bucket Challenge.[30]

On the same day, golfer Chris Kennedy did the challenge, then challenged his cousin Jeanette Senerchia ofPelham, New York,whose husband, Anthony, had ALS for 11 years.[31]Kennedy's challenge was the first documented instance of the challenge being connected with ALS.[31]At this time, the challenge was not connected directly with ALS.[32]Participants would donate to a charity of their choice.[32]

Green Baylocal radio and TV personality John Maino performs the ALS Ice Bucket Challenge.

Pat Quinn, who was friends on Facebook with the Senerchias, encouraged his friends to take the challenge, and soon after, Pete Frates began posting about the challenge onTwitter.[33]Frates was awarded theStephen Heywood Patients Today Awardin 2012 for his fundraising and advocacy work.[34]Frates'Boston Collegeand sporting connections became an initial focus of the challenge and strengthened its focus on ALS.[35]Both Quinn and Frates did the challenge in support of theALS Therapy Development Institute.After its initial start with Pete Frates, aminor league baseballplayer diagnosed with the disease in 2012, the movement went viral in the Boston area which showed a much higher number of posts than any other area of the United States.[36]

In his video,Stephen Hawkingdeclined to perform the challenge due topneumoniathe year before; however, his three children took the challenge for him.[37]

The President of the United States,Barack Obama,was challenged byEthel Kennedyas well as by businessman and future successor to the PresidencyDonald Trumpbut declined, opting to contribute to the campaign with a donation of $100.[38]Justin Bieber[39]LeBron James,[40]and"Weird Al" Yankovic[41]also challenged President Obama after completing the Ice Bucket Challenge.Hirohiko Araki,creator of the manga seriesJoJo's Bizarre Adventure,created a YouTube channel and uploaded only one video, which was an Ice Bucket Challenge video.[42]Former PresidentGeorge W. Bushcompleted the challenge and nominated fellow former PresidentBill Clinton.[43]The Prime Minister of the United Kingdom,David Cameron,was challenged by bothAlex Salmond[44]andRussell Brand,[45]but also declined in favor of a donation.[46]

Peter Frates died on December 9, 2019, at his home inBeverly, Massachusetts,at the age of 34.[47]

The Challenge's success

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The Ice Bucket Challenge raised over $220M worldwide.[48]Its combination of competitiveness, social media pressure, online narcissism, and low barriers to entry led to more than 2.4 million tagged videos circulatingFacebook.[49]Even though 40–50% of the new donors were likely to make one-time gifts only,[50]the Challenge instigated large numbers of people, videos, and donations. The challenge also benefited from a unique balance of mass interest and individual identification.[51]In using social media as its platform, it accessed many people worldwide; in having its participants individually identify potential candidates – calling them out by "tagging" them – it felt personal. Furthermore, the videos were often entertaining. The average participants kept their videos under a minute,[citation needed]requiring limited commitment from any viewers. Another concept the Challenge benefited from was its ripple effect, inspiring features for articles, such asThe Guardian's "10 More of the Best Celebrity Takes on the Ice Bucket Challenge."[52]Despite its marketing success, critics suggested that the ease of repeating the challenge's spiel do not increase awareness of what the disease actually does and who it is so harmful to.

The success of the challenge prompted theMuscular Dystrophy Association,which also raises funds to combat ALS, to discontinue its long-running annual telethon, theMDA Show of Strength,after the 2014 edition, stating that the Ice Bucket Challenge prompted the MDA to reevaluate how it can connect with the public.[53]

In 2017, Frates published a book about the Ice Bucket Challenge detailing his own experience with ALS as well as his involvement in the social movement. Half of the proceeds will go to the Frates family.[54]

Revivals

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2015

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On August 1, 2015, a group of ALS organizations in the United States, including the ALS Association, relaunched the Ice Bucket Challenge for 2015. The group said they intended to rerun the campaign "this August, and every August, until there's a cure (for ALS)."[8]"We have to finish what started last summer: every August until there's a cure," said Barb Newhouse, President and CEO of the ALS Association.[55]

The 2015 campaign received the support ofMajor League Baseball,with each club due to organise its own branch of the Challenge and then nominate another franchise, along with two other local organizations or personalities, to participate in the Challenge. "We are so thrilled and grateful to have every Major League Baseball team supporting us this year," commented Frates.[55]

Celebrity participants in the 2015 challenge includedMassachusettsgovernorCharlie Bakerwho took the challenge while wearing a "Free Brady" T-shirt (calling for the lifting of the suspension given toTom Bradyof theNew England PatriotsoverDeflategate),[56]Bieber once again,[57]actorHugh Jackman(belatedly in early September 2015)[citation needed]and actressRenee Zellwegerwho, in response to criticisms of the challenge for wasting water in drought conditions, used water from a drinking trough in a horse stables while standing in the trough to ensure every last drop was recycled back into its original source.[58]PresidentBarack Obamaalso received another nomination, this time by formerNew Orleans SaintsplayerSteve Gleason(himself diagnosed with ALS).[59]Republican presidential candidateDonald Trump,despite having done the challenge in 2014, turned down his 2015 nomination fromBostonmayorMarty Walsh,labelling Walsh "a clown" and suggesting that Boston "get a new mayor."[60]

In the UK, theMND Associationdeclined to revive the challenge. "We felt we raised a significant amount of money and awareness last summer. While people might be keen to do it again, we wouldn't say please do it again," said Chris James, the Association's director of external affairs.[61]Instead, the Association ran a "Last Summer" campaign commemorating the efforts of the public with the challenge, including the testimonies of those with ALS.[62]Despite the reluctance of the MND Association, the cast ofsoap operaHollyoaksnonetheless performed the challenge, nominating the cast of another soap,Casualty.[63]Eddie Redmayne,having been nominated by Zellweger, also accepted the challenge for a second year, filming his video in London and nominatingCharlie Cox,[64]who did his 2015 challenge in New York.[65]An attempt at the world record for the largest number of people simultaneously performing the challenge took place September 6, 2015, inTewkesburyas part of a fundraiser for child bereavement charity Winton's Wish.[66]In the event, the world record of 428 remained untouched but a new UK record of 248 people was set.[67]TV presenterEamonn Holmesperformed the challenge in early October onThis Morning[68]after announcing he would do so while hosting thePride of Britain Awardsa few days earlier.[69]

By early October, it was reported that the 2015 challenge had raised $500,000 as compared with the $115 million raised by the 2014 challenge.[70]The final figure was reported by the ALS Association in mid-October as being $1,000,000, with a survey by health analystsTreatoshowing that only 14% of donors from 2014 donated again in 2015.[71][72]

2016–2019

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Australian Deputy Prime MinisterBarnaby Joyceperformed the challenge in 2016, nominating his colleagueMichael McCormack,theMinister for Small Business.[73][9][74]Fellow Australian MPAdam Marshallalso performed the challenge.[73]A new variant on the challenge this year, the "What's In Your Bucket?" challenge, featured the replacement of the ice cubes with other substances, including tomato ketchup, spaghetti, pickles, beer, baby powder, coffee, and sand.[10][75][76]A further attempt on the world record for the largest mass Ice Bucket Challenge in Buffalo, New York drew 650 participants, 71 short of the existing record of 721.[11]

Charlie Baker,governor of Massachusetts, formalized the annual challenge by signing a bill declaring the first week of August each year to be Ice Bucket Challenge Week.[12]MND South Australia held an Ice Bucket Challenge campaign in February (during the Southern hemispheric summer)[77][78]Pete Frates' family joined with theBeverlyPolice Department to hold an Ice Bucket Challenge event on August 27 in which family members and officers took part.[79]In 2016, the Motor Neurone Disease New Zealand Association Inc (later to become theMotor Neurone Disease New Zealand Charitable Trust) promoted the ice-bucket challenge which raised NZ$35,000.[80]

In June 2018 inSeoul,South Koreathe Challenge raised funds to build Korea's first dedicated hospital for ALS patients.[13]TheEmpire City CasinoinYonkersannounced it would hold a Challenge event for the fifth year running.[81]Political participants this year included Massachusetts State SenatorJoan Lovely.[82]

A fifth anniversary commemorative mass Ice Bucket Challenge was held atCopley Squarein Boston, Massachusetts, with Frates and state governorCharlie Bakerin attendance.[14]ALS Canada's staff's annual commemorative performance of the Ice Bucket Challenge also reached its fifth year[83]to end the Ice Bucket Challenge.

2020 onwards

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The 2021 and 2022 annual Yonkers Ice Bucket Challenge events were dedicated to the memory of Pat Quinn.[15][84]with the latter held on July 31[84](in spite of the "Every August..." slogan). By this point the Empire City Casino had held an Ice Bucket Challenge event every year since 2015 except 2020 on account of theCOVID-19 pandemic.[84]

Rules

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Governor of South CarolinaNikki Haleydoes the ALS Ice Bucket Challenge.
Matt Damondid the challenge with toilet water to also promote access to safe drinking water and sanitation.

Within 24 hours of being challenged, participants have to record a video of themselves in continuous footage.[85]First, they are to announce their acceptance of the challenge, followed by pouring ice into a bucket of water.[86]Then, the bucket is to be lifted and poured over the participant's head.[86] Then the participant can nominate a minimum of three other people to participate in the challenge.[87]

Whether people choose to donate, perform the challenge, or do both varies.[85][88]

In one version of the challenge, the participant was expected to donate $10 if they poured the ice water over their head or donate $100 if they did not.[89]In another version, dumping the ice water over the participant's head was done in lieu of any donation, which led to some criticisms of the challenge being a form of "slacktivism".[90]Many participants donated $100 in addition to doing the challenge.[91]

Impact

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Awareness

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In mid-2014, the Ice Bucket Challenge went viral on social media, particularly in theUnited States,with people, celebrities, politicians and athletes posting videos of themselves online and on TV participating in the event.[6][38]According toThe New York Times,people shared more than 1.2 million videos onFacebookbetween June 1 and August 13 and mentioned the phenomenon more than 2.2 million times onTwitterbetween July 29 and August 17.[87]At its peak, the challenge generated more than 70,000 tweets per day with hashtags such as#IceBucketChallenge,#ALSIceBucketChallenge,and#StrikeOutALS.[92]Mashablecalled the phenomenon "theHarlem Shakeof the summer ".[26]

Prior to the challenge, public awareness of the diseaseamyotrophic lateral sclerosis(ALS) was relatively limited; theALS Associationstated that prior to the challenge going viral only half of Americans had heard of the disease,[87]often referred to as "Lou Gehrig's disease", after baseball playerLou Gehrig,who publicly revealed his diagnosis in 1939.[93]After the Ice Bucket Challenge went viral on social media, public awareness and charitable donations to ALS charities soared. Hits to theEnglish Wikipedia's article onamyotrophic lateral sclerosisgrew from an average of 163,300 views per month to 2.89 million views in August 2014, and similar increases occurred in theSpanishandGermanWikipedias.[94]

Donations

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Within weeks of the challenge going viral,The New York Timesreported that the ALS Association had received $41.8 million in donations from more than 739,000 new donors from July 29 until August 21, more than double the $19.4 million the association received during the year that ended January 31, 2013.[95]On August 29, theALS Associationannounced that their total donations since July 29 had exceeded $100 million.[96]The ALS Association is just one of several ALS-related charities that have benefited from the challenge:

Organization Additional funding
reported
ALS Association
$220m[96]
ALS Society of Canada
$26m[97]
Motor Neurone Disease Association
£7m[98]
ALS Therapy Development Institute
$4m[99]
ALS FoundationNetherlands
€1m[100]
Project ALS
$500k[101]

While the Ice Bucket Challenge raised much in donations, studies show that the majority of participants did not actually donate.[102][103]In theUK,one in every six people participated, but only ten percent of the participants donated, according to theCharities Aid Foundation.[104]The percentage was higher in the U.S., but the majority still did not donate.[105]

In July 2015, theHuffington Postreported on theALS Association's summary of how the funds raised through the Ice Bucket Challenge were distributed.[106][107]By percentage, 67% of all funds (about $77 million) went to research, 20% to patient and community services, 9% to public and professional education, 2% to additional fundraising, and 2% to external processing fees.[108]

Research

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On July 25, 2016, the ALS Association announced that, thanks in part to donations from the Ice Bucket Challenge, theUniversity of Massachusetts Medical Schoolhas identified a third gene that is a cause for the disease.[109]Project MinE,a globalgene sequencingeffort to identify genetic drivers of ALS, received $1 million from the challenge, allowing them to broaden the scope of their research to include new sources in new parts of the world. Having identified the link between the gene,NEK1,and ALS will allow for a new targeted gene for therapy development, as well as focused drug development.[110]

Influences

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The Ice Bucket Challenge serves as a strong example of the effectiveness of digital media, showcasing its ability to spread information and awareness about various topics. The digital sphere allows for similar challenges to go viral through hashtags, infographics, and fundraisers. The success of the Ice Bucket Challenge has sparked other social media challenges to be publicized, reaching a wide and diverse audience. The My Tree Challenge is an activity launched inKeralawhich consists of planting a tree sapling and challenging others to do so.[111]The My Tree Challenge was preceded by a Book List Challenge, started by Facebook users, where users post a list of books that they have read and liked the most.[112]TheRice Bucket Challenge,that started in India in late August 2014 and later spread to other South Asian nations, was also partly a response to the Ice Bucket Challenge's wastefulness of water.[113][114]The "Pie In The Eye Challenge" challenges the nominated person to receive apie in the face.[115][116]One particular occurrence of this, the late 2016 Waitress Pie Challenge, was initiated by the cast of the musicalWaitressto raise awareness of breast cancer.[117]The Milk Bucket Challenge in which milk is poured over the nominated person, was organised in August 2015 by English dairy farmers to raise awareness of their financial plight.[118]The Rubble Bucket Challenge, started by Jordanian comedian Mohammed Darwaza, involves dumping a bucket of sand and rocks over one's head.[119]This challenge was further popularized by Palestinian journalist Aymal al Aloul, and aims to increase awareness of Gazans who have lost their homes in the ongoing conflict with Israel.[120]The Love Bucket Challenge, started by Kerala newspaperMalayala Manoramaencourages people to fill a bucket with items to donate to orphanages.[121]The Kaapi Challenge usescoffee,and is a challenge done primarily by theChennai Super Kingsto commemorate the 375th anniversary of the city ofChennai.[122][123]

Criticism

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A number of criticisms arose relating to the campaign, accusing it of being self-congratulatory,[124][125]focusing primarily on fun rather than donating money to charity, and substituting a trivial activity for more genuine involvement in charitable activities.[126]Writing inThe Daily Telegraph,Willard Foxton described the challenge as "a middle-classwet T-shirt contestfor armchair clicktivists ",[127]and theEvening Standard Magazinesaid that "it has become less about raising funds and all about showing off your star-pulling power".[128]

On August 28, 2014, it was reported that the ALS Association had filed an application to trademark the term "ice bucket challenge",[129][130]but the application was retracted amid criticism a day later.[131]

Importance of the cause

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William MacAskill,vice-president ofGiving What We Can,an organization that advocates for people to engage in moreeffective altruism,was critical of the Ice Bucket Challenge, citing two chief objections.[132]First, he claimed that the Ice Bucket Challenge resulted in "funding cannibalism": "for every $1 we raise, 50¢ would have been donated anyway".[132]Relatedly, MacAskill claimed that the challenge encouragedmoral licensing,whereby people who engage in one act they consider good may feel more licensed to engage in bad behavior.[132][133]MacAskill's piece was met with considerable critical push-back, and he published a follow-up a few days later suggesting an Ice Bucket Challenge for causes he considered more important and cost-effective to support. Citing research fromGiveWell,MacAskill gave the example of donating to theAgainst Malaria Foundationto endmalaria.[134]MacAskill's pieces were cited inNonprofit Quarterly,[135]andBoston Review.[136]

Julia BelluzatVoxwrote a piece with similar criticisms, linking to MacAskill's piece. Belluz noted that funding for diseases was often not proportional to the number of deaths caused by the diseases. She also noted that donating to developing world health causes could provide much greaterhealthcare valuethan donating for the treatment of rare diseases, an observation that is common in theeffective altruismmovement.[137]

In theBBC'sMore or Lesspodcast, economistTim Harforddiscussed the Ice Bucket Challenge and how to select the best charities, referencing work byGiveWell.[138]He himself participated in the Ice Bucket Challenge, donating to theSchistosomiasis Control Initiative.[139]Ben Carter and Keith Moore wrote an article for theBBC Newsdrawing on the arguments made in the podcast.[140]

Use of donated funds

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Retiredprofessional wrestlerLance Stormdeclined the challenge despite being nominated twice, and posted a note on his official website stating that most of the money that is donated goes towards promotional and advertising of the ALS Association while the remaining amount (at most 25% of what is donated) "is going into the pockets of Big Pharma", which is already doing ALS research and is therefore inflating their already-high profits. Storm went on to comment that it would be better to actually help someone with ALS and donate money directly to ALS patients.[141][142]The ALS Association responded to similar criticisms by saying that 79% of their annual budget went toward programs in the past year.[143]

Members of thepro-life movement,such asLila RoseofLive Action,criticised donations to the ALS Association, because it usesembryonic stem cellsin its ALS research.[144]Related organisations such as theFamily Research Councilsuggested that people participating in the Ice Bucket Challenge instead donate money to Midwest Stem Cell Therapy Center,Mayo Clinic,and theJohn Paul II Medical Research Institute,all three of which runclinical trialswithadult stem cells,rather than embryonic ones.[145]TheArchdiocese of Cincinnati,with its 113schoolsalso recommended individuals participating in the Ice Bucket Challenge to donate to such groups, but not to the ALS Association "saying the group's funding of embryonic stem cell research is 'in direct conflict with Catholic teaching'."[146]

PETAcriticized the ALS Association's Ice Bucket Challenge, saying that money raised through the fundraiser would be used to fund "archaic and painful tests on animals."[147]Russell Simmons,[147]Pamela Anderson,[148]andGrimes,[149][150]among other celebrities, also criticized the ALS Association's fundraiser for its support of animal testing. Anderson wrote on herFacebookpage, "Trying to cure human diseases by relying on outdated and ineffective animal experiments isn't only cruel – it's a grave disservice to people who desperately need cures."[148]

Focus on the stunt rather than donations

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American stunt performer and TV personalitySteve-Oquestioned the campaign, suggesting that celebrities' videos generally did not share donation information for ALS charities, and that the initial $15 million in funds was insignificant, given the star power of the celebrities participating. He noted that, of the videos he viewed, onlyCharlie SheenandBill Gatesmentioned that the point is to donate money.[151]A similar criticism was made by Jacob Davidson inTime Magazine[152]and by Arielle Pardes inVice.[126]

Health risks

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On August 22, 2014, Dr. Brian O'Neill, a physician at theDetroit Medical Center,warned that the challenge may have adverse health effects on participants, including potentially inducing avagal responsewhich might, for example, lead to unconsciousness in people taking blood pressure medications.[153]A number of participants have sustained injuries,[154]and at least one death has been indirectly linked to the challenge, as a result of injuries sustained unrelated to the dumping of ice water,[155]with another death thought to be caused by a variation on the challenge, jumping feet first into ice water.[156]

"Michael's Story" poster

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"Michael's Story" was a campaign poster from the UK MND Association's summer 2015 "Last Summer" first anniversary campaign which featured Michael Smith. He had not taken part in the Ice Bucket Challenge and was subsequently diagnosed with motor neurone disease. This caused controversy, with some critics saying that the poster was implying that Smith had deserved his illness for his previous non-participation. The claims were strongly refuted by the Association and by Smith himself.[62]

Waste of water

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Drought in California in 2014

MeteorologistJason Samenowestimated that during the peak of the movement's popularity in 2014, the equivalent of 5,000,000 US gallons (19,000,000 L; 4,200,000 imp gal) of water would have been used for the challenge. This calculation assumes that the average of one 4-US-gallon (15 L; 3.3 imp gal) bucket of water was used per video for the 1.2 million challenge videos[157]which were posted during that time.[158]

In January 2014, GovernorJerry BrowndeclaredCaliforniato be in adrought state of emergency.[159]This state of emergency was still in place as the Ice Bucket Challenge became most popular, and many local news stations in California took to criticizing the Challenge's unnecessary waste of water.[160][161][162]Also at the time inChina,various regions (including the important crop-producingHenanprovince) experienced months of extreme drought during the summer of 2014.[citation needed]On August 22, 2014, citizens of Henan stood together to protest the challenge, with signs that said "Henan, please say 'NO' to Ice Bucket Challenge."[163][164]

To prevent wasting drinkable water, many performed the ALS Ice Bucket Challenge by using natural water sources.Carole Kingperformed the challenge using creek water that was immediately returned to the creek,[165]and the Killer Clown, a YouTube personality, performed the challenge using rainwater.[166]In response to the criticisms in California, some Californians performed the challenge by using dirt instead of water.[167]

Some ALS organizations, such as the ALS Therapy Development Institute, has published guidelines for the Ice Bucket Challenge to minimize water usage through alternatives, like "filling the bucket with socks."[168]

See also

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References

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