Antimicrobial resistance is a growing threat to good health and well-being
Antimicrobial resistance is growing worldwide, rendering many "work horse" medicines ineffective. Without intervention, drug-resistant pathogens could lead to millions of deaths by 2050. Thankfully, companies like Pfizer are taking action.
Pfizer Corporate Responsibility develops programs that help expand global access to medicines by providing direct assistance to underserved populations. Our initiatives include providing product donations and steep discounts that help patients access the medicine they need. We also collaborate with Pfizer business teams and nonprofit organizations to help shape sustainable business models that address affordability and the vast differences in economies around the world.
- Antimicrobial-resistant pathogens are one of the largest threats to global health today.
- As we get older, our immune systems age, increasing our risk of life threatening infections. Without reliable antibiotics, life expectancy could decline for the first time in modern history.
- If antibiotics become ineffective, common infections could result in hospitalization or even death. Life-saving interventions like cancer treatments and organ transplantation would become more difficult, more often resulting in death. Routine procedures would become hard to perform.
- Without intervention, resistant pathogens could result in 10 million annual deaths by 2050.
- By taking a multi-faceted approach—inclusive of adherence to good stewardship, surveillance and responsible manufacturing practices, as well as an emphasis on prevention and treatment—companies like Pfizer are fighting to help curb the spread.
Antibiotics have revolutionized healthcare.
With the advent of modern medicine, life threatening diseases such as smallpox, pertussis (whooping cough), tetanus (lockjaw) and measles have essentially been eradicated. More importantly, complicated procedures that increase our risk of infections—including plastic surgery, joint replacement, cancer treatments, and organ transplant, among others—have become routine because any resulting infection can be treated effectively.
But modern medicine depends on antibiotics to treat and cure many kinds of infections—infections that could impact anyone from the premature baby to the elderly. Unfortunately, antimicrobial resistance (AMR) has made some infections impossible and others increasingly difficult to treat, threatening the progress we have worked so hard to achieve.
AMR causes 700,000 deaths annually across the globe, a number projected to skyrocket to 10 million by 2050 without intervention.
What is antimicrobial resistance?
Antimicrobial drugs target the microorganisms that cause infection, such as bacteria, viruses, fungi, and parasites, and either kills them or inhibits their growth.
Anytime an antibiotic is used, either appropriately or inappropriately, the 30 trillion or more bacteria that live in or on our bodies undergo selective pressure to become resistant. Any that are sensitive to the antibiotic are killed, while those that remain are resistant or immune from the effects of that antibiotic. This is called AMR. Once a bacterial pathogen has reached a state of resistance to several types of antibiotics, it is colloquially referred to as a "superbug."
The consequences of AMR can be stated simply: Commonly used antibiotics are rendered ineffective against that pathogen. If an infection caused by resistant bacteria is treated by that antibiotic, the bacteria are unaffected, resulting in disease persistence, worsening of the infection and/or even death. Treatments for both minor and serious infections are compromised, surgeries and other routine procedures become riskier, and the treatment of diseases like pneumonia and tuberculosis becomes very complicated. For example, according to the World Health Organization, resistance in Klebsiella pneumoniae—a common intestinal bacterium that is a major cause of hospital-acquired infections, bloodstream infections, and infections in newborns and intensive-care unit patients—has spread to all regions of the world. In some countries, because of resistance, carbapenem antibiotics (often the "last resort" treatments) do not work in more than half of people treated for these types of infections. This results in prolonged hospitalization, increased medical costs and higher rates of death for infections that were easily treated only a few years ago.
"What's more, AMR is a truly global issue—it can affect anyone, of any age, in any country," Jill Inverso, Pfizer's Vice President of Global Medical Affairs and Anti-Infectives, told Big Think.
AMR causes 700,000 deaths annually across the globe, a number projected to skyrocket to 10 million by 2050 without intervention. The rise of resistant pathogens is causing many countries to accrue significantly higher healthcare costs due to longer duration of illness, additional tests, and the need for different medicines to treat patients.
And these costs add up. The World Bank Group estimates that AMR could reduce annual global gross domestic product from 1.1–3.8 percent depending on severity, with up to $10.8 trillion in additional health expenditures.
At Pfizer, we take this growing threat very seriously and are driven by our desire to protect global public health and address the medical needs of people suffering from infectious diseases.
Giving antimicrobial resistance a helping hand
The development of bacterial resistance to antibiotics is a natural process. Unlike almost every other class of drugs, antibiotics drive their own obsolescence by selecting antibiotic-resistant bacteria, even when used appropriately according to guidelines. When this happens, resistant bacteria survive and continue to multiply, causing the infection to worsen. These resistant bacteria can then also spread to other patients, causing new infections with these bacteria that are difficult to treat.
Overuse and misuse of antibiotics accelerates this process without providing any benefit to the patient. This happens when patients take a drug without need, do not finish their dose or stop taking the medication mid-course; it could also happen when a drug is either overprescribed or prescribed for the wrong duration/type of illness. All of these misuses create environments in which pathogens are exposed to drugs more often, allowing them to acclimate and breed resistance without any benefit to the patient.
Hence, antibiotics must be used wisely and sparingly.
Fighting the resistance
WHO calls AMR an "increasingly serious threat to global public health" and one that "requires action across all government sectors and society." Its widespread growth is threatening the United Nations General Assembly's Sustainable Development Goal of Good Health and Well-Being.
Companies like Pfizer are heavily committed to the fight against AMR, taking action across a variety of areas such as surveillance, stewardship, and prevention and treatment.
On the surveillance front, Pfizer is proud to sponsor one of the largest AMR surveillance programs in the world, the Antimicrobial Testing Leadership and Surveillance (or ATLAS). ATLAS monitors real-time changes in bacterial resistance and tracks these trends in real-time. Gathering information from more than 760 hospitals across 73 countries in many underserved areas, ATLAS has generated 14 years of continuous global data on bacteria. Researchers and healthcare professionals can access ATLAS's data—free of charge—to study resistance trends, even in emerging market countries like Africa, Asia, and Latin America.
"At Pfizer, we take this growing threat very seriously," Inverso added, "and are driven by our desire to protect global public health and address the medical needs of people suffering from infectious diseases."
Pfizer also encourages good stewardship practices and supports education and training programs to help ensure patients receive the correct antibiotic only if needed, at the right dose and for the right duration.
"We believe that everybody can play a part in AMR stewardship by not taking an antibiotic unless provided by a healthcare professional, sticking to antibiotic regimens when prescribed, and keeping their vaccinations up to date," said Inverso. She added, "Vaccines are administered to help prevent infections from happening in the first place, thereby reducing the need for antibiotic usage that can lead to the development of resistance."
To date, several studies have demonstrated the beneficial role vaccines play in the reduction of AMR, such as reducing the use of antibiotics by preventing bacterial infections which may, in turn, prevent antimicrobial resistant infections from developing. Pfizer is committed to continue the development of new, innovative vaccines to help prevent infectious diseases globally.
We believe that everybody can play a part in AMR stewardship by not taking an antibiotic unless provided by a healthcare professional, sticking to antibiotic regimens when prescribed, and keeping their vaccinations up to date.
Given this, we should ask ourselves the following:
- Have I ever not finished an antibiotic given to me by my doctor?
- Have I ever used an antibiotic given to someone else?
- Am I up-to-date on my vaccinations that prevent infections that would need antibiotics?
- Have I ever demanded an antibiotic for myself or a child that the doctor thought was caused by a virus?
- Have I ever saved antibiotics given to me for one infection and used it at a different time?
The key takeaway? AMR is a pervasive, growing threat that cannot be tamed without the collective efforts of government, industry, health systems, society and others. Working together, we may have a fighting chance.
Milgram's experiment is rightly famous, but does it show what we think it does?
- In the 1960s, Stanley Milgram was sure that good, law-abiding Americans would never be able to follow orders like the Germans in the Holocaust.
- His experiments proved him spectacularly wrong. They showed just how many of us are willing to do evil if only we're told to by an authority figure.
- Yet, parts of the experiment were set up in such a way that we should perhaps conclude something a bit more nuanced.
Holding a clipboard and wearing a lab coat makes you a very powerful person. Add in a lanyard and a confident voice, and you're pretty much in Ocean's Eleven.
Though we believe ourselves to be contrarians, most of us like to obey authority. We answer questions, help with any number of tasks, and obey commands unthinkingly. The vast majority of the time, this is relatively harmless and even requisite for a functioning society, but it can also lead humanity to very dark places.
It could happen here
As we've seen with Asch's experiments on conformity, the post-World War II community was determined to answer how and why the Holocaust took place. Just after the trial of Adolf Eichmann, the American media and public came to see German society as some special kind of monster in just how willing they were to follow orders unthinkingly, at odds with any sense of duty or morality.
Into this came Stanley Milgram. In 1961, Milgram set out a series of experiments to show, in his view, how the German people were more susceptible to authoritarianism than Americans. Milgram believed, as a lot of people did, that the American people would never be capable of such horrendous evil.
The experiment was to be set up in two stages: the first would be on American subjects, to gauge how far they would obey orders; the second would be on Germans, to prove how much they differed. The results stopped Milgram in his tracks.
Shock, shock, horror
Milgram wanted to ensure that his experiment involved as broad and diverse a group of people as possible. In addition to testing the American vs. German mindset, he wanted to see how much age, education, employment, and so on affected a person's willingness to obey orders.
So, the original 40 participants he gathered came from a wide spectrum of society, and each was told that they were to take part in a "memory test." They were to determine the extent to which punishment affects learning and the ability to memorize.
Milgram believed, as a lot of people did, that the American people would never be capable of such horrendous evil.
The experiment involved three people. First, there was the "experimenter," dressed in a lab coat, who gave instructions and prompts. Second, there was an actor who was the "learner." Third, there was the participant who thought that they were acting as the "teacher" in the memory test. The apparent experimental setup was that the learner had to match two words together after being taught them, and whenever they got the answer wrong, the teacher had to administer an electric shock. (The teachers (participants) were shocked as well to let them know what kind of pain the learner would experience.) At first, the shock was set at 15 volts.
The learner (actor) repeatedly made mistakes for each study, and the teacher was told to increase the voltage each time. A tape recorder was played that had the learner (apparently) make sounds as if in pain. As it went on, the learner would plead and beg for the shocks to stop. The teacher was told to increase the amount of voltage as punishment up to a level that was explicitly described as being fatal — not least because the learner was desperately saying he had a heart condition.
The question Milgram wanted to know: how far would his participants go?
Just obeying orders
The results were surprising. Sixty-five percent of the participants were willing to give a 450-volt shock described as lethal, and all administered a 300-volt shock described as traumatically painful. It should be repeated, this occurred despite the learner (actor) begging the teacher (participant) to stop.
In the studies that came after, in a variety of different setups, that 60 percent number came up again and again. They showed that roughly two out of three people would be willing to kill someone if told to by an authority figure. Milgram proved that all genders, ages, and nationalities were depressingly capable of inflicting incredible pain or worse on innocent people.
Major limitations in Milgram's experiment
Milgram took many steps to make sure that his experiment was rigorous and fair. He used the same tape recording of the "learner" screaming, begging, and pleading for all participants. He made sure the experimenters used only the same four prompts each time when the participants were reluctant or wanted to stop. He even made sure that he himself was not present at the experiment, lest he interfere with the procedure (something Phillip Zimbardo did not do).
But, does the Milgram experiment actually prove what we think it does?
First, the experimenters were permitted to remind the participants that they were not responsible for what they did and that the team would take full blame. This, of course, does not make the study any less shocking, but it does perhaps change the scope of the conclusions. Perhaps the experiment reveals more about our ability to surrender responsibility and our willingness simply to become a tool. The conclusion is still pretty depressing, but it shows what we are capable of when offered absolution rather than when simply following orders.
Second, the experiment took place in a single hour, with very little time either to deliberate or talk things over with someone. In most situations, like the Holocaust, the perpetrators had ample time (years) to reflect on their actions, and yet, they still chose to turn up every day. Milgram perhaps highlights only how far we'll go in the heat of the moment.
Finally, the findings do not tell the whole tale. The participants were not engaging in sadistic glee to shock the learner. They all showed signs of serious distress and anxiety, such as nervous laughing fits. Some even had seizures. These were not willing accomplices but participants essentially forced to act a certain way. (Since then, many scientists have argued that Milgram's experiment is hugely unethical.)
The power of authority
That all being said, there's a reason why Milgram's experiment stays with us today. Whether it's evolutionarily or socially drilled into us, it seems that humans are capable of doing terrible things, if only we are told to do so by someone in power — or, at the very least, when we don't feel responsible for the consequences.
One silver lining to Milgram is in how it can inoculate us against such drone-like behavior. It can help us to resist. Simply knowing how far we can be manipulated helps allow us to say, "No."
As the American population grows, fewer people will die of cancer.
- A new study projects that cancer deaths will decrease in relative and absolute terms by 2040.
- The biggest decrease will be among lung cancer deaths, which are predicted to fall by 50 percent.
- Cancer is like terrorism: we cannot eliminate it entirely, but we can minimize its influence.
As the #2 leading cause of death, cancer takes the lives of about 600,000 Americans each year. In comparison, heart disease (#1) claims more than 650,000 lives, while accidents (#3) take about 175,000 lives. (In 2020 and likely 2021, COVID will claim the #3 spot.)
Headlines are usually full of terrible news about cancer. Seemingly, you can't get away from anything that causes it. RealClearScience made a list of all the things blamed for cancer — antiperspirants, salty soup, eggs, corn, Pringles, bras, burnt toast, and even Facebook made the list.
The reality, however, is much more optimistic. We're slowly but surely winning the war on cancer.
Winning the war on cancer
How can we make such a brazen statement? A new paper published in the journal JAMA Network Open tracks trends in cancer incidence and deaths and makes projections to the year 2040. The authors predict that around 568,000 Americans will have died of cancer in 2020, but they project that number to fall to 410,000 by 2040. That's a drop of nearly 28 percent, despite the U.S. population being projected to grow from roughly 333 million today to 374 million in 2040, an increase of 12 percent. That means cancer deaths will decrease in both relative and absolute terms.
What accounts for this unexpected good news? The lion's share is the number of deaths attributable to lung cancer, which is projected to decrease by more than 50 percent, from 130,000 to 63,000. This drop is largely due to the decreasing use of tobacco products. Other deaths predicted to decline include those from colorectal, breast, prostate, and ovarian cancers, among others, such as leukemia and non-Hodgkin lymphoma (NHL).
The authors credit screening and biomedical advances for saving many of these lives. For instance, lead author Dr. Lola Rahib wrote in an email to Big Think that "colonoscopies remove precancerous polyps." She also noted that targeted therapies and immunotherapies have helped reduce the number of deaths from leukemia and NHL.
We'll never cure cancer
Now the bad news: We'll never cure cancer. There are at least three reasons for this. The first is obvious: We all die. The lifetime prevalence of death is 100 percent. The truth is that we are running out of things to die from. After a long enough period of time, something gives out — often your cardiovascular system or nervous system. Or you develop you cancer.
The second reason is that we are multicellular organisms and, hence, we are susceptible to cancer. (Contrary to popular myth, sharks get cancer, too.) The cells of multicellular organisms face an existential dilemma: they can either get old and stop dividing (a process called senescence) or become immortal but cancerous. For this reason, the problem of cancer may not have a solution.
Finally, there isn't really such a thing as a disease called "cancer." What we call cancer is actually a collection of several different diseases, some of which are preventable (like cervical cancer with the HPV vaccine) or curable (like prostate cancer). Unfortunately, some cancers probably never will be curable, not least because cancers can mutate and develop resistance to the drugs we use to treat them.
But the overall optimism still stands: We are slowly and incrementally winning the war on cancer. Like terrorism, it's not a foe that we can completely vanquish, but it is one whose influence we can minimize in our lives.
China has reached a new record for nuclear fusion at 120 million degrees Celsius.
This article was originally published on our sister site, Freethink.
China wants to build a mini-star on Earth and house it in a reactor. Many teams across the globe have this same bold goal --- which would create unlimited clean energy via nuclear fusion.
But according to Chinese state media, New Atlas reports, the team at the Experimental Advanced Superconducting Tokamak (EAST) has set a new world record: temperatures of 120 million degrees Celsius for 101 seconds.
Yeah, that's hot. So what? Nuclear fusion reactions require an insane amount of heat and pressure --- a temperature environment similar to the sun, which is approximately 150 million degrees C.
If scientists can essentially build a sun on Earth, they can create endless energy by mimicking how the sun does it.
If scientists can essentially build a sun on Earth, they can create endless energy by mimicking how the sun does it. In nuclear fusion, the extreme heat and pressure create a plasma. Then, within that plasma, two or more hydrogen nuclei crash together, merge into a heavier atom, and release a ton of energy in the process.
Nuclear fusion milestones: The team at EAST built a giant metal torus (similar in shape to a giant donut) with a series of magnetic coils. The coils hold hot plasma where the reactions occur. They've reached many milestones along the way.
According to New Atlas, in 2016, the scientists at EAST could heat hydrogen plasma to roughly 50 million degrees C for 102 seconds. Two years later, they reached 100 million degrees for 10 seconds.
The temperatures are impressive, but the short reaction times, and lack of pressure are another obstacle. Fusion is simple for the sun, because stars are massive and gravity provides even pressure all over the surface. The pressure squeezes hydrogen gas in the sun's core so immensely that several nuclei combine to form one atom, releasing energy.
But on Earth, we have to supply all of the pressure to keep the reaction going, and it has to be perfectly even. It's hard to do this for any length of time, and it uses a ton of energy. So the reactions usually fizzle out in minutes or seconds.
Still, the latest record of 120 million degrees and 101 seconds is one more step toward sustaining longer and hotter reactions.
Why does this matter? No one denies that humankind needs a clean, unlimited source of energy.
We all recognize that oil and gas are limited resources. But even wind and solar power --- renewable energies --- are fundamentally limited. They are dependent upon a breezy day or a cloudless sky, which we can't always count on.
Nuclear fusion is clean, safe, and environmentally sustainable --- its fuel is a nearly limitless resource since it is simply hydrogen (which can be easily made from water).
With each new milestone, we are creeping closer and closer to a breakthrough for unlimited, clean energy.
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