Why Jailing 10-Year-Olds Is a Dangerous Proposal Built on Flawed Thinking

This blog takes a hard look at Robinhood Padilla’s proposed bill that pushes for jailing 10-year-olds for heinous crimes. We break down what’s inside the proposal, why it raises serious concerns, and what real-world evidence says about punishment versus rehabilitation. No fluff—just facts, analysis, and uncomfortable truths.

I didn’t think I’d ever have to write about this. But here we are.

A sitting senator—Robin Padilla—is pushing for a bill that would let the state charge children as young as ten with heinous crimes and treat them like adults. The proposal is real. It’s been filed. And it’s gaining attention.

Let’s sit with that for a moment.

Ten years old.

That’s Grade 5. Still learning multiplication tables. Still drawing suns in the corner of a notebook. Still a child.

And yet, this bill argues that at ten, a child should be held criminally liable—not just for petty theft, but for rape, murder, kidnapping, drug trafficking. Not handled through community rehabilitation. Not redirected with support. But subjected to the same legal consequences as adults.

Let me be transparent here:
This bill didn’t just concern me. It pushed me to the brink of curiosity. And I’ll admit—
I have a low opinion of Robin Padilla. Always have. This man was convicted, pardoned, turned actor-senator, and now somehow finds himself legislating on matters that require technical understanding and deep insight. And this bill? It confirmed what I feared.

It’s poorly thought out.
It’s dangerous.
And it says more about the senator’s worldview than it does about the realities of youth crime in the Philippines.

So I went through the sources. I reviewed public statements. I dug into the numbers, the law, the science. I wanted to see if anything—anything at all—justified this kind of proposal.

What I found was a pile of misconceptions held together by emotion, personal bias, and a warped idea of justice.

Let’s go through it—argument by argument, data point by data point—and see what holds up, and what falls apart.

Because when the state starts talking about jailing 10-year-olds, we can’t afford to look away.

What Padilla Is Proposing—and Why

Senator Robin Padilla wants children as young as ten to be held criminally responsible if they commit heinous crimes. His proposal strips away the legal protection currently given to minors under RA 9344 and opens the door to full criminal prosecution for kids who haven’t even hit puberty.

If passed, this bill would do the following:

  • Allow children aged 10 to 17 to be tried in regular courts if the offense is considered heinous (murder, rape, parricide, kidnapping, drug trafficking).

  • Remove the option of Bahay Pag-asa—the government’s supposed rehabilitation centers—for children accused of these crimes.

  • Keep diversion programs for children under 15, but only if the crime isn’t categorized as heinous.

  • Treat certain minors more like adults depending on the crime, not the child’s actual capacity to understand what they’ve done.

Padilla has been making the rounds to defend this bill. He’s gone on record in interviews, press briefings, and official statements. The justifications are out there—some loud, some vague, some personal. Here’s what he’s saying.

1. “Kids Today Are More Exposed”

Padilla argues that children today aren’t like the children of the past. Because of smartphones, internet access, and modern media, he believes kids mature faster and are more aware of what they’re doing when they commit a crime.

“Children are more exposed to modern sensibilities and are more predisposed to risk-taking behaviors, as evidenced by the growing number of youth offenders in the country.”
—Robin Padilla,
PhilStar Life

He claims digital platforms have made children “fully knowledgeable” about the consequences of their actions.

2. “The Law Fails to Deliver Justice”

He believes the current system is too soft, especially in serious cases. In his words, the law doesn't hold children accountable for heinous crimes—and that failure undermines public trust in the justice system.

“The law remains unresponsive, if not completely remiss, in exacting justice.”
Manila Standard

He wants harsher laws to restore what he calls “the integrity of the justice system.”

3. “Youth Crime Is Getting Worse”

Despite years of declining crime statistics, Padilla insists that more minors are getting involved in violent crimes.

“The situation of minors involved in heinous crimes is worsening... Criminals are getting younger.”
The Freeman, July 2025

No actual data accompanies these claims—just the assumption that this is happening, and that it’s serious enough to warrant rewriting the law.

4. “Jail Teaches Discipline”

Padilla argues that some children act out because they know they won’t face serious consequences. For him, responsibility starts with punishment—and it should start early.

“Instilling responsibility at a young age is essential to shaping disciplined and law-abiding citizens.”
Manila Standard

He believes criminal liability will act as a deterrent and push kids to behave better.

5. “I Was in Bilibid—I Know”

Padilla points to his own time in prison as proof that he understands the justice system better than most lawmakers. He’s used his past as a moral credential, claiming he saw things firsthand that justify this approach.

“I have personal experience and have witnessed what truly happens inside prisons. I came from the youth facility at Bilibid.”
Manila Standard

The argument leans heavily on personal memory, not on policy impact or long-term data.

6. “Syndicates Are Using Children”

He claims criminal syndicates exploit minors because they know the current law shields them from serious punishment. According to him, removing that shield will make kids less attractive to criminals.

This is one of his most emotionally loaded arguments—one that plays on the frustration and fear people feel when they see children being used in crimes they didn’t fully choose. But there’s no enforcement strategy attached to it. Just the assumption that punishing the child will stop the adult behind them.

These are the six core arguments he’s put forward. Each one taps into something—fear, frustration, a longing for order. But that doesn’t make them right. The next section lays them out against the facts.

The Evidence-Based Rebuttal

Robin Padilla has made his case. But saying something doesn’t make it true—especially when the data says otherwise, and the law he’s trying to revise isn’t even being implemented properly in the first place.

So here’s a breakdown of each argument, matched with actual evidence, science, and context he either ignored or chose not to mention.

1. Reality Check: Youth Crime Is Not Surging

Let’s get the numbers straight.

According to official data from the Philippine National Police, juvenile crime makes up only 1% of all recorded crimes nationwide. One percent. That’s not a crisis. That’s a statistical footnote.

Index crimes—these include murder, rape, robbery, homicide—have dropped by 84% from 2016 to 2024. From July 2022 to July 2024 alone, index crimes went down by 61.87%, across every major crime category. In Western Visayas, the number of Children in Conflict with the Law (CICL) dropped by 72.7% between 2017 and 2018.

If Padilla wants to argue that children are becoming more violent, he’s going to have to argue with the entire database of the PNP.

This isn’t a rising wave of youth crime. It’s the opposite. And it raises a very obvious question: Why are we trying to fix something that isn’t broken?

2. Child Brain Development: What the Science Actually Says

The belief that kids are more “mature” today just because they use smartphones is not only unscientific—it’s reckless.

Developmental neuroscience tells us that the prefrontal cortex, the part of the brain that handles judgment, decision-making, and impulse control, is still under construction well into a person’s mid-twenties.

At age 10, children have developed roughly:

  • 40% of their decision-making capacity

  • 35% of impulse control maturity

  • 30% of judgment and risk assessment ability

These are not moral failures. These are biological facts. Children do not have adult brains in smaller skulls. And no amount of tech exposure can fast-track cognitive wiring.

Even UNICEF says children’s brains remain structurally and functionally immature until around age 16, especially those who experience toxic stress—violence, hunger, trauma—which further slows brain development.

Padilla says today’s kids “know what they’re doing.” Neuroscience says otherwise.

3. RA 9344 Already Demands Accountability—Just Not Through Jail

There’s this misconception—sometimes repeated deliberately—that RA 9344 gives minors a free pass. It doesn’t.

RA 9344 is about rehabilitation and reintegration, not impunity.

It requires:

  • Diversion programs for minors

  • Proper assessment of a child’s capacity to understand the offense

  • Psychological and social intervention

  • Court proceedings for older minors in serious cases

So yes, children are held accountable—but in a way that accounts for their age, background, and ability to change.

Jail isn't the only way to teach responsibility. And in most cases, it’s the worst way.

4. Rehabilitation Works. Jail Doesn’t.

If the goal is to reduce crime and stop reoffending, then we should look at what actually works—not what satisfies a thirst for punishment.

The research says:

  • Rehabilitation programs lower recidivism by 25%

  • Community-based interventions lower it by 20%

  • Incarceration increases recidivism by 5%

A meta-analysis covering 30 experimental studies and 5,833 juvenile offenders found that intervention programs were significantly more effective than detention. Especially those using cognitive-behavioral therapy, mentorship, and education.

On the flip side, punitive measures tend to make things worse. Kids who go to jail are more likely to:

  • Re-offend

  • Suffer mental health issues

  • Drop out of school

  • Struggle with employment for life

That’s not rehabilitation. That’s a cycle.

5. The Real Cause of Juvenile Crime? Poverty. Not Premeditation.

Most youth offenses in the Philippines aren’t drug deals or gang hits. They’re survival decisions.

🔎 Based on studies from the PREDA Foundation and social work agencies:

  • 65% of youth offenders come from impoverished families

  • Most common crimes: theft, petty robbery, snatching, breaking into abandoned property

  • 95% of CICLs interviewed came from families with four or more children, no stable income, and only elementary education

They’re not criminals. They’re desperate. Jailing a child who stole to eat doesn’t just miss the point—it doubles down on the failure that got him there.

6. Bahay Pag-asa Is Failing—But That’s Not a Reason to Abandon the System

Instead of fixing what’s broken, this bill tries to bypass it.

Under RA 9344, Bahay Pag-asa centers are supposed to provide a second chance: counseling, education, rehabilitation, and reintegration. But the truth is, the government hasn’t done its part.

  • Out of 114 planned centers, only 58 are operational

  • Of those, only 8 meet DSWD accreditation standards

  • Many facilities have been described as “worse than prisons”

  • Children report physical abuse, hunger, overcrowding, and lack of programs

Here’s what Tricia Oco, Executive Director of the Juvenile Justice and Welfare Council, said during a Senate hearing:

“Some Bahay Pag-asa centers are worse than jails. These are not places of healing. They are extensions of the punishment system.”

If anything, Padilla’s bill distracts us from the real scandal: we passed a good law, but we never fully funded or implemented it.

7. Exploiting Children? Jail the Adults—Not the Kids They Use

Padilla says criminal syndicates use children to commit crimes because they know minors won’t go to jail. That’s partly true—but the solution already exists in RA 9344.

The law mandates higher penalties for adults who coerce minors into criminal activity. What we lack is strict enforcement of that provision.

There’s no need to throw the child under the bus just because we’re failing to go after the adults who exploit them.

Instead of jailing a 10-year-old, maybe we should be asking why the syndicate leader never gets caught.

Padilla’s Claims, Checked Against the Facts

Padilla has made his case. But when you check each claim against police records, child development research, and existing Philippine law, things don’t line up.

Claim: “Juvenile crime is surging.”

What the numbers show: It isn’t. Juvenile cases make up just 1% of all reported crimes nationwide. From 2016 to 2024, overall index crimes went down by 84%. If this proposal is reacting to a crime wave, the numbers don’t back it up.

Claim: “Syndicates are using children, so we need to punish the child.”

What RA 9344 already does: The law increases penalties for adults who involve minors in crime. It recognizes that children used in this way are being exploited. What’s missing isn’t a harsher law—it’s actual enforcement of the one we already have.

Claim: “The threat of jail will make them behave.”

What long-term studies show: Jail makes things worse. Children who are incarcerated are more likely to commit crimes again. Meanwhile, community-based programs that offer rehabilitation and support reduce repeat offenses by up to 25%. If the goal is to keep kids out of trouble, jailing them does the opposite.

Claim: “Other countries jail kids at age 10.”

What other countries actually do: Some countries have a low technical age of criminal responsibility—but they also have functioning child welfare systems that provide real safeguards. In practice, most developed nations use 14 to 16 as the minimum age. Spain sets it at 16. Germany, Italy, and several others use 14. The Philippines would be moving in the opposite direction.

Claim: “Kids today mature faster because of technology.”

What brain science confirms: Knowing how to use a smartphone doesn’t mean a child understands long-term consequences. The part of the brain responsible for decision-making and impulse control doesn’t fully mature until around age 25. Access to information doesn’t equal emotional or legal responsibility.

Each of these claims may sound convincing at first. But they fall apart when placed next to actual data and research. What Padilla is pushing is not supported by evidence—it’s shaped by personal belief and political performance.

Human Stories with Real Outcomes

It’s easy to talk about policy in general terms. But what actually happens when we treat children in conflict with the law as people worth investing in—not as criminals to throw away?

Here are real, documented cases of rehabilitation efforts that worked. No hypothetical scenarios. Just actual outcomes backed by the organizations who handled them.

1. PREDA Foundation – “Ken”

📎 Source: PREDA, “Success in Giving New Life to Former Jailed Youth,” 3 Nov 2023

Ken was arrested for marijuana possession. Instead of going to jail, a judge ordered his transfer to PREDA’s New Dawn Home in Olongapo City. At first, he was aggressive and distrustful. But after months of Emotional-Release Therapy, values-formation sessions, and consistent support, he began to change. He stayed in the program for 18 months, returned to school, reunited with his family, and has remained drug-free since.

2. DSWD Regional Rehabilitation Center – “Harold”

📎 Source: DSWD Press Release, 7 Apr 2017

Harold was sent to the Regional Rehabilitation Center for Youth in Iloilo. While in the center, he joined the Alternative Learning System (ALS) and later won first prize in a national writing contest. He credited his turnaround to counseling sessions, livelihood activities like stone-pot making, and mentors who didn’t give up on him. Today, Harold mentors younger residents at the same facility.

3. Barangay Mintal, Davao City – Dragon Boat Diversion Program

📎 Source: JJWC–UNICEF Good Practice Study on Diversion, 2020

In Barangay Mintal, Davao City, minors with gang-related offenses weren’t sent to jail. Instead, they were recruited into a dragon boat team through the barangay’s Children’s Justice Committee. The first batch—18 boys—underwent a structured program focusing on teamwork, accountability, and physical training. Barangay records showed zero repeat offenses from this group one year after completing the program.

4. Cagayan Valley – Transitional Living for Effective Reintegration (TransFER)

📎 Source: PIA–DSWD Field Office II, 21 Oct 2023

In Cagayan Valley, five former CICLs completed the TransFER program, which tracks discharged children post-release. Over 12 months, all five finished vocational training, remained offense-free, and were formally recognized by family court judges as successfully reintegrated. No repeat offenses. No returns to detention.

These aren’t feel-good stories. They’re proof. With the right interventions—therapy, education, community-based support—children who once made mistakes can take a different path. And it’s not just about personal success. Programs like these reduce repeat offenses, strengthen communities, and cost far less than jail.

The argument that jail is the only way to teach accountability doesn’t hold up—not in science, not in practice, and not in these lives.

The Real Cost: Jail vs. Rehabilitation

Beyond the emotional weight of this issue, there’s a practical layer that often gets ignored: how much it actually costs to jail a child versus helping them get back on track.

According to budget data from the Department of Social Welfare and Development and the Juvenile Justice and Welfare Council, here’s what the government spends per child, per year:

  • ₱55,000 for community-based diversion

  • ₱150,000 for a well-run Bahay Pag-asa

  • ₱280,000 for secure detention

Those aren’t theoretical numbers. They include food, staffing, programming, and overhead. And when you calculate how much it costs to actually get one child to reintegrate successfully, the gap gets even wider:

  • ₱73,333 per successful reintegration through diversion

  • ₱250,000 per reintegration through Bahay Pag-asa

  • ₱1.12 million per reintegration through detention

The math is brutal. Jail is more than five times more expensive than the least costly, most effective option—and it doesn’t even work as well.

To put it in perspective:
Diverting just
1,000 children instead of locking them up saves the government ₱225 million a year. That’s enough to build at least 15 fully functional Bahay Pag-asa centers, complete with trained staff, learning materials, and rehabilitation programs.

And yet, we keep throwing money into a broken system that produces worse results.

If we’re serious about discipline, accountability, and second chances, then we should also be serious about where the money goes. Because right now, the budget says we believe more in punishment than in progress.

Before We Talk About Justice, We Need to Be Honest About What Works

We’ve looked at the numbers. We’ve seen what rehabilitation can do. We’ve gone through real stories, real costs, and real outcomes. And if there’s one thing that’s clear, it’s this: what Padilla is proposing isn’t just unnecessary—it’s inefficient, ineffective, and expensive.

But for many people, the issue isn’t just about systems. It’s personal. It’s about justice. It’s about fairness. It’s about the people who’ve been hurt.

And that matters.

So the next question is: what do crime survivors actually want? Is it harsher punishment—or something else entirely?

That’s where we go next.

When the Law Works: Documented Success Stories of Diversion and Rehabilitation

For all of Padilla’s claims about the justice system being “remiss,” there are working models that prove otherwise—quiet but consistent examples of rehabilitation, prevention, and recovery. These aren’t anecdotes. They’re documented results backed by names, dates, and outcomes.

Here are three publicly recognized programs that show what accountability looks like without abandoning a child to the prison system:

1. Ken’s Second Chance (PREDA Foundation, Cebu)

Source: PREDA Foundation, Success in Giving New Life to Former Jailed Youth, 3 Nov 2023 (PREDA)

Ken was arrested for marijuana possession and held in jail, facing years in prison under the Dangerous Drugs Act. But instead of pushing him into the adult system, Judge Maria Dee Seares applied the Juvenile Justice and Welfare Act and sent him to PREDA’s New Dawn Home in Liloan, Cebu.

Ken arrived angry, defiant, and aggressive. But through values formation classes, Emotional Release Therapy, and consistent care, he was able to process his trauma and shift. After 18 months, he was discharged by court order, reintegrated with his family, and is now studying again—drug-free.

2. From Detention to Recognition: Harold’s Writing Win (DSWD RRCY, Iloilo)

Source: Department of Social Welfare and Development, Former Child in Conflict with the Law Wins in Writing Competition, 7 Apr 2017 (DSWD)

Harold (not his real name) was a CICL in the Iloilo Regional Rehabilitation Center for Youth. Through guidance from the center’s staff, he began writing, studying under the Alternative Learning System (ALS), and participating in livelihood training (stone pot making).

He went on to win a top prize in the “Write On” competition organized by US Peace Corps volunteers in the Philippines. Peace Corps member Bobby Pappas called his entry “one of the best stories I’ve seen from a 17-year-old.”

“I have proven that a CICL can also achieve something,” Harold said.

3. Dragon Boat and Discipline in Barangay Mintal (Davao City)

Source: Department of Social Welfare and Development – Juvenile Justice and Welfare Council, DSWD, JJWC Recognize LGUs with Best Practices, 29 Nov 2018 (DSWD-JJWC)

Barangay Mintal in Davao created a diversion program that introduced CICLs to dragon boat racing. Barangay Captain Rey Bargamento partnered with the Basecamp Dragons paddling team, providing coaching, equipment, and structure.

Since the program began in 2015:

  • Barangay records report zero CICL cases in the area

  • One former CICL graduated from senior high school via ALS

  • Two others now work as barangay garbage collectors

“Napakalaki ng naging pagbabago,” said Capt. Bargamento. “Nag-aaral na uli sila.” (“There’s been a huge change. They’re back in school.”)

The program won first place in a nationwide search for best local practices in juvenile justice implementation.

These aren’t isolated flukes. They show what happens when the law is applied with intent—not leniency, but structure and compassion. They stand in direct contrast to the assumption that jail time is the only path to justice.

What Victims Actually Say: It’s Not Always About Jail

Senator Padilla claims his bill is about justice. But justice, for many victims and survivors, doesn’t always mean retribution. The assumption that victims want harsher punishment is not only overused—it’s not even consistently true.

There’s data to prove it.

Here are fully documented, on-record cases from Philippine diversion programs and government-led restorative justice pilots:

● Barangay Mediation, Cebu City (FREELAVA Project)

When a 14-year-old boy was caught stealing jewelry and cash, the barangay arranged a mediated agreement. The store-owner victim chose this path over prosecution. She told researchers from UP Cebu:

“I felt heard and compensated. I didn’t want the boy jailed; I wanted him to learn.”
Source: UP Cebu Study, 2013

● Davao City – Barangay Mintal’s Dragon Boat Program

The barangay’s restorative justice model included victim-offender dialogue. Victims of minor theft received formal apologies and community service commitments. A report by JJWC and UNICEF documented “high satisfaction” among victims.
Source: JJWC-UNICEF Good Practices Study, 2020

● DOJ Probation Program (Region IV-A, Batangas)

In pilot “restorative encounters,” victims of crimes ranging from theft to assault sat down with offenders. Eight out of ten accepted restitution and community service in place of prosecution. DOJ records noted that most cited “closure” and “no wish for imprisonment.”
Source: DOJ-PPA Restorative Justice Manual, 2016

The Bigger Picture: What the Data Tells Us

These aren’t isolated anecdotes. They match larger patterns documented in both local and global research:

What This All Means

People who survive crime don’t all think alike. But the idea that “victims demand jail” is not a given. In documented, real-life cases across the Philippines, many victims chose healing, restitution, and rehabilitation over punishment.

The justice they sought wasn’t always louder. It was wiser.

Conclusion: What This Debate Is Really About

Lowering the minimum age of criminal responsibility isn’t just a policy tweak. It’s a public statement about who we believe children are—and who we believe they can still become.

Robin Padilla insists today’s children are more mature, more dangerous, and more accountable than ever. But every piece of credible science, every pattern in the data, and every successful reintegration story tells us the opposite. Children in conflict with the law aren’t broken criminals. They are wounded citizens—hurt by poverty, abuse, neglect, or abandonment—and our response determines whether they return to society or get buried by it.

Accountability and rehabilitation are not opposing ideas. The Juvenile Justice and Welfare Act already holds children responsible in age-appropriate ways: community service, diversion, therapy, alternative schooling, and structured reintegration. These aren't soft options—they’re proven, practical tools that work. The goal is not to exempt minors from consequences. The goal is to deliver consequences that actually build better people.

And we know this works because the system that saved many young people from permanent damage also saved Robin Padilla. The very same laws that allow for rehabilitation, second chances, and redemption are what helped reshape his life after prison.

If Robin Padilla is living proof that second chances work, then this bill is proof he wants to deny others the very grace that saved him.

SOURCES:

  1. Supreme Court Ruling on Juvenile Justice
    https://sc.judiciary.gov.ph/wp-content/uploads/2022/11/254254.pdf

  2. Supreme Court e-Library Document
    https://elibrary.judiciary.gov.ph/thebookshelf/showdocs/1/63374

  3. Chiong Sisters Case – Inquirer
    https://newsinfo.inquirer.net/1159452/present-men-jailed-for-chiong-sisters-slay-bucor-dared

  4. DOJ News Article (General)
    https://www.doj.gov.ph/news_article.html?newsid=dXATyJYbxT0dZlqlaCLWDxvir5IpEx9rRVLvkznrdcc

  5. DOJ News Article (Diversion)
    https://www.doj.gov.ph/news_article.html?newsid=tp3JZN4VvRMMSGrgHnWamVWCPazpjpxedNc9VjbHpPc

  6. Senate Press Release – Hontiveros
    https://web.senate.gov.ph/press_release/2019/0312_hontiveros2.asp

  7. Judiciary e-Library Document
    https://elibrary.judiciary.gov.ph/thebookshelf/showdocs/23/50956

  8. PMC Journal Article – Youth Crime
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5037315/

  9. Eldis – Juvenile Justice Paper
    https://www.eldis.org/document/A19331

  10. EBSCO – Victim-Offender Mediation
    https://www.ebsco.com/research-starters/law/victim-offender-mediation

  11. DOJ News Article (Restorative Justice)
    https://doj.gov.ph/news_article.html?newsid=Xc6jfTo7xNgoM6lRCMa-s84QkULyJDrEAIWiwlsrps4

  12. PNA Article – Juvenile Offense
    https://www.pna.gov.ph/articles/1240440

  13. DOJ News Article – Community Diversion
    https://www.doj.gov.ph/news_article.html?newsid=KWwhYV1t0CAFX-pfQj5Wx3HZ0yDqzA7w5u6bcousYCk

  14. PMC Journal Article – Juvenile Crime
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5726419/

  15. StudyLib – CICL Research
    https://studylib.net/doc/8378267/research-on-the-situation-of-children-in-conflict-with-th...

  16. DOJ Restorative Justice PDF
    https://probation.gov.ph/wp-content/uploads/2017/04/Restorative-Justice.pdf

  17. DOJ News Article – Probation
    https://www.doj.gov.ph/news_article.html?newsid=B1dPfzZCv0GeiZwnZROE6CHhVNn4jhwrbPTBXMiGDIc

  18. DOJ News Article – Legal Framework
    https://www.doj.gov.ph/news_article.html?newsid=xpLVa_sVKtBjaFK_vCeXb_aRrFgGB5nBR29BBZabUtQ

  19. GMA News – Gang Rape Case
    https://www.gmanetwork.com/news/topstories/regions/930708/15-year-old-girl-dies-after-alleged-gang-rape-in-cebu-cidg/story/

  20. PMC Journal Article – Juvenile Detention Impact
    https://pmc.ncbi.nlm.nih.gov/articles/PMC8196268/